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"Antibiotika golongan penisilin adalah antibiotika yang paling luas serta paling banyak digunakan untuk terapi pasien infeksi. Dari berbagai studi diperoleh fakta bahwa telah banyak mikroba resisten terhadap penisilin. Pemberian penisilin yang telah resisten berbahaya bagi pasien dengan penyakit infeksi, selain itu lebih lambatnya penemuan obat baru serta lebih mahalnya harga obat baru merupakan hal penting yang berhubungan dengan kejadian resistensi. Resistensi sendiri dapat berubah menurut waktu dan berbeda di setiap tempat. Penelitian ini bertujuan untuk mengetahui pola resistensi bakteri yang diisolasi dari darah di Laboratorium Mikrobiologi Klinik Fakultas Kedokteran Universitas Indonesia (LMK FKUI) terhadap beberapa antibiotik penisilin, yaitu amoksilin, sulbenisilin, amoksilin/asam klavulanat , tikarsilin dan oksasilin selama periode 2001-2006. Pada penelitian ini digunakan data isolat darah dengan bakteri positif yang diisolasi di LMK FKUI selama periode 2001-2006. Data diolah dengan menggunakan piranti lunak WHONET 5.4. Dari 791 isolat darah, didapatkan enam bakteri tersering penyebab bakteremia yaitu Staphylococcus epidermidis (25%), Acinetobacter anitratus (16%), Pseudomonas aeruginosa (13%), Klebsiella pneumoniae (8%), Staphylococcus aureus (6%), dan Salmonella Typhi (5%). Hasil uji resitensi menunjukkan kejadian resistensi bakteri terhadap amoksilin sudah tinggi pada Klebsiella pneumoniae , masih cukup rendah pada Salmonella Typhi, sedangkan keampuhannya terhadap Staphylococcus epidermidis, dan Staphylococcus aureus mulai menurun. Kejadian resistensi bakteri terhadap sulbenisilin rendah pada Staphylococcus epidermidis,Staphylococcus aureus dan Salmonella Typhi , dan sudah cukup tinggi pada Klebsiella pneumoniae. Kejadian amoksilin/asam klavulanat sudah tinggi pada Acinetobacter anitratus dan Pseudomonas aeruginosa dan masih cukup rendah pada Klebsiella pneumoniae, Salmonella Typhi, Staphylococcus epidermidis, dan Staphylococcus aureus. Kejadian resistensi bakteri terhadap tikarsilin sudah tinggi pada Acinetobacter anitratus, Pseudomonas aeruginosa dan Klebsiella pneumoniae dan masih cukup rendah pada, Salmonella Typhi,dan Staphylococcus epidermidis. Kejadian resistensi Staphylococcus aureus terhadap oksasilin masih cukup rendah, sedangkan keampuhan oksasilin terhadap Staphylococcus epidermidis mulai menurun.

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The group of penicillins antibiotics is the widest and the most used antibiotics for infection patient therapy. From several studies, there is a fact that many microbes have resistence to penicillins. The giving of penicillin that has resisted to a patient who gets an infection may be perilous. Besides that, the slower invention of new medicines and the more expensive their prices are important factors related to the resistance. The resistance itself may change in every second of time and would be different in some places. The research which was conducted in Clinical Microbiology Laboratory FMUI aims to know the pattern of the resistance of bacteria which is isolated from blood toward several kinds of penicillin; they are amoxicillin, sulbenicillin, amoxicillin/ clauvalanic acid, ticarcillin, and oxacillin between 2001-2006. The data was processed using WHONET 5.4 software. From 174 isolat bloods, there are six kinds of bacteria that often cause bacterimia; they are Staphylococcus epidermidis (25%), Acinetobacter anitratus (16%), Pseudomonas aeroginosa (13%), Klebsiella pneumoniae (8%), Staphylococcus aureus (6%), and Salmonella typhi (5%). The result of resistance test shows that the frequency of bacteria’s resistance toward amoxillin has been high in Klebsiella pneumoniae and still low in Salmonella Typhi, on the other hand, the effectiveness of amoxicillin toward Staphylococcus epidermidis and Staphylococcus aerus is getting decreased. The frequency of bacteria’s resistance toward sulbenicillin still low in Staphylococcus epidermidis, Staphylococcus aerus and Salmonella Typhi and has been high in Klebsiella pneumoniae. The frequency of bacteria’s resistance toward amoxicillin/ clavulaic acid has been high in Acinetobacter anitratus and Pseudomonas aeruginosa and still low in Klebsiella pneumoniae, Salmonella Typhi, Staphylococcus epidermidis, and Staphylococcus aureus. The frequency of bacteria’s resistance toward ticarcillin has been high in Acinetobacter anitratus, Pseudomonas aeuginosa and Klebsiella pneumoniae and still low in Salmonella Typhi and Staphylococcus epidermidis. The frequency of Staphylococcus aerus is still low. On the other hand, the effectiveness of oxacillin toward Staphylococcus epidermidis is getting decreased."

"Latar Belakang. Penyakit kardiovaskular masih merupakan masalah kesehatan utama global. Banyak penelitian menghubungkan kondisi Penyakit Ginjal Kronik (PGK) pada pasien Sindrom Koroner Akut (SKA) dengan luaran klinis yang lebih buruk. Mengetahui peran faktor-faktor yang mempengaruhi Major Adverse Cardiovascular Event (MACE) pada pasien SKA dengan PGK penting dalam upaya pencegahan luaran yang buruk.Tujuan. Mengetahui hubungan skor Global Registry of Acute Coronary Events (GRACE), skor Gensini, Left Ventricular Hypertrophy (LVH), dan Rasio Netrofil Limfosit (RNL) terhadap kejadian MACE 30 hari pasien SKA yang mengalami PGK non-dialisis.Metode. Desain penelitian kohort retrospektif menggunakan data sekunder dari rekam medis117 pasien SKA yang menjalani PCI di Rumah Sakit Umum Pemerintah Cipto Mangunkusumo sejak Januari 2018 hingga Juni 2018. Pasien dibagi berdasarkan derajat PGK serta dinilai MACE 30 hari. Dilakukan pencatatan data skor GRACE, skor Gensini, LVH, dan RNL. Analisis hubungan faktor-faktor tersebut dilakukan menggunakan uji chi square.Hasil. Dari 117 pasien 62,3% ST Elevation Myocardial Infarction (STEMI), pada akhir perawatan 67,5% pasien termasuk dalam kelompok derajat 1-2 PGK, 17,1% dalam kelompok PGK derajat 3a-3b dan 15,4% dalam kelompok PGK derajat 4-5. MACE terjadi pada 47 (40,2%) pasien dengan 17 (14,5%) mengalami kematian.Terdapat hubungan bermakna antara skor GRACE dengan MACE (54,8% MACE pada skor GRACE tinggi vs 32% MACE padaskor GRACE rendah-sedang ( p = 0,016) (OR : 2,57 IK95% : 1,18-5,59), sedangkan pada skor Gensini,LVH dan RNL walaupun terdapat peningkatan proporsi MACE namun tidak didapatkan hubungan yang signifikan.Kesimpulan. Skor GRACE berhubungan dengan MACE 30 hari pasien SKA dengan PGK non dialisis.

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Background. Cardiovascular disease is still a major global health problem. Many studies have linked Chronic Kidney Disease (CKD) in Acute Coronary Syndrome (ACS) patients with worse clinical outcomes. Knowing the role of factors that influence MACE in ACS with CKD patients is important in preventing poor outcomes.

Objective. To determine the relationship between GRACE scores, Gensini scores, LVH, and NLR to the 30-day MACE incidence in ACS patients with CKD.

Method. This study is a retrospective cohort study using secondary data from the medical records of 117 ACS patients who underwent PCI at the Cipto Mangunkusumo Government General Hospital from January 2018 to June 2018. Patients were divided based on the degree of CKD and assessed for 30-day MACE. Data were recorded on GRACE scores, Gensini

scores, LVH, and RNL. Analysis of the relationship between these factors was carried out using the Chi Square test.

Results. Of the 117 patients 62.3% were STEMI, at the end of hospital treatment 67.5% were in the normal-grade 2 CKD group, 17.1% in the CKD grade 3a-3b group and 15.4% in the CKD grade 4-5 group. MACE occurred in 47 (40.2%) patients with 17 (14.5%) dying. There was a significant relationship between GRACE scores and MACE (54.8% MACE at high GRACE scores vs. 32% MACE at low-moderate GRACE scores (p = 0.016) (OR : 2,57

CI95% : 1,18-5,59)), while the Gensini score, LVH and NLR scores even though there was an increase in the proportion of MACE but no significant relationship was found.

Conclusion. The GRACE score correlates with the 30-day MACE of ACS with non- dialysis

CKD patients.

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