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"Keberadaan Antimicrobial Resistance (AMR) di lingkungan mengalami peningkatan seiring berjalannya waktu. AMR mulai ditemukan terkandung pada air tanah sebagai salah satu pencemar mikrobiologis. Kota Metro sebagai mayoritas pengguna air tanah dari sumur bor dan gali, yakni mencapai 90% perlu waspada terhadap keberadaan AMR. Penelitian ini bertujuan untuk menganalisis konsentrasi E. coli dan E. coli resistan terhadap cefotaxime serta rasio perbandingannya, menganalisis pengaruh faktor curah hujan, suhu, kelembaban, pH, total padatan terlarut, dan kekeruhan terhadap kadar konsentrasi, serta memberikan rekomendasi tindakan pengelolaan air tanah berdasarkan prevalensi bakteri E. coli dan E. coli resistan di Kota Metro. Penelitian ini dilakukan di 11 lokasi selama bulan November – Februari menggunakan IDEXX Colilert-18 dan Quanti-Tray/2000 untuk mendeteksi konsentrasi E. coli dan E. coli resistan melalui penggunaan antibiotik cefotaxime. Hasil penelitian menunjukkan sebanyak 67% air tanah mengandung E. coli dan sebanyak 27% di antaranya bersifat resistan terhadap cefotaxime. Persentase keberadaan (1) E. coli dan (2) E. coli resistan dengan kategori risiko sangat tinggi (>100 MPN/100 ml) mencapai (1) 24% dan (2) 0%; risiko tinggi (>10 – 100 MPN/100 ml) (1) 13% dan (2) 2%; risiko menengah (1 – 10 MPN/100 ml) (1) 31% dan (2) 16%; dan risiko rendah (<1 MPN/100 ml) (1) 33% dan (2) 82%. Peningkatan konsentrasi E. coli berkorelasi dengan faktor curah hujan, suhu, dan kekeruhan sedangkan peningkatan konsentrasi E. coli resistan berkorelasi dengan faktor curah hujan. Hubungan korelasi didapatkan melalui uji peringkat Spearman berdasarkan signifikansi (p-value) < 0,05. Berdasarkan hasil prevalensi, masyarakat dapat meminimalisasi konsentrasi dengan cara memodifikasi kondisi fisik sumur agar sesuai dengan standar yang telah ditetapkan oleh Kementerian PUPR dan SNI. Masyarakat juga dapat menggunakan filter sederhana, misalnya filter granular untuk memfiltrasi air sebelum digunakan. Walaupun langkah tersebut dilakukan, perlu diingat bahwa terdapat faktor pengaruh lain yang dapat memengaruhi konsentrasi E. coli dan E. coli resistan, salah satunya adalah kontaminan di sekitar sumur, seperti feses manusia, feses hewan ternak, dan sisa air buangan rumah tangga. Maka, peran pemerintah dalam penyediaan layanan fasilitas air bersih menjadi salah satu langkah untuk mengurangi penggunaan air tanah yang terkontaminasi.

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The prevalence of Antimicrobial Resistance (AMR) in the environment has been increasing over time. AMR has been detected in groundwater as one of the microbiological pollutants. Metro City, where the majority relies on groundwater from boreholes and wells, accounting for 90%, must be vigilant against AMR. This study aims to analyze the concentration of E. coli and cefotaxime-resistant E. coli, along with their ratio, to analyze the influence of rainfall, temperature, humidity, pH, total dissolved solids, and turbidity on concentration levels, and to provide recommendations for groundwater management based on the prevalence of E. coli and cefotaxime-resistant E. coli in Metro City. The research was conducted at 11 locations from November to February using the IDEXX Colilert-18 and Quanti-Tray/2000 to detect the concentration of E. coli and cefotaxime-resistant E. coli through the use of antibiotics. The results showed that 67% of the groundwater contained E. coli, with 27% being resistant to cefotaxime. The percentage of presence of (1) E. coli and (2) cefotaxime-resistant E. coli with very high-risk categories (>100 MPN/100 ml) reached (1) 24% and (2) 0%; high risk (>10 – 100 MPN/100 ml) (1) 13% and (2) 2%; moderate risk (1 – 10 MPN/100 ml) (1) 31% and (2) 16%; and low risk (<1 MPN/100 ml) (1) 33% and (2) 82%. The increase in E. coli concentration correlated with rainfall, temperature, and turbidity, while the increase in cefotaxime-resistant E. coli concentration correlated with rainfall. Correlation relationships were determined through Spearman rank tests based on significance (p- value) < 0.05. Based on the prevalence, the community can minimize concentrations by modifying the physical conditions of wells to meet the standards set by the Ministry of Public Works and SNI. The community can also use simple filters, such as granular filters, to filter water before use. Despite these measures, it should be noted that there are other influencing factors that can affect the concentration of E. coli and cefotaxime-resistant E. coli, such as contaminants around the well, such as human feces, livestock feces and household wastewater. Therefore, the government's role in providing clean water facilities becomes one of the steps to reduce the use of contaminated groundwater."

"ABSTRAK Latar belakang: Anak dengan gizi buruk tak hanya rentan terhadap infeksi, keparahan infeksi dan angka kematian akibat infeksi juga meningkat. Sefotaksim merupakan antibiotik empiris yang paling sering digunakan pada anak di Rumah Sakit Cipto Mangunkusumo RSCM tanpa melihat status gizi. Hingga saat ini data mengenai rsepon terhadap sefotaksim pada anak gizi buruk di RSCM serta fokus infeksi dan etiologinya masih terbatas. Tujuan: Mengetahui respon pemberian antibiotik sefotaksim sebagai terapi empiris pada anak gizi buruk yang dirawat inap berikut karakteristik, fokus infeksi, profil kuman dan sensitifitasnya terhadap sefotaksim. Metode: Penelitian prospektif observasional pada anak gizi buruk usia 10 ?g/L dan juga semua subyek dengan HIV positif yang mengalami sepsis tidak berespon dengan terapi sefotaksim. Simpulan: Enam puluh lima persen infeksi pada anak gizi buruk tidak memberikan respon terhadap terapi empiris sefotaksim. Antibiotik sefotaksim sebaiknya tidak digunakan sebagai terapi empiris pada anak gizi buruk dengan sepsis berat atau HIV positif yang mengalami sepsis.

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ABSTRACT Background Children with severe malnutrition is vulnerable to infection, increase in its severity and death rate. Cefotaxime has been widely used as empirical antibiotic for children in Cipto Mangunkusumo General Hospital, regardless their nutritional status. However there is little data about etiology of infection in our population and the response to empirical antibiotic cefotaxime. Aim To evaluate the response to empirical antibiotic cefotaxime in children with severe malnutrition, its characteristic, diagnosis of infection, and antibiotic susceptibility profile. Method Children 18 year old hospitalized from October to December 2016 with severe malnutrition and received cefotaxime as empirical antibiotic were included and followed for 5 days. A clinical examination, complete blood count, urinalysis, procalcitonin PCT , c reactive peptide CRP , blood and urine culture were performed systematically on admission. Stool and sputum culture were also done as indicated. Repeated PCT and CRP were done between day 3 to 5. Result Among 40 children included in the study, 50 has more than one infection. The most frequent infection is urinary tract infection 50 , followed by pneumonia 47,5 and acute diarrhea 32,5 . Blood culture was positive only in 4 subjects, 4 5 isolates were gram positive bacteria. Escherecia coli was the most common pathogen in urine 30 . Only 9,5 of all isolated bacteria were sensitive to cefotaxime. Overall, only 35 responded to antibiotic cefotaxime. All patient with PCT 10 g L on admission, and those with HIV positive and sepsis did not respond. Conclusion Sixty five children with severe malnutrition and infection did not respond to empirical antibiotic cefotaxime. Clinician must reconsider giving cefotaxime as empirical antibiotic in severely malnourished children, especially those with severe sepsis and HIV with sepsis. "