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Abstrak :
Latar belakang: Infeksi C. diphtheriae toksigenik memerlukan penanganan segera karena dapat mengancam nyawa. Pemeriksaan kultur sebagai uji baku emas hanya dapat dilakukan di laboratorium rujukan dan memakan waktu lama. Pemeriksaan awal yang dapat dilakukan adalah menggunakan teknik pewarnaan. Pewarnaan khusus difteri seperti Albert atau Neisser dapat menggambarkan granul metakromatik yang spesifik terhadap Corynebacterium sp., namun laboratorium yang mampu mengerjakannya sangat terbatas. Oleh karena itu, berbagai laboratorium menggunakan teknik pewarnaan Gram sebagai alternatif untuk menunjang diagnosis dini difteri. Tujuan: Evaluasi pemeriksaan mikroskopik langsung yang rutin dilakukan pada spesimen swab tenggorok untuk menunjang diagnosis dini difteri. Metode: Uji diagnostik dengan desain potong lintang. Pemeriksaan mikroskopik Gram dan pewarnaan khusus Albert serta Neisser dibandingkan dengan kultur sebagai baku emas untuk mendapatkan nilai sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif, dan akurasi. Uji kesesuaian antara kedua teknik pewarnaan dan PCR dinilai menggunakan koefisien Kappa. Analisis multivariat dilakukan pada variabel independen data faktor risiko dan gambaran klinis. Nilai probabilitas yang dihasilkan dimasukkan ke dalam kurva Receiver Operating Characteristic (ROC). Pertambahan luas Area Under Curve (AUC) dinilai setelah menambahkan pemeriksaan mikroskopik ke dalam model. Hasil: Pewarnaan khusus difteri dan Gram memiliki sensitivitas 70% dan 20%, spesifisitas 83,72% dan 79,06%, nilai duga positif 33,33% dan 10%, nilai duga negatif 96% dan 89,47% serta akurasi 82,29% dan 72,92%. Kesesuaian minimal antara kedua metode pewarnaan (reliabilitas 4-15%). Pewarnaan khusus difteri memiliki kesesuaian yang lebih baik dengan uji PCR,dibandingkan dengan pewarnaan Gram. Pewarnaan khusus difteri menunjukan penambahan nilai diagnostik sebesar 3,8% pada model faktor risiko dan gambaran klinis yang bermakna untuk menunjang diagnosis dini difteri. Kesimpulan: Pewarnaan khusus difteri pada spesimen klinis langsung untuk diagnosis dini difteri tidak dapat digantikan dengan pewarnaan Gram. .....Background: Infection caused by toxigenic C. diphtheriae requires immediate treatment because it can be life threatening. Culture examination as gold standard can only be done in a reference laboratory and is time-consuming. The initial examination can be performed using the staining technique. Diphtheria special staining such as Albert or Neisser can characterize metachromatic granules that are specific to Corynebacterium sp., but the availability of these stains in many laboratories are limited. Therefore most laboratories use Gram staining technique as an alternative to support early diagnosis of diphtheria. Objective: Evaluation of the direct microscopic examination commonly used on throat swab specimens to support the early diagnosis of diphtheria. Methods: Diagnostic test with a cross-sectional design. Gram microscopic examination and special staining of Albert and Neisser were compared with culture examination as the gold standard to obtain sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. The realibility test between the two staining and PCR techniques was assessed using the Kappa coefficient. Multivariate analysis was performed on the independent variables of risk factors and clinical features data. The resulting probability value was entered into the Receiver Operating Characteristic (ROC) curve. The improvement of the area under the curve (AUC) was assessed after microscopic examination was added on the model. Results: Diphtheria and Gram staining had a sensitivity of 70% and 20%, specificity 83.72% and 79.06%, positive predictive value 33.33% and 10%, negative predictive value 96% and 89.47% and accuracy 82.29 % and 72.92%. Minimal concordance was found between the two staining methods (4-15%). Diphtheria-specific staining have better realibility result, compared to the PCR test, than Gram staining. Diphtheria special staining showed an additional 3.8% diagnostic value, in the significant of risk factors and clinical features model, to support the early diagnosis of diphtheria. Conclusion: Diphtheria special staining directly on clinical specimens for early diagnosis of diphtheria cannot be replaced by Gram staining.

Abstrak :
Latar belakang: Infeksi saluran kemih ISK merupakan salah satu penyakit infeksi yang paling sering pada anak usia 2 bulan ndash; 2 tahun. Infeksi saluran kemih sulit dideteksi karena gejalanya yang tidak khas. Diagnosis pasti dengan biakan urin membutuhkan waktu yang lama, sedangkan pemeriksaan urinalisis sulit mendeteksi ISK karena pengosongan kandung kemih yang cepat. Pewarnaan Gram urin lebih mudah dilakukan, cepat, dan murah sehingga diajukan sebagai metode diagnosis alternatif. Tujuan: Mengetahui kesesuaian pemeriksaan pewarnaan Gram urin dibandingkan dengan biakan urin dalam mendiagnosis ISK pada anak usia 2 bulan - 2 tahun. Metode: Studi potong lintang, di RSCM Jakarta, bulan Mei hingga Desember 2016. Penelitian melibatkan 59 anak usia 2 bulan ndash; 2 tahun dengan klinis tersangka ISK. Urin diambil dengan teknik kateterisasi peruretra. Sampel urin diperiksakan pewarnaan Gram, biakan urin dan urinalisis. Biakan urin sebagai baku emas pemeriksaan, dinyatakan sebagai ISK apabila tumbuh kuman dengan koloni >50.000 cfu/mL. Pewarnaan Gram dinyatakan positif ISK apabila ditemukan satu jenis bakteri per lapang pandang besar. Hasil: Prevalens ISK pada penelitian ini sebesar 38,9. Sensitivitas pewarnaan Gram urin sebesar 47,8 IK 95 26,8-69,4, spesifisitas 97,2 IK 95 85,5-99,9, NDP 91,7 IK 95 60,3-98,8, NDN 74,5 IK 95 60,3-98,8, LR 17,2 IK 95 2,4-124,6, LR - 0,54 IK 95 0,36-0,8, akurasi 78. Simpulan: Terdapat kesesuaian antara pemeriksaan pewarnaan Gram urin dengan biakan urin dalam mendiagnosis ISK. Terapi antibiotik dapat segera diberikan apabila hasil pemeriksaan Gram urin positif menunjukkan hasil positif. Pemberian antibiotik dapat ditunda menunggu hasil biakan urin, apabila gejala klinis ISK tidak terlalu khas dan tidak ditemukan bakteri dari pewarnaan Gram urin. ...... Background: Urinary tract infection UTI one of the most common disease in children age 2 months 2 years. Urinary tract infection in children is often difficult to diagnose because of the atypical symptoms. The definitive diagnosis with urine culture has its limitations because it takes a long time to get results, while it is difficult to detect UTI using urinalysis due to the rapid bladder emptying. Gram staining of urine is thought to be easier, faster, and cheaper, therefore it is proposed as an alternative method for early diagnosis of UTI. Objective: To compare the diagnostic accuracy of urine Gram staining with urine culture to diagnose UTI in children aged 2 months to 2 years. Methods: A cross sectional study was conducted at Cipto Mangunkusumo Hospital from May to December 2016. The study involved 59 children aged 2 months 2 years drawn through consecutive sampling method with clinically suspected UTI. Urine sample was taken with per urethra catheterization techniques. Urine samples were examined by Gram staining, urine culture and urinalysis. Urine culture as a gold standard examination is expressed as UTI when colonies of bacterias grow 50,000 cfu mL. Gram stain tested positive for UTI if one type of bacteria is found per high power field. Results: The prevalence of UTI in this study is 38.9. The sensitivity of urine Gram staining is 47.8 95 CI 26.8 to 69.4, specificity of 97.2 95 CI 85.5 to 99.9, NDP 91.7 CI 95 from 60.3 to 98.8, NDN 74.5 95 CI 60.3 to 98.8, LR 17.2 95 CI 2.4 to 124.6, LR 0.54 95 CI 0.36 to 0.8, and accuracy of 78. Conclusion There is a correlation between the urine Gram staining with urine culture in diagnosing UTI in children aged 2 months 2 years. Antibiotics may be administered immediately when urine Gram staining shows positive result. Antibiotics for UTI may be delayed until the results of urine culture, if clinical symptoms of UTI is not very distinctive and urine Gram staining shows negative result.