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Abstrak :
Background and objective: Antimicrobial resistance is a global problem and the prevalence is high in many Asian countries. Methods: A prospective observational study of the prevalence of bacterial pathogens and their antimicro-bial susceptibilities in patients with acute exacerba-tions of chronic bronchitis (AECB) was conducted in Indonesia, Philippines, Korea, Thailand, Malaysia, Taiwan and Hong Kong from August 2006 to April 2008. The diagnosis of AECB was based on increased cough and worsening of two of following: dyspnoea, increased sputum volume or purulence. Patients who had taken antibiotics within 72 h of presentation were excluded. All bacterial strains were submitted to a central labo-ratory for re-identification and antimicrobial suscepti-bility testing to 16 antimicrobial agents according to Clinical and Laboratory Standards Institute. Results: Four hundred and seven isolates were iden-tified among 447 patients of AECB. The most frequent organisms isolated were Klebsiella pneumoniae and associated species (n = 91 + 17), Haemophilus influen-zae (n = 71), Pseudomonas aeruginosa (n = 63), Streptococcus pneumoniae (n = 32), Acinetobacter baumannii (n = 22) and Moraxella catarrhalis (n = 21). According to Clinical and Laboratory Standards Insti-tute susceptibility breakpoints, 85.7% and >90% of these pathogens were susceptible to levofloxacin and cefepime respectively. Other options with overall lower susceptibilities include imipenem, ceftazidime, ceftri-axone and amoxicillin/clavulanate. Conclusions: Gram-negative bacteria including Kleb-siella spp., P. aeruginosa and Acinetobacter spp. consti-tute a large proportion of pathogens identified in patients with AECB in some Asian countries. Surveil-lance on the local prevalence and antibiotic resistance of these organisms is important in guiding appropriate choice of antimicrobials in the management of AECB.

Abstrak :
Background: Limited understanding of the presentation and course of infl uenza A(H5N1) infection in humans hinders evidence-based management. Methods: We reviewed the case records of patients admitted to the Persahabatan Hospital (RSP), Jakarta, Indonesia, with infl uenza A(H5N1) confi rmed by real-time polymerase chain reaction. Results: Twenty-two previously well patients, aged 3 to 47 years (median 24.5 years), were identifi ed. All attended a clinic or hospital after a median of 2 days of illness (range 0-7). Times to fi rst dose of oseltamivir (three died before receiving oseltamivir) were 2 to 12 days (median 7 days), administered mostly (n 5 15) at RSP. Nineteen patients required mechanical ventilation. Deaths numbered 18 (case fatality 5 82%) occurring within hours to 6 days of RSP admission, corresponding to 6 to 16 days of illness. Admission hyperglycemia (  140 mg/dL), unrelated to steroids or known underlying diabetes mellitus, and elevated D-dimer levels (0.81-5.2 mg/L, upper limit of normal , 0.5 mg/L) were present in 14/21 (67%) and 20/21 (95%) patients, respectively. Fibrinogen concentrations were mostly low/normal at 129.9 to 517.9 mg/dL (median 241.1, normal 200-400 mg/dL), whereas C-reactive protein (9/11) and ferritin (6/8) levels were increased. Risk factors for death (univariate analysis) included: (1) increased D-dimers, (2) hyperglycema, (3) increased urea, (4) more extensive chest radiograph shadowing, and (5) lower admission oxygen saturation. Conclusions: Early diagnosis and effective treatment of human infl uenza A(H5N1) infection remains challenging. Most patients were referred late with advanced disease. Oseltamivir had limited clinical impact. Elevated D-dimer levels, consistent with fi brinolysis, and hyperglycemia warrant more research to determine their underlying mechanisms and optimal treatment.