Cause of The Low Positivity of Blood Culture in Septic Patients

Introduction. Sepsis due to bacterial infection is one of the main causes of high disease morbidity and mortality. Management of sepsis, the detection of bacteriemia by examination of blood cultures has an important role, but until now the positivity of blood culture results at Hasan Sadikin Hospital (RSHS) is still low (13.45%). The purpose of this study was to determine profile the causes of low positivity of blood culture results in sepsis patients in RSHS. Methods. A cross sectional study was conducted on sepsis patient treated in Emergency Un it (ER) and inpatient of Hasan Sadikin hospital Internal Medicine from December 2016 until April 2017. This study collects patient clinical information, laboratory, history Administration of antibiotics, and techniques of examination of bacterial blood cultures in sepsis patients. Results. During the study period 179 subjects were obtained. The subject mainly uses the Health Guarantee Agency (BPJS) for financing. The positivity of blood cultures was found to be 24%. The mean leukocyte count on positive blood culture results was 18,100 / mm3 and there were 79.07% cultures with Neutrofil Limfosit Count Ratio (NLCR) >10. The time for taking blood cultures is mainly done at> 6 hours after admission. The number of blood cultures is taken at least once. The amount of blood volume in each culture tube is mostly 5 cc. Taking blood cultures is mainly carried out by competent nurses who have not received blood culture taking training. Conclusions. The positive results of blood culture in septic patients in RSHS are still low. Taking blood cultures should be carried out in accordance with the guidelines, which consist of not giving antibiotics before taking blood culture, taking blood time at 1 time, the amount of blood volume in a culture tube is at least 10 cc, use 2 types of antiseptics, the use of antiseptics on culture bottle caps, the time lag between antiseptic action and blood collection for culture. It is necessary to monitor the factors that influence the positivity of blood cultures in septic patients. Researchers also recommend training and policy improvements to improve blood culture positivity

Treatment Seeking Patterns among Dengue Fever Patients: A Qualitative Study

Background: Incidence of dengue fever is increasing drastically and has become a major public health problem globally. The reason patients are late in seeking medical treatment should be identified in order to prevent complications which can be avoided to produce a good prognosis. This study was conducted to find the pattern of treatment seeking behaviour among dengue fever patients and their influencing factors using a health utilisation model. Methods: Data on health seeking behaviour were collected among the dengue fever patients who were admitted to Dr. Hasan Sadikin General Hospital Bandung from September–October 2014. The data were collected through in-depth interview with patients who were diagnosed with dengue fever and dengue haemorrhagic fever. All the interviews were recorded using an audio recorder. The recordings were transcribed and then translated into English and analyzed using thematic analysis.Results: Nine patients were interviewed. The age of the patients ranged between 17 to 46 years.  Altogether 7 patterns were identified with patients treatment seeking behavior. Most of them took longer steps to reach adequate care with blood examination. These longer steps, caused by lack of facilities to perform blood test in primary health care facilities, no bed for admission and also low skills of health care providers in diagnosing patients. The primary health care facility played an important role in the delay of patients acquiring definite care for their dengue fever.Conclusions: Health care seeking behavior is hampered by the inadequacy of primary health care facilities to provide adequate services to dengue patients.

Level of Knowledge about Tuberculosis among Type 2 Diabetes Mellitus Patients at the Endocrine Clinic Dr. Hasan Sadikin General Hospital Bandung

Background: Diabetes Mellitus (DM) is one of the risk factors for tuberculosis (TB). Knowledge of TB is essential in prevention control for the person at risk. This study aimed to describe the level of knowledge about TB among DM patients. Methods: A cross sectional study was performed involving 72 adult DM patients at the Endocrine Clinic, Dr. Hasan Sadikin General Hospital Bandung. The subjects were interviewed using a standardized questionnaire including socio-demographic information and knowledge about TB: manifestation of TB, transmission, treatment, DM-TB co-infections, and status acquiring TB information in the last 12 months. Knowledge was categorized as high, moderate and low if total scores were >75, 56–75 and <56 respectively. Data were presented descriptively as percentage and mean (SD) after testing for the normality of distribution. Results: The mean of age of subjects was 56.6 years, and 55% were female. Most were unemployed (72.2%), had an education background lower than high school (75%), and lived in Bandung (91.7%).  The mean score of knowledge was 54.4. Proportion of subjects based on the level of knowledge which is high, moderate and low, were 29.2%, 26.4%, and 44.4% respectively.  Conclusions: The level of knowledge about TB among Type 2 DM patients at the Endocrine Clinic Dr. Hasan Sadikin General Hospital Bandung was low. TB education program among DM patients needs to be improved

Characteristics and Clinical Outcomes of COVID-19 Patients with Hyperglycemia: Retrospective Cohort Study from a COVID-19 Referral Hospital, Bandung, Indonesia

Background: COVID-19 often causes severe complications in patients with metabolic disorders such as diabetes mellitus. Conversely, inflammation caused by infection may also trigger insulin resistance, resulting in hyperglycemia and is related to the disease severity. This study aimed to describe the characteristics and clinical outcomes of COVID-19 patients with hyperglycemia at one of the COVID-19 referral hospitals in Bandung, Indonesia.Methods: This retrospective cohort study used secondary data from medical records of COVID-19 patients admitted to Dr. Hasan Sadikin General Hospital Bandung, Indonesia from March 2020 to March 2021. This study included all patients with confirmed COVID-19, aged >18 years, and had at least one blood glucose test at admission. Patients were grouped based on three possible types of hyperglycemia, namely diabetes mellitus, reactive hyperglycemia, and steroid-induced hyperglycemia; then their characteristics and disease outcomes were compared. Results: This study identified 1,114 patients’ medical records and included 1,013 data in the analysis. Hyperglycemia occurred in 45.1% of COVID-19 patients. The most common hyperglycemia types were diabetes mellitus (55.7%), reactive hyperglycemia (37.4%), and steroid-induced hyperglycemia (7%). The steroid-induced hyperglycemia group had similar characteristics as the diabetes group. The reactive hyperglycemia group exhibited a metabolic syndrome pattern resembling pre-diabetic conditions. The highest rates of severe disease and mortality were seen in the steroid-induced hyperglycemia group, followed by the diabetes group.Conclusions: There is an elevated prevalence of hyperglycemia in COVID-19 patients with diabetes. The steroid-induced hyperglycemia group has the most unfavorable outcomes. These observations emphasize the importance of identifying hyperglycemic conditions to improve management and outcomes

Knowledge, Attitude and Behavior Related to Antibiotic Use in Community Dwellings

Background: Irrational antibiotic use is the major reason for insidence of antibiotic resistance. Antibiotic misuse in community is influenced by environmental and behavioral factors. Environment included community preference for purchasing antibiotics, lack of health care infrastructure, lack of general practitioner and policy in regulating  antibiotic use. Behavior is influenced by lack of information in antibiotic use and unawareness of antibiotic resistancy. The aim of the study was to assess the level of knowledge, attitude and behavior regarding antibiotic use in community dwellings.Methods: A cross sectional descriptive study was carried out to 96 respondents who were selected by a rapid survey sampling method in Cileles village Jatinangor, Sumedang, West Java, Indonesia in August 2013. Data were collected using questionnaires. The data was analyzed in the form of frequency and percentage.Results: Out of 96 respondents, only 40.6% had good knowledge regarding antibiotic use, 12.5% of respondents were prescribed antibiotics, but in the last course did not purchased all the antibiotics prescribed by the clinician and 55.2% of respondents did not complete their treatment course.Conclusions: Most of the community still have poor knowledge regarding antibiotic use and its consequences such as allergy, and resistancy based on the knowledge questions has a total score ≤6. Their attitude and behavior regarding antibiotic use are still poor which is also based on  incompletion of the antibiotic treatment and irregular use.DOI: 10.15850/amj.v4n2.108

Identification of Enteric Bacterial Pathogens in Beverages Sold By Hawkers around Jatinangor, Bandung

Background: Water is essential for life and is considered as a medium for the propagation and dissemination of bacteria. Water-borne disease is one of the problems in Indonesia, therefore, this study was conducted to explore the presence of enteric bacterial pathogens in the beverages sold by hawkers.Methods: A descriptive laboratory method was conducted in September 2015 Beverages were collected from hawkers that were randomly chosen around Jatinangor using sterile containers, and brought to the laboratory within 1 hour. The beverages were incubated on Mueller Hinton Broth, followed by culturing on MacConkey Agar. The organisms were identified using Gram Staining, Kliger Test, Motility-Indole-Urease test and Citrate test.Results: Out of 30 samples collected, 2 of the samples were tested positive for enteric bacterial pathogen Salmonella paratyphi. Furthermore, Klebsiella pneumoniae (n=12), Enterobacterspp (n=10) Alcaligenes faecalis (n=3) and Pseudomonas spp. (n=3) were detected in the samples.Conclusions: The Salmonella paratyphi as enteric bacterial pathogen found in the beverages sold by hawkers has potential to cause water-borne disease. Education to hawkers need to be enhanced

Health-Seeking Behavior of Dengue Hemorrhagic Fever Patients in Several Hospitals in Bandung West Java Indonesia

Background: Dengue hemorrhagic fever is one of  the major global public health problems. Secondary prevention of dengue fever must be conducted to prevent high mortality rate by giving appropriate diagnosis and early management. This study was conducted to identify health-seeking behavior in dengue hemorrhagic patients and its related factors.Methods: This study involved 98 dengue hemorrhagic patients from four hospitals in Bandung region during July until November 2014. The hospitals were 2 public hospitals and 2 private hospitals. A questionnaire and in depth interview were used to collect the data.Results: Among 98 patients, 54 patients (55%) sought a right medical treatment timely, whereas 44 patients (45%) delayed. The first seeking behaviour to treat the disease was using over-the-counter drugs, followed by visiting a private clinic doctor. The second choice to seek health care was going to a private clinic doctor and hospital.Conclusions: Health-seeking behavior in dengue hemorrhagic patients in Bandung is inappropriate which can cause delay in treatment.

Profil Ekspresi Koreseptor Human Immunodeficiency Virus CCR5 dan CXCR4 pada penderita Infeksi Human Immunodeficiency Virus yang menggunakan Narkoba Suntik

Infeksi human immunodeficiency virus masih merupakan masalah kesehatan global, termasuk di Indonesia dan pemakai narkoba suntik merupakan populasi yang besar di antara orang dengan  infeksi HIV/AIDS (ODHA) yang berperan penting dalam  transmisi infeksi HIV. Opioid banyak digunakan penasun dan memengaruhi ekspresi CCR5 serta CXCR4 yang merupakan  koreseptor yang digunakan oleh HIV untuk menginfeksi sel limfosit T CD4. Penelitian ini bertujuan menganalisisperbedaan  ekspresi koreseptor HIV CCR5 dan CXCR4 antara ODHA penasun dan ODHA bukan pemakai narkoba. Penelitian observasional analitik dengan  rancangan cross sectional ini dilaksanakan pada September 2011−Mei 2013. Subjek penelitian adalah ODHA penasun yang diikutsertakan secara consecutive sampling  di RSUP Dr. Hasan Sadikin Bandung  serta di komunitas di Jawa Barat. Pemeriksaan ekspresi koreseptor CCR5, CXCR4 dan jumlah sel limfosit T CD4 dilakukan dengan metode flowsitometri. Ditemukan 80 orang subjek penelitian dengan 17 orang pengguna narkoba suntik aktif, 16 orang dalam terapi metadon, 15 orang mantan penasun, dan 32 orang bukan pemakai narkoba. Persentase CXCR4 di permukaan sel limfosit T CD4 lebih tinggi bermakna pada ODHA bukan pemakai narkoba dibanding dengan ODHA penasun (86,13; 78,23; p 0,001). Tidak terdapat perbedaan bermakna  ekspresi CCR5 dan MFI CXCR4 di permukaan sel limfosit T CD4 antara ODHA penasun dan ODHA bukan pemakai narkoba (p>0,05).  Dari penelitian ini disimpulkan bahwaekspresi CXCR4  lebih tinggi pada ODHA penasun dibanding dengan ODHA bukan pemakai narkoba pada sel limfosit T CD4. Ekspresi koreseptor CXCR4 yang lebih tinggi dibanding dengan CCR5 baik pada kelompok ODHA penasun dan bukan pemakai narkoba

Erythropoiesis Differences in Various Clinical Phases of Dengue Fever using Immature Reticulocyte Fraction Parameter

Objective: To determine the mechanism of erythropoiesis that led to anemia using the Immature Reticulocyte Fraction (IRF) parameter in various clinical phases of dengue fever.Methods: This study was a comparative analytical research using secondary data derived from the Dengue-associated Endothelial Cell Dysfunction and Thrombocyte Activation (DECENT) research. The study was performed at Dr. Hasan Sadikin Hospital Bandung, Indonesia from March 2011 to March 2012. Patients were grouped into fever, critical, recovery, and convalescent phases and a healthy control was established. Data collected were analyzed using the Kolmogorov-Smirnov normality test, followed by Friedman test and Mann-Whitney post hoc test.Results: There were 244 subjects participating in this study. The median IRF for all subjects was 4.8% with an IQR of 2.4-8.1%. The values of Immature Reticulocyte Fraction in fever-phase, critical-phase, recovery-phase, convalescent-phase and healthy-control were 1.8% (IQR of 0.5-2.85%), 3.6% (IQR of 1.8-5.0%), 7.05% (IQR of 4.08-11.85%, 7.3 % (IQR of 3.95-9.3%) and 4.1% (IQR of 2.2-6.6%), respectively. There was a significant difference in IRF between groups (p<0.05).  The immature Reticulocyte Fraction in fever phase was significantly different from the IRF in other phases and healthy controls (p<0.05).Conclusions:There are changes in erythropoiesis activities detected through the IRF in various clinical phases of dengue infection. Erythropoiesis suppression occurs mainly during the fever phase and starts to be restored in the critical phase. In the recovery and convalescent phases, the erythropoiesis activities increase.  This is the first study describing IRF in multiple phases of dengue disease.