EVALUASI PENGGUNAAN TERAPI ANTIBIOTIK EMPIRIS TERHADAP LUARAN KLINIS PASIEN PNEUMONIA KOMUNITAS RAWAT INAP

Pneumonia komunitas merupakan penyakit infeksi pada parenkim paru-paru yang mengancam jiwa sehingga dapat diberikan terapi antibiotik empiris. Penelitian ini bertujuan mengetahui nilai DDD dan kualitas penggunaan terapi antibiotik empiris menggunakan metode Gyssens pada pasien pneumonia komunitas rawat inap serta hubungannya terhadap luaran klinis pasien di RSUD Kota Makassar. Penelitian ini bersifat observasional dengan pengambilan data dilakukan secara retrospektif dari rekam medis pasien usia >19 tahun yang memenuhi kriteria inklusi periode Januari 2018-Desember 2019. Dikumpulkan data karakterisik pasien, pengobatan dan luaran klinis pasien setelah pemberian antibiotik. Analisis data dilakukan secara deskriptif dan dilanjutkan uji Chi square  untuk menganalisis hubungan penggunaan antibiotik dengan luaran klinis pasien. Karakteristik pasien yang beresiko yaitu usia, jenis kelamin, jumlah obat dan komorbid turut dianalisis. Hasil evaluasi kuantitatif antibiotik bahwa seftriakson memiliki DDD  tertinggi yaitu 44,9 DDD/100 patient-days, pada evaluasi kualitatif dari 74 sampel sebanyak 14 pasien (18,9%) memenuhi kategori ketepatan pemberian antibiotik (kategori 0) dan ketidaktepatan pemberian antibiotik pada kategori IVa sebanyak 50 pasien (67,6%), kategori IVb sebanyak 9 pasien (12,2%) dan kategori IIa sebanyak 1 pasien (1,4%). Uji chi-square menunjukkan tidak ada hubungan bermakna antara jumlah dan ketepatan penggunaan terapi antibiotik empiris terhadap luaran klinis pasien pneumonia komunitas pada periode Januari 2018-Desember 2019. Pasien yang memiliki komorbid baik yang berkategori infeksi maupun kategori infeksi dan non infeksi merupakan faktor resiko yang memiliki hubungan yang bermakna dengan luaran klinis pasien pada periode tersebut

KARAKTERISTIK PASIEN TUBERKULOSIS PARU DI PUSKESMAS KOTA BAUBAU SULAWESI TENGGARA

Tuberkulosis (TB) adalah salah satu penyakit infeksi menular melalui udara yang paling mematikan. Penyakit TB disebabkan terutama oleh bakteri patogen Mycobacterium tuberculosis (Mtb ). Penelitian ini bertujuan untuk mengetahui karakteristik pasien sebagai data pendukung untuk evaluasi tatalaksana terapi pada pasien TB paru. Penelitian ini merupakan penelitian deskriptif yang dilakukan di Puskesmas Kota Baubau Sulawesi Tenggara sejak Desember 2020-Februari 2021. Sampel Penelitian berjumlah 49 orang. Pengumpulan data dilakukan dengan bersumber dari data rekam medis, SITB (Sistem Informasi Tuberkulosis) dan kuesioner. Data penelitian kemudian dianalisis dengan menggunakan uji statistik SPSS. Hasil penelitian berupa data karakteristik pasien tuberkulosis paru di Puskesmas kota Baubau yang menunjukkan bahwa pasien tuberkulosis paru terbanyak pada jenis kelamin laki-laki (65,3%), umur 15-35 tahun (65,3%), pendidikan dasar dan menengah (73,5%), pekerjaan wiraswasta (51%), penghasilan >Rp 500.000 (75,5%), pemeriksaan akhir bulan ke enam BTA(-) (95,9%), pasien BTA(+) (4,1%), kepatuhan pasien (89,8%), pengetahuan responden tinggi (51%), efek samping obat terbanyak badan lemas (28,6%), mual (28,6%). Sebanyak (26,53%) pasien dengan penyakit penyerta dan 14,29% dengan keluhan gangguan asam lambung telah menerima Antasida

Detection of LytA Genes in Streptococcus pneumoniae Isolated from sputum pneumonia patients

Streptococcus pneumoniae (pneumococcus) is a Gram-positive facultative anaerobic bacterium that is a major cause of morbidity and mortality worldwide. But the lack of reporting of disease by this bacterium in Indonesia, one of the causes is because the diagnosis of pneumococcal infection is often clinically not typical and conventional methods which are still the standard gold method often give false-negative results. So the purpose of this study was to evaluate the performance of culture and molecular diagnostic methods using the Polymerase Chain Reaction (PCR) technique in detecting Streptococcus pneumoniae in sputum clinical samples using the Autolysin (LytA) gene which is a virulence factor of this bacterium. 57 isolates from 60 samples were confirmed as Streptococcus sp through microscopic identification, culture, and biochemical tests. Then the sensitivity test with an optochin test of 9 (9%) compared the results descriptively with the PCR technique using the Autolysin A (LytA) gene which was obtained more sensitive by 15 (25%)

Pulmonary Tuberculosis CT-Scan Features and Sputum Smear in Tertiary Referral Hospital

Introduction: Management of pulmonary tuberculosis (PTB) from primary and secondary health centers might affect the result of sputum acid-fast bacilli (AFB) smear and features of lung computed tomography scan (CT-scan) presented in tertiary hospitals. The study aims to investigate comparison between CT-scan features of PTB with sputum AFB smear in Wahidin Sudirohusodo Hospital as the top referral hospital in the Eastern part of Indonesia. Methods: This is a retrospective study of patients diagnosed as PTB by pulmonologist of nine months period. Patients with available CT-scan and sputum AFB smear results are included in the study. CT-scan features re-evaluated with RadiAnt DICOM viewer for standardized reading. The relationship between data obtained was analyzed with a chi-square test. Results: Sixty-one PTB patients were entered into the study. The three most common features found in CT were consolidation (93.4%) followed by Tree-in-bud (91.8%), and fibrosis calcification (85.2%). Relationship of CT features and sputum AFB smear was significant on cavity (p-value: 0.002) and pleural effusion (p-value: 0.020). However, unlike cavity (OR = 1.667), pleural effusion has opposite relationship (OR = 0.205) with sputum AFB smear. Conclusions: Pulmonary tuberculosis CT features seen in top referral hospitals can be very severe with consolidation and tree-in-buds as the most common features found in more than 90% of the cases. Feature of cavity may help radiologist to distinct highly active PTB with positive sputum AFB smear while presence of pleural effusion should raise the suspicion from pulmonologists to add further laboratory investigation

Penyerupa dan Penyerta Tuberkulosis Paru yang Terdiagnosis Berdasarkan Gambaran CT-scan Toraks Pada Rumah Sakit Rujukan Tersier

Latar belakang: Sistem rujukan berjenjang dapat mempengaruhi karakteristik lesi pada CT-scan toraks pasien terduga tuberkulosis (TB) paru pada rumah sakit rujukan tersier. Hal ini dapat menyamarkan keberadaan penyerupa dan penyerta TB paru. Metode Penelitian: Sampel adalah pasien yang terdiagnosis TB paru oleh ahli radiologi pada periode Oktober 2018 hingga Juni 2019. Analisis Chi-square dilakukan untuk menguji kesesuain 12 karakteristik CT-scan toraks (Konsolidasi, kavitas, tree-in-bud, fibrokalsifikasi, air-bronchogram-sign, lesi noduler, efusi pleura, atelektasis, bercak infiltrat, lymphadenopathy, bronchiectasis, ground glass opacity) dengan diagnosis akhir klinisi. Pencatatan penyerupa dan penyerta TB dilakukan setelah diagnosis akhir ditegakkan. Hasil: Dari 137 sampel, hanya 61 (44.5%) pasien yang terdiagnosis sebagai TB paru aktif, 38 (27.7%) terdiagnosis sebagai bekas TB paru dan 38 (27.7%) lainnya terdiagnosis sebagai penyakit paru bukan tuberkulosis. Dari 12 variabel yang dievaluasi, karakteristik yang sesuai dengan diagnosis klinisi adalah tree-in-bud (p = 0.019) dan lymphadenopathy (p = 0.039). Penyakit penyerupa dan penyerta terbanyak adalah tumor paru dan infected bronchiectasis. Simpulan: Gambaran CT-scan pasien TB paru sangat beragam pada rumah sakit rujukan tersier. Diperlukan ketelitian ahli radiologi dan kerja sama yang baik dengan klinisi untuk mendeteksi berbagai kemungkinan diagnosis yang dapat menyerupai dan menyertai TB par

Karakteristik serta Profil Koagulasi Pasien Covid-19

Latar belakang: Derajat keparahan Covid-19 dikaitkan dengan koagulasi dan kerusakan endotel yang dipicu oleh reaksi inflamasi akibat dari pelepasan sitokin proinflamasi yang berlebihan oleh karena infeksi SARS CoV-2. Metode: Penelitian deskriptif analitik yang dilakukan dengan pendekatan kohor retrospektif dilakukan di Rumah Sakit Umum Pemerintah Wahidin Sudirohusodo Makassar dengan mengumpulkan data rekam medis pasien Covid-19 pada bulan Juni 2020 – Juni 2021 dengan menggunakan total sampling yang memenuhi kriteria inklusi dan eksklusi. Hasil: Pada penelitian ini didapatkan rerata trombosit lebih rendah (265.442) pada kasus berat, sedangkan rerata fibrinogen (405,54) dan D-dimer (9,84) lebih tinggi pada derajat keparahan lebih berat, serta Prothrombin time (PT) lebih panjang (10,92) pada derajat keparahan lebih berat. Kesimpulan: Profil koagulasi penderita Covid-19 didatakan rerata rombosit lebih rendah pada derajat keparahan lebih berat, sedangkan fibrinogen dan D-dimer lebih tinggi serta Prothrombin time (PT) lebih panjang pada derajat keparahan lebih berat

Factors Influencing the Implementation of Interprofessional Collaborative Practice in Teaching Hospital Setting: A Mixed-Method Study

Introduction: Health service in the current global era requires health workers to provide qualified service, this also applies to teaching hospitals. Collaboration between several professions involved (doctors, nurses, and pharmacists) in an interprofessional collaboration system is needed in providing such service. Factors influencing interprofessional collaboration is unique to each health care center. The purpose of this study was to determine the factors that influence the implementation of interprofessional collaborative practice among health workers in Dr. Wahidin Sudirohusodo General Hospital.Methods: This is a mixed-method explanatory sequential design study, utilizing quantitative and qualitative data. Quantitative data were obtained from the Indonesian-validated Collaborative Practice Assessment Tool (CPAT) questionnaire. CPAT in Indonesian language has been validated in previous research by Findyartini, et al. in 2019 in Indonesian population. The questionnaire was internally validated with the study population with Cronbach alpha of 0.812. All health care professionals meeting the selection criteria were enrolled for the quantitative study. Thequestionnaire was given to 152 health professionals enrolled as research subjects, including nutritionists, nurses, doctors, pharmacists, and medical rehabilitation specialists serving in Dr. Wahidin Sudirohusodo Hospital for >3 years. Five participants with highest and lowest CPAT score from each profession were invited for FGD entitled “Exploring factors involved in interprofessional collaboration in Wahidin Sudirohusodo General Hospital” and divided into 2 groups according to the CPAT score. The score from each subscale in the questionnaire is obtained for each research subjects and the median is compared among each profession group using Kruskall-Wallis test significant to a p-value of <0.05. Qualitative data as recording transcript is acquired from FGD; the transcript was then coded into several general themes by 2 of the authors and was discussed using thematic analysis using MaxQDA. Results: Research subjects were predominantly women (121 respondents (79.6%)), 32.9% were nurses, and most of the healthcare professional (81 subjects (55.1%)) have been working for >10 years. Among profession groups (Doctors, Pharmacists, Medical Rehabilitation Specialists, Nutritionists, and Nurses), difference in score distribution (P<0.05) wasfound in relationships among team members (40 vs 39 vs 39.5 vs 36 vs 42, P<0.001), barriers to team collaboration (10 vs 18.5 vs 14 vs 18 vs 10, P<0.001), and leadership (20 vs 20 vs 23 vs 20 vs 20, p 0.045). From the FGD, factors influencing interpersonal collaborative practice are leadership factors, system/rule factors, and personal factors. Conclusion: This research showed that personal, system/organizational and leadership factors influence the implementation of interprofessional collaboration. In this study, there is a different perception regarding relationships among team members, barriers to team collaboration, and leadership among profession group

Molecular Analysis of rrs Gene Mutation on Detecting The Resistance of Kanamycin from the Clinical Isolates of Tuberculosis Patient

The resistance of kanamycin (KAN) as a second-line drug treatment for tuberculosis is associated with mutations in the 16S rRNA gene (rrsgene).rrsgene mutations occur at different locus causing changes in codons and amino acids.This study aimed to analyze mutations in the rrs gene and its relationship with the resistance of KANin isolate clinical sample ofMycobacterium tuberculosis(MTB). The isolate clinical sample of MTB was obtained from the TB HUM-RC laboratory. The analysis of rrs gene mutation was conducted using PCR sequencing.The results described that from 93 samples isolates, 51 (54.8%) samples shown multidrug resistant (MDR) while 42 samples shown (45.2%) non-MDR. Drug sensitivity test (DST) from the second line drugs samples isolates7 of 93 samples (7.5%) that shown resistance with KAN. The result of PCR sequencing shown6 (6.4%) of 93 isolates samples had mutations rrsgenein the locus of T1521C (1.1%), G1484C (1.1%), A1401G (2.1%), G940T (1.1%), and A514C (1.1%). Based on that gene locus, an unreported new mutation in the locus of rrs gene, called G940T,was discovered.The results of statistical analysis based on the number of mutations in each of anti-tuberculosis drugs indicate the p&lt;0.05,described a relatioship between the mutation of rrs gene with the resistance of KAN. In conclusion, significance and impact of study, there is an association between the mutation in the rrs gene and the resistance to the second-line drugs of KAN in clinical isolates of MTB.Thus, samples of clinical isolates of MTB could be used to detect any resistance of KAN in advance

Excess mortality attributable to antimicrobial-resistant bacterial bloodstream infection at a tertiary-care hospital in Indonesia

The burden of antimicrobial-resistant (AMR) infections in low and middle-income countries (LMICs) is largely unknown. Here, we evaluate attributable mortality of AMR infections in Indonesia. We used routine databases of the microbiology laboratory and hospital admission at Dr. Wahidin Sudirohusodo Hospital, a tertiary-care hospital in South Sulawesi from 2015 to 2018. Of 77,752 hospitalized patients, 8,341 (10.7%) had at least one blood culture taken. Among patients with bacteriologically confirmed bloodstream infections (BSI), the proportions of patients with AMR BSI were 78% (81/104) for third-generation cephalosporin-resistant (3GCR) Escherichia coli, 4% (4/104) for 3GCR plus carbapenem-resistant E. coli, 56% (96/171) for 3GCR Klebsiella pneumoniae, 25% (43/171) for 3GCR plus carbapenem-resistant K. pneumoniae, 51% (124/245) for methicillin-resistant Staphylococcus aureus, 48% (82/171) for carbapenem-resistant Acinetobacter spp., and 19% (13/68) for carbapenem-resistant Pseudomonas aeruginosa. Observed in-hospital mortality of patients with AMR BSI was 49.7% (220/443). Compared with patients with antimicrobial-susceptible BSI and adjusted for potential confounders, the excess mortality attributable to AMR BSI was -0.01 (95% CI: -15.4, 15.4) percentage points. Compared with patients without a BSI with a target pathogen and adjusted for potential confounders, the excess mortality attributable to AMR BSI was 29.7 (95%CI: 26.1, 33.2) percentage points. This suggests that if all the AMR BSI were replaced by no infection, 130 (95%CI: 114, 145) deaths among 443 patients with AMR BSI might have been prevented. In conclusion, the burden of AMR infections in Indonesian hospitals is likely high. Similar large-scale evaluations should be performed across LMICs to inform interventions to mitigate AMR-associated mortality

Relationship between Vitamin D Level and Serum TNF-α Concentration on the Severity of Chronic Obstructive Pulmonary Disease: Vitamin D Level and Serum TNF-α related to the Severity of Chronic Obstructive Pulmonary Disease

Background: Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory disease and disturbed bacterial clearance. Vitamin D deficiency is sometimes observed in COPD patients and as significant roles in increasing inflammation of airway obstruction and systemic obstruction, increasing proinflammatory cytokine including TNF-α, reduction of bacterial clearance and increase exacerbation risk due to infection. Also, vitamin D plays significant roles in the metabolism of calcium and mineralization of bones and regulation system of immune. TNF-α also has essential roles in pathogenesis and inflammation of COPD. &nbsp;Several studies that investigate the relationship between vitamin D level and serum TNF-α concentration in COPD patients are relatively uncommon, including in Indonesia. For that reason, this study aimed to assess the relationship between vitamin D level and TNF-α concentration in patients on the severity of the chronic obstructive pulmonary disease. Methods This study was a hospital-based descriptive cross-sectional study. Total samples were 50 COPD patients with the average age of older than 60 years during their enrollments at the Department of Pulmonology and Respiratory Medicine of the Dr.Wahidin Sudirohusodo General hospital&nbsp; Makassar in September 2018-January 2019. All procedures of the present study were reviewed and approved by the Research Ethics Committee of Medicine Faculty of Hasanuddin University. The severity of COPD was assessed according to the combination of COPD assessment stages that referred to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guideline 2015 that consisted of the combination of scoring COPD Assessment Test (CAT), the modified Medical Research Council (mMRC) questionnaire and results of the spirometric measurement. Assessment of airway obstruction levels referred to the GOLD spirometric criteria. Determination of thoracic photographs was conducted to verify the COPD diagnosis of the severity of COPD. Determination of serum TNF-α concentration and vitamin D3 [1,25(OH)2D3] level used the ELISA method. Results &nbsp;The majority of COPD patients were observed in the category of older than 60 years old accounted for 34 COPD patients (68%), and the majority of COPD patients were males accounted for 47 males with COPD (94%). The majority of COPD patients were observed in the group of D (38%). All the study subjects observed in this study were smokers, and 82% of them were in the category of heavy smokers. 21 study subjects had higher concentration of serum TNF-α&nbsp; (tertile 3 = 0.21-1.83 pg/dl), 20 study subjects&nbsp; and lower level of vitamin D (tertile 1 = 182.1-364.5 pg/dl). The majority of the study subjects (38%) were in the category of severe COPD (category D of the severity of COPD at the tertile 3) according to the GOLD Combine Assessment. In view of the relationship between vitamin D level and serum TNF-α concentration on the airway obstruction, there were significant positive correlations between the increase of vitamin D levels and the increase of serum TNF-α concentrations on airway obstruction. In view of the relationship between vitamin D level and serum TNF-α concentration on the severity of COPD, there were significant positive correlations between the increase of vitamin D levels (tertiles 1, 2 and 3) and the increase of serum TNF-α concentrations on the severity of COPD at p-value&lt;0.05. Overall, there were non-linear relationships between vitamin D level and serum TNF-α concentration on the severity of COPD. Conclusions: Serum TNF-α concentration was positively associated with airway obstruction level and severity of COPD. Low level of vitamin D was negatively associated with airway obstruction level and severity of COPD. Vitamin D3 level (1,25(OH)2D) was negatively associated with serum TNF-α concentration and airway obstruction level and severity of COPD