Infeksi Nosokomial Saluran Kencing (Insk) di Rumah Sakit Khusus Penyakit Menular, Jakarta

A prospective survey to establish the incidence of urinary tract nosocomial infection (UTNI) was conducted at the Infectious Diseases Hospital of Jakarta for one year duration in 1982-1983. The study was done by taking random samples from patients hospitalized for longer than 2 days through urine cultures on day 1, 3 and 7 and other necessary examination. From 2288 patients hospitalized during that period, 723 patients (aged 2 months-70 years) met the requirement to be included in the study, and 115 (15.9%) of them met the criteria for UTNI. Female patients had higher rate of UTNI compared to male patients (19.8% vs 12.4%). The age group with highest rate of UTNI was children with < 1 year of age and the rate of UTNI decreased as the age of patients increased. Febrile patients had significantly higher rate of UTNI compared to diarrhea patients (33.4% vs 2,4%, p < 0.001). Patients who had catheterization had significantly higher rate of UTNI compared to patients without catheter placement (85.7% vs 12.3% p <0.05). Antibiotics treatment prior to hospitalization was associated with higher rate of UTNI compared to patients without it (22.8% vs 12.6% p < 0.01) as it was also observed with hospitalization for 7 days or longer (15.8% vs 11.9%) of it is compared to shorter duration of hospitalization. Gram negative bacterias were the most commonly recovered from the urine cultures compared to gram positive (89.8% vs 10.2%) with E. coli (24.2%) as the leading organism. Other recovered organism, Proteus spp and Citrobacter bacilli showed high resistancy toward antibiotics commonly used in the hospital. Average duration of hospitalization for patients with UTNI (9.6 days) was longer compared to average duration for patients without UTNI (4.4 days). Six out of 115 patients with UTNI died (5.2%) compared to only 1.3% mortality in patients without UTNI. No single factor was significantly shown to be responsible for higher mortality rate of patients with UTNI, possibly was due to more severe condition of underlying disease of patients with UTNI

Infeksi Komunitas (Ik)/infeksi Luar Rumah Sakit (Ilrs) (Community Acquired Infection) di Rumah Sakit Khusus Penyakit Menular, Jakarta

A one year prospective study was conducted at the Infectious Diseases Hospital (IDH) of Jakarta in 1982-1983 to survey the rate of community acquired infection (CAI). Blood culture, rectal swab, urine culture and in some patients cerebro spinal fluid culture were obtained randomly from hospitalized patient at the time of admission. From 723 patients with age 2 months-70 years, who were examined and fulfilled the study criteria, 504 (69,7%) patients were positive for CAI resulted in total of 611 CAIs. Based on anatomical location, this number consists of 53.5% CAI of GI Tract, 20.9% CAI of Urinary Tract, 9.5% CAI bacteremia and 0.6% CAI involving central nervous system. Incidence rate was significantly higher in female (74.1%) compared to male (65.7%) (p12 years patients (73.9%) compared to children <12 years (p<0,01). Diarrhea patients had significantly higher CAI (77.4%) compared to febrile patients (55.2%) (p<0,01). Patients who had not received antibiotic prior to admission had higher rate of CAI (70.9%) compared to who received it prior to admission (67.1%) Etiologic agents most commonly recovered were gram negative bacterias (94.9%) with Vibrio cholerae (48.6%) as the leading cause, and only 5.1% were gram positive. Some of bacteria found as the etiologic agent of CAI, were Salmonella group D, Salmonella group E4, Proteus vulgaris and ruttgerii, Klebsiella pneumoniae, Mima polymorpha, Alkaligenes sp showed high rate of resistancy to commonly used antibiotics. (Ampicillin, Tetracycline, Chloramphenicol and Trimethoprim + Sulfamethoxazole). Average duration of hospitalization for CAI cases (6,4 days) was longer than in cases without CAI (4,3 days). There were 11 deaths (2.2%) in cases with CAI and 2 deaths (1.4%) in patients without CAI, with death rate was higher in males (2.4%) compared to female (1.9%), and highest was in less than 1 year old age group patient (13.6%), also significantly higher in febrile patients compared to diarrhea patients (7.2% vs 0.3%, p< 0.001). The higher mortality rate in CAI is due to more severe condition of underlying disease of patients who had CAI

Pencemaran Jarum Infus Intervena (IV) di Rumah Sakit Khusus Penyakit Menular, Jakarta

A prospective survey to evaluate rate of intravenous needle contamination was conducted at Infectious Diseases Hospital of Jakarta among patients whom received intravenous (i.v.) fluid or transfusion during 1 year period in 1982-1983. The survey was conducted through random culture of the distal part of the intravenous needle placed in the patients vein after completion of intravenous treatment. The exact time for the needle placement and extraction, local and systemic reactions observed in patients, were all recorded. From 559 culture of the i.v. needles which fulfilled the survey criteria, 238 were positive, indicating 42.3% contamination rate of the i.v. needles. The rate was higher in febrile patients (47.2%) compared to diarrhea patients (41.5%) Average duration of infusion (the duration of time the needle stayed in the vein) was 38.9 hours, with average of 15.8 hours in diarrhea patients and 104,6 hours in febrile patients. Mean duration of time for local reaction development was 36.8 hours, with 24.3 hours in diarrhea patients and 65.9 hours in febrile patients. Patients with positive culture had higher rate of local reaction (17.6% vs 13.4%), systemic reaction (18.4% vs 11.8%), nosokomial bacteremia (88% vs 4,4%) and community acquired infection (5.9% vs 3.7%) compared to patients with negative cultures. For patients with longer than 48 hours infusion, 58.5% had positive culture from i.v. needles, 21.9% had local reaction, 40.2% had systemic reaction which all were higher compared to patients who had less than 48 hour infusion with p&lt;0.001, p&lt;0.02 and p&lt;0.001 respectively. Isolated bacteria from i.v. needles were 74.6% gram positive bacterias and 25.4% gram negative, with Staphylococcus epidermidis (38%) as the leading positive culture. Isolated bacteria had high rate of resistancy \u27oward commonly used antibiotics in the hospital

Infeksi Nosokomial Saluran Nafas Bawah (Insnb) di Rumah Sakit Khusus Penyakit Menular, Jakarta

A prospective study to determine the incidence of lower respiratory tract nosocomial infection (LRNI) was conducted at the Infectious Diseases Hospital of Jakarta (IDH) in 1982-1983 for one year duration. Samples were taken randomly from 2 group of hospitalized patients: diarrheal and febrile patients. The criteria for development of lower respiratory infection were based on history, physical examination and chest x-ray examination, which was done only Li some of the patients those with duration of hospitalization &gt;2 days. From 2288 patients hospitalized during that period,723 (31.6%) patients fulfilled the criteria to be included in the nosocomial study, and from this group 34 (4.7%) of them met the criteria for LRNI. The LRNI was observed in almost similar percentage in both sexes of patients (4.5% in males and 4.9% in females). Comparison of different age group of patients showed that 5-11 years old children had highest rate of LRNI (14,5%) and significantly (p&lt;0,01) compare to &gt; 12 years old followed by children 1-4 year old (7,1%), while children &lt;1 year had 5.9%, and the lowest rate was in &gt; 12 years group with 2.7% Febrile patients had significantly higher rate of LRNI compared to diarrhea patients (11.6% vs 1.1%; p&lt; 0,001). Patients who received oxygen and bronchial mucus suction had significantly higher rate of LRNI (27.4%) vs 3.1%; p&lt;0,001) compared to those who did not (3,1%, p&lt; 0,001). Average duration of hospitalization for patients with LRNI was longer than for patients without it (11.1 vs 5.1 days). Case fatality rate in patients with LRNI was also higher 17.7%, compared only 1.2% in patients without LRNI. Factors involved in CFR was mostly due to severity of underlying disease and respiratory failure due to pneumonia in patients who developed LRNI

Progress in Diarrheal Disease Research at Namru-2 in Collaboration with Badan Litbangkes and Rspi

Penyakit diare termasuk kolera masih merupakan masalah kesehatan yang penting untuk Indonesia. Kejadian luar biasa (KLB) "muntah-berak" masih terus dilaporkan dari berbagai daerah di Indonesia. Salah satu upaya yang dilakukan untuk mengatasi keadaan ini adalah menemukan suatu vaksin yang aman, praktis dan terjangkau harganya. CVD-103 adalah strain V. cholerae yang sebagian besar gen penyebab diare, toksin subunit A, telah dibuang. Pada penelitian dengan peserta anak-anak di Jakarta, CVD 103-HgR ternyata memberikan kenaikan antibodi dan dapat diterima baik oleh anak-anak Indonesia berusia 5-9 tahun dan 25-59 bulan. Di samping itu pemeriksaan sampel bakteriologik dari lingkungan dekat tempat kediaman peserta dengan menggunakan teknik yang peka untuk mendeteksi V. cholerae, tidak menemukan adanya strain vaksin. Suatu penelitian lapangan dengan tujuan untuk menilai kemanjuran dosis tunggal vaksin oral kolera CVD 103-HgR untuk pencegahan kolera secara klinis selama tiga tahun, telah dimulai didaerah Jakarta Utara pada tahun 1993. Selain itu penelitian ini juga bertujuan untuk menetapkan kemanjuran vaksin terhadap berbagai kelompok umur, terhadap kolera berat, serta membandingkan kemanjurannya pada peserta dengan golongan darah O. Jumlah penduduk yang ikut dalam penilaian vaksin ini adalah 67.000 peserta sukarela. Hasil penelitian ini diharapkan dapat diketahui pada akhir tahun 1996.Di samping penelitian tentang vaksin kolera, NAMRU dan Badan Litbangkes juga telah ikut serta dalam berbagai penelitian WHO, misalnya tentang larutan garam oralit (ORS) yang dilakukan di RS Karantina/RS Penyakit Infeksi Prof. Dr. Sulianti Saroso. Salah satu penelitian terakhir adalah manfaat larutan ORS dengan osmolaritas rendah pada tahun 1994. Hasil penelitian ini telah mendorong WHO untuk melaksanakan penelitian dengan larutan yang sama di berbagai pusat penelitian (multicenter) pada tahun 1995 sebelum mengusulkan suatu Perubahan formulasi larutan ORS secara global

Pencemaran Kuman di Lingkungan Rumah Sakit Khusus Penyakit Menular, Jakarta

A survey to establish environmental contamination was conducted at the Infectious Diseases Hospital (IDH) of Jakarta by taking swabs from 90 hospital personnels who are directly involved in patients care. These swabs were taken from their hands, nails, throat and rectum. Swabs and cultures were also obtained from 167 equipments, solid and liquid material, food from the hospital, and the air in the hospital wards. From total of 437 specimen obtained, 73.7% showed presence contaminated result. There was 100% positive culture result noted in hands and nails swabs, 94.8% culture positive for any microorganism result was obtained from throat swabs while rectal swab indicated only 4.4% rate of contamination. Results of 167 swabs from material/equipments in the hospital, showed that 85.1% of them were not sterile, this included 59.1% of 54 liquid material, 37.3% from 35 liquid material which were supposed to be sterile, 100% positive culture of 17 liquid material specimen that were supposed to be clean. From solid materials 66.7% of 51 specimen were not sterile. This included 76.2% from 21 specimen that were supposed to be sterile, and 100% from 7 specimen that supposed to be clean. Also 100% non sterility was obtained from 23 other material and 62 equipment. Recovered bacterias consisted of both gram positive and negative bacterias and almost all of them represented normal human flora. Some of them potentially could became pathogen including pathogen for nosocomial infection. From the hospital personnels hand swabs, 25.4% were spore-forming bacteria and from the throat swabs 46.7% yielded Streptococcus ~ hemolyticus, and 4.4% were positive for coliform bacteria from rectal swabs. Results of material and equipment showed majority of aerobic rods (31.5%). Some of the bacteria recovered, including Pseudomonas aeruginosa and Enterobacter aerogenes were resistant to commonly used antibiotics in the hospital (Ampicillin, Tetracycline and Chloramphenicol)

20 Years of Progress in Intestinal Parasitic Diseases Research

Since 1968 investigators from U.S. Naval Medical Research Unit No. 2 Detachment (NAMRU-2) and the National Institute of Health Research and Development (NIHRD) have conducted parasitological/biomedical surveys in every major island in the Indonesian archipelago. Even smaller islands such as Nasi and Beras off of Sumatra and Beeuw off of Irian Jaya are represented in these studies. These activities were aimed to update and provide new information on the prevalence and distribution of intestinal parasites as well as other infectious agents. These surveys were done in collaboration with the Directorate General of Communicable Disease Control and Environmental Health (CDC&amp;EH), universities and other health institutions such as the Indonesian Armed Forces Health Services, Provincial Health Services, and others. Stool specimens, blood smears, and venous blood examined in these studies showed that most of the population surveyed were infected with one to 7 different species of parasites. Between 50% to 95% of the population had multiple infections

20 Years of Progress in Typhoid Research

In 1981, the reported number of cases of typhoid fever in Indonesia was 19,596, increasing to 26,606 m 1986, most of the increase was due to improved detection and recognition of the pathogen. A more realistic estimate of incidence for this underreported and underdiagnosed disease would be from 540,000 to 1,210,000 cases per year. This was based on results of a household survey done by Budiarso R. et al. in 1980 and 1986, and on result of a community surveillance done by Ruwido and Simanjuntak et al. from 1983-1988. These studies were done in Plaju, South Sumatera, representing an urban area and Paseh, West Java, representing a semi-rural area. The results showed that the incidence rate of typhoid fever in the semi rural area was 358/100,000 population/year, and between 760-810/100,000 population/year in the urban area. These studies also indicated that the high risk group in the population was school age children between ages of 3-19 years. From other observations, it is also noted that the case fatality in urbanized and growing areas of Indonesia, may be higher than it is reported in other areas of the worl

Safety, Immunogenicity, and Transmissibility of Single-Dose Live Oral Cholera Vaccine Strain CVD l03-HgR in 24- to 59-Month-Old Indonesian Children

Recombinant A-B+ Vibrio cholerae O1 strain CVD 103-HgR is a safe, highly immunogenic, single-dose live oral vaccine in adults in industrialized countries, Safety, excretion, immunogenicity, vaccine transmissibility, and environmental introduction ofCVD 103-HgR were investigated among 24- to 59-month-old children in Jakarta. In 81 households, 1 child was randomly allocated a single dose of vaccine (5 x 109 cfu) and another, placebo. Additionally, 139 unpaired children were randomly allocated vaccine or placebo. During 9 days of follow-up, diarrhea or vomiting did not occur more often among vaccinees than controls. Vaccine was minimally excreted and was isolated from no controls and from 1 (0.6%) of 177 unvaccinated family contacts. A 4-fold or higher rise in serum vibriocidal antibody was observed in 75% of vaccinees (10-fold rise in geometric mean titer over baseline). Of 135 paired placebo recipients or household contacts, 5 had vibriocidal seroconversions. Moore swabs placed in sewers and latrines near 97 households failed to detect vaccine. These observations pave the way for a large-scale field trial of efficac

Standard WHO-ORS Versus Reduced-osmolarity ORS in the Management of Cholera Patients

The study compared the safety and efficacy of an oral rehydration salts (ORS) solution, containing 75 mmol/L of sodium and glucose each, with the standard World Health Organization (WHO)-ORS solution in the management of ongoing fluid losses, after initial intravenous rehydration to correct dehydration. The study was conducted among patients aged 12-60 years hospitalized with diarrhoea due to cholera. One hundred seventy-six patients who were hospitalized with acute diarrhoea and signs of severe dehydration were rehydrated intravenously and then randomly assigned to receive either standard ORS solution (311 mmol/L) or reduced-osmolarity ORS solution (245 mmol/L). Intakes and outputs were measured every six hours until the cessation of diarrhoea. During maintenance therapy, stool output, intake of ORS solution, duration of diarrhoea, and the need for unscheduled administration of intravenous fluids were similar in the two treatment groups. The type of ORS solution that the patients received did not affect the mean serum sodium concentration at 24 hours after randomization and the relative risk of development of hyponatraemia. However, patients treated with reduced-osmolarity ORS solution had a significantly lower volume of vomiting and significantly higher urine output than those treated with standard WHO-ORS solution. Reduced-osmolarity ORS solution was as efficacious as standard WHO-ORS solution in the management of cholera patients. The results indicate that reduced-osmolarity ORS solution is also as safe as standard WHO-ORS solution. However, because of the limited sample size in the study, the results will have to be confirmed in trials, involving a larger number of patients