The potential of meropenem and piperacillin-tazobactam combination to Acinetobacter spp clinical isolates in vitro

Acinetobacter spp is one of the most common causes of nosocomial infection, especiallysepsis. A lot of antibiotics resistance happen related to Acinetobacter-related sepsis treatment. This study aimed to evaluate the potential of meropenem and piperacillin-tazobactam combination against Acinetobacter spp in in vitro by using paper strip test. This was experimental study conducted in September to December 2015 at Departement of Microbiology, Faculty of Medicine, Public health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia. Clinical isolates of Acinetobacter samples were obtained from collections of the Department of Microbiology. The data were analyzed using post-test analysis which was conducted by observation over 24 h after the paper strip test was applied in bacterial culture. The MIC value of the antibiotic combination was recorded based on observation. The result showed 12 of 17 clinical isolates were synergistic potential (70.59%) and 5 others were indifferent potential (29.41%). Two of five clinical isolates that show indifferent potential were A. baumannii and all of the clinical isolates that show synergistic potential were Acinetobacter spp. It can be concluded that the combination of meropenem and piperacillin-tazobactam showed more synergistic dominantly than the single use of each of them

Geographic Accessibility to Primary Healthcare: Study Case Dengue Fever in Purwosari Sub-District, Gunungkidul Regency, Yogyakarta, Indonesia

Distribution and spatial analysis of public healthcare in Indonesia are rarely discussed. Most of the research tell about quantity and quality which do not mention the spatial aspect. This research purposes to know the relationship between health facilities selection and geographic conditions by combining medical facilites data, number of doctor and spatial analysis approach. The selected study areas are referral health facilities chosen by DHF (Dengue Hemorrhagic Fever) patients in Purwosari District, Gunungkidul Regency. Information was collected by interviews and field measurements (altitude and location plotting) and also secondary data collection (hospital accreditation data, number of doctors, and number of beds). GPS, Altimeter, ArcGIS, and SPSS used for data collection and analysis. The spatial analysis method in this research were kernel density, buffer, ruler, and altitude of each facility. Meanwhile, the medical analysis approach used Pearsons' correlation and multinomial logistic regression in SPSS. The results of the spatial analysis show that the DHF patients in Purwosari dominantly choose health facilities in Bantul Regency because of having closer distance, relatively short travel time, lower elevation, and many health facilities centers. At the same time, Puskesmas Purwosari (Sub-district level Health center) was only chosen as an early reference and a place for treating mild dengue patients. In addition, distance, duration of travel time, and the number of doctors had a strong correlation based on the Pearson's correlation. These three variables have the greatest linear relationship with the response variable. Meanwhile, some variables; elevation, number of doctors, accreditation, and number of beds were considered by patients in choosing a hospital based on multinomial logistic regression analysis

The Spatiotemporal Analysis of Dengue Fever in Purwosari District, Gunungkidul Regency, Indonesia

From 2014 to 2016, the number of prevalence of Dengue Hemorrhagic Fever (DHF) and deaths associated with DHF in Indonesia increased. DHF fatal cases were also reported from three administrative units in the Special Region of Yogyakarta, namely Bantul Regency, Gunungkidul Regency, and Yogyakarta City. Two related deaths in Purwosari, a district in Gunungkidul, raised the status of DHF to an outbreak. This study was designed to characterize the spread pattern of DHF in its endemic areas in Purwosari District using the retrospective method, anamnesis, in-depth interviews, Geographic Information System (GIS), and environmental analysis. The kernel density estimation revealed that in 2011-2017, DHF was concentrated in four villages, namely Giriasih, Giricahyo, Giritirto, and Giripurwo. There was a correlation between DHF incidents and physical geographical features of these villages, including proximity to water sources, high vegetation density, elevation, humidity, and rainfall, which created habitats for mosquito growth. A high incidence of DHF has been observed in children (50.8%) and students (57.4%), with most cases (78.7%) showing typical symptoms of the disease. A few of the 61 cases in the district developed into dengue shock syndrome (DSS) and led to death (4.9%), mainly because the public was unable to recognize the warning signs of DHF early and had limited knowledge of required management therapy. Moreover, the preventive or precautionary measures known as the 3M-Plus were not fully implemented yet.