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"This book, which is the translated version of a Swedish book, combines a general introduction of a variety of antibiotics with a more in-depth discussion of resistance. The focus on resistance in learning about antibiotics will help future scientists recognize the problem antibiotics resistance poses for medicinal and drug-related fields, and perhaps trigger more research and discoveries to fight antibiotic resistant strains. Current overviews of the topic are included, along with specific discussions on the individual mechanisms (betalactams, glycopeptides, aminoglycosides, etc) used in various antibacterial agents and explanations of how resistances to those develop. Methods for counteracting resistance development in bacteria are discussed as well."

"This book describes antibiotic resistance amongst pathogenic bacteria. It starts with an overview of the erosion of the efficacy of antibiotics by resistance and the decrease in the rate of replacement of redundant compounds. The origins of antibiotic resistance are then described. It is proposed that there is a large bacterial resistome which is a collection of all resistance genes and their precursors in both pathogenic and non-pathogenic bacteria. Ongoing resistance surveillance programs are also discussed, together with the perspective of a clinical microbiologist. The book then turns to specific themes such as the most serious area of resistance in pathogens, namely in Gram-negative organisms. The role of combinations of antibiotics in combating resistance emergence is discussed, particularly in the tuberculosis field, and then the importance of non-multiplying and persistent bacteria which are phenotypically resistant to antibiotics and prolong the duration of therapy of antibiotics which leads to poor compliance and resistance emergence. The role of anti-microbial compounds in textiles is covered, with its potential to exacerbate the spread of resistance. Then, efflux pumps are discussed. The final chapter describes the compounds which are in late stage clinical development, illustrating the paucity of the antibiotic pipeline, especially for Gram-negative bacteria."

"Latar belakang: Resistensi antibiotik merupakan ancaman kesehatan global. Tingginya tingkat reproduksi mikroorganisme dan kemampuan tekanan selektif yang kuat dari mikroorganisme menghadapi antibiotik pilihan merupakan permasalahan penggunaan antibiotik saat ini. Salah satu cara agar dapat menguatkan pemahaman dan ketaatan staf medis adalah melalui edukasi. Pemanfaatan teknologi seperti e-learning merupakan salah satu cara untuk meningkatkan tingkat pengetahuan dan ketepatan penggunaan antibiotik.Metode: Penelitian intervensi ini melibatkan seluruh DPJP dan PPDS Sp1 Ilmu Kesehatan Anak yang berstatus aktif di FKUI RSCM. Intervensi e-learning dilakukan terhadap DPJP dan PPDS dengan topik Antimicrobial Stewardship (AMS) via website EMAS UI kemudian dinilai tingkat pengetahuan pra- dan pasca-intervensi. Penggunaan antibiotik satu bulan pra- dan pasca-intervensi dinilai dengan alur Gyssens untuk menilai ketepatan penggunaan antibiotik.Hasil: Total penggunaan antibiotik pra- dan pasca-intervensi berturut-turut adalah 248 dan 229 antibiotik. Sebanyak 135 (54,4%) penggunaan antibiotik pra-intervensi dan 170 (72,24%) penggunaan antibiotik pasca-intervensi dinilai tepat. Analisis bivariat terhadap ketepatan penggunaan antibiotik menunjukkan terdapat hubungan bermakna pra- dan pasca-intervensi (OR= 0,537, IK 95% 0,363-0,795; p< 0,002). Sebanyak 42 dari total 56 DPJP anak dan 119 dari total 123 PPDS Sp1 Ilmu Kesehatan Anak mengikuti intervensi e-learning. Analisis bivariat menunjukan terdapat hubungan bermakna terhadap tingkat pengetahuan DPJP pra- dan pasca-intervensi (1 vs 32; p<0,001) dan PPDS pra- dan pasca-intervensi (10 vs 66; p<0,001).Kesimpulan: Terdapat peningkatan signifikan tingkat ketepatan penggunaan antibiotik pada pasien anak di ruang perawatan RSCM dan tingkat pengetahuan ketepatan pemberian antibiotik pada DPJP dan PPDS setelah dilakukan intervensi edukasi melalui metode e-learning.

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Backgorund: Antibiotic resistance is a global health threat. The high rate of reproduction of microorganisms and the strong selective pressure ability of microorganisms against antibiotics are the problems of the current use of antibiotics. Education is a way to strengthen the understanding and obedience of medical staff. Utilization of technology such as e-learning can be used to increase the level of knowledge and the effectiveness of using antibiotics.

Method: This intervention study involved all active pediatric staff and pediatric residents from the Department of Child Health in FMUI-CMH. Staff and residents underwent intervention through e-learning on the topic of Antimicrobial Stewardship (AMS) via the EMAS UI website, and then the level of their pre- and post-intervention knowledge was assessed. The use of antibiotics one month pre- and post-intervention was assessed by Gyssen's flowchart to assess the appropriateness of the antibiotics usage.

Result: A total of 135 (54.4%) uses of pre-intervention antibiotics and 170 (72.24%) uses of post-intervention antibiotics were considered appropriate. Bivariate analysis of the appropriate use of antibiotics showed that there was a significant relationship pre- and post-intervention (135 vs. 170, 95% CI 0.363-0.795; p 0.002). Forty two out of 56 staff and 119 out of 123 residents participate in e-learning. Bivariate analysis showed that there was a significant relationship between the level of knowledge of pre- and post-intervention in pediatric staff (1 vs. 32; p 0.001) and pre- and post-intervention pediatric residents (10 vs. 66; p 0.001).

Conclusion: There was a significant increase in the appropriateness level of using antibiotics in pediatric patients at CMH and the level of knowledge about the appropriateness of giving antibiotics to staff and residents after educational interventions were carried out through the e-learning."

"Latar Belakang : Meropenem, salah satu antibiotik yang paling efektif terhadap bakteri gram negatif dan bakteri gram positif, dianggap sebagai pengobatan terakhir yang paling dapat diandalkan untuk infeksi bakteri. Penyebaran yang cepat dari resistensi meropenem, terutama diantara bakteri gram negatif, merupakan masalah kesehatan yang sangat penting. Berbagai faktor diketahui berhubungan dengan kejadian resistensi meropenem terhadap bakteri gram negatif, namun penelitian yang dilakukan pada pasien infeksi intra abdomen masih terbatas. Tujuan : Mengetahui faktor-faktor yang berhubungan dengan resistensi antibiotik meropenem terhadap bakteri gram negatif pada pasien infeksi intra-abdomen di RSCM tahun 2013-2017. Metode : Penelitian desain cross sectional dengan mengambil data dari rekam medis pasien infeksi intra abdomen pada rentang waktu tahun 2013-2017 sebanyak keseluruhan populasi terjangkau. Hasil : Tidak terdapat perbedaan bermakna secara statistik dari faktor-faktor yaitu, usia, jenis kelamin, penyakit yang menyertai, riwayat antibiotik, jumlah leukosit dan jumlah albumin yang berhubungan dengan resistensi meropenem terhadap bakteri gram negatif. Kesimpulan : Usia, jenis kelamin, penyakit yang menyertai, riwayat antibiotik, jumlah leukosit dan jumlah albumin bukan merupakan faktor yang berhubungan dengan resistensi meropenem terhadap bakteri gram negatif pada pasien infeksi intra abdomen. Penelitian lebih lanjut dibutuhkan untuk mengetahui pengaruh faktor-faktor lain yang berhubungan dengan resistensi meropenem terhadap bakteri gram negatif pada pasien infeksi intra abdomen.

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Background : Meropenem, one of the most effective antibiotics against gram-negative bacteria and gram-positive bacteria, is considered to be the most reliable last treatment for bacterial infections. The rapid spread of meropenem resistance, especially among gram negative bacteria, is a very important health problem. Various factors are known to be associated with the incidence of meropenem resistance to gram-negative bacteria, but studies conducted on patients with intra-abdominal infections are still limited.

Objectives : To determine the factors associated with meropenem resistance against gram-negative bacteria in patients with intra-abdominal infections at Cipto Mangunkusumo Hospital in the year of 2013-2017.

Methods : A cross sectional design study by taking data from medical records of intra-abdominal infection patients in the period of 2013-2017 as much as the entire affordable population.

Results : There were no statistically significant differences in factors, namely age, sex, accompanying disease, history of antibiotics, number of leucocyte and amount of albumin associated with meropenem resistance against gram-negative bacteria.

Conclusion : Age, sex, accompanying disease, history of antibiotics, number of leucocytes and amount of albumin are not factors associated with meropenem resistance against gram-negative bacteria in patients with intra-abdominal infections. Further research is needed to determine the effect of other factors related to meropenem resistance against gram-negative bacteria in patients with intra-abdominal infections. "

"The book starts with four chapters in which the potential, advantages, and phylogeny of enzybiotics are reviewed. Then, the new ways of controlling infections by Gramnegative bacteria and an updated view of bacteriophage holins are presented. After a review of antistaphylococcal lytic enzymes, the book goes on to discuss membrane targeted enzybiotics, as well as the design of phage cocktails for current therapy. Finally, the last two chapters deal respectively with the novel methods to identify new enzybiotics and the use of modified phages to induce suicide in bacteria.Enzybiotics is a promising way of fighting bacterial or fungal infectious diseases by using viruses or viral-derived lysins. Drawing from the fields of medicinal chemistry, microbiology, genetics, and biochemistry, this book presents the state of the science in enzybiotics research, fully exploring its emerging therapeutic applications.The book begins with four chapters that review the potential applications, possible advantages, and phylogeny of enzybiotics. Next, the book explores :- A new approach to controlling infections using Gram-negative bacteria- Bacteriophage holins and their membrane-disrupting activity- Anti-staphylococcal lytic enzymes- Membrane-targeted enzybiotics- Design of phage cocktails for therapy from a host-range point of view- Novel methods to identify new enzybiotics- Genetically modified phages that deliver suicidal genes to target bacteriaThe authors, all active enzybiotics researchers, offer a variety of perspectives, the benefit of their own hands-on investigations, as well as a thorough review and analysis of the current literature.As more and more bacteria become resistant to antibiotics, the development of new disease-fighting agents has become essential. This book demonstrates the full potential of the emerging field of enzybiotics to control infectious diseases. Moreover, it will serve as a springboard for new research and the development of new therapeutics."

"Provinsi DKI Jakarta umumnya mengandalkan tangki septik di perumahan dan IPAL permukiman di kawasan tertentu sebagai tempat pembuangan tinja setempat serta membuang cairan efluennya ke saluran drainase, tetapi penelitian mengenai kinerja penyisihan unsur AMR-nya masih minim. IPAL permukiman sebagai salah satu sistem pengolahan tinja setempat menciptakan kondisi yang kondusif bagi terjadinya akuisisi resistensi antarinang via transfer gen horizontal (HGT) berdasarkan kelimpahan nutrisi, kelimpahan mobile genetic elements (MGE) yang memfasilitasi HGT, proses pengolahan, kandungan logam berat sebagai tekanan selektif, dan variabel lain-lain. Dengan demikian, penelitian ini dilakukan untuk menganalisis prevalensi ARG dan MGE dengan metode High-Throughput Quantitative Polymerase Chain Reaction (HT-qPCR), tingkat reduksi atau peningkatan ARG dan MGE, serta hubungan antara logam berat dan MGE dengan ARG di IPAL permukiman. Sebanyak 8 dari 65 gen target masih terdeteksi di semua sampel unit final (n = 8). Salah satunya adalah crAss56 yang mengindikasikan bahwa efluen cairan IPAL permukiman menjadi potensial sumber diseminasi AMR di hilir. IPAL permukiman tidak menunjukkan kemampuan reduksi kelimpahan absolut gen 16S rRNA, MGE, ARG yang konsisten, bahkan salah satunya (ST4) mengamplifikasi semua gen-gen tersebut. Terlihat pola kelimpahan ARG berbeda antara IPAL permukiman terindikasi terbengkalai dengan yang beroperasional yang menyiratkan mekanisme pengolahan tertentu, seperti pengolahan biologis (aerobik, anaerobik, kombinasi) dan klorinasi, dapat berkontribusi dalam proliferasi ARG. Analisis korelasi Spearman menunjukkan korelasi signifikan secara statistik (p-value < 0.05) dengan arah positif antara mangan (Mn) vs. ARG (qacE∆1_3 > aph3-ib > ereA), seng (Zn) vs. ARG (aph3-ib > vanA > ereA > blaSHV11 > intl3 > qnrS2), serta MGE (intl3) vs. ARG (ereA > vanA > aph3-ib > blaSHV11 > qacE∆1_3 > qnrS2). Maka, korelasi tersebut menandakan intl3 memiliki potensial tinggi sebagai fasilitator HGT. Logam berat juga mungkin menginduksi HGT dan/atau menyeleksi dengan antibiotik secara bersamaan terhadap ARB. Maka, penemuan penelitian ini menyorotkan pentingnya diadakannya pemantauan AMR di berbagai sistem air limbah, khususnya black water.

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The DKI Jakarta Province generally relies on septic tanks in residential areas and tenement wastewater treatment plants in certain areas as on-site feces disposal sites along with discharging their effluent water into drainage channels, but research on their AMR element removal performance is still limited. Tenement WWTPs as one of the on-site feces treatment systems create conditions that are conducive to the acquisition of resistance between hosts via horizontal gene transfer (HGT) based on the abundance of nutrients, the abundance of mobile genetic elements (MGE) which facilitate HGT, treatment processes, heavy metal content as selective pressure, and other variables. Thus, this research was conducted to analyze the prevalence of ARG and MGE using the High-Throughput Quantitative Polymerase Chain Reaction (HT-qPCR) method, the level of reduction or increase in ARG and MGE, as well as the relationship between heavy metals and MGE and ARG in tenement WWTPs. A total of 8 of the 65 target genes were still detected in all final unit samples (n = 8). One of them was crAss56 which indicated that tenement WWTP effluent water is a potential source of downstream AMR dissemination. Tenement WWTPs did not show a consistent ability to reduce the absolute abundance of 16S rRNA, MGE, ARG genes, in fact one of them (ST4) amplified all of these genes. It can be seen that the pattern of ARG abundance is different between tenement WWTP indicated to be abandoned and those that are operational, which implies that certain treatment mechanisms, such as biological treatment (aerobic, anaerobic, combined) and chlorination, can contribute to the proliferation of ARGs. Spearman correlation analysis showed a statistically significant correlation (p-value < 0.05) in the positive direction between manganese (Mn) vs. ARGs (qacE∆1_3 > aph3-ib > ereA), zinc (Zn) vs. ARGs (aph3-ib > vanA > ereA > blaSHV11 > intl3 > qnrS2), as well as MGEs (intl3) vs. ARGs (ereA > vanA > aph3-ib > blaSHV11 > qacE∆1_3 > qnrS2). Therefore, this correlation indicates that intl3 has high potential as a facilitator of HGT. Heavy metals may also induce HGT and/or co-select against ARBs with antibiotics. Thus, the findings of this study highlight the importance of monitoring AMR in various wastewater systems, especially black water."

"Interactions of yeasts, moulds, and antifungal agents : how to detect resistance covers the available antifungal agents, how to perform in vitro testing and how those results should be interpreted for the most common fungal pathogens."

"Penyebaran mikroba yang resisten terhadap pengobatan merupakan tantangan kesehatan masyarakat yang menyeluruh, yang akan menurunkan efektivitas obat dan mengakibatkan tingginya angka kesakitan dan kematian serta bertambahnya biaya pengobatan. Pengawasan resistensi obat antimikrobial melalui laporan data tentang pola resistensi mikroba terhadap suatu antimikroba akan berguna untuk mencegah timbulnya resistensi. Pada studi ini akan dilaporkan tentang pola resistensi mikroba terhadap ceftriaxone dalam 4 tahun terakhir. Data yang dilaporkan ini berasal dari spesimen yang diperiksa di Laboratorium Mikrobiologi Klinik, Departemen Mikrobiologi FKUI dari tahun 2002 sampai dengan 2005. Spesies mikroba ditentukan melalui kultur dan uji identifikasi. Disc Diffussion Methods digunakan untuk uji sensitivitas ceftriaxone terhadap 14 bakteri Gram-negatif dan 7 bakteri Gram-positif. Hasilnya memperlihatkan, walaupun angka resistensi mikroba terhadap ceftriaxone meningkat dari tahun 2002 sampai 2005, tetapi secara umum masih kurang dari 50%. Angka resistensi yang rendah (< 3%) terlihat untuk Salmonella typhi, Salmonella paratyphi A, Shigella flexneri, Serratia marcescens, dan Streptococcus pneumoniae. Hasil ini dapat digunakan untuk menyusun pedoman penggunaan ceftriaxone di Indonesia.

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AbstractThe spread of drug resistant microbes is a global public health challenge which impairs the efficacy of antimicrobial agents and causes substantial increase in morbidity and mortality rates, including healthcare-associated costs. Monitoring of antimicrobial drug resistance from documented microbial epidemiology & resistance rate is useful in preventing the emergence of resistance. This study reports on the pattern of bacterial resistance against ceftriaxone in the past 4 years. The data were obtained from specimens examined in the Clinical Microbiology Laboratory, Department of Microbiology Faculty of Medicine, University of Indonesia from 2002 to 2005. Microbial species were determined from culture and identification tests. Disc diffusion method was used for sensitivity testing of ceftriaxone to 14 Gram-negative and 7 Gram-positive bacteria. Although resistance rates were increased from 2002 to 2005, resistance rates of ceftriaxone were found to be less than 50%. Low resistance rates (< 3%) were observed for Salmonella typhi, Salmonella paratyphi A, Shigella flexneri, Serratia marcescens, and Streptococcus pneumoniae. These results could be useful in developing guidelines on the use of ceftriaxone in Indonesia. "

"The first book was on "Theory and practice" of antibiotic stewardship in its broadest sense -the how to do it and the do's and don’ts. The second, on "Controlling resistance" was very much on the relationships between use and resistance and beginning to home in on the hospital as the main generator of resistance, but mainly looking at it from a disease/clinical perspective. The last 3 chapters on MRSA, ended where the 3rd book will take off. "Controlling HAI " will concentrate on specific MDR organisms highlighting their roles in the current pandemic of HAI and emphasizing that the big issue is not so much infection control but antibiotic control, in the same way that antibiotic over-reliance/ over-use has caused the problem in the first place. Up 'till now the emphasis for controlling MRSA, C diff and all the other MDROs has very much been on IC, which clearly isn't working. This book will gather all the evidence for the increasingly popular view that much more must be done in the area of antibiotic policies/ stewardship, especially when we are in danger of a "post antibiotic" era, due to a real shortage of new agents in the pipeline."