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"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."

"Burn injury causes mechanical disruption to the skin,which allows environmental mocrobes to invade the deeper tissues....."

"Latar Belakang: Infeksi HAP oleh bakteri multidrug-resistant (MDR) menyebabkan mortalitas yang tinggi, lama rawat yang memanjang dan biaya perawatan yang tinggi. Karena itu perlu diketahui gambaran faktor risiko terjadinya infeksi bakteri MDR pada pasien HAP. Tujuan: Mengetahui gambaran faktor risiko terjadinya infeksi bakteri MDR pada pasien HAP di RSUPN Cipto Mangunkusumo. Metode: Penelitian dengan desain Kohort retrospektif menggunakan rekam medik pasien HAP yang memiliki hasil kultur sputum di RSUPN Cipto Mangunkusumo tahun 2015-2016 dengan metode total sampling. Pasien HAP diklasifikasikan menjadi terinfeksi bakteri MDR dan terinfeksi bakteri bukan MDR berdasarkan kategori resistensi isolat yang paling resisten pada sputum yang pertama kali didiagnosis MDR. Evaluasi gambaran faktor risiko dilakukan kepada semua subjek. Seluruh analisis dilakukan menggunakan program Microsoft Excel. Hasil: Proporsi HAP selama tahun 2015 dan 2016 berturut-turut adalah 6,12 dan 6,15/1000 admisi. Proporsi pasien HAP yang terinfeksi bakteri MDR selama tahun 2015 dan 2016 berturut-turut adalah 95% dan 82,1%. Gambaran proporsi faktor risiko infeksi bakteri MDR pada pasien HAP RSUPN Cipto Mangunkusumo tahun 2015-2016 mulai dari yang paling tinggi ke yang paling rendah berturut-turut adalah riwayat pemakaian antibiotik 90 hari sebelum diagnosis (100%), albumin <2.5 g/dL (100%), Charlson Comorbidity index≥3 (95,9%), usia> 60 (95,2%), lama rawat> 5 hari (92,5%), riwayat pemasangan NGT (92,1%), riwayat perawatan ICU/HCU sebelumnya (81,8%) dan penggunaan steroid setara prednison>10 mg/hari atau ekivalen selama>14 hari (28,6%). Simpulan: Proporsi infeksi bakteri MDR pada pasien HAP RSUPN Cipto Mangunkusumo tahun 2015 dan 2016 berturut-turut adalah 95% dan 82,1% dengan proporsi faktor risiko infeksi bakteri MDR yang paling tinggi adalah pada pasien dengan riwayat pemakaian antibiotik 90 hari sebelum diagnosis dan albumin <2.5 g/dL.>

Background: Multi-drug Resistant (MDR) Hospital-acquired Pneumonia (HAP) is associated with high mortality, prolonged hospital stay and high cost. Therefore, it is important to have description risk factors distribution for MDR HAP.

Aim: To have description of risk factors proportion for infection with MDR bacteria in HAP patients hospitalized in Cipto Mangunkusumo General Hospital.

Methods: A Cohort retrospective study with total sampling methode was conducted to collect medical records of HAP patients hospitalized in 2015-2016. Patients were classified as infected with MDR bacteria and infected with non-MDR bacteria based on the most resistant category of the sputum firstly diagnosed infected with multidrug-resistant bacteria. Risk factors evaluation were conducted to all subjects. All analysis was done using Microsoft Excel.

Results: Proportion of HAP during 2015 and 2016 respectively were 6.12 per 1000 admission and 6.15 per 1000 admission. Proportion of HAP patients infected with MDR bacteria in 2015 and 2016 were 95% and 82,1% respectively. MDR bacteria in 2015 and 2016 were 95% and 82,1% respectively. Description of risk factors proportion for infection with MDR bacteria from the highest to lowest respectively were prior antibiotic use 90 days before diagnosis (100%), albumin level <2.5 g/dL (100%), Charlson Comorbidity index≥3 (95,9%), age >60 years (95,2%), hospitalization>5 days (92,5%), NGT insertion (92,1%), prior ICU/HCU hospitalization in the last 90 days (81,8%) and prior steroid use equivalent to prednisone >10 mg/day for >14 days (28,6%).

Conclusion: Proportion of HAP patients infected with MDR bacteria in 2015 and 2016 were 95% and 82,1% respectively with the highest risk factors proportion for infection with multidrug-resistant bacteria were prior antibiotic use in 90 days before diagnosis and albumin <2,5 g/dL."

"The “always on-hand” pocket guide to the treatment of infectious diseases.- The most important antibiotics and antimycotics :Spectrum – dosage – side-effects- Numerous tables sorted by substances, pathogens, indications- Administration of antibiotics during pregnancy, renal and hepatic insufficiency, dialysis- Including statements on the cost of therapyNumerous tips and troubleshooting guides on topics such as :- Potential mistakes- Therapy failures- Perioperative antibiotic prophylaxisAdjusted to European standards :Up-to-date substances, authorizations, resistances and trade names."

"ABSTRAKLatar belakang: Pneumonia komunitas merupakan penyakit yang sering terjadi dan berhubungan dengan angka kesakitan dan kematian yang tinggi. Perhimpunan Dokter Paru Indonesia (PDPI) mengeluarkan pedoman pemberian antibiotik penanganan pasien pneumonia komunitas di Indonesia untuk mengurangi angka kematian pasien pneumonia komunitas.Tujuan: untuk mengetahui angka kepatuhan penggunaan panduan antibiotik untuk pasien pneumonia komunitas yang di rawat inap berdasarkan panduan PDPI di RSUP Persahabatan serta pengaruhnya terhadap lama perawatan dan angka mortalitas pasien.Metode: Penelitian observasional kohort retrospektif di Rumah Sakit Umum Pusat Persahabatan. Data diambil dari data rekam medis pasien yang didiagnosis pneumonia komunitas, yang dirawat di ruang rawat inap Departemen Pulmonologi dan Ilmu Kedokteran Respirasi RSUP Persahabatan, periode Juli 2014 sampai dengan Juli 2016.Hasil: Sampel penelitian 107 subjek, dengan karateristik pasien laki-laki 70,1% dan perempuan 29,9%. Median usia 56 tahun dengan usia minimum 18 tahun dan usia maksimum 96 tahun. Angka kepatuhan dokter terhadap penggunaan antibiotik berdasarkan pedoman penatalaksanaan pneumonia PDPI pada pasien pneumonia komunitas yang dirawat inap di RSUP Persahabatan sebesar 70,1%. Angka mortalitas pasien pneumonia komunitas berhubungan secara bermakna dengan kesesuaian pemberian antibiotik dengan pedoman PDPI dan derajat risiko PSI dengan nilai OR berturut-turut 2,93 (95%IK1,23-6,94) dan OR 3.02 (95%IK 1.25-7.29). Kesimpulan: Angka kepatuhan penggunaan antibiotik angka kepatuhan penggunaan panduan antibiotik untuk pasien pneumonia komunitas berdasarkan panduan PDPI berhubungan dengan angka mortalitas pasien.

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ABSTRACT<>br>Background: Community acquired pneumonia (CAP) is a common disease and is associated with high morbidity and mortality. Indonesian Society of Respirology has been recommended empiric antibiotic guidelines for patients with community-acquired pneumonia in 2014. These guidelines are designed to reduce the mortality rate of CAP patients. Objective: to determine the compliance rate of antibiotic guidance for inpatient community pneumonia patients based on PDPI antibiotic guidelines in Persahabatan Hospital and its effect on the length of stay and mortality rate CAP patients. Method: This is a retrospective cohort observational study inPersahabatan Hospital. Data were collected from medical records of patients diagnosed with CAP, who were admitted to the Department of Pulmonology and Respiratory Medicine during July 2014 to July 2016. Results: The sample was 107 subjects. Proportion male and female were 70.1% and 29.9%. The median age was 56 years old with a minimum age was 18 years and a maximum age was 96 years. Doctors' compliance rates on PDPI's guidelines for the management CAP patients was 70.1%. The mortality rate of CAP patients was significantly associated with the national guidelines-concordant empiric antibiotic therapy and the class risk of PSI with OR 2.93 (95% IK1,23-6,94) and OR 3.02 (95% IK 1.25-7.29) reversely. "

"Community acquired pneumonia (CAP) oleh patogen resisten obat (PRO) memiliki tingkat keparahan yang tinggi. CAP akibat PRO memerlukan terapi antibiotik spektrum luas, skor Drugs Resistance in Pneumonia (DRIP) mampu memprediksi kasus tersebut. Penggunaan skor DRIP dapat mencegah kegagalan terapi antibiotik empirik dan mempersingkat lama rawatan, untuk itu diperlukan validasi. Penelitian ini merupakan studi Cohort Retrospektif pada pasien CAP yang dirawat inap selama periode Januari 2019 hingga Juni 2020. Data diambil dari rekam medis, kegagalan antibiotik bila terdapat kematian, pindah rawat ICU dan eskalasi antibiotik. Performa skor DRIP dianalisis dengan menentukan nilai kalibrasi dan diskriminasi, uji Hosmer-Lemeshow dan Area Under Curve (AUC). Diperoleh 480 pasien yang telah memenuhi kriteria. Terdapat 331 pasien (69%) dengan skor DRIP <4 dan 149 pasien (31%) dengan skor DRIP ≥4, dengan jumlah kegagalan antibiotik sebesar 283 pasien (59%), 174 pasien (61,4%) skor DRIP <4 dan 109 pasien (38,5%) skor DRIP ≥4. Kalibrasi DRIP menggunakan uji Hosmer-Lemeshow diperoleh p-value = 0,667 (p>0,05), diskriminasi AUC pada kurva ROC diperoleh 0,651 (IK 95%; 0,601-0,700). Skor DRIP menunjukkan performa yang cukup baik dalam memprediksi kegagalan antibiotic empiric pada pasien CAP yang terinfeksi PRO. Skor DRIP tidak berhubungan dengan lama rawatan di Rumah Sakit.

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Community-acquired pneumonia (CAP) caused by drug resistant pathogens (DRP) has a high level of severity. The incidence of CAP due to DRP requires broad spectrum antibiotic therapy, the Drugs Resistance in Pneumonia (DRIP) score is able to predict these cases. The use of the DRIP score can prevent antibiotic failure and minimize length of hospitalization, but validation is needed . This research is a retrospective cohort study in CAP patients who were hospitalized during the period January 2019 to June 2020. Data were taken from patient medical records, and failure of empiric antibiotics occurs when one of this criteria are found: patient mortality, ICU transfer and escalation of antibiotics as well as length of stay. Furthermore, the performance of the DRIP score was analyzed by determining the calibration and discrimination, using the Hosmer-Lemeshow test and the Area Under Curve (AUC). There were 480 patients who met the criteria. There were 331 patients (69%) with a DRIP score <4 and 149 patients (31%) with a DRIP score ≥4, with a total of 283 patients (59%) of antibiotic failures which were detailed in 174 patients (61.4%) with a DRIP score <4 and 109 patients (38.5%) DRIP score ≥4. DRIP calibration using the Hosmer-Lemeshow test obtained p-value=0.667 (p>0.05), AUC observations on the ROC curve obtained 0.651 (95% CI; 0.601-0.700). The DRIP score showed good performance in predicting failure of empiric antibiotics in infected CAP patients. PRO. The DRIP score is not related to the length of stay in the hospital."

"Latar Belakang : Data World Health Organization (WHO) tahun 2019 menunjukkan infeksi saluran napas bawah menjadi penyebab kematian keempat di dunia dengan angka kematian 6.1%. Pneumonia merupakan salah satu infeksi saluran napas bawah yang disebabkan oleh mikroorganisme. Jenis pneumonia yang banyak di masyarakat adalah pneumonia komunitas. Tingginya angka kejadian penumonia komunitas yang disebabkan oleh bakteri menyebabkan meningkatnya kebutuhan antibiotik sebagai pengobatan. Pemberian antibiotik dapat berupa empirical antibiotic treatment (EAT) atau pathogen-directed treatment (PDT). Penelitian ini bertujuan untuk melihat keberhasilan pengobatan pasien pneumonia komunitas rawat inap dengan EAT atau PDT.Metode : Penelitian ini merupakan penelitian observasional menggunakan desain kohort retrospektif dengan pengambilan data rekam medis di RSUP Persahabatan. Subjek peneltian ini adalah pasien pneumonia komunitas rawat inap periode 1 Januari 2021 hingga 31 Desember 2022. Pemilihan sampel menggunakan metode total sampling.Hasil : Subjek penelitian terdiri dari 220 pasien EAT dan 62 pasien PDT. Mayoritas bakteri yang ditemukan pada biakan sputum adalah gram negatif (82%) dengan jenis terbanyak adalah Klebsiella pneumonia (29.3%), Acinetobacter baumanii (16.7%) dan Eschericia coli (15.3%). Antibiotik terbanyak pada EAT adalah levofloksasin (87.3%) dan pada PDT adalah meropenem (34%). Keberhasilan pengobatan pasien dengan EAT sebesar 74.5% yang dipengaruhi oleh skor PSI (OR 5.318 (IK 95% 2.046 - 13.820, p=<.001), lama perawatan (OR 1.949 (IK 95% 1.043 - 3.641, p=0.035) dan riwayat penggunaan ventilator (OR 29.364 (IK 95% 12.80 - 67.34, p= <.001). Keberhasilan pengobatan pasien dengan PDT sebesar 46.8% yang dipengaruhi oleh riwayat penggunaan ventilator (OR 9.615 (IK 95% 2.712-34.08, p=<.001) dan hasil biakan sputum Acinetobacter baumanii (OR 2.608 (IK 95% 1.089 - 6.246), p = 0.028).Kesimpulan : Keberhasilan pengobatan pasien dengan EAT sebesar 74.5% dipengaruhi oleh skor PSI, lama perawatan dan riwayat penggunaan ventilator. Keberhasilan pengobatan pasien dengan PDT sebesar 46.8% dipengaruhi oleh riwayat penggunaan ventilator dan biakan sputum Acinetobacter baumanii.

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Background: Data from the World Health Organization (WHO) in 2019 shows that lower respiratory tract infections are the fourth cause of death in the world with a mortality rate of 6.1%. Pneumonia is a lower respiratory tract infection caused by microorganisms. The type of pneumonia that is common is community-acquired pneumonia. The high incidence of community-acquired pneumonia caused by bacteria causes an increased need for antibiotics as treatment. Antibiotics can be given as empirical antibiotic treatment (EAT) or pathogen-directed treatment (PDT). This study aims to see the success rate of inpatient community-acquired pneumonia with EAT or PDT.

Methods : This study was an observational study using a retrospective cohort design by collecting medical record data at Persahabatan Hospital. The subjects of this study were inpatient community-acquired pneumonia patients for the period January 1, 2021 to December 31, 2022. The total sampling method was selected for the study.

Results : The subjects in this study consisted of 220 EAT patients and 62 PDT patients. The majority of bacteria found were gram-negative (82%) with the most common types were Klebsiella pneumonia (29.3%), Acinetobacter baumannii (16.7%) and Escherichia coli (15.3%). The most antibiotics in EAT was levofloxacin (87.3%) and in PDT was meropenem (34%). The success rate of patients with EAT was 74.5%, which was affected by PSI score (OR 5.318 (IK 95% 2.046 - 13.820, p=<.001), length of stay (OR 1.949 (IK 95% 1.043 - 3.641, p=0.035) and history of ventilator use (OR 29.364 (IK 95% 12.80 - 67.34, p= <.001). The success rate of PDT was 46.8%, influenced by the history of ventilator use (OR 9.615 (IK 95% 2.712-34.08, p=<.001) and Acinetobacter baumanii in sputum culture (OR 2.608 (IK 95% 1.089 - 6.246), p = 0.028).

Conclusions : The success rate of patients with EAT was 74.5%, influenced by PSI score, length of stay and history of ventilator use while those with PDT were 46.8%, influenced by the history of ventilator use and Acinetobacter baumanii in sputum culture.

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"Thoroughly revised and updated for its Fourth Edition, a comprehensive reference on hospital epidemiology and infection control. Written by over 150 leading experts, this new edition examines every type of hospital-acquired (nosocomial) infection and addresses every issue relating to surveillance, prevention, and control of these infections in patients and in healthcare workers. This new edition features new or significantly increased coverage of emerging infectious diseases, avian influenza, governmental regulation of infection control and payment practices related to hospital-acquired infections, molecular epidemiology, the increasing prevalence of community-acquired MRSA in healthcare facilities, system-wide infection control provisions for healthcare systems, hospital infection control issues following natural disasters, and antimicrobial stewardship in reducing the development of antimicrobial-resistant organisms."

"Hospital Acquired Pneumonia (HAP) merupakan infeksi nosokomial yang sering dijumpai pasien yang dirawat di rumah sakit. Mortalitas akibat HAP sangat tinggi, bahkan dapat mencapai 50%, namun belum ada data mengenai hal tersebut di Indonesia, serta belum diketahuinya faktor-faktor prediktor mortalitas. Hal ini penting untuk meningkatkan tata kelola HAP dalam menurunkan angka mortalitas. Tujuan penelitian ini adalah untuk mengidentifikasi faktor-faktor prediksi kematian pada pasien HAP di ruang rawat Penyakit Dalam RSCM dan mengetahui proporsi mortalitas pada pasien tersebut. Penelitian ini merupakan studi kohort retrospektif. Data diambil dari rekam medik mulai awal tahun 2006 sampai akhir tahun 2012. Variabel-variabel yang diduga sebagai faktor prediksi mortalitas pasien HAP adalah usia > 60 tahun, penurunan kesadaran, renjatan, sepsis, albuminemia < 3g/dL, imunokompromais, HAP awitan lambat. Analisis bivariat dilakukan dengan menggunakan uji perbedaan dua kelompok kategorik (Uji Chi-square atau Fisher) serta analisis multivariat dilakukan dengan menggunakan regresi logistik ganda. Selama penelitian kami mendapatkan 204 subjek dengan HAP pada kurun waktu yang telah ditentukan, dengan proporsi mortalitas sebesar 44,1%. Sebanyak 109 subjek (53,4%) adalah pria dengan rentang usia 18 sampai 88 tahun (median 51 tahun). Komorbidatas tersering yang didapatkan adalah hipertensi (17,22%). Dari hasil kultur sputum kami dapatkan kuman terbanyak adalah Klebsiella pneumonia yaitu 36 dari 61 isolat (59%). Analisis multivariat menunjukkan faktor yang bermakna secara statistik adalah penurunan kesadaran (OR 7,86 IK95% 3,363-18,36), renjatan (OR 3,80 IK95% 1,342-10,742), imunokompromais (OR 3,36 IK95% 1,738-6,483), serta hipoalbuminemia (OR 2,781 IK95% 1,298-5,958). Faktor-faktor prediksi mortalitas HAP adalah penurunan kesadaran, renjatan, imunokompromais dan hipoalbuminemia. Proporsi mortalitas HAP sebesar 44,1%.

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Mortality and morbidity due to Hospital Acquired Pneumonia (HAP) are high. Mortality rate reaches up to 50%, but currently there is no local Indonesian data about the issue. Predictors of mortality are also not yet identified. These are important to improve the management of HAP in order to decrease mortality and morbidity.

The aims of this study were to identify factors that can be used to predict mortality in HAP patients in Internal Medicine Ward of Cipto Mangunkusumo Hospital (CMH) and to recognize the mortality proportion of those patients. This was a retrospective cohort study. Subject’s data were taken from medical records from January 2006 to December 2012. Independent variables consisted of age over 60, decrease of consciousness, shock, sepsis, hypoalbuminemia less than 3 g/dL, immune-compromised, late onset HAP.

For bivariate analysis, we used chi-square test or Fisher test and for multivariate analysis the logistic regression test. There was 204 patients included, all complete data and no drop-out. The mortality proportion of HAP of our cohort was 44.1%. Patients were mostly men, 109 subjects (53.4%) with age ranging between 18 to 88 years old (median age 51 years). The most common co morbidity was hypertension (17.22%). The most frequent microorganism isolated from sputum culture was Klebsiella pneumonia, 36 out of 61 isolates (59%).

Bivariate analysis revealed that decrease of consciousness, shock, sepsis, immune-compromised and hypoalbuminemia as statistically significant predictors of mortality. Multivariate analysis showed statistically significant predictors of mortality were decrease of consciousness (OR 7.86 95%CI 3.363-18.36), shock (OR 3.80 95%CI 1.342-10.742), immune-compromised (OR 3.36 95%CI 1.738-6.483) and hypoalbuminemia (95%OR 2.78 95%CI 1.298-5.958).Significant predictors of HAP mortality were decrease of consciousness, shock, immune-compromised and hypoalbuminemia. Mortality of HAP was 44.1%."