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"ABSTRAK Latar belakangKematian akibat sepsis dan syok septik pada pasien rawatan Intensive Care Unit (ICU) yaitu 20-30%. Pemberian antibiotik empirik yang tepat merupakan salah satu langkah awal yang sangat penting. Amikasin merupakan salah satu antibiotik terpilih untuk tata laksana sepsis di ICU RSUPN dr. Cipto Mangunkusumo (RSCM). Saat ini belum pernah dilakukan penelitian mengenai ketercapaian kadar terapi amikasin dengan menggunakan dosis standar amikasin pada pasien sepsis dewasa di ICU RSCM, sehingga studi ini menjadi penelitian pertama di Indonesia.Penelitian ini bertujuan untuk mengetahui ketercapaian kadar amikasin optimal pada pasien ICU RSCM.MetodeData dikumpulkan secara potong lintang melalui observasi terhadap hasil pemeriksaan kadar plasma amikasin, pengukuran minimum inhibitory concentration (MIC) dan perhitungan rasio Cmax/MIC pada pasien sepsis di ICU RSCM periode Mei-September tahun 2015.Hasil penelitianProporsi pasien sepsis dengan kadar amikasin optimal ialah sebesar 57% (4/7). Kadar puncak amikasin yang dapat dicapai dengan dosis 1000 mg sekali sehari tanpa menghiraukan berat badan ialah median 86,4 (43,5-238) µg/mL. Pada penelitian ini ditemukan 87% pasien dengan kadar puncak amikasin di atas 64 µg/mL, meskipun amikasin 1000 mg tersebut lebih rendah dari dosis yang dianjurkan untuk sepsis (25 mg/kgBB). Sebagian besar (78,3 %) subyek pada kenyataannya menerima dosis 15-25 mg/kgBB, dengan pemberian 1000 mg amikasin tanpa memperhatikan berat badan. Bakteri yang banyak ditemukan dari hasil kultur pasien sepsis di ICU RSCM, yaitu K. pneumoniae, A. baumanii, P. aeruginosa dan E. coli. Rentang nilai MIC untuk patogen tersebut berturut-turut yaitu 0,75 - >256 µg/mL, 0,75 - >256 µg/mL, 1,5 - >256 µg/mL dan 0,75 - 16) µg/mL. Sebanyak 84% isolat K. pneumoniae masih sensitif terhadap amikasin, diikuti oleh 63% untuk A. baumanii, 47% P. aeruginosa dan 100% untuk E. coli.KesimpulanOptimalitas amikasin terhadap bakteri Gram negatif penyebab sepsis bergantung kadar puncak dan MIC bakteri. Kadar puncak plasma amikasin yang dicapai dengan dosis 1000 mg sekali sehari sangat bervariasi. Pemberian amikasin dengan dosis per kgBB dapat dipertimbangkan. Kepekaan beberapa bakteri Gram negatif terhadap amikasin mulai menurun dengan rentang MIC yang cukup lebar. Pengukuran ketercapaian kadar optimal dalam terapi definitif dapat dilakukan untuk meningkatkan keberhasilan terapi.ABSTRACT BackgroundThe mortality caused by sepsis and septic shock in the Intensive Care Unit (ICU) is 20-50%. The important first step to reduce this conditions is to give the right empirical antibiotics. Amikacin is one of the antibiotics of choice for the sepsis and septic shock in ICU of Cipto Mangunkusumo (CM) Hospital. Studies on the amikacin plasma level in adult patients being given amikacin in ICU RSCM has never been done.The objective of this study is to explore the plasma level of amikacin in septic patients in CM Hospital.MethodsThis was a cross sectional study. Data on plasma amikacin level, microbiological culture, measurement of minimum inhibitory concentration (MIC), and amikacin optimal level in septic patients admitted to ICU of RSCM during May-September 2015.ResultsThe proportion of septic patients that achieve amikacin optimal level was 57% (4/7). Peak amikacin level that can be reached with 1 gram per day dose was 86,4 (43,5-238) g/mL. Although amikacin was given less than recommended dose for sepsis (25 mg/body weight), 87% patients was found to have peak amikacin level > 64 µg/mL. Most (78.3%) of the patients received amikacin with dose range 15-25 mg/kgBW, in which patients was given 1000 mg of amikacin regardless of the body weight. The organisms commonly identified from the microbiological culture septic in patients in ICU of RSCM were K. pneumoniae, A. baumanii, P. aeruginosa, and E. coli. The MIC for these pathogen were 0.75 - >256 µg/mL, 0.75 - >256 µg/mL, 1.5 - >256 µg/mL and 0.75 ? 16 µg/mL, respectively. Most (84%) of K. pneumoniae isolates was still sensitive to amikacin, while 63% A. baumanii isolate, 47% of P. aeruginosa, and 100% of E. coli were sensitive to amikacin.ConclusionsAmikacin?s efficacy to eradicate Gram negative microorganism causing sepsis depend on peak level and MIC of the microorganism. By giving 1000 mg dose per day of amikacin, highly variable peak plasma concentration of the drug was observed. Therefore, amikacin dosing based on weight might be useful to reduce the wide variation. In this study, we found that sensitivity of some Gram negative pathogen are decreasing, with wide range of MIC. Evaluation of optimal level for definitive therapy might be useful to reach more successful treatment.;BackgroundThe mortality caused by sepsis and septic shock in the Intensive Care Unit (ICU) is 20-50%. The important first step to reduce this conditions is to give the right empirical antibiotics. Amikacin is one of the antibiotics of choice for the sepsis and septic shock in ICU of Cipto Mangunkusumo (CM) Hospital. Studies on the amikacin plasma level in adult patients being given amikacin in ICU RSCM has never been done.The objective of this study is to explore the plasma level of amikacin in septic patients in CM Hospital.MethodsThis was a cross sectional study. Data on plasma amikacin level, microbiological culture, measurement of minimum inhibitory concentration (MIC), and amikacin optimal level in septic patients admitted to ICU of RSCM during May-September 2015.ResultsThe proportion of septic patients that achieve amikacin optimal level was 57% (4/7). Peak amikacin level that can be reached with 1 gram per day dose was 86,4 (43,5-238) g/mL. Although amikacin was given less than recommended dose for sepsis (25 mg/body weight), 87% patients was found to have peak amikacin level > 64 µg/mL. Most (78.3%) of the patients received amikacin with dose range 15-25 mg/kgBW, in which patients was given 1000 mg of amikacin regardless of the body weight. The organisms commonly identified from the microbiological culture septic in patients in ICU of RSCM were K. pneumoniae, A. baumanii, P. aeruginosa, and E. coli. The MIC for these pathogen were 0.75 - >256 µg/mL, 0.75 - >256 µg/mL, 1.5 - >256 µg/mL and 0.75 ? 16 µg/mL, respectively. Most (84%) of K. pneumoniae isolates was still sensitive to amikacin, while 63% A. baumanii isolate, 47% of P. aeruginosa, and 100% of E. coli were sensitive to amikacin.ConclusionsAmikacin?s efficacy to eradicate Gram negative microorganism causing sepsis depend on peak level and MIC of the microorganism. By giving 1000 mg dose per day of amikacin, highly variable peak plasma concentration of the drug was observed. Therefore, amikacin dosing based on weight might be useful to reduce the wide variation. In this study, we found that sensitivity of some Gram negative pathogen are decreasing, with wide range of MIC. Evaluation of optimal level for definitive therapy might be useful to reach more successful treatment.;BackgroundThe mortality caused by sepsis and septic shock in the Intensive Care Unit (ICU) is 20-50%. The important first step to reduce this conditions is to give the right empirical antibiotics. Amikacin is one of the antibiotics of choice for the sepsis and septic shock in ICU of Cipto Mangunkusumo (CM) Hospital. Studies on the amikacin plasma level in adult patients being given amikacin in ICU RSCM has never been done.The objective of this study is to explore the plasma level of amikacin in septic patients in CM Hospital.MethodsThis was a cross sectional study. Data on plasma amikacin level, microbiological culture, measurement of minimum inhibitory concentration (MIC), and amikacin optimal level in septic patients admitted to ICU of RSCM during May-September 2015.ResultsThe proportion of septic patients that achieve amikacin optimal level was 57% (4/7). Peak amikacin level that can be reached with 1 gram per day dose was 86,4 (43,5-238) g/mL. Although amikacin was given less than recommended dose for sepsis (25 mg/body weight), 87% patients was found to have peak amikacin level > 64 µg/mL. Most (78.3%) of the patients received amikacin with dose range 15-25 mg/kgBW, in which patients was given 1000 mg of amikacin regardless of the body weight. The organisms commonly identified from the microbiological culture septic in patients in ICU of RSCM were K. pneumoniae, A. baumanii, P. aeruginosa, and E. coli. The MIC for these pathogen were 0.75 - >256 µg/mL, 0.75 - >256 µg/mL, 1.5 - >256 µg/mL and 0.75 ? 16 µg/mL, respectively. Most (84%) of K. pneumoniae isolates was still sensitive to amikacin, while 63% A. baumanii isolate, 47% of P. aeruginosa, and 100% of E. coli were sensitive to amikacin.ConclusionsAmikacin?s efficacy to eradicate Gram negative microorganism causing sepsis depend on peak level and MIC of the microorganism. By giving 1000 mg dose per day of amikacin, highly variable peak plasma concentration of the drug was observed. Therefore, amikacin dosing based on weight might be useful to reduce the wide variation. In this study, we found that sensitivity of some Gram negative pathogen are decreasing, with wide range of MIC. Evaluation of optimal level for definitive therapy might be useful to reach more successful treatment."

"Tujuan: Melakukan telaah sistematis untuk membandingkan terapi hidrokortison dan hidrokortison, asam askorbat, dan tiamin (HAT) sebagai ajuvan pada tingkat mortalitas pasien syok septik. Metode: Pencarian komprehensif dilakukan menggunakan empat pangkalan data (PubMed, EMBASE, Scopus, and Cochrane) menggunakan kata kunci spesifik hingga tanggal 18 Mei 2022. Semua studi yang dipublikasikan mengenai penggunaan terapi HAT pada pasien syok septik dikumpulkan dan ditelaah. Hasil: Dua studi uji acak terkendali, satu studi kontrol kasus, dan satu studi kohort yang melibatkan 635 pasien. Terapi HAT ditemukan tidak signifikan dalam menurunkan angka kematian di ICU (RR 0.89 95% CI [0.60 sampai 1.32], p=0.56), angka kematian di rumah sakit (RR 1.2 95% CI [0 ,90 sampai 1.59], p= 0,21), dan mortalitas 28 hari (RR 0,95, 95% CI [0,56 hingga 1,58], p=0,83) Kesimpulan: Tidak ditemukan perbedaan signifikan dalam mortalitas pada kelompok yang menggunakan HAT bila dibandingkan dengan terapi hidrokortison. Registrasi: ID pendaftaran PROSPERO untuk penelitian ini adalah CRD42022296055 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=296055).

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Objective: We systematically reviewed the comparison between hydrocortisone and hydrocortisone-ascorbic acid-thiamine combined therapy (HAT) as adjuvant in the mortality rate of septic shock patients. Method: Four databases (PubMed, EMBASE, Scopus, and Cochrane) are comprehensively searched using specific keywords up to 18th May 2022. All published studies on the use of HAT on septic shock patients were collected and reviewed Results: Two randomized controlled trials, one case control study and one cohort study enrolling 635 patients were included. HAT therapy was found to be not significant in reducing the ICU mortality rate (RR 0,89 95% CI [0,60 to 1,32], p=0,56), hospital mortality rate (RR 1.2 95% CI [0,90 to 1,59], p=0,21), and 28 days mortality (RR 0,95, 95% CI [0,56 to 1,58], p=0,83). Conclusion: No significant difference in mortality was found in the HAT group when compared with hydrocortisone therapy. Trial registration: PROSPERO registration ID for this study is CRD42022296055 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=296055)."

"This book is unique in approaching multiple organ dysfunction syndrome (MODS) from the perspective of its pathophysiological mechanism, and addressing aspects that are overlooked in most of the available literature. Eminent experts in the field from Europe and beyond offer new insights into risk stratification, severity assessment, and management of critically ill patients with sepsis. The principal focus is on recently developed concepts in infection management and in antibiotic use, bearing in mind that in these patients the pharmacokinetics of antibiotics are altered, affecting renal clearance and requiring dosage adjustments. The significance of the PIRO (predisposing factors, infection, response, organ dysfunction) model in the development of effective treatment strategies is emphasized. "

"Background: Amikacin is one of the antibiotics of choice for sepsis and septic shock. Pharmacokinetic of amikacin can be influenced by septic condition with subsequent effect on its pharmacodynamic. At Cipto Mangunkusumo Hospital (RSCM), Jakarta, adult patients in the ICU were given standard amikacin dose of 1 g/day, however the achievement of optimal plasma level had never been evaluated. This study aimed to evaluate whether the optimal plasma level of amikacin was achieved with the use of standard dose in septic conditions.Methods: all septic patients admitted to the intensive care unit of a national tertiary hospital receiving standard dose of 1g/day IV amikacin during May-September 2015 were included in this study. Information of minimum inhibitory concentration MIC was obtained from microbial culture. Cmax of amikacin was measured 30 minutes after administration and optimal level was calculated. Optimal amikacin level was considered achieved when Cmax/MIC ratio >8.Results: average Cmax achieved for all patients was 86.4 (43.5-238) µg/mL with 87% patients had Cmax of >64 µg/mL.MIC data were available for 7 of 23 patients. MICs for identified pathogens were 0.75 - >256 µg/mL (K. pneumonia), 0.75 - >256 µg/mL(A. baumanii), 1.5 - >256 µg/mL (P. aeruginosa)and 0.75 - 16 µg/mL(E. coli). Four out of seven patients achieved optimal amikacin level.Conclusion: despite high Cmax, only half of the patients achieved optimal amikacin level with highly variable Cmax. This study suggests that measurement of Cmax and MIC are important to optimize septic patients management."

"ABSTRAKLatar belakang: Sepsis merupakan masalah kesehatan penting yang dapat menyebabkan insidens kematian sampai 50% pada pasien dengan sepsis berat. Antibiotik aminoglikosidaterutama amikasin semakin banyak digunakan untuk mengobati infeksi kuman Gram negatif pada pasien sepsis di ICU, meskipun penggunaan obat tersebut pada dosisterapi dapat meningkatkan risiko kerusakan ginjal sekitar 10-25%. Pemantauan kadar lembah amikasin serta biomarker dini diperlukan untuk mencegah kerusakan ginjal pada pasien sepsis yang dirawat di ICU. Penelitian ini dilakukan untuk mengetahui hubungan kadar lembah amikasin pada pasien ICU dewasa yang dirawat di Rumah Sakit Cipto Mangunkusumo yang diberikan amikasin 1000 mg/hari denganpeningkatan kadar KIM-1 normalisasi dalam urin yang merupakan biomarker dini nefrotoksisitas.Metode:Penelitian ini merupakan penelitian pendahuluan yang dilakukan pada 12 pasien sepsis dewasa yang dirawat di ICU RSCM dan diberikan amikasin 1000 mg/hari pada bulan Mei-September 2015. Kadar lembah amikasin dosis ketiga dihubungkan dengan peningkatan kadar KIM-1 normalisasi yang diukur melalui urin 24 jam setelah pemberian amikasin dosis pertama/kedua dan dosis ketiga.Hasil:Dari 12 subyek penelitian, didapatkan 3 subyek penelitian dengan kadar lembah amikasin di atas 10 g/mL, sedangkan 9 subyek penelitian kadar lembahnya ada dalam batas aman (di bawah 10 g/mL). Delapan dari 12 subyek penelitian (66,7%) mengalami peningkatan kadar KIM-1 normalisasi dalam urin hari ketiga dibandingkan hari pertama. Tidak ada hubungan antara kadar lembah amikasin dengan peningkatan kadar KIM-1 normalisasi dalam urin (p=0,16; r=0,43).Kesimpulan:Pasien sepsis yang mendapat amikasin 1000 mg/hari di ICU RSCM selama 3 hari memperlihatkan kadar lembah amikasin plasma dalam batas aman untuk ginjal.

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ABSTRACT

Background: Sepsis is a common caused of mortality which may account for up to 50% death rate in patients with severe sepsis. Aminoglycoside antibiotics, especially amikacin, are the most commonly used antibiotics in the septic patients with Gram-negative bacterial infections, despite these drugs may induce nephrotoxicity in 10-25%

patients. Hence, it is essential to monitor amikacin trough plasma concentration and to detect nephrotoxicity as early as possible. The aim of this study is to find out the correlation between amikacin trough plasma concentration with normalized KIM-1 concentration in the urine as a sensitive and specific biomarker.

Methods:

This is a pilot study conducted in 12 septic patients treated with amikacin 1000 mg/day from May, 2015 to September, 2015. The correlation between amikacin

trough plasma concentrations measured at the third doses with the elevation of urine normalized KIM-1 concentrations measured at the first/second and the third doses were evaluated.

Results:

We observed 3 patients with amikacin trough plasma concentration above the safe level (>10 g/mL), while 9 patients had amikacin concentrations within the safe

plasma level (<10 g/mL). Furthermore, we observed 8 out of 12 patients with higher normalized KIM-1 concentrations measured at third doses compared to normalized KIM-1 concentrations measured at first/second doses. There was no correlation between amikacin trough concentration with elevated urine normalized KIM-1

concentration (p=0,16; r=0,43).

Conclusion:

Septic patients treated with amikacin 1000 mg/day hospitalized in ICU RSCM for 3 days have amikacin safe trough plasma concentration."

"Pengaruh obesitas terhadap morbiditas dan mortalitas pasien kritis masih kontroversial. Tingginya massa lemak pada pasien obesitas menyebabkan disregulasi sistem imun, peningkatan risiko kadiovaskular, gangguan penyembuhan luka, dan perubahan farmakokinetik antimikroba. Walau demikian, banyak studi menunjukkan pasien yang dirawat di ruang rawat intensif (intensive care unit - ICU) dengan obesitas memiliki kelangsungan hidup yang lebih tinggi dibandingkan dengan yang memiliki indeks massa tubuh (IMT) 18,5 – 24,9 kg/m2. Fenomena ini disebut paradoks obesitas. Tujuan penelitian ini adalah untuk melihat hubungan obesitas berdasarkan IMT dengan lama rawat dan kejadian infeksi nosokomial di ICU. Penelitian ini menggunakan desain kohort prospektif dengan subjek pasien kritis yang di rawat di ICU Dewasa RSUPN Dr. Cipto Mangunkusumo. Pasien dilakukan pemeriksaan antropometri kemudian IMT dihitung dan dikelompokan menjadi kelompok tidak obes dan obes berdasarkan kriteria IMT Asia-Pasifik. Pemantauan pasien dilakukan setiap hari untuk mengambil data lama rawat dan diagnosis infeksi nosokomial dari rekam medis. Dari 79 subjek, sebagian besar (65%) berjenis kelamin perempuan dengan median usia 46 tahun. Sebagian besar subjek masuk ICU pasca pembedahan (89%) dan skor qSOFA 1 (52%). Sebagian besar pasien (92%) keluar dari ICU untuk stepdown ke ruang rawat biasa dan sebanyak 8% pasien meninggal dunia. Sebanyak 5% dari seluruh subjek mengalami infeksi nosokomial berupa ventilator associated pneumonia (VAP). Tidak terdapat hubungan antara infeksi nosokomial dengan status gizi (OR (IK 95%): 1,03 (0,1-14,85)). Tidak ada perbedaan lama rawat di ICU antara pasien obesitas dibandingkan dengan pasien yang tidak obesitas (P = 0,663).Pengaruh obesitas terhadap morbiditas dan mortalitas pasien kritis masih kontroversial. Tingginya massa lemak pada pasien obesitas menyebabkan disregulasi sistem imun, peningkatan risiko kadiovaskular, gangguan penyembuhan luka, dan perubahan farmakokinetik antimikroba. Walau demikian, banyak studi menunjukkan pasien yang dirawat di ruang rawat intensif (intensive care unit - ICU) dengan obesitas memiliki kelangsungan hidup yang lebih tinggi dibandingkan dengan yang memiliki indeks massa tubuh (IMT) 18,5 – 24,9 kg/m2. Fenomena ini disebut paradoks obesitas. Tujuan penelitian ini adalah untuk melihat hubungan obesitas berdasarkan IMT dengan lama rawat dan kejadian infeksi nosokomial di ICU. Penelitian ini menggunakan desain kohort prospektif dengan subjek pasien kritis yang di rawat di ICU Dewasa RSUPN Dr. Cipto Mangunkusumo. Pasien dilakukan pemeriksaan antropometri kemudian IMT dihitung dan dikelompokan menjadi kelompok tidak obes dan obes berdasarkan kriteria IMT Asia-Pasifik. Pemantauan pasien dilakukan setiap hari untuk mengambil data lama rawat dan diagnosis infeksi nosokomial dari rekam medis. Dari 79 subjek, sebagian besar (65%) berjenis kelamin perempuan dengan median usia 46 tahun. Sebagian besar subjek masuk ICU pasca pembedahan (89%) dan skor qSOFA 1 (52%). Sebagian besar pasien (92%) keluar dari ICU untuk stepdown ke ruang rawat biasa dan sebanyak 8% pasien meninggal dunia. Sebanyak 5% dari seluruh subjek mengalami infeksi nosokomial berupa ventilator associated pneumonia (VAP). Tidak terdapat hubungan antara infeksi nosokomial dengan status gizi (OR (IK 95%): 1,03 (0,1-14,85)). Tidak ada perbedaan lama rawat di ICU antara pasien obesitas dibandingkan dengan pasien yang tidak obesitas (P = 0,663).Pengaruh obesitas terhadap morbiditas dan mortalitas pasien kritis masih kontroversial. Tingginya massa lemak pada pasien obesitas menyebabkan disregulasi sistem imun, peningkatan risiko kadiovaskular, gangguan penyembuhan luka, dan perubahan farmakokinetik antimikroba. Walau demikian, banyak studi menunjukkan pasien yang dirawat di ruang rawat intensif (intensive care unit - ICU) dengan obesitas memiliki kelangsungan hidup yang lebih tinggi dibandingkan dengan yang memiliki indeks massa tubuh (IMT) 18,5 – 24,9 kg/m2. Fenomena ini disebut paradoks obesitas. Tujuan penelitian ini adalah untuk melihat hubungan obesitas berdasarkan IMT dengan lama rawat dan kejadian infeksi nosokomial di ICU. Penelitian ini menggunakan desain kohort prospektif dengan subjek pasien kritis yang di rawat di ICU Dewasa RSUPN Dr. Cipto Mangunkusumo. Pasien dilakukan pemeriksaan antropometri kemudian IMT dihitung dan dikelompokan menjadi kelompok tidak obes dan obes berdasarkan kriteria IMT Asia-Pasifik. Pemantauan pasien dilakukan setiap hari untuk mengambil data lama rawat dan diagnosis infeksi nosokomial dari rekam medis. Dari 79 subjek, sebagian besar (65%) berjenis kelamin perempuan dengan median usia 46 tahun. Sebagian besar subjek masuk ICU pasca pembedahan (89%) dan skor qSOFA 1 (52%). Sebagian besar pasien (92%) keluar dari ICU untuk stepdown ke ruang rawat biasa dan sebanyak 8% pasien meninggal dunia. Sebanyak 5% dari seluruh subjek mengalami infeksi nosokomial berupa ventilator associated pneumonia (VAP). Tidak terdapat hubungan antara infeksi nosokomial dengan status gizi (OR (IK 95%): 1,03 (0,1-14,85)). Tidak ada perbedaan lama rawat di ICU antara pasien obesitas dibandingkan dengan pasien yang tidak obesitas (P = 0,663).

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There are still many controversies regarding the impact of obesity on morbidity and mortality of the critically ill patient. Immune dysregulation, increased cardiovascular risk, impaired wound healing and changes antimicrobial pharmacokinetics can all be attributed to increased fat mass in obese individuals. Even so, numerous studies show increased survival of obese critically ill patiens compared to normal BMI. This phenomenon is known as the obesity paradox. This study aims to see the relationship between obesity with ICU Length of Stay and nosocomial infection in critically ill patient of RSUPN Cipto Mangunkusumo. Subjects’ anthropometric measurements were taken and then grouped into obese or normal BMI group based on Asia-Pacific BMI classification. Length of stay and diagnosis of nosocomial infection were recorded during daily follow up while the subjects were still admitted in the ICU. There is a total of 79 subjects, mostly female (65%) with median age of 46 years. Most patients were admitted to the ICU following surgery (89%) with a qSOFA score of 1 (52%). 92% of patients stepdown from the ICU with the remaining 8% died. 5% of patients had nosocomial infection, all of them being ventilator associate pneumonia. There is no significant relationship between rate of nosocomial infection and obesity status (OR (95% CI): 1,03 (0,1-14,85)). The median length of stay for both subject groups is 2 days. There is no difference in ICU length of stay between obese patients and normal BMI (p=0,663)."

"Latar belakang: Sepsis neonatal masih menjadi masalah besar di negara berkembang seperti Indonesia. Penggunaan antibiotik pada sepsis neonatal penting untuk eleminasi kuman penyebab. Untuk meningkatkan pemakaian yang bijak dan mengurangi potensi terjadi resistensi terhadap antibiotik, penggunaannya perlu selalu dievaluasi. Evaluasi penggunaan antibiotik dan antimikroba lain khususnya pada sepsis neonatal belum banyak dilakukan. Penelitian ini bertujuan melakukan kajian kualitatif dan kuantitatif peresepan antibiotik dan antimikroba lainnya pada pasien sepsis neonatal yang dirawat di Neonatal Intensive Care Unit NICU RSCM pada periode September 2014-Desember 2015. Ketepatan penggunaan antibiotik dievaluasi berdasarkan alur Gyssen, kuantitas penggunaan antibiotik dihitung berdasarkan Defined Daily Dose, kesesuaian pemilihan jenis antibiotik empiris dengan hasil kultur darah juga dievaluasi. Metode: Penelitian ini bersifat observasional deskriptif dengan rancangan potong lintang menggunakan data retrospektif. Analisis dilakukan terhadap 192 kasus sepsis neonatal yang terdiri dari dua kelompok: berat lahir normal 96 pasien dan berat lahir rendah 96 pasien. Hasil: Dari 192 pasien dengan diagnosis sepsis neonatorum 96 pasien berat lahir normal, dan 96 pasien berat lahir rendah didapatkan 4763 peresepan antimikroba 4408 antibiotik dan 355 antimikroba lainnya . Tiga rejimen antibiotik yang paling banyak digunakan pada kelompok neonatal berat lahir normal dan neonatal berat lahir rendah berturut-turut adalah kombinasi ampisilin - sulbaktam dan gentamisin 42,1 dan 35,3 , yang merupakan antibiotik lini pertama untuk diagnosis klinis sepsis neonatorum, disusul oleh piperasilin - tazobaktam dan amikasin lini ke dua, 26,0 dan 29,6 dan meropenem lini ke tiga, 15,5 dan 12,8 . Ketepatan penggunaan antibiotik Gyssens kategori I mencapai 90,35 pada bayi berat lahir normal dan 88,11 pada neonatal dengan berat lahir rendah. Ketidaktepatan penggunaan antibiotik sebagian besar tergolong dalam Gyssen kategori V tidak tepat indikasi . Terdapat 12 jenis antibiotik yang diresepkan dengan total nilai DDD/100 bed-days sebesar 79,72 untuk kelompok berat lahir normal dan 66,807 untuk kelompok berat lahir rendah. Nilai DDD /100 bed-days terbesar adalah ampisilin sulbaktam 40,60 untuk kelompok berat lahir normal dan 39,10 untuk kelompok berat lahir rendah, disusul oleh meropenem 13,72 untuk kelompok berat lahir normal dan 12,86 untuk kelompok berat lahir rendah , dan piperasilin tazobaktam 10,40 untuk kelompok berat lahir normal dan 16,05 untuk kelompok berat lahir rendah . Di antara antimikroba lain, yang terbanyak digunakan adalah nistatin 1,19 DDD/100 bed-days untuk kelompok berat lahir rendah , dan mikafungin 0,19 DDD/100 bed-days untuk kelompok berat lahir normal dan 0,15 DDD/100 bed-days untuk kelompok berat lahir rendah , yang digunakan sesuai indikasi profilaksis antijamur pada pasien sepsis neonatal. Dari 192 sampel darah yang dikultur, yang berhasil tumbuh 27 sampel 14,06 dengan bakteri terbanyak Acinetobacter baumanii. Uji resistensi memperlihatkan 37 bakteri yang tumbuh resisten terhadap semua rejimen antibiotik empiris lini I, II, dan III untuk terapi sepsis neonatal yang tercantum di Pedoman Penggunaan Antibiotik Divisi Neonatologi Departemen Ilmu Kesehatan Anak RSCM 2015. Kesimpulan: Ketepatan penggunaan antibiotik pada pasien sepsis neonatal di Neonatal Intensive Care Unit RSUPN Cipto Mangunkusumo cukup baik khususnya pada kelompok neonatal berat lahir normal. Tiga rejimen antibiotik dengan persentase penggunaan terbanyak sesuai dengan antibiotik lini I, II dan III pada Pedoman Penggunaan Antibiotik Divisi Neonatologi Departemen Ilmu Kesehatan Anak RSCM 2015. Didapatkan 37 kasus resistensi terhadap antibiotik lini I, II dan III tersebut. Kuantitas penggunaan antibiotik di NICU RSCM tahun 2015 secara total relatif lebih rendah dibandingkan dengan di Belanda pada tahun 2005 rata-rata 221,26 DDD/100 bed days dan di Polandia pada tahun 2013 352,17 DDD/100 bed days.

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Background: Neonatal sepsis is still a major problem in developing countries like Indonesia. The use of antibiotics in neonatal sepsis is important for the elimination of the causative microorganism. To improve the prudent use and to reduce the potential of antibiotic resistance, antimicroial use should always be evaluated. Evaluation of antibiotics and other antimicrobials use, especially in neonatal sepsis has not been done frequntly. The purposes of this study were to conduct qualitative and quantitative study of prescribing antibiotics and other antimicrobial in neonatal sepsis patients who were treated in the Neonatal Intensive Care Unit NICU RSCM in the period of September 2014 December 2015. The accuracy of the use of antibiotics was evaluated based on the Gyssen methods, the quantity of antibiotic use was calculated based on Defined Daily Dose, the compatibility of selection of empirical antibiotics with blood culture results was also evaluated.

Methods: This research was a descriptive observational study with cross sectional design using retrospective data. The analysis is performed on 192 cases of neonatal sepsis consisting of two groups with normal birth weight 96 patients and with low birth weight 96 patients.

Results: Based on 192 patients with neonatal sepsis diagnosis 96 patients with normal birth weight, and 96 patients with low birth weight , 4763 antimicrobial prescriptions 4408 antibiotics and 355 other antimicrobials were obtained. The three most widely use empiric regimens of antibiotics in the neonatal group of normal birth weight and low birth weight neonatal were combination of ampicillin sulbactam and gentamicin 42.1 and 35.3 , which was the first line antibiotic for clinical diagnosis of neonatal sepsis, followed by piperacillin tazobactam and amikacin second line, 26.0 and 29.6 and meropenem third line, 15.5 and 12.8. The accuracy of antibiotics use Gyssens category I is 90.35 in normal birth weight neonates and 88.11 in low birth weight neonates. The inaccuracy of antibiotic use is largely classified as Gyssen category V no indication. There were 12 types of antibiotics which prescribed with a total DDD 100 bed days value of 79.72 for the normal birth weight group and 66.807 for the low birth weight group. The largest DDD 100 bed days values were ampicillin sulbactam 40.60 for normal birth weight group and 39.10 for low birth weight group, followed by meropenem 13.72 for normal birth weight group and 12.86 for birth weight group Low, and piperacillin tazobactam 10.40 for normal birth weight group and 16.05 for low birth weight group. Among other antimicrobials, the most widely used is Nystatin 1.19 DDD 100 bed days for groups of low birth weight , and micafungin 0.19 DDD 100 bed days for a normal birth weight group and 0.15 DDD 100 bed days for low birth weight group , which were used as indicated by antifungal prophylaxis for neonatal sepsis patients. Of 192 cultured blood samples, 27 samples 14.06 were successfully grown with most bacteria Acinetobacter baumanii. 37 of bacteria were obtained resistant to all first line, second line and third line empiric antibiotic regimen for the treatment of neonatal sepsis which listed Guidelines for the Use of Antibiotics Division of Neonatology Department of Pediatrics RSCM, 2015.

Conclusions: The appropiate use of antibiotics in neonatal sepsis patients in the Neonatal Intensive Care Unit RSUPN Cipto Mangunkusumo is good, especially in the normal birth weight neonatal group. Three antibiotic regimens with the highest percentage of use in accordance with first line, second line and third line antibiotics of the Guidelines for the Use of Antibiotics Division of Neonatology Department of Pediatrics RSCM 2015. It is obtained 37 of cases of all antibiotic empiric resistance. The quantity of antibiotic use in the NICU RSCM 2015 in total is relatively lower than Neonatal Centres in Netherlands in 2005 average of 221.26 DDD 100 bed days and in Poland in 2013 352.17 DDD 100 bed days. "

"Penggunaan antibiotik yang tinggi pada pasien sepsis dapat memicu penggunaan antibiotik yang tidak rasional. Upaya untuk memaksimalkan penggunaan antibiotik yang rasional merupakan salah satu tanggung jawab apoteker. Penelitian ini bertujuan untuk mengevaluasi kualitas dan kuantitas penggunaan antibiotik pada pasien sepsis di ruang rawat Intensive care unit (ICU) dengan metode Gyssens dan ATC/DDD dan mengevaluasi pengaruh intervensi apoteker dalam meningkatkan kualitas penggunaan antibiotik dan outcome terapi. Penelitian dilakukan secara prospektif selama periode Agustus-November 2018 dengan menggunakan rancangan studi pra eksperimen one grup pretest-posttest. Rekomendasi diberikan kepada penulis resep terhadap masalah ketidaktepatan penggunaan antibiotik yang ditemukan. Evaluasi kualitatif dengan metode Gyssens diperoleh hasil bahwa penggunaan antibiotik pada pasien sepsis yang rasional sebesar 85,09 % dan yang tidak rasional sebesar 14,91 %. Jenis antibiotik, jenis terapi antibiotik, jumlah antibiotik  dan lama penggunaan antibiotik berpengaruh terhadap kualitas penggunaan antibiotik. Intervensi meningkatkan ketepatan penggunaan antibiotik (0 % menjadi 64,71 %), menurunkan masalah pemilihan antibiotik (88,24 % menjadi 32,35 %), masalah lama pemberian antibiotik (5,88 % menjadi 0 %) dan masalah rute pemberian obat (5,88 % menjadi 0 %). Kualitas penggunaan antibiotik yang rasional dan yang tidak rasional berpengaruh terhadap hasil terapi. Kuantitas penggunaan antibiotik sebesar 63,84 DDD/patient-day dengan nilai terbesar pada antibiotik meropenem yaitu 32,91 DDD/patient-day.

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High use of antibiotics in sepsis patients can lead to irrational use of antibiotics. Pharmacist has responsibility to improve appropriate antibiotics usage. This study was proposed to evaluate quality and quantity of antibiotics usage in sepsis patients in the Intensive care unit (ICU) ward with the Gyssens and ATC/DDD methods and evaluate whether intervention of pharmacy can improve quality of antibiotics usage and therapy outcome. The study was conducted prospectively during the period August - November 2018 using pre experiment one grup pretest-posttest design. Recommendations were given to prescribers to solve the problems of inappropriate antibiotics usage. Qualitative evaluation using that about 85.09 % antibiotic prescriptions were appropriate, and 14.91 % were inappropriate. Type of antibiotics, type of antibiotic therapy, total and duration antibiotics used by patients have effect on quality and quantity antibiotics usage. Intervention of pharmacist improve appropriateness of antibiotics (0% to 64.71 %), decrease drug choice problems (88.24 % to 32.35 %), duration problems (5.88 % to 0 %) and route of administration problems (5.88 % to 0 %). Appropriate used of antibiotics had significant different effect to outcome therapy compare with inappropriate used of antibiotics. The quantity of antibiotic use is 63.84 DDD/patient-day with the greatest value on meropenem antibiotics is 32.91 DDD/patient-day."

"Sepsis merupakan kondisi yang sulit untuk didiagnosis. Definisi sepsis berdasarkan International Consensus Conference on Pediatric Sepsis 2005 terlalu sensitif dan tidak spesifik. Akibatnya sering terjadi underdiagnosed/overdiagnosis terhadap sepsis. Sampai saat ini tidak ada data tentang karakteristik pasien sepsis, kepatuhan diagnosis berdasarkan konsensus yang disepakati, dan luaran sepsis pasien di PICU. Penelitian ini bertujuan untuk mengetahui gambaran karakteristik sepsis di PICU RS dr. Cipto Mangunkusumo. Metode penelitian ini adalah deskriptif retrospektif dari data rekam medis pasien sepsis di PICU periode Januari 2012 sampai April 2016. Didapatkan 85 pasien yang didiagnosis dokter dengan sepsis, 7 pasien diantaranya tidak memenuhi kriteria konsensus. Hanya 1 pasien yang didiagnosis sepsis berat oleh dokter, sedangkan berdasarkan konsensus didapatkan 66 pasien sepsis berat. Infeksi respiratorik adalah penyakit primer penyebab sepsis di PICU (51,3%). Angka kejadian sepsis berat di PICU sebesar 85% dan syok septik 70%. Klebsiella pneumonia kuman gram negatif terbanyak penyebab sepsis (22%). Angka kematian sepsis sebesar 29%, pada sepsis berat 32% dan meningkat pada syok septik 37%. Penelitian ini menunjukkan kepatuhan diagnosis sepsis oleh dokter berdasarkan konsensus masih kurang. Diagnosis sepsis pasien di PICU berdasarkan kadar prokalsitonin yang meningkat.

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Sepsis is a condition that is difficult to diagnose. Definition of sepsis based on the International Consensus Conference on Pediatric Sepsis 2005 is too sensitive and not specific. As a result underdiagnosed/overdiagnosis often occurs in sepsis. Until now there are no data on the characteristics of sepsis patients, compliance to diagnosis based on consensus, and the outcome of sepsis patients in PICU. The aim of this study is to determine the characteristic features of sepsis in PICU of dr. Cipto Mangunkusumo hospital. The methods is descriptive retrospective study from medical records of sepsis patients in PICU from January 2012 until April 2016. There were 85 patients diagnosed with sepsis by physicians, 7 of them did not meet the criteria of consensus. Only one severe sepsis patients diagnosed by a doctor, but based on the consensus, there are 66 patients with severe sepsis. Respiratory infections are the primary cause of sepsis (51.3%). The incidence of severe sepsis in PICU is 85% and of septic shock is 70%. Klebsiella pneumonia, Gram negative bacteria, is the most common cause of sepsis (22%). Sepsis mortality rate is 29%, severe sepsis is 32% and increased in septic shock by 37%. This study describes compliance of diagnosis of sepsis by doctor based on consensus is still lacking. The diagnosis of sepsis patients in PICU based on increased levels of procalcitonin."

"Anak yang dirawat di ICU cenderung mengalami malnutrisi sejak masuk atau selama perawatan yang dapat memperberat penyakit dasar, memperpanjang lama rawat serta meningkatkan mortalitas. Baik underfeeding atapun overfeeding dapat terjadi di ICU Anak selama perawatan. Penelitian ini merupakan penelitian potong lintang, menggunakan data rekam medis. Selama 3 bulan penelitian. didapatkan 45 subjek penelitian. Dari 45 data pasien didapatkan 127 peresepan untuk menilai keseuaian peresepan dengan pemberian nutrisi pada pasien. Pemberian nutrisi pada pasien yang dirawat di ICU Anak merupakan hal yang sangat penting. Perlu perhitungan kebutuhan nutrisi yang cermat, pemberian nutrisi tepat yang sesuai kebutuhan pasien agar tidak terjadi malnutrisi yang lebih berat lagi.

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Children admitted to the Pediatric Intensive Care Unit (PICU) are at risk for poor and potentially worsening nutritional status, a factor that further increases comorbidities and complications, prolongs the hospital stay, increases cost and increases mortality. Both underfeeding and overfeeding are prevalent in PICU and may result in large energy imbalance. This was cross sectional study design, with 3 month consecutive sampling in PICU which met 45 patients as the subject and 127 prescription of nutrition. Nutrition support therapies in PICU is very important .Adequate nutrition therapy is essential to improve nutrition outcomes in critically ill children."