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"Background: multidrug-resistant organisms (MDRO) caused pneumonia has become a crucial case. MDRO infection has been a problem concern to community-acquired pneumonia (CAP). A lot of factors play roles in CAP with MDRO infection. This study aimed to analyze MDRO as the etiology of hospitalized patients with CAP along with its risk factors in Dr. Soetomo Hospital as one of the top referral hospitals in east Indonesia. Methods: this retrospective cohort study was conducted from January 2016 to December 2018. Data were collected from patients' medical records. Automatic Rapid Diagnosis (Phoenix TM) was used as a standard method for culture and susceptibility test. Various risk factors were analyzed for MDRO infection. Results: five most common pathogens in hospitalized patients with CAP were Acinetobacter baumannii 244/1364 (17.9%), Klebsiella pneumoniae 134/1364 (9.8%), Pseudomonas aeruginosa 91/1364 (6.7%), Escherichia coli 58/1364 (4.3%), and Enterobacter cloacae 45/1364 (3.3%). There were 294/1364 (21.5%) MDROs isolated from patients with CAP. MDRO infection was linked to previous hospitalization, malignancy, cardiovascular disease, and structural lung disease with p values of 0.002, <0.001, 0.024, and <0.001, respectively. Conclusion: the incidence of MDRO in CAP is high (21.5%). The risk factors related were previous hospitalization, malignancy, cardiovascular disease, and structural lung disease."

"ABSTRAKPendahuluan: Pneumonia komunitas CAP salah satu penyebab kematian tertinggi. Tujuan mengetahui respons pengobatan selama perawatan pasien CAP secara empiris serta faktor yang berkaitan dengan pola kuman, respons pengobatan, gejala klinis, laboratorium, foto toraks, lama rawat dan faktor komorbid di RS persahabatan.Metode: Kohort prospektif pasien pneumonia komunitas rawat inap di RS Persahabatan selama 15 bulan terkumpul 47 pasien. Gejala klinis, hasil laboratorium, foto toraks dan hasil mikrobiologi. Sampel mirkobiologi dikumpulkan sebelum dan sesudah pemberian antibiotik.Hasil: Terkumpul 47 pasien. laki-laki 74,5% dan perempuan 25,5%. Rerata umur 61 tahun. Gejala klinis awal paling banyak sesak napas 51% berkurang 27,7% dan batuk 32% berkurang 23,4%. Nilai awal leukosit rerata 15,27. sel/mm3 berkurang 12,0. sel/mm3. Foto toraks awal infiltrat 89,3% menurun 38,3%. Patogen pada sputum sebelum penggobatan Klebseiella pneumonia 34,0%. Hasil sputum pasca terapi empiris eradikasi 91.5%. Pengobatan antibiotik tersering seftriakson. Faktor komorbid tersering keganasan rongga toraks. Lama rawat minimal 4 hari dengan terapi sulih minimal 3 hari.Kesimpulan: Pasien CAP paling dominan menunjukan gejala klinis sesak napas dan batuk, gambaran infiltrat pada foto toraks dan gram-negatif Klebsiella pneumonia pada sputum. Terjadi penurunan leukosit setelah pemberian antibiotik. Terapi empiris dengan antibiotik tunggal masih sensitif.

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ABSTRACTIntroduction : Pneumonia is the first leading disease with the highest mortality in hospitalized patients. The purpose of this study is to determine treatment response for the empirical treatment of CAP patients and factors associated with patterns of bacteria, treatment response, clinical symptoms, laboratory and chest X-ray, length of stay and comorbidities in Persahabatan Hospital, Jakarta. Methods : Prospective cohort study in hospitalized community acquired pneumonia patients at Persahabatan Hospital while 15 month. Clinical symptoms, laboratory findings, chest x-ray and microbiologic. Microbiologic sample is before and after antibiotic administration.Results : There were 47 patients. Male accounted 74,5% and female 25,5%. The average age was 61 years old. Clinical symptoms before treatment were dyspnea 51% decreased to 27,7% and cough 32% decreased to 23,4%. Leukocytes count was 15,27 cell/mm3 decreased to 12,0 cell/mm3. Chest x-ray infiltrates 89,3% decreased to 38,3%. Before-treatment microbiological patterns were K. pneumoniae 34,0%. Result after empirical treatment was eradication 91,5%. The most frequent innitial antibiotic administration was ceftriaxone.The most frequent comorbidity was thoracic malignancy. The patients were hospitalized at least for 4 days with replacement therapy at least for 3 days.Conclusion: Patients with CAP predominantly showed symptoms of dypnea and cough, infiltrates on chest x-ray and gram-negative Klebsiella pneumonia in sputum samples. There were resolution of leucocyte counts after antibiotic administration. Empirical antibiotic treatments with single drug were still sensitive."

"Latar Belakang : Pneumonia komunitas merupakan satu masalah kesehatan yang besar. Mortalitas akibat pneumonia komunitas masih tinggi, terutama di Indonesia bila dibandingkan dengan negara-negara lain. Skor CURB-65 merupakan sistem skoring yang telah dipakai secara luas, namun memiliki beberapa kekurangan sehingga diperlukan sistem skor baru untuk menilai derajat keparahan pneumonia komunitas. Saat ini telah diperkenalkan sistem skor expanded-CURB-65 yang dinilai dapat lebih baik dalam hubungannya sebagai prediktor mortalitas 30 hari pneumonia komunitas. Tujuan : Menilai performa kalibrasi dan diskriminasi skor expanded-CURB-65 untuk digunakan dalam memprediksi mortalitas 30 hari pasien pneumonia komunitas di Rumah Sakit Umum Pusat Nasional dr.Cipto Mangunkusumo. Metode : Penelitian ini merupakan studi kohort prospektif dengan subyek penelitian pasien pneumonia komunitas yang datang ke IGD, poliklinik paru atau dirawat di ruang rawat RSCM. Keluaran yang dinilai adalah mortalitas pasien dalam 30 hari. Dilakukan penilaian performa diskriminasi skor expanded-CURB-65 menggunakan area under the curve AUC . Performa kalibrasi dinilai dengan plot kalibrasi dan tes Hosmer-Lemeshow. Hasil : 267 pasien ikut serta dalam penelitian ini dengan angka mortalitas 31,5 . Performa kalibrasi ditunjukkan oleh plot kalibrasi skor expanded-CURB-65 dengan r = 0,94 serta uji Hosmer-Lemeshow dengan nilai p = 0,57. Performa diskriminasi skor expanded-CURB-65 ditunjukkan oleh kurva ROC dengan nilai AUC 0,796 IK95 0,74-0,86. Simpulan : Mortalitas meningkat seiring peningkatan kelas risiko expanded-CURB-65. Expanded-CURB-65 menunjukkan performa kalibrasi dan diskriminasi yang baik dalam memprediksi mortalitas 30 hari pasien pneumonia komunitas di Rumah Sakit Cipto Mangunkusumo.

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Background : Community acquired pneumonia is a major health problem. Mortality due to community pneumonia is still high, especially in Indonesia compared to other countries. The CURB 65 score is a widely used scoring system, but has some drawbacks so a new scoring system is needed to assess the severity of community pneumonia. Currently, the expanded CURB 65 scoring system has been assessed better to predict 30 day mortality of community acquired pneumonia.

Aim : To evaluate calibration and discrimination performance of the expanded CURB 65 score in predicting 30 days mortality of community acquired pneumonia patients at the National Center General Hospital dr.Cipto Mangunkusumo.

Method : This study was a prospective cohort study with the study subjects community acquired pneumonia patients who came to the Emergency Room ER , pulmonary polyclinics or hospitalized in RSCM. The assessed outcome was patient mortality within 30 days. Discrimination performance of the expanded CURB 65 score assessed using the area under the curve AUC . Calibration was evaluated with calibration plot and Hosmer Lemeshow test.

Results : 267 patients participated in the study with a mortality rate of 31.5. Calibration plot of expanded CURB 65 score showed r 0,94 and Hosmer Lemeshow test showed p 0,57. Discrimination was shown by ROC curve with AUC 0,796 CI95 0,74 0,86.

Conclusion : Mortality increases with increasing risk class of expanded CURB 65. Expanded CURB 65 showed a good calibration and discrimination performance in predicting 30 day mortality higher in community acquired pneumonia patients in Cipto Mangunkusumo Hospital."

"Pneumonia nosokomial, juga disebut sebagai pneumonia yang didapat di rumah sakit, didefinisikan sebagai pneumonia yang bermanifestasi 48 jam atau lebih setelah rawat inap dan tidak dalam masa inkubasi. Tujuan dari penulisan ini adalah untuk memaparkan hasil temuan dengan menggunakan latihan pernapasan teknik pernapasan buteyko untuk membantu mengatur kembali pola nafas pasien yang bertujuan untuk mengatasi dispnea yang pasien alami, Latihan pernapasan ini diberikan selama enam hari dengan durasi intervensi 5-10 menit dilakukan 1x dalam sehari. Analisis dilakukan pada perempuan berusia 69 tahun yang mengalami Hospital Acquired Pneumonia dengan keluhan utama yang seringkali muncul yaitu Dispnea pasien juga mengeluhkan batuk serta sulit mengeluarkan dahaknya. Masalah keperawatan yang muncul adalah bersihan jalan nafas tidak efektif, intoleransi aktivitas, dan nyeri akut. Hasil dari intervensi yang telah diberikan diketahui bahwa teknik pernapasan buteyko dapat meningkatkan saturasi dan memperbaiki pola nafas namun perbaikan tersebut hanya terlihat segera setelah dilakukannya intervensi, namun belum menunjukkan perbaikan yang terlihat jika dibandingkan dengan data harian. Kesimpulan teknik buteyko dapat dilakukan kapanpun dan dimanapun, selain mudah dan bermanfaat teknik ini dapat membantu meningkatkan pernapasan, mengurangi sesak dan meningkatkan saturasi.

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Nosocomial pneumonia, also known as hospital-acquired pneumonia (HAP), is defined as pneumonia that manifests 48 hours or more after hospitalization and is not in the incubation period. The analysis was conducted on a 69-year-old woman who had HAP (Hospital Acquired Pneumonia) with the main complaint that often arises, namely dyspnea, the patient also complained of coughing and difficulty in expelling phlegm. Problems that arise include ineffective airway hygiene, activity intolerance, and acute pain. The purpose of this paper is to present the findings and analysis of nursing care using breathing exercises with the Buteyko breathing technique to help rearrange the patient's breathing pattern which aims to overcome the dyspnea that the patient is experiencing, this breathing is given for six days with a duration of 5-10 minutes of intervention. 1x in a day. It is known from the results of the intervention that the buteyko breathing technique can increase saturation and improve breathing patterns, but these improvements were only seen immediately after the intervention, but have not shown any visible improvement when compared to daily data. Conclusion: The Buteyko technique can be done anytime and anywhere, besides being easy and useful this technique can help improve breathing, reduce tightness and increase saturation."

"Pneumonia nosokomial, juga disebut sebagai pneumonia yang didapat di rumah sakit, didefinisikan sebagai pneumonia yang bermanifestasi 48 jam atau lebih setelah rawat inap dan tidak dalam masa inkubasi. Tujuan dari penulisan ini adalah untuk memaparkan hasil temuan dengan menggunakan latihan pernapasan teknik pernapasan buteyko untuk membantu mengatur kembali pola nafas pasien yang bertujuan untuk mengatasi dispnea yang pasien alami, Latihan pernapasan ini diberikan selama enam hari dengan durasi intervensi 5-10 menit dilakukan 1x dalam sehari. Analisis dilakukan pada perempuan berusia 69 tahun yang mengalami Hospital Acquired Pneumonia dengan keluhan utama yang seringkali muncul yaitu Dispnea pasien juga mengeluhkan batuk serta sulit mengeluarkan dahaknya. Masalah keperawatan yang muncul adalah bersihan jalan nafas tidak efektif, intoleransi aktivitas, dan nyeri akut. Hasil dari intervensi yang telah diberikan diketahui bahwa teknik pernapasan buteyko dapat meningkatkan saturasi dan memperbaiki pola nafas namun perbaikan tersebut hanya terlihat segera setelah dilakukannya intervensi, namun belum menunjukkan perbaikan yang terlihat jika dibandingkan dengan data harian. Kesimpulan teknik buteyko dapat dilakukan kapanpun dan dimanapun, selain mudah dan bermanfaat teknik ini dapat membantu meningkatkan pernapasan, mengurangi sesak dan meningkatkan saturasi.

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Nosocomial pneumonia, also known as hospital-acquired pneumonia (HAP), is defined as pneumonia that manifests 48 hours or more after hospitalization and is not in the incubation period. The analysis was conducted on a 69-year-old woman who had HAP (Hospital Acquired Pneumonia) with the main complaint that often arises, namely dyspnea, the patient also complained of coughing and difficulty in expelling phlegm. Problems that arise include ineffective airway hygiene, activity intolerance, and acute pain. The purpose of this paper is to present the findings and analysis of nursing care using breathing exercises with the Buteyko breathing technique to help rearrange the patient's breathing pattern which aims to overcome the dyspnea that the patient is experiencing, this breathing is given for six days with a duration of 5-10 minutes of intervention. 1x in a day. It is known from the results of the intervention that the buteyko breathing technique can increase saturation and improve breathing patterns, but these improvements were only seen immediately after the intervention, but have not shown any visible improvement when compared to daily data. Conclusion: The Buteyko technique can be done anytime and anywhere, besides being easy and useful this technique can help improve breathing, reduce tightness and increase saturation."

"ABSTRAKUsia balita merupakan masa yang paling penting atau periode emas bagipertumbuhan dan perkembangan anak. Pengetahuan ibu terhadap pemberianmakanan, penyediaan dan pengolahan makanan di perlukan agar dapatmemberikan nutrisi yang baik pada anak. Tujuan penelitian adalah mengetahuigambaran pengetahuan ibu tentang pola dan perilaku makan balita yang di rawatdengan diagnosis Pneumonia di rumah sakit Persahabatan.Penelitian ini merupakan penelitian deskriptif (descriptive) desain crosssectional.Jumlah sampel 40orang responden dengan tehnik purposive sampling.Hasil uji analisis univariat didapatkan sebagian besar (52,5%) responden memilikibalita pada usia 13-36 bulan atau usia toddler. Tingkat pengetahuan ibu tentanggizi seimbang berada pada kategori cukup sebesar 67,5%, dan kategori baiksebesar 25%.Strategi pendidikan kesehatan perlu diberikan kepada ibu yangmemiliki balita untuk meningkatakan pengetahuan ibu mengenai gizi seimbangpada balita

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ABSTRACTToddlers is in golden period time for growth and development. Toddlers is a verydependence group on mothercare.Knowledge of the mother in feeding, and theprovision of food processing is very needed to provide good nutrition in children.This study aims to describe mothers knowledge and patterns of diet behavior inhospitalized toddlers with a pneumonia in Persahabatan Hospital.This study is a cross sectional method with descriptive design. Samples are 40mothers by purposive sampling technique. The results of univariate analysisshowed that the average age of children 13-36 months of age or toddler by 52.5%.Mother’slevel of knowledge about balanced nutrition is in enough category by67.5%, and good categories by 25%.Health education strategies need to be givento mothers who have children to increase mother’s knowledge about balancednutrition in childhood"

"Latar belakang: Pneumonia rumah sakit adalah infeksi paru yang didiagnosis setelah rawat >48 jam setelah masuk rawat dan tanpa adanya tanda infeksi paru pada saat awal perawatan atau pneumonia yang didiagnosis pada saat awal masuk perawatan dengan riwayat perawatan di rumah sakit sebelumnya dengan jarak antar rawat inap 10-14 hari. Pneumonia rumah sakit merupakan salah satu infeksi nosokomial yang sering terjadi pada perawatan pasien anak di rumah sakit. Kasus pneumonia rumah sakit dapat berakibat meningkatkan angka kesakitan dan kematian, memperpanjang lama rawat inap serta biaya yang dikeluarkan. Tujuan: mengetahui karakteristik dan proporsi mortalitas pneumonia rumah sakit pada anak. Metode: Studi kohort retrospektif dilakukan terhadap subyek usia >1 bulan dan ≤18 tahun di RSCM selama 2015-2018 melalui telusur rekam medis. Hasil: Sebanyak 86 subyek didapatkan dengan karakteristik subyek dengan pneumonia rumah sakit terbanyak pada penelitian ini adalah usia 1-24 bulan, memiliki lebih dari satu komorbiditas status nutrisi gizi baik dan memiliki awitan lambat. Simpulan: Subyek dengan pneumonia rumah sakit terbanyak pada penelitian ini mempunyai karakteristik usia 1-24 bulan, memiliki lebih dari satu komorbiditas, status nutrisi gizi baik, memiliki lama rawat 8-14 hari, dan berawitan lambat. Proporsi mortalitas subyek dengan pneumonia rumah sakit pada penelitian ini sebesar 24,4%. Karakteristik mortalitas juga dapat dipengaruhi oleh status nutrisi yaitu gizi buruk, kelompok usia, jenis komorbiditas, lama rawat dan jenis awitan.

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Background: Hospital-acquired pneumonia (HAP) is defined as a pulmonary infection that occurs >48 hours after admission to hospital or within 10-14 days after discharge. It is the most common hospital-acquired infection in children. Its occurrence represents increase hospital stay, additional cost, morbidity and mortality. Objective: To investigate the characteristic and mortality of hospital-acquired pneumonia in children Methods: It is a retrospective cohort study involving 86 subjects through medical records, inclusive to >1 months old - ≤18 years old patients, in RSCM Jakarta within 2015-2018. Results: There are 86 subjects with characteristic of HAP in this study are age 1-24 months old, has more than one comorbidity, good nutritional status and late onset. Conclusion: General characteristic of HAP in this study are, age 1-24 months old, has more than one comorbidity, good nutritional status, length of stay 8-14 days and late onset. The mortality proportion of HAP in this study is 24.4%. The mortality characteristic was influenced by nutritional status (severe malnutrition), comorbidities, age, length of hospital stay and onset of the disease."

"Pneumonia komunitas adalah penyebab kematian terbesar di Indonesia. Sistem skor PSI dan CURB-65 telah digunakan dalam menentukan keparahan penyakit dan keputusan tempat rawat berdasarkan risiko kematian dalam 30 hari. Tujuan penelitian ini adalah membandingkan sistem skor modifikasi PSI dan modifikasi CURB-65 pada pasien CAP sebagai prediktor mortalitas 30 hari di RS Persahabatan. Penelitian ini adalah kohort prospektif yang dilakukan pada pasien CAP yang dirawat di RS Persahabatan sejak bulan Oktober 2012-Maret 2013. Gejala klinis nilai laboratorium, foto toraks, penyakit penyerta skor PSI dan CURB-65 serta hasil akhir berupa kematian dicatat untuk dianalisis. Selama 30 hari subjek penelitian diikuti. Sebanyak 167 pasien CAP mengikuti penelitian ini didapatkan angka kematian sebesar 18,6%. Sensitivitas PSI sama dengan CURB-65 yaitu sebesar 77,4%. Spesifisitas PSI sedikit lebih tinggi dari pada CURB-65 (58,1% vs 53,7% p < 0,001). Risiko relatif mortalitas berdasarkan PSI pada kelompok risiko tinggi sebesar 3,64 kali dibandingkan kelompok risiko rendah, sedangkan risiko relatif mortalitas berdasarkan CURB-65 pada kelompok risiko tinggi sebesar 3,15 kali dibandingkan kelompok risiko rendah. Skor CURB-65 dapat dipertimbangkan sebagai prediktor mortalitas pada pasien CAP yang di rawat inap.

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Community Acquired Pneumonia (CAP) is the first leading disease with the highest mortality in hospitalized patient in Indonesia. Pneumonia severity assessment systems such as the pneumonia severity index (PSI) and CURB-65 were designed to predict severity of illness and site of care base on 30-d mortality. The purpose of this study is to comparing the PSI with CURB-65 in patient admitted with CAP as predictor 30 days mortality in Persahabatan Hospital, Jakarta. This is a prospective cohort study in hospitalized community acquired pneumonia patients in Persahabatan Hospital since October 2012- Maret 2013. Clinical symptoms, laboratory findings, chest x-ray , comorbidities, score of PSI and CURB-65, 30 days mortality were recorded for analysis. Thirty days mortality outcome were recorded to analysis which score system as the best to predict 30 days mortality. One hundred and sixtty seven patients CAP were studied with an overall 30-d mortality of 18,6%. Sensitivity of PSI were simillar with CURB-65 for predicting patients who died within 30 d (77,4% ; p < 0.001). Specificity of PSI was slighty higher than CURB-65 (58,1% vs 53,7% p < 0,001). Score PSI have risk mortality 3,64 times in high risk group CAP than low risk group CAP. Score CURB-65 have risk mortality 3,15 times in high risk group CAP than low risk CAP. CURB-65 modification was considerable to predict mortality in CAP patients hospitalized."

"[ABSTRAK Latar belakang: Penggunaan antibiotik empirik pada tata laksana penyakit infeksi, misalnya pneumoniakomunitas, sebaiknya mempertimbangkan bukti kemanfaatan klinis dan hasilsensitivitas antibiotik pada suatu institusi pelayanan kesehatan. Penggunaan antibiotikyang tidak tepat dapat menyebabkan kegagalan terapi, resistensi kuman, komplikasidan kematian. Biaya yang tinggi juga merupakan keluaran langsung dari penggunaanantibiotik namun biasanya tidak dilaporkan. Oleh sebab itu, analisis terhadap biaya,keluaran klinis, dan pola sensitivitas kuman menjadi sangat penting untuk menentukanantibiotik empirik pada terapi pneumonia komunitas.Tujuan:Tujuan penelitian ini adalah menentukan antibiotik yang paling efektif dari aspek biayadan keluaran klinis pada tata laksana pneumonia komunitas.Metode:Penelitian ini dilakukan secara retrospektif pada pasien pneumonia komunitas di RSUDr. Soetomo Surabaya sejak 1 Januari sampai 31 Desember 2013. Analisis costeffectiveness digunakan untuk evaluasi farmakoekonomi berdasarkan perbaikan klinishari ke-5, mortalitas, dan biaya total.Hasil:Sebanyak 434 pasien dirawat di RSU Dr. Soetomo dan menerima antibiotik empirik.Sebanyak 200 pasien dikelompokkan menjadi 4 grup: seftriakson(35%), seftazidim(26%), levofloksasin (14,5%), dan kombinasi seftazidim dan levofloksasin (24,5%).Perbaikan klinis hari ke-5 tertinggi adalah kelompok yang diberi seftazidim sekitar67,3%. Seftriakson merupakan antibiotik empirik yang paling efektif dengan ACER505.585,3 untuk perbaikan klinis hari ke-5 namun hasil sensitivitas kumanmenunjukkan bahwa seftazidim masih lebih sensitif dari pada seftriakson (61,1% vs38,5%) dengan nilai ACER seftazidim sebesar 763.322. Kombinasi seftazidim danlevofloksasin digunakan untuk pasien dengan klinis yang buruk (PSI: 84,1+28,6) danberdampak pada tingginya biaya pengobatan (ACER 23685450.5).Kesimpulan:Seftazidim dapat dipertimbangkan sebagai antibiotik empirik yang efektif dan efisiendalam tata laksana pneumonia komunitas yang dirawat di rumah sakit. Kombinasi seftazidim dan levofloksasin juga dapat dipertimbangkan untuk pasien pneumonia komunitas yang berat.ABSTRACT Introduction:

Empirical antibiotic use in the management of infectious disease such as community

pneumonia should be considered based on evidence of clinical effectiveness and

institutional antibiotic sensitivity results. Inappropriate antibiotic leads to failure in

treatment, microbial resistance, complications and mortality. In addition, high cost is

one of the direct impact of this condition that is usually under-reported. Thus, analysis

of cost and clinical outcome, besides antibiotic sensitivity pattern, should be performed

to find effective empirical antibiotic in the treatment in community acquired

pneumonia (CAP).

Aim:

The objective of the study was to determine the most effective antibiotic in cost and

clinical outcome in CAP.

Methodology:

This study has been conducted retrospectively in patient with CAP in Dr. Soetomo

Hospital Surabaya from 1 January to 31 December 2013. Cost effectiveness analysis

was used to evaluate pharmacoeconomic outcomes based on clinical improvement in

day 5, mortality, and total cost.

Results:

There were 434 hospitalized patients with pneumonia that received empirical

antibiotic. Two hundred patients were selected based on inclusion and exclusion

criteria of this study. Subjects were categorized into 4 groups: ceftriaxone (35%),

ceftazidim (26%), levofloxacin (14.5%), and combination ceftazidim and levofloxacin

(24.5%). Clinical improvement in day 5 and clinical remission was assessed with

highest number in ceftazidim group, roughly 67.3% and 76,9% respectively.

Furthermore, ceftriaxone was the most effective one with ACER 505585.3 for day 5

outcome. However, the ceftazidim sensitivity was higher than ceftriaxone (61,1% vs

38,5%), while ceftazidime was in the one second position with ACER 763322. The

combination ceftazidim and levofloxacin particularly used in worse clinical symptom

(PSI: 84,1+28,6) and lead to the highest cost with ACER 23685450.5.

Conclusion:

Ceftazidim should be considered as effective and efficient empirical antibiotic in the

management of hospitalized CAP. However, combination ceftazidim and levofloxacin is also could be effective to improve clinical sign for particular patient even with severe CAP. , Introduction:

Empirical antibiotic use in the management of infectious disease such as community

pneumonia should be considered based on evidence of clinical effectiveness and

institutional antibiotic sensitivity results. Inappropriate antibiotic leads to failure in

treatment, microbial resistance, complications and mortality. In addition, high cost is

one of the direct impact of this condition that is usually under-reported. Thus, analysis

of cost and clinical outcome, besides antibiotic sensitivity pattern, should be performed

to find effective empirical antibiotic in the treatment in community acquired

pneumonia (CAP).

Aim:

The objective of the study was to determine the most effective antibiotic in cost and

clinical outcome in CAP.

Methodology:

This study has been conducted retrospectively in patient with CAP in Dr. Soetomo

Hospital Surabaya from 1 January to 31 December 2013. Cost effectiveness analysis

was used to evaluate pharmacoeconomic outcomes based on clinical improvement in

day 5, mortality, and total cost.

Results:

There were 434 hospitalized patients with pneumonia that received empirical

antibiotic. Two hundred patients were selected based on inclusion and exclusion

criteria of this study. Subjects were categorized into 4 groups: ceftriaxone (35%),

ceftazidim (26%), levofloxacin (14.5%), and combination ceftazidim and levofloxacin

(24.5%). Clinical improvement in day 5 and clinical remission was assessed with

highest number in ceftazidim group, roughly 67.3% and 76,9% respectively.

Furthermore, ceftriaxone was the most effective one with ACER 505585.3 for day 5

outcome. However, the ceftazidim sensitivity was higher than ceftriaxone (61,1% vs

38,5%), while ceftazidime was in the one second position with ACER 763322. The

combination ceftazidim and levofloxacin particularly used in worse clinical symptom

(PSI: 84,1+28,6) and lead to the highest cost with ACER 23685450.5.

Conclusion:

Ceftazidim should be considered as effective and efficient empirical antibiotic in the

management of hospitalized CAP. However, combination ceftazidim and levofloxacin is also could be effective to improve clinical sign for particular patient even with severe CAP. ]"