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"Antimicrobial Resistance Bacteria (AMRB) adalah kondisi di mana bakteri, parasit, virus atau jamur penyebab infeksi menjadi kebal terhadap obat yang digunakan untuk mengobati infeksi. Extended Spectrum Beta-Lactamase producing E. coli (ESBL-Ec) termasuk salah satu contoh bakteri yang mampu menghasilkan enzim yang membuatnya resistan terhadap banyak antibiotik yang umum digunakan. Berdasarkan hal tersebut WHO telah menetapkan pengawasan global tricyle project yang berfokus pada ESBL-Ec. Salah satunya adalah Sungai Ciliwung pada bagian hilir dimana lokasi tersebut merupakan kawasan padat penduduk, perbelanjaan, dan perdagangan terbesar di Jakarta Utara. Penelitian ini bertujuan untuk menganalisis konsentrasi E. coli, konsentrasi ESBL-Ec, rasio konsentrasi serta mengkarakterisasi gen terhadap antibiotik cefotaxime (bla_CTX-M) pada E. coli. Metode yang digunakan pada penelitian ini menggunakan direct one-step spread plate method menggunakan media Tryptone-Bile-X-Glucuronide (TBX) agar, dilakukan pengujian secara fenotipe Antimicrobial Susceptibility Test (AST) dengan metode Double Disk Synergy Test (DDST). Serta, mengkarakterisasi gen ESBL bla_CTX-M dengan metode multiplex Polymerase Chain Reaction (PCR) kemudian divisualisasikan menggunakan elektroforesis. Hasil pengujian menunjukkan konsentrasi E. coli untuk sampel hilir A sebesar sebesar (1,3 ± 0,02) × 10⁵ CFU/100 mL dengan konsentrasi ESBL-Ec sebesar (3,5 ± 1,09) × 10⁴ CFU/100 mL. Sedangkan, konsentrasi E. coli untuk sampel hilir B sebesar (0,9 ± 0,18) × 10⁵ CFU/100 mL dengan konsentrasi ESBL-Ec sebesar (4,1 ± 0,3) × 10⁴ CFU/100 mL. Hasil rasio ESBL-Ec pada hilir Sungai Ciliwung di titik hilir A sebesar 26,48%, sedangkan rasio ESBL-Ec pada hilir B sebesar 45,83%. Rasio ini masuk kategori yang tinggi dimana jika dibandingkan dengan RAN-PRA sebesar 14% untuk sektor lingkungan. Berdasarkan hasil karakterisasi gen terdeteksi gen positif bla_CTX-M  sebanyak 9 dari 10 sampel (90%) pada titik hilir A. Sedangkan untuk titik hilir B terdeteksi gen positif bla_CTX-M  sebanyak 10 dari 10 sampel (100%). Semua sampel yang terdeteksi isolat penghasil EBL merupakan jenis bla_CTX-M grup 1 dimana gen tersebut terdiri atas jenis gen blaCTX-M-1, gen blaCTX-M-3, dan gen blaCTX-M-15. Berdasarkan prevalensi konsentrasi ESBL-Ec pada titik hilir Sungai Ciliwung menjadi isu-isu yang penting terhadap pencemaran lingkungan oleh AMRB. Perlu adanya tindakan pencegahan penyebaran ESBL-Ec dengan melakukan peningkatan personal higiene dan manajemen air bersih, peningkatan kontrol penggunaan dan pengawasan antibiotik, penegakkan penjualan antibiotik illegal di e-commerce, perketatan dan kebijakan usaha dalam pembuangan limbah industri, dan peningkatan cakupan pelayanan IPAL domestik.

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Antimicrobial Resistance Bacteria (AMRB) is a condition in which infection-causing bacteria, parasites, viruses or fungi become resistant to the drugs used to treat the infection. Extended Spectrum Beta-Lactamase producing E. coli (ESBL-Ec) is one example of a bacterium capable of producing an enzyme that makes it resistant to many commonly used antibiotics. Based on this, WHO has established a global surveillance tricyle project that focuses on ESBL-Ec. One of them is the Ciliwung River at the downstream where the location is the largest densely populated, shopping and trading area in North Jakarta. This study aims to analyze the concentration of E. coli, ESBL-Ec concentration, concentration ratio and characterize genes against cefotaxime antibiotics (bla_CTX-M) in E. Coli. The method used in this study was one-step spread plate method using Tryptone-Bile-X-Glucuronide (TBX) agar media, phenotypically testing Antimicrobial Susceptibility Test (AST) with Double Disk Synergy Test (DDST) method. Also, characterize the ESBL bla_CTX-M gene by multiplex Polymerase Chain Reaction (PCR) method and then visualized using electrophoresis. The test results showed E. coli concentration for downstream sample A of (1,3 ± 0,02) × 10⁵ CFU/100 mL with ESBL-Ec concentration of (3,5 ± 1,09) × 10⁴ CFU/100 mL. Meanwhile, the average E. coli concentration for downstream B samples was (0,9 ± 0,18) × 10⁵ CFU/100 mL with ESBL-Ec concentration of (4,1 ± 0,3) × 10⁴ CFU/100 mL. The results of the ESBL-Ec ratio in the downstream Ciliwung River at downstream point A amounted to 26.48%, while the ESBL-Ec ratio in downstream B amounted to 45.83%. This ratio is categorized as high when compared to the RAN-PRA of 14% for the environmental sector. Based on the results of gene characterization, the bla_CTX-M positive gene was detected in 9 out of 10 samples (90%) at downstream point A. As for the downstream point B, positive bla_CTX-M genes were detected in 10 out of 10 samples (100%). All samples detected EBL-producing isolates are group 1 bla_CTX-M types where the gene consists of the blaCTX-M-1 gene, blaCTX-M-3 gene, and blaCTX-M-15 gene. Based on the prevalence of ESBL-Ec concentrations at the downstream point of the Ciliwung River, it becomes an important issue for environmental pollution by AMRB. Improved personal hygiene and clean water management, improved antibiotic use control and surveillance, enforcement of illegal antibiotic sales in e-commerce, tightening and business policies in industrial waste disposal, and increasing the coverage of domestik WWTP services."

"Resistansi antimikroba (AMR) telah menjadi permasalahan global dalam beberapa tahun terakhir. Tren AMR dapat diamati dengan mengacu pada prevalensi bakteri E. coli yang memproduksi enzim ESBL Extended spectrum β-lactamase (ESBL-Ec). Menurut panduan WHO berjudul Global Tricycle Surveillance ESBL-Ec, sektor peternakan merupakan salah satu sumber pencemar ESBL-Ec. Penelitian ini dilakukan dengan mengambil sampel air dari Sungai Ciliwung yang terkontaminasi oleh limbah peternakan A (titik A) dan limbah peternakan B (titik B). Bakteri E. coli dan ESBL-Ec dihitung dengan menggunakan teknik membran filtrasi dan spread plate pada media TBX dan TBX-CTX. Aktivitas ESBL dilakukan dengan uji konfirmasi melalui antibiotic susceptibility test metode Double Disk Synergy Test (DDST). Karakterisasi gen CTX-M pada ESBL-Ec dilakukan dengan metode PCR dan gel elektroforesis. Konsentrasi bakteri E. coli di titik A dan titik B (8,3± 0,02) × 104 CFU/100 mL dan (8,4 ± 0,75) × 104 CFU/100 mL. Adapun untuk konsentrasi ESBL-Ec terkonfirmasi pada titik A dan titik B adalah (1,5 ± 0,16) × 103 CFU/100 mL dan (8,8 ± 1,2) × 102 CFU/100 mL. Rasio ESBL-Ec terhadap E. coli untuk titik A dan B adalah 1,86% dan 1,04%. Gen yang teridentifikasi pada ESBL-Ec untuk semua sampel merupakan CTX-M grup 1 meliputi blaCTX-M-1, blaCTX-M-3, dan blaCTX-M-15. Keberadaan ESBL-Ec pada studi ini indikator bahwa sektor peternakan menjadi sumber pencemar di perairan. ESBL-Ec pada sungai berpotensi mengontaminasi manusia dan lingkungan di sekitarnya. Oleh karena itu, perlu dilakukan penanganan seperti perluasan kontrol penggunaan antibiotik, pengelolaan limbah peternakan, dan revitalisasi saluran drainase.

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Antimicrobial resistance (AMR) has become a global problem in recent years. AMR surveillance can be done by analyzing prevalence of E. coli bacteria that produce Extended spectrum β-lactamase enzymes (ESBL-Ec). According to the WHO Global Tricycle Surveillance ESBL-Ec, the livestock sector is one of the sources of ESBL-Ec contaminants. This study was conducted by collecting water samples from two sides of the Ciliwung River contaminated by livestock waste (sample A and B) . E. coli and ESBL-Ec bacteria were counted using membrane filtration and spread plate techniques on TBX and TBX-CTX media, respectively. ESBL activity was confirmed by antibiotic susceptibility test using Double Disk Synergy Test (DDST) method. CTX-M gene prevalence in ESBL-Ec was characterized by PCR method. The concentrations of E. coli and ESBL-Ec in sample A and B were (8,3± 0,02) × 104 CFU/100 mL and (8,4 ± 0,75) × 104 CFU/100 mL, respectively. Whereas the confirmed ESBL-Ec concentrations in sample AN and B were (1,5 ± 0,16) × 103 CFU/100 mL and (8,8 ± 1,2) × 102 CFU/100 mL, respectively. Ratio of ESBL-Ec to E. coli were calculated and it was found to be 1.86% and 1.04% for sample A and B, respectively. The genes identified in ESBL-Ec were CTX-M group 1, including blaCTX-M-1, blaCTX-M-3, and blaCTX-M-15. The presence of ESBL-Ec in this study indicated that the livestock sector is one of the sources of water pollution. ESBL-Ec in rivers has the potential to contaminate humans and the surrounding environment. Therefore, it is necessary to do prevention measures, such as controlling antibiotics usage, managing livestock waste, and revitalizing drainage channels."

"Resistensi antibiotik terjadi karena adanya penyalahgunaan antibiotik. Salah satu dari dampak resistensi antibiotik adalah produksi enzim ESBL (Extended Spectrum Beta-Lactamase) pada bakteri. WHO menciptakan tricycle protocol untuk pengawasan global pada bakteri E.coli penghasil ESBL (ESBL-Ec) salah satunya di lingkungan. Penelitian ini memilih objek studi air drainase dan air sungai di Kawasan DKI Jakarta berdasarkan standar ekonomi. Tujuan penelitian ini adalah untuk menganalisis konsentrasi E.coli, ESBL-Ec, rasio ESBL-Ec terhadap E.coli, dan pengaruh lokasi pengambilan sampel terhadap konsentrasi E. coli dan ESBL-Ec. Metode prevalensi E.coli dan ESBL-Ec dilakukan dengan metode spread plate dan antibiotic susceptibility test (AST). Hasil pengujian menunjukkan rata-rata konsentrasi E.coli kategori menengah atas sebesar 4,8x106 CFU/100 mL, menengah sebesar 3,9x106CFU/100 mL, dan menengah bawah sebesar 6,5x106 CFU/100 mL dengan nilai konsentrasi terbesar 9,1x106 CFU/100 mL pada kategori menengah bawah. Rasio ESBL-Ec terhadap E.coli pada setiap sampel berada diangka 0,74%-12,24%. Terdapat tiga lokasi yang tidak ditemukan konfirmasi ESBL-Ec sehingga rasio 0%. Lokasi pengambilan sampel mempengaruhi tinggi rendahnya konsentrasi E.coli dan ESBL-Ec terutama lokasi sampel dengan kategori menengah bawah yang memiliki kepadatan penduduk yang tinggi dan sanitasi yang rendah. Masih adanya prevalensi ESBL-Ec di DKI Jakarta menunjukkan perlu adanya pengawasan penggunaan antibiotik oleh fasilitas kesehatan dan peningkatan sanitasi masyarakat seperti penyuluhan kepada masyarakat demi kesehatan dan keamanan.

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Antibiotic resistance occurs due to the misuse of antibiotics. One of the impacts of antibiotic resistance is the production of ESBL (Extended Spectrum Beta-Lactamase) enzymes in bacteria. WHO has established the tricycle protocol for global surveillance of ESBL-producing E. coli (ESBL-Ec) bacteria, including in the environment. This study selected drainage water and river water in the Jakarta area based on economic standards as the study objects. The aim of this research is to analyze the concentration of E. coli, ESBL-Ec, the ratio of ESBL-Ec to E. coli, and the effect of sampling locations on the concentration of E. coli and ESBL-Ec. The prevalence method for E. coli and ESBL-Ec was conducted using the spread plate method and antibiotic susceptibility test (AST). The test results showed the average concentration of E. coli in the upper-middle category was 4.8×106 CFU/100 mL, middle category was 3.9×106 CFU/100 mL, and lower-middle category was 6.5×106CFU/100 mL, with the highest concentration value of 9.1×106CFU/100 mL in the lower-middle category. The ratio of ESBL-Ec to E. coli in each sample ranged from 0.74% to 12.24%. There were three locations where ESBL-Ec was not detected, resulting in a 0% ratio. The sampling location influenced the concentration of E. coli and ESBL-Ec, particularly in lower-middle category locations with high population density and poor sanitation. The continued prevalence of ESBL-Ec in Jakarta indicates the need for monitoring antibiotic use in medical facility and improving community sanitation for public health and safety."

"Antimicrobial Resistance (AMR) menyebabkan penurunan efektivitas pengobatan dan dapat dideteksi dengan keberadaan Antibiotik Resistance Genes (ARG) seperti bla_CTX-M yang paling banyak ditemukan dan memberikan resistansi terhadap antibiotik sefotaksim. Hingga saat ini, belum ada penelitian yang bertujuan untuk mendeteksi keberadaan gen bla_CTX-M pada Sungai Bekasi. Penelitian ini bertujuan untuk menganalisis konsentrasi bakteri Escherichia coli non-selektif dan resistan pada hilir Sungai Bekasi, menganalisis keberadaan ARG bla_CTX-M pada bakteri E. coli tersebut, serta memberikan rekomendasi lokasi sampling bakteri E. coli untuk mendeteksi AMR. Metode Polymerase Chain Reaction pada penelitian ini digunakan untuk mengamplifikasi DNA dan dilanjutkan dengan elektroforesis untuk pembacaan ukuran DNA. Berdasarkan hasil penelitian, hilir Sungai Bekasi memiliki rata-rata konsentrasi bakteri E. coli non-selektif sebesar 261 CFU/mL dengan titik sampling 1/3 dari pinggir sungai dan sebesar 207 CFU/mL dengan titik sampling di pinggir sungai. Sedangkan, rata-rata konsentrasi bakteri E. coli resistansi antibiotik sefotaksim sebesar 26 CFU/mL dengan titik sampling 1/3 dari pinggir sungai dan sebesar 20 CFU/mL dengan titik sampling di pinggir sungai. Rasio perbandingan bakteri E. coli resisten antibiotik dengan bakteri E. coli non-selektif adalah 9,78% dengan titik sampling 1/3 dari pinggir sungai dan 9,27% dengan titik sampling di pinggir sungai. Hasil penelitian mendapatkan bahwa adanya keberadaan gen resistansi antibiotik bla_CTX-M pada hilir Sungai Bekasi sebanyak 80% dari sampel yang diambil. Dimana gen yang mendominasi adalah CTX-M grup 1 yang beranggotakan gen CTX-M-1, CTX-M-3, dan CTX-M-15. Hasil penelitian juga menunjukan bahwa sampel dari pinggir sungai memiliki hasil yang lebih homogen dan lebih mudah untuk dilakukan.

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Antimicrobial Resistance (AMR) causes a decrease in the effectiveness of treatment and can be detected by the presence of Antibiotic Resistance Genes (ARG) such as bla_CTX-M which is the most commonly found and provides resistance to the antibiotic cefotaxime. Until now, there has been no research aimed at detecting the presence of the bla_CTX-M gene in the Bekasi River. This study aims to analyze the concentration of non-selective and resistant Escherichia coli bacteria at downstream of the Bekasi River, analyze the presence of ARG bla_CTX-M in the E. coli bacteria, and provide recommendations for sampling locations for E. coli bacteria to detect AMR. The Polymerase Chain Reaction method in this study was used to amplify DNA and was followed by electrophoresis to read the size of the DNA. Based on the research results, the downstream Bekasi River has an average concentration of non-selective E. coli bacteria of 261 CFU/mL with a sampling point 1/3 from the riverbank and 207 CFU/mL with a sampling point on the riverbank. Meanwhile, the average concentration of cefotaxime-resistant E. coli bacteria was 26 CFU/mL with a sampling point of 1/3 from the riverbank and 20 CFU/mL with a sampling point on the riverbank. The ratio of antibiotic resistant E. coli bacteria to non-selective E. coli bacteria was 9.78% with a sampling point of 1/3 from the riverbank and 9.27% with a sampling point on the riverbank. The results of the study found that the presence of the bla_CTX-M antibiotic resistance gene in the downstream of the Bekasi River was as much as 80% of the samples taken. Where the dominant gene was CTX-M group 1 consisting of the CTX-M-1, CTX-M-3, and CTX-M-15. The results of the study also shown that samples from the riverbank have more homogeneous results and are easier to carry out."

"Seven antibiotics including norfloxacin (NOR) were tested via disk susceptibility test on E. coliculture isolated from the MLSS of the two types of lab-scale sequencing batch reactors (SBR), acommon SBR and an SBR with rnicrofiltration membrane (SB-MBR) for treatment of syntheticmunicipal wastewater. The same experiment treating the NOR-added wastewater to examine thepossible induction of resistance to itself and the other antibiotics. The MLSS from Banglculture (TISTR780) were spiked daily into both reactors. The reactors were continuously operatedunder 2hr/2hr of aeration/non-aeration cycle and resistances to antibiotics of E. coli in MLSS weremonitored. When NOR was not added, the SB-MBR showed lower percentages of resistant E. colithan the SBR did to amoxicillin/clavulanic acid, amikacin, nalidixic acid, tetracycline andchloramphenicol. Oppositely, the SB-MBR treating the NOR-added wastewater appeared topromote resistances of E. coli to nalidixic acid, sulfamethoxasole and tetracycline probably due to along SRT and low DO compared to that of SBR. Although its mechanism should be analyzed withmolecular techniques in further studies, this NOR-induced expression of resistance resulted in ahigher occurrence of multidrug resistant E. coli in the SB-MBR than that in the SBR."

"Ketersediaan air bersih yang aman dan sehat menjadi tantangan utama dalam memastikan keberlanjutan kehidupan manusia dan ekosistem di sekitarnya. Penelitian ini mengangkat permasalahan kualitas air danau, khususnya Danau Mahoni di Kampus Depok Universitas Indonesia, yang terpapar oleh tingkat pencemaran bakteri Escherichia coli yang melebihi standar keamanan air. Melalui pemodelan sistem dinamis, penelitian ini bertujuan untuk menganalisis konsentrasi eksisting pencemaran bakteri E. Coli, menyimulasikan model dinamis konsentrasi bakteri, dan menyusun strategi intervensi untuk meningkatkan kualitas air danau tersebut. Metode pengambilan sampel air akan dilakukan berdasarkan SNI 9063:2022 dan pengujian sampel Bakteri E. Coli dilakukan menggunakan metode Total Plate Count dengan media Triptone Bile X-Glucuronida. Model akan disimulasikan menggunakan aplikasi Vensim PLE. Hasil pengujian laboratorium menunjukkan konsentrasi bakteri E. Coli pada Danau Mahoni berada pada rentang 1,0 x 103 hingga 1,003 x 105 CFU/100 ml. Hasil simulasi kondisi eksisting menunjukkan konsentrasi bakteri E. Coli pada Danau Mahoni pada rentang 2,05 x 102 hingga 1,9 x 105 CFU/100 ml dengan nilai validasi MAPE sebesar 7% untuk segmen 1 (kategori sangat baik), 13% untuk segmen 2 (kategori baik), dan 18% untuk segmen 3 dan masuk kedalam kategori baik. Terdapat dua strategi intervensi perbaikan kualitas pencemaran bakteri E. Coli yaitu dengan pembangunan IPAL dan pembuatan Disinfeksi Ultraviolet pada kedua kanal inlet danau.

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The availability of clean and safe water presents a major challenge in ensuring the sustainability of human life and surrounding ecosystems. This research addresses the issue of water quality in lakes, particularly Lake Mahoni at the University of Indonesia's Depok Campus, which is exposed to levels of Escherichia coli (E. coli) bacteria pollution that exceed water safety standards. Through dynamic system modeling, this research aims to analyze the existing concentration of E. coli bacterial contamination, simulate a dynamic model of bacterial concentration, and develop intervention strategies to improve the water quality of the lak. Water sampling will be conducted according to SNI 9063:2022 standards, and E. coli bacteria testing will be performed using the Total Plate Count method with Triptone Bile X-Glucuronida media. The model will be simulated using the Vensim PLE application. Laboratory test results show that the concentration of E. Coli bacteria in Lake Mahoni is in the range of 1.0 x 103 to 1.003 x 105 CFU/100 ml. Simulation results of existing conditions show that the concentration of E. Coli bacteria in Lake Mahoni is in the range of 2.05 x 102 to 1.9 x 105 CFU/100 ml with MAPE validation values of 7% for segment 1(very good category), 13% for segment 2 (good category), and 18% for segment 3 and included in the good category. There are two intervention strategies to improve the quality of E. Coli bacterial contamination, namely by constructing an IPAL and constructing Ultraviolet Disinfection in the two inlet canals of Lake Mahoni."

"Latar belakang. Bakteremia yang disebabkan oleh kuman resisten antibiotik Escherichia coli (E. coli) penghasil Extended-Spectrum Beta-Lactamase (ESBL) dipengaruhi beberapa faktor risiko. Kondisi ini dapat berlanjut menjadi sepsis yang dapat meningkatkan tingginya morbiditas dan mortalitas. Prevalensi bakteremia yang disebabkan E. coli penghasil ESBL cukup tinggi mencapai 57,7%. Pentingnya melakukan penelitian untuk mengevaluasi faktor risiko pada terjadinya bakteremia E. coli penghasil ESBL yang dapat menyebabkan tingginya biaya perawatan dan penggunaan antibiotik yang tidak sesuai di awal sebagai antisipasi terhadap kejadian mortalitas. Penelitian ini bertujuan mengidentifikasi faktor risiko bakteremia E. coli penghasil ESBL dan menentukan faktor risiko terhadap mortalitas.Metode. Penelitian kohort retrospektif menggunakan data rekam medis pasien kultur darah positif E. coli yang di rawat pada dua Rumah Sakit Rujukan di Jakarta yaitu Rumah Sakit Umum Pusat Nasional (RSUPN) Dr. Cipto Mangunkusumo dan Rumah Sakit Umum Pusat (RSUP) Persahabatan periode Januari sampai Desember 2019. Faktor risiko terjadinya ESBL yang dicari sesuai dengan kepustakaan adalah usia, komorbiditas berdasarkan indeks Charlson, pemakaian alat medis, riwayat terapi antibiotik dan riwayat perawatan sebelumnya serta faktor risiko terhadap mortalitas. Uji bivariat perbedaan dua kelompok kategorik (Chi-square atau Fisher) dan uji regresi logistik multivariat dilakukan untuk menentukan faktor yang berpengaruh terhadap bakteremia ESBL dan mortalitas.Hasil. Total 116 subjek dalam kurun waktu penelitian dengan usia ≥18 tahun sebanyak 81% subjek, didominasi 52,6% berjenis kelamin laki-laki. Sumber lokasi infeksi terbanyak berasal dari saluran cerna dan intra abdomen yang ditemukan pada 43 subjek (37,1%) dan sebanyak 54 subjek (46,6%) memiliki komorbiditas keganasan. Faktor risiko yang bermakna secara statistik pada seluruh subjek adalah riwayat terapi antibiotik (adjusted OR 2,78; IK95% 1,20–6,45; p=0,017) dan pemakaian alat medis (adjusted OR 3,21; IK95% 1,10–9,34; p=0,033), sementara pada pasien ≥18 tahun (94 subjek) hanya faktor riwayat terapi antibiotik yang bermakna (adjusted OR 2,77; IK95% 1,13 – 6,81; p= 0,027). Tidak terdapat perbedaan mortalitas antara bakteremia E.coli penghasil ESBL dan non-ESBL (p=0,059). Proporsi mortalitas bakteremia E. coli penghasil ESBL adalah 55,7% dan faktor risiko mortalitas yang bermakna adalah usia (adjusted OR 15,0; IK95% 1,54–146,0; p=0,020) dan sepsis (adjusted OR 6,5; IK95% 1,91–22,16; p=0,003).Simpulan. Faktor risiko terjadinya bakteremia E. coli penghasil ESBL adalah riwayat terapi antibiotik dan pemakaian alat medis. Lebih dari separuh pasien mengalami mortalitas dan faktor risiko yang berhubungan adalah usia dan sepsis.

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Background. Bacteremia caused by the Extended-Spectrum Beta-Lactamase (ESBL)-producing Escherichia coli (E. coli) causing septicaemia and lead to high morbidity and mortality. Factors to ESBL bacteremia are important to recognize soon as patient admitted to hospital since the prevalence of ESBL bacteremia is as high as 57,7% among admitted patient to hospital. The understanding of the risk factors ESBL-producing E. coli bacteremia give the opportunity to provide costs effective treatment costs and antibiotics use to save the lives. This study aims to identify and analyze the risk factor in bacteremia patients with ESBL producing E. coli and its mortality.

Methods. A retrospective cohort study based on medical record data on all patients with a confirmed positive E. coli blood culture examinations were collected from January to December 2019 at two referral hospital in Jakarta, Cipto Mangunkusumo National Hospital and Persahabatan Hospital. Identified risk factors for ESBL-producing E. coli bacteremia were age, comorbidities based on the Charlson index, medical devices, history of hospitalization and history of antibiotics therapy including risk factors on mortality. Bivariate analysis of categorical group differences (Chi-square or Fisher test) and multivariate analysis with logistic regression tests were performed to identify the correlation of these factors to ESBL bacteremia and mortality.

Results. A total of 116 subjects E. coli bacteremia were included, eighty one percent of subjects ≥18 years old and 52.6% was male. The common site of infection was gastrointestinal tract 37.1% (43 subjects) and 54 subjects (46.6%) had malignancy comorbidity. History of antibiotic therapy (adjusted OR 2.78; 95%CI 1.20–6.45; p=0.017) and medical devices (adjusted OR 3.21; 95%CI 1.10–9.34; p=0.033) were associated with ESBL bacteremia. Among patients ≥18 years old (94 subjects) marely the history of antibiotics (adjusted OR 2.77; 95% CI 1.13 – 6.81; p= 0.027) was associated with ESBL-producing E. coli bacteremia. Mortality among bacteremia ESBL and non-ESBL-producing E. coli were not significantly different (p=0.059). Mortality was found 55,7% among ESBL-producing E. coli bacteremia and associated independent risk factors were age (adjusted OR 15.0; 95%CI 1.54–146.0; p=0.020) and sepsis (adjusted OR 6.5; 95%CI 1.91–22.16; p=0.003).

Conclusion. The risk factors for ESBL-producing E. coli bacteremia patients were a history of antibiotic therapy and medical devices. High mortality was found in patient with ESBL-producing E.coli bacteremia and the risk factors was associated with mortality were age and sepsis."

"ABSTRACTLatar Belakang: Organisme yang memproduksi ESBL merupakan masalah kesehatan masyarakat di seluruh dunia. Salah satu organisme yang paling sering yang menghasilkan ESBL yaitu Escherichia coli E.coli . Bakteri yang memproduksi ESBL lebih resisten terhadap antibiotik dan mengakibatkan infeksi menjadi lebih sulit untuk diobati. Di Indonesia, tidak banyak data yang memadai mengenai prevalensi E. coli yang memproduksi ESBL, terutama di Jakarta.Tujuan dari penelitian ini yaitu untuk memberikan laporan terkini tentang munculnya E. coli yang memproduksi ESBL di Indonesia.Metode: Isolat E. coli diambil dari berbagai sampel klinis pasien yang diperoleh dari Laboratorium Mikrobiologi Klinik, Universitas Indonesia pada tahun 2009-2014. Jenis data isolat yang digunakan berupa data sekunder mengenai kerentanan E. coli terhadap beberapa antimikroba. Data dianalisis menggunakan SPSS versi 20 untuk melihat kemungkinan terdapatnya kenaikan atau penurunan prevalensi E. coli penghasil ESBL yang terjadi secara signifikan.Hasil: Dari total 471 isolat E. coli, 56 11.9 merupakan E. coli penghasil ESBL. Prevalensi E. coli yang memproduksi ESBL menunjukkan kecenderungan menurun setiap tahun dari tahun 2009 sampai 2014, kecuali tahun 2012-2014, terdapat sedikit peningkatan. Namun secara statistik, penurunan atau kenaikan prevalensi tersebut, secara statistik tidak bermakna dengan p>0.05. Prevalensi E.coli yang memproduksi ESBL pada tahun 2009-2014 berturut-turut 19.1 , 21.2 , 6.9 , 5.4 , 7.56 , dan 8 .Kesimpulan:Terjadi penurunan prevalensi Escherichia coli yang memproduksi ESBL pada tahun 2009-2014, namun hasilnya tidak signifikan secara statistik. Kata kunci: E. coli, Extended-spectrum beta-lactamases, Indonesia.

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ABSTRACTBackground ESBL producing organism has been a public health concern in the entire world. One of the most prevalent organisms that produce ESBL is Escherichia coli E.coli . The production of ESBL has made bacteria to be more resistant to antibiotics and therefore make infections harder to treat. In Indonesia, there is not many adequate data regarding prevalence of ESBL producing E. coli, especially in Jakarta. The aim of this research is to provide an updated report about the emergence of ESBL producing E. coli in Indonesia.Method E. coli isolates are obtained from many clinical samples of patients obtained from Clinical Microbiology Laboratory, Universitas Indonesia from 2009 2014. The isolates data was obtained as a secondary data that has been tested for its antimicrobial susceptibility. The data was analyzed using SPSS version 20 to see whether the increase or decrease was statistically significant.Results From a total of 471 E. coli isolates, 56 11.9 are identified as ESBL producing E. coli. The prevalence of positive ESBL producing E. coli decreased each year from 2009 to 2014, except for 2012 to 2014 where there is a slight increase. However, the decrease or increase of the prevalence was not statistically different p 0,05 . This p value illustrated that the change in prevalence was not significant from year to year. The prevalence of ESBL producing E. colifrom 2009 to 2014 was 19.1 , 21.2 , 6.9 , 5.4 , 7.56 , and 8 respectively.Conclusion There has been a decrease in the prevalence of ESBL producing Escherichia coli from 2009 2014. However, the result is statistically insignificant. "

"Enterobacter penghasil extended spectrum beta-lactamse (ESBL) merupakan organisme yang resisten terhadap beta-lactamase jenis baru seperti sefalosporin. Kejadian ESBL pada instansi kesehatan diketahui meningkatkan lama rawat pasien, biaya perawatan, dan angka kematian. Prevalensi ESBL juga terus meningkat secara signifikan sehingga ESBL merupakan masalah yang serius bagi dunia kesehatan. Pasien yang di rawat di rumah sakit, khususnya Intensive Care Unit (ICU) cenderung memiliki risiko yang lebih tinggi untuk mengalami kolonisasi ESBL.Tujuan penelitian ini yaitu mengetahui prevalensi ESBL di ICU dan hubungannya dengan salah satu faktor risiko kolonisasi, yaitu riwayat rawat inap. Penelitian ini menggunakan metode cross-sectional dengan sampel sejumlah 97 orang yang merupakan pasien ICU Rumah Sakit Ciptomangunkusumo (RSCM) dalam tahun 2011. Identifikasi ESBL dilakukan dengan uji laboratorium mikrobiologi sesuai standar The Clinical and Laboratory Standards Institute (CLSI) 2010. Data riwayat rawat inap didapatkan dari rekam medik pasien yang kemudian dikategorikan menjadi pernah dirawat dan tidak pernah dirawat. Hasil uji labotatorium menunjukkan 26 dari 97 sampel (26.8%) mengalami kolonisasi ESBL. Data kemudian dianalis menggunakan uji hipotesis chi-square. Hasil analisis menunjukkan bahwa tidak terdapat hubungan bermakna antara riwayat rawat inap dengan kejadian ESBL (p=0.798). Dari hasil tersebut, dapat disimpulkan bahwa tidak terdapat hubungan antara riwayat rawat inap sebelum masuk ICU dengan angka kejadian ESBL di ICU RSCM pada tahun 2011.

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Enterobacter producing extended spectrum beta lactamases (ESBL) are organisms which develop resistance to new type beta-lactam antibiotic. ESBL in health instances are known to increase hospital length of stay, costs, and mortality rate. ESBL prevalences increase significantly nearly in every part of the world. Hospitalized patient, especially those in Intensive Care Unit (ICU) tend to have an increased risk of ESBL colonization. Thus ESBL is a serious threat. The objectives of this study is to identify the prevalence of ESBL in ICU and its correlation with hospital admission history. This study used cross-sectional design with 97 samples taken from ICU Rumah Sakit Ciptomangunkusumo (RSCM) in 2011. Identification of ESBL used the standardized method according to The Clinical and Laboratory Standards Institute (CLSI) 2010. The hospital admission history data was taken from patient’s medical record in ICU. Laboratory test results show 26 of 97 samples (26.8%) were colonized with ESBL. Chi-square is used to analyze the data which shows that there is no correlation between hospital admission history and ESBL colonization (p=0.798). It is concluded that there is no correlation between hospital admission history and ESBL colonization in ICU RSCM in 2011."

"Resistensi terhadap antibiotik pada bakteri dan penyebarannya di lingkungan menjadi ancaman terhadap kesehatan masyarakat. Keberadaan bakteri resisten terhadap antibiotik dipicu oleh aktivitas antropogenik, salah satunya adalah penyalahgunaan antibiotik. Bakteri resisten terhadap antibiotik yang ditemukan di lingkungan domestik dapat menimbulkan risiko kesehatan pada warga setempat. Penelitian ini dilakukan untuk mengetahui konsentrasi bakteri E. coli resisten di lingkungan domestik di Kota Bekasi, menilai risiko kesehatan yang ditimbulkan akibat paparan mikroorganisme, dan mengidentifikasi rute paparan bakteri E. coli resisten terhadap antibiotik ke manusia. Identifikasi konsentrasi bakteri E. coli resisten terhadap antibiotik menggunakan kultur bakteri dan penilaian risiko dilakukan menggunakan metode Quantitative Microbial Risk Assessment (QMRA). Hasil penelitian menunjukkan rata-rata konsentrasi bakteri E. coli resisten terhadap antibiotik (n=3) di tanah sebesar 1,28  105 CFU/mL, air sungai sebesar 3,9  101 CFU/mL, tangki septik sebesar 8,06  102 CFU/mL, feses ayam sebesar 1,33  106 CFU/mL, sedangkan di air tanah tidak ditemukan keberadaan E. coli resisten terhadap antibiotik. Penilaian risiko dengan metode QMRA pada bakteri E. coli resisten terhadap antibiotik dilakukan pada galur E. coli O157:H7 sebagai galur yang paling umum menyebabkan penyakit diare pada manusia. Probabilitas infeksi harian (Pinf,d) yang disebabkan oleh bakteri E. coli O157:H7 di tanah berkisar antara 33,37% - 36,99% sesuai kelompok usia dengan probabilitas infeksi tahunan (Pinf,a) 100% dengan probabilitas munculnya penyakit (Pill) sebesar 25%. Sementara itu, probabilitas infeksi harian (Pinf,d) yang disebabkan oleh bakteri E. coli O157:H7 di air sungai berkisar antara 4,88% - 14,28% dengan probabilitas infeksi tahunan (Pinf,a) 99% - 100% dan probabilitas munculnya penyakit (Pill) adalah 24,9% - 25% tergantung jenis ingestinya. Berdasarkan penilaian risiko tersebut, rute paparan bakteri E. coli resisten terhadap antibiotik ke manusia melalui media tanah dan air sungai, sehingga pencegahan dapat dilakukan untuk menangani risiko kesehatan pada manusia seperti meminimalisir penggunaan air sungai untuk aktivitas domestik, peningkatan fasilitas sanitasi, dan penerapan teknologi atau metode pencegahan resistensi terhadap antibiotik.

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The occurrence of antibiotic-resistant bacteria in the environment is a threat to public health. The spread of antibiotic-resistant bacteria in the environment is influenced by anthropogenic activities, such as antibiotic misuse. Antibiotic-resistant bacteria found in the domestic environment pose a health risk to inhabitants. This study aims to identify antibiotic-resistant E. coli concentration in a domestic environment in Bekasi City, assess public health risks associated with exposure to pathogenic bacteria, and identify the exposure route of antibiotic-resistant E. coli to humans. The bacterial culture method was used to identify the concentration of antibiotic-resistant E. coli and the risk assessment was carried out using Quantitative Microbial Risk Assessment (QMRA). The results showed the average concentration of antibiotic-resistant E. coli (n=3) found in soil was 1,28  105 CFU/mL, in river water was 3,9  101 CFU/mL, in septic tank effluent was 8,06  102 CFU/mL, chicken feces was 1,33  106 CFU/mL, and none found in groundwater. Risk assessment was carried out using QMRA on E. coli O157:H7 strain as the most common strain to cause diarrheal illness in humans. The daily probability of infection (Pinf,d) caused by E. coli O157:H7 in soil ranged from 33,37% - 36,99% according to the age group with an annual probability of infection of 100% and the probability of illness obtained was 25%. Furthermore, the daily probability of infection caused by E. coli O157:H7 in river ranging from 4,88% - 14,28% with annual probability of infection (Pinf,a) ranged from 99% - 100% depending on the types of ingestion with the probability of illness obtained ranged from 24,9% - 25%. Based on the risk assessment, the exposure route of antibiotic-resistant E. coli can be determined by involving human, animal, and environmental sectors. Routes help to identify prominent exposure pathways in posing health risks to humans. The study revealed the route of antibiotic-resistant E. coli contamination to humans through environmental matrices, such as soil and river. Therefore, prevention can be done in order to deal with human health risks, such as reducing domestic uses of river water for communities, improving sanitation facility, and the application of technology and prevention methods to combat antibiotic resistance."