Hasil Pencarian  ::  Simpan CSV :: Kembali

"Pendahuluan: Peningkatan resistensi antibiotik global menjadikan kolistin sebagai pilihan terapi untuk infeksi bakteri pandrug resistant (PDR). Namun, karena efek nefrotoksiknya, pemilihan kolistin harus dilakukan secara hati-hati setelah diperoleh hasil uji kepekaannya. Sifat molekul kolistin yang kompleks menyebabkan uji kepekaan tidak dapat dilakukan dengan metode difusi cakram atau mesin otomatis yang tersedia, sehingga diperlukan metode lain yang praktis dan dengan hasil yang baik.Metode: Sebanyak 120 isolat bakteri Gram negatif, terdiri dari Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, masing-masing berjumlah 30 isolat diuji kepekaannya terhadap kolistin. Metode uji menggunakan media CHROMagar Col-APSE dan sebagai baku emas digunakan metode broth microdilution (BMD). Hasil uji kepekaan dianalisis untuk mendapatkan sensitivitas, spesifisitas, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio serta akurasi.Hasil: Ditemukan sebanyak 20 isolat yang resisten terhadap kolistin dari 120 isolat yang diuji pada media CHROMagar Col-APSE. Diantara 20 isolat yang resisten kolistin tersebut, hanya 10 isolat yang resisten kolistin pada uji kepekaan dengan metode BMD. Didapatkan nilai sensitivitas 100% (95% CI, 72,25 – 100), spesifisitas 90,91% (95% CI, 84,07 – 94,9), Positive Predictive Value (PPV) 50% (95% CI, 29,93 – 70,07), Negative Predictive Value 100% (95% CI, 96,3 – 100), positive likelihood ratio 11 (95% CI, 9,04 – 13,38), negative likelihood ratio 0 (95% CI 0), dan nilai akurasi diagnostik 91.67% (95%CI, 85.34 – 95.41).Kesimpulan: Uji kepekaan bakteri Gram negatif terhadap kolistin dapat dilakukan menggunakan CHROMagar Col-APSE, dengan interpretasi dengan hati-hati. Bila hasil uji kepekaan bakteri Gram negatif terhadap kolistin ditemukan resisten berdasarkan CHROMagar Col-APSE, maka hasil tersebut perlu dikonfirmasi lebih lanjut menggunakan metode BMD.

---

Introduction: The global increase in antibiotic resistance has made colistin a therapeutic option for infections caused by pandrug-resistant (PDR) bacteria. However, due to its nephrotoxic effects, the use of colistin must be administered carefully after susceptibility test results are obtained. The complex molecular structure of colistin renders susceptibility testing unsuitable using the disc diffusion method or automated systems. Therefore, alternative methods that are both practical and capable of delivering accurate and reliable results are required.

Methods: A total of 120 Gram-negative bacterial isolates, consisting of Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa with a total of 30 isolates were tested for susceptibility to colistin. The susceptibility testing was conducted using CHROMagar Col-APSE, with the broth microdilution (BMD) method serving as the gold standard. The results were analyzed to determine sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and accuracy.

Results: A total of 20 colistin resistant isolates were identified out of 120 isolates tested on CHROMagar Col-APSE. Among these, only 10 isolates were confirmed as colistin-resistant by the broth microdilution (BMD) method. The analysis yielded a sensitivity of 100% (95% CI, 72.25–100), specificity of 90.91% (95% CI, 84.07–94.9), positive predictive value (PPV) of 50% (95% CI, 29.93–70.07), negative predictive value (NPV) of 100% (95% CI, 96.3–100), positive likelihood ratio of 11 (95% CI, 9.04–13.38), negative likelihood ratio of 0 (95% CI, 0), and diagnostic accuracy of 91.67% (95% CI, 85.34–95.41).

Conclusion: Colistin susceptibility testing for Gram-negative bacteria can be performed using CHROMagar Col-APSE, with careful interpretation. When colistin resistance is detected in Gram-negative bacteria based on CHROMagar Col-APSE results, these findings should be further confirmed using the broth microdilution (BMD) method."

""The founding objective of Koneman's Color Atlas and Textbook of Diagnostic Microbiology is to provide a clear exposition of procedures routinely employed in the laboratory identification of microbial agents causing infectious diseases"--Provided by publisher."

"Summary: This new 13th edition features the same comprehensive, authoritative content - and adds new and updated material throughout. The team of authors includes three well-respected clinical microbiologists, all of whom have experience both in the classroom and the clinical laboratory. A NEW section on clinical laboratory management. More case studies help to develop critical thinking skills, with answers in an appendix. More photos of the major organisms have been included to help in identifying different organisms."

"Penyakit infeksi merupakan salah satu masalah utama di negara berkembang saat ini. Keadaan ini memicu peningkatan frekuensi pemakaian anti mikroba sehingga resiko panresisten semakin besar. Tujuan penelitian ini adalah untuk melihat gambaran MIC mikroba panresisten terhadap anti mikroba yang paling sering digunakan di lingkungan RSUPNCM. Mikroba yang diuji merupakan mikroba panresisten yang terbanyak berdasarkan peta kuman yang disusun oleh Loho dkk pada bulan juli - desember 2012. Penelitian potong lintang ini terdiri dari 90 mikroba panresisten yaitu Acinetobacter spp, Pseudomonas spp dan Klebsiella spp. Data karakteristik sampel pemeriksaan dicatat dan dilakukan uji resistensi. Uji resistensi mengunakan metode difusi cakram dan metode MIC strip test kemudian dicari 'interpretative error' kedua metode. Pada ketiga mikroba yang panresisten dengan metode difusi cakram diketahui bahwa masih terdapat nilai intermediate dan sensitif dengan metode MIC strip test. Pada Acinetobacter spp nilai sensitif paling tinggi didapat pada anti mikroba CS sebesar 55 isolat (100%) dan diikuti dengan anti mikroba AK sebanyak 7 isolat (12,7%) dan oleh CAS 1 isolat (1.8%). Nilai intermediate tertinggi terdapa pada AK yaitu 6 isolat (10,9%) yang diikuti oleh CAS 1 isolat (1.8%). Pada Pseudomonas spp yang diperoleh nilai sensitif terbesar pada anti mikroba CS 17 isolat (89.5%) diikuti dengan AK yaitu sebesar 3 isolat (15.7%), Nilai intermediate tertinggi terdapat pada AK yaitu 6 isolat (31,5%) yang diikuti oleh CAS 4 isolat (21.1%) dan CS 2 isolat (10.5%). Klebsiella spp dengan jumlah 16 isolat didapatkan nilai sensitif tertinggi pada CS 16 isolat (100%) diikuti DOR dengan 2 isolat (12.5%) dan kemudian oleh AK dan CAS dengan masing masing 1 isolat (6.25%). Nilai intermediate terdapat pada DOR dan AK dengan masing masing 1 isolat (6.25%). Hasil nilai "interpretative error" menunjukan tidak ditemukan VME. Nilai MJE dan MNE Acinetobacter spp yang melebihi kriteria FDA adalah AK yaitu 12.7% dan 10.9%. Pada Pseudomonas spp nilai MJE yang melebihi kriteria FDA adalah AK, CAS dan DOR yaitu 15.7%, 10,5% dan 5,2%. Nilai MNE yang melebihi kriteria FDA adalah AK, CAS dan CS yaitu 31,5%, 21,1% dan 10,5%. Pada Klebsiella spp nilai MJE pada DOR, AK dan CAS yaitu 12.5%, 6.25% dan 6.25%. Nilai MNE pada AK dan DOR yaitu 6.25% dan 6.25%. Kami menyimpulkan bahwa untuk mikroba yang panresisten dengan metode difusi cakram dapat digunakan MIC test.

---

Infectious diseases are one of the major problems in developing countries today. This condition triggers an increase in frequency of anti-microbial used that leads increase panresistance. The purpose of this study was to descriptive of the MIC microbes resistant to anti-microbial is most often used in RSUPNCM. Microbes tested is the most resistant microbes germs based map compiled by Loho et al in July - December 2012.

This cross-sectional who study consisted of 90 microbes resistant ie. Acinetobacter spp, Pseudomonas spp and Klebsiella spp. The characteristics of the data sample are recorded and performed resistance test. Resistance test its done using the disc diffusion and MIC test strip method and then analized 'interpretative error' for both methods. On the third microbial panresisten with disc diffusion method is known that there are intermediate values and sensitive with MIC method. In Acinetobacter spp sensitive highest value whose obtained on the anti- microbial CS by 55 isolates (100 %) followed by antimicrobial and AK were 7 isolates (12.7 %) and by CAS 1 isolates ( 1.8 % ).

The highest intermediate value ie there exist at AK 6 isolates (10.9 %) , followed by CAS 1 isolates (1.8 %). In Pseudomonas spp were most sensitive to the values whose obtained anti- microbial CS 17 isolates (89.5 %) followed by the AK is equal to 3 isolates (15.7 %) , the highest intermediate value that is contained in AK 6 isolates ( 31.5 % ) , followed by CAS 4 isolates (21.1 %) and CS 2 isolates (10.5 %) . Klebsiella spp isolates whose obtained with the number 16, the highest score on the CS 16 sensitive isolates (100 %) followed DOR with 2 isolates (12.5 %) and then by AK and CAS with each 1 isolates (6,25 %). Intermediate values contained in DOR and AK with each 1 isolates ( 6,25 %).

Results of "interpretative error" is not found in Very major error. Minor error and Major error Acinetobacter spp that exceeds the FDA criteria are AK is 12.7% and 10.9%. In Pseudomonas spp Major error value that exceeds the FDA criteria are AK, CAS and DOR with 5.7%, 10.5% and 5.2%. The Minor error value that exceeds the FDA criteria are AK, CAS and CS are 31.5%, 21.1% and 10.5%. In Klebsiella spp, Major error on DOR, AK and CAS with 12.5%, 6:25% and 6:25%. The Minor error value on AK and DOR is 6:25% and 6:25%. We conclude that MIC test can be used for microbial panresisten with the disc diffusion."

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

---

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

"Berbagai penelitian memperlihatkan angka resistensi kuman patogen meningkat dengan tajam, sehingga angka morbiditas dan mortalitas akibat infeksi nosokomial makin meningkat pula. Penyebab resistensi utama pada kuman Gram negatif antara lain adalah extended-spectrum beta-lactamases (ESBLs) pada Klebsiella pneumoniae dan Escherichia coli. Dalam pemilihan pengobatan empirik untuk infeksi nosokomial, klinisi perlu mempertimbangkan pola resistensi setempat.Frekuensi kuman patogen dan pola resistensi dapat sangat berbeda antara satu negara dengan negara lain dan juga antar rumah sakit dalam suatu negara. Oleh karena itu surveilans setempat perlu dilakukan agar dapat menjadi pedoman pemberian terapi empirik dan tindakan-tindakan pengendalian infeksi.Pada penelitian ini uji resistensi dilakukan terhadap Klebsiella pneumoniae penghasil ESBL dan Escherichia colt penghasil ESBL dengan menggunakan metode Kirby-Bauer. Sejumlah 37 isolat Klebsiella pneumoniae penghasil ESBL dan 35 isolat Escherichia coif penghasil ESBL diperoleh sejak bulan September 2003 sampai dengan Mel 2004 dari 3 laboratroium di Jakarta dan Karawaci.Prevalensi Klebsiella pneumoniae penghasil ESBL adalah sebesar 33,03% dan Escherichia coli penghasil ESBL 20,11% Sensitivitas Kiebsiella pneumoniae penghasil ESBL terhadap meropenem, siprofloksasin, levofloksasin, piperasilinltazobaktam, sefoperazonlsulbaktam dan sefepim berturut-turut adalah 100%, 45,95%, 51,95%, 78,38%, 62,16% dan 72,97%. Dan sensitivitas Escherichia coli penghasil ESBL terhadap meropenem, siprofloksasin, levofloksasin, piperasilinltazobaktarn, sefoperazonlsulbaktam dan sefepim berturut-turut adalah 100%, 37,14%, 28,57%, 97,14%, 82,86% dan 60%.

---

Multiple surveillance studies have demonstrated that resistance among prevalent pathogen is increasing at an alarming rate, leading to greater patient morbidity and mortality from nosocomial infection. Important causes of Gram-negative resistance include extended-spectrum beta-lactamases (ESBLs) in Klebsiella pneumoniae and Escherichia coll. In selecting an empiric treatment for a nosocomial infection, one should consider the prevalent resistance patterns.

Pathogen frequency and resistance patterns may vary significantly from country to country and also in different hospitals within a country. Thus regional surveillance programs are essential to guide empirical therapy and infection control measures.

In this study antimicrobial susceptibility testing was performed using the Kirby-Bauer method against the ESBL producing K. pneumoniae and E. coli A total of 37 ESBL producing K. pneumoniae isolates and 35 ESBI producing E coil isolates were obtained from September, 2003 to May, 2004 from 3 laboratories in Jakarta and Karawaci.

The prevalence of ESBL producing K. pneumoniae was 33,03% and ESBL producing E. coil 20,11%. Susceptibility of ESBL producing K. pneumoniae isolates to meropenem, ciprofloxacin, levofloxacin, piperacillin/tazobactam, cefoperazonfsulbactam and cefepime was 100%, 45,95%, 51,95%, 78,38%, 62,16% and 72,97% respectively. And susceptibility of ESBL producing E. coil isolates to meropenem, ciprofloxacin, levofloxacin, piperacillinltazobactam, cefoperazonlsulbactam and cefepime was 100%, 37,14%, 28,57%, 97,14%, 82,86% and 60% respectively."

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

---

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

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

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

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

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

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

---

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

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

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

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

"Glycyrrhizae Succus dan air yang terdapat di dalamObat Batuk Hitam akan mempermudah tumbuhnya mila'oorganismesehingga Obat Batuk Hitam tidak bisa tahan lama. Telah di:lakukan perielitian stabilitas mil'obio1ogik Obat Batuk Hitam de=an pengawet NiDagin dan Asam Benzoat.Femeriksaan stabilitas milobiologik dilakukan de -ngan menghiturig jumlah miioo.anis1e total yang, terdaçatdi dalam Obat Batuk 1-litam den-an mempergunakan perbenihanAgar tripton soya. Untuk pemeriksaan bakteri patogen Escherichia coli, Salmonella, Shigella..dan Staphylococcus aureusdigunakan perbenihan perbenihan Agar Endo, Agar EMB, AgarSalmonella Shigella dan perbenihan gula-gula.Hasil yang diperoleh menunjukkan bahwa Obat Batul: -Hitam dent--an pengawet Nipagin 0,1% ; 0,15% dan 02% sesu -dali enam bulan masih memenuhi syarat. Demikian juga Obat -Batuk Hitam dengan pengawet Asam Benzoat 0,05% ; 0,1% dan0,15% sesudah enambulan masih memenuhi syarat.

---

The Glycyrrhizae Succus and water contained in Potio

Nigra Contra Tussim will make the microorganism's growth

easier, that cause Potio Nigra Contra Tussim unstable.There

fore the study to determine microbiological stability of Po

tio Nigra Contra Tussim with Ni pagin and Benzoic acid .• as

reservatives have been done.

The observation of microbiological stability carried

out by counting the total microorganism contained in Potio

Nigra Contra Tussim using Tryptic soya agar medium • To

observe patogeni.cmicrooranism such as Escherichia coli,

Salmonella, Shigella and Staphylococcus aureus, the media

Endo agar, EMB agar, Salmonella Shigella agax and sugars

media have been used.

The result obtained showed Potio Nira Contra Tussim

containing Nipagin 00% ; 0,15% and 0,2% after six month

still qualified.

The Potio Nigra Contra Tussim that contained Benzoic

acid 0,05% ; 00% and 0,15% after six month also give the

same result"