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Soedarsono
The risk factors of multidrug-resistant organisme in hospitalized patients with community-acquired pneumonia in dr. soeromo hospital Surabaya, Indonesia
"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."
Jakarta: University of Indonesia. Faculty of Medicine, 2021
610 UI-IJIM 53:2 (2021)
Artikel Jurnal  Universitas Indonesia Library
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Purba, Abdul Khairul Rizki
Analisis cost effectiveness terapi antibiotik empirik berdasarkan hasil sensitivitas antibiotik pada pasien pneumonia komunitas rawat inap di RSU Dr. Soetomo, Surabaya = Cost effectiveness analysis of empirical antibiotics use under antimicrobial susceptibility for hospitalized community pneumonia in Dr. Soetomo Hospital Indonesia
"[ABSTRAK
Latar belakang:
Penggunaan antibiotik empirik pada tata laksana penyakit infeksi, misalnya pneumonia
komunitas, sebaiknya mempertimbangkan bukti kemanfaatan klinis dan hasil
sensitivitas antibiotik pada suatu institusi pelayanan kesehatan. Penggunaan antibiotik
yang tidak tepat dapat menyebabkan kegagalan terapi, resistensi kuman, komplikasi
dan kematian. Biaya yang tinggi juga merupakan keluaran langsung dari penggunaan
antibiotik namun biasanya tidak dilaporkan. Oleh sebab itu, analisis terhadap biaya,
keluaran klinis, dan pola sensitivitas kuman menjadi sangat penting untuk menentukan
antibiotik empirik pada terapi pneumonia komunitas.
Tujuan:
Tujuan penelitian ini adalah menentukan antibiotik yang paling efektif dari aspek biaya
dan keluaran klinis pada tata laksana pneumonia komunitas.
Metode:
Penelitian ini dilakukan secara retrospektif pada pasien pneumonia komunitas di RSU
Dr. Soetomo Surabaya sejak 1 Januari sampai 31 Desember 2013. Analisis cost
effectiveness digunakan untuk evaluasi farmakoekonomi berdasarkan perbaikan klinis
hari 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 sekitar
67,3%. Seftriakson merupakan antibiotik empirik yang paling efektif dengan ACER
505.585,3 untuk perbaikan klinis hari ke-5 namun hasil sensitivitas kuman
menunjukkan bahwa seftazidim masih lebih sensitif dari pada seftriakson (61,1% vs
38,5%) dengan nilai ACER seftazidim sebesar 763.322. Kombinasi seftazidim dan
levofloksasin digunakan untuk pasien dengan klinis yang buruk (PSI: 84,1+28,6) dan
berdampak pada tingginya biaya pengobatan (ACER 23685450.5).
Kesimpulan:
Seftazidim dapat dipertimbangkan sebagai antibiotik empirik yang efektif dan efisien
dalam 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. ]"
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Annisa Sutera Insani
Faktor risiko dan pola kuman hospital acquired pneumonia (HAP) di Rumah Sakit Rujukan Respirasi Nasional Persahabatan = Risk factors and microorganisms profile hospital acquired pneumonia (HAP) in National Respiratory Referral Hospital Persahabatan
"ABSTRAK
Metode : Penelitian ini menggunakan studi kasus kontrol berpasangan, dilakukan di ruang rawat inap RSUP Persahabatan pada bulan November 2018-Maret 2019. Kriteria kasus semua pasien yang terdiagnosis HAP saat perawatan, kriteria kontrol berpasangan adalah, jenis kelamin sama dengan kasus, usia ± 10 tahun dengan kasus dan dirawat di ruang perawatan yang sama dengan kasus. Pada kelompok kasus dan kontrol dilakukan pemeriksaan foto toraks untuk melihat infiltrat baru dibandingkan dengan foto lama. Pada kelompok kasus dilakukan pemeriksaan biakan sputum dan darah sebagai data pola mikroorganisme HAP.
Hasil : Didapatkan 25 kasus HAP dan faktor risiko HAP dinilai dari 23 pasang subjek penelitia. Faktor risiko intrinsik yang paling berperan pada HAP adalah hipoalbuminemia (OR 5 [IK 95% 3,34-6,63], p=0,039). Faktor ekstrinsik HAP yang paling berperan adalah penggunaan obat lambung dengan (p=0,016). Pola mikroorganisme pasien HAP dari 25 pasien HAP biakan yang tumbuh 19 (78,7% dahak dan 21,3% darah). Lima belas sampel (78,9%) adalah Gram negatif, dan 5 (26,3%) diantaranaya adalah Acinetobacter baumanii. Dari 19 mikroorganisme yang tumbuh terdapat 63,5% MDRO.
Kesimpulan: Hipoalbuminemia adalah faktor risiko yang paling berperan dalam terjadinya HAP serta mikroorganisme terbanyak adalah Acinetobacter baumanii.
ABSTRACT
Background: Hospital acquired pneumonia (HAP) is the second largest cause of nosocomial infections. The pneumonia occurs after 48 hours of inpatient admission in hospital. Risk factors affecting HAP consists of intrinsic and extrinsic factors. Early detection of risk factors would decrease morbidity and mortality in HAP case.
Objectives: This study was to identify risk factors that influence the occurrence of HAP infections and microbiological profile of HAP patients.
Methods: This matched-case control study involved patients treated at regular wards (e.g. not an intensive care ward) of National Respiratory Referral Hospital Persahabatan Jakarta, Indonesia between November 2018 and March 2019. The case and control group were matched for their sex, age (±10 yo), and length of hospital stay (±7 days). Both groups received chest x-ray (CXR) examination while the control group exclusively received sputum and blood culture for microbiology of HAP.
Results: This study involved 25 HAP patients and 23 matched-control patients. The main intrinsic risk factor for HAP was hypoalbuminemia (OR 5.00 [CI95% 3.34-6.63], p=0.039) and the main extrinsic risk factor for HAP was administration of gastric medications (p=0.016). Nineteen out of 25 microbiological samples were collected; of which, 78.7% were collected from sputum culture and 21.3% were collected from blood culture. Fifteen (78.9%) of those were positive for Gram-negative, 5 (26.3%) were positive for Acinetobacter baumanii, and 12 (63.5%) were positive for multi-drug resistance organism."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
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UI - Tugas Akhir  Universitas Indonesia Library