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"[ABSTRAKLatar Belakang : Pemberian kotrimoksazol diberikan sebagai standar pencegahan primer terhadap infeksi toksoplasmosis dan pneumonia Pneumocystis jirovecii (PCP) pada pasien HIV dengan CD4 kurang dari 200 sel/mm3 dan pasien tuberkulosis. Beberapa penelitian di luar negeri mendapatkan bahwa pemberian profilaksis kotrimoksazol belum sesuai dengan panduan nasional, sehingga perlu dilakukan penelitian untuk menilai kepatuhan dokter dalam meresepkan profilaksis primer kotrimoksazol.Tujuan : mengetahui pola peresepan dokter terutama dalam memulai, menghentikan, dosis obat, efek samping, durasi pemberian dan persentase lama pemberian profilaksis primer kotrimoksazol pada pasien HIVMetode : Studi ini merupakan studi kohort retrospektif dan mengambil data semua pasien HIV usia lebih dari 18 tahun yang berobat ke UPT HIV RSCM tahun 2004-2013 dan memenuhi kriteria pemberian profilaksis primer kotrimoksazol. Variabel yang diteliti adalah pola inisiasi peresepan, penghentian peresepan, dosis, durasi, persentase lama pemberian, serta ada tidaknya efek samping kotrimoksazolHasil : Sejumlah 3818 pasien mempunyai indikasi pemberian kotrimoksazol dengan nilai tengah usia pasien adalah 29 tahun, pria (79,1%), tuberkulosis (58,5%), stadium 3 dan 4 (86%). Nilai tengah CD4 saat awal adalah 51 sel/mm3 (RIK 101). Profilaksis primer kotrimoksazol sudah dimulai pada 83% pasien. Pemberian dosis kotrimoksazol sudah sesuai pedoman pada 99,8% pasien. Efek samping yang dari yang paling sering sampai yang jarang terjadi adalah peningkatan transaminase (38,1%), leukopenia (16,9%), anemia (16,5%), mual (15,4%), muntah (7,8%), trombositopenia (7,4%) dan alergi (5,3%). Efek samping yang menyebabkan penghentian peresepan adalah alergi (100%), anemia (2,4%), peningkatan transaminase (2,1%), muntah (0,8%) dan leukopenia (0,6%). Pola penghentian peresepan tidak sesuai pedoman pada 61,6% dengan nilai tengah persentase lama pemberian 87,5% (RIK 39) dan nilai tengah durasi pemberian profilaksis primer kotrimoksazol adalah 20 bulan (RIK 20). Durasi pada pasien dengan CD4≤100 sel/mm3 dan >100 sel/mm3 adalah 21 bulan (RIK 22) dan 12,5 bulan (RIK 14,75) dengan nilai p=0,000.Kesimpulan : walaupun pada saat awal 83% pasien HIV dewasa dilakukan pemberian profilaksis primer kotrimoksazol dengan pengaturan dosis yang sangat baik, namun 61,6% penghentian peresepan tidak sesuai pedoman.

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ABSTRACTBack Ground : Cotrimoxazole was standard of primary prevention against toxoplasmosis infection and Pneumocystis jirovecii pneumonia (PCP) in patients with CD4 less than 200 cell/mm3 and tuberculosis. Some study found that prophylactic use cotrimoxazole in patients with HIV was inappropriate with national guideline. It was necessary to have research in order to know clinician adherence to prescribe primary cotrimoxazole prophylaxis.Objective : to know initiation, discontinuation, dosage, adverse events, duration and duration percentage of primary cotrimoxazole prophylaxis in HIV patientsMethods : This was cohort retrospective study and was done in UPT HIV RSCM and subject of study were all patients more than 18 years old from 2004 to 2013 and had indication of primary cotrimoxazole prophylaxis. Variable in this study were initiation, discontinuation, dosage, duration, duration percentage and adverse events of primary cotrimoxazole prophylaxis.Result : There were 3818 patients had indication of primary cotrimoxazole prophylaxis with median age of study subjects were 29 years old, 79,1% were male, 58,5% were tuberculosis, WHO clinical stage 3 and 4 were 86%. Median CD4 at beginning was 51 cell/mm3 (IQR 101). Initiation of primary cotrimoxazole prophylaxis was performed in 83% patients who met indication. 99,8% patients used appropriate dose of cotrimoxazole. Frequent adverse events were increasing hepatic transaminase (38,1%), leucopenia (16,9%), anemia (16,5%), nausea (15,4%), vomiting (7,8%), thrombocytopenia (7,4%) and hypersensitivity (5,3%). Adverse event causing discontinuation were hypersensitivity (100%), anemia (2,4%), increasing hepatic transaminase (2,1%), vomiting (0,8%) and leucopenia (0,6%). Inappropriate discontinuation of cotrimoxazole was 61,6% with median duration percentage was 87,5% (IQR 39) and median of duration was 20 month (IQR 20). Duration in patients with CD4≤100 cell/mm3 and >100 cell/mm3 was 21 month (IQR 22) and 12,5 month (IQR 14,75) p=0,000.Conclusion : although initiation of primary cotrimoxazole prophylaxis was done in 83% adult HIV patients with appropriate dosage, but 61,6% discontinuation was inappropriate with guideline;Back Ground : Cotrimoxazole was standard of primary prevention against toxoplasmosis infection and Pneumocystis jirovecii pneumonia (PCP) in patients with CD4 less than 200 cell/mm3 and tuberculosis. Some study found that prophylactic use cotrimoxazole in patients with HIV was inappropriate with national guideline. It was necessary to have research in order to know clinician adherence to prescribe primary cotrimoxazole prophylaxis.Objective : to know initiation, discontinuation, dosage, adverse events, duration and duration percentage of primary cotrimoxazole prophylaxis in HIV patientsMethods : This was cohort retrospective study and was done in UPT HIV RSCM and subject of study were all patients more than 18 years old from 2004 to 2013 and had indication of primary cotrimoxazole prophylaxis. Variable in this study were initiation, discontinuation, dosage, duration, duration percentage and adverse events of primary cotrimoxazole prophylaxis.Result : There were 3818 patients had indication of primary cotrimoxazole prophylaxis with median age of study subjects were 29 years old, 79,1% were male, 58,5% were tuberculosis, WHO clinical stage 3 and 4 were 86%. Median CD4 at beginning was 51 cell/mm3 (IQR 101). Initiation of primary cotrimoxazole prophylaxis was performed in 83% patients who met indication. 99,8% patients used appropriate dose of cotrimoxazole. Frequent adverse events were increasing hepatic transaminase (38,1%), leucopenia (16,9%), anemia (16,5%), nausea (15,4%), vomiting (7,8%), thrombocytopenia (7,4%) and hypersensitivity (5,3%). Adverse event causing discontinuation were hypersensitivity (100%), anemia (2,4%), increasing hepatic transaminase (2,1%), vomiting (0,8%) and leucopenia (0,6%). Inappropriate discontinuation of cotrimoxazole was 61,6% with median duration percentage was 87,5% (IQR 39) and median of duration was 20 month (IQR 20). Duration in patients with CD4≤100 cell/mm3 and >100 cell/mm3 was 21 month (IQR 22) and 12,5 month (IQR 14,75) p=0,000.Conclusion : although initiation of primary cotrimoxazole prophylaxis was done in 83% adult HIV patients with appropriate dosage, but 61,6% discontinuation was inappropriate with guideline;Back Ground : Cotrimoxazole was standard of primary prevention against toxoplasmosis infection and Pneumocystis jirovecii pneumonia (PCP) in patients with CD4 less than 200 cell/mm3 and tuberculosis. Some study found that prophylactic use cotrimoxazole in patients with HIV was inappropriate with national guideline. It was necessary to have research in order to know clinician adherence to prescribe primary cotrimoxazole prophylaxis.Objective : to know initiation, discontinuation, dosage, adverse events, duration and duration percentage of primary cotrimoxazole prophylaxis in HIV patientsMethods : This was cohort retrospective study and was done in UPT HIV RSCM and subject of study were all patients more than 18 years old from 2004 to 2013 and had indication of primary cotrimoxazole prophylaxis. Variable in this study were initiation, discontinuation, dosage, duration, duration percentage and adverse events of primary cotrimoxazole prophylaxis.Result : There were 3818 patients had indication of primary cotrimoxazole prophylaxis with median age of study subjects were 29 years old, 79,1% were male, 58,5% were tuberculosis, WHO clinical stage 3 and 4 were 86%. Median CD4 at beginning was 51 cell/mm3 (IQR 101). Initiation of primary cotrimoxazole prophylaxis was performed in 83% patients who met indication. 99,8% patients used appropriate dose of cotrimoxazole. Frequent adverse events were increasing hepatic transaminase (38,1%), leucopenia (16,9%), anemia (16,5%), nausea (15,4%), vomiting (7,8%), thrombocytopenia (7,4%) and hypersensitivity (5,3%). Adverse event causing discontinuation were hypersensitivity (100%), anemia (2,4%), increasing hepatic transaminase (2,1%), vomiting (0,8%) and leucopenia (0,6%). Inappropriate discontinuation of cotrimoxazole was 61,6% with median duration percentage was 87,5% (IQR 39) and median of duration was 20 month (IQR 20). Duration in patients with CD4≤100 cell/mm3 and >100 cell/mm3 was 21 month (IQR 22) and 12,5 month (IQR 14,75) p=0,000.Conclusion : although initiation of primary cotrimoxazole prophylaxis was done in 83% adult HIV patients with appropriate dosage, but 61,6% discontinuation was inappropriate with guideline, Back Ground : Cotrimoxazole was standard of primary prevention against toxoplasmosis infection and Pneumocystis jirovecii pneumonia (PCP) in patients with CD4 less than 200 cell/mm3 and tuberculosis. Some study found that prophylactic use cotrimoxazole in patients with HIV was inappropriate with national guideline. It was necessary to have research in order to know clinician adherence to prescribe primary cotrimoxazole prophylaxis.Objective : to know initiation, discontinuation, dosage, adverse events, duration and duration percentage of primary cotrimoxazole prophylaxis in HIV patientsMethods : This was cohort retrospective study and was done in UPT HIV RSCM and subject of study were all patients more than 18 years old from 2004 to 2013 and had indication of primary cotrimoxazole prophylaxis. Variable in this study were initiation, discontinuation, dosage, duration, duration percentage and adverse events of primary cotrimoxazole prophylaxis.Result : There were 3818 patients had indication of primary cotrimoxazole prophylaxis with median age of study subjects were 29 years old, 79,1% were male, 58,5% were tuberculosis, WHO clinical stage 3 and 4 were 86%. Median CD4 at beginning was 51 cell/mm3 (IQR 101). Initiation of primary cotrimoxazole prophylaxis was performed in 83% patients who met indication. 99,8% patients used appropriate dose of cotrimoxazole. Frequent adverse events were increasing hepatic transaminase (38,1%), leucopenia (16,9%), anemia (16,5%), nausea (15,4%), vomiting (7,8%), thrombocytopenia (7,4%) and hypersensitivity (5,3%). Adverse event causing discontinuation were hypersensitivity (100%), anemia (2,4%), increasing hepatic transaminase (2,1%), vomiting (0,8%) and leucopenia (0,6%). Inappropriate discontinuation of cotrimoxazole was 61,6% with median duration percentage was 87,5% (IQR 39) and median of duration was 20 month (IQR 20). Duration in patients with CD4≤100 cell/mm3 and >100 cell/mm3 was 21 month (IQR 22) and 12,5 month (IQR 14,75) p=0,000.Conclusion : although initiation of primary cotrimoxazole prophylaxis was done in 83% adult HIV patients with appropriate dosage, but 61,6% discontinuation was inappropriate with guideline]"

"ABSTRAKHubungan Ketidaktepatan Pemberian Antibiotika Profilaksis denganKejadian Infeksi Daerah Operasi Post Laparatomi di RSPADGatot Soebroto Tahun 2014-2017Pembimbing : dr. Asri C. Adisasmita MPH., M.Phil., Ph.DInfeksi Daerah Operasi IDO termasuk salah satu dari Healthcare AssociatedInfection rsquo;s HAI 39;s yang paling banyak ditemukan seiring dengan meningkatnya jumlahtindakan operasi. Laparatomi merupakan jenis tindakan operasi yang paling berisikountuk terjadinya infeksi. Salah satu upaya pencegahan infeksi daerah operasi denganpemberian antibiotika profilaksis yang diberikan sebelum, saat dan sampai 24 jam setelahoperasi pada kasus yang secara klinis tidak didapatkan tanda-tanda infeksi. Penelitian inibertujuan untuk mengetahui hubungan ketidaktepatan pemberian antibiotika profilaksisdengan kejadian infeksi daerah operasi post laparatomi di RSPAD Gatot Soebroto Tahun2014-2017. Desain penelitian menggunakan studi kasus kontrol dengan pengambilan datasecara retrospektif menggunakan 268 sampel dari data rekam medik pasien post operasilaparatomi di RSPAD Gatot Soebroto pada tahun 2014-2017, kasus yaitu 67 pasien yangterjadi IDO dan kontrol 201 pasien tidak terjadi IDO . Analisa data dengan uji regresilogistik dengan conditional matching. Hasil penelitian menunjukkan waktu pemberianantibiotika profilaksis pre operasi tidak tepat memiliki risiko 5.17 kali terhadap kejadianinfeksi daerah operasi OR= 5.17 ; 95 CI=1.85-14.40 setelah dikontrol dengan variabellain. Variabel kovariat yang berhubungan terhadap kejadian infeksi daerah operasi yaitudiagnosis operasi digestif OR=3.51; 95 CI=1.04-11.83 , kadar albumin OR= 3.83;95 CI= 1.30-11.25 dan penyakit penyerta OR = 4.05 ; 95 CI=1.40-11.66 . Hasilpenelitian ini dapat menjadi masukan bagi RSPAD Gatot Soebroto untuk lebihmeningkatkan kepatuhan penggunaan antibiotika profilaksis secara tepat waktu, jenis,dosis dan durasi pemberian sesuai panduan untuk mencegah kejadian infeksi daerahoperasi.Kata Kunci: Antibiotika Profilaksis, Infeksi daerah operasi, Laparatomi.

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ABSTRACT Correlation of Inappropriate Antibiotic Prophylaxis with PostLaparatomy Surgical Site Infection at Gatot Soebroto Army CentralHospital Year 2014 to 2017Counsellor dr. Asri C. Adisasmita MPH., MPhil., Ph.DSurgical Site Infection SSI is one of the most commonly infection foundHealthcare Associated Infection 39 s HAI 39 s type as surgery procedure increases.Laparotomy is the type of surgery that is the most at risk for infection. One of theprevention efforts of surgical site infection is antibiotic prophylaxis administrationbefore, during and up to 24 hours after surgery in cases of clinically missing signs ofinfection. This study aims to determine the correlation of inappropriate antibioticsprophylaxis with the post laparatomy surgical site infection in Army Central Hospital RSPAD Gatot Soebroto from 2014 to 2017. The research design was case controlstudy with retrospective data retrieval, using 268 samples from medical record data ofpost laparotomy patient at Army Central Hospital RSPAD Gatot Soebroto from 2014to 2017, cases of 67 patients with SSI and control of 201 patients without SSI . Datawas analyzed using regression logistic conditional matching test. The result of thestudy showed that the inappropriate timing of antibiotic administration in preoperativetreatment made a risk of 5.17 times higher on the incidence of surgical site infection OR 5.17 95 CI 1.85 14.40 after control of other variables. Covariate variables,related to the incidence of surgical site infection, was digestive operation diagnose OR 3.51 95 CI 1.04 11.83 , albumin level OR 3.83 95 CI 1.30 11.25 and comorbid disease OR 4.05 95 CI 1.40 11.66 . The results of this studyhopefully can be an input data for Army Central Hospital RSPAD Gatot Soebroto,to improve adherence of correct timing, type, dose and duration of antibioticsprophylaxis according to guidelines of surgical site infection prevention.Key words Antibiotic Prophylaxis, Surgical Site Infection, Laparatomy"

"Infeksi daerah operasi (IDO) merupakan infeksi pada sayatan atau organ yang terjadi setelah pembedahan. Upaya pencegahan terhadap infeksi ini menjadi semakin penting dengan jumlah operasi yang semakin meningkat. Pemberian antibiotik profilaksis seringkali dianggap sebagai pencegahan IDO yang paling mudah dilakukan. Namun ketidaktepatan dalam penggunaannya dapat menjadi faktor risiko penyebab terjadinya IDO. Tujuan penelitian ini adalah untuk menganalisis ketidaktepatan penggunaan antibiotik profilaksis pada pasien bedah di RSUD Kota Depok pada periode Januari-Maret 2020. Penelitian ini dilakukan secara observasional dengan disain penelitian deskriptif cross sectional dan pengambilan data dilakukan secara retrospektif. Analisis dilakukan pada sampel sebanyak 139 menggunakan metode Gyssens. Hasil analisis ketidaktepatan penggunaan antibiotik profilaksis dengan metode Gyssens yaitu pada kategori VI sebanyak 138 sampel (99,28%), kategori V sebanyak 83 sampel (60,14%) kategori IVa sebanyak 52 sampel (94,54%). Untuk kategori IVb sampai IIc memiliki nilai yang sama yaitu sebanyak 0 sampel. Kategori I semua sampel tidak tepat waktu pemberian sehingga analisa berakhir pada kategori I dengan jumlah 3 sampel.(100%). Sedangkan angka kejadian infeksi daerah operasi pada pasien bedah di RSUD Kota Depok periode 1 Januari -19 Maret 2020 sebanyak 2,87%. Faktor penyebab terjadinya infeksi daerah operasi karena ketidaktepatan penggunaan antibiotik profilaksis pada waktu pemberian, kepatuhan pasien dan penyakit penyerta (komorbid).......Surgery area infection (SSI) is an infection of the incision or organ that occurs after surgery. prevention against this infection is becoming increasingly important with an increasing number of operations. Treatment of prophylactic antibiotics as the easiest prevention of SSIs. However, inaccuracy in its use can be a factor in causing SSI. The purpose of this study was to analyze the inaccuracy of prophylactic use in surgical patients at RSUD Kota Depok in the period January-March 2020. This study was conducted observational with a cross-sectional descriptive study and data collection was carried out retrospectively. The analysis was carried out on a sample of 139 using the Gyssens method. The results of the inaccuracy analysis of prophylactic antibiotics using the Gyssens method were 138 samples (99.28%) in category VI, 83 samples (60.14%) in category IVa as many as 52 samples (94.54%). For categories IVb to IIc, there are 0 samples. Category I all samples are not presented on time so that the analysis ends in category I with a total of 3 samples. (100%). Meanwhile, the incidence of infection in the surgical area in surgical patients at the Depok City Hospital for the period January 1-March 19 2020 was 2.87%. Factors causing regional infection due to inappropriate use of prophylactic antibiotics at the specified time, patient and comorbidities (comorbid)."

"Bedah katarak merupakan tindakan pembedahan yang paling sering dilakukan oleh seorang mata. Hal ini dapat dimengerti karena katarak merupakan penyebab kebutaan yang paling utama dan pemedahan merupakan salah satu pilihan dalam penanggulangan kebutaan katarak.Pilihan antibiotika pencegahan infeksi intraokular pasca bedah katarak di bagian Mata FKUI / RSCM selama ini berlebihan daripada yang disebutkan di kepustakaan, dan karenanya harus disesuaikan. Di bagian Ilmu Penyakit Mata FKUI / RSCM telah ditetapkan protokol bedah katarak yang baru dengan antara lain pemberian salep mata antibiotika setelah prosedur pengguntingan bulu mata pra bedah. Tidak disebutkan di situ jenis antibiotika apa yang akan digunakan, sehingga masih terbuka kesempatan untuk melakukan pengujian utuk menari antibiotika apa yang terbaik diberikan pada saat tersebut.Penelitian ini bertuuan membandingkan salep mata antibiotika Kloramfenikol dengan kombinasi Neomisin - Polimiksin B - Gramisidin dalam menurunkan jumlah bakteri pada mata pasien pra bedah katarak."

"Surgical site infections are the second most frequent nosocomial infection after catheter infection. They are associated with increase morbidity and mortality, iength of stay in hospital and cost of care. Antibiotic prophylaxis use is addressed to reduce incidence of surgical site infection. The aim of this research was to find out the pattern of antibiotic prophylaxis use; incidence of surgical site infection; association between antibiotic prophylaxis use and incidence of surgical site infection; and other factors that influence the incidence of surgical site infection. This research was carried out in Dr. Cipto Mangunkusumo Hospital Jakarta and it was a retrospective study with cross-sectional design. A total of 220 samples had been taken proportional randomly according to the type of surgery division from 1,841 medical records in 2005. The result showed that the most antibiotic prophylaxis frequently used was cephalosporin (first and third generation). followed by phosphomycin and metronidazole. Most of the patients were given antibiotic prophylaxis in inappropriate time and the duration of use was more than one day. This study found that the incidence of surgical site infection was 8.6% with the highest percentage occurred at orthopedic surgery (23.3%). Statistically, there was no relationship of class. Timing and duration of antibiotic prophylaxis use with incidence of surgical site infection. Adherence of antibiotic prophylaxis use to hospital guideline was not influenced the incidence of surgical site infection. Multivariate analysis with logistic regression analysis showed that the incidence of surgical site infection were influenced by the type of surgery (OR=2.6) and the use of antibiotics during hospitalization prior to surgery (OR=3.2). The conclusion of this research were the incidence of surgical site infection relatively high and class. timing, duration and adherence to hospital guideline of antibiotic prophylaxis use did not influence it. The wound contaminated and the use antibiotics during hospitalization prior to surgery were risk factors for surgical site infection. It was recommended that the hospital management revise the currently used surgical antibiotic prophylaxis guideline which is no longer relevant to the current situation."

"ABSTRAKNama : Echa AisyahProgram Studi : Ilmu Kesehatan MasyarakatJudul : Evaluasi Ekonomi Penggunaan Antibiotika Profilaksis CefotaximeDan Ceftriaxone Pada Pasien Operasi Seksio Sesarea Di RumahSakit X Tahun 2017Pemberian antibiotik profilaksis pada operasi seksio sesarea sangat dianjurkan.Menurut pedoman umum penggunaan antibiotik obat dipilih atas dasar keamanan danefektivitas biaya. Evaluasi ekonomi ini menggunakan metode alongside observationalstudy, data dikumpulkan selama bulan April ndash;Mei 2017 secara prospektif mencakup 60pasien dengan operasi seksio sesarea yang mendapatkan antibiotik profilaksis,membandingkan efektivitas biaya antara Cefotaxime dan Ceftriaxone. Hasil ujistatistik menunjukkan bahwa tidak ada perbedaan karakteristik pada 60 pasien tersebut.Analisis menggunakan perspektif rumah sakit, dilaksanakan di rumah sakit milikPemerintah di Jawa Barat. Hasil Systematic Review menunjukkan bahwa tidak adaperbedaan efikasi pada penggunaan kedua obat tersebut. Hasil penelitian inimenkonfirmasi bahwa tidak ada perbedaan outcome klinis berupa infeksi luka operasibaik pada pasien yang mendapatkan antibiotik profilaksis Ceftriaxone maupunCefotaxime. Komponen biaya terbesar adalah biaya operasional 84,79 , diikutibiaya alokasi dari unit penunjang 13,68 , lalu biaya investasi 1,2 dan biayapemeliharaan 0,32 . Analisis memberikan hasil biaya inkremental sebesar Rp.342.535,00 pada satu episode rawat inap. Rumah sakit memiliki potensi untukmenghemat sebesar Rp. 317.529.945,00 setahun dengan memilih antibiotik profilaksisCefotaxime pada pasien operasi seksio sesarea.Kata Kunci : Antibiotik Profilaksis; Operasi Seksio Sesarea; Efektivitas Biaya.

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ABSTRACTName Echa AisyahProgram of Study Public HealthTitle Economic Evaluation on The Use of Prophylaxis AntibioticCefotaxime and Ceftriaxone in Caesarean Section SurgeryPatients at X Hospital in The Year 2017.Prophylactic antibiotic for patients with caesarean section surgery is highlyrecommended in the clinical guideline. The use of antibiotics is selected by usingcriteria safety and cost effectiveness. This economic evaluation was using alongsideobservational study method, prospective data was collected from April to May 2017covering 60 patients with cesarean section surgery who received prophylaxisantibiotics, comparing cost effectiveness between Cefotaxime and Ceftriaxone. Thestatistical test showed that there was no differences of characteristics in the 60 patients.The analysis based on hospital perspective, carried out in a public hospital in WestJava. The Systematic Review showed that there were no difference in the efficacy ofthe drugs. This study confirmed that there was no difference in clinical outcome onsurgical wound infections either in patient who received Ceftriaxone prophylaxis orCefotaxime. The greatest component of the cost was the operational cost 84,79 ,followed by the indirect cost 13,68 , investment cost 1,2 , and maintenance cost 0,32 . The analysis suggested the incremental cost was IDR 342.535 in one episodeof treatment. Hospital would save cost of IDR 317.529.945 a year by choosingCefotaxime prophylactic antibiotics for patients with cesarean section surgery.Keywords Prophylaxis Antibiotic Cesarean Section Surgery Cost Effectiveness"

"ABSTRAKHemartrosis berulang dan artropati merupakan morbiditas utama pada hemofilia A berat. Bagi negara berkembang seperti Indonesia, terapi profilaksis dosis standar tidak terjangkau karena memerlukan biaya yang sangat mahal. Penelitian ini bertujuan mengetahui efektivitas terapi profilaksis sekunder dosis rendah dibandingkan terapi on-demand pada anak hemofilia A berat.Uji klinis acak terbuka selama 24 minggu telah dilakukan pada anak hemofilia A berat berusia 4?18 tahun dengan riwayat perdarahan sendi berulang, di Poliklinik Hematologi Departemen Ilmu Kesehatan Anak FKUI/RSCM. Subjek dialokasikan secara acak menjadi dua kelompok yaitu kelompok profilaksis dan on-demand. Kelompok profilaksis mendapat terapi faktor VIII 10 IU/kgBB 2 kali seminggu, sedangkan kelompok on-demand mendapat terapi sesuai protokol standar. Luaran primer adalah kekerapan perdarahan sendi dan luaran sekunder adalah skor HJHS) dan skor ultrasonografi (HEAD-US). Penelitian ini juga membandingkan kadar CTX-II urin dan inhibitor faktor VIII (Bethesda Assay) pada kedua kelompok.Sejak bulan Juni 2015?Februari 2016 didapatkan 50 subjek yang memenuhi kriteria inklusi. Kekerapan perdarahan sendi pada kelompok profilaksis (5 ± 4,3) lebih baik dari pada kelompok on-demand (8 (3?30)), IK95% 0.9?6.99; p = 0,009. Perubahan skor HJHS pada kedua kelompok menunjukkan perbaikan klinis pada kelompok profilaksis dan perburukan pada kelompok on-demand, walaupun tidak bermakna secara statistik (IK95% -0.99?3; p = 0,320). Skor HEAD-US kelompok profilaksis lebih baik dibandingkan kelompok on-demand (IK95% 2? 8,81; p = 0,003). Perubahan kadar CTX-II urin pada kedua kelompok berbeda bermakna (IK95% 2.777?16.742; p < 0,001). Tidak didapatkan subjek yang terbentuk inhibitor faktor VIII pada kedua kelompok selama penelitian.Dari hasil penelitian ini disimpulkan bahwa terapi profilaksis sekunder dosis rendah efektif mengurangi kekerapan perdarahan sendi, memperbaiki skor HEAD-US dan kadar CTX-II urin, dibandingkan terapi on-demand.

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ABSTRACTRepeated joint bleeds leading to irreversible progressive joint damage (hemophilic arthropathy) is the main problem in children with hemophilia. Current standard prophylacytic treatment in developed countries is beyond our capability as Indonesia has constraint resources. This study aimed to investigate the efficacy and safety of low dose secondary prophylaxis compare to on-demand treatment in children with severe hemophilia A.An open, randomized controlled trial was conducted on severe hemophilia A children aged 4?18 years in Pediatric Hematology-Oncology Division Dr. Cipto Mangunkusumo Hospital for 24 weeks. Eligible subjects were randomized into 2 groups: prophylaxis and on-demand group. All subjects were evaluated at week-0 and week-24 for inhibitor factor VIII (Bethesda Assay), ultrasonography (HEADUS scores) of six index joints (bilateral knees, ankles and elbows), HJHS (version 2.1, 2011) and urinary CTX-II (EIA). Subjects in prophylaxis group received factor VIII 10 IU/kgBW 2 times per week for 24 weeks. Any bleeding episodes in both groups were treated according to standard treatment (on-demand).During June 2015?February 2016 there were 50 subjects enrolled in the study. Mean age in prophylaxis group was 12 ± 3.5 years and median age in on-demand group was 11.9 (6.518.2) years. Mean frequency of joint bleeds in prophylaxis group was 5 ± 4.3 compare to 8 (3?30) in on-demand group (95%CI 0.9?6.99; p = 0.009). Mean difference of HJHS between two groups was not significant (95% CI -0.99?3; p = 0.320). HEAD-US scores and urinary CTX-II in prophylaxis group was significantly better compare to on-demand group (95%CI 2?8.81; p = 0.003 and 95%CI 2,777?16,742; p < 0.001 respectively). No subjects showed showed inhibitor factor VIII in both groups.We conclude that secondary low dose prophylaxis was effective to decrease joint bleeding episodes and improved HJHS scores, HEAD-US scores and urinary CTX-II, compared to on-demand treatment."

"Angka kejadian bedah caesar di seluruh dunia terus meningkat setiap tahun. Namun, angka risiko kematian pasca bedah caesar sangat tinggi akibat infeksi. Pemakaian suatu jenis antibiotik profilaksis pada sebagian kasus bedah caesar telah terbukti dapat mengurangi kejadian infeksi luka operasi. Tujuan penelitian ini untuk mengetahui pola penggunaan antibiotik profilaksis serta kerasionalan antibiotik profilaksis yang digunakan pada pasien bedah caesar di RSUPN Dr. Cipto Mangunkusumo tahun 2015. Penelitian dilakukan secara observasional dengan menggunakan metode deskriptif dan data diperoleh dari rekam medis pasien secara retrospektif. Pengambilan data dilakukan dengan teknik purposive sampling. Evaluasi kerasionalan penggunaan antibiotik profilaksis dinilai dari ketepatan pasien, tepat indikasi, tepat obat, tepat dosis, tepat waktu pemberian dan tanpa infeksi luka operasi. Pasien yang memenuhi kriteria sebagai subjek penelitian sebanyak 245 pasien. Data yang diperoleh menunjukkan bahwa jenis antibiotik profilaksis yang paling banyak digunakan adalah sefazolin (72,66%). Pada penelitian terdapat pasien bedah caesar yang menerima antibiotik profilaksis 100% tepat pasien, 100% tepat indikasi, 98,78% tepat obat, 98,37% tepat dosis dan 72,24% tepat waktu pemberian, serta 98,37% tanpa infeksi luka operasi. Penggunaan antibiotik profilaksis pada pasien bedah sesar terbukti 72,24% pasien menunjukkan kerasionalan.

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The number of caesarean section in all over the world continue to increase each year. But the rate of post caesarean section risk of death is very high due to infection. The use of a type of antibiotics prophylaxis in some cases of caesarean section has been proven to reduce the occurrence of surgical site infection. The purpose of this study was to know the image of antibiotic prophylaxis and the rationality of antibiotic prophylaxis on caesarean section patients in RSUPN Dr. Cipto Mangunkusumo in 2015. This study was conducted in observation using descriptive method and the data is acquired from medical record investigation retrospectively. Data were collected using purposive sampling technique. Rational use of antibiotics assessed evaluation of the appropriate patient, appropriate indication, appropriate drug, appropriate dose, appropriate time and without the provision of surgical site infection. Eligible patients as subjects of research were 245 patients. Data obtained showed that the most common kind of antibiotic prophylaxis that being used is cefazoline (72.66%). In this study were caesarean patients who received antibiotic prophylaxis showed 100% appropriate patient, 100% appropriate indication, 98.78% appropriate drug, 98.37% appropriate dose, 72.24% appropriate time and 98.37% no surgical site infection. The usage of antibiotic prophylaxis in patients with proven 72.24% caesarean section patients showed rationality."

"Latar Belakang: Petugas kesehatan memiliki risiko terpajan darah atau jaringan tubuh saat bekerja. World Health Organization (WHO) memperkirakan adanya 3 juta pajanan setiap tahunnya pada 35 juta petugas kesehatan. Adanya profilaksis pascapajanan dapat menurunkan risiko penularan. Tujuan: Mengetahui pelaksanaan profilaksis pascapajanan terhadap terhadap HIV, hepatitis B dan hepatitis C pada petugas kesehatan di RSUPN Cipto Mangunkusumo (RSCM). Metode: Penelitian potong lintang dilakukan pada petugas terpajan yang terdata melalui laporan IGD, poli pegawai dan UPT HIV pada tahun 2014-2016. Data dikumpulkan dan diolah melalui SPSS versi 20.Hasil Penelitian: Dari 196 pekerja yang melaporkan pajanan, sebagian besar merupakan perempuan (69,9%), bekerja sebagai perawat (38,3%) dan dokter (38,3%), serta terpajan secara perkutan (93,4%). Anti-HIV reaktif ditemui pada 25 (13%) sumber pajanan, HBsAg reaktif pada 13 (8%) dan anti-HCV reaktif pada 12 (6%) sumber. Petugas dengan anti-HBs protektif adalah 55 (28,1%) petugas. Dari 183 pajanan berisiko, 45,9% (81) petugas direkomendasikan pemberian ARV, 81,5% (66) petugas melakukan profilaksis dengan ARV, 60% petugas minum ARV secara lengkap (28 hari). Follow-up anti-HIV bulan ke-3 dan 6 dilakukan oleh 44 (24%) dan 41 (22,4%) petugas. Terdapat 37 pekerja yang direkomendasikan menerima vaksinasi Hepatitis B dan/atau immunoglobulin (HBIG). Dari 22 (59%) yang direkomendasikan vaksinasi hepatitis B, hanya 1 (2,7%) yang melakukan. Dari 15 (41%) yang direkomendasikan vaksinasi hepatitis B dan HBIG, hanya 2 (5,4%) yang melakukannya. Follow-up 3 dan 6 bulan HBsAg serta anti-HBs dilakukan oleh 41 (31,1%), 38 (28,8%) dan 2 (1,5%) petugas. Dari 182 petugas yang melakukan follow-up anti-HCV bulan ke 3 dan ke 6 adalah 39 (21,4%) dan 37 (20,3%) petugas. Kesimpulan: Pelaksanaan profilaksis pasca pajanan terhadap HIV, hepatitis B dan hepatitis C masih rendah. Oleh karena itu, penanganan profilaksis secara komprehensif penting dilakukan termasuk peningkatan pengetahuan dan kesadaran pekerja, peninjauan kembali SOP, dan komunikasi yang efektif.

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Introduction: Health care workers (HCW) have exposure risk of blood or body tissue at work. World Health Organization (WHO) estimates there is 3 millions exposure to 35 millions workers annually. The existance of post-exposure prophylaxis could reduce the transmission risk. Goal: To identify the implementation of post-exposure prophylaxis of HIV, Hepatitis B, and Hepatitis C among HCW in RSUPN Cipto Mangunkusumo (RSCM). Method: A cross-sectional study was conducted to exposured workers who had been recorded in emergency ward, employee ward, and UPT HIV on 2014-2016. Data was collected and analyzed with SPSS 20.Result: Among 196 HCW who reported the exposure, most of them were female (69.9%), worked as nurse (38.3%) and doctor (38.3%), and exposed percutaneously (93.4%). Positive anti-HIV was found in 25 (13%) people of exposure sources, positive HBsAg in 13 (8%) people and positive HCV in 12 (6%) people. Workers with protective anti-HBs were 55 (28.1%) people. In 183 reports, 81 (45,9%) workers were recommended to receive ARV, 66(81.5%) workers did receive it, and 40(60%) workers took complete ARV (28 days). Follow-up 3 and 6 months was done by 44 (24%) and 41 (22,4%) workers. There were 37 workers recommended to receive Hepatitis B vaccination and/or immunoglobulin (HBIG). In 22 (59%) recommended to receive Hepatitis B vaccination, only 1 (2,7%) who took that. In 15 (41%) recommended to receive both Hepatitis B vaccination and immunoglobulin, only 2 (5,4%) who took both. Follow-up of HBsAg and anti-HBs on 3rd and 6th months were done by 41 (31,1%), 38 (28,8%) and 2 (1,5%) workers who were recommended to receive prophylaxis. In 182 workers recommended to do follow-up of anti-HCV, 39 (21,4%) and 37 (20,3%) workers did the follow-up on 3rd and 6th month. Conclusion: The implementation of post-exposure propyhlaxis of HIV, Hepatitis B, and Hepatitis C was still low. Thus, it was important to do the management of prophylaxis comprehensively. It was also included the increasing of worker's knowledge and awareness, reconsidering the operational standard, and communicating effectively."