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"Sepsis, yang salah satunya ditandai dengan adanya bakteri dalam darah (bakteremia), merupakan keadaan klinis yang mengancam jiwa seseorang. Sehingga pemilihan antibiotik yang tepat sangatlah penting untuk mengurangi angka kecacatan dan kematian. Beberapa antibiotik yang dapat digunakan untuk menangani sepsis adalah kloramfenikol, kotrimoksasol, dan tetrasiklin. Oleh karena itu diperlukan pemantauan pola resistensi bakteri penyebab sepsis terhadap ketiga antibiotik tersebut. Data yang digunakan dalam penelitian ini adalah data sekunder yang diperoleh dari hasil uji resistensi bakteri dari spesimen darah terhadap berbagai antibiotik dari tahun 2001-2006 yang dikirim ke Laboratorium Mikrobiologi Klinik Fakultas Kedokteran Universitas Indonesia. Dari 791 isolat darah, didapatkan enam bakteri tersering yang diisolasi dari spesimen darah yaitu Staphylococcus epidermidis (25%), Acinetobacter anitratus (16%), Pseudomonas aeruginosa (13%), Klebsiella pneumoniae (8%), Staphylococcus aureus (6%), dan Salmonella Typhi (5%). Hasil uji resistensi keenam bakteri tersebut terhadap ketiga antibiotik di atas sangat bervariasi. Staphylococcus epidermidis sudah cukup resisten (37,4-51,9%) terhadap ketiga antibiotik di atas. Resistensi Acinetobacter anitratus dan Pseudomonas aeruginosa terhadap kloramfenikol dan kotrimoksasol masih rendah, masing-masing 10-16,2% dan 6,2-21,4%, sedangkan terhadap tetrasiklin resistensinya sudah cukup tinggi, 62,5% pada Acinetobacter anitratus dan 71% pada Pseudomonas aeruginosa. Klebsiella pneumoniae sudah cukup resisten (36,6-71,4%) terhadap ketiga antibiotik di atas. Resistensi Staphylococcus aureus masih cukup rendah (5,9-28,6%) terhadap ketiga antibiotik di atas. Resistensi Salmonella Typhi terhadap ketiga antibiotik di atas juga masih rendah (0-5,6%). Dapat disimpulkan bahwa resistensi bakteri yang diisolasi dari spesimen darah terhadap ketiga antibiotik di atas sudah cukup tinggi, kecuali pada Staphylococcus aureus dan Salmonella Typhi, serta pada Acinetobacter anitratus dan Pseudomonas aeruginosa terhadap kloramfenikol dan kotrimoksasol.

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Sepsis which is characterized by the presence of bacteria in bloodstream (bacteremia) is a harmful clinical state that can be life-threatening. Correct choice of antibiotics is a very important issue in reducing morbidity and mortality rates among sepsis patients. Some antibiotics that can be used to treat sepsis are chloramphenicol, co-trimoxazole, and tetracycline. Hence, it is necessary to monitor sepsis-causing bacteria resistance pattern to those three antibiotics mentioned before. The data utilized was a secondary one that was obtained from the result of blood-specimen bacterial resistance test against antibiotics in Clinical Microbiology Laboratory of Faculty of Medicine, University of Indonesia from 2001 to 2006. Of 791 blood isolates, six most frequent bacteria isolated from blood specimen were Staphylococcus epidermidis (25%), Acinetobacter anitratus (16%), Pseudomonas aeruginosa (13%), Klebsiella pneumoniae (8%), Staphylococcus aureus (6%), and Salmonella Typhi (5%), of which the results varied widely. Moderate resistance rates (37.4-51.9%) against those three antibiotics were observed from Staphylococcus epidermidis. Low resistance rates against chloramphenicol and co-trimoxazole were observed from Acinetobacter anitratus and Pseudomonas aeruginosa, each showed 10-16.2% and 6.2-21.4% respectively, while their resistance against tetracycline were already high, 62.5% in Acinetobacter anitratus and 71% in Pseudomonas aeruginosa. Klebsiella pneumonia showed moderate resistance against those three antibiotics mentioned above (36,6-71,4%). Low resistance rates (5.9-28.6%) against those three antibiotics were observed from Staphyhlococcus aureus. Very low resistance rates (0-5.6%) against those three antibiotics were also observed from Salmonella Tyhpi. It can be concluded that the resistance rates among bacteria isolated from blood specimen against those three antibiotics are already high, except Staphylococcus aureus and Salmonella Typhi, and Acinetobacter anitratus and Pseudomonas aeruginosa against chloramphenicol and co-trimoxazole."

"Sepsis adalah kondisi klinis yang disebabkan oleh respon imun pejamu terhadap infeksi atau stimulus lain yang ditandai oleh inflamasi sistemik. Respon klinis pada sepsis dapat bervariasi tergantung dari tahap kompensasi atau dekompensasi, proses inflamasi dan kondisi pejamu. Tujuan penelitian ini adalah untuk menilai peran dari parameter (klinis, biokimia, hematologi, analisis gas darah dan koagulasi) dalam menunjang diagnosis sepsis. Dilakukan penelitian dengan disain potong lintang di unit rawat inap Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo, Jakarta, antara bulan Pebruari hingga Juli 2002. Empat puluh dua pasien memenuhi kriteria sepsis, sepsis berat dan renjatan septik. Dikumpulkan data klinis, sampel darah untuk pemeriksaan hematologi, biokimia, analisis gas darah dan koagulasi. Empat puluh dua subyek berpartisipasi dalam penelitian ini, dengan usia antara 19 hingga 78 tahun. Sebelas subyek memenuhi kriteria sepsis awal, 20 sepsis berat dan 11 renjatan septik. Pemeriksaan klinis menunjukkan Glasgow coma scale menurun secara bermakna pada sepsis berat dan renjatan septik. Denyut jantung, frekuensi nafas dan suhu tubuh meningkat pada semua kelompok. Pada sebagian besar subyek hemoglobin kurang dari 10 g/dl dan hematokrit kurang dari 30%. Hitung lekosit meningkat pada lebih dari 80% subyek dengan jumlah lebih dari 15.000/mm3. Hitung trombosit menurun (kurang dari 50.000/mm3) terutama pada renjatan septik. Kreatinin serum meningkat (> 2 mg/dl) secara bermakna pada sepsis berat dan renjatan septik. Albumin menurun, LDH dan prokalsitonin meningkat. Analisis gas darah menunjukkan: pH dan HCO3 menurun terutama pada renjatan septik; PO2 menurun pada sepsis berat dan renjatan septik; dan PCO2 kurang dari 32 mmHg pada semua kelompok. Pemeriksaan koagulasi menunjukkan fibrinogen menurun secara bermakna pada renjatan septik, PT dan APTT memanjang pada sepsis berat dan renjatan septik lebih dari 18.8 dan 48 detik. D-dimer juga pada umumnya meningkat pada semua kelompok. Disimpulkan bahwa pemeriksaan klinis termasuk tingkat kesadaran, denyut jantung, tekanan arteri rata-rata, suhu dan frekuensi nafas, serta tambahan pemeriksaan laboratorium termasuk hematologi, biokimia, analisis gas darah dan koagulasi dapat digunakan sebagai parameter dalam mendiagnosis sepsis. Beberapa parameter yaitu tingkat kesadaran, kreatinin serum, hemoglobin, hitung trombosit dan fibrinogen dapat membedakan darajat sepsis. (Med J Indones 2004; 14: 26-32)

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Sepsis is a spectrum of clinical conditions caused by the host immune response to infection or other inflammatory stimuli characterized by systemic inflammation. Clinical response to sepsis could be varies according to compensate or decompensate state, inflammatory process and host condition. Aims of this study is to assess the role of some parameters (clinical and biochemical, hematology, arterial blood gas analysis and coagulation) in supporting the diagnosis of sepsis. A cross-sectional study was performed in the Internal Medicine Inpatient Unit of Dr. Cipto Mangunkusumo National General Hospital, Jakarta, from February to July 2002. Forty-two patients who fulfilled the criteria of sepsis, severe sepsis, and septic shock were enrolled in this study. Clinical details and blood specimens for hematological, biochemical, arterial blood gas analysis and coagulation were collected. There were 42 subjects who participated in the study, aged from 19 to 78 years old. Eleven subjects fulfilled the criteria for early sepsis, 20 severe sepsis and 11 septic shock. Clinical examination showed that the Glasgow coma scale (GCS) was significantly reduced in severe sepsis and septic shock. Heart rate, respiration rate and body temperature were increased in all groups. Hemoglobin levels mostly below 10 g/dl and hematocrite levels below 30 %. The leucocyte counts were increased in more than 80%, mostly above 15.000/mm3. The platelet count were low (below 50.000/mm3) especially in septic shock. The serum creatinine were significantly increased (>2 mg/dl) in severe sepsis and septic shock. Albumin was decreased, lactate dehydrogenase/LDH and procalcitonin were increased. The arterial blood gas analysis showed that: pH and HCO3 were decreased especially in septic shock; the PO2 was lower in severe sepsis and septic shock; and PCO2 was below 32 mmHg in all groups. Coagulation examinations showed that fibrinogen was significantly decreased in septic shock; PT and APTT were prolong in severe sepsis and septic shock more than 18.8 and 48 seconds respectively. The d-dimer was also increased mostly in all groups. In conclusions that clinical examinations include level of consciousness, heart rate, mean arterial pressure, temperature and respiration rate and additional laboratory examinations include hamatological, biochemical, blood gas analysis and coagulation examinations can be used as parameters in diagnosis of sepsis. Some parameters include level of consciousness (Glasgow coma scale), serum creatinine, hemoglobin, platelet count and fibrinogen can differ sepsis according to severity. (Med J Indones 2004; 14: 26-32)"

"ABSTRAKLatar Belakang. Terdapat gangguan sistem imun pada sepsis. Fase awal ditandaidengan hiperinflamasi, sedangkan fase lanjut ditandai dengan imunosupresi.Kematian kumulatif lebih banyak pada fase lanjut. Saat ini belum terdapatpenelitian yang secara khusus meneliti faktor prognostik mortalitas sepsis faselanjut dan mengembangkan model prediksi mortalitasnya.Tujuan. Mengetahui faktor prognostik mortalitas sepsis berat fase lanjut di ICUdan mengembangkan sistem skor untuk memprediksi mortalitas.Metode. Penelitian kohort retrospektif dilakukan pada pasien dewasa yangmengalami sepsis berat di ICU RSCM pada periode Oktober 2011 – November2012 dan masih bertahan setelah > 72 jam diagnosis sepsis ditegakkan di ICU.Tujuh faktor prognostik diidentifikasi saat diagnosis sepsis berat ditegakkan diICU. Prediktor independen diidentifikasi dengan analisis Cox’s proportionalhazard. Prediktor yang bermakna secara statistik dikuantifikasi dalam modelprediksi. Kalibrasi model dinilai dengan uji Hosmer-Lemeshow dan kemampuandiskriminasi dinilai dari area under curve (AUC) dari receiver operating curve.Hasil. Subjek penelitian terdiri atas 220 pasien. Mortalitas 28 hari sepsis beratfase lanjut adalah 40%. Faktor prognostik yang bermakna adalah alasan masukICU (medis (HR 2,75; IK95%:1,56-4,84), pembedahan emergensi (HR 1,96;IK95%:0,99 – 3,90), indeks komorbiditas Charlson > 2 (HR 2,07; IK95%:1,32-3,23), dan skor MSOFA > 4 (HR 2,84; IK95%:1,54-5,24). Model prediksimemiliki kemampuan diskriminasi yang baik (AUC 0,844) dan kalibrasi yangbaik (uji Hosmer-Lemeshow p 0,674). Berdasarkan model tersebut risikomortalitas dapat dibagi menjadi rendah (skor 0, mortalitas 5,4%), sedang (skor 1 –2,5, mortalitas 20,6%), dan tinggi (skor > 2,5, mortalitas 73,6%).Simpulan. Alasan masuk medis dan pembedahan emergensi, indeks komorbiditasCharlson > 2, dan skor MSOFA > 4 merupakan faktor prognostik mortalitassepsis berat fase lanjut di ICU RSCM. Sebuah model telah dikembangkan untukmemprediksi dan mengklasifikasikan risiko mortalitas.

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ABSTRACTBackground. Immune system derrangement occurs during the course of sepsis,characterized by hyperinflamation in early phase and hypoinflamation andimmunosupression in late phase. The number of patient die during late phase islarger than early phase. Until now, there is no study specifically addressingprognostic factors of mortality from late sepsis and developing a mortalityprediction model.Aim. To determine prognostic factors of mortality from late phase of severesepsis in ICU and to develop scoring system to predict mortality.Method. A retrospective cohort study was conducted to identify prognosticfactors associated with mortality. Adult patients admitted to ICU duringNovember 2011 until October 2012 who developed severe sepsis and still alivefor minimum 72 hours were included in this study. Seven predefined prognosticfactors were indentified at the onset of severe sepsis in ICU. Cox’s proportionalhazard ratio was used to identify independent prognostic factors. Eachindependent factors was quantified to develop a prediction model. Calibration ofthe model was tested by Hosmer-Lemeshow, and its discrimination ability wascalculated from area under receiver operating curve.Result. Subjects consist of 220 patients. Twenty eight-day mortality was 40%.Significant prognostic factors indentified were admission source (medical (HR2.75; CI95%: 1.56 – 4.84), emergency surgery (HR 1.96; CI95%:0.99 – 3.90),Charlson comorbidity index > 2(HR 2.07; CI95%:1.32 – 3.23), and MSOFA score> 4 (HR 2.84; CI95% : 1.54 – 5.24). Prediction model developed has gooddiscrimination ability (AUC 0.844) and good calibration (Hosmer-Lemeshow testp 0.674). Based on the model mortality risk can be classified as low (score 0,mortality 5.4%), moderate (score 1 – 2.5, mortality 20.6%), and high (score > 2.5,mortality 73.6%).Conclusion. Medical and emergency surgery admission, Charlson comorbidityindex > 2, and MSOFA score > 4 were prognostic factors of mortality from latephase of severe sepsis in ICU at Dr.Cipto Mangunkusumo general hospital. Amodel has been developed to predict and classify mortality risk."

"Latar belakang. Selama sepsis, terjadi penglepasan ICAM-1 yang dipercaya berperan dalam kerusakan otak. Sedangkan S100β telah diteliti sebagai penanda kerusakan sel otak. Tujuan. Mengetahui rerata nilai ICAM-1, protein S100β, korelasi antara ICAM-1 dengan skala koma Glasgow (GCS), korelasi antara protein S100β dengan GCS, dan korelasi antara ICAM-1 dengan S100β. Metode. Deskriptif analitik potong lintang pada 34 anak sepsis, pengukuran kadar ICAM-1 dan S100β dalam darah pada hari pertama dan ketiga sejak sepsis ditegakkan. Hasil. Median ICAM-1 hari pertama 548,1 (158,6 – 1256,1) ng/mL dan ketiga 596,5 (185,5 – 1264,5) ng/mL (p=0,164). Median S100β pada sepsis berat lebih tinggi secara signifikan dibandingkan sepsis ringan pada hari pertama maupun ketiga (p=0,008 dan p=0,021). Hari ketiga, kadar S100β berkorelasi negatif dengan GCS (r= - 0,452; p=0,003). Korelasi antara ICAM-1 dan S100β pada hari pertama r=0,146 (p=0,409) dan ketiga r=0,184 (p=0,298). Simpulan. Prevalens ensefalopati sepsis 5,9%. Median ICAM-1 hari ketiga sepsis lebih tinggi dibandingkan hari pertama. Median S100β pada sepsis berat lebih tinggi secara signifikan dibandingkan sepsis ringan. Tidak terdapat korelasi antara ICAM-1 dengan GCS pada kelompok sepsis ringan maupun berat. Terdapat korelasi negatif antara S100β dengan skor GCS pada hari ketiga sepsis. Tidak terdapat korelasi antara ICAM-1 dan S-100β pada hari I dan III sepsis.

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Background: ICAM-1 release during sepsis is perceived to be related to brain injury. Whereas S100β has been known as one of brain injury markers.

Objective: To measure mean value of ICAM-1, S100β, to find correlation between ICAM-1 and Glasgow Coma Scale (GCS), between S100β and GCS, also ICAM- 1 and S100β.

Methods. Analytical cross sectional study in 34 sepsis children, measurement of ICAM-1 and S100β plasma levels within day 1 and 3 since diagnosis of sepsis.

Results. Median level of ICAM-1 day one 548,1 (158,6 – 1256,1) ng/mL and day three 596,5 (185,5 – 1264,5) ng/mL (p=0,164). S100β median is significantly higher in severe than mild sepsis (p=0,008 dan p=0,021). On third day S100β was negatively related to GCS (r= - 0,452; p=0,003). The correlation observed between ICAM-1 and S100β on day one was r=0,146 (p=0,409) while on third day was r=0,184 (p=0,298).

Conclusion. The prevalence of encephalopathy sepsis is 5.9%, Median ICAM-1 is higher on day three. Median of S100β is higher in severe than mild sepsis.There is no correlation between ICAM-1 and GCS in both sepsis. There was negative correlation between S100β and GCS on 3rd day of sepsis. No correlation between ICAM-1 and S100β on both measurement days."

"ABSTRAK Latar belakangKematian akibat sepsis dan syok septik pada pasien rawatan Intensive Care Unit (ICU) yaitu 20-30%. Pemberian antibiotik empirik yang tepat merupakan salah satu langkah awal yang sangat penting. Amikasin merupakan salah satu antibiotik terpilih untuk tata laksana sepsis di ICU RSUPN dr. Cipto Mangunkusumo (RSCM). Saat ini belum pernah dilakukan penelitian mengenai ketercapaian kadar terapi amikasin dengan menggunakan dosis standar amikasin pada pasien sepsis dewasa di ICU RSCM, sehingga studi ini menjadi penelitian pertama di Indonesia.Penelitian ini bertujuan untuk mengetahui ketercapaian kadar amikasin optimal pada pasien ICU RSCM.MetodeData dikumpulkan secara potong lintang melalui observasi terhadap hasil pemeriksaan kadar plasma amikasin, pengukuran minimum inhibitory concentration (MIC) dan perhitungan rasio Cmax/MIC pada pasien sepsis di ICU RSCM periode Mei-September tahun 2015.Hasil penelitianProporsi pasien sepsis dengan kadar amikasin optimal ialah sebesar 57% (4/7). Kadar puncak amikasin yang dapat dicapai dengan dosis 1000 mg sekali sehari tanpa menghiraukan berat badan ialah median 86,4 (43,5-238) µg/mL. Pada penelitian ini ditemukan 87% pasien dengan kadar puncak amikasin di atas 64 µg/mL, meskipun amikasin 1000 mg tersebut lebih rendah dari dosis yang dianjurkan untuk sepsis (25 mg/kgBB). Sebagian besar (78,3 %) subyek pada kenyataannya menerima dosis 15-25 mg/kgBB, dengan pemberian 1000 mg amikasin tanpa memperhatikan berat badan. Bakteri yang banyak ditemukan dari hasil kultur pasien sepsis di ICU RSCM, yaitu K. pneumoniae, A. baumanii, P. aeruginosa dan E. coli. Rentang nilai MIC untuk patogen tersebut berturut-turut yaitu 0,75 - >256 µg/mL, 0,75 - >256 µg/mL, 1,5 - >256 µg/mL dan 0,75 - 16) µg/mL. Sebanyak 84% isolat K. pneumoniae masih sensitif terhadap amikasin, diikuti oleh 63% untuk A. baumanii, 47% P. aeruginosa dan 100% untuk E. coli.KesimpulanOptimalitas amikasin terhadap bakteri Gram negatif penyebab sepsis bergantung kadar puncak dan MIC bakteri. Kadar puncak plasma amikasin yang dicapai dengan dosis 1000 mg sekali sehari sangat bervariasi. Pemberian amikasin dengan dosis per kgBB dapat dipertimbangkan. Kepekaan beberapa bakteri Gram negatif terhadap amikasin mulai menurun dengan rentang MIC yang cukup lebar. Pengukuran ketercapaian kadar optimal dalam terapi definitif dapat dilakukan untuk meningkatkan keberhasilan terapi.ABSTRACT BackgroundThe mortality caused by sepsis and septic shock in the Intensive Care Unit (ICU) is 20-50%. The important first step to reduce this conditions is to give the right empirical antibiotics. Amikacin is one of the antibiotics of choice for the sepsis and septic shock in ICU of Cipto Mangunkusumo (CM) Hospital. Studies on the amikacin plasma level in adult patients being given amikacin in ICU RSCM has never been done.The objective of this study is to explore the plasma level of amikacin in septic patients in CM Hospital.MethodsThis was a cross sectional study. Data on plasma amikacin level, microbiological culture, measurement of minimum inhibitory concentration (MIC), and amikacin optimal level in septic patients admitted to ICU of RSCM during May-September 2015.ResultsThe proportion of septic patients that achieve amikacin optimal level was 57% (4/7). Peak amikacin level that can be reached with 1 gram per day dose was 86,4 (43,5-238) g/mL. Although amikacin was given less than recommended dose for sepsis (25 mg/body weight), 87% patients was found to have peak amikacin level > 64 µg/mL. Most (78.3%) of the patients received amikacin with dose range 15-25 mg/kgBW, in which patients was given 1000 mg of amikacin regardless of the body weight. The organisms commonly identified from the microbiological culture septic in patients in ICU of RSCM were K. pneumoniae, A. baumanii, P. aeruginosa, and E. coli. The MIC for these pathogen were 0.75 - >256 µg/mL, 0.75 - >256 µg/mL, 1.5 - >256 µg/mL and 0.75 ? 16 µg/mL, respectively. Most (84%) of K. pneumoniae isolates was still sensitive to amikacin, while 63% A. baumanii isolate, 47% of P. aeruginosa, and 100% of E. coli were sensitive to amikacin.ConclusionsAmikacin?s efficacy to eradicate Gram negative microorganism causing sepsis depend on peak level and MIC of the microorganism. By giving 1000 mg dose per day of amikacin, highly variable peak plasma concentration of the drug was observed. Therefore, amikacin dosing based on weight might be useful to reduce the wide variation. In this study, we found that sensitivity of some Gram negative pathogen are decreasing, with wide range of MIC. Evaluation of optimal level for definitive therapy might be useful to reach more successful treatment.;BackgroundThe mortality caused by sepsis and septic shock in the Intensive Care Unit (ICU) is 20-50%. The important first step to reduce this conditions is to give the right empirical antibiotics. Amikacin is one of the antibiotics of choice for the sepsis and septic shock in ICU of Cipto Mangunkusumo (CM) Hospital. Studies on the amikacin plasma level in adult patients being given amikacin in ICU RSCM has never been done.The objective of this study is to explore the plasma level of amikacin in septic patients in CM Hospital.MethodsThis was a cross sectional study. Data on plasma amikacin level, microbiological culture, measurement of minimum inhibitory concentration (MIC), and amikacin optimal level in septic patients admitted to ICU of RSCM during May-September 2015.ResultsThe proportion of septic patients that achieve amikacin optimal level was 57% (4/7). Peak amikacin level that can be reached with 1 gram per day dose was 86,4 (43,5-238) g/mL. Although amikacin was given less than recommended dose for sepsis (25 mg/body weight), 87% patients was found to have peak amikacin level > 64 µg/mL. Most (78.3%) of the patients received amikacin with dose range 15-25 mg/kgBW, in which patients was given 1000 mg of amikacin regardless of the body weight. The organisms commonly identified from the microbiological culture septic in patients in ICU of RSCM were K. pneumoniae, A. baumanii, P. aeruginosa, and E. coli. The MIC for these pathogen were 0.75 - >256 µg/mL, 0.75 - >256 µg/mL, 1.5 - >256 µg/mL and 0.75 ? 16 µg/mL, respectively. Most (84%) of K. pneumoniae isolates was still sensitive to amikacin, while 63% A. baumanii isolate, 47% of P. aeruginosa, and 100% of E. coli were sensitive to amikacin.ConclusionsAmikacin?s efficacy to eradicate Gram negative microorganism causing sepsis depend on peak level and MIC of the microorganism. By giving 1000 mg dose per day of amikacin, highly variable peak plasma concentration of the drug was observed. Therefore, amikacin dosing based on weight might be useful to reduce the wide variation. In this study, we found that sensitivity of some Gram negative pathogen are decreasing, with wide range of MIC. Evaluation of optimal level for definitive therapy might be useful to reach more successful treatment.;BackgroundThe mortality caused by sepsis and septic shock in the Intensive Care Unit (ICU) is 20-50%. The important first step to reduce this conditions is to give the right empirical antibiotics. Amikacin is one of the antibiotics of choice for the sepsis and septic shock in ICU of Cipto Mangunkusumo (CM) Hospital. Studies on the amikacin plasma level in adult patients being given amikacin in ICU RSCM has never been done.The objective of this study is to explore the plasma level of amikacin in septic patients in CM Hospital.MethodsThis was a cross sectional study. Data on plasma amikacin level, microbiological culture, measurement of minimum inhibitory concentration (MIC), and amikacin optimal level in septic patients admitted to ICU of RSCM during May-September 2015.ResultsThe proportion of septic patients that achieve amikacin optimal level was 57% (4/7). Peak amikacin level that can be reached with 1 gram per day dose was 86,4 (43,5-238) g/mL. Although amikacin was given less than recommended dose for sepsis (25 mg/body weight), 87% patients was found to have peak amikacin level > 64 µg/mL. Most (78.3%) of the patients received amikacin with dose range 15-25 mg/kgBW, in which patients was given 1000 mg of amikacin regardless of the body weight. The organisms commonly identified from the microbiological culture septic in patients in ICU of RSCM were K. pneumoniae, A. baumanii, P. aeruginosa, and E. coli. The MIC for these pathogen were 0.75 - >256 µg/mL, 0.75 - >256 µg/mL, 1.5 - >256 µg/mL and 0.75 ? 16 µg/mL, respectively. Most (84%) of K. pneumoniae isolates was still sensitive to amikacin, while 63% A. baumanii isolate, 47% of P. aeruginosa, and 100% of E. coli were sensitive to amikacin.ConclusionsAmikacin?s efficacy to eradicate Gram negative microorganism causing sepsis depend on peak level and MIC of the microorganism. By giving 1000 mg dose per day of amikacin, highly variable peak plasma concentration of the drug was observed. Therefore, amikacin dosing based on weight might be useful to reduce the wide variation. In this study, we found that sensitivity of some Gram negative pathogen are decreasing, with wide range of MIC. Evaluation of optimal level for definitive therapy might be useful to reach more successful treatment."

"Latar Belakang. Sepsis merupakan masalah besar yang menyumbang tingkat mortalitas tinggi. Hal ini diperparah dengan adanya komorbid keganasan. Dalam salah satu penelitian menyebutkan pasien sepsis dengan komorbid keganasan mempunyai resiko 2,32 kali lebih tinggi dibandingkan dengan pasien tanpa komorbid keganasan. Untuk itu diperlukan data faktor-faktor yang memengaruhi mortalitas pasien sepsis dengan komorbid keganasan agar dapat memberikan terapi yang efektif dan efisien dan menurunkan angka mortalitas.Tujuan Penelitian. Mengetahui faktor-faktor yang memengaruhi mortalitas pada pasien sepsis dengan komorbid keganasan.Metode. Penelitian dilaksanakan dengan desain kohort retrospektif . Data diambil dari rekam medis pasien sepsis dengan komorbid keganasan yang dirawat di RS Ciptomangunkusumo dan memenuhi kriteria inklusi dari tahun 2020 sampai 2022. Dilakukan uji kategorik dan dilanjutkan dengan Uji regresi log pada variabel-variabel yang memenuhi syarat.Hasil. Dari 350 subjek sepsis dengan komorbid keganasan yang memenuhi kriteria inklusi didapatkan mortalitas sebanyak 287 (82%) subjek. Pada ujia kategorik bivariat didapatkan 2 variabel yang mempunyai kemaknaan secara statistik yaitu skor SOFA dan performa status dengan nilai P masing-masing <0,001 dan <0,001. Setelah dilakukan uji log regresi didapatkan Odds Ratio 5.833 IK (3,214-10,587) untuk variabel skor SOFA dan Odds Ratio3,490 IK (1,690-7,208) untuk variabel performa status.Kesimpulan. Variabel skor SOFA dan performa status mempunyai hubungan yang bermakna terhadap mortalitas pasien sepsis dengan komorbid keganasan

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Background. Sepsis is a major problem that contributes to a high mortality rate. This is exacerbated by the presence of malignancy. In one study, sepsis patients with malignancy had a 2.32 times higher risk compared to patients without malignancy. For this reason, factors that influence mortality in sepsis patients with malignancy are needed in order to provide effective and efficient therapy and reduce mortality.

Research purposes. Knowing the factors that influence mortality in sepsis patients with  malignancy.

Method. The study was conducted with a retrospective cohort design. Data were taken from the medical records of sepsis patients with comorbid malignancy who were treated at Ciptomangunkusumo Hospital and met the inclusion criteria from year 2020 to 2022. A categorical test was carried out and followed by a log regression test on eligible variables.

Results.  Of the 350 sepsis subjects with comorbid malignancy who met the inclusion criteria, 287 (82%) subjects had a mortality. In the bivariate categorical test, there were 2 variables that had statistical significance, namely the SOFA score and status performance with P values ​​of <0.001 and <0.001respectively. After doing the log regression test is obtained Odds Ratio 5.833 CI (3.214-1.587) for SOFA score variables and Odds Ratio 3.490 CI (1.690-7.208) for status performance variables.

Conclusion. SOFA score and performance status variables have a significant relationship to the mortality of sepsis patients with comorbid malignancy."

"Latar belakang: Sepsis neonatal masih menjadi masalah kesehatan di dunia. Hal ini tidak terlepas dari kesulitan dalam menegakkan diagnosis akibat sistem imun yang belum sempurna sehingga tidak memiliki gejala yang khas dan tidak memiliki penanda laboratorium tunggal. Tujuan: Penelitian ini bertujuan untuk menilai potensi CD64 neutrofil, HLA-DR monosit dan rasio CD64 neutrofil per HLA-DR monosit sebagai penanda sepsis neonatal. Metode: Subjek penelitian ini adalah neonatus yang  dicurigai sepsis secara klinis yang ditandai dengan gejala pada salah satu sistem organ. Diagnosis sepsis neonatal secara klinis ditegakkan berdasarkan kriteria dari European Medical Association. Expresi CD64 neutrofil dan HLA-DR monosit dilakukan menggunakan flow cytometry mengikuti protokol Quantibrite dengan hasil dilaporkan sebagai indeks fluoresens dan dikonversi menjadi antibody bound per cell (ABC). Sedangkan rasio CD64 neutrofil per HLA-DR monosit didapatkan dari hasil perhitungan. Hasil: Lima puluh subjek neonatus berhasil direkrut dalam penelitian ini, yang terdiri 24 subjek sepsis, dan 26 subjek non sepsis. Ekspresi CD64 neutrofil dan rasio CD64 neutrofil per HLA-DR monosit lebih tinggi pada kelompok sepsis neonatal dan masing-masing memiliki area under curve (AUC) 71,8% dan 70,2%. Nilai titik potong CD64 neutrofil didapatkan 5.196,15 ABC sedangkan rasio CD64 neutrofil terhadap HLA-DR monosit memiliki titik potong 13,44%. Kesimpulan: CD64 neutrofil dan rasio CD64 neutrofil per HLA-DR monosit berpotensi menjadi penanda sepsis neonatal.

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Background: Neonatal sepsis remains a global health concern. This is attributed to the challenges in establishing a diagnosis due to an immature immune system, resulting in a lack of specific symptoms and a singular laboratory marker. Objective: This research aims to explore the potential of CD64 neutrophils, HLA-DR monocytes, and the CD64 neutrophil to HLA-DR monocyte ratio as markers for neonatal sepsis. Methods: The subjects of this study were neonates with suspected sepsis, identified by symptoms affecting one of the organ systems. Neonatal sepsis confirmation followed the criteria set by the European Medical Association. CD64 neutrophil and HLA-DR monocyte examinations were conducted using flow cytometry following the Quantibrite protocol and reported as fluorescence index that were converted to antibody bound per cell (ABC). Meanwhile, the CD64 neutrophil to HLA-DR monocyte ratio was calculated. Results: Fifty neonatal subjects were recruited into this study, comprising 24 sepsis cases and 26 non-sepsis cases. The expression of CD64 neutrophils and the CD64 neutrophil to HLA-DR monocyte ratio were higher in the neonatal sepsis group, with respective areas under the curve (AUC) of 71.8% and 70.2%. The cutoff value for CD64 neutrophils was determined to be 5,196.15 ABC, while the cutoff for the CD64 neutrophil to HLA-DR monocyte ratio was 13.44%. Conclusion: CD64 neutrophils and the CD64 neutrophil to HLA-DR monocyte ratio show potential as markers for neonatal sepsis."