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"Latar belakang: Rekomendasi Centers for Disease Control and Prevention (CDC) 2010 (revisi 2002) tidak spesifik memberi panduan dalam pencegahan sekunder sepsis awitan dini (SAD) pada neonatus cukup bulan (NCB), asimtomatik lahir dari ibu yang mengalami KPD < 18 jam.Tujuan: Didapatnya model determinan SAD pada NCB sesuai masa kehamilan (SMK), asimtomatik lahir dari ibu yang mengalami KPD lebih dari 12 jam.Metodologi: penelitian observasional potong lintang untuk mendapatkan model determinan sepsis neonatorum awitan dini (SNAD) yang dilakukan dari Februari 2013 sampai bulan Mei 2014 di RSAB Harapan Kita, RSUD Tarakan, RSIA Budi Kemuliaan. Determinan yang diteliti adalah jenis persalinan, petanda infeksi saluran kemih (ISK) pada ibu, petanda infeksi intra amnion (IIA) seperti demam intrapartum, ibu takikardia, janin takikardia, adanya perubahan warna dan bau cairan ketuban, leukosit darah ibu, dan petanda infeksi darah tali pusat (peningkatan jumlah total leukosit, neutrofil, peningkatan rasio I/T, hs-CRP dan IL-6). Diagnosis sepsis ditegakkan berdasarkan catatan medis bayi yang dipastikan berdasarkan hasil positif biakan darah tali pusat. Model determinan SNAD yang dihasilkan adalah suatu persamaan regresi logistik yang digunakan untuk menentukan probabilitas terjadinya SNAD sebagai acuan terapi antibiotik.Hasil: model determinan SAD pada NCB SMK, asimtomatik lahir dari ibu KPD > 12 jam berupa kalkulator dan sistem skor yang dibentuk dari determinan persalinan per vaginam, perubahan warna dan bau cairan ketuban, leukosit darah ibu, leukosit darah tali pusat, kadar hs-CRP darah tali pusat dan kadar IL-6 darah tali pusat. Model determinan SNAD memiliki dua varian, varian lengkap digunakan untuk fasilitas pelayanan neonatus subspesialistik dan varian alternatif digunakan untuk fasilitas pelayanan spesialistik. Titik potong ideal penentuan probabilitas terjadinya SNAD memiliki sensitivitas di antara 24,2 – 40,3 % dan spesifisitas 87,1 - 94,5 %. Nilai diskriminasi dengan nilai AUC berkisar di antara 0,743 – 0,816 dengan kalibrasi baik berdasarkan uji Hosmer-Lemeshow.Simpulan: Hasil penelitian ini adalah model determinan SAD pada NCB SMK asimtomatik lahir dari ibu yang mengalami KPD > 12 jam, berbentuk kalkulator dan sistem skor yang memiliki varian lengkap dan alternatif untuk menentukan probabilitas terjadinya SNAD sebagai dasar pemberian terapi antibiotik empiris secara rasional.

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Background: Centers for Disease Control and Prevention (CDC) 2010 (revised 2002) recommendations does not specifically provide guidance in secondary prevention of asymptomatic early-onset sepsis (EOS) on term infant born to mother experiencing PROM < 18 hours.

Objective: to develop early-onset neonatal sepsis (EONS) determinant model as a rational basis for determining the empirical antibiotic therapy in asymptomatic, term infant born to mother with PROM > 12 hours.

Method: A cross-sectional observational study to obtain an EONS determinant model which was conducted from February 2013 to May 2014 in RSAB Harapan Kita, Tarakan Hospital, RSIA Budi Kemuliaan. The determinant factor is the type of delivery, marker of maternal urinary tract infection (UTI), intra-amniotic infection markers (intrapartum fever, maternal tachycardia, fetal tachycardia, change in the color and odor of amniotic fluid, maternal blood leukocytes), and umbilical cord blood infection marker (increased the total number of leukocytes, neutrophils, an increase in the ratio of I / T, hs-CRP and IL-6). Early-onset neonatal sepsis was diagnosed base on infant medical record on 72 hours afeter birth and confirmed by the positive results of umbilical cord blood cultures. The resulting of EONS determinants model is a logistic regression equation used to determine the probability of the occurrence of EONS as reference rational basis empirical antibiotic therapy.

Results: The EOS determinants model on asymptomatic term infant born to mothers with PROM> 12 hours is a calculator and scoring system that is formed from the determinant of vaginal delivery, change the color and odor of amniotic fluid, maternal blood leukocytes, cord blood leukocytes, the levels of hs-CRP and IL-6 umbilical cord blood level. Early-onset neonatal sepsis determinant model has two variants, the full variant used for subspecialty neonatal care facilities and alternative variant is used for specialty neonatal care facilities. Ideal cutoff point probability of occurrence SNAD has sensitivity range of 24.2 to 40.3% and specificity of 87.1 to 94.5%. The model performe is good based on Hosmer-Lemeshow test anda discrimination value AUC in in range of 0.743 to 0.816.

Conclusion: The EOS determinant model of asymptomatic term infant born to mothers with PROM > 12 hours is a calculator and scoring system that is used to determine the probability of EONS occurrence as the basis of determining the rational empirical antibiotic therapy."

"Sepsis merupakan kondisi yang sulit untuk didiagnosis. Definisi sepsis berdasarkan International Consensus Conference on Pediatric Sepsis 2005 terlalu sensitif dan tidak spesifik. Akibatnya sering terjadi underdiagnosed/overdiagnosis terhadap sepsis. Sampai saat ini tidak ada data tentang karakteristik pasien sepsis, kepatuhan diagnosis berdasarkan konsensus yang disepakati, dan luaran sepsis pasien di PICU. Penelitian ini bertujuan untuk mengetahui gambaran karakteristik sepsis di PICU RS dr. Cipto Mangunkusumo. Metode penelitian ini adalah deskriptif retrospektif dari data rekam medis pasien sepsis di PICU periode Januari 2012 sampai April 2016. Didapatkan 85 pasien yang didiagnosis dokter dengan sepsis, 7 pasien diantaranya tidak memenuhi kriteria konsensus. Hanya 1 pasien yang didiagnosis sepsis berat oleh dokter, sedangkan berdasarkan konsensus didapatkan 66 pasien sepsis berat. Infeksi respiratorik adalah penyakit primer penyebab sepsis di PICU (51,3%). Angka kejadian sepsis berat di PICU sebesar 85% dan syok septik 70%. Klebsiella pneumonia kuman gram negatif terbanyak penyebab sepsis (22%). Angka kematian sepsis sebesar 29%, pada sepsis berat 32% dan meningkat pada syok septik 37%. Penelitian ini menunjukkan kepatuhan diagnosis sepsis oleh dokter berdasarkan konsensus masih kurang. Diagnosis sepsis pasien di PICU berdasarkan kadar prokalsitonin yang meningkat.

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Sepsis is a condition that is difficult to diagnose. Definition of sepsis based on the International Consensus Conference on Pediatric Sepsis 2005 is too sensitive and not specific. As a result underdiagnosed/overdiagnosis often occurs in sepsis. Until now there are no data on the characteristics of sepsis patients, compliance to diagnosis based on consensus, and the outcome of sepsis patients in PICU. The aim of this study is to determine the characteristic features of sepsis in PICU of dr. Cipto Mangunkusumo hospital. The methods is descriptive retrospective study from medical records of sepsis patients in PICU from January 2012 until April 2016. There were 85 patients diagnosed with sepsis by physicians, 7 of them did not meet the criteria of consensus. Only one severe sepsis patients diagnosed by a doctor, but based on the consensus, there are 66 patients with severe sepsis. Respiratory infections are the primary cause of sepsis (51.3%). The incidence of severe sepsis in PICU is 85% and of septic shock is 70%. Klebsiella pneumonia, Gram negative bacteria, is the most common cause of sepsis (22%). Sepsis mortality rate is 29%, severe sepsis is 32% and increased in septic shock by 37%. This study describes compliance of diagnosis of sepsis by doctor based on consensus is still lacking. The diagnosis of sepsis patients in PICU based on increased levels of procalcitonin."

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Prevalensi sepsis neonatorum diantara bayi baru lahir cukup tinggi. Oleh karena itu, dibutuhkan diagnosis yang akurat. Namun, gejala klinis sepsis tidak cukup spesifik untuk menegakkan diagnosa, dan ini merupakan tantangan bagi para dokter. Penelitian ini bertujuan untuk mempelajari hubungan antara enam faktor resiko terhadap prevalensi sepsis neonatorum awitan dini (SNAD). Terdapat 67 pasien yang lahir dan dirawat di Rumah Sakit Cipto Mangunkusumo pada tahun 2018 dan diikutsertakan dalam penelitian ini, dan data yang digunakan didapatkan dari rekam medis. Subjek dibagi menjadi dua kelompok berdasarkan durasi pengobatan antibiotik: sepsis (pengobatan >5 hari) dan non-sepsis (pengobatan ≤5 hari). Penelitian ini cross-sectional, dan menggunakan analisis univariat dan bivariat. 52 (77.6%) dari 67 pasien memiliki SNAD. Melalui analisis bivariat, faktor resiko yang diteliti tidak signifikan secara statistik (nilai p> 0.05) terhadap sepsis maupun non-sepsis, dengan pengecualian untuk demam pada ibu dengan nilai p yang tidak ada. Ketuban pecah dini (KPD) ≥18 jam, nilai APGAR rendah, usia gestasi <37 minggu, dan berat badan lahir (BBL) < 2500 gram memiliki OR>1, Sedangkan leukosit ibu ≥18000 sel/ µL memiliki OR <1. Untuk demam ibu dan nilai APGAR rendah OR tidak dapat dihitung. Pada kesimpulannya, KPD ≥18 jam, usia gestasi <37 minggu, BBL < 2500 gram, leukosit ibu ≥ 18000 sel/ µL, dan nilai APGAR rendah tidak berhubungan dengan prevalensi SNAD. Tidak ada faktor resiko yang paling berpengaruh.

 

Kata kunci: Faktor resiko sepsis, sepsis neonatorum awitan dini

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The prevalence of sepsis among neonates are high. Hence, accurate diagnosis is required. However, diagnosis through clinical signs and symptoms are still vague, which remains a challenge for physicians. This research aims to study the association of six risk factors towards the prevalence of neonatal Early Onset Sepsis (EOS). A total of 67 patients that were born and treated in Ciptomangunkusumo Hospital in 2018 were used in this research, obtained from medical record. The subjects were divided into two groups based on the duration of treatment using antibiotics: sepsis (treatment >5 days) and non-sepsis (treatment ≤ 5 days). This study is cross-sectional, and uses univariate and bivariate analysis. 52 (77.6%) out of 67 patients have EOS. From bivariate analysis, the risk factors that were examined did not show a statistical significance (p-value > 0.05) towards sepsis and non-sepsis, except for maternal fever which p-value has no result.  Prolonged rupture of membranes, low APGAR score, gestational age <37 weeks, and birth weight <2500 grams had an OR>1. On the other hand, high maternal leukocyte count has an OR< 1. The OR of maternal fever and low APGAR score was not able to be calculated. In conclusion, prolonged rupture of membrane, premature infant, birth weight <2500 grams, maternal leukocyte counts of ≥ 18000 cells/ µL, and low APGAR score has no relation with the prevalence of EOS. There are no most influential risk factors.

 

Keywords: Risk factors of sepsis, early onset sepsis

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"Tuberkulosis merupakan penyakit menular yang disebabkan oleh bakteri mycobacterium tuberculosis. Salah satu penyebab perburukan dan kematian pada pasien dengan tuberkulosis paru adalah adanya sepsis. Sepsis merupakan disfungsi organ mengancam nyawa yang disebabkan oleh disregulasi respon host terhadap infeksi. Syok sepsis akibat tuberkulosis dapat menyebabkan beberapa gejala yang umum pada tuberkulosis, seperti demam dan sesak napas hingga disfungsi multiorgan. Angka kematian yang tinggi dan kesalahan diagnosis sepsis pada tuberkulosis masih umum terjadi. Oleh karena itu, perawat berperan penting dalam pengenalan dini dan perawatan pada pasien dengan sepsis. Penulisan karya ilmiah ini bertujuan untuk memaparkan hasil praktik mengenai pemberian asuhan keperawatan pada pasien tuberkulosis paru dengan sepsis. Analisis asuhan keperawatan dilakukan pada pasien laki-laki berusia 49 tahun yang mengalami tuberkulosis paru disertai dengan sepsis di ruang rawat inap. Masalah keperawatan yang dapat diangkat pada kasus pasien dengan sepsis, antara lain bersihan jalan napas tidak efektif, ketidakseimbangan nutrisi: kurang dari kebutuhan tubuh, dan risiko syok. Penerapan intervensi pada karya ilmiah ini khususnya berfokus untuk menangani risiko syok dengan menggunakan bundel yang disertai dengan perawatan terperinci pada pasien. Intervensi diberikan selama empat hari kepada pasien. Intervensi yang diterapkan efektif dalam meningkatkan kondisi klinis pasien ketika dilakukan penerapan, namun tidak berdampak signifikan pada peningkatan kondisi klinis pasien secara kumulatif.

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Tuberculosis is an infectious disease caused by the bacteria mycobacterium tuberculosis. One of the causes of deterioration and death in patients with pulmonary tuberculosis is sepsis. Sepsis is a life-threatening organ dysfunction caused by dysregulation of the host response to infection. Septic shock due to tuberculosis can cause several symptoms common to tuberculosis, such as fever and shortness of breath to multiorgan dysfunction. The high mortality rate and misdiagnosis of sepsis in tuberculosis are still common. Therefore, nurses play an important role in early recognition and treatment of patients with sepsis. The aim of writing this scientific work is to present practical results regarding the provision of nursing care to pulmonary tuberculosis patients with sepsis. Analysis of nursing care was carried out on a 49 year old male patient who experienced pulmonary tuberculosis accompanied by sepsis in the inpatient room. Nursing problems that can be raised in cases of patients with sepsis include ineffective airway clearance, imbalanced nutrition: less than body requirements, and risk of shock. The implementation of interventions in this scientific work specifically focuses on managing the risk of shock using a bundle accompanied by detailed patient care. The intervention was given for four days to the patient. The intervention implemented was effective in improving the patient's clinical condition when implemented, but did not have a significant impact on improving the patient's clinical condition cumulatively."

"Manifestasi klinis sepsis berupa systemic inflammatory response syndrome/SIRS, terdapatnya infeksi dan disfungsi organ merupakan kriteria yang digunakan dalam diagnosis sepsis saat ini. Pada 2 tahun terakhir berkembang pemikiran untuk menambahkan beberapa parameter disamping kriteria tersebut, dengan diajukannya terminologi PIRO (P: predisposition, I: infection, R: response dan O: organ failure). Manifestasi klinis sepsis di tiap rumah sakit maupun unit perawatan dapat berbeda bergantung dari beratnya sepsis, fokus infeksi, komorbiditas dan disfungsi atau kegagalan organ. Pada penelitian ini akan dievaluasi data demografi, komorbiditas, sumber infeksi, manifestasi SIRS, disfungsi organ dan profil mikrobiologik sepsis di rawat di Unit Penyakit Dalam RSUPN Dr. Cipto Mangunkusumo, Jakarta. Dilakukan penelitian deskriptif korelatif dengan disain potong lintang, pada 42 subyek dengan sepsis, sepsis berat dan renjatan septik. Penelitian dilakukan di Unit Rawat RSPUN Dr. Cipto Mangunkusumo, Jakarta pada tahun 2002. Dilakukan pencatatan data klinis, laboratorium (hematologi, biokimia, analisis gas darah) dan kultur aerob (darah dan spesimen lain). Kriteria sepsis yang digunakan berdasarkan American College of Chest Physician dan Society of Critical Care Medicine tahun 1992. Hasil penelitian menunjukkan terdapatnya distrubusi sepsis yang proporsional menurut usia dan jenis kelamin, komorbiditas didapatkan pada 88% subyek, berupa diabetes melitus dan penyakit kronik lainnya. Sumber infeksi terbanyak berasal dari paru, kulit-jaringan lunak, abdomen dan traktus urinarius; dengan gambaran kuman Gram negatif lebih banyak dari Gram positif. Manifestasi SIRS didapatkan pada lebih dari 70% subyek dengan manifestasi terbanyak berupa takikardia dan takipnu. Manifestasi disfungsi organ terbanyak berupa penurunan kesadaran, asidosis metabolik, disfungsi renal dan penurunan tekanan arteri rata-rata, dan didapatkan korelasi parameter tersebut dengan derajat sepsis. (Med J Indones 2004; 13: 90-5)"

"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)"

"ABSTRAK Latar Belakang: Pengaruh metastasis sebagai penyebab peningkatan procalcitonin(PCT) pada pasien tumor padat nonsepsis masih belum jelas. Studi-studisebelumnya memberikan hasil yang tidak konklusif. Nilai titik potong PCT untukdiagnosis sepsis pada tumor padat metastasis juga belum diketahui. Tujuan: Mengetahui peran PCT dalam diagnosis sepsis pada pasien tumor padatdengan metastasis. Metode: Studi potong lintang terhadap pasien tumor padat yang berobat di RSCMSeptember-Desember 2015. Pada pasien ditentukan ada tidaknya sepsismenggunakan kriteria sepsis ACCP/SCCM 2001, dilakukan pemeriksaan darahperifer, serta PCT. Dilakukan analisis untuk mengetahui perbedaan kadar PCTpasien tumor padat metastasis dan tanpa metastasis yang tidak sepsis. Selain itu,dilakukan pula pencarian nilai titik potong PCT untuk diagnosis sepsis pada pasientumor padat metastasis dengan menggunakan ROC. Hasil dan Pembahasan: Didapatkan 112 pasien tumor padat, pria sebanyak 51%,dengan rerata usia 47,9 ±12,47 tahun. Sebanyak 71 (63,4%) pasien sudahdidapatkan metastasis, 36 (32,1%) diantaranya sepsis, dan 6 (5,3%) mengalamiSIRS. Dari 41 (36,6%) pasien tanpa metastasis, 9 (8%) mengalami sepsis, dan 5(4,4%) SIRS. Terdapat perbedaan bermakna kadar PCT pada pasien tumor padatmetastasis dibandingkan tanpa metastasis pada kondisi nonsepsis [0,25 ng/mL(0,07-1,76) vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Pasien tumor padat metastasisyang mengalami sepsis memiliki kadar PCT lebih tinggi dibandingkan nonsepsis[3,5 ng/mL (0,66-189,4) vs. 0,25 ng/mL (0,07-1,76); p<0,001]. Dari kurva ROCkadar PCT pada tumor padat metastasis, didapatkan AUC [0,956, IK 0,916-0,996]untuk mendiagnosis sepsis. Nilai titik potong PCT untuk diagnosis sepsis padapasien tumor padat metastasis adalah 1,14 ng/mL dengan sensitivitas 86% danspesifisitas 88%. Kesimpulan: Pada kondisi nonsepsis, kadar PCT pasien tumor padat metastasislebih tinggi dibandingkan pasien tanpa metastasis. Nilai titik potong PCT untuk diagnosis sepsis pada tumor padat metastasis adalah 1,14 ng/mL. ABSTRACT Background: The effect of metastasis as a cause of increased procalcitonin (PCT)in patients with solid tumors without sepsis remains unclear. Previous studies didnot provide conclusive results. Cut off point of PCT for sepsis diagnosis inmetastatic solid tumors is also unknown. Objective: To determine the role of PCT in the diagnosis of sepsis towardmetastatic solid tumors patients. Methods: A cross sectional study was conducted in solid tumor patients who wereadmitted to Cipto Mangunkusumo, Jakarta between September 2015 and December2015. The ACCP/SCCM 2001 criteria was used to identify sepsis or SIRS inpatients. Procalcitonin level, as well as routine blood examination, was performedto determine the differences of PCT level among solid tumor patients with andwithout metastasis. Cut off point of PCT for diagnosing sepsis in patients withmetastatic solid tumors was determined using ROC curve. Results and Discussion: There were 112 patients with solid tumors, 51% male,with mean of age 47,9 ± 12,47 years. A total of 71 (63,4%) patients had metastasis,while 36 (32,1%) of them had sepsis and 6 (5,3%) experienced SIRS. Among 41(36,6%) patients without metastasis, 9 (8%) had sepsis and 5 (4,4%) had SIRS. Inthe absence of sepsis, the PCT level was significantly higher in patients withmetastatic solid tumors compared those without metastasis [0,25 ng/mL (0,07-1,76)vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Metastatic solid tumor patients with sepsishad PCT levels higher than those without sepsis [3,5 ng / mL (0,66 to 189,4) vs.0,25 ng / mL (0,07-1,76); p <0,001]. ROC curve showed that level of PCT for sepsisin metastatic solid tumors was AUC [0,956, IK 0,916-0,996]. Cut off point of PCTfor sepsis in patients with metastatic solid tumors was 1.14 ng / mL with asensitivity of 86% and specificity of 88%. Conclusion: In the absence of sepsis, PCT levels of patients with metastatic solidtumors is higher than patients without metastasis. Cut off point of PCT for sepsisdiagnosis in metastatic solid tumors was 1,14 ng / mL. ;Background: The effect of metastasis as a cause of increased procalcitonin (PCT)in patients with solid tumors without sepsis remains unclear. Previous studies didnot provide conclusive results. Cut off point of PCT for sepsis diagnosis inmetastatic solid tumors is also unknown. Objective: To determine the role of PCT in the diagnosis of sepsis towardmetastatic solid tumors patients. Methods: A cross sectional study was conducted in solid tumor patients who wereadmitted to Cipto Mangunkusumo, Jakarta between September 2015 and December2015. The ACCP/SCCM 2001 criteria was used to identify sepsis or SIRS inpatients. Procalcitonin level, as well as routine blood examination, was performedto determine the differences of PCT level among solid tumor patients with andwithout metastasis. Cut off point of PCT for diagnosing sepsis in patients withmetastatic solid tumors was determined using ROC curve. Results and Discussion: There were 112 patients with solid tumors, 51% male,with mean of age 47,9 ± 12,47 years. A total of 71 (63,4%) patients had metastasis,while 36 (32,1%) of them had sepsis and 6 (5,3%) experienced SIRS. Among 41(36,6%) patients without metastasis, 9 (8%) had sepsis and 5 (4,4%) had SIRS. Inthe absence of sepsis, the PCT level was significantly higher in patients withmetastatic solid tumors compared those without metastasis [0,25 ng/mL (0,07-1,76)vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Metastatic solid tumor patients with sepsishad PCT levels higher than those without sepsis [3,5 ng / mL (0,66 to 189,4) vs.0,25 ng / mL (0,07-1,76); p <0,001]. ROC curve showed that level of PCT for sepsisin metastatic solid tumors was AUC [0,956, IK 0,916-0,996]. Cut off point of PCTfor sepsis in patients with metastatic solid tumors was 1.14 ng / mL with asensitivity of 86% and specificity of 88%. Conclusion: In the absence of sepsis, PCT levels of patients with metastatic solidtumors is higher than patients without metastasis. Cut off point of PCT for sepsisdiagnosis in metastatic solid tumors was 1,14 ng / mL. ;Background: The effect of metastasis as a cause of increased procalcitonin (PCT)in patients with solid tumors without sepsis remains unclear. Previous studies didnot provide conclusive results. Cut off point of PCT for sepsis diagnosis inmetastatic solid tumors is also unknown. Objective: To determine the role of PCT in the diagnosis of sepsis towardmetastatic solid tumors patients. Methods: A cross sectional study was conducted in solid tumor patients who wereadmitted to Cipto Mangunkusumo, Jakarta between September 2015 and December2015. The ACCP/SCCM 2001 criteria was used to identify sepsis or SIRS inpatients. Procalcitonin level, as well as routine blood examination, was performedto determine the differences of PCT level among solid tumor patients with andwithout metastasis. Cut off point of PCT for diagnosing sepsis in patients withmetastatic solid tumors was determined using ROC curve. Results and Discussion: There were 112 patients with solid tumors, 51% male,with mean of age 47,9 ± 12,47 years. A total of 71 (63,4%) patients had metastasis,while 36 (32,1%) of them had sepsis and 6 (5,3%) experienced SIRS. Among 41(36,6%) patients without metastasis, 9 (8%) had sepsis and 5 (4,4%) had SIRS. Inthe absence of sepsis, the PCT level was significantly higher in patients withmetastatic solid tumors compared those without metastasis [0,25 ng/mL (0,07-1,76)vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Metastatic solid tumor patients with sepsishad PCT levels higher than those without sepsis [3,5 ng / mL (0,66 to 189,4) vs.0,25 ng / mL (0,07-1,76); p <0,001]. ROC curve showed that level of PCT for sepsisin metastatic solid tumors was AUC [0,956, IK 0,916-0,996]. Cut off point of PCTfor sepsis in patients with metastatic solid tumors was 1.14 ng / mL with asensitivity of 86% and specificity of 88%. Conclusion: In the absence of sepsis, PCT levels of patients with metastatic solidtumors is higher than patients without metastasis. Cut off point of PCT for sepsisdiagnosis in metastatic solid tumors was 1,14 ng / mL. ;Background: The effect of metastasis as a cause of increased procalcitonin (PCT)in patients with solid tumors without sepsis remains unclear. Previous studies didnot provide conclusive results. Cut off point of PCT for sepsis diagnosis inmetastatic solid tumors is also unknown. Objective: To determine the role of PCT in the diagnosis of sepsis towardmetastatic solid tumors patients. Methods: A cross sectional study was conducted in solid tumor patients who wereadmitted to Cipto Mangunkusumo, Jakarta between September 2015 and December2015. The ACCP/SCCM 2001 criteria was used to identify sepsis or SIRS inpatients. Procalcitonin level, as well as routine blood examination, was performedto determine the differences of PCT level among solid tumor patients with andwithout metastasis. Cut off point of PCT for diagnosing sepsis in patients withmetastatic solid tumors was determined using ROC curve. Results and Discussion: There were 112 patients with solid tumors, 51% male,with mean of age 47,9 ± 12,47 years. A total of 71 (63,4%) patients had metastasis,while 36 (32,1%) of them had sepsis and 6 (5,3%) experienced SIRS. Among 41(36,6%) patients without metastasis, 9 (8%) had sepsis and 5 (4,4%) had SIRS. Inthe absence of sepsis, the PCT level was significantly higher in patients withmetastatic solid tumors compared those without metastasis [0,25 ng/mL (0,07-1,76)vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Metastatic solid tumor patients with sepsishad PCT levels higher than those without sepsis [3,5 ng / mL (0,66 to 189,4) vs.0,25 ng / mL (0,07-1,76); p <0,001]. ROC curve showed that level of PCT for sepsisin metastatic solid tumors was AUC [0,956, IK 0,916-0,996]. Cut off point of PCTfor sepsis in patients with metastatic solid tumors was 1.14 ng / mL with asensitivity of 86% and specificity of 88%. Conclusion: In the absence of sepsis, PCT levels of patients with metastatic solidtumors is higher than patients without metastasis. Cut off point of PCT for sepsisdiagnosis in metastatic solid tumors was 1,14 ng / mL. ;Background: The effect of metastasis as a cause of increased procalcitonin (PCT)in patients with solid tumors without sepsis remains unclear. Previous studies didnot provide conclusive results. Cut off point of PCT for sepsis diagnosis inmetastatic solid tumors is also unknown. Objective: To determine the role of PCT in the diagnosis of sepsis towardmetastatic solid tumors patients. Methods: A cross sectional study was conducted in solid tumor patients who wereadmitted to Cipto Mangunkusumo, Jakarta between September 2015 and December2015. The ACCP/SCCM 2001 criteria was used to identify sepsis or SIRS inpatients. Procalcitonin level, as well as routine blood examination, was performedto determine the differences of PCT level among solid tumor patients with andwithout metastasis. Cut off point of PCT for diagnosing sepsis in patients withmetastatic solid tumors was determined using ROC curve. Results and Discussion: There were 112 patients with solid tumors, 51% male,with mean of age 47,9 ± 12,47 years. A total of 71 (63,4%) patients had metastasis,while 36 (32,1%) of them had sepsis and 6 (5,3%) experienced SIRS. Among 41(36,6%) patients without metastasis, 9 (8%) had sepsis and 5 (4,4%) had SIRS. Inthe absence of sepsis, the PCT level was significantly higher in patients withmetastatic solid tumors compared those without metastasis [0,25 ng/mL (0,07-1,76)vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Metastatic solid tumor patients with sepsishad PCT levels higher than those without sepsis [3,5 ng / mL (0,66 to 189,4) vs.0,25 ng / mL (0,07-1,76); p <0,001]. ROC curve showed that level of PCT for sepsisin metastatic solid tumors was AUC [0,956, IK 0,916-0,996]. Cut off point of PCTfor sepsis in patients with metastatic solid tumors was 1.14 ng / mL with asensitivity of 86% and specificity of 88%. Conclusion: In the absence of sepsis, PCT levels of patients with metastatic solidtumors is higher than patients without metastasis. Cut off point of PCT for sepsisdiagnosis in metastatic solid tumors was 1,14 ng / mL. "

"Sepsis merupakan suatu disfungsi organ yang bersifat mengancam jiwa yang disebabkan oleh infeksi, sedangkan syok septik adalah sekumpulan tanda-tanda sepsis dengan resiko mortalitas yang lebih tinggi. Penatalaksanaan pasien bergantung pada pemberian antibiotik empiris yang sesuai untuk mencegah resistensi bakteri terhadap antibiotik yang diberikan. Tujuan penelitian ini yaitu untuk melihat pola antibiotik yang diberikan kepada pasien sepsis dan menilai kesesuaian penggunaan antibiotik pada pasien sepsis di Instalasi Gawat Darurat RSUP Fatmawati periode Oktober-Desember 2016. Penelitian ini dilakukan dengan desain cross sectional dan bersifat deskriptif secara retrospektif dengan mengevaluasi catatan rekam medis dari 99 pasien sepsis. Pengambilan sampel penelitian dilakukan dengan teknik total sampling. Hasil analisis pada 99 pasien sepsis, didapatkan jumlah penderita laki-laki lebih tinggi daripada perempuan, yaitu sebesar 56.57 dan paling banyak diderita oleh pasien lansia akhir >55-65 tahun sebesar 34.34. Kriteria pasien sepsis didapatkan bahwa pasien sepsis sebesar 73.74 dan syok septik sebesar 26.26. Antibiotik tunggal yang paling sering digunakan adalah seftriakson, sedangkan antibiotik yang paling sering dikombinasi adalah levofloksasin seftriakson. Penggunaan antibiotik yang memenuhi kriteria tepat pasien sebanyak 49.49 , tepat indikasi sebanyak 70.71 , dan tepat dosis sebanyak 34.34.

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Sepsis is defined as life threatening organ dysfunction caused by infection, whereas septic shock is a subset of sepsis in which substantially increase mortality. The management of the patient depends on treating septic patient especially with appropriate empirical antibiotics to prevent bacterial resistance.

The purpose of this study was to perceive of the antibiotic prescription patterns given to sepsis patients and assess the accuracy of antibiotic usage in sepsis patients in the Emergency Department of Fatmawati Central General Hospital October to December 2016 period.

The design of this study was cross sectional and this sudy was descriptive with retrospective data collection by evaluated medical records from 99 patients. This sudy used the total sampling technique.

Based on analysis of 99 sepsis patients, the number of men was higher than women, which was 56.57 and the most suffered by the elderly 55 65 years old patients was 34.34.

This study showed that sepsis patients were 73.74 and septic shock were 26.26. The single most antibiotic commonly used was ceftriaxone and the most combined antibiotic was levofloxacin ceftriaxone. The administration of antibiotics which patient 39 s properly criteria was 49.49 , appropriate indication was 70.71 , and appropriate dosage was 34.34."