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Abstrak :
ABSTRAK
Pendahuluan: Modifikasi dari kriteria klinis infeksi menurut International Disease Society of America dan International Working Group on Diabetic Foot (IDSA-IWGDF) diperlukan untuk mengevaluasi infeksi pada ulkus kaki diabetik setelah pengobatan. Prokalsitonin (PCT), penanda infeksi yang spesifik untuk infeksi bakteri diketahui bermanfaat dalam menegakkan diagnosis infeksi pada ulkus kaki diabetik. Namun, peranannya dalam menentukan ada tidaknya infeksi pada ulkus kaki diabetik setelah pengobatan belum diketahui, begitu juga nilai tambahnya terhadap penanda klinis infeksi. Penelitian ini dilakukan untuk menentukan kemampuan penanda klinis infeksi menurut IDSA-IWGDF yang dimodifikasi dan PCT dalam mengevaluasi masih ada atau tidaknya infeksi pada ulkus kaki diabetik setelah pengobatan. Metode: Dilakukan studi potong lintang berbasis riset diagnostik pada penyandang diabetes dengan ulkus kaki terinfeksi yang sedang mendapatkan pengobatan dan perawatan di Rumah Sakit dr. Cipto Mangunkusumo (RSCM) Jakarta pada kurun waktu Oktober 2011-April 2012. Pasien yang sudah memenuhi kriteria inklusi dan eksklusi penelitian dilakukan penilaian infeksi pada ulkus menggunakan kriteria klinis infeksi menurut IDSA-IWGDF yang dimodifikasi (eritema, edema, nyeri, dan panas) dan pemeriksaan PCT. Kemudian dinilai kemampuannya dalam mengevaluasi masih ada atau tidaknya infeksi pada ulkus kaki diabetik setelah pengobatan dengan membuat kurva ROC dan menghitung AUC. Lalu ditentukan titik potong dengan sensitivitas dan spesifisitas terbaik pada penelitian ini yang dibandingkan dengan baku emas berupa pemeriksaan bakteri secara kuantitatif dari kultur jaringan ulkus. Hasil: Dari 47 subjek yang diteliti, terdapat 41 subjek dengan ulkus kaki diabetik yang masih terinfeksi berdasarkan pemeriksaan bakteri secara kuantitatif dari kultur jaringan ulkus. Penanda klinis infeksi menurut IDSA-IWGDF yang dimodifikasi memilki kemampuan prediksi yang baik dalam menentukan masih ada atau tidaknya infeksi pada ulkus kaki diabetik setelah pengobatan dengan AUC: 0,744 (IK 95% 0,576-0,912) dengan titik potong bila ditemukan ≥2 tanda klinis infeksi (Sn: 41,46%; Sp: 100%; NPP: 100%, NPN: 20%). Sedangkan, untuk prokalsitonin didapatkan AUC: 0,642 (IK 95% 0,404-0,880). Simpulan: Kriteria klinis infeksi menurut IDSA-IWGDF yang dimodifikasi memiliki kemampuan yang baik untuk menentukan masih ada atau tidaknya infeksi pada ulkus kaki diabetik setelah pengobatan. Belum didapatkan manfaat prokalsitonin dalam mengevaluasi masih ada atau tidaknya infeksi pada ulkus kaki diabetik setelah pengobatan.

Abstrak :
Background: Amikacin is one of the antibiotics of choice for sepsis and septic shock. Pharmacokinetic of amikacin can be influenced by septic condition with subsequent effect on its pharmacodynamic. At Cipto Mangunkusumo Hospital (RSCM), Jakarta, adult patients in the ICU were given standard amikacin dose of 1 g/day, however the achievement of optimal plasma level had never been evaluated. This study aimed to evaluate whether the optimal plasma level of amikacin was achieved with the use of standard dose in septic conditions. Methods: all septic patients admitted to the intensive care unit of a national tertiary hospital receiving standard dose of 1g/day IV amikacin during May-September 2015 were included in this study. Information of minimum inhibitory concentration MIC was obtained from microbial culture. Cmax of amikacin was measured 30 minutes after administration and optimal level was calculated. Optimal amikacin level was considered achieved when Cmax/MIC ratio >8. Results: average Cmax achieved for all patients was 86.4 (43.5-238) µg/mL with 87% patients had Cmax of >64 µg/mL.MIC data were available for 7 of 23 patients. MICs for identified pathogens were 0.75 - >256 µg/mL (K. pneumonia), 0.75 - >256 µg/mL(A. baumanii), 1.5 - >256 µg/mL (P. aeruginosa)and 0.75 - 16 µg/mL(E. coli). Four out of seven patients achieved optimal amikacin level. Conclusion: despite high Cmax, only half of the patients achieved optimal amikacin level with highly variable Cmax. This study suggests that measurement of Cmax and MIC are important to optimize septic patients management.

Abstrak :
Background: real-time RT-PCR was recommended by WHO for COVID-19 diagnosis. The cycle threshold (Ct) values were expected to have an association with clinical manifestation. However, the diagnostic modalities such as quantitative molecular detection and virus isolation were not yet available for the routine test. This study has been conducted to analyze the relationship between the Ct values of qualitative rRT-PCR and the clinical manifestation and to describe the factors determining the result. Methods: from March to April 2020, specimens were sent to our laboratory from different healthcare centers in Jakarta. The patient's characteristic and clinical manifestation were extracted from the specimen's epidemiology forms. The specimens extracted and tested using rRT-PCR, and the Ct value were collected. The data were analyzed using the appropriate statistic test. Results: from 339 positive results, the mild to moderate case was 176 (52%) and the severe cases was 163 (48%). Female was dominant in the mild to moderate cases (58%), while the male was prevalent in the severe cases (60%). The median age for mild to moderate case was 35 years old and severe cases was 49 years old. Statistical analysis found relationship between both group with gender (p = 0.001) and age (p < 0.001), but not with the Ct value. Conclusion: many variables in specimen sampling and processing could affect the Ct value result. In addition, the disease's severity was depended with the host immune response, regardless the number of virus. There was suggested no significant difference between the Ct values of mild-moderate and severe COVID-19, and thus should not be loosely interpreted.