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Abstrak :

Latar belakang: Resistensi antibiotik merupakan masalah penting dan ancaman bagi kesehatan manusia di hampir seluruh negara. Dampak infeksi bakteri multidrug-resistant (MDR) berupa luaran pasien lebih buruk, biaya perawatan lebih besar, dan penggunaan antibiotik spektrum luas yang berpotensi meningkatkan prevalensi resistensi. Surveilans healthcare-associated infection (HAI) dan identifikasi faktor risiko diharapkan bisa menurunkan laju resistensi.

Tujuan: Menilai kekuatan pengaruh dari komorbiditas, riwayat pengobatan dengan antibiotik intravena 15 hari terakhir, tindakan bedah, penggunaan lebih dari 2 indwelling medical device, dan rawat inap lebih dari 7 hari terhadap terjadinya infeksi bakteri MDR pada pasien anak.

Metode: Penelitian retrospektif di Rumah Sakit Cipto Mangunkusumo Jakarta terhadap pasien berusia 1 bulan-18 tahun dengan pertumbuhan bakteri pada hasil kultur. Data diperoleh dari electronic health record yaitu data demografi, komorbid, riwayat terapi antibiotik, tindakan bedah, medical device, lama rawat inap, data mikrobiologi, dan luaran akhir perawatan.

Hasil: Proporsi bakteri MDR pada penelitian ini sebesar 76,3%. Analisis bivariat tidak menunjukkan adanya hubungan antara komorbiditas, riwayat terapi antibiotik, tindakan bedah, dan penggunaan lebih dari 2 indwelling medical device, dengan infeksi bakteri MDR pada pasien anak. Namun rawat inap lebih dari 7 hari akan meningkatkan risiko pasien anak mengalami infeksi bakteri MDR (OR 2,755; 95% IK 1,107-6,857; P = 0,036).

Simpulan: Pasien anak dengan rawat inap lebih dari 7 hari memiliki risiko hampir 2,7 kali lipat untuk mengalami infeksi bakteri MDR dibanding pasien anak dengan rawat inap 7 hari atau kurang.

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Background: Antibiotic resistance is an important problem and threats to human health worldwide. Multidrug-resistant (MDR) bacteria infection is associated with poor outcome, higher treatment cost, and higher rate of broad spectrum antibiotic use which may lead to subsequent antibiotic resistance. Healthcare-associated infection surveillance and identification of risk factors can provide effort to control the development of antibiotic resistance.

Objective: Measure the strength of association between comorbidity, intravenous antibiotic use within the last 15 days, surgery procedure, use of more than two indwelling medical devices, and hospital stay more than 7 days, with MDR bacteria infection in pediatric patient.

Methods: Restrospective study in 1 month - 18 years old pediatric patient at Cipto Mangunkusumo Hospital Jakarta who had bacteria growth on microbiological culture. Demographic data, comorbid condition, history of antibiotic use, surgery, indwelling medical device use, length of hospital stay, microbiological data, and mortality were collected from the electronic health record.

Results: Rate of MDR bacteria infection in this study was 76,3%. Bivariate analysis showed no relationships between comorbidity, intravenous antibiotic use in prior 15 days, surgery, and use of more than two indwelling medical devices, with MDR bacteria infection. Pediatric patients with hospital stay longer than 7 days were more likely to have MDR bacteria infection (OR 2,755; CI 95% 1,107-6,857; P = 0,036) compared to those with hospital stay 7 days or less.

Conclusion: Hospital stay longer than 7 days increase risk pediatric patient to contract MDR bacteria infection by 2,7 fold.

Abstrak :
Latar belakang: Difteri merupakan penyakit infeksi endemis dan menjadi masalah kesehatan di Indonesia. Pada tahun 2017 kejadian luar biasa difteri terjadi di beberapa provinsi di Indonesia. Tujuan: Untuk mengetahui prediktor kematian difteri klinis pada anak di Provinsi DKI Jakarta dan Kabupaten Tangerang selama kejadian luar biasa tahun 2017-2018. Metode: Penelitian kohort retrospektif dilakukan di lima rumah sakit rujukan di DKI Jakarta dan satu di Kabupaten Tangerang periode 1 Januari 2017-31 Agustus 2018. Pasien anak usia 1-18 tahun dengan diagnosis difteri klinis dinilai faktor prediktor yang berhubungan dengan luaran kematian. Uji korelasi chi square dilakukan untuk mengetahui hubungan variabel bebas dan luaran. Multivariat analisis dilakukan untuk menentukan prediktor kematian. Analisis data dilakukan dengan program SPSS for Window ver 20,0. Hasil: Pasien anak dengan difteri klinis sejumlah 283 kasus dengan case fatality rate 3,5%. Riwayat imunisasi dasar (RR 6,967; p 0,003), suara serak (RR 7,611; p 0,035), stridor (RR 16,963; p<0,001), bullneck (RR 28,456; p<0,001), limfadenopati (RR 3,838; p 0,045), komplikasi miokarditis (p<0,001), leukositosis >15.000sel/mm3 (RR 7,500; p 0,004), trombositopenia (RR 35,549; p<0,001), kultur C. diphtheriae positif (RR 6,587; p 0,04) berhubungan dengan kematian. Analisis multivariat menunjukkan stridor (HR 11,951; p 0,006), lekositosis (HR 11,425; p 0,01), dan trombositopenia (HR 44,199; p<0,001) berhubungan dengan kematian. Simpulan: Stridor, lekositosis dan trmbositopenia merupakan faktor prediktor kematian pada difteri klinis anak.

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Background: Diphtheria is endemic in Indonesia. In 2017 diphtheria outbreak has taken place in several provinces. Objective: To identify predictors of mortality of pediatric patients with clinical diphtheria during 2017-2018 outbreak in the Province of Jakarta and Tangerang District. Methods: A retrospective cohort study has been held at five referral hospitals in the Province of Jakarta and one in Tangerang District during January 2017 and 31 August 2018. The study group is children age group of 1-18 years old admitted with sign and symptoms and discharge as clinical diphtheria. All details that is demographic data, clinical features, immunization status, complication and laboratory profiles and outcome were analysed. Variables were compared among survivors and non survivors to determine the predictors of mortality. A chi square test and cox regression was done to assess association between variables and outcome. Data were analysed using SPSS for Window ver 20,0. Results: A total of 283 pediatric patients with clinical diphtheria were included in the study group with case fatality rate of 3.5%. Basic immunization status (RR 6.967; p0.003), hoarseness (RR 7.611; p0.035), stridor (RR 16.963; p<0.001), bullneck (RR 28.456; p<0.001), limphadenopaty (RR 3.838; p0.045), myocarditis (p<0,001), leukocytosis >15,000 cell/mm3 (RR 7.500; p0.004), thrombocytopenia <150,000 cell/mm3 (RR 35.549; p<0.001), C. diphtheriae positive culture (RR 6.587; p0.04) were found correlated to mortality. Multivariat analysis showed that stridor (HR 11.951; p0.006), leukocytosis (HR 11,425; p0,01), and thrombocytopenia (HR 44.199; p<0.001) correlated to death. Conclusion: Diphtheria is fatal disease with increased mortality. Presence of stridor, leukocytosis and thrmbocytopenia are important predictors of mortality.

Abstrak :
Latar belakang: Infeksi virus Epstein-Barr (EBV) dapat menjadi infeksi oportunistik pada anak dengan HIV. Gejala infeksi EBV sulit dibedakan dengan infeksi HIV dan bersifat laten. Infeksi EBV laten dapat reaktivasi mulai dari gangguan limfoproliferatif hingga terjadinya keganasan. Di Indonesia belum ada data mengenai infeksi EBV pada anak dengan HIV. Tujuan: Mengetahui proporsi, karakteristik dan faktor-faktor yang berhubungan dengan terjadinya infeksi EBV pada anak dengan HIV di RSUPN Dr. Cipto Mangunkusumo Jakarta. Metode: Penelitian potong lintang untuk melihat karakteristik infeksi EBV pada anak dengan HIV dan faktor-faktor yang berhubungan di RSUPN Dr. Cipto Mangunkusumo Jakarta, periode bulan September 2020 hingga Februari 2021. Sampel darah diambil untuk dilakukan pemeriksaan PCR EBV kualitatif (whole blood), darah perifer lengkap, kadar CD4 dan viral load HIV. Hasil: Total subyek 83 anak dengan HIV. Proporsi subyek terinfeksi EBV sebesar 28,9%, dengan rerata usia 9,58 tahun. Limfadenopati merupakan gejala terbanyak, meskipun tidak dapat dibedakan dengan infeksi lain. Dua anak mengalami keganasan akibat EBV yaitu Limfoma Non Hodgkin dan leiomiosarkoma. Sebanyak 75% subyek terinfeksi EBV yang berusia di bawah 12 tahun mengalami anemia (rerata Hb 10,68 ± 2,86 g/dL), dapat disebabkan infeksi EBV atau penyebab lain. Hasil analisis bivariat menunjukkan kadar viral load HIV > 1000 kopi/mL berhubungan dengan terjadinya infeksi EBV pada subyek (OR 2,69 (1,015-7,141); P = 0,043). Simpulan: Proporsi anak dengan HIV yang terinfeksi EBV di RSUPN Dr. Cipto Mangunkusumo Jakarta adalah 28,9%, dengan kadar viral load HIV > 1000 kopi/mL berhubungan dengan terjadinya infeksi EBV pada anak dengan HIV. ......Background: Epstein-Barr virus (EBV) infection can be an opportunistic infection in HIV-infected children. EBV infection is difficult to be differentiated from HIV infection, and it can be latent. Latent EBV infection can reactivate into lymphoproliferative disorders and malignancy. There is no data on EBV infection in HIV-infected children in Indonesia. Objective: To identify the proportion, manifestations and factors associated with EBV infection in HIV-infected children in Dr. Cipto Mangunkusumo National Central Hospital Jakarta. Methods: Cross-sectional study to examine the manifestations of EBV infection in HIV-infected children and it’s associated factors in Dr. Cipto Mangunkusumo National Central Hospital Jakarta, during September 2020 to February 2021. Blood samples were taken to examine qualitative EBV PCR (whole blood), complete blood count, CD4 levels and HIV viral load. Results: Total subjects were 83 HIV-infected children. The proportion of children infected with EBV was 28.9%, with mean age 9.58 years. Lymphadenopathy was the most common symptoms, although it was difficult to differentiate from other infections. Two children have malignancy due to EBV, namely Non-Hodgkin's lymphoma and leiomyosarcoma. Total 75% of EBV-infected subjects under 12 years of age were anemic (mean Hb 10.68 ± 2.86 g/dL), could be due to EBV infection or other causes. Bivariate analysis showed HIV viral load levels > 1000 copies/mL were associated with EBV infection in subjects (OR 2.69 (1.015-7.141); P = 0.043). Conclusion: The proportion of EBV infection in HIV-infected children in Dr. Cipto Mangunkusumo National Central Hospital Jakarta is 28.9%, with HIV viral load levels > 1000 copies/mL were associated with the EBV infection in HIV-infected children.