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Objectives: Pneumonia is the leading cause of morbidity and mortality worldwide, eighth rank in the United States. The use of antibiotic for pneumonia theraphy contribute the highest rate compared to the usage of antibiotic therapy for other diseases. Antibiotic resistance can occur due to the irrational use of antibiotics. World Health Organization (WHO) predicts that by 2050 there will be 10 million people per year who die due to drug resistance. The Gyssens method is a tool to evaluate the quality of antibiotic use that has been widely used in various countries. The purpose of this study was to assess the compatibility of antibiotic use based on Gyssens plot categories in pneumonia patients. Methods: This study used descriptive-observational with a cross-sectional study in pneumonia patients at Dr. Wahidin Sudirohusodo Hospital on periode from July-December 2023. The compatibility of antibiotics was assessed using the Gyssens flow. Results: This study involved 116 subjects, 70 males, 46 females. In this study, found that the use of rational antibiotics is 58% and irrational 42%. From irrational group we obtained category IV (3%), IIIa (31%), IIIb (8%). The most often antibiotic that used are ceftriaxone (26,8%)) and azithromycin (26,3%). Conclusions: The use of antibiotic in pneumonia patients assessed using the gyssens method in the Inpatient Installation of Dr. Wahidin Sudirohusodo Hospital from July to December 2023 found that the usage for antibiotic is rational for 58%, of the total patient and irrational use was 42% of the total patient during the research study.

Objectives: Infection with antibiotic resistant organisms has become a global problem, including in cases of pneumonia. Multi drug resistance organism (MDRO) has an impact on mortality, morbidity, and health costs. There are several risk factors that play a role in the incidence of MDRO in community acquired pneumonia. The purpose of this study was to analyze the risk factors for the incidence of MDRO in hospitalized patients with community acquired pneumonia at Wahidin Sudirohusodo Hospital. Methods: This study used an analytic observational method with a retrospective cohort. Data were taken from patient medical records from July-December 2023. Results: There were 49 (46.7%) MDRO and 56 (53.3%) non-MDRO. Based on statistical tests, MDRO infection is associated with comorbid malignancy (p value 0.002) and cardiovascular comorbidities (p value 0.015). The most common pathogens found were Acitenobacter baumanii (22.8%) and Klebsiella pneumonia (20%). Conclusions: Risk factors associated with the incidence of MDRO in community acquired pneumonia patients are malignancy and cardiovascular disease.

Objectives: Meropenem has become one of the most widely used antibiotics and is considered to be the drug of choice for empirical treatment in patients with pneumonia. The aim of this study is to evaluate factors associated with the use of Meropenem as a broad-spectrum antibiotic in a referral hospital in Makassar. Methods: In a retrospective observational study we conducted over one-month period (January- February 2024), adult patients diagnosed with pneumonia who received Meropenem were selected. We included data such as length of stay, admission to the intensive care unit, use of ventilator, basis of prescription (either empirical or culture-based), and laboratory profiles such as white blood cell count, procalcitonin levels, blood culture and resistance towards antibiotics. Results: Over one-month period, thirty patients admitted to our hospital with pneumonia were evaluated. Among these patients, several factors such as admission in intensive care unit, use of ventilator, and procalcitonin levels showed statically significance (p < 0,05) while blood culture and antibiotic resistance showed minimal impact towards utilization of Meropenem in patients with pneumonia. Conclusions: In conclusion, our study indicates that Meropenem usage for pneumonia treatment is significantly influenced by admission to the intensive care unit, use of ventilator, and specific laboratory parameters such as procalcitonin levels. Further research with larger scale is needed to evaluate utilization of Meropenem in clinical practices.

Chikungunya virus (CHIKV) is often overlooked as an etiology of fever in tropical and sub-tropical regions. Lack of diagnostic testing capacity in these areas combined with co-circulation of clinically similar pathogens such as dengue virus (DENV), hinders CHIKV diagnosis. To better address CHIKV in Indonesia, an improved understanding of epidemiology, clinical presentation, and diagnostic approaches is needed. Acutely hospitalized febrile patients ≥1-year-old were enrolled in a multi-site observational cohort study conducted in Indonesia from 2013 to 2016. Demographic and clinical data were collected at enrollment; blood specimens were collected at enrollment, once during days 14 to 28, and three months after enrollment. Plasma samples negative for DENV by serology and/or molecular assays were screened for evidence of acute CHIKV infection (ACI) by serology and molecular assays. To address the co-infection of DENV and CHIKV, DENV cases were selected randomly to be screened for evidence of ACI. ACI was confirmed in 40/1,089 (3.7%) screened subjects, all of whom were DENV negative. All 40 cases initially received other diagnoses, most commonly dengue fever, typhoid fever, and leptospirosis. ACI was found at five of the seven study cities, though evidence of prior CHIKV exposure was observed in 25.2% to 45.9% of subjects across sites. All subjects were assessed during hospitalization as mildly or moderately ill, consistent with the Asian genotype of CHIKV. Subjects with ACI had clinical presentations that overlapped with other common syndromes, atypical manifestations of disease, or persistent or false-positive IgM against Salmonella Typhi. Two of the 40 cases were possibly secondary ACI. CHIKV remains an underdiagnosed acute febrile illness in Indonesia. Public health measures should support development of CHIKV diagnostic capacity. Improved access to point-of-care diagnostic tests and clinical training on presentations of ACI will facilitate appropriate case management such as avoiding unneccessary treatments or antibiotics, early response to control mosquito population and eventually reducing disease transmission.

Background Reports of human rickettsial infection in Indonesia are limited. This study sought to characterize the epidemiology of human rickettsioses amongst patients hospitalized with fever at 8 tertiary hospitals in Indonesia. Methods Acute and convalescent blood from 975 hospitalized non-dengue patients was tested for Rickettsia IgM and IgG by ELISA. Specimens from cases with seroconversion or increasing IgM and/or IgG titers were tested for Rickettsia IgM and IgG by IFA and Rickettsia genomes using primers for Rickettsia (R.) sp , R. typhi , and Orientia tsutsugamushi . Testing was performed retrospectively on stored specimens; results did not inform patient management. Results R. typhi, R. rickettsii , and O. tsutsugamushi IgG antibodies were identified in 269/872 (30.8%), 36/634 (5.7%), and 19/504 (3.8%) of samples, respectively. For the 103/975 (10.6%) non-dengue patients diagnosed with acute rickettsial infection, presenting symptoms included nausea (72%), headache (69%), vomiting (43%), lethargy (33%), anorexia (32%), arthralgia (30%), myalgia (28%), chills (28%), epigastric pain (28%), and rash (17%). No acute rickettsioses cases were suspected during hospitalization. Discharge diagnoses included typhoid fever (44), dengue fever (20), respiratory infections (7), leptospirosis (6), unknown fever (6), sepsis (5), hepatobiliary infections (3), UTI (3), and others (9). Fatalities occurred in 7 (6.8%) patients, mostly with co-morbidities. Conclusions Rickettsial infections are consistently misdiagnosed, often as leptospirosis, dengue, or Salmonella typhi infection. Clinicians should include rickettsioses in their differential diagnosis of fever to guide empiric management; laboratories should support evaluation for rickettsial etiologies; and public policy should be implemented to reduce burden of disease.

Objective: A phylogenetic study was carried out on the avian influenza virus (AIV) isolated from a disease outbreak in Sidenreng Rappang Regency, South Sulawesi, Indonesia, in 2018. Material and Methods: Oropharyngeal swabs and organ samples were obtained from ducks that showed clinical symptoms: torticollis, fascial edema, neurological disorders, the corneas appear cloudy, and death occurs less than 1 day after symptoms appear. In this study, isolate A/duck/ Sidenreng Rappang/07180110-11/2018 from duck was sequenced and characterized. Results: It was found that each gene segment of the virus has the highest nucleotide homology to the Indonesian highly pathogenic avian influenza (HPAI) H5N1 clade 2.3.2.1c. Multiple alignments of the sample Hemagglutinin (HA) gene with the avian influenza references virus showed that the pattern of amino acid arrangement in the cleavage site PQRERRRK-RGLF is the characteristic of the HPAI virus. In addition, the HA gene contained Q222 (glutamine) and G224 (glycine), signifying a high affinity to avian receptor binding specificity (SA a2,3 Gal). Furthermore, there was no genetic reassortment of this virus based on the phylogenetic analysis of HA, NA, PB1, PB2, PA, NP, M, and NS genes. Conclusion: The HPAI H5N1 clade 2.3.2.1c virus was identified in duck farms in South Sulawesi, Indonesia.

Background: HIV is still a global health concern worldwide and in 2021, a total of 27,000 newly infected cases were detected in the Indonesian population, specifically among adults. However, there is no available data found about serotonin levels in newly infected cases of HIV. Objective: This study aimed to preliminary investigate serotonin levels in newly-infected HIV-positive cases in the Indonesian population. Methods: A quantitative cross-sectional analytic design was used with a total of 54 newly-infected HIV-positive participants who were enrolled using the purposive sampling technique. The questionnaire, blood sampling, and ELISA methods for measuring serotonin were applied. Furthermore, the serotonin distribution was compared based on participants’ characteristics using the Mann-Whitney U test. The main effect of characteristics was also tested by the generalized linear model. Results: The mean serotonin level was low and did not differ based on participants’ characteristics. Conclusion: Low serotonin level is characteristic of people newly infected with HIV in Indonesia. This might be a manifestation of the depression stage, a consequence of infection, or the involvement in provoking HIV infection progression.

Sepsis is a major global health burden with high incidence and mortality. Sepsis is mostly caused by a bacterial infection. Based on the location of infection, the most common causes of sepsis were pulmonary infections (31%) followed by intra-abdominal infections (26.3%), urinary tract infections (18.4%), and soft tissue (10.9%). In sepsis,there are several tests including procalcitonin and blood lactate

Uric acid is a byproduct of purine metabolism, mostly found as urate (ionic form) in body fluids. The concentration of uric acid in the blood depends on the synthesis and excretion of uric acid. Hyperuricemia is an important marker for metabolic disease and also associated with various forms of arthritis including osteoarthritis (OA).