ABSTRAKPendahuluan. Virulensi methicillin-resistant Staphylococcus aureus (MRSA) yang berasal dari komunitas terutama disebabkan keberadaan toksin Panton Valentin Leukocidin (PVL) dan Phenol Soluble Modulin (PSM) yang tidak dimiliki oleh MRSA yang berasal dari rumah sakit. Kedua toksin tersebut diketahui menyebabkan lisis neutrofil yang kemudian menurunkan kadar neutrofil. Penelitian ini bertujuan untuk menilai perbedaan nilai hitung neutrofil absolut antara infeksi MRSA yang didapat dari rumah sakit dengan yang dari komunitas.Metode. Penelitian in merupakan studi potong lintang yang melibatkan pasien terinfeksi MRSA yang dirawat di RSCM pada kurun waktu 2012-2017. Klasifikasi varian MRSA dilakukan berdasarkan pola kepekaan dan resistensi kuman terhadap antibiotik non beta laktam menjadi community acquired MRSA (resisten ≤ 2 antibiotik non beta laktam) dan hospital acquired MRSA (resisten ≥ 3 antibiotik non beta laktam). Hitung neutrofil absolut diambil pada 24 jam dilakukan kultur yang positif MRSA. Data dianalisis menggunakan program SPSS versi 22 dengan uji T dan Mann-Whitney.Hasil. Dari penelitian ini didapatkan 62 subjek dengan infeksi MRSA dengan infeksi HA-MRSA (n=35) lebih banyak dibandingkan CA-MRSA (n=27). Median hitung neutrofil absolut 7 (11.47,,2) dan HA-MRSA 16.198,0 (3.921,6-28.794,1) dengan nilai p < 0,001.Simpulan. Terdapat perbedaan nilai hitung neutrofil absolut yang signifikan antara infeksi MRSA yang berasal dari rumah sakit dengan yang dari komunitas. MRSA and hospitalized during 2012-2017. Classification of MRSA were divided due to its sensitivity and resistance to non-beta lactam antibiotics. Isolate that resistance to ≤ 2 antibiotics were classified as CA-MRSA. The others with resistance to ≥ 3 antibiotics were classified as hospital acquired MRSA. Absolute neutrophils count (ANC) were collected 24 hours from the positive MRSA culture. Data were analyzed by using independent T test and Mann-Whitney test. Kata Kunci: Hitung neutrofil absolut, MRSA, Panton valentin leukocidin ABSTRACT Introduction. The virulence factors from community acquired-methicillin resistant Staphylococcus aureus (CA-MRSA) mainly due to toxins like Panton Valentin Leukocidin (PVL) and Phenol Soluble Modulin (PSM). Both of toxins cause decrease of value through neutrophil lysis. This study aimed to identify different value of absolute neutrophil count between hospital and community acquired MRSA. Methods. A cross sectional was conducted which included subjects who were infected byResults. We collected 62 subjects infected by MRSA which 35 subjects were HA-MRSA and 27 subjects were CA-MRSA. The median of ANC from 410.7 (1,560.2) and 198.0 (3,794.1) with p value < 0.001. Conclusion.There was a different value of absolute neutrophil count in infections due to community and hospital acquired MRSA.

Malaria is still a health problem in Indonesia. The number of malaria cases according to the 2018 RISKESDAS reached 8076 cases, and the highest number was obtained from Papua province with 3,334 cases. Multiple infection malaria in Indonesia according to RISKESDAS 2018, has a rate of 0.01% of the total cases, namely Plasmodium Falciparum malaria and Plasmodium non Falciparum malaria. A 47 year old man was referred from the clinic with complaints of high fever preceded by chills 10 days before being admitted to the hospital. Accompanied by shortness of breath, unable to get off the treatment bed due to feeling very weak, nauseous, sick and having a bulging stomach. Physical examination revealed a pale conjunctiva, ronkhi in the lower field of the right lung, dim percussion in the basal of the left lung, hepatomegaly, splenomegaly, shifting dullness. ring form vivax, on chest X-ray found a left pleural effusion. It is known that the patient previously lived in Papua from September 2018 to May 2019. During treatment, the patient was given artesunate injection therapy, dihydroartemisin + piperaquine and primaquin for seven days of treatment. At the end of the treatment, another chest X-ray was performed and re-examination of the peripheral blood smear, no more pleural effusions were found and no parasites were found on re-examination of the peripheral blood smear. Mixed infection of vivax and falciparum malaria, is a rare case that may occur in endemic areas where both plasmodium can be found. The prevalence in Indonesia according to RISKESDAS is only about 0.01% of all malaria cases in Indonesia.

Background: Acute pancreatitis (AP) is an inflammation of the pancreas, a serious emergency with no definitive treatment. It may progress to infected necrosis, non-pancreatitis infection, also death that may occur within the first 1 to 2 weeks. The use of prophylactic antibiotics in AP to prevent complications remains a controversy. The objective of this meta-analysis is to assess the benefit of prophylaxis antibiotics administration to prevent the complication.Method: Trials were identified by searching the medical database. Literature range is within the year 1975 to 2021.  Review Manager 5.4.1 was used to analyse data extraction and risk of bias of included studies were elaborated. Risk ratio (RR) was calculated with 95% confidence interval (CI). P 0.05 was considered significant.Results: Twenty trials with a total of 1.287 patients of AP were analysed; 646 patients treated with antibiotic prophylaxis and 641 patients treated with placebo. Prophylaxis antibiotics were found to have significant difference between the two groups. The administration of prophylaxis antibiotics lower the risk of non-pancreatic infections (RR = 0.77; 95% CI: 0.62–0.95; p 0.05) and infected pancreatic necrosis (RR = 0.74; 95% CI: 0.58-0.94; p 0.05). Meanwhile, prophylaxis antibiotics were found to be insignificant to lower the risk of mortality (RR = 0.75; 95% CI: 0.54-1.03; p 0.05). Conclusion: Prophylaxis antibiotics lower the risk of non-pancreatic infections and infected pancreatic necrosis, but did not lower the risk of mortality.