ObjectivesTo evaluate the clinical and microbiological appearance among hospitalized pneumonia patients focusing on resistance and risk factors for mortality in a referral hospital.Patients and methodsThe study was an observational retrospective study on patients with CAP from 2014 to 2016 at Dr Soetomo referral hospital of Surabaya, Indonesia. All positive cultures with antimicrobial susceptibility results from blood and respiratory specimens were included. Patients infected with drug-susceptible pathogens and MDR organisms were also assessed in terms of clinical characteristics, day-3 clinical improvement, and 14-day mortality.ResultsOf 202 isolates, 181 possessed antimicrobial susceptibility data. S. pneumoniae was the most prevalent pathogen causing CAP (18.3%). Most patients were empirically treated with ceftriaxone (n=75; 41.4%). Among beta-lactam antibiotics, the susceptibility to the third-generation cephalosporins remained relatively high, between 67.4% and 82.3%, compared with the other beta-lactams such as amoxicillin/clavulanate and ampicillin/sulbactam (a sensitivity rate of 36.5% and 47.5, respectively). For carbapenem antibiotics, imipenem and meropenem susceptibility was 69.6% and 82.3% respectively. Approximately 22% of isolates were identified as MDR that showed significant differences in clinical outcomes of 14-day mortality rates (p<0.001). Notably, patients with day-3 improvement had a lower risk of mortality (OR= 0.06; 95% CI= 0.02–0.19).ConclusionOne-fifth of causative agents among hospitalized CAP cases were identified as MDR organisms. The pathogens of MDR and non-MDR CAP remain susceptible to the third-generation cephalosporins. Together with additional consideration of culture findings and Pneumonia Severity Index (PSI) assessment, a 3-day clinical assessment is essential to predict the prognosis of 14-day mortality.

Indonesia is one of the largest producers of red seaweed in the world, but there is very little research done on the role of red seaweed in the health sector. This study is about red seaweed type Euchema cottoni and it’s potential as seaweed salt that has lower natrium and rich in other minerals.This research was divided into two phases and conducted from December 2016 to March 2017. The first phase is a safety analysis in terms of metal, mold and bacteria contamination of seaweed from three different places of Indonesia: Saumlaki, Maluku; Nusa Dua, Bali and Flores, Nusa Tenggara Barat. After the seaweed safety was selected, the seaweed was made into powder at Industrial Research and Development Agency (BPPT), Tangerang. The seaweed powder mixed with ordinary salt with four type of concentrations were subjected to a salty sensory test by nine panellists who have been working at the food production at Hospital for at least one year. The second phase was to do acceptance sensory test of the seaweed salt product taste against a concentration that was selected in first phase to first-degree hypertensive subjects aged 25–59 years by using soup as the meal-media. Chi-square test was used to analyse the difference.Seaweed from Saumlaki, Maluku was selected as the safest seaweed due to it’s lowest content of metal, mold and bacterial contaminations. The ratio of seaweed powder to ordinary salt powder 1:1 was selected by nine panellists in salty sensory test. Analysis of minerals from the seaweed salt product found that besides the lower sodium and Iodium content, it’s potassium and magnesium content were much higher than ordinary salt. Salty taste test by 62 respondents with first degree hypertension with age 25-59 years showed no significant difference in saltiness between seaweed salt and ordinary salt.In conclusion, the seaweed salt product with a 1:1 ratio to ordinary salt powder is safe and acceptable to be used as an alternative low Na salt.

Objective: This study aimed to compare the effectiveness and safety of fixed dose combination (FDC) versus separate (separate formulation [SF]) antituberculosis (TB) formulations in patients with bacteriologically confirmed pulmonary TB.Methods: Data were collected retrospectively from patient records, which included all newly diagnosed bacteriologically confirmed pulmonary TB patients treated with first category FDC or SF between January 2014 and January 2017 at the Dr. Esnawan Antariksa Hospital. The efficacy of the formulations was determined according to acid-fast bacilli (AFB) sputum smear conversion at the end of the intensive phase (month 2), after 6 months of therapy, and after the extended treatment phase (month 3). Adverse drug reactions (ADRs) during treatments were recorded as safety outcomes. Chi-square tests were used to analyze the differences between the groups. Results:On comparing patients treated with FDC (n=33) and SF (n=30), rates of sputum conversions did not differ significantly after 2 months (83.3% vs. 78.7%, p=0.693) and the intensive phase was extended by 1 month for patients with conversion failures at this time point. One of seven patients in the FDC group did not achieve sputum conversion during the extended phase and was recorded as a medication failure. At the end of continuation phase, all other subjects achieved sputum conversion. The overall frequencies of ADRs were not significantly higher in the FDC group than that in the SF group (36.4% vs. 23.3%, p=0.260). Conclusion:No differences in effectiveness and safety profiles were identified between first category FDC and separate anti TB formulations.

ObjectiveThis study analyzes the cost-effectiveness of culture-based treatment (CBT) versus empirical treatment (ET) as a guide to antibiotic selection and use in hospitalized patients with community-acquired pneumonia (CAP).Patients and methodsA model was developed from the individual patient data of adults with CAP hospitalized at an academic hospital in Indonesia between 2014 and 2017 (ICD-10 J.18x). The directed antibiotic was assessed based on microbiological culture results in terms of the impact on hospital costs and life expectancy (LE). We conducted subgroup analyses for implementing CBT and ET in adults under 60 years, elderly patients (≥ 60 years), moderate-severe CAP (PSI class III-V) cases, and ICU patients. The model was designed with a lifetime horizon and adjusted patients’ ages to the average LE of the Indonesian population with a 3% discount each for cost and LE. We applied a sensitivity analyses on 1,000 simulation cohorts to examine the economic acceptability of CBT in practice. Willingness to pay (WTP) was defined as 1 or 3 times the Indonesian GDP per capita (US$ 3,570).ResultsCBT would effectively increase the patients’ LE and be cost-saving (dominant) as well. The ET group’s hospitalization cost had the greatest influence on economic outcomes. Subgroup analyses showed that CBT’s dominance remained for Indonesian patients aged under 60 years or older, patients with moderate-severe CAP, and patients in the ICU. Acceptability rates of CBT over ET were 74.9% for 1xWTP and 82.8% for 3xWTP in the base case.ConclusionBoth sputum and blood cultures provide advantages for cost-saving and LE gains for hospitalized patients with CAP. CBT is cost-effective in patients all ages, PSI class III or above patients, and ICU patients.