Prophylactic antibiotic usage during delivery is a common practice worldwide, especially in low- to middle-income countries. Guidelines have been published to reduce antibiotic overuse; however, data describing the use of prophylactic antibiotics and clinician adherence to guidelines in low- to middle-income countries remain limited. This study aimed to describe the prevalence of prophylactic antibiotic use, factors associated with its use, and clinician adherence to guidelines. A retrospective review was conducted for all deliveries from 1 January 2016 to 31 December 2018 at a tertiary level hospital in Indonesia. The prevalence of prophylactic antibiotic use during delivery was 47.1%. Maternal education level, Ob/Gyn specialist-led delivery, a history of multiple abortions, C-section, premature membrane rupture, and antepartum hemorrhage were independently associated with prophylactic antibiotic use. Clinician adherence to the guidelines was 68.9%. Adherence to guidelines was the lowest in conditions where the patient had only one indication for prophylactic antibiotics (aOR 0.36, 95% CI 0.24–0.54). The findings showed that the prevalence of prophylactic antibiotic use during delivery was moderate to high. Adherence to local guidelines was moderate. Updating the local prescribing guidelines may improve clinician adherence.
Introduction: Culture-negative and multidrug-resistant neonatal sepsis frequently occur in developing countries and complicate neonatal sepsis management. These conditions contribute to a high neonatal mortality rate and accelerate the misuse of antibiotics. However, the extent of culture-negative and multidrug-resistant neonatal sepsis in developing countries remains poorly characterized. This study aims to describe culture-negative and culture-proven neonatal sepsis epidemiology and the antimicrobial resistance patterns in Palembang, Indonesia. Methodology: A retrospective review of the medical records of all neonatal admissions between January 2016 and December 2018 was conducted at a tertiary-level referral hospital in Indonesia. The maternal and neonatal characteristics and microbiological results of the identified sepsis cases were obtained and analyzed. Results: Three hundred and fifty-six neonatal sepsis cases were admitted from 2016 to 2018, accounting for 14.1% of neonatal hospital admissions. The percentages of early-onset and late-onset sepsis were comparable (49.7% vs. 50.3%), with an 18.1% case fatality rate. The proportion of culture-negative sepsis was 44%. The mortality rates between culture-proven and culture-negative sepsis cases did not differ statistically (p = 0.11). Coagulase-negative staphylococci (30.9%), Klebsiella pneumoniae (18.1%), and Acinetobacter spp. (10.7%) were the most frequently isolated pathogens. Overall, 62.6% of all isolated organisms were multidrug-resistant bacteria, with a high prevalence of extended-spectrum cephalosporin-resistant and carbapenem-resistant strains. Conclusions: Culture-negative sepsis accounts for a significant proportion of neonatal sepsis cases. Early- and late-onset and culture-negative and culture-proven neonatal sepsis contribute to a comparable proportion of neonatal sepsis morbidity and mortality. There is an alarmingly high prevalence of resistance to extended-spectrum cephalosporin and carbapenem in neonatal sepsis cases.
Background Vitamin D deficiency and vitamin D receptor (VDR)
Implementasi protokol kesehatan yang ketat dalam bentuk intervensi non-farmakologis pada masa pandemi COVID-19 diakui telah memberikan dampak positif langsung dalam usaha pengendalian transmisi virus SARS-CoV2. Selain menekan penularan COVID-19, pelaksanaan protokol kesehatan ternyata juga menurunkan insiden banyak penyakit infeksi lain. Namun, kombinasi dari adanya pembatasan sosial berskala besar di masyarakat yang panjang dan penerapan protokol kesehatan lain telah menurunkan kuantitas paparan fisiologis anak dengan berbagai berbagai mikroba di lingkungan secara bermakna. Padahal paparan inilah yang ikut menstimulasi dan membentuk sistem imunitas anak. Pandemi juga telah menimbulkan disrupsi besar pada angka cakupan imunisasi dasar. Sehingga menurunnya stimulasi imunitas akibat rendahnya sirkulasi mikroba yang diiringi dengan penurunan cakupan imunisasi telah menyebabkan timbulnya suatu fenomena yang dikenal dengan immunity debt. Banyak anak yang tidak mampu membangun imunitas terhadap berbagai mikroba yang pada saat sebelum pandemi sering terpapar secara alami. Saat ini dengan semakin terkendalinya COVID-19, berbagai restriksi telah dilonggarkan. Tetapi hal ini diikuti dengan timbulnya laporan peningkatan kasus berbagai penyakit infeksi selain COVID-19 sehingga timbul kekhawatiran akan terjadinya pandemi-pandemi baru akibat semakin besarnya proporsi anak yang rentan terhadap infeksi. Untuk mencegah hal tersebut, upaya vaksinasi kejar perlu diperkuat dan dipercepat. Monitoring dan surveilans kejadian penyakit infeksi lain di masyarakat harus dilakukan dengan baik. Selain itu, kebijakan pelaksanaan protokol kesehatan perlu diimbangi dengan penggunaan strategi lain yang masih memberikan kesempatan bagi anak-anak untuk tetap terpapar dengan berbagai mikroba secara wajar sehingga dapat membangun sistem imunitas yang kuat.
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