Objectives: Urinary tract infections (UTIs) are a common reason for empirical treatment with broad-spectrum antibiotics worldwide. However, population-based antimicrobial resistance (AMR) prevalence data to inform empirical treatment choice are lacking in many regions, because of limited surveillance capacity. We aimed to assess the prevalence of AMR to commonly used antimicrobial drugs in Escherichia coli and Klebsiella pneumoniae isolated from patients with community- or healthcare-associated UTIs on two islands of Indonesia. Methods: We performed a cross-sectional patient-based study in public and private hospitals and clinics between April 2014 and May 2015. We screened patients for symptoms of UTIs and through urine dipstick analysis. Urine culture and susceptibility testing were supported by telemicrobiology and interactive virtual laboratory rounds. Surveillance data were entered in forms on mobile phones. Results: Of 3424 eligible patients, 3380 (98.7%) were included in the final analysis, and yielded 840 positive cultures and antimicrobial susceptibility data for 657 E. coli and K. pneumoniae isolates. Fosfomycin was the single oral treatment option with resistance prevalence <20% in both E. coli and K. pneumoniae in community settings. Tigecycline and fosfomycin were the only options for treatment of catheter-associated UTIs with resistance prevalence <20%, whilst the prevalence of resistance to meropenem was 21.3% in K. pneumoniae. Conclusions: Patient-based surveillance of AMR in E. coli and K. pneumoniae causing UTIs indicates that resistance to the commonly available empirical treatment options is high in Indonesia. Smart AMR surveillance strategies are needed to inform policy makers and to guide interventions.

Background:The efficacy of multidrug resistant tuberculosis (MDR TB) therapy is still being questioned. It has lesser quality, longer duration therapy and high toxicity level. This study was conducted to identify clinical characteristics and side effect of MDR TB therapy at Dr. Hasan

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This study aims to determine the effect of buteyko breathing technique on asthma control test.The quasi experimental study with the pretest and post test one group design approach involved 14 patients with asthma selected from the Lung Polyclinic of Dr. Hasan Sadikin Bandung with consecutive sampling. Asthma control was collected using time series ACT. The collected data were analyzed descriptively and inferentially with the scale of significance p smaller than 0.05.The results showed a significantly higher mean difference between ACT scores after buteyko breathing technique 19.79 more or less 1.47 with ACT score at week III 17.50 moe or less 1.78 week II 12.64 more or less 1.82, week I 9.57 more or less 1.95, and pretest 7.64 more or less 1.82. Post hoc analysis found the fourth week post test score 19.79 more or less 1.47 significantly better than post test week III 17.50 more or less 1.78, week II 12.64 more or less 1.82, week I 9.57 more or less 1.95, and pretest 7.64 more or less 1.82 in improving asthma control. It was concluded that there was an effect of buteyko breathing technique on asthma control test. Thus, the results of this study become important as a study material for nurses at the Hospital in an effort to increase asthma control test. Keywords: ACT, Breathing Technique, Bronchial Asthma, Buteyko

Risk Factors of Pneumonia in Acute Stroke at Hasan Sadikin Hospital Bandung Abstract Background and Objective:Pneumonia is the most common non neurological complications in acute stroke (22%) that increase mortality rate, length of stay and hospitalization cost. It is necessary to identified risk factors for pneumonia including neurogenic pulmonary edema (NPE) for better prevention and early intervention. The purpose of this study is to determine risk factors of pneumonia (including NPE) in acute stroke patients at Hasan Sadikin General Hospital Bandung. Subject and Methods: Prospective observational descriptive study, consecutive sampling method, during September – October 2019. Primary data collected from acute stroke patients such as stroke severity, type, location and size of stroke, treatment during hospitalizataion, comorbidities (including NPE). Pneumonia was diagnosed based on Central for Disease Control Prevention (CDC) criteria, NPE based on Davison criteria. Results: 30 patients (28.3%) with pneumonia in acute stroke patients. Pneumonia were commonly found in NGT insertion (90%), dysphagia (64,71%), total anterior circulation infarct (TACI) (61,54%), large infarct size (61,54%), GCS 9-12 (50%) and NIHSS 16-20 (50%). NPE only found in 6,60% acute stroke patients, 57,14% of them developed pneumonia. Conclusions: Pneumonia in acute stroke patients is more often found in NGT insertion, dysphagia, TACI location, large infarct size, lower GCS and more severe stroke degree.

Background: Understanding the bronchoalveolar-lavage fluid immunopathology biomarker interactions can help clinicians decipher the pathophysiology of severe pneumonia and get better management for early extubation.Objectives: The objectives were to assess bronchoalveolar lavage fluid biomarker interactions of severely affected lung and their association in determining the early extubation success.Methods: In this cross-sectional study, we consecutively evaluated 137 severe pneumonia patients. Patients who fulfilled inclusion criteria will undergo early bronchoscopy. The BALF was collected from the right and left lungs. Two Respirologist and Critical Illness consultants, plus one internist, determined the location for severely affected lung. Biomarker interactions in severely affected lung were analyzed. The primary outcome was the 19-days extubation.Results: Forty patients underwent bronchoscopy for BALF collection. The right lung was the predominant severely affected lung (28 patients). Eight patients survived and were successfully extubated within 19 days. There were significantly higher absolute CD4+ BALF cell counts (95% Confidence Interval = 9,24 – 49,50, p = 0,003) in the left lung and higher absolute CD4+ BALF cell counts (95% Confidence Interval = 9,00 – 29,75, p = 0,010) in the patients with extubation success and survived. Among all the patients with extubation success within 19 days, eight patients (100%) displayed the tendency of high CD4 levels (cutoff points median 16 cells/μL), low expression of alveolar macrophage function (cutoff points by ROC 756.5 MFI CD169), and low expression of IL-6 (cutoff points by ROC 369 pg/mg protein).Conclusion: In severely affected lung of severe pneumonia patients with early extubation success and survived, we found biomarker interactions marked by low alveolar macrophage function, low IL-6 levels, and high CD4 levels. Trial Registration: The study was registered at UMIN Clinical Trials Registry (UMIN-CTR) (registration number UMIN000046236), accessible at: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000049197

The accumulation of fluid in the pleural cavity will interfere with the restriction process, namely disruption of lung expansion so that the air entering the lungs is less than normal. One of the effects is shortness of breath and a decrease in oxygen saturation. In this case, nursing actions play an important role in inadequate ventilation, namely positioning. The lateral position is one of the recommended positions for patients with unilateral lung disease, one of which is unilateral pleural effusion. Position selection is very important to facilitate adequate breathing, namely one with a head-up of 45°. According to some literature, the 45° head-up position can reduce consumption and maximize lung expansion which will result in greater ventilation. To determine the effect of the lateral position with a head-up 45°on oxygen saturation and respiratory rate in a patient with unilateral pleural effusion at the Dr. H. A. Rotinsulu Lung Hospital Bandung. The research design was a quasi-experimental design with one group pre and post-test design with a sample of 44 people. The sampling technique used consecutive sampling. The results showed that there were differences in median oxygen saturation and respiratory rate before and after the intervention. The results of a comparative study using the Wilcoxon test obtained a p value of 0.0001 (p value<0.05). There is an effect of giving a lateral position with a head-up 45° on increasing oxygen saturation and decreasing respiratory rate. Thus, it is expected for the service unit to establish a lateral position in the direction of the effusion with a head-up of 45°as the operational standard for the management of unilateral pleural effusion impaired oxygenation patients.

Negative perception towards vaccination is one of the reasons for low coverage of diphtheria immunization in Indonesia. Perception, which is difficult to change, is related to stress level, possibly influences outcome of diseases, and also vaccination. This study aims to identify the correlation between perception of diphtheria vaccination and antibody response after vaccination. This study used secondary data from two unpublished studies on 30 medical interns in Hasan Sadikin Hospital, Bandung, West Java, after diphtheria outbreak, from June to July 2019. Antibody level after diphtheria emergency vaccination was measured using ELISA and perception towards vaccination was measured using a questionnaire. Perception towards vaccination was expressed as perception score and was divided into 4 components: perceived threat, benefit, barrier, and cues to action. Higher perception score indicated more positive perception towards vaccination. Diphtheria antibody level was grouped into reliable protection (≥0,10 IU/mL) or unreliable protection (<0,10 IU/mL). Statistical correlation analysis was done with GraphPad Prism version 7.0. Most of our subjects were female. Median age was 22 (20–24) years old. Median time elapsed between vaccination date and measurement of antibody level was 18 (6–18) months. Median antibody level was 0,28 (0,09–3,47) IU/mL. Twenty-three subjects (82,1%) had reliable protection. Subjects with reliable protection had more positive perception compared to unreliable protection (perception score 80,6 ​± ​5,4 vs 69,0 ​± ​1,8, p ​= ​0,0001). Subjects with reliable protection had less perceived barrier for vaccination (15,6 ​± ​2,1 vs 13,0 ​± ​1,8, p ​= ​0,0083). Perception score showed strong, positive correlation to reliable protection against diphtheria (R ​= ​0,705, p ​< ​0,001). Perceived barrier and threat showed positive correlation to reliable protection (R ​= ​0,489, p ​= ​0,008 and R ​= ​0,402, p ​= ​0,034). In conclusion, perception towards diphtheria vaccination is strongly correlated to protective antibody. Improving perception of vaccination are needed to overcome vaccine hesitancy.