Indonesia is another developing country affected by the emergence and spread of bacterial strains harbouring ESBL genes, including the CTX-M-15-producing B2-E. coli O25b-ST131 clone.

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High prevalence may be due to clonal spread and emergence of resistant strains.

In 2001-2002, faecal carriage of ESBL-producing Enterobacteriaceae as dominant flora in Indonesia was almost exclusively hospital-associated. The presence of various bla(ESBL) genes and the extensive genetic diversity among isolates argue against a single/dominant strain outbreak.

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Objectives To explore the occurrence and characterization of carbapenemase‐producing pathogens among carbapenem‐resistant Gram‐negative bacilli isolated from hospitalized patients with urinary tract infection in Indonesia. Methods This was a study promoted by the Japanese–Indonesian collaborative research program in the Japan Initiative for Global Research Network on Infectious Diseases. Bacterial pathogens were prospectively isolated from urine specimens of hospitalized urinary tract infection patients at Dr. Soetomo Hospital (Surabaya, Indonesia). All Gram‐negative bacteria resistant to third‐generation cephalosporin or carbapenem were included in this study. Carbapenemase genes were investigated for phenotype and genotype. Results In total, 1082 Gram‐negative bacilli were isolated, of which 116 strains were resistant to imipenem or meropenem (carbapenem‐resistant Gram‐negative bacilli), and 22 strains were carbapenemase‐producing Gram‐negative bacilli. Carbapenemase‐producing Gram‐negative bacilli consisted of Acinetobacter baumannii (n = 4), Pseudomonas aeruginosa (n = 4), Klebsiella pneumoniae (n = 5), Providencia rettgeri (n = 4) and five others. The carbapenemase‐producing Gram‐negative bacilli included NDM‐1 (n = 18, 81.8%, in Enterobacteriaceae and Acinetobacter spp.) and IMP‐7 (n = 4, 18.2%, all in P. aeruginosa). Among carbapenem‐resistant Gram‐negative bacilli, all four P. aeruginosa were sensitive to colistin, and all six Acinetobacter spp. were sensitive to minocycline, colistin and tigecycline. Of those patients harboring carbapenemase‐producing Gram‐negative bacilli, 12 (54.5%) were seriously ill at the time of admission, with longer hospital stays and three deaths (13.6% mortality rate). Conclusions Urinary tract infection‐causing carbapenem‐resistant Gram‐negative bacilli are widely disseminated in Indonesia. The NDM‐1 phenotype seems to be dominant, and it can be treated with colistin and tigecycline in most cases. Most patients harboring carbapenemase‐producing Gram‐negative bacilli are seriously ill, have a bad prognosis, with a longer hospital stay and a significant mortality rate.

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Background Drug-resistant tuberculosis (DR-TB) is the barrier for global TB elimination efforts with a lower treatment success rate. Loss to follow-up (LTFU) in DR-TB is a serious problem, causes mortality and morbidity for patients, and leads to wide spreading of DR-TB to their family and the wider community, as well as wasting health resources. Prevention and management of LTFU is crucial to reduce mortality, prevent further spread of DR-TB, and inhibit the development and transmission of more extensively drug-resistant strains of bacteria. A study about the factors associated with loss to follow-up is needed to develop appropriate strategies to prevent DR-TB patients become loss to follow-up. This study was conducted to identify the factors correlated with loss to follow-up in DR-TB patients, using questionnaires from the point of view of patients. Methods An observational study with a cross-sectional design was conducted. Study subjects were all DR-TB patients who have declared as treatment success and loss to follow-up from DR-TB treatment. A structured questionnaire was used to collect information by interviewing the subjects as respondents. Obtained data were analyzed potential factors correlated with loss to follow-up in DR-TB patients. Results A total of 280 subjects were included in this study. Sex, working status, income, and body mass index showed a significant difference between treatment success and loss to follow-up DR-TB patients with p-value of 0.013, 0.010, 0.007, and 0.006, respectively. In regression analysis, factors correlated with increased LTFU were negative attitude towards treatment (OR = 1.2; 95% CI = 1.1–1.3), limitation of social support (OR = 1.1; 95% CI = 1.0–1.2), dissatisfaction with health service (OR = 2.1; 95% CI = 1.5–3.0)), and limitation of economic status (OR = 1.1; 95% CI = 1.0–1.2)). Conclusions Male patients, jobless, non-regular employee, lower income, and underweight BMI were found in higher proportion in LTFU patients. Negative attitude towards treatment, limitation of social support, dissatisfaction with health service, and limitation of economic status are factors correlated with increased LTFU in DR-TB patients. Non-compliance to treatment is complex, we suggest that the involvement and support from the combination of health ministry, labor and employment ministry, and social ministry may help to resolve the complex problems of LTFU in DR-TB patients.