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All Journal Jurnal Kedokteran Syiah Kuala Jurnal Kedokteran Brawijaya Sari Pediatri Paediatrica Indonesiana Pediatric Sciences Journal
Irene Ratridewi
Department Of Child Health, Faculty Of Medicine, Universitas Brawijaya– Dr. Saiful Anwar Hospital, Malang
Health Professions Medicine & Pharmacology Public Health

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Microbiologically documented infection and antimicrobial sensitivities in pediatric malignancy patients with febrile neutropenia at Dr Saiful Anwar Hospital, Malang, Indonesia Savitri Laksmi Winaputri; Dominicus Husada; Budi Utomo; Irene Ratridewi; Susanto Nugroho; I Dewa Gede Ugrasena; Parwati Setiono Basuki; Ismoedijanto Ismoedijanto
Jurnal Kedokteran Syiah Kuala Vol 21, No 1 (2021): Volume 21 Nomor 1 April 2021
Publisher : Universitas Syiah Kuala

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24815/jks.v21i1.20903

Abstract

Abstract. Background: Febrile neutropenia in malignancy children increase the risk of infection, morbidity and mortality. Microbiologically documented infection in pediatric malignancy has not been studied in Saiful Anwar Hospital. Purpose: Determine profile of blood, urine, sputum, and wound bed culture and antimicrobial sensitivities pattern in pediatric malignancy patients with febrile neutropenia. Methods: Pediatric malignancy patients with febrile neutropenia and microbiologically documented infection admitted to dr Saiful Anwar General Hospital Malang, were studied from 2016 to 2019.  Bacterial and fungal etiology were identified, along with antimicrobial sensitivities patterns. Results: 53 (17%) of 307 pediatric malignancy patients with febrile neutropenia experienced 75 episodes of microbiologically documented infection. 40 (53,3%) gram-negative and 34 (45,3%) gram-positive isolated from 75 isolated pathogens. The most common gram-negative were Klebsiella pneumonia (n=15) and Escherichia coli (n=8). The most common gram-positive were Coagulase-negative Staphylococci (n=14) and Enterococcus faecalis (n=7). Escherichia coli, Coagulase-negative Staphylococci, Enterococcus faecalis, and Staphylococcus aureus were 100% sensitive to all tested antimicrobials. Klebsiella pneumonia and Acinetobacter baumanni were 100% sensitive to almost all tested antimicrobials. Pseudomonas aeruginosa was found less sensitive (0-80%) to all tested antimicrobials. Conclusion: Investigation of antimicrobial sensitivities of these organisms may guide successful antimicrobial therapy and improve quality of pediatric malignancy care. Abstrak. Latar Belakang: Demam neutropenia pada keganasan anak meningkatkan risiko infeksi, morbiditas dan mortalitas. Microbiologically Documented Infection merupakan masalah utama di dunia, namun belum dilakukan penelitian di RSUD Dr. Saiful Anwar. Tujuan: Melihat gambaran kultur darah, urine, sputum, dan dasar luka dan pola sensitivitas antimikroba pada keganasan anak dengan demam neutropenia. Metode: Pasien keganasan anak dengan demam neutropenia di bangsal Hemato-onkologi Departemen Ilmu Kesehatan Anak RSUD Dr. Saiful Anwar Malang dan terdiagnosis Microbiologically Documented Infection pada tahun 2016-2019, ditentukan etiologi, serta pola sensitivitas antimikroba. Hasil: Dari 307 pasien keganasan anak dengan demam neutropenia, 53(17%) pasien mengalami 75 episode microbiologically documented infection. Didapatkan 40(53,3%) bakteri gram negatif dan 34(45,3%) gram positif dari 75 hasil kultur. Bakteri gram negatif yang paling banyak ditemukan adalah Klebsiella pneumonia (n=15) dan Escherichia coli (n=8), serta Coagulase-negative Staphylococci (n=14) dan Enterococcus faecalis (n=7) pada gram positif. Escherichia coli, Coagulase-negative Staphylococci, Enterococcus faecalis, dan Staphylococcus aureus 100% sensitif terhadap semua antimikroba yang diuji. Klebsiella pneumonia dan Acinetobacter baumanni 100% sensitif terhadap hampir semua anitmikroba yang diuji. Pseudomonas aeruginosa memiliki sensitivitas rendah (0-80%) terhadap semua antimikroba yang diuji. Kesimpulan: Penelitian tentang sensitivitas antimikroba pada organisme tersebut dapat menjadi panduan untuk keberhasilan terapi dan meningkatkan kualitas pelayanan pada keganasan anak.
Peran Skor Kandida Sebagai Metode Diagnostik Kandidiasis Invasif Terhadap Neutropenia Berat pada Anak dengan Keganasan Irene Ratridewi; Nanda Juwita; Marvin Anthony Putera; Susanto Nugroho
Sari Pediatri Vol 22, No 6 (2021)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp22.6.2021.351-8

Abstract

Latar belakang. Infeksi kandidiasis invasif meliputi infeksi aliran darah dan infeksi invasif dalam lainnya yang disebabkan oleh spesies Kandida dan merupakan penyebab morbiditas dan mortalitas yang signifikan, khususnya pada pasien dengan status immunocompromised, seperti pada kondisi keganasan hematologis, kelainan limfoproliferatif, dan gangguan myeloproliferative.Tujuan. Menginvestigasi peran skor Kandida, dibandingkan dengan kultur darah dan PCR, sebagai alat diagnostik kandidiasis invasif pada pasien dengan neutropenia berat, khususnya pada kasus keganasan.Metode. Penelitian ini menggunakan desain penelitian cross sectional. Data yang diperoleh diolah dan dianalisis menggunakan metode Receiver operating characteristic (ROC) untuk mendapatkan nilai area under curve (AUC). Berdasarkan kurva AUC kemudian dilakukan pencarian titik potong yang paling optimal untuk mendapatkan nilai sensitivitas dan spesifisitasHasil. Hasil penelitian menunjukkan bahwa pada kedua kelompok dengan kultur positif dan negatif tidak didapatkan perbedaan bermakna berdasarkan karakteristik jenis kelamin, usia, berat badan, status gizi, dan diagnosis klinis (uji Mann-Whitney, p>0,05).Kesimpulan. Berdasarkan hasil tersebut, dapat disimpulkan bahwa tidak didapatkan perbedaan pada sensitivitas dan spesifisitas skor Kandida dibandingkan dengan hasil kultur pada pada pasien anak dengan neutropenia berat.
Malaria Kongenital di Daerah Endemis Indonesia: Studi di RSUD Dr. Tc Hillers Maumere Flores Mario B. Nara; Irene Ratridewi Huwae; Loeki Enggar Fitri; Natalia Erica Jahja
Sari Pediatri Vol 17, No 1 (2015)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (57.599 KB) | DOI: 10.14238/sp17.1.2015.21-4

Abstract

Latar belakang. Di distrik Sumba Barat pada tahun 2004 dilaporkan malaria merupakan penyakit terbanyak. Era transportasi yangtinggi menyebabkan kemungkinan kejadian malaria kongenital di Lembata dan Flores (Maumere) juga tinggiTujuan. Memberikan gambaran mengenai malaria kongenital di RSUD dr. TC. Hillers, Maumere.Metode: Penelitian deskriptif dilakukan mulai Desember 2012 – Desember 2013. Spesimen darah diambil dari neonatus dan ibunya,dikirim dengan dry ice ke Fakultas Kedokteran Universitas Brawijaya dan dilakukan pemeriksaan hapusan darah dan nested PCR.Hasil. Angka kejadian malaria kongenital di RSUD dr. TC. Hillers Maumere selama 1 tahun penelitian 7,78%. Dari 39 subjekyang terinfeksi malaria kongenital, 74,4% terinfeksi P. vivax. Gejala neonatus yang terinfeksi antara lain, anemia (46,2%), sepsis like(28,2%), prematur (38,5%), ikterus (5,5%), dan asimtomatis (48,7%).Kesimpulan. Angka kejadian malaria kongenital di RSUD dr. TC. Hillers Maumere cukup tinggi dan dapat memberikan manifestasiklinis pada bayi yang dilahirkan.
Evaluasi Jumlah Sel T-CD4 dan Berat Badan Anak dengan HIV/AIDS yang Mendapatkan Anti Retro Virus Lini Pertama di Rumah Sakit Dr. Saiful Anwar Malang Irene Ratridewi
Sari Pediatri Vol 11, No 4 (2009)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp11.4.2009.276-81

Abstract

Latar belakang. Infeksi HIV merupakan masalah di dunia dan juga Indonesia. Peningkatan kejadian pada ibu hamil juga meningkatkan kasus HIV anak. Virus HIV menginfeksi dan menurunkan jumlah sel T CD4 sehingga menambah risiko terjadi infeksi oportunistik dan memperburuk gizi.Tujuan. Mengevaluasi jumlah sel T CD4 dan berat badan pada pemberian anti retro virus (ARV) terhadap anak HIV/AIDS di RSU dr Saiful Anwar Malang.Metode. Penelitian longitudinal mengukur CD4 dan perubahan berat badan pada anak HIV/AIDS dengan ARV lini pertama (zidovudine, lamivudine, nevirapine) lebih dari 6 bulan. Data disajikan dalam tabel dan gambar.Hasil. Terdapat 13 kasus HIV (dari total 40) dengan ARV ≥6 bulan, tanpa kasus meninggal. Rerata peningkatan berat badan setelah 6 bulan 29,6% (12 kasus), 1 kasus berat badan turun 2,1%, 6 bulan – 1 tahun 8,7% (11 kasus), 1 kasus berat badan turun 8%. Rerata peningkatan berat badan dalam kurun, Waktu 1–1,5 tahun 7,9% (pada 6 kasus), 1,5–2 tahun 6,5% (3 kasus), 1 kasus berat badan turun 2%, rerata peningkatan berat badan 2–2,5 tahun 11,5% (2 kasus), dan 1 kasus telah mencapai 3 tahun pengobatan (berat badan meningkat 19,1%). Jumlah sel T CD4 cenderung meningkat pada 11 kasus dan menurun pada 2 kasus.Kesimpulan. Terdapat peningkatan jumlah sel T CD4 dan berat badan anak HIV/AIDS dengan ARV ≥6 bulan. Obat ARV lini pertama masih dapat digunakan, perlu dipertimbangkan ARV lini kedua pada dua kasus yang mengalami kegagalan terapi.
The rationalization of personal protective equipment usage and the solution of its limitation during COVID-19 era Irene Ratridewi; Saptadi Yuliarto
Pediatric Sciences Journal Vol. 1 No. 1 (2020): (Supplementary)
Publisher : Medical Faculty of Brawijaya University, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (214.124 KB) | DOI: 10.51559/pedscij.v1i1.8

Abstract

Covid-19 pandemic is a global burden health problem caused by Coronavirus. The disease can be transmitted swiftly by droplets after sneezing, coughing, or holding stuff (droplet contaminated). The contagion is eased by bad habit like does not wash hand after touching others or stuff. To date, data says that The Covid-19 morbidity rate is still highest in a densely populated place. Even though several mechanisms in the community have been done to prevent the spreading of this disease, but the spread is still relatively high and needs medical treatment intervention in the health care system especially in the hospital.1 Moreover, the daily hospital treatment of Covid-19 patients’ needs appropriate personal protective equipment (PPE) to protect and to minimalize the risk of infection to health workers.
Comparison of Methanolic Extract of Piper Betle to Amikacin against the Growth of Pseudomonas aeruginosa Azalia Ayu Rysaputri; Hery Susilo; Dwi Yuni Nur Hidayati; Irene Ratridewi
Jurnal Kedokteran Brawijaya Vol. 32 No. 3 (2023)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2023.032.03.3

Abstract

Pseudomonas aeruginosa is one of the most common pathogens that cause Healthcare-Associated Infections (HAIs). A previous study stated that Piper betle L. extract has antibacterial activity against certain bacteria, including Pseudomonas aeruginosa. This study has the objective of comparing antibacterial activity of the methanolic extract of Piper betle L. and amikacin on the growth of Pseudomonas aeruginosa. This study used the tube dilution method with a sample of Pseudomonas aeruginosa from Microbiology Laboratory Dr. Saiful Anwar General Hospital, Malang. The results of this study showed that the value of MIC and MBC from the methanolic extract of the Piper betle L. treatment was 4800μg/mL. Meanwhile, the amikacin treatment resulted in 0.4μg/mL for MIC and 0.45μg/mL for MBC. From linear regression, it was found that the methanolic extract of Piper betle L. had a β-coefficient value closer to -1 compared to amikacin. Therefore, it can be concluded that the methanolic extract of Piper betle L. has a greater inhibiting effect on the growth of Pseudomonas aeruginosa.
Difference in outcomes of pediatric septic shock after fluid resuscitation according to the Ultrasound-guided Fluid Resuscitation (USFR) and American College of Critical Care Medicine (ACCM) protocols: A randomized clinical trial Saptadi Yuliarto; Kurniawan Taufiq Kadafi; Nelly Pramita Septiani; Irene Ratridewi; Savitri Laksmi Winaputri
Paediatrica Indonesiana Vol 63 No 1sup (2023): Supplementary Issue March 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1sup.2023.49-56

Abstract

Background Sepsis is a major cause of morbidity and mortality in children. The American College of Critical Care Medicine (ACCM) protocol currently in use in the management of septic shock carries a risk of fluid overload. With the use of ultrasonographic monitoring, the Ultrasound-guided Fluid Resuscitation (USFR) protocol may reduce the incidence of fluid overload and mortality. Objective To assess the difference in outcomes of fluid resuscitation in pediatric septic shock using the USFR vs. ACCM protocols. Methods This randomized clinical trial involved 36 subjects randomized equally into the USFR and ACCM groups. After randomization, each subject was given fluid resuscitation starting at 20 mL/kg and repeated every 5-10 minutes as needed, according to the ACCM protocol. After fluid resuscitation was given, patients in the ACCM group were evaluated for clinical signs, liver span, and rhonchi, whereas those in the USFR group underwent USCOM examination for cardiac index (CI), stroke volume index (SVI), and systemic vascular resistance index (SVRI). After 60 minutes, subjects in both groups were re-assessed for clinical signs, USCOM, pulmonary edema using lung ultrasound score (LUS), and liver span. Subjects were blinded as to the protocol they received. We compared 24-hour and 72-hour mortality rates, clinical improvement of shock at 60 minutes, cardiac index (CI), stroke volume index (SVI), and systemic vascular resistance index (SVRI), as well as pulmonary edema and hepatomegaly, between the two groups. Results At 60 minutes after resuscitation, there were significant differences between the ACCM and USFR groups in the proportion of clinical improvement (0/18 vs. 5/18, P=0.016), pulmonary edema (15/18 vs. 4/18, P<0.001), and hepatomegaly (16/18 vs. 5/18, P<0.001). Mortality rates at 24 hours and 72 hours in the ACCM vs. USFR groups were 17% vs. 12% (P=0.199) and 78% vs. 39% (P=0.009), respectively. Conclusion The USFR protocol reduces the occurrence of fluid overload and leads to a lower mortality rate at 72 hours compared to the ACCM fluid resuscitation protocol.
Risk factors of late onset sepsis caused by extended spectrum beta-lactamase (ESBL) - producing bacteria in preterm infants Irene Ratridewi; Savitri Laksmi Winaputri; Eko Sulistijono; Fireka Imsa Sastia Juniantika
Paediatrica Indonesiana Vol 63 No 1sup (2023): Supplementary Issue March 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1sup.2023.21-28

Abstract

Background High incidence of late-onset sepsis (LOS) in preterm infants contributes to neonatal morbidity. Therapeutic outcomes of LOS have deteriorated as a result of increased antibiotic resistance problems, mainly from ESBL isolates. Controlling risk factors is important in reducing morbidity and mortality as well as providing guidance for antibiotic selection. Objectives To determine the risk factors of LOS due to ESBL-producing bacteria in preterm infants. Methods This is a retrospective study. The inclusion criteria was neonates diagnosed with late-onset neonatal sepsis by clinical signs and a positive blood culture. The blood culture result and characteristics patients as secondary data were extracted from medical records within the hospital facilities and the institutional database of the Neonatology Department of Universitas Brawijaya (January 2019 to March 2021). Statistical analysis was done to compare characteristics of the patients in the ESBL positive group to those in the ESBL negative group to assess the potential risk factors. Results Among 124 preterm infants with LOS, 62 of them were ESBL-positive case subjects and the other 62 were non-ESBL-producing control subjects. Gram-negative bacteria were the most common pathogens identified, with 96% (n=59) of them being the ESBL-producing strain, predominated by Klebsiella pneumoniae (n=56). Factors significantly correlated with the occurrence of LOS-ESBL included prior history of invasive procedures (OR 3.13; 95%CI 1.45 to 6.73; P=0.00), central access insertion (OR 9.54; 95%CI 3.7 to 24.2; P=0.00), and parenteral nutrition (OR 6.03; 95%CI 2.77 to 13.16; P=0.00). Central access insertion had the strongest influence (Exp(B) 6.98; P= 0.00). Conclusion Prior invasive procedures, central access insertion, and parenteral nutrition had significant correlations with the occurrence of LOS-ESBL in preterm infants. Central access insertion is a predictive factor for LOS-ESBL.
Combination of red cell distribution width and procalcitonin as diagnostic biomarkers of neonatal sepsis in preterm infants Irene Ratridewi; Savitri Laksmi Winaputri; Eko Sulistijono; Brigitta I. R. V. Corebima; Achmad Yunus
Paediatrica Indonesiana Vol 63 No 1sup (2023): Supplementary Issue March 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1sup.2023.29-34

Abstract

Background Diagnosis of neonatal sepsis is still challenging. Several diagnostics test have been developed to help diagnose of neonatal sepsis, but sometimes it could not be done routinely in limited facilities. Procalcitonin (PCT) and red cell distribution width (RDW) have been reported to have correlations with the risk of developing sepsis. Objective To evaluate the diagnostic value of combined of PCT and RDW as markers for neonatal sepsis in preterm infants. Methods A cross sectional study was conducted in the neonatal ward, Syaiful Anwar hospital, Malang, East Java. The subjects were preterm infants with neonatal sepsis. Blood culture were taken as the gold standard and RDW and PCT levels were assessed as the comparison. All of the test were performed at the begining of the study. The incidence of sepsis was reported as the main outcome. The data obtained were processed and analyzed using the receiver operating characteristic (ROC) method to obtain the area under curve (AUC) value. Results Fifty-five preterm infants presenting neonatal sepsis were enrolled in this study. The combination of RDW and PCT showed AUC 0.814 (P=0.199) with sensitivity and specificity 78.9% and 80.6%, respectively in diagnosing neonatal sepsis compared to blood culture. Conclusion Combination of RDW and PCT as markers of sepsis in preterm infants have good sensitivity and specificity.
Use of hemodynamic and laboratory monitoring tools to reduce the risk of mortality from pediatric septic shock Saptadi Yuliarto; Kurniawan Taufiq Kadafi; Ika Maya Suryaningtias; Irene Ratridewi; Savitri Laksmi Winaputri
Paediatrica Indonesiana Vol 63 No 1sup (2023): Supplementary Issue March 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1sup.2023.35-48

Abstract

Background Early recognition of septic shock in terms of clinical, macrocirculatory hemodynamic, and microcirculatory laboratory parameters is a fundamental challenge in the emergency room and intensive care unit for early identification, adequate management, prevention of disease progression, and reduction of mortality risk. Objective To evaluate for possible correlations between survival outcomes of post-resuscitation pediatric septic shock patients and parameters of clinical signs, macrocirculatory hemodynamics, as well as microcirculatory laboratory findings. Methods This prospective, study was conducted in the PICU at Saiful Anwar Hospital, Malang, East Java. Inclusion criteria were children diagnosed with septic shock according to the 2005 Surviving Sepsis Campaign (SSC) criteria, aged >30 days-18 years, who were followed up for 72h after resuscitation. The measured variables such as cardiac index (CI), systemic vascular resistance index (SVRI), stroke volume index (SVI) were obtained from ultrasonic cardiac output monitor (USCOM). Blood gas and lactate were obtained from laboratory findings. Heart rate, pulse strength, extremity temperature, mean arterial pressure (MAP), systolic blood pressure (SBP), capillary refill time (CRT), Glasgow coma scale (GCS), and diuretic used were obtained from hemodynamic monitoring tools. Survival outcomes of post-resuscitation pediatric septic shock patients were noted. Results There was a significant correlation between the outcomes of the pediatric septic shock patients 72h after fluid resuscitation and clinical, macrocirculatory hemodynamic, and microcirculatory laboratory parameters. After the 6th hour of observation, strong pulse was predictive of survival, with 88.2% area under the curve (AUC). At the 12th hour of observation, MAP >50th percentile for age was predictive of survival, with 94% AUC. Conclusion For pediatric patients with septic shock, the treatment target in the first 6 hours is to improve strength of pulse, and that in the first 12 hours is to improve MAP >50th percentile for age to limit mortality.
Co-Authors Achmad Yunus Azalia Ayu Rysaputri Brigitta I. R. V. Corebima Budi Utomo Dian Maharani Dominicus Husada Dwi Yuni Nur Hidayati Eko Sulistijono Fireka Imsa Sastia Juniantika Hery Susilo I Dewa Gede Ugrasena Ika Maya Suryaningtias Ismoedijanto Kurniawan Taufiq Kadafi Loeki Enggar Fitri Mario B. Nara Marvin Anthony Putera Nanda Juwita Natalia Erica Jahja Nelly Pramita Septiani Parwati Setiono Basuki Saptadi Yuliarto Saptadi Yuliarto Savitri Laksmi Winaputri Savitri Laksmi Winaputri Susanto Nugroho