Characteristics of clinical isolates of nontuberculous mycobacteria in Java-Indonesia: A multicenter study.

BACKGROUND: Nontuberculous mycobacterial (NTM) lung infections are a major public health concern. Diagnosis of NTM-pulmonary disease (NTM-PD) is difficult because its clinical, microbiological, and radiological features resemble to those of pulmonary tuberculosis (TB), leading to misdiagnosis. Identification at the species level is essential for diagnosis and determination of therapy, which is currently not performed routinely in Indonesian laboratories. METHODOLOGY AND PRINCIPAL FINDINGS: From January 2020 to May 2021, 94 NTM isolates were collected from three TB referral centers in Java Province. Species were identified using matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI-TOF MS). Tests were performed to determine antibiotic susceptibility, biofilm formation ability, sliding motility characteristics, and the ability to adhere to and invade pneumocytes. After identifying the species of all the isolates, we found nine groups of NTMs: M. fortuitum group 51% (48/94), M. abscessus 38.3% (36/94), M. intracellulare 3.1% (3/94), M. neoaurum 2.1% (2/94), M. chelonae 1.1% (1/94), M. gordonae 1.1% (1/94), M. szulgai 1.1% (1/94), M. mucogenicum 1.1% (1/94), and M. arupense 1.1% (1/94). Amikacin was the most effective antibiotic against M. fortuitum group and M. abscessus. The M. fortuitum group was significantly better at forming biofilms than M. abscessus, but both had the same sliding motility capability. The ability of the M. fortuitum group to adhere to and invade pneumocytes was better than that of M. abscessus, with the number isolates of the M. fortuitum group capable of superior adhesion and invasion to that of M. abscessus. CONCLUSIONS/SIGNIFICANCE: This study shows that M. fortuitum group and M. abscessus were the most common NTM found in Java, Indonesia. The M. fortuitum group and M. abscessus were the most susceptible to amikacin; therefore, this was the empirical treatment of choice. The ability to form biofilms is directly proportional to the ability to adhere to and invade pneumocytes but not to the susceptibility profile or sliding motility characteristics.

Collaborative progress test (cPT) in three medical schools in Indonesia: the validity, reliability and its use as a curriculum evaluation tool.

BACKGROUND: Three medical schools in Indonesia have been collaborating in evaluating the learning process in the current curriculum by administering a collaborative progress test (cPT). The 120 multiple choice questions for cPT was developed by the three schools. This study aimed to assess the validity and reliability of the cPT as a part of curriculum evaluation. METHOD: The cPT was administered to year 1-5 students. A stratified random sampling based on the student Grade Point Average (GPA) was performed. The construct validity was established by assessing the accordant increase of mean score of cPT to the student year level. Finally, the reliability of the cPT was calculated using Cronbach Alpha coefficient. RESULT AND DISCUSSION: A total of 223, 219 and 161 year 1 to 5 students completed the cPT in FM UI, FM UNAND, and FM UNS, respectively. The content and construct validity of the cPT were evident. There was an increase of the mean score from year 1 to 5, either in the pooled data (one way ANOVA F 174.7(4), p < 0.001) and in each school (one way ANOVA FMUI F 102.5 (4) p < 0.001, FM UNAND F 83.0 (4) p < 0.001, FM UNS 28.28(4) p < 0.001). The internal consistency of the cPT was very good in the three institutions. CONCLUSION: The cPT was proven to be a valid and reliable test to measure the increase of knowledge of medical students and was also useful to provide feedback for curriculum evaluation in the three medical schools. Further improvement is required in assuring the test blueprint and the content of the test items.