RESUMO
Susceptibility to infection and increased antibiotic resistance place burn patients at risk of infection caused by multidrug-resistant organisms (MDRO). This condition can progress to sepsis, which can increase morbidity and mortality. A retrospective cohort study using medical record data of patients treated at RSUPN dr. Cipto Mangunkusumo in the period January 2020 to June 2022 was conducted. Of a total 160 subjects in the study period, 82.5% were aged <60 years, 16.88% had comorbidities, the most common cause of burns was fire (86.25%), the use of medical devices was 90.63%, with a median length of stay of 14 days. The most common Gram-negative MDRO pathogens were K. pneumoniae (29.91%), Enterobacter sp (22.32%) and Acinetobacter (20.54%): 45% of MDRO infected patients died. Bivariate analysis was conducted to find the effect of MDRO infection on burn patient mortality (RR 1,103; 95% CI 1,004-1,211, p=0.046). After adjusting for the role variables, namely: age, comorbidities, TBSA, use of medical devices, length of stay and multivariate analysis, it was found that the variables that had an effect on MDRO infection mortality were length of stay and age. MDRO infection has an effect on the mortality rate of burn patients. Mortality of burn patients due to MDRO infection is greater (45%) compared to non MDRO (21.43%). The most common Gram-negative MDRO pathogen is K. pneumoniae.
Leur sensibilité aux infections et l'augmentation globale de la résistance bactérienne font des brûlés des patients particulièrement à risque d'infections par BMR, pouvant déclencher sepsis/choc septique, qui augmentent morbidité et mortalité. Nous avons revu rétrospectivement les dossiers de 160 patients hospitalisés dans l'hôpital national Dr Cipto Mangunkusumo entre janvier et juin 2022. Parmi eux, 82,5% avaient moins de 60 ans ; 16,88% étaient comorbides ; 86,25% avaient été brûlés par flamme ; 90,63% avaient besoin de matériel invasif. La durée médiane de séjour était de 14 j. Les BGN BMR les plus fréquents étaient K. pneumoniæ (29,91%), Enterobacter (22,32%) et Acinetobacter (20,5%). La mortalité des patients infectés à BMR était de 45% (21,43% pour les non-BMR), avec une association significative BMR-mortalité (OR 1,103 ; IC95 1,004-1,211 ; p= 0,046). En explorant en analyse multivariée les variables classiquement associées à la mortalité (âge, comorbidités, surface brûlée, matériel invasif et durée de séjour), âge et durée de séjour contribuaient à la mortalité par BMR.
RESUMO
AIM: The premier platinum Helicobacter pylori (H pylori) stool antigen (HpSA) test is an enzyme immunoassay (EIA) that detects an H pylori antigen present in human stools. However, at present there is no uniformity about the cut off level required to consider the test as positive or negative. So we need the cut off level for our local population. The aim of this study was to evaluate the HpSA for the detection of H pylori infection in dyspeptic patients and to determine the sensitivity, specificity of the HpSA test in the diagnosis of H pylori infection, as compared to other standardized diagnostic techniques. METHODS: Sixty-three dyspeptic patients were selected from patients who came to the Division of Gastrointestinal Clinic in Cipto Mangunkusumo Hospital, Jakarta, Indonesia. H pylori infection was confirmed in all patients by histology and rapid urease test (CLO test). Positive results for H pylori were based on positive results from both rapid urea test and microscopic detection of H pylori. Stool specimens were analyzed for H pylori antigen using HpSA immunoassay. RESULTS: A total 63 patients consisted of 31 (49.2%) males and 32 (50.8%) females ranging in ages between 16 and 73 years with a mean age of 42.4+/-15 years. The mean age of men was 43.2+/-15.7 years and women was 41.6+/-14.4 years. Endoscopic findings in this study included gastric cancer 1.6%, peptic ulcer 4.8%, duodenal ulcer 7.9%, esophagitis 6.3%, gastritis 77.7%, and gastroduodenitis 4.8%. According to the predefined study criteria, 6 (9.5%) of 63 patients were positive for H pylori. In the diagnosis of infection, the area under the receiver operating characteristic (ROC) curve for the HpSA test was 0.722 (95% CI, 0.518-0.927). Using a cut-off value of 0.274 instead of 0.16 (as recommended by the manufacturer) the sensitivity and the specificity were 66.7% and 78.9% respectively. CONCLUSION: The HpSA stool test, using a cut-off value of 0.274, may be useful for the primary diagnosis of H pylori infection, its specificity is similar to other standard tests but its sensitivity was lower.
