Characteristics and susceptibility pattern of catheter-associated urinary tract infections (CAUTI) bacteria in Indonesia: A study in a national reference hospital of Sumatra region 2020-2021.

Catheter-associated urinary tract infection (CAUTI) is defined as a urinary tract infection associated with catheter placement for more than two consecutive days. Hence, antibiotic resistance in the context of CAUTIs represents a substantial challenge. The aim of this study was to present the characteristics of patients with CAUTI and the susceptibility pattern of CAUTI bacteria in the national reference hospital of the Sumatra region of Indonesia. A cross-sectional study was conducted at H. Adam Malik General Hospital, Medan, Indonesia, from 2020 to 2021, using a total sampling. All CAUTI patients included were on catheterization and diagnosed based on the Centers for Disease Control and Prevention (CDC) guidelines. The patient's urine culture and antibiotic susceptibility test were carried out on the patient's admitted urine sample for further assessment. Identification of bacteria, antibiotic susceptibility test, and the extended-spectrum beta-lactamase (ESBL) test for Escherichia coli and Klebsiella pneumoniae were conducted using the VITEK-2 Compact. A total of 74 CAUTI patients were included in the study, 59.5% were female, 54.1% were 46-65 years old, and a third had cardiovascular disease comorbidities (33.8%). A total of 83 CAUTI-associated bacteria were isolated. The majority were Gram-negative bacteria (74.7%), and the most bacteria isolated was E. coli (31.3%), followed by K. pneumoniae, Enterococcus faecalis, Acinetobacter baumannii, and Enterococcus faecium. The ESBL test was positive mostly in K. pneumoniae (100%) and E. coli (76.9%). CAUTI-associated E. coli was susceptible to tigecycline, meropenem, ertapenem, nitrofurantoin, and gentamicin. The isolated K. pneumoniae was susceptible to tigecycline, meropenem, ertapenem, and amikacin. While E. faecalis showed susceptibility to tigecycline, nitrofurantoin, vancomycin, imipenem, linezolid, ampicillin, piperacillin/tazobactam, amoxicillin/clavulanic acid, ampicillin/sulbactam, and piperacillin.

Medical nutritional therapy in infected bronchiectasis with impending respiratory failure: A case report.

OBJECTIVE: Bronchiectasis is a chronic infective and inflammatory respiratory disease that causes significant morbidity and mortality. Repeated respiratory infections may lead to infected bronchiectasis (IB) and acute exacerbations which often require hospital admission, increase risk of malnutrition and impact quality of life and eventually leads to death. Nutritional therapy is needed to modulate inflammation and enhance immunity to reduce severity of exacerbation, overcome malnutrition, as well as to decrease morbidity and mortality. METHODS: A 59-year-old female patient, diagnosed with IB. The patient had low oral intake due to productive cough and anorexia since 2 weeks before admission. Moreover, she had gradual shortness of breath that caused an impending respiratory failure during hospitalization, supported by continuous positive airway pressure (CPAP). Nutritional assessment was made based on Subjective Global Assessment (SGA) score C. Abnormal laboratory findings seen were increased in neutrophil-to-lymphocyte ratio (NLR) 9.3, moderate depletion of immune system with total lymphocyte count (TLC) 808.4/µl, hypoalbuminemia (3.2g/dl) and increased in liver enzymes: aspartate aminotransferase (AST) 206U/l, Alanine aminotransferase (ALT) 224U/l. Nutritional therapy was given gradually with target calorie 1400-1900kcal, protein 0.8-1.5g/kg IBW/day, carbohydrates 45-50%, and fat 33.3-43% through oral and parenteral nutrition. The patient was given supplementations such as vitamins (A, B complex, C, D), zinc, curcumin and snakehead fish extract high albumin content. RESULT: After 14 days of treatment, significant clinical and metabolic improvement in NLR, TLC, plasma albumin, liver enzymes (AST/ALT), blood gas analysis, and functional capacity (handgrip strength) were found. CONCLUSION: An adequate nutritional therapy with macro and micro-nutrients in IB patient can improve clinical outcome, nutritional status and quality of life.

Medical nutritional therapy in infected bronchiectasis with impending respiratory failure: A case report

Objective: Bronchiectasis is a chronic infective and inflammatory respiratory disease that causes significant morbidity and mortality. Repeated respiratory infections may lead to infected bronchiectasis (IB) and acute exacerbations which often require hospital admission, increase risk of malnutrition and impact quality of life and eventually leads to death. Nutritional therapy is needed to modulate inflammation and enhance immunity to reduce severity of exacerbation, overcome malnutrition, as well as to decrease morbidity and mortality. Methods: A 59-year-old female patient, diagnosed with IB. The patient had low oral intake due to productive cough and anorexia since 2 weeks before admission. Moreover, she had gradual shortness of breath that caused an impending respiratory failure during hospitalization, supported by continuous positive airway pressure (CPAP). Nutritional assessment was made based on Subjective Global Assessment (SGA) score C. Abnormal laboratory findings seen were increased in neutrophil-to-lymphocyte ratio (NLR) 9.3, moderate depletion of immune system with total lymphocyte count (TLC) 808.4/μl, hypoalbuminemia (3.2 g/dl) and increased in liver enzymes: aspartate aminotransferase (AST) 206 U/l, Alanine aminotransferase (ALT) 224 U/l. Nutritional therapy was given gradually with target calorie 1400–1900 kcal, protein 0.8–1.5 g/kg IBW/day, carbohydrates 45–50%, and fat 33.3–43% through oral and parenteral nutrition. The patient was given supplementations such as vitamins (A, B complex, C, D), zinc, curcumin and snakehead fish extract high albumin content. Result: After 14 days of treatment, significant clinical and metabolic improvement in NLR, TLC, plasma albumin, liver enzymes (AST/ALT), blood gas analysis, and functional capacity (handgrip strength) were found. Conclusion: An adequate nutritional therapy with macro and micro-nutrients in IB patient can improve clinical outcome, nutritional status and quality of life. (AU)

Antibacterial activity of betle leaf (Piper betle l.) extract on inhibiting Staphylococcus aureus in conjunctivitis patient.

The aim of this study is to determine the antibacterial activity of Piper betle L. leaf extract on inhibiting Staphylococcus aureus in conjunctivitis patient. This study follows a post-test only group experimental design. Antibacterial activities of five Piper betle L. extract concentrations (0.5%, 1%, 1.5%, 2%, 2.5%, and 3%) against Staphylococcus aureus were evaluated by agar well diffusion method. The negative control group (P-) was treated with standard 10% DMSO solution, the positive control group (P+) with ceftriaxone. The diameters of clear zone surrounding the well were analyzed with Kruskal-Wallis test and showed that in between 1% and 1.5%; 1.5% and 2%; 2% and 2.5%; 2.5% and 3% concentrations do not show a significant difference but in between 0.5% and 1%; 0.5% and 1.5%; 0.5% and 2%; 0.5% and 2.5%; 0.5% and 3%; 1% and 2%; 1% and 2.5%; 1% and 3%; 1.5% and 2.5%; 1.5% and 3%; 2% and 3% concentrations, Piper betle L. leaf extract shows a significant difference on inhibiting the growth of Staphylococcus aureus. In conclusion the results obtained show that that Piper betle L. leaf extract has a significant potential use as an antibacterial agent.

Association between Glycated Hemoglobin with the Levels of Serum Proinflammatory Cytokines and Antioxidants in Patients with Type 2 Diabetes Mellitus in Universitas Sumatera Utara Hospital.

BACKGROUND: Hyperglycemia condition in diabetes mellitus (DM) influences proinflammatory cytokine levels and disrupts antioxidant balances. Glycated Hemoglobin is used as a biomarker of glycemic control in DM. AIM: This study aimed to analyse the association between glycated Hemoglobin with the levels of serum proinflammatory cytokines (interleukin (IL)-6) and antioxidants (glutathione peroxidase (GPx) and glutathione (GSH)) in type 2 diabetes mellitus (T2DM) patients in Universitas Sumatera Utara (USU) Hospital. METHODS: A total of eighty-nine T2DM patients were recruited at USU Hospital. Glycated Hemoglobin levels were measured using routine laboratory tests at USU Hospital. The IL-6, GPx, and GSH levels were measured using enzyme-linked immunosorbent (ELISA) method. The statistical significance was determined using the Kruskal Wallis test, followed by Mann-Whitney test (p < 0.05). RESULTS: The mean of glycated hemoglobin (%), IL-6 (pg/ml), GPx (ng/ml), and GSH (ng/ml) levels in T2DM patients were 8.96 ± 2.28, 59.27 ± 16.04, 32.13 ± 12.10, and 7.42 ± 3.50, respectively. Regarding the glycated Hemoglobin levels, 28.09% of patients had controlled diabetes, 24.72% of patients had poorly controlled diabetes, and 47.19% of patients had uncontrolled diabetes. The IL-6 levels of the three study groups based on glycated Hemoglobin levels were related significantly (p < 0.05), but there was no statistically significant difference observed between the GPx and GSH levels (p > 0.05). CONCLUSION: The present study suggests that the glycated Hemoglobin was associated with the levels of serum IL-6 levels but not GPx and GSH levels in T2DM patients in USU Hospital.

Superoxide Dismutase Levels and Polymorphism (Ala16val) In Tuberculosis Patients with Diabetes Mellitus in Medan City.

BACKGROUND: Infectious diseases and metabolic disorders would result in oxidative stress in cells. Superoxide dismutase (SOD) is an antioxidant present inside cells that acts against oxidative stress. SOD gene polymorphism can affect the activity and levels of SOD. AIM: This study aimed to analyse SOD levels and polymorphism of gene (ala16val) that regulated SOD in tuberculosis patients with diabetes mellitus in Medan city. METHODS: A total of 40 tuberculosis patients with diabetes mellitus and 40 healthy subjects participated in the study. The levels of SOD were measured using enzyme-linked immunosorbent assay (ELISA). Analysis of SOD gene polymorphism (ala16val) was done using polymerase chain reaction-restriction fragment lengths polymorphisms (PCR-RFLP) with BsaW1 as the restriction enzyme. The statistical significance was determined using the Mann Whitney test, Fisher's exact test, and Kruskal Wallis test (p < 0.05). RESULTS: The SOD levels of tuberculosis patients with diabetes mellitus were lower than those of the healthy subjects (102.474 ± 36.07 U/L vs 294.543 ± 58.75 U/L, p < 0.05). Patients of tuberculosis with diabetes mellitus tend to have more value/Val genotypes than the healthy group (57.5% vs 50%, p > 0.05). There was no association between SOD levels and SOD gene polymorphism (ala16val) in tuberculosis patients with diabetes mellitus. CONCLUSION: In this study, there was an association between the levels of SOD and tuberculosis patients with diabetes mellitus, but not for the SOD gene polymorphism (ala16val). The SOD gene polymorphism (ala16val) was not the key role to influence the SOD levels in tuberculosis patients with diabetes mellitus in Medan city.

The Gene Polymorphisms (-308G/A) and the Tumor Necrosis Factor-alpha Levels in Type 2 Diabetic Patients with and Without Tuberculosis Infection.

BACKGROUND: The gene polymorphism (-308G/A) and tumor necrosis factor-alpha (TNF-α) levels influence development of disease in type 2 diabetic patients and tuberculosis patients. AIM: In this study, we analyze the association between the TNF-α polymorphisms (-308G/A) and the levels of TNF-α in type 2 diabetic patients with and without tuberculosis infection. METHODS: This study was an analytic observational with cross sectional approach consisting 40 type 2 diabetic patients with tuberculosis infection, 40 type 2 diabetic patients without tuberculosis infection and 40 healthy control (HC) subjects. The TNF-α gene polymorphism (-308G/A) was analyzed with polymerase chain reaction-restriction fragment lengths polymorphisms (PCR-RFLP) method. The TNF-α levels were measured using an enzyme-linked immunosorbent assay. The association between gene polymorphism (-308G/A) in study groups was analyzed by Fisher's exact test, tumor necrosis factor-alpha (TNF-α) levels in study groups was carried out using the Kruskal-Wallis test. Hardy-Weinberg Equilibrium also determined genotype deviation and allele frequencies. RESULTS: The GG and GA+AA genotypes frequency in both of patient groups and HC subjects were not differ significantly (95% and 5% vs 95% and 5% vs 92.5% and 7.5%; p > 0.05). The TNF-α levels (pg/ml) of type 2 diabetic without tuberculosis infection were higher than those of type 2 diabetic with tuberculosis infection and HC subjects (7.42 ± 0.78 vs 2.23 ± 0.51 vs 2.57 ± 0.63; p < 0.01). The TNF-α levels in the GA+AA genotypes were higher than the GG wild-type genotype (p > 0.05). There was no significant deviation of genotype frequency and allele from Hardy-Weinberg Equilibrium. CONCLUSION: The gene polymorphism (-308G/A) had no association with type 2 diabetic patients with and without tuberculosis infection and the gene polymorphism (-308G/A) was not influence the TNF-α levels but there was a significant differentiation of TNF-α levels between the groups.

Analysis of Concordance of Medication-Taking Behaviour in Tuberculosis Patients in Medan, Indonesia.

AIM: This study aimed to analyse tuberculosis (TB) medication-taking behaviour based on the concept of concordance between health workers and TB patients in Medan, Indonesia. METHODS: This study was an analytical study with a cross-sectional design. A total of 100 patients undergoing TB treatment at several public health centres in Medan City participated in the study. RESULTS: The results showed that there was a relationship between the concordance behaviour of the health workers with the attitude and medication-taking behaviour of the patients (p < 0.05). However, there was no relationship found between concordance and knowledge of the patients (p > 0.05). CONCLUSION: The results showed that most of the concordance behaviour, knowledge, attitude, and behaviour in the sample were good.