Objective: Several studies reported that infection of extended-spectrum β lactamase (ESBL)-producing Escherichia coli (E. coli) or Klebsiella pneumoniae (K. pneumoniae) contributed to higher mortality rates but others found it was not associated with mortality. A prospective cohort study which involved 72 patients was conducted to assess the risk of mortality of bloodstream infection due to ESBL-producing K. pneumoniae or E. coli as compared to those infected by either K. pneumoniae or E. coli which not produce ESBL. Result: Mortality in the group of patients infected with ESBL-producing bacteria was 30.6%, whereas in another group which was infected with non ESBL-producing bacteria was 22.2% (p = 0.59). Kaplan–Meier’s analysis showed that the survival rate during 14-days follow-up among these two group was not significantly different (p = 0.45) with hazard ratio 1.41 (95% CI 0.568–3.51). Stratification analysis found that adult and elderly patients, patients with sign of leukocytosis, and patients treated with carbapenem were modifier effect variables.

Background and Aim: The emergence of methicillin-resistant Staphylococcus aureus (MRSA) as a highly pathogenic strain in veterinary and human medicine is a growing global problem. This study aimed to evaluate MRSA isolates of human and animal origin against various antibiotics in Yogyakarta, Indonesia. Materials and Methods: The susceptibility test was carried out by the disk diffusion method using Mueller-Hinton agar against nine antibiotic disks. Methicillin-resistant S. aureus strains were genetically confirmed through mecA gene detection encoding for methicillin resistance by polymerase chain reaction. Results: All 240 S. aureus strains isolated from animals and humans were resistant to penicillin G (P) (100% and 99%, respectively), followed by ampicillin (AMP), amoxicillin (AML), oxacillin (OX), erythromycin (E), clindamycin (DA), tetracycline (TE), gentamicin (GEN), and ciprofloxacin (CIP). Eighty-three MRSA strains were resistant to OX (100%), P (100%), AMP (99.27%), AML (95.52%), E (87.77%), TE (71.33%), DA (63.24%), GEN (38.81%), and CIP (26.87%). Conclusion: The antimicrobial resistance pattern of S. aureus human isolates was similar to their animal counterpart, with 77.20% of MRSA strains classified as multidrug-resistant (MDR) bacteria. These findings indicate an increase in MDR S. aureus strains of animal origin in Yogyakarta, thus raising public health concerns about MRSA zoonotic spread.

In a clinical laboratory services pre-analytical phase has plays an important role in term of quality and patient safety. Pre-analytical phase is a phase before analyzing sample in laboratory which includes patient preparation, sampling, labeling, sample transportation, sample storage, and preservation of samples that might influence the laboratory results. In this phase it involves interaction between patient, doctor, laboratory personels, and other staff outside the laboratory. Therefore, it could be assumed that in this phase many sample are collected, many laboratory tests are requested, many individuals are involved and therefore laboratory errors might be occured. Laboratory errors can occur either in pre-analytical, analytical, or post analytical phases but the most frequently errors occur in pre-analytical phase. In this article, quality improvement efforts in pre-analytical phase will be discussed in order to minimize pre-analytical error.

Background and Aim: Methicillin-resistant Staphylococcus aureus (MRSA) has been known as a highly pathogenic bacteria in animals and humans, which is still becoming a global health issue. The prevalence of MRSA infection continues to increase worldwide and has become a global concern as a dangerous zoonotic disease. The World Health Organization estimates that by 2050 MRSA will be the leading cause of death. This study aimed to estimate the prevalence of MRSA in S. aureus isolates of veterinary and human origin in Yogyakarta, Indonesia. Materials and Methods: A total of 42 cases of S. aureus infection were examined in this study, consisting of nine isolates from cattle, five from goat, and 28 from human. All isolates were confirmed as S. aureus based on bacterial culture and detection of 23S rRNA and thermonuclease nuc gene by polymerase chain reaction (PCR). Results: Among 42 isolates, 35 isolates (83.3%) were identified as MRSA by PCR positive of mecA gene encoding methicillin resistance. Most MRSA strains were found in human isolates (100%), followed by cattle isolates (55.5%) and goats (40%). All MRSA strains were also multi-resistant to penicillin (blaZ gene) and tetracycline (tetK, and tetM genes) with a prevalence of about 98%. Conclusion: MRSA prevalence in humans and animals has increased significantly in Yogyakarta, Indonesia, compared to the previous study. The antimicrobial resistance pattern of MRSA animal isolates tends to be similar to humans and, thus, raises public health concerns about MRSA zoonotic spread. Keywords: animal, antimicrobial resistance, human, methicillin-resistant Staphylococcus aureus, Staphylococcus aureus.

Sensitivity of Total Protein Creatinine Ratio in Urine for Diagnosis Diabetic Nephropathy

BACKGROUND: Klepsiella pneumoniae, one of clinical isolates, is frequently found causative agent of hospital acquired infection. Currently, K. pneumoniae is found as extended-Spectrum β-lactamases (ESBL) producer, allowing it to become multidrugresistant. A clinical laboratory with limited facility needs a valid, reliable, inexpensive and simple laboratory test to control its infection and antimicrobial-resistancy. The aim of this study is to evaluate the diagnostic performance of a ESBL media to detect ESBL-producing K. pneumoniae.METHODS: An independent and blind comparative study of ChromID ESBL media and Double Disc Synergy Test (DDST) was conducted for detecting the clinical isolate of ESBL-producing K. pneumoniae. Clinical isolates of K. pneumoniae collected from the Clinical Laboratory of Dr. Sardjito Hospital were isolated.RESULTS: There were 103 clinical isolates of K. pneumoniae, which were isolated from urine, pus, blood, stool, cerebrospinal fluid, sputum, drain liquid, nasal sinus liquid, gastric wash, bronchi liquid, injury liquid and nasal swab. The number of true positive, true negative, false positive and false negative results were 74, 18, 9 and 2, respectively. Meanwhile, the sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for positive result and likelihood ratio for negative result of the new ESBL media were 97.4%, 66.7%, 89.2%, 90%, 2.9 and 0.03, respectively.CONCLUSION: Since the new ESBL media and DDST results were similar, so the new ESBL media could be used for screening patients with clinical presentation that indicating a high suspicious of ESBL-producing bacteria.KEYWORDS: K. pneumoniae, ChromID ESBL, DDST, ESBL, sensitivity