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PROBLEM OF ANTIBIOTIC USE AND ANTIMICROBIAL RESISTANCE IN INDONESIA: ARE WE REALLY MAKING PROGRESS? Hadi, Usman; Kuntaman, Kuntaman; Qiptiyah, Mariyatul; Paraton, Hari
Indonesian Journal of Tropical and Infectious Disease Vol 4, No 4 (2013)
Publisher : Institute of Topical Disease

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Abstract

Background: Based on the results Antimicrobial Resistance in Indonesia: prevalence and prevention-study (AMRIN-study), the Ministry of Health of Indonesia in 2005 began a program antibiotic resistance control (PPRA) in some government hospitals, and is currently developing to all government teaching hospitals in Indonesia. Aim: The core activities of the PPRA are to implement standardized surveillance emergence of antibiotic resistant bacteria, and the surveillance of antibiotic use in terms of quantity and quality. Method: Our research in the years 2003 showed the proportion of antibiotic use 84% of patients in a hospital. The use of inappropriate antibiotics was very high, 42% no indication. Result: In 2012 the results of surveillance showed decline of inappropriate use of antibiotic, but prevalence extended-spectrum b-lactamase (ESBL)-producing K.pneumoniae (58%), and E.coli (52%) andmethicillin-resistant S.aures (MRSA) (24%) were increasing. Conclusion: It was needed to implement the most appropriate programs to prevent the growth and development of bacteria resistant to antibiotics.
The Effectiveness of Audit Guideline Using Directive Discourse for Control and Prevention of Methicillin Resistant Staphylococcus aureus Infection Kusbaryanto Kusbaryanto; K. Kuntaman; WJ. Pudjirahardjo
International Journal of Public Health Science (IJPHS) Vol 5, No 1: March 2016
Publisher : Intelektual Pustaka Media Utama

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (183.673 KB) | DOI: 10.11591/ijphs.v5i1.4766

Abstract

Methicillin Resistant Staphylococcus aureus (MRSA) infection is one of the major problems in the hospital, due to its increasing of prevalence. The aim of this study was to analyze the effectiveness of the Audit Guideline for control and prevention of MRSA infection, using directive discourse on nurses in hospitals. The Audit Guideline was focused on its effectiveness in improving the situation awareness of the nurses. This study was a quasi-experimental study using a pretest-posttest control group design. The population was ward nurses in a hospital. The samples were taken from four medical wards, two wards as the treatment group (25 nurses) and two wards as the control group (28 nurses). The two groups get the training of MRSA infection control and prevention. The training of the guideline of MRSA infection control and prevention using directive discourse was only applied in the treatment group. The analysis of the results of the situation awareness action was conducted, and the result of situation awareness action was improved from 0.8 response to 1.8 response (p = 0.014). This result was significantly difference because of the training using Audit Guideline for MRSA infections control and prevention with directive discourse become a positive reinforcement, the positive driven to stimulate behavior change of the nurses.
The Potency of Dextranase from Arthrobacter sp. Strain B7 as Dental Plaque Removal AFAF BAKTIR; NOOR CHOLIES ZAINI; UNTUNG MURDIYATMO; KUNTAMAN KUNTAMAN
HAYATI Journal of Biosciences Vol. 12 No. 4 (2005): December 2005
Publisher : Bogor Agricultural University, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (92.646 KB) | DOI: 10.4308/hjb.12.4.162

Abstract

Dextranase of Arthrobacter sp. strain B7 (B7DEX enzyme) was characterized in this study. This enzyme hydrolyzed sucrose and dextran, but not other glucans (starch, nigeran, cellulose, -soluble glucan). It also hydrolyzed glucan from dental plaque with the activity of 7.38 +/- 66 U/ml, where the activity toward dextran was 31.88 +/- 1.24 U/ml. The enzyme exhibited the pH optimum of 7 and the temperature optimum of 50 0C. Its optimum stability was at pH 7 and 50 0C. The enzyme was inhibited by Fe3+, Cu2+, Zn2+, and Ag+, but not by the anionic detergent (SDS) and the nonionic detergent (Triton-X). The enzyme was activated by Ca2+, Na+, Mg2+, and saliva.
Prevalensi dan Pola Gen Extended Spectrum B-lactamase Bakteri Usus Sapi Perah dan Penduduk Sekitar Peternakan di Surabaya Triffit Imasari; Wiwiek Tyasningsih; Eddy Bagus Wasito; Kuntaman Kuntaman
Jurnal Veteriner Vol 19 No 3 (2018)
Publisher : Faculty of Veterinary Medicine, Udayana University and Published in collaboration with the Indonesia Veterinarian Association

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Abstract

Since identified in 1980s, the multiple drug resistant organisms such as Extended Spectrum Beta Lactamases (ESBL) producing bacteria is increasing. These bacteria Enterobacteriaceae strain are mostly resistant against third and also fouth generation cephalosporin. ESBL-producing bacteria are identified in both of human, environment and also in animal. There are three main ESBL genes that are commonly found namely SHV, TEM and CTX-M. The aims of this study were to explore the prevalence and pattern of ESBL gene among dairy cows and people around the farm. The faecal samples were collected from dairy cows and people around the farm, cultured on MacConkey agar supplemented with cefotaxim 1 mg/L, incubated at 37oC for 24 hours. Then the growing colony were tested for ESBL producer by Double Disk Synergy Test (DDST), then followed by Polymerase Chain Reaction (PCR) for ESBL gene. Total sampling technique with inclusion and exclusion criteria, Total 49 samples were collected, consisting of 25 dairy cows faeces and 24 people faeces. Among these, were identified 18 samples (72%) positive in dairy cows and 19 samples (79.1%) positive results in the people around the dairy farm. The ESBL gene, SHV, TEM, CTX-M were identified dairy cows were zero for SHV, TEM (12%), CTX-M (72%) while in people around the farm SHV (25%), TEM (16.7%), CTX-M (66.7%). There were significant different (p < 0.05) between dairy cows and people around the farm, of SHV ESBL gene and not different (p>0.05) of TEM and CTX-M ESBL gene respectively. The ESBL genes have spread among dairy cows and people around the farm.
Pattern of disease and type of operation of Surgical Site Infection in obstetrics and gynecology at Dr Soetomo Hospital, Surabaya, Indonesia Ardi Eko Marsanto; Kuntaman Kuntaman; Hari Paraton; Budi Prasetyo
Majalah Obstetri dan Ginekologi Vol. 27 No. 2 (2019): August
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (455.374 KB) | DOI: 10.20473/mog.V27I22019.49-55

Abstract

Objectives: to find correlation between risk factors and classification of SSI, the distribution of SSI, and cost in Soetomo Hospital.Materials and Methods: descriptive retrospective observational with correlation analysis between risk factors and SSI classification according to Centers for Disease Control (CDC) definition with univariate analysis. Sub-group descriptive analysis on microbiology result, length of stay (LOS) and cost was also performed. All patients was diagnosed SSI between January 2015 until June 2017.Results: age, referral cases, Body Mass Index, Hemoglobin and Albumin results, types of surgery, types of case are the risk factors we included. Analysis result shows no strong and significance correlation in all risk factors (r 0.053 – 0.447; p 0.072 – 0.971). According to SSI types, the distribution are: superficial (7; 13.2%), deep (26; 49.1%), organ/space (20; 37.7%). Extended-Spectrum Beta-Lactamase (ESBL) was obtained in 19 (14 Obstetrics; 5 Gynecology) from 28 patients with microbiology results. Five deaths occured in ESBL patients (1 Obstetrics; 4 Gynecology; ratio 1 : 11.2). Mean length of stay in Obstetrics and Gynecology was 41.7 and 19.2 days, respectively. Mean cost per day in Obstetrics and Gynecology was 1.2 amd 2.6 million rupiah, respectively.Conclusions: no strong and significant results in all risk factors. Death rate in SSI and malignancy with positive ESBL result are high. Less cost needed for SSI patients, but with longer LOS. Comprehensive approaches are needed to patients at risk of SSI, further study with larger sample are needed.
The role of inducible Nitric Oxide Synthase in teeth periapical lesions immunopathogenesis caused by Enterococcus faecalis Tamara Yuanita; Latief Mooduto; Kuntaman Kuntaman
Dental Journal (Majalah Kedokteran Gigi) Vol. 46 No. 1 (2013): March 2013
Publisher : Faculty of Dental Medicine, Universitas Airlangga https://fkg.unair.ac.id/en

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (198.797 KB) | DOI: 10.20473/j.djmkg.v46.i1.p14-17

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Background: Periapical lesions, are characterized by an immune response to the invading bacteria consequences periapical bone destruction. In root canal treatment failure was found Enterococcus faecalis (E. faecalis) as most species. iNOS found an important role in protection against infection, plays vital roles in fighting pathogens and contributing to disease pathology. Purpose: This study was to observed the role of iNOS in teeth periapical lessions immunopathogenesis caused by E. faecalis. Methods: The randomized post-only control group design used in this study, This study used 24 Wistar rats, were divided into three groups (each group consisted of 8 rats), as negative controls group is a normal teeth, in the positive controls group was made by drilling the upper right first molar to penetrate the dental pulp and was induced with 10µl BHI-b then filled with Glass Ionomer Cement (GIC) and the treatment group, after drilling the teeth, then inoculated with E. faecalis ATCC 29212 106 CFU into 10µl BHI-b then filled with GIC to prevent contamination. It takes 21 days to get periapical lesions and rat were sacrificed, and then the expression of iNOS was measured. Results: Statistical analysis using ANOVA found a significant differenced between control and treatment groups (p<0.05). Conclusion: This study concluded that iNOS role in teeth periapical lesions immunopathogenesis caused by E. faecalis.Latar belakang: Lesi periapikal merupakan hasil suatu respon imun untuk melawan invasi bakteri yang mengakibatkan destruksi tulang periapikal. Pada perawatan saluran akar yang mengalami kegagalan ditemukan Enterococcus faecalis sebagai spesies terbanyak. iNOS berperan penting untuk proteksi terhadap bakteri, mempunyai peran yang vital untuk melawan patogen dan berkonstribusi secara patologik untuk menyebabkan suatu penyakit. Tujuan: Penelitian ini bertujuan untuk mengobservasi peran iNOS secara imunohistokimia pada lesi periapikal tikus Wistar. Metode: Penelitian ini menggunakan disain randomized post-only control group, digunakan 24 ekor tikus Wistar yang dibagi menjadi tiga kelompok yang masing-masing terdiri dari 8 ekor tikus, sebagai kelompok kontrol negatif adalah gigi normal, pada kelompok kontrol positif dilakukan pengeboran pada gigi molar pertama rahang atas sampai menembus pulpa kemudian diinduksi 10µl BHI-b kemudian ditumpat (Glass Ionomer Cement) GIC dan pada kelompok perlakuan, setelah dilakukan pengeboran dilakukan induksi E. faecalis ATCC 29212 sebanyak 106 CFU ke dalam 10 µl BHI-b kemudian ditumpat GIC untuk mencegah kontaminasi. Diperlukan waktu 21 hari untuk mendapatkan lesi periapikal pasca perlakuan kemudian tikus dikorbankan lalu dihitung sel-sel yang mengekspresikan iNOS. Hasil: Analisis menggunakan ANAVA membuktikan bahwa ada perbedaan yang bermakna antara kelompok kontrol dan kelompok perlakuan (p<0,05). Kesimpulan: iNOS berperan pada imunopatogenesis lesi periapikal gigi akibat E. faecalis.
The distribution of Streptococcus mutans and Streptococcus sobrinus in children with dental caries severity level Nur Dianawati; Wahyu Setyarini; Ira Widjiastuti; Rini Devijanti Ridwan; K. Kuntaman
Dental Journal (Majalah Kedokteran Gigi) Vol. 53 No. 1 (2020): March 2020
Publisher : Faculty of Dental Medicine, Universitas Airlangga https://fkg.unair.ac.id/en

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/j.djmkg.v53.i1.p36-39

Abstract

Background: The prevalence of dental caries is high worldwide and specifically in Indonesia, especially in children. Cariogenic bacteria are the major cause of dental caries. Streptococcus mutans (S. mutans) is one of the bacteria often associated with caries, due to its ability in producing acid and forming the biofilm for bacterial colonisation on the surface of oral cavities. In addition to S. mutans, Streptococcus sobrinus (S. sobrinus) bacteria are also thought to play an important role in the process of caries. Purpose: This study aims to analyse the distribution of S. mutans and S. sobrinus in children with seriously high dental caries levels. Methods: This study was an observational analytical study. Bacterial isolation was conducted in carious lesions of 50 paediatric patients 6-12 years old with superficial dental caries. Samples of caries lesions were put directly into a tube containing the Brain Heart Infusion Broth (BHI-B) and incubated at 37o C for 24 hours. The samples were sub-cultured on selective tryptone yeast cystine sucrose bacitracin (TYCSBHimedia) agar, and then incubated for two days. Bacterial identification was then performed using the polymerase chain reaction (PCR) Multiplex method. Statistical analysis with Chi-square. Results: The total number of children with dental caries included in this study was 50. Among these, 94% showed positive for S. mutans and 30% positive for S. sobrinus. The analysis of the prevalence of bacterial colonisation (S. mutans and S. sobrinus) based on caries severity and the Simplified Oral Hygiene Index (OHI-S), showed there was no significant difference (p> 0.05). Conclusion: This study showed that among 50 caries noted in the children, 94% were colonised S. mutans and 30% S. sobrinus. There was no significant difference between the colonisation of S. mutans and S. sobrinus among children from the severe to mild decayed exfoliated filling teeth (DEFT) category, and between bad and good OHI-S.
Comparation of Phenotypic and Genotypic Profile of Carbapenemase Producing Escherichia coli Silvia Sutandhio; Budiono Budiono; Hardiono Hardiono; Kuntaman Kuntaman; Eddy Bagus Wasito; Maria Inge Lusida
Folia Medica Indonesiana Vol. 54 No. 1 (2018): March
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (221.592 KB) | DOI: 10.20473/fmi.v54i1.8045

Abstract

Carbapenemase-producing Escherichia coli (E. coli) has caused trouble in therapeutic antibiotic selection. Carbapenemase screening procedure in laboratories is usually based on inacurate semi-automatic system. Confirmation and classification of carbapenemases according to Ambler can be done with combination of phenotypic methods, i.e., Modified Hodge Test (MHT), Sodium Mercaptoacetic Acid (SMA), and 3-Aminophenylboronic Acid (PBA). This study aimed to compare profiles of carbapenemase-producing E. coli which were confirmed and classified phenotypically with the genotypic profiles. E. coli isolates from urine specimens which were potential as carbapenemase-producers according to semi-automatic system BD Phoenix were phenotypically tested with MHT, SMA, and PBA. Isolates were grouped as carbapenemase-producers and non carbapenemase-producers. Phenotypic carbapenemase-producer isolates were classified based on Ambler criteria. All isolates were then tested with Polymerase Chain Reaction (PCR) for the presence of OXA-48, IMP1, IMP2, GES, VIM, NDM, KPC genes. Out of 30 isolates, 6 isolates (20.0%) were MHT positive, and 25 isolates (83.3%) were SMA positive, which indicated that most isolates produced were carbapenemase Ambler B. PCR confirmed 12 isolates (40.0%) had VIM gene which were classified as carbapenemase Ambler B. Phenotypic confirmatory test had 100% sensitivity and 22.2% specificity. Classification with phenotypic confirmatory test had 91.7% match with PCR. Phenotypic confirmatory test detected more carbapenemase than PCR. This low specificity may be caused by inappropriate use of diagnostic gold standard. PCR should not be used for routine carbapenemase confirmation because of vast diversity of carbapenemases. Phenotypic confirmatory test can classify carbapenemase according to Ambler classification.
The Prevalence of Extended Spectrum Beta-Lactamase (ESBL) Producing Gut Bacterial Flora Among Patients in Dr. Soetomo Hospital and Primary Health Centre in Surabaya Dian Neni Naelasari; Eko Budi Koendhori; Linda Dewanti; Rosantia Sarassari; K Kuntaman
Folia Medica Indonesiana Vol. 54 No. 4 (2018): December
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (240.376 KB) | DOI: 10.20473/fmi.v54i4.10708

Abstract

The extended-spectrum b-lactamase (ESBL) producer bacteria until now were mostly identified in hospital environment. The aim of this study was to analyze the prevalence of ESBL-producing gut flora and distribution of ESBL encoding genes between hospitalized patient in Tropical Wards of Dr. Soetomo Hospital and patient from a primary health centre (PHC) as community environment in Surabaya. Thiry rectal swab samples from hospital of Dr. Soetomo patients and from PHC (60 samples in total) were collected for this study. Samples were screened in MacConkey agar supplemented with 2 mg/L of cefotaxim, incubated at 37ºC for 24 hours. Then the growing colony were confirmed with Disk Diffusion Synergy test (DDST) for diagnosis of ESBL producer. The identified ESBL producers were then identified the bacteria species by biochemical method. ESBL gene were detected by PCR with specific primers. The results showed that there was not difference of positif nuber of ESBL-producing bacteria gut floral between patients of Dr.Soetomo Hospital, 25/30 (83.3%) and PHC, 11/30 (36.7%) (p=1). The pattern of ESBL gene distributions among samples from hospital showed that SHV was 12%, TEM was 36%, and CTX-M was 80%, and from PHC were SHV 18.2%, TEM 27,3% and CTX-M 81,8%. Statistical analysis showed that the pattern was not significantly different among hospitals and PHC samples as shown by SHV gene (p=0,631), TEM (p= 0.715), and CTX -M (p=1). From each ESBL gene, the dominant genes that found producing ESBL were the CTX-M genes followed by TEM and SHV genes. The prevalence of ESBL producersin intestinal flora of both the hospital (83,3%) and the PHC (36,7%) was very high. There was not significant difference between the prevalence of ESBL producer in gut flora of hospitalized patients compared to PHC. There was found other patterns of ESBL gene combinations in the hospital of SHV+CTX-M genes, TEM+CTX-M, SHV+TEM+CTX-M genes and PHC, the combination pattern of SHV+CTX-M, TEM+CTX-M.
icaA/D Genes and Biofilm Formation of Methicillin-Resistant Staphylococcus aureus in Dr. Soetomo Hospital, Surabaya Putu Arya Suryanditha; Yoeke Dewi Rasita; Kartuti Debora; K Kuntaman
Folia Medica Indonesiana Vol. 54 No. 4 (2018): December
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (154.605 KB) | DOI: 10.20473/fmi.v54i4.10709

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is a global health concern. One of the factors causing hospital infection is related to the ability of MRSA bacteria to form biofilms. Polysaccharide intercellular adhesin (PIA), encoded by ica gene, have an important role in S. aureus intracellular accumulation and aggregation. The aims of this study was to analyze the relationship between icaA, icaD genes and biofilm production in MRSA carrier and clinical isolate in Dr. Soetomo Hospital Surabaya. This study was an observational study using cross sectional approach. The sample was 47 MRSA isolates is as follow 28 isolates from carrier and 19 were clinical isolates. All of MRSA isolates carried mecA gene. PCR was performed to detect icaA and icaD genes. Biofilm formation was detected using microtiter plate assay (MTP). icaA gene was detected in all isolates whereas icaD gene in 96,4% carrier isolates and all (100%) of clinical isolates. Positive MTP results showed in all (100%) of carrier isolates and 57,9% of clinical isolates. Statistic result was significantly different in biofilm formation between carrier and clinical MRSA isolates. The proportion of positive biofilm formation in isolate with positive icaA/D genes was 82.6%. There was not any association between icaA and icaD gene with biofilm production.
Co-Authors A. M. Widya A.A.W., I Wayan Putra Abdul Khairul Rizki Purba Mustofa Indwiani Astuti AFAF BAKTIR Agung Dewi Sekar Agus Santosa Agus Santosa akhmad sudibya, akhmad Alimsardjono, Lindawati Aquaresta, Febriana Ardani, I Gusti Wahju Ardhiya Puspita Ardi Eko Marsanto Arina Setyaningtyas Aryati , Aryati Aryati Aryati Aryati Aryati Bahraini, Fahrisah Nurfadeliah Benediktus Yohan Binti Mu’arofah Bramantono Bramantono, Bramantono Budi Prasetyo Budi Utomo Budiono Budiono Deby Kusumaningrum Dewi, Lisa Dharmawati, Ira Dian Neni Naelasari Dian Rachmawati Diani Dwi Indrasari Didik Hasmono Dwiyanti Puspitasari, Dwiyanti Eddy Bagus Wasito Eddy Bagus Wasito Eko B. Koendhori Eko Budi Khoendori Eko Budi Koendhori, Eko Budi Erni J. Nelwan, Erni J. Erni Juwita Nelwan, Erni Juwita Fourier Dzar Eljabbar Latief Gondo Mastutik Hardiono Hardiono Hari Basuki Notobroto Hari Paraton Hari Paraton Hidayah, Ana Nurlaili Ida Bagus Narmada Iqhrammullah, Muhammad Ira Widjiastuti Irwanto Irwanto Ishak Samuel Wuwuti Kartuti Debora, Kartuti Kusbaryanto L. Alimsardjono Latief Mooduto, Latief Linda Dewanti Listyawati, Agusniar Furkani Maftuchah Maftuchah Margyaningsih, Nur Ita Maria Inge Lusida Marinda Dwi Puspitarini Mariyatul Qiptiyah, Mariyatul Marsheila Harvy Mustikaningtyas Masfufatun Masfufatun Masyeni, Sri Muchlis AU Sofro N. D. Kurniati Naritha Noor Cholies Zaini Nur Dianawati Nurul Ma'rifah P. N. Endraputra Parawidnyaningsih, Putu Ayu Aryanda Pristiawan Navy Endraputra Purnomo, Windu Putu Arya Suryanditha R. Tedjo Sasmono Radita Yuniar Arizandy Rakhmatul Binti Sulistya Regita Cahyani, Nafansya Rini Devijanti Ridwan Risnanda, Kadek Rio Rosantia Sarassari Rosantia Sarassari Rosantia Sarassari Rosantia Sarassari S. R. S. Oktaviani S. Soedarsono Sacharissa Zerlina Tsarwah Thirafi Sasmono, R. Tedjo Semedi, Bambang Pujo Sholeh, Mohammad Akbaruddin Silvia Sutandhio Soekoyo, Agusta Reny Sofro, Muchlis AU Sofro, Muchlis AU. Sri Masyeni, Dewa Ayu Putri Sulistiawati Sulistiawati Syaiful, Irbasmantini Tamara Yuanita Terza Aflika Happy Thayyib, Muqoddar Triffit Imasari UNTUNG MURDIYATMO Usman Hadi Wahyu Setyarini Wahyu Setyorini Wahyu, Agung Dwi Wahyuni Dyah Parmasari, Wahyuni Dyah Windu Purnomo Wiwiek Tyasningsih WJ. Pudjirahardjo Yasmeen Lashari Yoeke Dewi Rasita Yohan, Benediktus