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All Journal International Journal of Integrated Health Sciences Majalah Kedokteran Bandung Althea Medical Journal Sari Pediatri Majalah Kesehatan FKUB Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML) Folia Medica Indonesiana
Adhi Kristianto Sugianli
Department Of Clinical Pathology, Faculty Of Medicine, Padjadjaran University/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Medicine & Pharmacology Neuroscience Public Health

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Antibiotic Susceptibility among Infective Endocarditis Population: Syndromic Antibiogram Evaluation at Indonesian National Cardiovascular Center Indrawati, Lilik; Sugianli, Adhi Kristianto; Prakoso, Baskoro Justicia; Gunawan, Adrian; Soerarso, Rarsari; Soesanto, Amiliana M.; Dewi, Andaru Dahesih
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 31 No. 1 (2024)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v31i1.2223

Abstract

Infective Endocarditis (IE) is a life-threatening disease with a high mortality rate (25%). Laboratory approaches to support the diagnosis of IE especially blood and/or cardiac vegetation culture, are crucial for providing definitive therapy. However, negative culture is frequently observed, therefore empirical use of antibiotics seems unavoidable and may lead to increasing antimicrobial resistance. This study aims to observe the prevalence of antibiotic susceptibility among the IE population using the WISCA approach. This retrospective study observed medical record data of all inpatients diagnosed with IE according to ICD-10 at Cardiovascular Center Harapan Kita Hospital (NCCHK) between January 2018 and December 2022. Patient data were combined with bacterial identification and antibiotic susceptibility test data from the laboratory information system, and evaluated based on period (year). A total of 67,858 inpatients and 1.1% (n=772) were diagnosed with IE. Successful culture growth (blood and/or cardiac vegetation specimen) was between 36.8% and 70% annually. Streptococcus viridans group (82/237, 34.6%) and Coagulase-negative Staphylococci (57/237, 24.1%) were dominantly observed among the IE population. Low susceptibility among Penicillin (34.3%) towards Gram-positive bacteria, as first-line treatment option in IE. Meanwhile, high susceptibility range was observed in Ceftriaxone (95.7%), Gentamicin (80.4%), Rifampicin (84.4%), and Vancomycin (98.7%) as second-line treatment in IE. Despite the low prevalence, the occurrence of antimicrobial resistance in IE has become a priority concern. Continuing the syndromic antibiogram is mandatory to assist the trend of empirical antibiotic usage and refine the established local treatment guidelines.
The Utility of Micro-R/Hypo-He Ratio Cut-off for Distinguishing Iron Deficiency Anemia and Minor Thalassemia Audiyananda, Dwika; Prihatni, Delita; Surata, Nida; Sugianli, Adhi Kristianto
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 31 No. 1 (2024)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v31i1.2234

Abstract

     Thalassemia is a genetic disease with impaired synthesis of the globin chain that causes anemia. Thalassemia and Iron Deficiency Anemia (IDA) are both microcytic hypochromic anemia but have different proportions of hypochromic and microcytic erythrocytes due to differences in disease mechanisms. Research parameters of the hematology analyzer: %Micro-R, %Hypo-He, and MH ratio can be used as early screening for thalassemia and IDA. This study aimed to evaluate the cut-off of %Micro-R, %Hypo-He, and MH ratio to differentiate thalassemia from IDA. A cross-sectional study was carried out on 217 subjects. Subjects were divided into two groups, thalassemia and IDA based on hemoglobin electrophoresis, hematology examination, and Mentzer index. Differences and cut-off values of %Micro-R, %Hypo-He, and MH ratio between the two groups were analyzed. The number of collected data was 134, consisting of 89 thalassemia patients and 45 IDA patients. Thalassemia patients had a median %Micro-R value of 51.2 (4.3-79.0), %Hypo-He value of 7.2 (0.2-50.2), and MH ratio of 7.17 (1.10-64.50), higher than IDA patients (p=0.000; p=0.176; p=0.000). The optimal cut-off value for %Micro-R in discriminating thalassemia trait from IDA was >12.7, with the area under the ROC curve (AUC) of 0.945, sensitivity of 92.1%, and specificity of 82.2%. The cut-off value for MH ratio > 3.27 with AUC 0.833, sensitivity of 85.4%, and specificity 77.8% showed lower performance of cut-off value compared to %Micro-R. The algorithm using %Micro-R and MH ratio was proposed for thalassemia trait screening. High %Micro-R and MH are suggestive of thalassemia trait than of IDA.
Crossmatch Results After Repeated Transfusions Horian, Erinca; Lismayanti, Leni; Sugianli, Adhi Kristianto
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 31 No. 3 (2025)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v31i3.2349

Abstract

Patients with thalassemia, chronic kidney disease, hematologic and non-hematologic malignancies may require repeated transfusions. Repeated transfusions can have a detrimental effect, leading to the formation of alloantibodies and/or autoantibodies. These antibodies can cause incompatible crossmatch results. This study aims to identify the clinical characteristics of patients with incompatible crossmatch results after repeated transfusions, to ensure safe transfusions. This study is a cross-sectional, observational descriptive study conducted at Dr. Hasan Sadikin General Hospital from January to December 2022. Patients were included if they had received more than one transfusion within the past year, defined as 'repeated transfusions'. The following data were collected: age, gender, blood type, diagnosis, quantity of blood bags, total number of transfusions, interval between transfusions, history of incompatibility, and Coombs Test. The data were obtained through the laboratory information system and from blood request forms in the Blood Service Unit. Out of 2285 subjects receiving repeated transfusions, 38.1% experienced crossmatch incompatibility. The majority (91.2%) of these cases were minor. Crossmatch incompatibility occurred more frequently in subjects under the age of 15 (22.6-23.3%) and those with diagnosis of thalassemia (25.6-27.3%). Most subjects with minor crossmatch incompatibility had a history of receiving more than four blood bags (51.9-60%), an interval between transfusions of four weeks or less (92.2-92.8%), and a history of previous incompatibility (72.1-80.5%). The important clinical characteristics of patients with incompatible crossmatch results after repeated transfusions were age, underlying diagnosis, quantity of blood bags, interval between transfusions, and history of previous crossmatch incompatibility.
KARAKTERISTIK PASIEN FRAKTUR TERBUKA TERINFEKSI DI RSUP dr. HASAN SADIKIN BANDUNG TAHUN 2018-2020 Fatimah; Rasyid, Hermawan Nagar; Sugianli, Adhi Kristianto
Majalah Kesehatan Vol. 12 No. 3 (2025): Majalah Kesehatan
Publisher : Faculty of Medicine Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/majalahkesehatan.2025.012.03.3

Abstract

Tujuan utama tata laksana fraktur terbuka yang tepat adalah mencegah terjadinya infeksi. Namun, infeksi pada fraktur terbuka dapat dipengaruhi oleh faktor yang berkaitan dengan pasien dan kejadian cedera. Tujuan penelitian ini untuk mengetahui karakteristik kejadian fraktur terbuka terinfeksi di RSUP dr. Hasan Sadikin Bandung (RSHS) pada periode Januari 2018–Desember 2020. Penelitian deskriptif dengan mengevaluasi secara retrospektif terhadap data rekam medis pasien dengan diagnosis fraktur terbuka menurut ICD-10 di RSHS, berdasarkan kriteria inklusi dan eksklusi. Data penelitian dikelompokkan menjadi (1) faktor terkait dengan pasien dan kejadian cedera, serta (2) faktor terkait dengan tata laksana fraktur terbuka. Data penelitian dianalisis dan ditabulasi sebagi tabel distribusi frekuensi menggunakan Microsoft Excel. Sebesar 2,9% kejadian infeksi ditemukan pada subjek terinklusi. Sebesar 70% subjek fraktur terbuka terinfeksi terjadi pada umur 18-50 tahun, dengan lokasi fraktur tersering pada anggota gerak bawah (92,3%), dengan tipe III fraktur terbuka menurut klasifikasi Gustilo-Anderson. Seluruh subjek fraktur terbuka terinfeksi mendapat pemberian antibiotik profilaksis, namun sebesar 53,8% subjek mendapatkan tindakan debridemen dalam waktu >24 jam. Jenis stabilisasi fraktur, fiksasi eksterna diterapkan pada 69,2% subjek dan sebesar 76,9% subjek dilakukan penutupan luka waktu <3 hari. Sebesar 76,9% subjek memiliki hasil biakan bakteri Gram negatif, dengan bakteri dominan adalah Pseudomonas aeruginosa. Faktor yang berkaitan dengan kejadian fraktur terbuka terinfeksi pada penelitian ini menjadi hal yang perlu diperhatikan dalam keberhasilan tata laksana infeksi, meliputi lokasi fraktur, tipe fraktur terbuka menurut klasifikasi Gustilo-Anderson, serta penundaan tata laksana fraktur terbuka.
The Combination of NLCR and Enhances the Sepsis-3 Strategy Pranggono, Emmy Hermiyanti; Aini, Endah Nurul; Sumardi, Uun; Hartranti, Yovita; Sugianli, Adhi Kristianto
Folia Medica Indonesiana Vol. 58, No. 2
Publisher : Folia Medica Indonesiana

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Highlights: • The combination of NLCR and PLR will improve the ability to distinguish infection rather than noninfection in the emergency setting for early antibiotic prescribing as well as the sepsis-3 strategy. • The diagnostic value of PLR in adult bacterial sepsis patients has never been studied. Abstract: According to Sepsis-3, antibiotics should be administered in the first hour of diagnosis of sepsis. Still, there is difficulty in differentiating between bacterial and nonbacterial infections and a lack of a rapid diagnostic tool to distinguish them. This study evaluated the diagnostic value of NLCR and PLR in suspected bacterial sepsis. The diagnostic value of PLR in adult bacterial sepsis patients has never been studied. This study was a retrospective study from the medical record of Dr. Hasan Sadikin Hospital Bandung. All patients at age ≥ 18 years diagnosed with sepsis based on ICD-10 code and qSOFA ≥ 2 were included. We calculated sensitivity, specificity, NPV, PPV, positive LR, and AUC of NLCR and PLR. There were 177 patients included in this study. The sensitivity of NLCR was 69.5%, specificity was 34.7%, NPV was 56.9%, PPV was 47.9%, and LR+ was 1.06, while the sensitivity of PLR was 62.2%, specificity was 38.9%, NPV was 54.4%, PPV was 46.8%, and LR+ was 1.02. We obtained cut-off values for NLCR 11.06, AUC 0.500, PLR 222.41, and AUC 0.497. The low value of AUC NLCR and PLR was due to prior antibiotic use. The combination of NLCR and PLR had higher positive LR (1.16) and specificity (54.7%), and also, according to NLCR, we had the highest sensitivity (69.5%). The combination of NLCR and PLR enhances the sepsis-3 strategy because it can be used as screening tools for bacterial sepsis, and antibiotics can also be administered in the first hour of managing sepsis, particularly in the emergency ward.
Microbial and Antimicrobial Susceptibility Profile of Pediatric Hematological Malignancy Patients at a Tertiary Hospital Adrizain, Riyadi; Sugianli, Adhi Kristianto; Kasih Pasaribu, Elisabeth Putri; Trie Utami, Fadila Dyah; Kwarteng, Alexander
Majalah Kedokteran Bandung Vol 57, No 4 (2025)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v57.4362

Abstract

Neutropenia is a major predisposing factor for infection in pediatric patients with hematological malignancies. In Indonesia, data on microbial patterns and antibiotic resistance in this group remain limited, highlighting the need for local data to guide empirical therapy. This study aimed to determine the microbial and antibiotic susceptibility profile of pediatric patients with hematological malignancies. A cross-sectional descriptive study was conducted in the pediatric ward of Dr. Hasan Sadikin General Hospital, Bandung, from April to June 2024. Data were collected retrospectively using total sampling from medical records and registers of patients diagnosed with hematological malignancies (subgroups I and II) between January 2021 and December 2022. Microbial identification and antibiotic susceptibility profiles were performed using an automated colorimetry method. A total of 33 bacterial isolates were identified, with Gram-negative bacteria being the most frequent (75.8%). The predominant isolates were Escherichia coli (39.4%), Klebsiella pneumoniae (15.15%), and Staphylococcus hominis (12.1%). From all isolates, 69.7% were multidrug-resistant organisms (MDROs). About 62.5% of Gram-positive bacteria were methicillin-resistant coagulase-negative Staphylococci (MRCoNS), while 48% and 24% of Gram-negative bacteria were extended-spectrum β-lactamase (ESBL) and carbapenem-resistant, respectively. Gram-positive bacteria showed 100% sensitivity to Linezolid, Tigecycline, and Vancomycin, while Gram-negative bacteria showed the highest sensitivity to Amikacin. Escherichia coli, as the most frequent isolate, showed 100% sensitivity to Tigecycline. In conclusion, Gram-negative bacteria were the predominant organisms, with Escherichia coli being the most common isolate. The antibiotic susceptibility test showed a high proportion of MDROs and decreased susceptibility levels in 2022 compared to 2021.
Co-Authors Adrian Gunawan, Adrian Adrizain, Riyadi Agus Sunardi Agustinus Wiraatmadja Aini, Endah Nurul Amalia, Ridha Amiliana M. Soesanto Andaru Dahesihdewi Ariel Bagoes Prakoso Audiyananda, Dwika Benjamin Yong Qing Nan Coriejati Rita Delita Prihatni Dewi Kartika Turbawaty Eka Surya Nugraha Emmy Hermiyanti Pranggono Endah Nurul Aini Fatimah Grace Amanda Maharani Hartranti, Yovita Hasti Savira Yudiana Hermawan Nagar Rasyid, Hermawan Nagar Horian, Erinca Ida Parwati Ida Parwati Ida Parwati Jennifer Hadiman Juandika Juandika Kasih Pasaribu, Elisabeth Putri Kwarteng, Alexander Leni Lismayanti Lilik Indrawati, Lilik Mia Milanti Dewi Nadjwa Zamalek Dalimoenthe Nina Tristina Nita Elvina Wisudawati Nur Suryawan Hidayat Prakoso, Baskoro Justicia Pranggono, Emmy Hermiyanti Prihatni, Delita Qing Nan, Benjamin Yong Raja Iqbal Mulya Harahap Rarsari Soerarso Reni Ghrahani Ronal Winter Shofia Widya Murti Siti Aminah Surata, Nida Susi Susanah Trie Utami, Fadila Dyah Uun Sumardi, Uun Yovita Hartranti Yoyos Dias Ismiarto