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All Journal Majalah Kedokteran Bandung Althea Medical Journal
Yarman, Indra Prasetya
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Medicine & Pharmacology

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Rationality of Empirical Antibiotic Usage among Digestive Surgery Inpatients at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia: Gyssens Criteria Analysis Yunivita, Vycke; Assyifa, Nanda; Yarman, Indra Prasetya; Bashari, Muhammad Hasan; Satriasih, Tulus
Althea Medical Journal Vol 11, No 3 (2024)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/amj.v11n3.3299

Abstract

Background: Many empirical antibiotics are prescribed unnecessarily, contributing to the rise in the incidence of antibiotic resistance. Preventing infection of surgical sites is one of the most frequent purposes of empirical antibiotic usage. Therefore, this study aimed to analyze the rationality of empirical antibiotic usage among digestive surgery inpatients based on the Gyssens criteria and clinical features outcomes.Methods: A descriptive method was used with a cross-sectional design. Data was collected from medical records of patients underwent digestive surgery and had received empirical antibiotic therapy post-surgery from July to September 2021 at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Subsequently, the data was analyzed using the Gyssens method to qualitatively assess the rationality of antibiotic use based on specific criteria, classified from rational (category 0) to various levels of irrational use (categories I-VI). Clinical outcomes were evaluated by assessing leukocyte count, clinical symptoms of fever, and the appearance of surgical site infection before and after administration of empirical antibiotics.Results: In total, 70 empirical antibiotic prescriptions were obtained from 42 patients, with only 40% of patients using rational antibiotics, whereas 60% of antibiotics were used inappropriately (category I-VI). Clinical evaluation showed no fever, edema, or erythema and reduced leukocytosis and exudate/pus post-therapy.Conclusions: Inappropriate empirical antibiotic prescription for digestive surgery inpatients at Dr. Hasan Sadikin General Hospital based on the Gyssens criteria is high. Nonetheless, clinical outcomes showed improvements in infection-related parameters. These results emphasize the importance of stricter adherence to antibiotic stewardship and regular evaluation of empirical antibiotic practices to optimize usage and patient outcomes.
Correlation between Duration of Placement of Non-tunneled Hemodialysis Catheter and Positive Bacterial Culture Incidence in Hemodialysis Patients Djajakusumah, Teguh Marfen; Hapsari, Putie; Yarman, Indra Prasetya; Utomo, Hafidh Seno Radi; Lukman, Kiki; Sulastri, Dian; Ulurrosyad, Muhammad Faiz
Majalah Kedokteran Bandung Vol 56, No 1 (2024)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v56.3042

Abstract

Non-tunneling hemodialysis catheter is one of the most convenient vascular accesses for hemodialysis in End Stage Kidney Disease (ESRD) patients. However, these catheters have the highest morbidity among all available accesses. Current guidelines recommend that non-tunneled hemodialysis catheters be placed for no more than 2 weeks to prevent bacterial contamination. This study was conducted in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, throughout January-December 2021. A correlation test with a prospective observational analysis design was applied to find the link between the duration of non-tunneled hemodialysis catheter placement and the incidence of positive bacterial culture on the catheter. Pearson correlation test was used to see the strength of the correlation, with a significance limit of 0.05. This study involved 28 subjects. The most common location for catheter placement was in the jugular vein, and laboratory examinations showed no correlation between leukocyte values and positive bacterial culture results. Hypertension and diabetes mellitus were not significant risk factors (p-value 0.887). At ≤14 days of catheter placement, only 1 (6.7%) of the subjects presented a positive culture result. Most of the positive bacterial culture results were found at a duration of 15-30 days of placement, (n=8; 53.3%). The results of the Pearson test showed a p-value of 0.036 and an r-value of 0.399, indicating a significant result with a strong correlation between the two variables. The duration of placement of hemodialysis catheters has a positive correlation with the incidence of positive bacterial cultures, which can increase the risk of systemic infection associated with hemodialysis catheters.
Correlation of Nutritional Status, HbA1c, and Duration of Diabetes Mellitus with Amputation Incidence in Patients with Diabetic Foot Ulcers Hapsari, Putie; Kharisma, Surti Wulan; Yarman, Indra Prasetya; Faried, Ahmad; Djajakusumah, Teguh Marfen; Maryani, Euis
Majalah Kedokteran Bandung Vol 57, No 2 (2025)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v57.4094

Abstract

Diabetic foot ulcer (DFU) is a severe complication of diabetes that significantly impairs quality of life and  may often lead to amputation, particularly when infections become extensive. This study investigated the correlation of nutritional status, HbA1c levels, and duration of diabetes exposure with the incidence of amputation in DFU patients. Using an observational analytic study with a retrospective cohort design, data from 47 DFU patients treated at the Vascular and Endovascular Surgery clinic and Emergency Room  of a hospital from 2019-2024 were analyzed. The majority of subjects were men aged 40-60 years (59.57%). Among the amputee group, 55.31% experienced neuropathy, primarily classified as Wagner's degree 4. Patients requiring amputation had significantly higher levels of urea, creatinine, and leukocytes compared to those who did not. A significant correlation was observed between the incidence of amputation and nutritional status—specifically, serum albumin (r=-0.616) and Body Mass Index (BMI) (r=0.823)—as well as HbA1c levels (r=0.806) and duration of diabetes exposure (r=0.445) (p<0.05). However, the Subjective Global Assessment (SGA) did not show a significant relationship with amputation incidence. The findings of this study suggest that nutritional status, HbA1c levels, and duration of diabetes exposure are significantly correlated with the likelihood of amputation in patients with diabetic foot ulcers (DFU).
Correlation of Leukocytes, Neutrophil-To-Lymphocyte Ratio, C-Reactive Protein, and Serum Lactate with Amputation Incidence in Diabetic Foot Ulcer Patients Primadian, Krisandi; Hapsari, Putie; Yarman, Indra Prasetya; Soedjana, Hardisiswo; Djajakusumah, Teguh Marfen
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.v57.4161

Abstract

Diabetic foot ulcers are a major cause of approximately 85% of amputations in non-trauma patients. One of the contributing factors is the presence of extensive gangrenous infections. Effective management of diabetic foot infections to prevent amputation requires knowledge of various factors such as ulcer location, depth, neuropathy, vasculopathy, infection, and the presence of infection, which can be identified through inflammatory markers. This retrospective cohort study aimed to evaluate the correlation between leukocyte count, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), and serum lactate levels with the incidence of amputation in DFU patients. All DFU patients admitted to Dr. Hasan Sadikin General Hospital, Bandung, from January 1 to December 31, 2023, who met the inclusion criteria were included using purposive sampling. A total of 47 patients with diabetic foot ulcers were included in this study. The mean, median, and range of leukocytes were 18,532, 16,015, and 55,184, respectively, with higher values observed in amputation cases. NLR values were also higher in amputation cases, with a mean of 9.54, median of 6.00, and range of 47.32. Similarly, CRP levels were elevated in amputation cases, with a mean of 9.56, median of 6.75, and range of 26.16. There is a significant correlation between leukocytes, NLR, CRP, and serum lactate with the incidence of amputation in diabetic foot ulcer patients.
Co-Authors Ahmad Faried Assyifa, Nanda Bashari, Muhammad Hasan Hapsari, Putie Hardisiswo Soedjana Kharisma, Surti Wulan Kiki Lukman Maryani, Euis Primadian, Krisandi Satriasih, Tulus Sulastri, Dian Teguh Marfen Djajakusumah, Teguh Marfen Ulurrosyad, Muhammad Faiz Utomo, Hafidh Seno Radi Yunivita, Vycke