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All Journal Jurnal Sosial dan Sains Jurnal Kedokteran Meditek
Wijaya, Rike Andy
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Astronomy Biochemistry, Genetics & Molecular Biology Environmental Science Immunology & microbiology Law, Crime, Criminology & Criminal Justice Library & Information Science Medicine & Pharmacology Neuroscience Physics Public Health

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Evaluasi Terapi Antibiotik pada Pasien yang Didiagnosis Sepsis di ICU RSUD dr. Mohamad Soewandhie berdasarkan Metode Gyssens Ristanti, Safira; Adiwinoto, Ronald Pratama; Wijaya, Rike Andy; Putro, Saptono
Jurnal Kedokteran Meditek Vol 31 No 3 (2025): MEI
Publisher : Fakultas Kedokteran Universitas Kristen Krida Wacana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36452/jkdoktmeditek.v31i3.3536

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ABSTRACT In the high-stakes world of Intensive Care Units (ICUs), the judicious application of empirical antibiotic therapy is crucial for managing sepsis in critically ill patients, as its misuse is often linked with unfavorable patient outcomes. Thus, timely and precise treatment strategies are indispensable. This study was designed to evaluate the rationality of such treatments among sepsis patients at RSUD Dr. Mohamad Soewandhie between January 2021 and September 2024. Using an observational and descriptive approach, researchers scrutinized secondary data from 120 patient medical records, with expert reviewers employing the Gyssens method to assess treatment rationality. Findings revealed that 60% of patients received appropriate empirical antibiotic therapy, most commonly intravenous Ceftriaxone. Alarmingly, culture and antibiotic sensitivity tests were conducted on only 18 patients, yielding 11 positive results, and among these were 19 gram-negative and 2 gram-positive bacterial isolates, with a troubling 67.9% being multidrug-resistant organisms (MDRO). Despite the empirical therapy's rationality, the study noted a concerning mortality rate of 81.67%, possibly owing to delays in obtaining culture results and the use of outdated local guidelines for antibiotic therapy in sepsis management, highlighting gaps in existing approaches. Keywords:Empirical Antibiotic Therapy, Intensive Care Unit, Sepsis, Septic Shock, Gyssens Method
A Rare and Fatal Pulmonary Cryptococcosis in HIV/AIDS: Chronological Clinical Decline in a Middle-Aged Male Ediyono, Ediyono; Wijaya, Rike Andy; Al Amin, Yoga Dian Pratama
Jurnal sosial dan sains Vol. 5 No. 10 (2025): Jurnal Sosial dan Sains
Publisher : Green Publisher Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59188/jurnalsosains.v5i10.32534

Abstract

Cryptococcosis represents a life-threatening opportunistic fungal infection with significant mortality rates among immunocompromised individuals, particularly those with advanced HIV/AIDS. While cryptococcal meningitis dominates the literature, pulmonary involvement remains underrecognized despite its prognostic significance. This case report aims to document the clinical presentation, diagnostic challenges, and fatal outcome of pulmonary cryptococcosis caused by the rare species Cryptococcus laurentii in a severely immunosuppressed HIV-positive patient, and to emphasize the importance of early bronchoscopic investigation and antifungal therapy. We report the case of a 44-year-old Indonesian male with a history of HIV/AIDS who presented with progressive shortness of breath, persistent cough, and intermittent fever over two weeks. He was non-adherent to antiretroviral therapy (ART) and had a CD4 count of fewer than 50 cells/mm³. Chest radiography showed bilateral infiltrates, and sputum culture grew Cryptococcus laurentii. Despite the initiation of broad-spectrum antibiotics and antifungal agents, his respiratory status deteriorated rapidly. Antifungal susceptibility testing confirmed sensitivity to amphotericin B, flucytosine, and fluconazole, yet the patient developed progressive respiratory failure. He ultimately succumbed to refractory hypoxemia on day 23 of hospitalization. This case highlights the diagnostic challenge of pulmonary cryptococcosis in advanced HIV, particularly with rare non-neoformans species. A high index of suspicion and early mycological investigation, including culture and species-level identification, are critical for timely diagnosis. This report contributes to the limited literature on C. laurentii pulmonary infections in Southeast Asia and underscores the importance of adherence to ART, as well as the need for early consideration of fungal infections in severely immunosuppressed patients presenting with atypical pulmonary findings.
Co-Authors Al Amin, Yoga Dian Pratama Ediyono Ediyono, Ediyono Ristanti, Safira Ronald Pratama Adiwinoto Saptono Putro