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Background: Diarrhea that could be caused by Staphylococcus aureus and Escherichia coli can be prevented by increasing hand hygiene using alcohol-based hand rub, but frequent use might cause skin irritation. Replacing alcohol with herbs could avoid this side effect. Cloves have been proved to have antibacterial properties. However, most researches used complex extraction methods that might not be applicable on a household scale. Objective: To prove that clove extracts have ability to inhibit and to kill S. aureus and E. coli . Methods: This is an experimental study by using post-test only control group design. Clove extract was obtained with simple aqueous maceration. Samples were Staphylococcus aureus ATCC 25923 and Escherichia coli ATCC 25922 allocated into six groups: clove extracts at concentrations of 12.5%, 25%, 50%, 100% respectively; 70% alcohol as a positive control; and aquadest as a negative control. Each group was given 5 repetitions of intervention. MIC was measured with dilution method, while MBC with streak method. Negative controls were only used to monitor the quality of this work. Results: MIC of S. aureus was started at 50% concentration of clove extract, while MBC of S. aureus was started at 25 % concentration of the same extract. MIC and MBC of E. coli was both started at 25% concentration of clove extract. MIC and MBC of 100% concentration of clove extract were equal with 70% alcohol. Conclusion: Concentration of 100% clove extracts have similar ability with 70% alcohol to inhibit and to kill S. aureus and E. coli. Keywords: Clove Extracts, Escherichia coli, MBC, MIC, Staphylococcus aureus

Introduction: One of the promotive and preventive efforts in the prevention of pulmonary tuberculosis (TB) disease in primary health care is a health services environment that includes counseling, inspection and intervention of environmental health. The purpose of this study is to evaluate the effectiveness of the Environmental health services in the primary health care against the prevention of Pulmonary TB disease in Regency of Banyuwangi. Method: This research was observational descriptive design of study cross-ssectional. The study population was the primary health care in districy of Banyuwangi and a large sample of 6 primary health care. The determination of the study sample by using purposive sampling based on criteria of results Assessment of Performance of primary health care (PKP) services and programs environmental health in primary health cares and numbers Case Notification Rate (CNR) at the top of the East Java Province. Processing and analysis of data using a scoring system based on the scale of the theoretically grouped in the category of good, enough, less. The data is then interpreted descriptively. Result and Discussion: The Program of health service in the prevention of the disease is said to be effective when the probability of >50.00%. The results showed the probability of the effectiveness of the environmental health services in the Primary Health Care of Klatak of 77.00%. The Primary Health Care of Mojopanggung, Sobo, and Kabat respectively 78.80%, Primary Health Care of Gitik by 64.20% and the Primary Health Care of Songgon 49.50%. Human resources at the Primary Health Care of Songgon not competent. The Primary Health Care of Gitik and Songgon not planning activities. The achievement of the output in all the primary health care less, it is because of the lack of commitment of the implementers and the coordination of cross-program not running. Conclusion: There are 5 primary health cares service programs environmental health in the prevention of Pulmonary TB effective that the Primary Health Care of Klatak, Mojopangung, Sobo, Kabat and Gitik while at the Primary Health Care of Songgon is not effective. The effectiveness of services and programs environmental health in TB patients is influenced by policies, human resources, infrastructure, planning and coordination across the program.

Introduction: Staphylococcus aureus is a spherical gram-positive bacterium that forms clusters and is frequently resistant to antibiotics. Methicillin-Resistant Staphylococcus aureus (MRSA) is a strain of S. aureus that is resistant to beta-lactam and cephalosporin groups of antibiotics, it is one of the biggest problems in resistant bacteria. Plants that have flavonoids in their extract can inhibit the growth of bacteria by impairing their cytoplasmic membrane. Arrowroot is an example of plants that have flavonoids in their extracts. Objectives: This research aims to determine the antimicrobial effect of arrowroot ( Maranta arundinacea L.) methanolic extract against the growth of Staphylococcus aureus in vitro. Methods : This is true experimental research with a post-test control group design with two control groups and eight experimental groups. The sample of this research utilizes the MRSA strain of S. aureus received from the Microbiology Laboratory of Diponegoro University Faculty of Medicine that was eligible with the inclusion criteria. The research was conducted by using arrowroot extract concentrations 6.5%, 12.5%, 25%, 50%, and 100% to determine the Minimum Inhibitory Concentration (MIC), Minimum Bactericidal Concentration (MBC), and inhibitory zone diameter. Results: MIC and MBC of arrowroot methanolic extract against MRSA is 100%. The arrowroot methanolic extract to have yielded an inhibitory zone diameter is 100% with a mean inhibitory zone diameter of 15.5mm. Conclusion: Arrowroot methanolic extract can inhibit the bacterial growth of MRSA Keywords : Staphylococcus aureus, growth, M. arundinacea L. methanolic extract

Background The burden of leptospirosis in Indonesia is poorly understood. Data from an observational study conducted from 2013 to 2016 in seven cities across Indonesia was used to estimate the incidence of leptospirosis and document its clinical manifestations in patients requiring hospitalization. Methods Specimens from patients hospitalized with acute fever were collected at enrollment, 14–28 days, and 3 months. Demographic and clinical information were collected during study visits and/or retrieved from medical records and double-entered into clinical report forms. After initially screening for dengue virus and other pathogens, specimens were tested at a central Reference Laboratory for anti-Leptospira IgM using commercial ELISA kits and for Leptospira DNA using an in-house quantitative real-time PCR assay. Results Of 1464 patients enrolled, 45 (3.1%) confirmed cases (by PCR and/or sero-coversion or four-fold increase of IgM) and 6 (0.4%) probable cases (by high titer IgM) of leptospirosis were identified by the Reference Laboratory. Disease incidence at sites ranged from 0 (0%) cases in Denpasar to 17 (8.9%) cases in Semarang. The median age of patients was 41.2 years (range of 5.3 to 85.0 years), and 67% of patients were male. Twenty-two patients (43.1%) were accurately diagnosed at sites, and 29 patients (56.9%) were clinically misdiagnosed as having another infection, most commonly dengue fever (11, 37.9%). Clinically, 20 patients (39.2%) did not present with hyperbilirubinemia or increased creatinine levels. Two patients (3.9%) died, both from respiratory failure. Fifteen patients (29.4%) clinically diagnosed with leptospirosis at sites were negative based on IgM ELISA and/or PCR at the Reference Laboratory. Conclusions Leptospirosis remains an important cause of hospitalization in Indonesia. It can have diverse clinical presentations, making it difficult to differentiate from other common tropical infections. PCR combined with ELISA is a powerful alternative to the cumbersome gold-standard microscopic agglutination test, particularly in resource-limited settings.

INTRODUCTION: The increasing number of multidrug-resistant Pseudomonas aeruginosa worldwide need to be continuously monitored to prevent its transmission. This study reviewed multidrug-resistant Pseudomonas aeruginosa in Southeast Asia.METHODS: Pubmed database was searched (January 2013-March 2018) for relevant articles using specific names of all eleven Southeast Asian countries. The articles retrieved were screened and analyzed to meet the inclusion criteria.RESULTS: A total of 17 articles met the inclusion criteria. Vietnam had the most published data included in this study, East Timor, Cambodia, and Laos had none. There are variations among Pseudomonas aeruginosa resistance in Southeast Asia. Thailand had complete data on antibiotic resistance and had the highest resistance rate of almost all antibiotics. Colistin had the lowest resistance rate among all antibiotics.CONCLUSIONS: Colistin had the lowest resistance rate among all antibiotics. Another study with more extensive data should be done to validate this study. Future research should be explicitly providing detail data results for antimicrobial resistance analyses.

World TB report from World Health Organization (WHO) in 2017 informed that Indonesia was second country with TB case. Multi Drug Resistance pulmonary infection’s case in Indonesia were 12.000. Kariadi hospital is one of tertiary hospital for pulmonary MDR-TB treatment but, there is no study about risk factor of it yet, so it needed to find risk factors of MDR-TB pulmonary infection in Kariadi hospital. Cross Sectional design using secondary data from Medical Record from January 1st - December 31, 2017 with result of Mycobacterium tuberculosis on GeneXpert sputum examination. Bivariate analysis with Chi square test and multivariate analysis was done by multiple logistic regression. The p value was considered significant if

Introduction: Tuberculosis (TB) is a global health crisis. Environmental health services in Primary health care provide counseling services, inspections and environmental health interventions. Research aims to determine the impact of environmental health services in Primary health care on the behavior of TB patients that includes the knowledge, attitudes and actions of pulmonary tuberculosis patients in the prevention of the transmission of pulmonary tuberculosis disease. Method: The method in this study was experimental quasi. Respondents were a new case of pulmonary TB at 6 Primary health care in Banyuwangi Regency April S/d June 2019. Pre test before obtaining environmental health services. Post test was given after counseling, inspection and environmental health intervention. Result and Discussion: The results showed a total of 24 respondents to the majority pulmonary tuberculosis patient was male (54.17%). Pre test knowledge of pulmonary TB patient is good (4.16%), enough (8.33%) and less (87.50%). Category Post test knowledge of TB patients acquired good (20.83%), sufficient category (75.00%) and less (4.20%). The average Pre test knowledge score is 37.70 and the Post test is 67.20. Category Prettest Action patients TB is good (4.16%) and less (95.83%). Category Post Test action patients pulmonary TB is good (54.17%), enough (41.67%) and less (4.16%) Which is an improvement in the form of masks, hand washing soap, the habit of spitting, the use of individual cutlery and drinking equipment, washing dinnerware and drinking with hot water/drying, drying the sleeping tools, opening a window every day, separate sleeping habits. Conclusion: The conclusion of this research is environmental health services in Primary health care in patients with pulmonary tuberculosis improves the behavior of TB patients in the form of increased knowledge, attitudes and actions of the patient in the prevention of disease transmission of TB.

Data of Staphylococcus aureus carriage in Indonesian hospitals are scarce. Therefore, the epidemiology of S. aureus among surgery patients in three academic hospitals in Indonesia was studied. In total, 366 of 1,502 (24.4%) patients carried S. aureus. The methicillin-resistant S. aureus (MRSA) carriage rate was 4.3%, whereas 1.5% of the patients carried Panton-Valentine leukocidin (PVL)-positive methicillin-sensitive S. aureus (MSSA). Semarang and Malang city (odds ratio [OR] 9.4 and OR 9.0), being male (OR 2.4), hospitalization for more than 5 days (OR 11.708), and antibiotic therapy during hospitalization (OR 2.6) were independent determinants for MRSA carriage, whereas prior hospitalization (OR 2.5) was the only one risk factor for PVL-positive MSSA carriage. Typing of MRSA strains by Raman spectroscopy showed three large clusters assigned type 21, 24, and 38, all corresponding to ST239-MRSA-SCCmec type III. In conclusion, MRSA and PVL-positive MSSA are present among patients in surgical wards in Indonesian academic hospitals.

Ethanol extract of Gratophyllum pictum L ( G. pictum L) . leaves contain phytochemical compounds such as alkaloids, tannins and flavonoids, which have antibacterial activity against Staphylococcus aureus. This study aims to prove the effectiveness of ethanol extract of G. pictum L. to reduce the level of TNF-α and NO in Swiss mice infected with S. aureus .The study treated 30 Swiss mice divided into 5 groups, consist of: K (-) normal mice ; K (+) mice were infected with S. aureus ; P1, P2, P3 were infected with S. aureus and given the ethanol extract of G. pictum leaves,75,150, and 300 mg/kgBW/day for 7 days . Mean levels of TNF-α of group K(-), K (+), P1, P2, P3 were 300.29; 550.29; 390.34; 517.67; 327.55 pg / mL respectively. One Way ANOVA test showed that there were significant differences between all treatment groups (p = 0.001), LSD Post Hoc test revealed P1 and P3 groups different significantly with K (+) with p= 0.013 and p = 0.001. Mean levels of NO of group K (-), K (+), P1, P2, P3 were 1.32; 3.56; 2.50; 2.64; and 1.56 μM/mL respectively. Kruskal WallisTest showed that the levels of NO not significantly different, although NO levels at 300 mg/kgBW/day similar with to the levels of NO group K(-). Spearman correlation test showed that there were correlations between TNF-α and NO with the variation results on each treatment groups. Ethanol extract of G. pictum leaves at 300 mg/kgBW/day for 7 days is regarded as the effective dose to reduce TNF-α and NO levels in Swiss mice infected by S. aureus.

OBJECTIVES To identify determinants of carriage of resistant Staphylococcus aureus in both hospitalized patients and individuals from the community in two urban centres in Indonesia. METHODS Staphylococcus aureus cultures and data on recent antibiotic use, demographic, socioeconomic, disease-related and healthcare-related variables were collected from 3995 community dwellers and hospitalized persons. Nasal S. aureus carriage was found in 362 persons (9.1%). Logistic regression analysis was performed to identify which variables were independently associated with carriage of resistant S. aureus. RESULTS The penicillins were the most frequently used antibiotics both in the community and in hospitalized patients. In the community, admission to a hospital was associated with carriage of S. aureus resistant to any of the tested antibiotics [odds ratio (OR) 2.5, 95% confidence interval (95% CI) 1.3-4.9] and any tetracycline resistance (OR 2.4, 95% CI 1.1-5.1). Having no symptoms was associated with less carriage of S. aureus with resistance to any of the tested antibiotics (OR 0.5, 95% CI 0.3-0.9) and any tetracycline resistance (OR 0.5, 95% CI 0.3-0.9). Crowding (OR 4.5, 95% CI 1.2-4.9) and low income (OR 8.9, 95% CI 1.8-43.9) were associated with multidrug resistance. In hospitalized patients, the use of penicillins was associated with resistance to any of the tested antibiotics (OR 3.9, 95% CI 1.4-11.6) and any tetracycline resistance (OR 3.7, 95% CI 1.1-12.0). CONCLUSIONS Antibiotic policies including proper diagnosis, treatment and drug delivery process should be made by healthcare providers in Indonesia to help limit the emergence of antibiotic resistance.

Contains fulltext : 70928.pdf (Publisher’s version ) (Open Access) OBJECTIVES: To estimate the antibiotic use of individuals visiting public healthcare facilities in Indonesia and to identify determinants of use against a background of high resistance rates. METHODS: Patients on admission to hospital (group A), visiting a primary health center (group B), and healthy relatives (group C) were included in the study. A questionnaire on demographic, socioeconomic, and healthcare-related items including health complaints and consumption of antibiotics was used. Logistic regression was performed to determine the co-variables of antibiotic use. RESULTS: Of 2996 individuals interviewed, 486 (16%) had taken an antibiotic. Compared to group C (7% consumption), groups B and A exhibited a three-fold and four-fold higher use of antibiotics, respectively. Respiratory (80%) and gastrointestinal (13%) symptoms were most frequent. Aminopenicillins and tetracyclines accounted for 80% of the prescribed antibiotics. Similar antibiotics were self-medicated (17% of users). Age less than 18 years and health insurance were independent determinants of antibiotic use. Urban provenance, being adult, male, and having no health insurance were independent determinants of self-medication. CONCLUSIONS: In addition to health complaints, other factors determined antibiotic consumption. In view of the likely viral origin of respiratory complaints and the resistance of intestinal pathogens, most antibiotic use was probably unnecessary or ineffective. Future interventions should be directed towards healthcare providers.

Objectives To determine the prevalence, antimicrobial susceptibility profiles and clonal distribution of either methicillin-resistant Staphylococcus aureus (MRSA) or Panton–Valentine leukocidin (PVL)-positive S. aureus obtained from clinical cultures in Indonesian hospitals. Methods S. aureus isolates from clinical cultures of patients in four tertiary care hospitals in Denpasar, Malang, Padang and Semarang were included. We assessed the antimicrobial susceptibility profiles using the Vitek2® system, determined the presence of the mecA gene and genes encoding PVL using PCR and analysed the clonal relatedness with Raman spectroscopy. SCCmec typing was performed for all MRSA isolates. Multilocus sequence typing (MLST) was performed for a subset of isolates. Results In total, 259 S. aureus strains were collected. Of these, 17/259 (6.6%) and 48/259 (18.5%) were MRSA and PVL-positive methicillin-susceptible S. aureus (MSSA), respectively. The prevalence of MRSA and PVL-positive MSSA ranged between 2.5–8.9% and 9.5–29.1%, respectively and depended on geographic origin. PVL-positive MRSA were not detected. Raman spectroscopy of the strains revealed multiple Raman types with two predominant clusters. We also showed possible transmission of a ST239-MRSA-SCCmec type III strain and a ST121 PVL-positive MSSA in one of the hospitals. Conclusions We showed that MRSA and PVL-positive MSSA are of clinical importance in Indonesian hospitals. A national surveillance system should be set-up to further monitor this. To reduce the prevalence of MRSA in Indonesian hospitals, a bundle of intervention measures is highly recommended.

Objectives: Antibiotic resistance is a worldwide healthcare problem exacerbated by antibiotic use and transmission of resistant bacteria. Not much is known about resistance in commensal flora and about determinants for resistance in Indonesia. This study analysed recent antibiotic use as well as demographic, socioeconomic, disease-related and healthcare-related determinants of rectal carriage of resistant Escherichia coli in the community and in hospitals in Indonesia. Methods: Carriers of susceptible E. coli were compared with carriers of E. coli with resistance to any of the tested antibiotics. Logistic regression analysis was performed to determine which variables were associated with carriage of resistant E. coli. Individuals in the community with varying levels of contact with healthcare institutions and hospitalized patients were analysed as separate populations. Results and conclusions: Of 3275 individuals (community 2494, hospital 781), 54% carried resistant E. coli. Recent antibiotic use was the most important determinant of resistance in both populations [community: odds ratio (OR) 1.8, 95% confidence interval (95% CI) 1.5‐2.3; hospital: OR 2.5, 95% CI 1.6‐3.9]. In the community, hospitalization (OR 2.4, 95% CI 2.0‐3.0), diarrhoeal symptoms (OR 1.9, 95% CI 1.3‐2.7) and age under 16 years (adults: OR 0.4, 95% CI 0.3‐0.5) were associated with carriage of resistant E. coli. For hospitalized patients, having no health insurance was associated with less resistance (OR 0.6, 95% CI 0.4‐0.9) and differences were observed between hospitals (Semarang: OR 2.2, 95% CI 1.5‐3.3) and departments (Paediatrics: OR 4.3, 95% CI 1.7‐10.7). Further research is needed to investigate whether transmission is responsible for these differences.

A cross-sectional surveillance of healthcare-associated infections (HAIs) and exposure to risk factors was undertaken in two Indonesian teaching hospitals (Hospitals A and B). Patients from internal medicine, surgery, obstetrics and gynaecology, paediatrics, a class department and intensive care were included. Patient demographics, antibiotic use, culture results, presence of HAI [phlebitis, surgical site infection (SSI), urinary tract infection (UTI) and septicaemia] and risk factors were recorded. To check for interobserver variation, a validation study was performed in Hospital B. In Hospitals A and B, 1,334 and 888 patients were included, respectively. Exposure to invasive devices and surgery was 59%. In Hospital A, 2.8% of all patients had phlebitis, 1.7% had SSI, 0.9% had UTI and 0.8% had septicaemia. In Hospital B, 3.8% had phlebitis, 1.8% had SSI, 1.1% had UTI and 0.8% had septicaemia. In the validation study, the prevalence as recorded by the first team was 2.6% phlebitis, 1.8% SSI, 0.9% UTI and no septicaemia, and that recorded by the second team was 2.2% phlebitis, 2.6% SSI, 3.5% UTI and 0.9% septicaemia. This study is the first to report on HAI in Indonesia. Prevalence rates are comparable to those in other countries. The reliability of the surveillance was insufficient as a considerable difference in prevalence rates was found in the validation study. The surveillance method used is a feasible tool for hospitals in countries with limited healthcare resources to estimate their level of HAI and make improvements in infection control. Efficiency can be improved by restricting the surveillance to include only those patients with invasive procedures. This can help to detect 90% of all infections while screening only 60% of patients.

Contains fulltext : 50130.pdf (Publisher’s version ) (Closed access) Standard precautions can prevent transmission of micro-organisms. This study investigated hand hygiene, handling of needles and use of personal protective equipment in an Indonesian teaching hospital, and performed a multi-faceted intervention study to improve compliance. An intervention was performed in an internal medicine ward and a paediatric ward, consisting of development of a protocol for standard precautions, installation of washstands, educational activities and performance feedback. Before, during and after the intervention, observers monitored compliance with hand hygiene, safe handling of needles and use of gloves, gowns and masks. A gynaecology ward served as the control. Unobtrusive observations were performed to check for an influence of the observers on the overt observations. In total, 7,160 activities were observed. Compliance with hand hygiene increased from 46% to 77% in the internal medicine ward and from 22% to 62% in the paediatric ward. Before the intervention, no safe recapping of needles was recorded in either ward. After the intervention, 20% of needles were recapped safely. Inappropriate gown use decreased in the internal medicine ward. There were no significant changes in use of gloves and masks. There may have been an effect of the overt observations in the paediatric ward, but there was no effect in the internal medicine ward. There were no significant changes in the control ward, except for a decrease in the use of gloves. In conclusion, compliance with hand hygiene procedures improved significantly due to an intervention project focused on education and improved facilities. Compliance with safe handling of needles improved slightly due to introduction of the one-handed method for safe recapping of used needles.

Contains fulltext : 70009.pdf (Publisher’s version ) (Closed access) This article estimates the magnitude and quality of antibiotic prescribing in Indonesian hospitals and aims to identify demographic, socio-economic, disease-related and healthcare-related determinants of use. An audit on antibiotic use of patients hospitalized for 5 days or more was conducted in two teaching hospitals (A and B) in Java. Data were collected by review of records on the day of discharge. The method was validated through concurrent data collection in Hospital A. Multivariate logistic regression analysis was performed to determine variables to explain antibiotic prescribing. Prescriptions were assessed by three reviewers using standardized criteria. A high proportion (84%) of 999 patients (499 in Hospital A and 500 in Hospital B) received an antibiotic. Prescriptions could be categorized as therapeutic (53%) or prophylactic (15%), but for 32% the indication was unclear. Aminopenicillins accounted for 54%, and cephalosporins (mostly third generation) for 17%. The average level of antibiotic use amounted to 39 DDD/100 patient-days. Validation revealed that 30% of the volume could be underestimated due to incompleteness of the records. Predictors of antibiotic use were diagnosis of infection, stay in surgical or paediatric departments, low-cost nursing care, and urban residence. Only 21% of prescriptions were considered to be definitely appropriate; 15% were inappropriate regarding choice, dosage or duration, and 42% of prescriptions, many for surgical prophylaxis and fever without diagnosis of infection, were deemed to be unnecessary. Agreement among assessors was low (kappa coefficients 0.13-0.14). Despite methodological limitations, recommendations could be made to address the need for improving diagnosis, treatment and drug delivery processes in this setting.

The prevalence of antimicrobial resistance among the commensal microflora was examined in the Indonesian population inside and outside hospitals. A total of 3,995 individuals were screened in two major urban centers. Among Escherichia coli from rectal samples (n = 3,284) the prevalence of resistance to ciprofloxacin and other classes of antibiotics was remarkably high, especially in individuals at the time of discharge from hospital. Staphylococcus aureus isolates (n = 361) were often resistant to tetracycline (24.9%), but this was not associated with hospital stay. Two S. aureus isolates harbored the mecA gene. Regional differences in resistance rates exist, suggesting regional differences in selection pressure, i.e., antibiotic usage patterns. The results show that antimicrobial resistance among commensal E. coli and S. aureus has emerged in Indonesia.