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"This book describes antibiotic resistance amongst pathogenic bacteria. It starts with an overview of the erosion of the efficacy of antibiotics by resistance and the decrease in the rate of replacement of redundant compounds. The origins of antibiotic resistance are then described. It is proposed that there is a large bacterial resistome which is a collection of all resistance genes and their precursors in both pathogenic and non-pathogenic bacteria. Ongoing resistance surveillance programs are also discussed, together with the perspective of a clinical microbiologist. The book then turns to specific themes such as the most serious area of resistance in pathogens, namely in Gram-negative organisms. The role of combinations of antibiotics in combating resistance emergence is discussed, particularly in the tuberculosis field, and then the importance of non-multiplying and persistent bacteria which are phenotypically resistant to antibiotics and prolong the duration of therapy of antibiotics which leads to poor compliance and resistance emergence. The role of anti-microbial compounds in textiles is covered, with its potential to exacerbate the spread of resistance. Then, efflux pumps are discussed. The final chapter describes the compounds which are in late stage clinical development, illustrating the paucity of the antibiotic pipeline, especially for Gram-negative bacteria."

"This book, which is the translated version of a Swedish book, combines a general introduction of a variety of antibiotics with a more in-depth discussion of resistance. The focus on resistance in learning about antibiotics will help future scientists recognize the problem antibiotics resistance poses for medicinal and drug-related fields, and perhaps trigger more research and discoveries to fight antibiotic resistant strains. Current overviews of the topic are included, along with specific discussions on the individual mechanisms (betalactams, glycopeptides, aminoglycosides, etc) used in various antibacterial agents and explanations of how resistances to those develop. Methods for counteracting resistance development in bacteria are discussed as well."

"Seven antibiotics including norfloxacin (NOR) were tested via disk susceptibility test on E. coliculture isolated from the MLSS of the two types of lab-scale sequencing batch reactors (SBR), acommon SBR and an SBR with rnicrofiltration membrane (SB-MBR) for treatment of syntheticmunicipal wastewater. The same experiment treating the NOR-added wastewater to examine thepossible induction of resistance to itself and the other antibiotics. The MLSS from Banglculture (TISTR780) were spiked daily into both reactors. The reactors were continuously operatedunder 2hr/2hr of aeration/non-aeration cycle and resistances to antibiotics of E. coli in MLSS weremonitored. When NOR was not added, the SB-MBR showed lower percentages of resistant E. colithan the SBR did to amoxicillin/clavulanic acid, amikacin, nalidixic acid, tetracycline andchloramphenicol. Oppositely, the SB-MBR treating the NOR-added wastewater appeared topromote resistances of E. coli to nalidixic acid, sulfamethoxasole and tetracycline probably due to along SRT and low DO compared to that of SBR. Although its mechanism should be analyzed withmolecular techniques in further studies, this NOR-induced expression of resistance resulted in ahigher occurrence of multidrug resistant E. coli in the SB-MBR than that in the SBR."

"Resistensi antibiotik merupakan masalah global yang semakin meningkat dan menjadi ancaman serius bagi kesehatan manusia. Untuk mengatasi masalah resistensi antibiotik, perlu dilakukan upaya pencegahan dan pengendalian yang melibatkan berbagai pihak, termasuk apoteker sebagai tenaga kesehatan yang berperan penting dalam penggunaan antibiotik yang tepat dan rasional. Tugas khusus ini bertujuan memberi pengetahuan kepada masyarakat melalui pemberian informasi antibiotik secara tepat dan menanggulangi resistensi antibiotik dengan menggunakan media poster. Metode penelitian yang digunakan adalah observasi terhadap respons dan pemahaman masyarakat terhadap poster yang berisi informasi tentang resistensi antibiotik di Puskesmas Kecamatan Cengkareng, Jakarta barat. Hasil tugas khusus ini menunjukkan bahwa penggunaan poster oleh apoteker efektif dalam meningkatkan pemahaman masyarakat mengenai dampak resistensi antibiotik dan pentingnya penggunaan antibiotik yang rasional. Implikasi dari penelitian ini adalah pentingnya peran aktif apoteker dalam mendidik masyarakat melalui media visual seperti poster untuk mengurangi risiko resistensi antibiotik dalam komunitas.

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Self-medication is an attempt by people to treat themselves. Passive provision of information is carried out through making price tags on solid preparations of medicine for diarrhea and constipation, while active information is carried out through self-medication services to patients. The aim of this special task is to provide drug information on the solid dosage price tags of the I1 drug department as many as 21 sku as a passive form of information and to provide active information through self-medication to patients. The special task method used is placing price tags and carrying out self-medication on Roxy Poltangan Pharmacy patients who need medication for diarrhea and constipation. The results of this special assignment show that the process of creating product information is carried out by considering legal aspects, safety and clinical information that are relevant to consumers. Factors such as patient needs also influence the content of the information displayed. The implication of this research is to increase the transparency of product information in pharmacies, so that consumers can make more informed decisions regarding the use of self-medication for diarrhea and constipation."

"Disertasi ini menghasilkan temuan bahwa clinical pathway yang disusun oleh berbagai profesi sesuai kompetensi, peran, tugas, dan tanggung jawab masing-masing profesi dalam perawatan pasien dapat digunakan sebagai media komunikasi, bekerja sama, berkoordinasi dalam praktek kolaborasi interprofesional. Praktek kolaborasi interprofesional dengan menggunakan clinical pathway dapat mengoptimalkan penggunaan antibiotik untuk mencegah terjadinya resistensi bakteri. Penelitian ini adalah kombinasi penelitian kuantitatif dan kualitatif dengan desain deskriptif analitik. Hasil penelitian menyarankan bahwa penyusunan clinical pathway tidak hanya berbasis bukti tetapi juga merupakan kesepakatan perawatan bersama oleh beberapa profesi tenaga kesehatan untuk meningkatkan kualitas pelayanan, terutama penggunaan antibiotik rasional.

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The finding of this dissertation is clinical pathways prepared by various professions according to the competencies, roles, values, and responsibilities of each profession in patient care. A clinical pathway is a tool for communication, working together, and coordination in interprofessional collaborative practices. Interprofessional collaboration practices using clinical pathways can optimize the use of antibiotics to prevent bacterial resistance. This research is quantitative and qualitative research that analyzes analytics descriptively. The study suggests that the development of a clinical pathway is not only evidence based practice but also a joint agreement by several healthcare professionals to improve the quality of services, especially the rational use of antibiotics."

"Gen resistensi antibiotik (ARGs) dapat ditransfer antar bakteri melalui elemen genetik bergerak (MGEs) dengan transfer gen horizontal (HGT), yang berkontribusi signifikan terhadap penyebaran bakteri yang resisten terhadap berbagai obat di lingkungan. Air limbah yang tidak terolah, terutama di daerah dengan sanitasi yang kurang memadai, berfungsi sebagai reservoir bagi resistensi antibiotik. Namun, penelitian mengenai konsentrasi ARGs pada air limbah tidak terolah masih terbatas. Penelitian ini berfokus pada keberadaan ARGs dalam air limbah tidak terolah yang berasal dari air drainase pada pemukiman di DKI Jakarta dan mengkaji hubungan antara logam berat, MGEs, dan kelimpahan ARGs. Metode pengujian yang digunakan adalah High- Throughput qPCR untuk menguji ARGs dan Spektrometri UV-Vis DR 2000 untuk logam berat. Hasil penelitian menunjukkan bahwa MGEs dan ARGs, khususnya gen intl3 dan aadA2_3, sangat melimpah dalam air limbah tidak terolah. Tidak terdapatnya perbedaan konsentrasi ARGs pada air drainase yang berasal dari kelompok menengah atas dan menengah dapat terjadi akibat sampel yang kurang representatif. Uji korelasi Spearman menunjukkan adanya korelasi cukup positif yang signifikan secara statistik antara kadar logam mangan dan seng dengan MGEs dan beberapa ARGs, serta korelasi yang sangat kuat antara MGEs dan semua ARGs. Temuan ini mendukung adanya hubungan antara logam berat, MGEs, dan kelimpahan ARGs.

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Antibiotic resistance genes (ARGs) can be transferred between bacteria through mobile genetic elements (MGEs) via horizontal gene transfer (HGT), significantly contributing to the spread of bacteria resistant to various drugs in the environment. Untreated wastewater, especially in areas with inadequate sanitation, serves as a reservoir for antibiotic resistance. However, research on ARG concentrations in untreated wastewater is still limited. This study focuses on the presence of ARGs in untreated wastewater from drainage in residential areas of Jakarta and examines the relationship between heavy metals, MGEs, and ARG abundance. Testing methods used were High- Throughput qPCR for ARGs and UV-Vis DR 2000 Spectrometry for heavy metals. The research results indicate that MGEs and ARGs, particularly the intl3 and aadA2_3 genes, are highly abundant in untreated wastewater. The lack of difference in ARG concentrations in drainage water from upper-middle and middle-class groups may be due to non-representative sampling. Spearman correlation tests show a statistically significant positive correlation between manganese and zinc levels with MGEs and some ARGs, as well as a very strong correlation between MGEs and all ARGs. These findings support the relationship between heavy metals, MGEs, and ARG abundance."

"Provinsi DKI Jakarta umumnya mengandalkan tangki septik di perumahan dan IPAL permukiman di kawasan tertentu sebagai tempat pembuangan tinja setempat serta membuang cairan efluennya ke saluran drainase, tetapi penelitian mengenai kinerja penyisihan unsur AMR-nya masih minim. IPAL permukiman sebagai salah satu sistem pengolahan tinja setempat menciptakan kondisi yang kondusif bagi terjadinya akuisisi resistensi antarinang via transfer gen horizontal (HGT) berdasarkan kelimpahan nutrisi, kelimpahan mobile genetic elements (MGE) yang memfasilitasi HGT, proses pengolahan, kandungan logam berat sebagai tekanan selektif, dan variabel lain-lain. Dengan demikian, penelitian ini dilakukan untuk menganalisis prevalensi ARG dan MGE dengan metode High-Throughput Quantitative Polymerase Chain Reaction (HT-qPCR), tingkat reduksi atau peningkatan ARG dan MGE, serta hubungan antara logam berat dan MGE dengan ARG di IPAL permukiman. Sebanyak 8 dari 65 gen target masih terdeteksi di semua sampel unit final (n = 8). Salah satunya adalah crAss56 yang mengindikasikan bahwa efluen cairan IPAL permukiman menjadi potensial sumber diseminasi AMR di hilir. IPAL permukiman tidak menunjukkan kemampuan reduksi kelimpahan absolut gen 16S rRNA, MGE, ARG yang konsisten, bahkan salah satunya (ST4) mengamplifikasi semua gen-gen tersebut. Terlihat pola kelimpahan ARG berbeda antara IPAL permukiman terindikasi terbengkalai dengan yang beroperasional yang menyiratkan mekanisme pengolahan tertentu, seperti pengolahan biologis (aerobik, anaerobik, kombinasi) dan klorinasi, dapat berkontribusi dalam proliferasi ARG. Analisis korelasi Spearman menunjukkan korelasi signifikan secara statistik (p-value < 0.05) dengan arah positif antara mangan (Mn) vs. ARG (qacE∆1_3 > aph3-ib > ereA), seng (Zn) vs. ARG (aph3-ib > vanA > ereA > blaSHV11 > intl3 > qnrS2), serta MGE (intl3) vs. ARG (ereA > vanA > aph3-ib > blaSHV11 > qacE∆1_3 > qnrS2). Maka, korelasi tersebut menandakan intl3 memiliki potensial tinggi sebagai fasilitator HGT. Logam berat juga mungkin menginduksi HGT dan/atau menyeleksi dengan antibiotik secara bersamaan terhadap ARB. Maka, penemuan penelitian ini menyorotkan pentingnya diadakannya pemantauan AMR di berbagai sistem air limbah, khususnya black water.

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The DKI Jakarta Province generally relies on septic tanks in residential areas and tenement wastewater treatment plants in certain areas as on-site feces disposal sites along with discharging their effluent water into drainage channels, but research on their AMR element removal performance is still limited. Tenement WWTPs as one of the on-site feces treatment systems create conditions that are conducive to the acquisition of resistance between hosts via horizontal gene transfer (HGT) based on the abundance of nutrients, the abundance of mobile genetic elements (MGE) which facilitate HGT, treatment processes, heavy metal content as selective pressure, and other variables. Thus, this research was conducted to analyze the prevalence of ARG and MGE using the High-Throughput Quantitative Polymerase Chain Reaction (HT-qPCR) method, the level of reduction or increase in ARG and MGE, as well as the relationship between heavy metals and MGE and ARG in tenement WWTPs. A total of 8 of the 65 target genes were still detected in all final unit samples (n = 8). One of them was crAss56 which indicated that tenement WWTP effluent water is a potential source of downstream AMR dissemination. Tenement WWTPs did not show a consistent ability to reduce the absolute abundance of 16S rRNA, MGE, ARG genes, in fact one of them (ST4) amplified all of these genes. It can be seen that the pattern of ARG abundance is different between tenement WWTP indicated to be abandoned and those that are operational, which implies that certain treatment mechanisms, such as biological treatment (aerobic, anaerobic, combined) and chlorination, can contribute to the proliferation of ARGs. Spearman correlation analysis showed a statistically significant correlation (p-value < 0.05) in the positive direction between manganese (Mn) vs. ARGs (qacE∆1_3 > aph3-ib > ereA), zinc (Zn) vs. ARGs (aph3-ib > vanA > ereA > blaSHV11 > intl3 > qnrS2), as well as MGEs (intl3) vs. ARGs (ereA > vanA > aph3-ib > blaSHV11 > qacE∆1_3 > qnrS2). Therefore, this correlation indicates that intl3 has high potential as a facilitator of HGT. Heavy metals may also induce HGT and/or co-select against ARBs with antibiotics. Thus, the findings of this study highlight the importance of monitoring AMR in various wastewater systems, especially black water."

"Fasilitas kesehatan, termasuk rumah sakit dan puskesmas, adalah suatu fasilitas penting pelayanan kesehatan perorangan yang dalam aktivitasnya menghasilkan limbah, salah satunya adalah limbah cair. Tingginya penggunaan obat-obatan di rumah sakit mendorong pertumbuhan dan persebaran gen yang resisten terhadap antibiotik, atau dapat disebut juga dengan Antibiotic Resistance Genes (ARGs). ARGs ini sangat sering diasosiasikan terhadap air limbah sehingga IPAL merupakan lokasi yang tepat untuk melakukan penelitian terkait hal tersebut. Karena hal tersebut, peneliti melakukan penelitian di dua rumah sakit besar dan enam puskesmas di Jakarta untuk mengetahui kelimpahan ARGs dan faktor-faktornya, serta melakukan perbandingan ARGs dengan logam berat dan MGEs. Dari penelitian ini, ditemukan bahwa terdapat jenis gen yang paling mendominasi pada Fasilitas Kesehatan di Jakarta adalah dari kelompok resistensi terhadap Beta-Lactam dan Aminoglycoside. Relative abundance tertinggi yang terdeteksi di lebih dari 50% lokasi pengambilan sampel adalah intI3 dari kelompok integron, yang mana menjadi dominan relative abundance di 93,75% lokasi pengambilan sampel. Disusul dengan kelompok integron juga, intI1_1 yang menjadi dominan relative abundance di 86,67% lokasi pengambilan sampel. Hal ini menunjukkan rata-rata gen yang paling mendominasi secara relative abundance di seluruh lokasi Fasilitas Kesehatan di Jakarta adalah dari kelompok integron. Terdapat ARGs yang tidak dapat disisihkan di 50% fasilitas kesehatan. Gen tersebut vanA dari kelompok Vancomycin, aadA1 dari kelompok Aminoglycoside, dan blaOXA51 dari kelompok Beta-Lactam. Di sisi lain, teradpat gen yang mampu disisihkan di lebih dari 50% fasilitas kesehatan, yaitu strB dan strA dari kelompok Aminoglycoside. Efisiensi penyisihan gen 16sRNA tertinggi dicapai oleh IPAL Puskesmas Kelurahan Keagungan, dengan nilai sebesar 99,57%. Di sisi lain, lokasi dengan efisiensi penyisihan gen 16sRNA terendah terdapat di Puskesmas Kecamatan Tebet Timur, dengan nilai -265,64%. Efisiensi penyisihan ARGs (tanpa taksonomik) tertinggi dicapai oleh IPAL Puskesmas Kelurahan Keagungan, yaitu sebesar 99,57% dan disusul dengan IPAL Puskesmas Kelurahan Manggarai, yaitu sebesar 98,28%. Di sisi lain, efisiensi penyisihan ARGs terendah terdapat pada IPAL Puskesmas RS X, yaitu sebesar -99,12%, di susul dengan IPAL Puskesmas Kecamatan Tebet Timur dengan efisiensi penyisihan sebesar -70,49%. Tidak ada korelasi kuat antara mangan dan seng terhadap kelimpahan absolut ARGs. Hal ini didasarkan atas rata-rata dari ρ yang didapat adalah sebesar 0,356 dan rata-rata p-value adalah sebesar 0,054. Di sisi lain, terdapat korelasi yang sangat kuat antara MGEs dan kelimpahan absolut ARGs. Hal ini didasarkan atas rata-rata dari ρ yang didapat adalah sebesar 0,869 dan rata-rata p-value adalah sebesar 3,82 x 10^9

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Health facilities, including hospitals and community health centers, are important individual health service facilities which in their activities produce waste, one of which is liquid waste. The high use of drugs in hospitals encourages the growth and spread of genes that are resistant to antibiotics, or what can also be called Antibiotic Resistance Genes (ARGs). These ARGs are very often associated with wastewater so WWTP is the right location to conduct research related to this. Because of this, researchers conducted research at two large hospitals and six public health center in Jakarta to find out reports of ARGs and their factors, as well as to compare ARGs with heavy metals and MGEs. From this research, it was found that the most dominant gene type in Health Facilities in Jakarta is the resistance group to Beta-Lactam and Aminoglycoside. The highest relative abundance detected in more than 50% of sampling locations was intI3 from the integron group, which was the dominant relative abundance in 93.75% of sampling locations. Followed by the integron group, intI1_1 which was the dominant relative abundance in 86.67% of sampling locations. This shows that on average the gene that dominates in relative abundance in all Health Facility locations in Jakarta is from the integron group. There are ARGs that cannot be set aside in 50% of health facilities. The genes are vanA from the Vancomycin group, aadA1 from the Aminoglycoside group, and blaOXA51 from the Beta-Lactam group. On the other hand, there are genes that can be removed in more than 50% of health facilities, namely strB and strA from the Aminoglycoside group. The highest efficiency of 16sRNA gene removal was achieved by the WWTP Keagungan Public Health Center, with a value of 99.57%. On the other hand, the location with the worst 16sRNA gene removal efficiency was the WWTP East Tebet District Public Health Center, with a value of -265.64%. The highest ARGs removal efficiency (without taxonomy) was achieved by the WWTP Public Health Center, namely 99.57% and followed by the WWTP Manggarai Public Health Center, namely 98.28%. On the other hand, the lowest ARGs removal efficiency was found at the WWTP X Hospital, namely -99.12%, followed by the WWTP East Tebet District Public Health Center with a removal efficiency of -70.49%. There was no strong correlation between manganese and zinc on the absolute abundance of ARGs. On the other hand, there was a very strong correlation between MGEs and the absolute abundance of ARGs."

"Pemakaian antibiotika tidak rasional menyebabkan resistensi antibiotika. Implementasi kebijakan penggunaan antibiotika di RSUP Sanglah Denpasar belum pernah di evaluasi. Tujuan penelitian ini mengetahui implementasi kebijakan penggunaan antibiotika, mencegah resistensi antibiotika dan mengetahui penerapan intervensi WHO untuk peningkatan penggunaan obat rasional. Penelitian ini merupakan penelitian deskriptif kualitatif, dengan melakukan wawancara dan penelusuran dokumen. Analisa data dengan content analysis. Hasil penelitian menunjukkan implementasi kebijakan penggunaan antibiotika dan penerapan intervensi WHO belum berjalan baik. Pencegahan resistensi antibiotika belum terkoordinir baik dari empat pilar Tim Program Pengendalian Resistensi Antimikroba. Diperlukan revisi dan sosialisasi pelaksanaan kebijakan pengguna anantibiotika, juga pencegahan dan pengendalian infeksi.

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Irrational use of antibiotics lead to antibiotic resistance. Implementation of the policy on the use of antibiotics in Sanglah Hospital in Denpasar has never been evaluated. The purpose of this study to know the implementation of policy on the use of antibiotics, preventing antibiotic resistance and determine the application ofthe WHO interventions to improve rational drug use. This research is aqualitative descriptive study, with interviews and document searches. Data analysis with content analysis.

The results showed the use of antibiotics policy implementation and application of WHO intervention has not gone well. Prevention of antibiotic resistance have not been well coordinated team of four pillars of Antimicrobial Resistance Control Program. Required revision and dissemination of antibiotic usage policy enforcement, as well as prevention and control of infection."