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"Pemantauan Terapi Obat pada Neonatus Kurang Bulan, Bayi Berat Lahir Rendah, dan Sepsis di Ruang Neonatus Intensive Care Unit (NICU) RSUP Fatmawati Bulan September 2020.

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Neonates, especially preterm infants have weak physical defenses and immature immune function, making them susceptible to bacterial invasion. One of the efforts to achieve the Sustainable Development Goals (SDGs), which is to reduce the incidence of neonatal mortality to 12 per 1,000 live births, it is necessary to collaborate between health workers in treating patients. Pharmacists in hospitals need to carry out their roles, one of which is by monitoring the therapy given. Data were collected directly by looking at the cardex and patient's medical records with the following criteria: less-month neonatal patients, receiving polypharmacy, patients with antibiotic therapy, and length of stay in the hospital ≥5 days. The data obtained were analyzed using the SOAP method and identified problems related to drugs. From the Monitoring of Drug Therapy (PTO), it was found that drug-related problems that occurred were dose mismatches and frequency mismatches, and analysis of the evaluation of antibiotic administration (EPA) with the Gyssens method found that the use of antibiotics was found in category IIIa, namely giving meropenem too long and category IIa, which was not the right dosage."

"Seorang apoteker memiliki peran penting dalam praktek pelayanan kesehatan di rumah sakit dan apotek. Apoteker harus memenuhi standar kompetensi sebagai persyaratan untuk memasuki dunia kerja dan menjalani praktek keprofesiannya. Standar kompetensi apoteker di Indonesia terdiri dari sepuluh standar kompetensi sebagai kemampuan yang diharapkan oleh apoteker saat lulus dan masuk ke tempat praktek kerja profesi. Sebagai bekal dan pengalaman calon apoteker untuk dapat memahami peran apoteker dan meningkatkan kompetensi, maka dilaksanakan Praktik Kerja Profesi Apoteker (PKPA) di RSUP Fatmawati dan Apotek Dini selama periode bulan Februari-Juni 2020. Selama PKPA, calon apoteker diharapkan dapat memperluas wawasan, pemahaman, dan pengalaman untuk melakukan pekerjaan kefarmasian di tempat praktik kerja profesi.

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A pharmacist has an important role in health services in hospitals and pharmacies. Pharmacists must meet competency standards as a requirement to enter professional work practice and undergo professional practice. Pharmacist competency standards in Indonesia consist of ten competency standards as the skills expected by pharmacists when they graduate and enter professional work practices. As a provision and experience for prospective pharmacists to be able to understand the role of pharmacists and improve competence, an internship was carried out at RSUP Fatmawati and Apotek Dini during the period February-June 2020. During internship, prospective pharmacists are expected to broaden their horizons, understanding, and experience doing pharmaceutical work in a professional work practices."

"Di Indonesia proporsi Bayi Berat Lahir Rendah (BBLR) <2500 gram pada bayi umur 0-59 bulan masih cukup tinggi, yaitu 6,2% di tahun 2013-2018. Padahal kondisi BBLR memiliki risiko lebih besar untuk mengalami morbiditas dan mortalitas dari pada bayi dengan berat badan normal. Salah satu masalah terbesar yang sering dialami BBLR adalah peningkatan risiko untuk terserang infeksi maupun sepsis, sehingga obat yang paling banyak digunakan di unit perawatan intensif neonatus adalah dari golongan antibiotik. Oleh sebab itu, diperlukannya peran Apoteker dalam melakukan praktik profesi berupa Pemantauan Terapi Obat (PTO) dalam proses pengobatan agar dapat membantu dalam mengoptimalkan efek terapi dan meminimalkan efek yang tidak dikehendaki sehingga prognosisnya dapat menjadi lebih baik. Pelaksanaan PTO dilakukan pada tanggal 15-24 September 2020 bertempat di ruang perinatologi 2B di gedung bougenville RSUP Fatmawati berdasarkan laporan kasus yang bersifat kualitatif dengan melakukan pengamatan langsung atau observasi. Data yang diperoleh kemudian diidentifikasi terkait Drug Related Problems (DRPs) menurut Cipolle dan dianalisis rasionalitasnya pada domain antibiotik dengan metode Gyssens. Dari analisa yang dilakukan ditemukan beberapa masalah DRP menurut Cipolle yaitu terkait lama pemberian obat meropenem yang terlalu panjang; pemberian dosis yang terlalu rendah pada obat fluconazole dan ketorolac; pemilihan obat bactesyn yang tidak rasional; adanya interaksi obat fluconazole dengan omeprazole yang bersifat moderat, serta interaksi obat gentamicin dengan bactesyn yang bersifat minor jika digunakan secara bersamaan. Sementara hasil evaluasi menggunakan metode Gyssens pada penggunaan antibiotik menunjukkan obat meropenem termasuk kategori IIIa (penggunaan antibiotik terlalu lama); gentamicin termasuk kategori 0 (penggunaan antibiotika tepat/bijak); bactesyn termasuk katagori IVa (ada antibiotik lain yang lebih efektif) dan katagori IIa (penggunaan antibiotik tidak tepat dosis) apabila tetap dipertahankan penggunaannya.

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In Indonesia, the proportion of Low Birth Weight Babies (LBW) <2500 grams in infants aged 0-59 months is still quite high at 6.2% in 2013-2018. In fact, LBW conditions have a greater risk of experiencing morbidity and mortality than babies with normal weight. One of the biggest problems that are often experienced by LBW is the increased risk for infection and sepsis, so the most widely drugs used in neonatal intensive care units are from the antibiotic class. Therefore, a pharmacist's role is needed in carrying out professional practice with Drug Therapy Monitoring (DTM) in order to help optimize the effect of therapy and minimize unwanted effects, so the prognosis can be better. The implementation of DTM was carried out on September 15-24, 2020 at the perinatology room 2B in the bougenville building of RSUP Fatmawati based on qualitative case reports by direct observation. Then the data was identified using the Drug Related Problems (DRPs) classification according to Cipolle and analyzed their rationality in the antibiotic domain using the Gyssens method. From the analysis conducted, it was found that several DRP problems were related to the the long duration of administration of meropenem; too low a dose of fluconazole and ketorolac; irrational choice of bactesyn; There is a moderate drug interaction between fluconazole and omeprazole, as well as a minor drug interaction between gentamicin and bactesyn when used concurrently. Meanwhile, the results of the evaluation using the Gyssens method on antibiotic use showed that meropenem was included in category IIIa (the use of antibiotic is too long); gentamicin was included in category 0 (the use of antibiotics is appropriate/wise); bactesyn was included category IVa (there are other antibiotics that are more effective) and category IIa (the use of antibiotics is not in the right dose) if its use is maintained."

"Penggunaan antibiotik yang tinggi pada pasien sepsis dapat memicu penggunaan antibiotik yang tidak rasional. Upaya untuk memaksimalkan penggunaan antibiotik yang rasional merupakan salah satu tanggung jawab apoteker. Penelitian ini bertujuan untuk mengevaluasi kualitas dan kuantitas penggunaan antibiotik pada pasien sepsis di ruang rawat Intensive care unit (ICU) dengan metode Gyssens dan ATC/DDD dan mengevaluasi pengaruh intervensi apoteker dalam meningkatkan kualitas penggunaan antibiotik dan outcome terapi. Penelitian dilakukan secara prospektif selama periode Agustus-November 2018 dengan menggunakan rancangan studi pra eksperimen one grup pretest-posttest. Rekomendasi diberikan kepada penulis resep terhadap masalah ketidaktepatan penggunaan antibiotik yang ditemukan. Evaluasi kualitatif dengan metode Gyssens diperoleh hasil bahwa penggunaan antibiotik pada pasien sepsis yang rasional sebesar 85,09 % dan yang tidak rasional sebesar 14,91 %. Jenis antibiotik, jenis terapi antibiotik, jumlah antibiotik  dan lama penggunaan antibiotik berpengaruh terhadap kualitas penggunaan antibiotik. Intervensi meningkatkan ketepatan penggunaan antibiotik (0 % menjadi 64,71 %), menurunkan masalah pemilihan antibiotik (88,24 % menjadi 32,35 %), masalah lama pemberian antibiotik (5,88 % menjadi 0 %) dan masalah rute pemberian obat (5,88 % menjadi 0 %). Kualitas penggunaan antibiotik yang rasional dan yang tidak rasional berpengaruh terhadap hasil terapi. Kuantitas penggunaan antibiotik sebesar 63,84 DDD/patient-day dengan nilai terbesar pada antibiotik meropenem yaitu 32,91 DDD/patient-day.

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High use of antibiotics in sepsis patients can lead to irrational use of antibiotics. Pharmacist has responsibility to improve appropriate antibiotics usage. This study was proposed to evaluate quality and quantity of antibiotics usage in sepsis patients in the Intensive care unit (ICU) ward with the Gyssens and ATC/DDD methods and evaluate whether intervention of pharmacy can improve quality of antibiotics usage and therapy outcome. The study was conducted prospectively during the period August - November 2018 using pre experiment one grup pretest-posttest design. Recommendations were given to prescribers to solve the problems of inappropriate antibiotics usage. Qualitative evaluation using that about 85.09 % antibiotic prescriptions were appropriate, and 14.91 % were inappropriate. Type of antibiotics, type of antibiotic therapy, total and duration antibiotics used by patients have effect on quality and quantity antibiotics usage. Intervention of pharmacist improve appropriateness of antibiotics (0% to 64.71 %), decrease drug choice problems (88.24 % to 32.35 %), duration problems (5.88 % to 0 %) and route of administration problems (5.88 % to 0 %). Appropriate used of antibiotics had significant different effect to outcome therapy compare with inappropriate used of antibiotics. The quantity of antibiotic use is 63.84 DDD/patient-day with the greatest value on meropenem antibiotics is 32.91 DDD/patient-day."

"ABSTRAKProfesi apoteker mempunyai tanggung jawab dan peranan penting dalam pelayanan kefarmasian di Rumah Sakit dan Apotek salah satunya untuk mengoptimalkan terapi yang bertujuan untuk memperbaiki kualitas hidup pasien. Apoteker harus memenuhi standar kompetensi sebagai persyaratan untuk memasuki dunia kerja dan menjalani praktik profesi. Standar kompetensi apoteker Indonesia terdiri dari sepuluh standar kompetensi sebagai bentuk dari suatu kemampuan yang diharapkan oleh apoteker saat lulus dan masuk ke tempat praktik kerja profesi. Sebagai bekal dan pengalaman calon apoteker untuk dapat memahami peran apoteker dan meningkatkan kompetensi, maka dilaksanakan Praktik Kerja Profesi Apoteker di RSUP Fatmawati dan Apotek PD Bhakti Husada Wonosobo periode bulan Februari-Juni tahun 2020.

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ABSTRACTThe pharmacist profession has an important responsibility and role in pharmacy services in hospitals and pharmacies, one of which is to optimize therapy that aims to improve the quality of life of patients. Pharmacists must have competency standards as requirements to enter the real  of work and undergo professional practice. Indonesian pharmacist competency standards consist of ten competency standards as a form of ability expected by pharmacists when they graduate and enter the professional work practice. As a provision and experience of pharmacists candidate to be able to understand the role of pharmacists and improve competence, the Professional Work Practice of Pharmacists at Fatmawati Central General Hospital and Apotek PD Bhakti Husada Wonosobo for the period February-June 2020. "

"Meningkatnya kompleksitas obat-obat yang digunakan dalam pengobatan danberkembangnya polifarmasi, memungkinkan terjadinya interaksi obat makinbesar. Berdasarkan hasil analisa resep pasien ICU di depo farmasi IGD dan IRIbulan Agustus 2008, didapatkan berbagai interaksi obat berdasarkan literaturyang meliputi : 44 % interaksi farmakodinamik, 34,5 % interaksi farmasetik dan21,5 % interaksi farmakokinetik. Penelitian ini bertujuan untuk melihat pengaruhbanyaknya item obat dan makanan yang diberikan kepada pasien dengan interaksiobat ? obat dan interaksi obat ? makanan yang terjadi. Survei yang dilakukan pada70 pasien yang dirawat di ruang ICU RSUP Fatmawati periode Maret ? April2010 berdasarkan instruksi harian dan rekam medik pasien. Dari hasil surveimenunjukan bahwa sebagian besar interaksi obat ? obat yang terjadi merupakaninteraksi farmakodinamik (54,87 %) dan farmakokinetik (20,35 %) dan farmasetik(24,78 %). Interaksi yang banyak terjadi, umumnya adalah obat-obat golongandiuretik (furosemid). Interaksi obat ? makanan yang terjadi secara farmakokinetik(68,18 %) dan farmakodinamik (31,82 %). Berdasarkan perhitungan Chi SquareTest ada hubungan antara jumlah obat yang diberikan secara bersamaan denganbanyaknya interaksi obat ? obat yang terjadi dan tidak ada hubungan antarajumlah makanan yang diberikan secara bersamaan dengan banyaknya interaksiobat ? makanan yang terjadi."

"Pemantauan terapi obat (PTO) merupakan kegiatan yang dilakukan untuk memastikan terapi obat aman, efektif, dan rasional bagi pasien. Pemantauan terapi obat dilakukan dengan menganalisis pilihan obat, dosis, cara pemberian obat, respon terapi, reaksi obat yang tidak diinginkan (ROTD), serta rekomendasi perubahan maupun alternatif terapi. Pemantauan terapi obat telah termasuk sebagai salah satu pelayanan farmasi klinis pada standar pelayanan kefarmasian di rumah sakit, puskesmas, dan apotek yang diatur oleh kementerian kesehatan RI. Sepsis merupakan respons sistemik pejamu terhadap infeksi, saat patogen atau toksin dilepaskan ke dalam sirkulasi darah sehingga terjadi aktivasi proses inflamasi. Sepsis merupakan salah satu masalah kesehatan dengan tingkat kejadian kasus serta kematian yang cukup tinggi dan terus meningkat di seluruh dunia. Meskipun telah terdapat berbagai panduan terkait terapi sepsis yang dibuat oleh para ahli untuk menurunkan angka kematian akibat sepsis, minimnya pengetahuan SDM, ketersediaan pemeriksaan penunjang dan modalitas terapi menjadi alasan sulitnya pengimplementasian panduan terapi sepsis secara menyeluruh di Indonesia. Penelitian dilakukan dengan pengambilan data menggunakan metode retrospektif. Pengumpulan data dilakukan dengan mengambil data dari rekam medis pasien yang kemudian dianalisis untuk mengetahui apakah terdapat masalah terkait obat atau DRP (Drug Related Problem). Data yang diambil berupa data identitas pasien, kajian status klinik, hasil pemeriksaan penunjang, dan profil penggunaan obat. Daari data yang dikumpulkan, dilakukan beberapa analisis, yakni interpretasi hasil pemeriksaan laboratorium, analisis penggunaan antibiotik, analisis ketepatan terapi, dan analisis masalah terkait obat/DRP. Berdasarkan hasil pemantauan terapi obat, dapat disimpulkan bahwa pengobatan yang diberikan mayoritas sudah sesuai dan tidak ada masalah. Namun, terdapat beberapa masalah terapi yang kemudian dianalisis DRP nya dengan metode SOAP pada pasien. Solusi yang diberikan yaitu perlunya dilakukan pengecekan terhadap masalah terapi obat yang muncul terutama potensi interaksi obat bagi pasien yang mendapatkan obat polifarmasi, serta selalu melakukan pemantauan terhadap tanda-tanda vital pasien maupun pemeriksaan lab apabila ada kemungkinan muncul efek samping obat.

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Drug therapy monitoring is an activity carried out to ensure the drug therapy is safe, effective and rational for patients. Drug therapy monitoring is carried out by analyzing drug choices, dosages, methods of drug administration, therapeutic response, adverse drug reactions (ADR), as well as recommendations for changes or alternative therapies. Drug therapy monitoring has been included as one of the clinical pharmacy services at pharmaceutical service standards in hospitals, health centers, and pharmacies regulated by the Indonesian Ministry of Health. Sepsis is a systemic response of the host to infection, when pathogens or toxins are released into the blood circulation resulting in the activation of the inflammatory process. Sepsis is a health problem with a high incidence of cases and deaths and continues to increase throughout the world. Although there have been various guidelines related to sepsis therapy made by experts to reduce mortality, the lack of knowledge of human resources, the availability of supporting examinations, and therapeutic modalities are the reasons for the difficulty in implementing comprehensive sepsis therapy guidelines in Indonesia. This research was carried out by collecting data using a retrospective method. Data collection was carried out by taking data from the patient's medical record which was then analyzed to find out whether there were drug-related problems or DRP. The data taken including the patient identity data, clinical status studies, results of supporting examinations, and drug use profiles. From the data collected, several analyzes were carried out, namely interpretation of laboratory examination results, analysis of antibiotic use, analysis of appropriateness of therapy, and analysis of drug-related problems/DRP. Based on the results of drug therapy monitoring, it can be concluded that the majority of the treatment given is appropriate and there are no problems. However, there were several potential therapeutic problems which were then analyzed by DRP using the SOAP method in patients. The solution given is the need to check drug therapy problems that arise, especially the potential for drug interactions for patients receiving polypharmacy drugs, and always monitor the patient's vital signs and lab tests if there is a possibility of drug side effects."

"[ABSTRAKBayi prematur dapat mengalami hambatan kenaikan berat badan yang disebabkan oleh usia gestasi, penyakit penyerta, dan pengalaman nyeri atau stres. Hambatan kenaikan berat badan dapat diatasi dengan asuhan keperawatan yang tepat dalam pemenuhan kebutuhan nutrisi pada bayi prematur. Asuhan keperawatan dengan Model Konservasi Levine telah digunakan pada aplikasi praktik residensi di Ruang Neonatus Rumah Sakit Cipto Mangunkusumo dalam menganalisis kenaikan berat badan bayi prematur pada lima kasus terpilih mulai dari Bulan Maret-Mei tahun 2015. Analisis kasus didapatkan dari tahap pengkajian, tropikognosis, hipotesis, intervensi, dan evaluasi. Tropikognosis yang telah teridentifikasi yaitu risiko gangguan pemenuhan kebutuhan nutrisi. Intervensi telah dilakukan berdasarkan prinsip konservasi dan hasil evaluasinya yaitu bayi prematur mengalami kenaikan berat badan dengan konservasi energi. Kenaikan berat badan pada bayi prematur menunjukkan keberhasilan dari penerapan asuhan keperawatan berbasis Model Konservasi Levine.

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ABSTRACTThe preterm infant can has an obstacle of increasing weight which is caused by gestational age, health problems which followed and pain/ stress experience. The obstacle of increasing weight can be handled with giving nursing care in proper nutrition needs. Nursing care with Levine?s Conservation Model has been applied in residence practice application in neonates wards Cipto Mangunkusumo hospital to analyze increasing weight of preterm infant in five selected cases start from March until May 2015. Case analyze is founded from assessment, trophicognosis, hypothesis, intervention, and evaluation. Trophicognosis which identified was disturbance risk in fullfil nutrition needs. Intervention were done based on conservation principle and the result of evaluation that preterm infant has increasing weight with energy conservation. Increasing weight in preterm infant showed a successful application of nursing care based on Levine?s Conservation Model. ;The preterm infant can has an obstacle of increasing weight which is caused by gestational age, health problems which followed and pain/ stress experience. The obstacle of increasing weight can be handled with giving nursing care in proper nutrition needs. Nursing care with Levine?s Conservation Model has been applied in residence practice application in neonates wards Cipto Mangunkusumo hospital to analyze increasing weight of preterm infant in five selected cases start from March until May 2015. Case analyze is founded from assessment, trophicognosis, hypothesis, intervention, and evaluation. Trophicognosis which identified was disturbance risk in fullfil nutrition needs. Intervention were done based on conservation principle and the result of evaluation that preterm infant has increasing weight with energy conservation. Increasing weight in preterm infant showed a successful application of nursing care based on Levine?s Conservation Model. , The preterm infant can has an obstacle of increasing weight which is caused by gestational age, health problems which followed and pain/ stress experience. The obstacle of increasing weight can be handled with giving nursing care in proper nutrition needs. Nursing care with Levine’s Conservation Model has been applied in residence practice application in neonates wards Cipto Mangunkusumo hospital to analyze increasing weight of preterm infant in five selected cases start from March until May 2015. Case analyze is founded from assessment, trophicognosis, hypothesis, intervention, and evaluation. Trophicognosis which identified was disturbance risk in fullfil nutrition needs. Intervention were done based on conservation principle and the result of evaluation that preterm infant has increasing weight with energy conservation. Increasing weight in preterm infant showed a successful application of nursing care based on Levine’s Conservation Model. ]"

"Prevalens SNAD NKB < 34 minggu dan atau BLSR di Indonesia masih tinggi. Asuhan antenatal yang tidak adekuat, gejala infeksi saat lahir yang sulit dibedakan dengan prematuritas, dan modalitas diagnostik yang suboptimal membuat diagnosis SNAD pada populasi ini sulit. Presepsin salah satu marker infeksi meningkat saat awal infeksi berpotensi dijadikan salah satu parameter diagnostik SNAD. Tujuan penelitian ini adalah untuk melihat akurasi presepsin sebagai salah satu parameter diagnosis SNAD dan dibandingkan dengan CRP. Studi ini merupakan studi potong lintang terhadap 71 NKB < 34 minggu dan atau BLSR dengan faktor risiko SNAD lebih tinggi atau faktor risiko SNAD rendah yang menunjukkan gejala sepsis di Unit Perinatologi RSCM. Penelitian ini mencari nilai batas presepsin sebagai parameter diagnostik SNAD pada berbagai waktu pengambilan, kemudian membandingkannya dengan CRP. Kurva ROC dikerjakan untuk menentukan nilai batasan optimal presepsin. Penelitian ini mendapat nilai presepsin lebih tinggi pada kelompok SNAD dibandingkan dengan non-sepsis (median 814, 802, dan 693 pg/mL, p<0,05). Presepsin mencapai nilai puncaknya pada T1 sedangkan CRP pada T24. Nilai batas optimal, batas bawah dan batas atas presepsin T1 adalah 621,5, 458, 808 pg/mL. Pada T4 yaitu 733, 518,5, 733 pg/mL serta T24 yaitu 667,5, 556,5, 820,5 pg/mL. Nilai batas presepsin T1 memiliki sensitivitas 82,14%, spesifisitas 81,4%, NDP 74,19%, NDN 87,5%, dan akurasi 81,69%. Sedangkan presepsin T4 memiliki sensitivitas 60,71%, spesifisitas 93,02%, NDP 85%, NDN 78,43% dan akurasi 80,28%. Nilai batasan presepsin T24 memiliki sensitivitas 64%, spesifisitas 86%, NDP 75% dan NDN 78,7% dan akurasi 77,46%. Sebagai kesimpulan, presepsin meningkat sesaat setelah lahir jika terjadi infeksi. Presepsin T1 dapat digunakan sebagai parameter skrining SNAD dengan menggunakan nilai batasan optimal 621,5 pg/mL. Presepsin dengan berbagai nilai batasan tertentu memiliki fungsi yang berbeda dan dapat diaplikasikan ke dalam alur diagnosis dan tata laksana SNAD berdasarkan faktor risiko populasi tersebut.

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Early onset neonatal sepsis prevalence in Indonesia remains high among preterm neonates born at <34 weeks' gestation and or VLBW. Inadequate antenatal care, infectious symptoms at birth that are confusing to distinguish from prematurity, and poor predictive performance of laboratory tests made diagnosis of EOS is wearisome. Presepsin, one of the biomarkers, increases early in onset of infection has potential to become diagnostic tools for EOS. The objective of this study is to find the accuracy of presepsin as one of EOS diagnostic tools and compared it with CRP. This study is a cross-sectional study of of 71 neonates born at < 34 weeks' gestation and or VLBW at higher risk of EOS or at lower risk for EOS that showing some degree of respiratory or systemic instability. Presepsin which was collected in different time interval (T1, T4 and T24), compared to diagnostic criteria of sepsis as the gold standard. The accuracy of CRP with currently cut-off points also analyzed in this study. The ROC curve was performed to determine the optimal cut-off points of presepsin. Presepsin values were higher in the EOS group than in uninfected group at T1(median 814 vs 438 pg/mL; p<0.05) T4 (802 vs 445 pg/mL; p<0.05), and T24 (693 vs 469 pg/ mL; p <0.05). Presepsin achieved best accuracy at T1 and reaches its peak value at T1 while CRP have it at T24. Optimal cut-off points, the lower limit and the upper limit of presepsin at T1 are 621.5, 458, 808 pg/mL. At T4 are 733, 518.5, 733 pg/mL and T24 are 667.5, 556.5, 820.5 pg/mL. With those optimal cut-off value, presepsin has 82.14% sensitivity, 81.4% specificity, 74.19% PPV, 87.5% NPV, and accuracy of 81.69%. Whereas presepsin at T4 has 60.71% sensitivity, 93.02% specificity, 85% PPV, 78.43% NPV and an accuracy of 80.28%. Presepsin at T24 has a sensitivity of 64%, a specificity of 86%, an NDP of 75% and an NDN of 78.7% and an accuracy of 77.46%. In conclusion, presepsin increases shortly after birth in EOS group. Presepsin at T1 can be used as EOS screening tools by using an optimal cut-off value of 621.5 pg/mL. Presepsin with certain boundary values have different functions and perhaps can be applied to the EOS diagnosis and management pathways in RSCM."

"Upaya untuk memaksimalkan penggunaan antibiotik yang rasional merupakan salah satu tanggung jawab penting dari pelayanan farmasi. Penggunaan obat dikatakan rasional jika obat yang digunakan sesuai indikasi, kondisi pasien dan pemilihan obat yang tepat terkait jenis, sediaan, dosis, rute, waktu dan lama pemberian, mempertimbangkan manfaat dan resiko dari obat yang digunakan. Penggunaan antibiotik yang tidak tepat dapat menyebabkan pengobatan lebih mahal, efek samping lebih toksik, meluasnya resistensi dan timbulnya kejadian superinfeksi yang sulit diobati. Setelah melakukan pemantauan terapi obat pada pasien di ruang ICU RSUP Fatmawati, kesimpulan yang didapat: Pengobatan yang diterima oleh Nn. TRA sudah sesuai dengan indikasi penyakit, yaitu abses submandibularis, dengan frekuensi pengobatan dan dosis antibiotik juga dinilai sudah tepat. Pada Ny. AAH, didapatkan adanya obat yang tidak sesuai indikasi, yaitu tigecycline dan penggunaan meropenem serta levofloxacin juga tidak tepat dosis dan tidak tepat frekuensi pemakaian. Sepanjang penggunaan tigecycline, kondisi pasien justru memburuk hingga kemudian dinyatakan meninggal pada tanggal 11 April 2022 akibat gagal ventilasi dan sepsis pneumonia. Penggunaan tigecycline kemungkinan tidak efektif. Perhitungan DDD/100 patient-days, meropenem memiliki nilai DDD tertinggi,  kemudian disusul oleh amikasin, levofloxacin, metronidazole, dan tigecycline secara berurutan. Pada perhitungan DU 90 %, meropenem, amikacin, dan levofloxacin termasuk dalam segmen tersebut. Antibiotik yang memiliki nilai DDD/100 patient-days yang tinggi dan termasuk dalam segmen 90 % perlu diawasi penggunaannya dengan baik karena penggunaan yang tinggi dapat meningkatkan resiko terjadinya resisten antibiotik.

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Efforts to maximize the rational use of antibiotics is one of the important responsibilities of pharmaceutical services. The use of drugs is said to be rational if the drugs used are according to the indications, the patient's condition and the selection of the right drug regarding type, preparation, dose, route, time and duration of administration, considering the benefits and risks of the drug used. Inappropriate use of antibiotics can cause more expensive treatment, more toxic side effects, widespread resistance and the emergence of superinfections that are difficult to treat. After monitoring drug therapy on patients in the ICU at Fatmawati Hospital, the conclusion was obtained: The treatment received by Ms. TRA is in accordance with the indications of the disease, namely submandibular abscess, with the frequency of treatment and dosage of antibiotics also considered to be appropriate. To Mrs. AAH, it was found that there were drugs that were not according to indications, namely tigecycline and the use of meropenem and levofloxacin, which also included incorrect doses and incorrect frequency of use. Throughout the use of tigecycline, the patient's condition worsened until he was declared dead on April 11 2022 due to ventilation failure and pneumonia sepsis. The use of tigecycline may not be effective. Calculating DDD/100 patient-days, meropenem has the highest DDD value, followed by amikacin, levofloxacin, metronidazole, and tigecycline in sequence. In the 90% DU calculation, meropenem, amikacin, and levofloxacin are included in this segment. Antibiotics that have a high DDD/100 patient-days value and are included in the 90% segment need to be monitored carefully because high use can increase the risk of antibiotic resistance."