MRSA infection in patients hospitalized at Sanglah Hospital: a case series.

This is the first report of MRSA infection in Sanglah Hospital. We reviewed eight patients with MRSA infection from microbiologi laboratory records between January and May 2011, than followed by tracing medical records to obtained data of the patients. Five of cases with sepsis, 1 case with osteomyelitis, and the two others with mediastinitis and pneumonia. The patients were kept in private isolated room and barrier-nursing technique was strictly followed. Further action was culturing specimen taken from the patients nose, throat, axilla, and samples taken from the health care workers, with no MRSA colonization were found. Five patients demonstrated good respond to intravenous administration of either vancomycin or linezolide. Three were died due to septic shock before the laboratory culture and antimicrobial susceptibility availabled. All of the strains isolated more than 48 hours after admission and also demonstrated clinical risk factors for hospitalized acquired MRSA (HA-MRSA). These strains had resistance to b-lactams but remain susceptible to many non b-lactam antibiotics, as reported in some community acquired MRSA (CA-MRSA) isolates. Future study using molecular typing required to fully understand the magnitude and ongoing evolution of MRSA infections.

Factors influencing bone mineral density in ARV-naive patients at Sanglah Hospital, Bali.

AIM: to evaluate factors which influence bone mineral density in ARV-naive patients in Sanglah Hospital, Bali. METHODS: a cross-sectional BMD measured by dual X-ray absorptiometry at the lumbar spine (LS) and femoral neck (FN) in 73 ARV-naive HIV-infected patients in out patient clinic of Sanglah Hospital, consecutively, from January to June 2012. Inclusion criteria are ARV-naive HIV-infected patients age 13-50 year old. The relationship among factors influence BMD, CD4 level, HIV RNA, HIV stage (WHO) analysed with Anova and Spearman's correlation test. RESULTS: this study involved 49 males and 24 females. Mean age was 33.08±8.29. Mean CD4 was 144.71±143.40 cell/mmc with the lowest CD4 is 1. Mean viral load (VL) was 272.330±282.990 copies/ml, the lowest VL 400 copies/ml, and the highest 750 000 copies/ml. Low BMD found in 32/73 (43.8%). Osteopenia and osteoporosis were diagnosed in 26/73 (35.6%) and 6/73 (8.2%). 13 (40.6%) of the low BMD cases occurred on the age group 21-30 year. Significant correlation found between low BMD with HIV stage (r=0.337; p<0.001). CONCLUSION: patients with higher HIV stage have higher risk of low BMD in ARV-naive patient. Further study is needed to evaluate correlation of low BMD with its risk factors.

Correlation of CD4/CD8 Ratio with Carotid Intima-Media Layer Thickness in HIV/AIDS Patients at Sanglah General Hospital, Bali, Indonesia.

BACKGROUND: The discovery of antiretroviral (ARV) drugs in 1996 led to a shift in the causes of mortality and morbidity of patients with HIV/AIDS. Initially, the cause of mortality and morbidity was associated with opportunistic infection HIV/AIDS-related complication, but now are more associated with non-AIDS complication such as cardiovascular disease. Atherosclerosis is a major cause of cardiovascular disease. The atherosclerosis was assessed by measuring carotid intima-media thickness (CIMT) using B mode ultrasound (USG), which is one of the diagnostic tools in indicating the presence of atherosclerotic plaque. AIM: This study aims to evaluate the ratio of CD4 / CD8 towards carotid intima-media thickness. METHODS: Design of study was analytic cross-sectional. This study was conducted in May - July 2017 in HIV patients who taken consecutively came to the VCT polyclinic of Sanglah hospital. Statistical analysis used Spearman correlation test to evaluate the correlation between the CD4/CD8 ratio and carotid intima-media thickness and multiple linear regression to predict carotid intima-media thickness through CD4/CD8 ratio. RESULTS: Total from 50 samples, data characteristic were 33 males (66%) and 17 females (34%), mean of age 30.60 ± 5.58 years, median of CD4/CD8 ratio 0.275 (0.02-1.39) and median of CIMT 0.75 (0.4-1.5) mm. There is a strong negative correlation (r = -0.85; p = 0.001) CD4/CD8 ratio with CIMT. The calculation of the prediction of carotid intima media thickness can be calculated through the equation Y = 0.727 -0.791 (X1) + 0.012 (X2), where X1 is CD4/CD8 ratio and X2 is the age of the patient. CONCLUSION: there is a significantly strong negative correlation between the CD4/CD8 ratio and CIMT in HIV patient who comes to VCT polyclinic of Sanglah Hospital. The smaller CD4/CD8 ratio, the value of CIMT will be thicker, and vice versa.