RESUMEN
Susceptibility to infection and increased antibiotic resistance place burn patients at risk of infection caused by multidrug-resistant organisms (MDRO). This condition can progress to sepsis, which can increase morbidity and mortality. A retrospective cohort study using medical record data of patients treated at RSUPN dr. Cipto Mangunkusumo in the period January 2020 to June 2022 was conducted. Of a total 160 subjects in the study period, 82.5% were aged <60 years, 16.88% had comorbidities, the most common cause of burns was fire (86.25%), the use of medical devices was 90.63%, with a median length of stay of 14 days. The most common Gram-negative MDRO pathogens were K. pneumoniae (29.91%), Enterobacter sp (22.32%) and Acinetobacter (20.54%): 45% of MDRO infected patients died. Bivariate analysis was conducted to find the effect of MDRO infection on burn patient mortality (RR 1,103; 95% CI 1,004-1,211, p=0.046). After adjusting for the role variables, namely: age, comorbidities, TBSA, use of medical devices, length of stay and multivariate analysis, it was found that the variables that had an effect on MDRO infection mortality were length of stay and age. MDRO infection has an effect on the mortality rate of burn patients. Mortality of burn patients due to MDRO infection is greater (45%) compared to non MDRO (21.43%). The most common Gram-negative MDRO pathogen is K. pneumoniae.
Leur sensibilité aux infections et l'augmentation globale de la résistance bactérienne font des brûlés des patients particulièrement à risque d'infections par BMR, pouvant déclencher sepsis/choc septique, qui augmentent morbidité et mortalité. Nous avons revu rétrospectivement les dossiers de 160 patients hospitalisés dans l'hôpital national Dr Cipto Mangunkusumo entre janvier et juin 2022. Parmi eux, 82,5% avaient moins de 60 ans ; 16,88% étaient comorbides ; 86,25% avaient été brûlés par flamme ; 90,63% avaient besoin de matériel invasif. La durée médiane de séjour était de 14 j. Les BGN BMR les plus fréquents étaient K. pneumoniæ (29,91%), Enterobacter (22,32%) et Acinetobacter (20,5%). La mortalité des patients infectés à BMR était de 45% (21,43% pour les non-BMR), avec une association significative BMR-mortalité (OR 1,103 ; IC95 1,004-1,211 ; p= 0,046). En explorant en analyse multivariée les variables classiquement associées à la mortalité (âge, comorbidités, surface brûlée, matériel invasif et durée de séjour), âge et durée de séjour contribuaient à la mortalité par BMR.
RESUMEN
OBJECTIVES: To establish the prevalence of HIV, syphilis, and sexual risk behaviour among three groups of men who have sex with men in Jakarta, Indonesia, and to investigate sexual links between these men and broader heterosexual populations. METHODS: Anonymous, cross sectional surveys among community recruited transgender and male sex workers and self recognised men who have sex with men (MSM) were undertaken in mid-2002 in Jakarta, Indonesia. Places where transgender and male sex workers sell sex and where men go to meet non-commercial male sex partners were mapped. Probability samples were selected for the sex worker populations, while a mixed probability and convenience sample was drawn for self recognised MSM. Blood was drawn for HIV and syphilis serology and community interviewers administered a standardised questionnaire. RESULTS: HIV prevalence was 22% among transgender sex workers, 3.6% among male sex workers, and 2.5% among self recognised MSM, and syphilis prevalence was 19.3%, 2.0% and 1.1% respectively. 59.3% of transgender sex workers and 64.8% of male sex workers reported recent unprotected anal intercourse with clients, and 53.1% of other MSM reported unprotected anal sex with male partners. Some 54.4% of male sex workers and 18.3% of other MSM reported female partners in the preceding year. CONCLUSION: HIV has reached substantial levels among transgender sex workers, and is not negligible in other MSM groups. Risk behaviour is high in all subpopulations, and bisexual behaviour is common, meaning the threat of a wider epidemic is substantial. Prevention programmes targeting male-male sex are needed to reduce this threat.