Development of a multiassay algorithm (MAA) to identify recent HIV infection in newly diagnosed individuals in Indonesia.

Ongoing HIV transmission is a public health priority in Indonesia. We developed a new multiassay algorithm (MAA) to identify recent HIV infection. The MAA is a sequential decision tree based on multiple biomarkers, starting with CD4+ T cells >200/µL, followed by plasma viral load (pVL) > 1,000 copies/ml, avidity index (AI) < 0 · 7, and pol ambiguity <0 · 47%. Plasma from 140 HIV-infected adults from 19 hospitals across Indonesia (January 2018 - June 2020) was studied, consisting of a training set (N = 60) of longstanding infection (>12-month) and a test set (N = 80) of newly diagnosed (≤1-month) antiretroviral (ARV) drug naive individuals. Ten of eighty (12 · 5%) newly diagnosed individuals were classified as recent infections. Drug resistance mutations (DRMs) against reverse transcriptase inhibitors were identified in two individuals: one infected with HIV subtype C (K219Q, V179T) and the other with CRF01_AE (V179D). Ongoing HIV transmission, including infections with DRMs, is substantial in Indonesia.

Hematology profile analysis in coronavirus disease 2019 (COVID-19) patients.

Objectives: Some hematological parameters were reported as markers to assess severity of COVID-19 patients. Comorbidities were risk factors for severe COVID-19. Differences in hematology profile based on severity and comorbidity, and correlation between hematology profile and Ct value were never studied at Makassar, Indonesia. The aim of this study were to know the differences of hematology profile based on severity and comorbidity, and the correlation between hematology profile and Ct value in COVID-19 patients. Methods: This study was retrospective, cross-sectional of confirmed COVID-19 patients who had been hospitalized at Dr. Wahidin Sudirohusodo hospital, Makassar, since June to August 2020. Hematology profile, Ct value, comorbidity, and severity of COVID-19 patients were obtained from Hospital Information System Data. Results: From 217 patients, subjects were 102 (47%) male dan 115 (53%) female, 127 mild-moderate patients (58.5%) and 90 severe patients (41.5%), 143 patients (65%) without comorbidity, 74 patients (35%) with comorbidity. White blood cells (WBC), red cell distribution width (RDW), neutrophil and monocyte count, and neutrophil lymphocyte ratio (NLR) were significantly higher in severe patients than mild-moderate patients (p<0.05), besides RBC, hemoglobin, hematocrit, lymphocyte and thrombocyte count were significantly lower in severe patients than mild-moderate patients (p<0.05). Hematology profile was not different significantly based on comorbidity and was not correlated significantly with Ct value, except eosinophil count (r=0.161; p=0.018). Conclusions: We suggest that hematology profile could predict the severity of COVID-19 patients. Moreover, eosinophil count could be considered to predict the infectivity of patient with COVID-19.

Excess mortality attributable to antimicrobial-resistant bacterial bloodstream infection at a tertiary-care hospital in Indonesia.

The burden of antimicrobial-resistant (AMR) infections in low and middle-income countries (LMICs) is largely unknown. Here, we evaluate attributable mortality of AMR infections in Indonesia. We used routine databases of the microbiology laboratory and hospital admission at Dr. Wahidin Sudirohusodo Hospital, a tertiary-care hospital in South Sulawesi from 2015 to 2018. Of 77,752 hospitalized patients, 8,341 (10.7%) had at least one blood culture taken. Among patients with bacteriologically confirmed bloodstream infections (BSI), the proportions of patients with AMR BSI were 78% (81/104) for third-generation cephalosporin-resistant (3GCR) Escherichia coli, 4% (4/104) for 3GCR plus carbapenem-resistant E. coli, 56% (96/171) for 3GCR Klebsiella pneumoniae, 25% (43/171) for 3GCR plus carbapenem-resistant K. pneumoniae, 51% (124/245) for methicillin-resistant Staphylococcus aureus, 48% (82/171) for carbapenem-resistant Acinetobacter spp., and 19% (13/68) for carbapenem-resistant Pseudomonas aeruginosa. Observed in-hospital mortality of patients with AMR BSI was 49.7% (220/443). Compared with patients with antimicrobial-susceptible BSI and adjusted for potential confounders, the excess mortality attributable to AMR BSI was -0.01 (95% CI: -15.4, 15.4) percentage points. Compared with patients without a BSI with a target pathogen and adjusted for potential confounders, the excess mortality attributable to AMR BSI was 29.7 (95%CI: 26.1, 33.2) percentage points. This suggests that if all the AMR BSI were replaced by no infection, 130 (95%CI: 114, 145) deaths among 443 patients with AMR BSI might have been prevented. In conclusion, the burden of AMR infections in Indonesian hospitals is likely high. Similar large-scale evaluations should be performed across LMICs to inform interventions to mitigate AMR-associated mortality.

Comorbidities and mortality in COVID-19 patients.

BACKGROUND: The high mortality rate in Coronavirus Disease (COVID-19) patients is associated with their comorbid conditions. Therefore, it is important to identify risk factors associated with poor outcomes among COVID-19 patients. The aims of this study were to find out the comorbidities in case of death due to COVID-19. METHODS: The design of this study was a retrospective descriptive method with a confirmed COVID-19 patient on hospitalized at Dr. Wahidin Sudirohusodo Hospital from March to September 2020. Ethics Council recommendation number: 357/UN4.6.4.5.31/PP36/2020. RESULTS: A total of 454 patients were included of this study. 78 (17.18%) patients death due to COVID-19, consisting of 52 (66.67%) male and 26 (33.33%) female. Range of ages between 18 and 85 years. The highest mortality rate occurred in the age group ≥60 years (35; 51.47%), followed by the age group of 45-59 years (33; 48.53%), and the age group of <45 years (10; 12%). The prevalent comorbidity was hypertension (42.31%), cardiovascular disease (30.77%), diabetes (28.21%), chronic kidney disease (23.08%), malignancy (15.38%), obesity (15.38%), chronic liver disease (7.69%), chronic respiratory disease (6.41%), immune related disease (3.85%), and non-traumatic cerebral infarction (3.85%). 41 (52.56%) patients reported having two or more comorbidities, and 37 (47.44%) only has one comorbidity. Elevated neutrophil-to-lymphocyte ratio (NLR) ≥3.13 was seen in the majority of patients (68; 87.18%). The mean value of NLR was 20.94. CONCLUSIONS: Hypertension, cardiovascular disease, and diabetes were the most common comorbidity in patients death due to COVID-19. More than half of the patients had two or more comorbidities.

Comorbidities and mortality in COVID-19 patients

Background: The high mortality rate in Coronavirus Disease (COVID-19) patients is associated with their comorbid conditions. Therefore, it is important to identify risk factors associated with poor outcomes among COVID-19 patients. The aims of this study were to find out the comorbidities in case of death due to COVID-19. Methods: The design of this study was a retrospective descriptive method with a confirmed COVID-19 patient on hospitalized at Dr. Wahidin Sudirohusodo Hospital from March to September 2020. Ethics Council recommendation number: 357/UN4.6.4.5.31/PP36/2020. Results: A total of 454 patients were included of this study. 78 (17.18%) patients death due to COVID-19, consisting of 52 (66.67%) male and 26 (33.33%) female. Range of ages between 18 and 85 years. The highest mortality rate occurred in the age group ≥60 years (35; 51.47%), followed by the age group of 45–59 years (33; 48.53%), and the age group of <45 years (10; 12%). The prevalent comorbidity was hypertension (42.31%), cardiovascular disease (30.77%), diabetes (28.21%), chronic kidney disease (23.08%), malignancy (15.38%), obesity (15.38%), chronic liver disease (7.69%), chronic respiratory disease (6.41%), immune related disease (3.85%), and non-traumatic cerebral infarction (3.85%). 41 (52.56%) patients reported having two or more comorbidities, and 37 (47.44%) only has one comorbidity. Elevated neutrophil-to-lymphocyte ratio (NLR) ≥3.13 was seen in the majority of patients (68; 87.18%). The mean value of NLR was 20.94. Conclusions: Hypertension, cardiovascular disease, and diabetes were the most common comorbidity in patients death due to COVID-19. More than half of the patients had two or more comorbidities. (AU)