Prevalence of Antimicrobial Resistance of ESKAPE Pathogens before and during Pandemic COVID-19 Pandemic in a University Affiliated Hospital in Tangerang, Indonesia

Introduction: Antimicrobial resistance is the most important health problems currently. Antibiotic prophylaxis to prevent bacterial co-infections in hospitalized COVID-19 patients, and lack of surveillance were associated with antimicrobial resistance. ESKAPE pathogens consisting of E. faecium, S. aureus, K. pneumoniae, A. baumanii, P. aeruginosa and Enterobacter spp. are associated with healthcare-associated infections. Patients and Methods: This descriptive, retrospective, longitudinal study aims to describe the resistance rates of bloodstream infection due to ESKAPE pathogens from patients admitted in Siloam Hospital Karawaci, before and during COVID-19 pandemic (January 1st, 2019 until December 31st, 2022). Out of 296 ESKAPE pathogens collected from blood samples, S. aureus was the most frequent species, followed by K. pneumoniae, A. baumannii, P. aeruginosa, Enterobacter spp., and E. faecium. Results: Resistance rates of E. faecium were alarmingly high from 2019 until 2021, but in 2022 no sample was found. Resistance rates of S. aureus and MRSA decreased from 2019 until 2021 and then increased again in 2022 while for K. pneumoniae it peaked in 2020 and reached the lowest in 2022. Resistance pattern of A. baumanii was not favorable from 2019 until 2021, but decreased dramatically in 2022. Resistance pattern of P. aeruginosa was quite variable in 2021 and 2022 while for Enterobacter spp. it was variable in 2020 to 2022. Conclusion: The COVID-19 pandemic affected the antimicrobial resistance pattern of ESKAPE pathogens in Banten province, Indonesia. Resistance rates increased as the pandemic peaked in 2020 to 2021, and decreased as the pandemic resolves in 2022.

Adverse Skin Reactions to Personal Protective Equipment Among Health-Care Workers During COVID-19 Pandemic: A Multicenter Cross-sectional Study in Indonesia

Objective:Health-care workers(HCWs)in Indonesia have been participating in the war against the coronavirus disease-2019 since March 2020.Ever since HCWs were exposed to the regular use of personal protective equipment(PPE)with varying levels and maintain hand hygiene more as recommended by the World Health Organization.Adverse skin reactions to PPE in Indonesia has yet to be acknowledged.This study aimed to study the prevalence and characteristics-,possible risk factors-,and suggest possible solutions towards adverse skin reactions to PPE among HCWs in a multi-center setting of Indonesia.Methods:A cross-sectional survey was conducted online among HCWs in the Siloam Hospitals Group of Banten province.HCWs of Banten Province were surveyed from June 1 to August 31,2020.The data was obtained using avalidated online survey questionnaire including(1)demographic characteristics;(2)occupational-related characteristics;(3)adverse skin reactions.Results:A response rate of 40.2%was obtained and 200 valid respondents were yielded.The mean age of respondents was(26.94±7.23)years old.Adverse skin reactions(66.5%)were reported primarily in female(73.7%)working as doctors(82.7%)of a non-referral center for coronavirus disease-2019(60.2%)wearing level 2 and 3 PPE(43.6% and 37.6%,respectively).The cheeks and chin was the most common site involved(69.9%)with dryness/tightness(63.9%)and acne(77.4%)as the highest symptoms and signs reported.Sex,age group classification,level of PPE worn,hand hygiene frequency,and duration of PPE worn daily were factors considerably associated with adverse skin reactions to PPE(P<0.05).Conclusions:Adverse skin reactions to PPE are common among HCWs in Indonesia.Comprehensive strengthening of the skin condition and awareness on adverse skin reactions should be advocated.