Epidemiology of sepsis in hospitalised neonates in Indonesia: high burden of multidrug-resistant infections reveals poor coverage provided by recommended antibiotic regimens

Background Neonatal sepsis is a leading cause of child mortality, and this burden is rising secondary to increasing antimicrobial resistance worldwide. There are marked global disparities in the burden of antimicrobial resistance, with Southeast Asia identified as a region of particular concern. Indonesia is the world’s fourth most populous country, with 4.2 million babies born each year. Despite this, there remains limited published data on the burden of neonatal sepsis and antimicrobial resistance in the country. Methods We conducted a 2-year analysis of the epidemiology of neonatal sepsis across three high-burden clinical settings in Indonesia, alongside an antibiotic point prevalence prescribing survey. Results Of 5439 blood cultures analysed, gram-negative bacteria predominated as causative pathogens for neonatal sepsis in Indonesia, with Klebsiella spp and Acinetobacter spp most common (prevalence 35% and 19%, respectively). Overall, the pathogens causing neonatal sepsis exhibit very low susceptibility to WHO-recommended antibiotic regimens for the treatment of neonatal sepsis, with only 25% coverage provided by aminopenicillins plus gentamicin (95% credible interval (CI) 22% to 29%) and 20% by third-generation cephalosporins (95% CI 17% to 23%). Almost half of all antibiotics prescribed to treat neonatal sepsis across the clinical settings included in our study were Watch and Reserve antibiotics. Conclusion Our multicentre study across three sites in Indonesia revealed neonatal sepsis is predominantly caused by Gram-negative pathogens, with very poor coverage provided by currently recommended empiric regimens. A high burden of multidrug-resistant pathogens drives empirical use of broad-spectrum antibiotics. There is an urgent need for new antibiotic regimens and infection prevention and control strategies to treat neonatal sepsis in regions with a high prevalence of multidrug-resistant infections

The Standings of Tax Receivables in Bankruptcy Cases : A Study on Managing and Settling Assets

The state's privilege right to tax receivables in bankruptcy cases is regulated differently under various laws and court decisions in Indonesia. In general, tax receivables in bankruptcy have privilege position over other creditors, including secured creditors such as banks, mortgage holders, fiduciary guarantees and finance companies, preferential creditors and concurrent creditors. The creditor's tax debt to the state should be paid first before any payment to other creditors. However, the Director General of Tax under the Ministry of Finance of the Republic of Indonesia often faces problems in claiming the payment as the Ministry claims for the payment are always rejected by the Court. Each of the existing legal rules and decisions provides different answers to this problem, resulting in legal uncertainties. This research is conducted using the normative juridical approach and supported by the empirical analysis. The data collection is conducted by document studies and supported by court decisions. This research aims to inquire and analyse the position of tax receivables in the distribution of bankruptcy estate of debtors among other creditors, the role of the curators, both state and private curators, in the bankruptcy estate distribution in order to find a legal solution to the aforementioned issue according to the normative legal provisions that apply

Problems, Expectations, and Recommendation in Guidelines for Implementation of COVID-19 Prevention Health Protocols in the Workplace in Bali Province; a Qualitative Study

BACKGROUND: Formal and informal sector worker is encouraged as the agent of change in the new normal era. They are demanded to perform adequate health measures, stay productive, and prevent the spread of COVID-19. Health protocol guidance has been issued and introduced to guide the initiative of COVID-19 prevention and control. AIM: This study aimed to describe the issues encountered during the implementation of the health protocol, the expectation, and recommendations for the current health protocol guidance in the workplaces setting. METHODS: This qualitative study enrolled a descriptive-exploratory design. We explored that the issues and hindrances had encountered during the execution of the guidance, the expectation, and recommendation. Eligible study participants recruited by the purposive sampling technique. Data were collected on June 2021 by directing sessions of focus group discussion. The collected data then analyzed by the thematic approach employing QSR Nvivo 12. RESULTS: Several issues identified were the vagueness of the parties responsible for the oversight and enforcement function on several issues or fields, lack of intensive dissemination of the importance of health measures in preventing COVID-19 transmission by the authorized officers, and inadequate health measures implementation. Participants yearned for more comprehensive and clear technical guidance. Health promotion education also suggested being included in the guidance. CONCLUSION: This study proposed the establishment of a more comprehensive, clear, and brief guidance to induce its adequate execution of health measures or protocols.</jats:p