Background: The rate of Healthcare Associated Infection (HAI) in the ICU is five to seven times higher compared to general. The aim of this study was to determine the incidence and risk factors for HAI in the ICU at Dr. Cipto Mangunkusumo hospital. Methods: This study use retrospective data, adult patients age ≥ 18 years who were treated in ICU and suspected diagnosis of HAI (including Ventilator associated pneumonia, Catheter associated urinary tract infection, Central line associated bloodstream infection and Surgical site infection) in period from October 2022 – January 2023 were included in this study. We analyze the examination results of each specimen with identification, antibiotic susceptibility test and genomic data using whole genome sequencing. Results: There were a total of 160 specimens with 108 positive culture results. The organisms that most commonly cause infections from blood specimens are Klebsiella pneumoniae (3/11), Acinetobacter baumannii (1/11) and Pseudomonas aeruginosa (1/11). For sputum specimens, the causative pathogens obtained included K. pneumoniae (23/57), A. baumannii (11/57), and P. aeruginosa (9/57). Meanwhile, for urine specimen the main bacteria causing infection was K. pneumoniae (4/7). In the antibiotic suscpetibility test, the results showed Carbapenem Resistant Organisms (CRO), namely A. baumannii 89.5% (17/19), K. pneumoniae 76.3% (29/38), P. aeruginosa 40% (4/10), and E. coli 20% (1/5) with positive ESBL presentation are 15,8% in K. pneumoniae and 40% in E. coli. Conclusion: We found that the most common risk factor for HAI was the use of medical devices. HAI infections that occurred from all the specimens we took were mainly caused by Klebsiella pneumoniae. The results of antibiotic resistance are also a matter of note because there are many organism that cause HAI were also Carbapenem-resistant antibiotics with variations in resistance genes (CTX-M, CTX-M-1, SHV, TEM).

Background: The incidence of Healthcare Associated Infection (HAI) in the ICU is five to seven times higher compared to general. The aim of this study was to determine the incidence and risk factors for HAI in the ICU at Dr. Cipto Mangunkusumo hospital. Methods: This study use retrospective data, adult patients age ≥ 18 years who were treated in ICU and suspected diagnosis of HAI (including Ventilator associated pneumonia, Catheter associated urinary tract infection, Central line associated bloodstream infection and Surgical site infection) in period from October 2022 – January 2023 were included in this study. We analyze the examination results of each specimen with identification, antibiotic susceptibility test and genomic data using whole genome sequencing. Results: There were 160 specimens with 108 positive culture results. The organisms that most commonly cause infections from blood specimens are Klebsiella pneumoniae (3/11), Acinetobacter baumannii (1/11) and Pseudomonas aeruginosa (1/11). For sputum, the causative pathogens obtained included K. pneumoniae (23/57), A. baumannii (11/57), and P. aeruginosa (9/57). Meanwhile, for urine specimen the main bacteria causing infection was K. pneumoniae (4/7). In the antibiotic susceptibility test, the results showed Carbapenem Resistant Organisms (CRO), namely A. baumannii 89.5% (17/19), K. pneumoniae 76.3% (29/38), P. aeruginosa 40% (4/10), and E. coli 20% (1/5) with positive ESBL presentation are 15,8% in K. pneumoniae and 40% in E. coli. Conclusion: We found that the most common risk factor for HAI was the use of medical devices. Most of HAI infections that occurred in all specimens we took were caused by Klebsiella pneumoniae. Antibiotic resistance results show that many organisms that cause HAI are also resistant to Carbapenem antibiotics with variations in resistance genes (gene CTX-M, CTX-M-1, SHV, or TEM).

Introduction: Hundreds of millions of patients worldwide are infected with Healthcare-Associated Infections (HAIs) each year causing deaths and significant financial losses to health systems. HAIs incidence in Indonesia (2021) reached 15.74%, far above in developed countries (4.8-15.5%). At Premier Bintaro Hospital (RSPB), the number of High Care Unit (HCU) patients at risk of HAIs reached 51% in the January - June 2023 period. The aim of this research is to reduce the risk of HAIs in HCU patients at RSPB. Methods: The HAIs risk identification was conducted on all HCU patients when first admitted using the SIRS (Systemic Inflammatory Response Syndrome) and REDS (Risk Emergency Department Scoring) criteria. Based on the screening results, interventions were applied through environmental modifications, implementation of HAIs care bundle, and nurse allocation based on colour codes: At risk of infection as RED, and no risk of infection as GREEN. The risk monitoring was conducted using HAIs scoring. Results: The research was conducted in the January - June 2023 period on 206 patients. It was found that 51% of the patients were at risk of HAIs. After interventions, the number reduced to 39%. In addition, there were zero incidents of HAIs during that period. Conclusions: To control the risk of HAIs in HCUs, the implementation of risk screening & scoring and interventions such as environmental modifications, nurse allocation, and HAIs care bundle, have shown to be effective strategies. This is evident from the decrease in the number of patients at risk of HAIs.

Recommendations for hospital is to continue implementing risk control of HAIs by regularly assessing the risk, applying interventions, and consistently monitoring the risk as efforts in continuously reducing the HAIs risks. For future research, it is recommended to expand the sample of patients and extend the period to implement risk control of HAIs even further.

Acknowledgements: We are very grateful to all members of CCU team at Premier Bintaro Hospital for their contribution in implementing the methods and strategies of HAIs risk control in this study.

Introduced over a century ago, Whittaker–Henderson smoothing remains widely used by actuaries in constructing one-dimensional and two-dimensional experience tables for mortality, disability, and other life insurance risks. In this paper, we reinterpret this smoothing technique within a modern statistical framework and address six practically relevant questions about its use. First, we adopt a Bayesian perspective on this method to construct credible intervals. Second, in the context of survival analysis, we clarify how to choose the observation and weight vectors by linking the smoothing technique to a maximum likelihood estimator. Third, we improve accuracy by relaxing the method’s reliance on an implicit normal approximation. Fourth, we select the smoothing parameters by maximizing a marginal likelihood function. Fifth, we improve computational efficiency when dealing with numerous observation points and consequently parameters. Finally, we develop an extrapolation procedure that ensures consistency between estimated and predicted values through constraints.

Objectives: Infection with antibiotic resistant organisms has become a global problem, including in cases of pneumonia. Multi drug resistance organism (MDRO) has an impact on mortality, morbidity, and health costs. There are several risk factors that play a role in the incidence of MDRO in community acquired pneumonia. The purpose of this study was to analyze the risk factors for the incidence of MDRO in hospitalized patients with community acquired pneumonia at Wahidin Sudirohusodo Hospital. Methods: This study used an analytic observational method with a retrospective cohort. Data were taken from patient medical records from July-December 2023. Results: There were 49 (46.7%) MDRO and 56 (53.3%) non-MDRO. Based on statistical tests, MDRO infection is associated with comorbid malignancy (p value 0.002) and cardiovascular comorbidities (p value 0.015). The most common pathogens found were Acitenobacter baumanii (22.8%) and Klebsiella pneumonia (20%). Conclusions: Risk factors associated with the incidence of MDRO in community acquired pneumonia patients are malignancy and cardiovascular disease.

Objectives: Pneumonia is the leading cause of morbidity and mortality worldwide, eighth rank in the United States. The use of antibiotic for pneumonia theraphy contribute the highest rate compared to the usage of antibiotic therapy for other diseases. Antibiotic resistance can occur due to the irrational use of antibiotics. World Health Organization (WHO) predicts that by 2050 there will be 10 million people per year who die due to drug resistance. The Gyssens method is a tool to evaluate the quality of antibiotic use that has been widely used in various countries. The purpose of this study was to assess the compatibility of antibiotic use based on Gyssens plot categories in pneumonia patients. Methods: This study used descriptive-observational with a cross-sectional study in pneumonia patients at Dr. Wahidin Sudirohusodo Hospital on periode from July-December 2023. The compatibility of antibiotics was assessed using the Gyssens flow. Results: This study involved 116 subjects, 70 males, 46 females. In this study, found that the use of rational antibiotics is 58% and irrational 42%. From irrational group we obtained category IV (3%), IIIa (31%), IIIb (8%). The most often antibiotic that used are ceftriaxone (26,8%)) and azithromycin (26,3%). Conclusions: The use of antibiotic in pneumonia patients assessed using the gyssens method in the Inpatient Installation of Dr. Wahidin Sudirohusodo Hospital from July to December 2023 found that the usage for antibiotic is rational for 58%, of the total patient and irrational use was 42% of the total patient during the research study.

For cardinals $\mathfrak {a}$ and $\mathfrak {b}$, we write $\mathfrak {a}=^\ast \mathfrak {b}$ if there are sets A and B of cardinalities $\mathfrak {a}$ and $\mathfrak {b}$, respectively, such that there are partial surjections from A onto B and from B onto A. $=^\ast $-equivalence classes are called surjective cardinals. In this article, we show that $\mathsf {ZF}+\mathsf {DC}_\kappa $, where $\kappa $ is a fixed aleph, cannot prove that surjective cardinals form a cardinal algebra, which gives a negative solution to a question proposed by Truss [J. Truss, Ann. Pure Appl. Logic 27, 165–207 (1984)]. Nevertheless, we show that surjective cardinals form a “surjective cardinal algebra”, whose postulates are almost the same as those of a cardinal algebra, except that the refinement postulate is replaced by the finite refinement postulate. This yields a smoother proof of the cancellation law for surjective cardinals, which states that $m\cdot \mathfrak {a}=^\ast m\cdot \mathfrak {b}$ implies $\mathfrak {a}=^\ast \mathfrak {b}$ for all cardinals $\mathfrak {a},\mathfrak {b}$ and all nonzero natural numbers m.

Introduction: In the Intensive Care Unit(ICU), healthcare-associated infections can arise from factors such as compromised patient immunity and the use of diverse medical equipment. Furthermore, inadequate awareness of infection control among ICU staff can further increase the risk of infections. Therefore, it is crucial for ICU staff to recognize and address infection risks proactively. To enhance infection control measures, designated infection control facilitators within the department have spearheaded infection control activities. Case Presentation: Internal assessments within the ICU identified areas requiring improvement in infection control, leading to the formulation of a self-improvement initiative. The evaluation results revealed deficiencies in pre- hub disinfection and the appropriateness of Chlorhexidine gluconate(CHG) bathing. To address this, ICU team members were tasked with monitoring hand hygiene and performing pre-hub disinfection at least 10 times before central venous catheter usage. The monitoring results were shared with department members monthly, encouraging performance improvement by rewarding outstanding employees. Additionally, protocols and educational videos for proper CHG bathing were developed within the ICU and reviewed by the Infection Control Department. Using this material, internal education sessions were conducted within the ICU to support all team members in achieving their goals. Discussion: Through various improvement initiatives, staff awareness of infection control has increased, leading to proper CHG bathing and hub disinfection. The incidence rate of central venous catheter-related bloodstream infections decreased from 4.25 in 2022 to 3.35 in 2023. Additionally, hand hygiene compliance increased from 92% in 2022 to 96% in 2023. For effective infection management, the participation of not only the Infection Control Department but also departmental members is crucial. Through effective collaboration and discussions between ICU staff and the infection control team, we were able to address departmental issues, improve staff awareness and performance in infection management. Sustained interest and participation in these activities require continuous staffing and support.

Background: The prevalence of surgery in Indonesia is increasing every year and may increase the prevalence of surgical site infection (SSI). SSI is an infection in the surgical site organ or space that occurs after surgery. Complex treatment of SSI has a significant impact on patient outcomes due to increased length of stay. There are a variety of risk factors, both endogenous and exogenous, that can affect the length of stay of SSI patients, especially the concentration of serum albumin before and after surgery. Albumin is an important component of proteins. Albumin plays a role in promoting inflammation, so tissue repair is done more quickly, and without albumin, the body is more difficult to carry out cell regeneration. This study aimed to determine the relationship between pre- and post-operative concentrations of albumin and duration of stay in SSI patients. Method: The study design used a quantitative study using cross-sectional secondary data from the medical records of 40 patients diagnosed with SSI at Gatot Soebroto Army Hospital. All SSI patients met the inclusion criteria. Results: The results showed that patients had moderate hypolbuminemia before surgery (35%) and after surgery (35%), long-term stay (50%), 19-60 years (77,5%), women (52,5%), comorbidities (50%), malnourished nutrition (60%), ASA score 2 (52,5%), clean surgical wound type (60%), abdominal or vaginal hysterectomy (17,5%), and showed that it has the characteristics of a normal operation period. (65%) Bivariate analysis using assay chi-squared shows a relationship between pre-operative serum albumin (p-value =0.005; PR=7.207; 95% CI=1.09-47.55) and post-operative (p-value=0.016; PR=3.857; 95% CI=1.05-14.08) with duration of stay in SSI patients. Concentration. Multivariate results indicate serum albumin preoperative concentration (p-value = 0.049). Conclusion: It can be concluded that serum albumin preoperative concentration is the only variable that greatly affects the length of stay of SSI patients.

Case Presentation: A 68 year old man. Hospitalized with decreased consciousness. Experienced severe shortness of breath 3 days before entering the hospital. The patient also had wounds on his right and left legs since 1 month ago. But then became more widespread. The patient has kidney failure and routinely undergoes hemodialysis. The patient had diabetes since 6 years ago. Laboratory: Hemoglobin 7.5 Leukocytes 17.8 Netrophils 91.70 Lymphocytes 4.20 Albumin 2.2 Creatinine 2.5 Ureum 61 Artery 2.30, urine bacteria+++. Pus culture results: Enterobacter cloacae with the antibiotic meropenem. Sputum culture results Klebsiella pneumoniae ss. Pneumoniae with amikacin. After 1 week pus culture results: Pseudomonas aeruginosa with amikacin. Blood culture results: Staphylococcus epidermidis suggested vancomycin. The patient underwent debriment in the operating room. However, the condition did not improve. Discussion: This patient experienced sepsis with MDRO. Apart from geriatric age, the patient also has diabetes with complications of kidney failure. This worsens the patient’s immune system. So the patient’s diabetic ulcers and decubitus ulcers worsened with the results of cultures with various antibiotic-resistant multiorganisms. And also the respiratory infections increase the risk of mortality. Conclusion : MDRO is a risk factor for inappropriate antibiotic therapy, which is undoubtedly associated with increased mortality.

Figure :

Diabetic ulcers and decubitus ulcers in patient

Background/Objectives: CSF shunts are widely used in neurosurgery practice for temporary or permanent CSF diversion. Patients on CSF shunts are at risk of device-associated CNS infections particularly ventriculitis or meningitis. The study objectives were to delineate the risk factors and infection rates for various shunt procedures and their microbial etiology. Methods: This is a single center prospective cohort study. The study period was 2 years (October 2020- September 2022). Patients were categorised using IDSA criteria as Contamination or Colonisation or Infection. Device days were also collected from the Hospital information system (HIS) for calculation of infection rates. Microbial etiology was identified by culture of CSF and shunt catheter tips. Cox regression model was used to estimate hazard risk for various risk factors. Results: During the 2-year study period, 161 shunts were inserted.133 were ventriculo-peritoneal (VP) shunts, 19 were lumbo-peritoneal (LP) shunts, 6 were subduro-peritoneal (SDP) shunts, 2 were syringo- subarachnoid (SS) shunt and 1 cysto-peritoneal (CP) shunt. Hydrocephalus was the commonest indication for a shunt insertion (71.4 %). There were 8 VP shunt and 1 LP shunt infections during the study period. The average infection rates for VP and LP shunts were 6 and 5.2 per procedure, respectively. Gram negative bacteria caused most of the shunt infections (7/9, 77%). The most common organism causing shunt infection was Klebsiella pneumoniae (n=4, 44%), followed by Staphylococcus aureus (n=2, 22%). The risk factors which were independently associated with increased risk for shunt infection were Pre-OP ASA score >3 [HR:8.28, p - 0.013], presence of associated perioperative systemic [HR:3.89, p-0.01] or scalp infections [HR:3.53, p-0.005]. Conclusion: VP and LP shunt infection rates were similar in our study. Klebsiella pneumoniae was the commonest causative agent causing shunt infection. High Pre-OP ASA score and associated perioperative scalp or systemic infections were independent risk factors for shunt infection.

Introduction: Bloodborne pathogens’ exposures are defined as injuries to contaminated sharps and exposures to patients’ blood or body fluids continue to present risks to healthcare workers (HCWs). This study was conducted to investigate the epidemiological characteristics of sharps injuries and evaluate the effectiveness of prevention strategies in an Academic Medical Centre (AMC) in Singapore. Method: This retrospective study was conducted at a 1,700 bedded AMC. The data was retrieved from the hospital’s electronic incident reporting system over a five-year period between 2019 and 2023 at Singapore General Hospital. Results: There are a total of 719 bloodborne pathogens’ exposures incidents. The highest incidence of bloodborne pathogens’ exposures was reported among doctors (3.5 incidents per 1000 healthcare workers per month), followed by nurses (1.4), allied health (0.4) and ancillary staff (0.3) during the 5- year period. Intraoperative procedures (IOP) 198 (27.5%) see the most frequent incidents followed by minor procedures 112(15.6%), splash incidents 91 (12.7%), blood taking 87(12.1%), IVIM (8.3%). The highest incidents among IOP were associated with use of suture needles. Approximately 2.9%, 2.3% and 0.7% of the source patients were carriers for Hepatitis B, Hepatitis C and HIV respectively. No seroconversion occurred among all injured HCWs. The overall sharps injury incidence has improved from 21.5 to 11.2 per 1000 healthcare workers per year following targeted preventive measures implementation. Conclusion: A comprehensive bloodborne pathogen exposures programme greatly helps to improve and mitigate the risk of exposures where key preventive measures are identified, followed by timely implementation of appropriate post-exposure management.

This article shares a unique form of public humanities created with an ethical community partnership between a university team, a community nonprofit organization, and a museum. Our podcast focuses on the stories of the staff of an organization that is affiliated with the International Rescue Committee and that resettles refugees, asylees, and immigrants. Most of the staff were immigrants themselves and shared their experiences as both outsiders and insiders in the communities that they serve. Given this historical moment of intense anti-immigrant sentiment, we aim for this podcast to serve for conversation and education about immigration not only in our local area but also in similar small cities and towns. Our podcast takes place in an upstate region of New York, approximately 200 miles outside of the city. We share our experience of putting into practice the methods and concepts drawn from public humanities, critical community engagement, ethnic studies, digital humanities, and podcast studies.

Objectives: The incidence of hospital-acquired infections (HAIs) related to the formation of biofilms reaches 80% of the total cases of infection in the world. It can infect patients using invasive medical equipment such as orthopaedics implants. Biofilm-related implant orthopaedics infections account for approximately 65% of all bacterial infections. Once bacteria adhere to the implant, a bacterial community established biofilm that can enhance resistance to antibiotics up to 1000 times. Therefore, an appropriate strategy is needed to eradicate biofilm. Chlorhexidine as an antiseptic and levofloxacin as an antibiotic are often used in the orthopaedics’ setting. This study investigated in vitro antibiofilm activity of chlorhexidine and levofloxacin against bacterial isolates obtained from patient with implant orthopaedics-related infections. Methods: Ten clinical isolates of bacteria with strong biofilm-producer were collected from patients with orthopaedics implant-related infections including Staphylococcus aureus (n=2), Staphylococcus haemolyticus (n=1), Serratia marcescens (n=2), Pseudomonas aeruginosa (n=2), Proteus mirabilis (n=1), Acinetobacter baumannii (n=1) and Klebsiella pneumoniae (n=1). The inhibition and eradication activity of chlorhexidine and levofloxacin on biofilm growth were performed using microtiter broth dilution method in 96-well plates. The minimum biofilm inhibitory concentration (MBIC) and minimum biofilm eradication concentration (MBEC) were determined using the MTT (3-(4-5- dimethylthiazol-2-yl)2,5-dyphenyl tetrazolium bromide) reduction assay. Results: This study found that chlorhexidine inhibited the growth of Gram-positive bacterial biofilms by 80% with MBIC80 values ranged from 4-16 μg/ml and eradicated 80% of biofilm with MBEC80 value was 32 μg/ml. For Gram-negative bacterial biofilms, the ability of chlorhexidine to inhibit 80% of biofilm growth was indicated by MBIC80 values ranged from 8-16 μg/ml and to eradicate 80% of biofilm with MBEC80 values ranged from16-64 μg/ml. Meanwhile, levofloxacin can inhibit the growth of Gram- positive bacterial biofilms by 80% with MBIC80 values ranged from 1-4 μg/ml and can eradicate 80% of biofilm with MBEC80 values ranged from 16-32 μg/ml. For Gram-negative bacterial biofilms, the MBIC80 values of levofloxacin ranged from 1-16 μg/ml and the MBEC80 values ranged from 4-32 μg/ml. Conclusions: This result indicated that chlorhexidine and levofloxacin are potential to inhibit and eradicate bacterial biofilm. However, further studies need to be done for clinical evaluation.

High BMI is an important risk factor for female colon and rectal, ovarian and uterine cancers. Current comprehensive studies on its effects on these cancers are limited. This paper aims to explore regional and age differences in the impact of high BMI on these cancers and the commonalities among the three by using the Global Burden of Disease 2021. Deaths, disability-adjusted life years and their age-standardised rates for these cancers were retrieved from 1990 to 2021, and burden trends were assessed using the estimated annual percentage change and percentage changes. The study also analysed the correlation between age-standardised rate and socio-demographic index across twenty-one regions and projected future disease burden trends using the Bayesian Age-Period-Cohort model. Results showed that the global burden of female colon and rectal cancer declined since 1990 but remained at the highest level among the three cancers in 2021. At the same time, these three cancers had high burdens in high-income areas. Since 1990, ovarian and uterine cancer burdens attributable to high BMI increased, and all three burdens grew fastest in low-middle-income regions and among younger people. The burden of all three is projected to continue increasing through 2050. This study confirms that high BMI’s impact on these cancers is regional and age-specific, with long-term effects. Therefore, subsequent public health interventions should adopt more targeted obesity prevention and control strategies based on national and regional situations to effectively mitigate the adverse effects of high BMI on these cancers.

Objectives: Management of outbreaks of the newly emerging pathogen Candida auris may include use of antimicrobial wash-mitts for decolonization. In the absence of large-scale clinical trials, the immediate assessment of the efficacy claims for these products can be based on in vitro experimental data that follows the standard protocols established by CEN (European committee for Standardization). In this study, the chemical tolerance of C. auris was compared with the surrogate test organism Candida albicans as established in the European standards (EN). Methods: The study was conducted following the protocol for the quantitative suspension test EN 13624 using C. albicans ATCC 10231 in comparison to C. auris DSMZ 21092 and C. auris DSMZ 105986. Two commercially available wash-mitts containing chlorhexidine digluconate (CHG) or octenidine dihydrochloride (OCT) were used. Experiments were conducted using the impregnation liquid squeezed from the wash-mitts at different dilution concentrations between 0.5% to 97% at a contact time of 30 sec in the presence of 0.03% bovine serum. Results: Yeasticidal efficacy according to EN 13624 was found for the OCT wash-mitts at 30 sec at ≥ 10% concentration with C. albicans (≥ 4 log RF). In comparison, for both C. auris strains ≥ 4 log RF was found at a much lower concentration of ≥ 1%. For the CHG wash-mitts efficacy against C. albicans was below 2 log RF at 97% concentration within 30 sec. In contrast efficacy against the two C. auris strains was around 3 log RF. Conclusion: In conclusion, both C. auris strains were found to be significantly more susceptible when compared to C. albicans in this study. Moreover, our data also demonstrates that not all antiseptic-impregnated body wipes is equally effective against C. auris with OCT having a higher efficacy compared to CHG.

Introduction: Purulent pericarditis is defined as an infection in the pericardial space that produces macroscopically or microscopically purulent fluid. It was a rare but life-threatening condition. It may be primary or secondary to another infectious process. The diagnosis can only be confirmed by pericardiocentesis. Treatment must include drainage of the pericardial space combined with systemic antibiotics. This case report focuses on a critical and rare clinical scenario of purulent massive pericardial effusion in an 85- year-old male patient. This condition, characterized by an infectious or inflammatory accumulation of fluid in the pericardial cavity, presents significant diagnostic and therapeutic challenges, particularly in the context of multiple comorbidities. Case Description: The patient’s presentation, complicated by pneumonia, diabetes mellitus (DM), and heart failure, underscores the complexities in diagnosing and managing elderly patients with diverse medical backgrounds. The diagnosis of massive pericardial effusion was confirmed through echocardiography, which revealed the purulent fluid from pericardiocentesis procedure, a finding critical for guiding the diagnostic and management strategy. The source of infection wasn’t clear in patient with immunocompromised condition. Some examination performed to find the source of infection that led to a subdiaphragmatic suppurative focus. Infection management was good, but the patient ended with a constrictive that make his condition worse. The patient passed away on the 10th day of hospitalization. Conclusion: It is importance to recognize and promptly address purulent massive pericardial effusion in elderly patients with complex medical histories. The successful clinical outcome following the pericardiocentesis and the adaptive antimicrobial treatment approach provides valuable insights into the management of this severe condition.