Sensitivitas ChromID ESBL untuk Skrining Isolat Klinis Klebsiella pneumonia Penghasil Extended Spectrum Beta-Lactamases (ESBL)
EMY NOERWIDAYATI, dr. Osman Sianipar DMM, MSc, Sp.PK(K).; dr. Andaru Dahesihdewi, Mkes, Sp.PK-K
2017 | Tesis | S2 Ilmu Kedokteran KlinikExtended-Spectrum Beta-lactamases (ESBL) adalah enzim yang menghidrolisis penisilin, sefalosporin (generasi pertama, kedua, ketiga), senyawa oxymino-Beta-laktam (aztreonam, tetapi bukan sefamicin dan karbapenem) dan dapat dihambat oleh inhibitor Beta-laktamase (klavulanat, sulbaktam dan tazobactam). Peningkatan resistensi Klebsiella spp. penghasil ESBL dapat berdampak buruk karena dapat meningkatkan angka morbiditas dan mortalitas serta menyebabkan beban ekonomi. Tujuan dari penelitian ini adalah untuk mengevaluasi sensitivitas media kromogenik ChromID ESBL dalam skrining isolat Klebsiella pneumonia penghasil enzim ESBL. Penelitian ini menggunakan desain uji diagnostik dimana media ChromID secara bebas dan tersamar dibandingkan dengan metode rujukan Double Disc Sinergy Test untuk deteksi isolat klinis K. pneumonia penghasil enzim ESBL. Subyek penelitian adalah isolat klinis K. pneumonia yang di identifikasi di Instalasi Laboratorium Klinis RSUP dr. Sardjito dari sampel klinis pasien. Data klinis pasien diperoleh dari catatan medis. Perbandingan deteksi oleh 2 metode selanjutnya dianalisis menggunakan tabel 2x2. Bahan pemeriksaan berasal dari 103 isolat, dengan sumber isolat terbanyak urin dan pus, dengan diagnosis terbanyak infeksi saluran kemih, gagal ginjal, ulkus diabetikum dan abses. Jumlah positif palsu 9 dan negatif palsu 2. Media kromogenik ChromID ESBL menghasilkan sensitivitas, spesifisitas, nilai ramal positif, nilai ramal negatif, likelihood ratio positif, likelihood ratio negatif secara berturut-turut 97,4%, 66,7%, 89,2%, 90%, 2,9, dan 0,03. Metode ChromID ESBL memiliki sensitivitas > 90% dan dapat digunakan untuk skrining isolat klinis K. pneumonia penghasil enzim ESBL. Untuk mengantisipasi hasil positif palsu dan negatif palsu, perlu mempertimbangkan beberapa faktor seperti tingkat keparahan penyakit, riwayat penggunaan antibiotik dan diagnosis yang melatarbelakangi.
Extended-Spectrum Beta-lactamases (ESBL) are enzymes which hydrolyze penicillin, cephalosporin (first generation, second, third), compound of oxymino-Beta-lactam (aztreonam, but not cephamicyn and carbapenems) but it is inhibited by Beta-lactamase inhibitor (clavulanate, sulbactam and tazobactam). Increased resistance of ESBL producing Klebsiella spp isolates can give rise to worse condition because it can increase morbidity, mortality as well as affects the economic burden. The purpose of this study is to evaluate sensitivity of chromogenic media ChromID ESBL to screening isolates K. pneumonia producing enzime ESBL. This is a diagnostic test study where the media ChromID is independently and blindly compared with the Double Disc Synergy Test to detect clinical isolate of ESBL-producing K. pneumonia. Subjects the study are clinical isolates of K. pneumonia identified in the Clinical Laboratory of Dr. Sardjito Hospital which are isolated from clinical samples of patients. Clinical data are obtained from a patient's medical records. Comparison detection by 2 methods next using analyzed statistics 2x2 tables. Substance examination are 103 isolates, substance isolates of the much urine and pus, with diagnosis infection urinary tractus, kidney failure, Diabetic ulkus and abses. Totally 9 false positive and 2 false negative. The chromogenic media ChromID ESBL has sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for positive result, and likelihood ratio for negative result of 97.4%, 66.7%, 89.2%, 90%, 2.9 and 0.03 respectively. Methods ChromID ESBL have sensitivity > 90% and can be used for screening for clinical isolates of ESBL-producing K. pneumonia. Anticipate the result of false positif and false negatif, need to consider several factors such severity of the disease, history of the use antibiotics and background diagnosis.
Kata Kunci : Infeksi KP-ESB, metode ChromID, ESBL, metode Double DiscSynergy Test, Extended-Spectrum Beta-lactamases (ESBL) are enzymes which hydrolyze penicillin, cephalosporin (first generation, second, third), compound of oxymino-Beta-lactam (aztreonam, but not ce
