PROPORSI KLEBSIELLA PNEUMONIAE ISOLAT KLINIK PENGHASIL EXTENDED SPECTRUM BETA LACTAMASE (ESBL)BESERTA POLA KEPEKAANNYA TERHADAP ANTIBIOTIKA DI RSUP DR SOERADJI TIRTONEGORO KLATEN

KIAN SINANJUNG, dr. Abu Tholib Aman, M.Sc, Ph.D, Sp.MK(K).; Dr. dr. Hera Nirwati, M.Kes, Sp.MK

2019 | Tesis-Spesialis | Mikrobiologi Klinik

Pendahuluan: Peningkatan prevalensi bakteri K. pneumoniae penghasil enzim ESBL terjadi secara global. K. pneumoniae penghasil ESBL mempunyai pola kepekaan bervariasi di berbagai negara. Oleh karena itu diperlukan investigasi K. pneumoniae penghasil ESBL beserta pola kepekaannya. Tujuan: mengetahui proporsi K. pneumoniae isolat klinik penghasil ESBL serta melihat pola kepekaannya terhadap antibiotika Metode: K. pneumoniae diisolasi dari spesimen klinik penderita yang berobat di RSUP dr. Soeradji Tirtonegoro Klaten. Identifikasi K. pneumoniae dilakukan dengan pemeriksaan morfologi koloni, pemeriksaan mikroskopik, dan uji biokimia menggunakan Microbact TM GNB 24E (Oxoid, UK). Uji kepekaan antibiotika dan skrining ESBL menggunakan disk ceftazidime, cefotaxime, dan ceftriaxone (Oxoid, UK) dengan metode disk difusi berdasarkan CLSI M100-28. Hasil skrining positif akan dikonfirmasi dengan Modified Double Disk Synergy (MDDST) menggunakan disk amoxicillin-clavulanate, ceftazidime, cefotaxime, dan cefepime (Oxoid, UK). Hasil: Selama Juni 2017-Mei 2018 dapat diidentifikasi 168 (17,46%) isolat K. pneumoniae dari 962 total isolat klinik bakteri. K. pneumoniae paling banyak didapatkan dari ruang perawatan intensif (29,17%) dan paling sering diisolasi dari sputum (45,24%). Sebagian besar isolat K. pneumoniae telah resisten terhadap antibiotika. Sensitivitas K. pneumoniae lebih dari 80% dari spesimen saluran pernafasan didapatkan terhadap amikacin, meropenem, piperacillin-tazobactam, dan levofloxacin. Demikian juga gentamicin, meropenem, piperacillin-tazobactam, dan amikacin merupakan antibiotika dengan sensitivitas lebih dari 80% dari spesimen luka. Sebanyak 52,98% (89/168) isolat K. pneumoniae merupakan penghasil ESBL, yang paling banyak didapatkan dari ruang perawatan intensif (41,57%), dan spesimen tersering berasal dari sputum (40,45%). K. pneumoniae penghasil ESBL juga resisten terhadap banyak antibiotika. K. pneumoniae penghasil ESBL yang diisolasi dari saluran pernafasan mempunyai sensitivitas lebih dari 80% terhadap amikacin, piperacillin-tazobactam, dan meropenem. Kesimpulan: K. pneumoniae penghasil ESBL sebesar 52,98% dari keseluruhan isolat K. pneumoniae. K. pneumoniae penghasil ESBL pada saluran pernafasan mempunyai sensitivitas lebih dari 80% terhadap piperacillin-tazobactam, amikacin, dan meropenem.

Background: Globally, the prevalence of K. pneumoniae producing ESBL has been increasing steadily. The susceptibility patterns of ESBL-producing K. pneumoniae varies considerably among countries. Therefore, the investigation of ESBL-producing K. pneumoniae clinical isolates and their susceptibility are warranted. Objective: To determine the proportion of ESBL producing K. pneumoniae and its susceptibility pattern to antibiotics. Methods: K. pneumoniae was isolated from clinical specimens at dr. Soeradji Tirtonegoro Hospital Klaten. Identification of K. pneumoniae was performed by analyzing colony morphology, microscopic examination, and biochemical testing using Microbact TM GNB 24E (Oxoid, UK). Both antibiotic susceptibility testing and ESBL screening (using ceftazidime, cefotaxime, and ceftriaxone discs, Oxoid, UK) were conducted using disc diffusion method in concordance with CLSI M100 28th Edition. The positive results were confirmed with Modified Double Disk Synergy (MDDST) using amoxicillin-clavulanate, ceftazidime, cefotaxime, and cefepime discs (Oxoid, UK). Results: From June 2017 to May 2018, 168 (17.46%) isolates were identified as K. pneumoniae from 962 clinical bacterial isolates. K. pneumoniae were mainly from intensive care unit (29.17%) and of sputum origin (45,24%). Most K. pneumoniae isolates were resistant to antibiotics. Sensitivity K. pneumoniae to antibiotic of more than 80% from respiratory specimen was found against amikacin, meropenem, piperacillin- tazobactam, and levofloxacin. Likewise K. pneumoniae isolates from wound specimen have a sensitivity more than 80% against gentamicin, meropenem, piperacillin- tazobactam, and amikacin. ESBL producers comprised of 52.98% total ESBL producers isolates. ESBL-producing K. pneumoniae were majority from intensive care unit (41.57%) and isolated from sputum (40.45%). ESBL K. pneumoniae were also resistant to many antibiotics. The sensitivity of ESBL K. pneumoniae isolated from respiratory tract against piperacillin-tazobactam, amikacin, and meropenem was more than 80%. Conclusion: Among all K. pneumoniae isolates, ESBL K. pneumoniae was 52.98%. ESBL K. pneumoniae from respiratory tract specimens had a sensitivity of more than 80% against piperacillin-tazobactam, amikacin, and meropenem.

Kata Kunci : K. pneumoniae, ESBL, MDDST, RSUP dr Soeradji Tirtonegoro, Klaten, K. pneumoniae, ESBL, MDDST