PENAMPILAN DIAGNOSTIK AGAR KROMOGENIK SELEKTIF UNTUK SKRINING BAKTERI PENGHASIL EXTENDED SPECTRUM BETA-LACTAMASE (ESBL) PADA SAMPEL DASAR LUKA PASIEN INFEKSI ULKUS KAKI DIABETIK

JEFFRY BOYKE LONGDONG, r. Andaru Dahesihdewi, M.Kes., Sp.PK(K).; Dr. Med dr. Suwarso, Sp.PK(K).

2017 | Tesis-Spesialis | SP ILMU PATOLOGI KLINIK

Angka kejadian infeksi ulkus kaki bisa mencapai 80% pada pasien ulkus kaki diabetik. Perhatian utama pada infeksi ulkus kaki diabetik adalah kejadian organisme resisten multi obat terutama resistensi bakteri penghasil extended spectrum beta-lactamase (ESBL). Bakteri penghasil ESBL merupakan MDRO yang paling banyak ditemukan (65,7%) periode Juni 2015 hingga Mei 2016 di RSUP Dr. Sardjito Yogyakarta. Kegagalan deteksi resistensi ESBL sedini mungkin dapat menyebabkan kegagalan pengobatan dan berkontribusi dalam penyebaran resistensi bakteri penghasil ESBL. Berbagai media kromogenik selektif telah dikembangkan untuk skrining langsung dari sampel klinis. Penelitian ini bertujuan mengevaluasi penampilan diagnostik media agar kromogenik Brilliance ESBL dalam skrining bakteri penghasil ESBL dari sampel dasar luka pasien infeksi ulkus kaki diabetik. Penelitian ini menggunakan desain uji diagnostik. Agar kromogenik selektif Brilliance ESBL dibandingkan secara bebas dan tersamar dengan metode rujukan mikrodilusi kaldu otomatis untuk skrining bakteri penghasil ESBL dari sampel dasar luka pasien ulkus kaki diabetik. Kriteria inklusi penelitian ini adalah sampel dasar luka pasien klinis infeksi ulkus kaki diabetik yang menunjukkan mikroskopis presumptive Gram negatif batang. Kriteria eksklusi penelitian ini adalah tidak adanya pertumbuhan isolat klinis di agar MacConkey dan hasil identifikasi bakteri otomatis menujukkan hasil bakteri non-Enterobacteriaceae.Data klinis pasien diperoleh dari catatan medis. Validitas diagnostik dianalisis dan dilaporkan sebagai nilai sensitivitas, spesifisitas, nilai ramal positif-negatif dan rasio kemungkinan positif-negatif. Terdapat 115 isolat dari 113 pasien, terbanyak merupakan E. coli (48,7%). Terdapat 10 hasil positif palsu dan 2 negatif palsu. Metode agar kromogenik selektif Brilliance ESBL menghasilkan sensitivitas, spesifisitas, nilai ramal positif, nilai ramal negatif, rasio kemungkinan positif, rasio kemungkinan negatif secara berturut-turut 97,3%, 76,2%, 87,7%, 94,1%, 4,1, dan 0,04. Hasil positif palsu paling banyak ditemukan pada high level AmpC cephalosporinase E. coli. Metode agar kromogenik selektif Brilliance ESBL memiliki sensitivitas > 90% dan dapat digunakan untuk skrining bakteri penghasil ESBL pada sampel dasar luka pasien infeksi ulkus kaki diabetik. Perlu diperhatikan faktor-faktor yang mempengaruhi hasil-hasil positif dan negatif palsu pada pemanfaatan klinisnya.

Foot ulcer infection can reach 80% in diabetic foot ulcer patients. The main concern in diabetic foot ulcer infection is its incidenc Beta-lactamase (ESBL). Extended spectrum beta-lactamase was the most MDRO that found in patients specimen in Dr. Sardjito General Hospital from June 2015 until May 2016. The failure of ESBL resistance early detection leads to treatment inappropriate or failure and contributes to the uncontrolled spread of ESBL-producing bacteria. Chromogenic selective mediums have been developed for direct screening of clinical specimen. The aim of this study was to evaluate the validity performance Brilliance ESBL in detection of ESBL-producing bacterial from wound sample of diabetic foot ulcer infection patient. This was a diagnostic test study. Brilliance ESBL chromogenic agar diagnostic performance was compared independently and blindly to an automatic microdilution broth method as standard reference in detecting of ESBL-producing bacteria from wound sample of diabetic foot ulcer infection patient. This studyinclusion criteria was diabetic foot ulcer infection wound sample that showed the result of presumptive Gram negative bacillus. The specimen with no growth in MacConkey agar and automatic bacterial identification showed nonEnterobacteriaceae were excluded. Patients clinical data were obtained from medical records. Diagnostic validity were analyzed and reported as sensitivity, specificity, positive-negative predictive value and positive-negative likelihood ratio. There were 115 isolates found from 113 patient, with the most was E. coli (48.7%). The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio of Brilliance ESBL were 97.3%, 76.2%, 87.7%, 94.1%, 4.1, and 0.04, respectively. There were 10 false positives and 2 false negatives. The false positive result most found in high- levelAmpC cephalosporinase E. coli. Brilliance ESBL chromogenic agar method has sensitivity > 90% and can be used to screen ESBL producing bacteria from clinical specimen of diabetic foot ulcer infection patient. It should be noted the factors that affect the clinical use of false-positive and false-negative results.

Kata Kunci : infeksi ulkus kaki diabetik, ESBL, agar kromogenik selektif ESBL, mikrodilusi kaldu otomatis, skrining,