SENSITIVITAS PEMERIKSAAN CHROM ID ESBL DALAM DETEKSI KLEBSIELLA PNEUMONIAE PENGHASIL EXTENDED SPECTRUM Beta-LACTAMASE

NI LUH PUTU SISKA KS, Dr. dr. Osman Sianipar, DMM, MSc, SpPK-K.; Dr.dr. Umi S. Intansari, M.Kes, Sp.PK-K.

2017 | Tesis-Spesialis | SP ILMU PATOLOGI KLINIK

Latar Belakang:. Klebsiella pneumoniae adalah salah satu kuman tersering penyebab infeksi nosokomial. Infeksi Klebsiella pneumoniae penghasil Extended spectrum Beta-lactamase (Kp-ESBL) cenderung bersifat multiresisten. Metode pemeriksaan menggunakan ChromID ESBL merupakan pemeriksaan yang sederhanan dan praktis untuk deteksi Kp-ESBL, yang diperlukan pada tempat pelayanan kesehatan dengan fasilitas kesehatan yang terbatas. Tujuan: Membuktikan sensitivitas diagnostik pemeriksaan metode ChromIDESBL dalam deteksi Klebsiella pneumoniae penghasil extended spectrum beta-lactamase lebih dari 90%. Cara Penelitian: Penelitian ini merupakan penelitian uji diagnostik dimana pemeriksaan ChromID ESBL dibandingkan dengan metode Uji cakram kombinasi (Combine Disk Test/CDT) secara bebas dan tersamar untuk deteksi Kp ESBL. Subjek penelitian adalah isolat klinis Klebsiella pneumoniae yang didapat dari berbagai contoh bahan klinis pasien (urin, darah, feces, pus, sputum dan drain). Penelitian dilakukan di Instalasi Laboratorium Klinik DR Sardjito, selama 1 bulan dan telah mendapatkan kelayakan etis dari Komite Etik Penelitian Kedokteran dan Kesehatan Fakultas Kedokteran Universitas gadjah Mada (UGM). Data yang diperoleh dianalisis mengunakan statistik deskriptif dan tabel 2x2 untuk menetapkan sensitivitas, spesifisitas, negative predictive value (NPV), positive predictive value (PPV), akurasi. Hasil: Karakteristik sumber isolat Klebsiella pneumoniae yang terbanyak masingmasing adalah jenis kelamin laki-laki, sumber sampel urin (29,63%), usia lanjut (48,15%), dan ruang perawatan non intensif (77,78%). Sensitivitas ChromID ESBL 100%, spesifisitas 83,33%, NPV 100%, PPV 95,45%, akurasi 96,29%, likelihood ratio positive 6, likelihood ratio negative 0. Positif palsu ditimbulkan karena kemungkinan enzim yang dihasilkan oleh 1 isolat Klebsiella pneumoniae itu menghasilkan AmpC hyperproduction. Simpulan: Dengan hasil sensitivitas yang tinggi ChromID ESBL layak dipakai sebagai skrining ESBL di laboratorium dengan sumber daya terbatas seperti Pemberi Pelayanan Kesehatan (PPK) 1 dan 2.

Background: Klebsiella pneumoniae is one of the most common causes of nosocomial infections. Infection Klebsiella pneumoniae producing Extended spectrum Beta-lactamase (Kp-ESBL) tend to be multiresisten. The examination method using ChromID ESBL is a simple and practical examination for KpESBL detection, which is needed at health-care establishments with limited health facilities. Aims: The purpose of this study was to demonstrate the diagnostic sensitivity of the ChromID ESBL method in detection of Klebsiella pneumoniae producing extended spectrum beta-lactamase by more than 90%. Methods: It was a diagnostic test study where the ChromID ESBL was independently and blindly compared with the Combine Disk Test (CDT) to detect clinical isolate of Kp-ESBL. The subjects were Klebsiella pneumoniae clinical isolates obtained from various samples of patient clinical materials (urine, blood, stool, pus, sputum and drain). The research was conducted in Installation of Clinical Laboratory of DR Sardjito, for one month and have obtained ethical feasibility from Medical Research and Medical Ethics Committee of Faculty of Medicine, University of gadjah Mada (UGM). The data obtained were analyzed using descriptive statistics and 2x2 tables to establish sensitivity, specificity, negative predictive value (NPP), positive predictive value (PPV), accuracy. Result: The most characteristic sources of isolates Klebsiella pneumoniae respectively are male, urine (29.63%), elderly (48.15%), and non-intensive room (77.78%). ChromID ESBL had sensitivity 100%, specificity 83.33%, negative predictive value 100%, positive predictive value 95.45%, accuracy 96.29%, positive likelihood ratio 6, and likelihood ratio negative 0. False positives caused by possible AmpC hyperproduction enzymes produced by 1 isolate Klebsiella pneumoniae. Conclution: ChromID ESBL had high sensitivity, appropriate for ESBL screening in laboratories with limited resources such as PPK 1 and 2.

Kata Kunci : Klebsiella pneumoniae, Kp-ESBL, ChromID ESBL, CDT, PPK, ds: Klebsiella pneumoniae, Kp-ESBL, ChromID ESBL