Perbandingan Microdilution Broth dan ChromID ESBL untuk Deteksi Isolat Klinis Klebsiella pneumonia Penghasil Extended Spectrum Beta- Lactamase

EMY NOERWIDAYATI, r. Osman Sianipar DMM, MSc, Sp.PK(K).; dr. Andaru Dahesihdewi, Mkes, Sp.PK-K

2017 | Tesis-Spesialis | SP ILMU PATOLOGI KLINIK

Extended-spectrum Beta-lactamases (ESBL) adalah enzim yang menghidrolisis penisilin, sefalosporin (generasi pertama, kedua, ketiga), senyawa oxymino--laktam (aztreonam, tetapi bukan sefamisin dan karbapenem) dan dapat dihambat oleh inhibitor Beta-laktamase (asam klavulanat, sulbaktam dan tazobactam). Peningkatan resistensi Klebsiella spp. penghasil ESBL dapat berdampak buruk karena dapat meningkatkan angka mortalitas dan morbiditas serta menyebabkan beban ekonomi. Tujuan dari penelitian ini adalah untuk membandingkan kemampuan metode microdilution broth dan ChromID ESBL dalam deteksi isolat klinis Klebsiella pneumonia Penghasil Extended Spectrum beta-Lactamase. Penelitian ini menggunakan desain uji diagnostik, metode microdilution broth dan metode ChromID secara bebas dan tersamar dibandingkan dengan metode rujukan uji sinergi cakram ganda 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 kemampuan deteksi metode microdilution broth, ChromID dibandingkan secara deskriptif. Isolat klinis K. pneumonia yang ditemukan sebanyak 103 isolat yang sebagian besar berasal dari urin (29,1%), pus (28,2%) dan darah (22,3%). Sebagian besar pasien dirawat di ruang rawat non intensif (67,9%) dan selebihnya dirawat di ruang rawat intensif (18,5%) serta pasien rawat jalan (13,6%). Sensitivitas metode ChromID lebih tinggi (97,4% vs 96%), namun metode ini memiliki spesifisitas yang lebih rendah (66,7% vs 100%). Metode ChromID memiliki nilai ramal positif lebih rendah (89,2% vs 100%), namun nilai ramal negatif kedua metode ini sama yaitu 90%. Metode ChromID memiliki rasio kemungkinan hasil positif lebih rendah (2,9 vs ~), metode ini memiliki rasio kemungkinan negatif lebih rendah (0,03 vs 0,04), sehingga dapat disimpulkan bahwa metode microdilution broth memiliki kemampuan mendeteksi isolat klinis Klebsiella pneumonia penghasil extended spectrum beta-lactamase tidak berbeda dengan metode ChromID ESBL.

Extended-spectrum Beta-lactamases (ESBL) is an enzyme that hydrolyze penicillin, cephalosporin (first generation, second, third), compound oxymino-Beta lactam (aztreonam, but not cephamycins and carbapenems) and can be inhibitedby the inhibitor of Beta-lactamase (clavulanic acid, sulbactam and tazobactam)Increased resistance Klebsiella spp. producer ESBL can be bad because it canimprove mortality and morbidity as well as causing economic impact bad. Thepurpose of this study was to compare capabilities broth microdilution method andChromID ESBL method in the detection of clinical isolates of ESBL Klebsiellapneumoniae producing extended spectrum Beta-lactamase. It was a diagnostic test study where the microdilution broth methodChromID was independently and blindly compared with the double disc synergytest to detect clinical isolate of ESBL-producing K. pneumonia. Subjects the studywere clinical isolates of K. pneumonia identified in the Clinical Laboratory of DrSardjito Hospital which are isolated from clinical samples of patients. ClinicalData a patients were obtained from medical records. Comparison of detectioncapability microdilution broth method, ChromID compared descriptively. K. pneumoniae clinical isolates were found among 103 isolates were largely derived from the urine (29.1%), pus (28.2%), and blood (22.3%). Most of thepatients treated in non-intensive care unit (67,9%) and the remaining were treatedin the intensive care ward (18.5%) and outpatients (13.6%). Sensitivity ChromID method was higher (97.4% vs 96%), but thismethod had a lower specificity (66.7% v. 100%). ChromID Method had a lowerpositive predictive value (89.2% vs 100%), but the negative predictive value of both method is the same, namely 90%. ChromID method had a likelihood ratioof positive results is lower (2.9 vs ~), this method had a lower negative likelihoodratio (0.03 vs 0.04), so it can be concluded broth microdilution method has theability to detect clinical isolates of Klebsiella pneumoniae producing extendedspectrum beta-lactamase does not differ from the methods ChromID ESBL.

Kata Kunci : Infeksi KP-ESBL, metode microdilution broth, metode ChromID ESBL, metode uji sinergi cakram ganda, Infection KP-ESBL, microdilution broth method, ChromID method, double disc synergy test method