Epidemiologi Molekuler Bakteri Eschericia Coli Extended-Spectrum Beta-Lactamase dari Sampel Daging Ayam Mentah dan Klinis di Jakarta

YULIA TANTI NARWATI, Prof. dr. Tri Wibawa, Ph.D., Sp. MK(K); dr. Abu Tholib Aman, Sp.MK (K), M.Sc., Ph.D; dr. Lutfan Lazuardi, M.Kes., Ph.D

2022 | Disertasi | DOKTOR ILMU KEDOKTERAN DAN KESEHATAN

Latar Belakang : Infeksi yang disebabkan oleh bakteri resisten terhadap antibiotik menyebabkan tingginya angka kesakitan dan kematian yang memberikan efek serius dalam meningkatnya biaya perawatan di rumah sakit. Antibiotik selain digunakan di rumah sakit untuk pengobatan, digunakan juga dalam bidang peternakan. Makanan dan hewan ternak dianggap sebagai salah satu reservoir dari bakteri penghasil ESBL. Tujuan Penelitian : Mengetahui prevalensi dan jenis-jenis gen pengkode ESBL pada bakteri E. coli yang berasal dari sampel klinis dan sampel daging ayam mentah di Jakarta dan hubungannya. Metode : Penelitian ini adalah penelitian observasional jenis deskriptif kategorik rancangan potong lintang. Sampel daging ayam diambil dari berbagai supermaket dan pasar tradisional di Jakarta, sampel klinis diperoleh dari tiga rumah sakit RSA, RSRT dan RSH. Uji skrining ESBL menggunakan metode difusi cakram. Deteksi fenotipik bakteri ESBL menggunakan metode DDST. Deteksi gen-gen pengkode enzim Beta-laktamase (blaSHV, blaTEM, blaCTX-M) menggunakan multiplex PCR. Sekuensing gen dilakukan oleh 1st BASE Singapura. Pohon filogenetik dibuat menggunakan MEGA 7. Analisis statistik dilakukan menggunakan uji chi-square. Hasil : Prevalensi bakteri E.coli pada sampel daging ayam dari pasar tradisional 97,14%, lebih tinggi dibandingkan di pasar modern sebesar 78,57% (p<0,05). Isolat E. coli pada sampel klinis tiga rumah sakit RSA (17,9%), RSRT (13%) dan RSH (17,4%). Rata-rata hasil deteksi fenotip ESBL isolat E. coli yang berasal dari sampel ayam adalah 43,45% dan sampel klinis sebesar 37,57%. Isolat dari sampel ayam memiliki gen penyandi ESBL dominan adalah blaTEM (56,2%) dan sampel klinis blaTEM (52,4%). Pohon filogenetik menunjukkan bahwa isolat dari sampel ayam dan sampel klinis memiliki kekerabatan yang erat. Kesimpulan : Terdapat kesamaan variasi gen pengkode ESBL pada isolat bakteri E. coli yang berasal dari sampel ayam mentah maupun sampel kilinis, dimana keduanya memimiliki gen dominan yang sama yaitu blaTEM. Pohon filogenetik menunjukkan bahwa isolat dari klinis maupun sampel ayam ada yang berada pada klaster yang sama.

Introduction Infections caused by antibiotic-resistant bacteria cause high rates of infection and death that have a serious effect on the rising cost of hospital care. Antibiotics in addition to being used in hospitals for treatment, are also used for livestock production. Food and farm animals are considered one of the reservoirs of ESBL-producing bacteria. Objective : To determine the prevalence and types of ESBL coding genes in E. coli bacteria from clinical samples and raw chicken meat samples in Jakarta and their relationship. Methods : This research is an observational research with a categorical descriptive cross-sectional design. Chicken meat samples were taken from various supermarkets and traditional markets in Jakarta, clinical samples were obtained from three RSA, RSRT and RSH hospitals. The ESBL screening test uses the disc diffusion method. ESBL bacterial phenotypic detection using the DDST method. Detection of Beta-lactamase encoding genes (blaSHV, blaTEM, blaCTX-M) using multiplex PCR. Gene sequencing was carried out by 1st BASE Singapore. Phylogenetic trees were constructed using MEGA 7. Statistical analysis was performed using the chi-square test. Results : The prevalence of E.coli bacteria in chicken meat samples from traditional markets was 97.14%, higher than that in modern markets of 78.57% (p<0.05). E. coli isolates in clinical samples from three hospitals RSA (17.9%), RSRT (13%) and RSH (17.4%). The average detection result for the ESBL phenotype of E. coli isolates from chicken samples was 43.45% and 37.57% for clinical samples. Isolates from chicken samples that had the dominant ESBL coding gene were blaTEM (56.2%) and clinical samples were blaTEM (52.4%). The phylogenetic tree shows that isolates from chicken samples and clinical samples are closely related. Conclusion : There are similar variations in ESBL-coding gene in E. coli bacterial isolates derived from raw chicken samples and kilinis samples, both of which have the same dominant gen blaTEM. Phylogenetic trees show that both clinical and chicken samples are in the same cluster.

Kata Kunci : E. coli, ESBL, blaSHV, blaTEM, blaCTX-M