Latar
belakang: Catheter-associated urinary tract infection (CAUTI)
adalah terjadinya
infeksi saluran kemih (ISK) yang berhubungan dengan pemasangan kateter urin. Studi
menunjukkan <!--[if supportFields]> ADDIN EN.CITE ADDIN EN.CITE.DATA <![if gte mso 9]><xml>
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</xml><![endif]--><!--[if supportFields]><![endif]-->pola bakteri dan kepekaan
terhadap antibiotik bakteri penyebab CAUTI bervariasi antar rumah sakit; dan
saat ini terjadi peningkatan bakteri multi resisten sebagai penyebab CAUTI. Tingginya
risiko terjadinya CAUTI pada pasien dengan kateter disebabkan karena kemampuan
uropatogen dalam membentuk biofilm. Beberapa studi melaporkan peranan gen adhesin dalam
pembentukan biofilm.
Tujuan penelitian: Penelitian ini bertujuan untuk
mengetahui jenis
bakteri, pola kepekaan antibiotik, dan kemampuan membentuk biofilm
bakteri penyebab ISK pada pasien dengan kateter di RSUD Dr. Moewardi,
Surakarta, provinsi Jawa Tengah, Indonesia. Selain itu, penelitian ini bertujuan
untuk mengidentifikasi gen adhesin pada isolat E. coli.
Metode: Penelitian ini adalah
penelitian deskriptif dan analitik dengan teknik cross sectional.
Sampel pada penelitian ini adalah semua isolat bakteri yang diisolasi
dari urin pasien ISK yang menggunakan kateter yang dirawat di RSUD Dr. Moewardi
dari bulan April 2022 - September 2022. Pada semua isolat bakteri yang
ditemukan dilakukan uji identifikasi spesies dan uji kepekaan antibiotik dengan Vitek2 system. Kemampuan
bakteri membentuk biofilm diukur dengan microplate culture assay.
Selain itu, pada semua isolat E. coli yang ditemukan dilakukan
identifikasi gen adhesin dengan PCR.
Hasil Penelitian: Terdapat 111
isolat bakteri yang diisolasi dari pasien ISK yang menggunakan kateter, yang
terdiri dari 20 spesies bakteri. Bakteri terbanyak adalah E. coli
(49,5%), K. pneumonia (15,3%), P. aeruginosa (6,3%), E.
faecalis (6,3%), P. mirabilis (3,6%), dan S. aureus (3,6%).
Bakteri penyebab CAUTI pada penelitian ini menunjukkan resistensi yang tinggi
terhadap antibiotik. Ditemukan Enterobacteriaceae penghasil ESBL yang
terbanyak adalah K. pneumonia (71%) dan E. coli (59%). Ditemukan
43% isolat P. aeruginosa dan 6% isolat K. pneumoni yang resisten carbapenem.
Sebanyak 66?kteri penyebab ISK pada pasien dengan kateter di RSUD dr,
Moewardi Surakarta adalah penghasil biofilm. Terdapat hubungan yang
signifikan antara kemampuan bakteri dalam membentuk biofilm dengan resistensi
antibiotik. Pada identifikasi gen adhesin, semua isolat E. coli (48
isolat) mempunyai gen adhesin fimH (100%), gen sfa (16%) dan
papC (24%).
Kesimpulan:
E. coli dan K. pneumonia adalah bakteri penghasil biofilm yang
paling umum diisolasi dari pasien ISK dengan kateter urin. Surveilans pola
bakteri, sensitivitas antibiotik, dan kemampuan membentuk biofilm pada bakteri
penyebab CAUTI perlu dilakukan secara berkala. Untuk mencegah CAUTI dan
penyebaran multi-resistant bacteria, penerapan kewaspadaan standar dan
bundel pemasangan kateter harus dipantau dan dievaluasi.
Keywords:
CAUTI; biofilm; infeksi saluran kemih; gen adhesin; multi-resistant-bacteria
Background: Catheter-associated
urinary tract infection (CAUTI) is the occurrence of a urinary tract infection
(UTI) associated with urinary catheter. Studies show that bacterial patterns
and antibiotic sensitivity of bacteria causing CAUTI were vary between
hospitals; and currently there is an increase of multi-resistant bacteria as
the pathogen causing CAUTI. The high risk of CAUTI in patients with catheters
is due to the ability of uropathogens to form biofilms. Several studies have reported
the role of adhesin genes in biofilm formation.
Aim of
the study: This study aims to identify the bacterial species,
antibiotic sensitivity pattern, and the ability to form biofilms of bacteria that
cause UTI in patients with catheters at Dr. Moewardi Hospital Surakarta,
Central Java province, Indonesia. In addition, this study aims to identify
adhesin genes in E. coli isolates.
Method: This
is a cross sectional study with a descriptive and analytical approaches. Samples
in this study were all bacteria isolated from the urine of hospitalized patient
with urinary catheter at Dr. Moewardi Hospital from April - September 2022. Isolate
identification and antimicrobial susceptibility testing were performed using
the Vitex2 system. Biofilm-producing bacteria were identified by the microplate
culture assay. A PCR test were conducted to identify the adhesion genes of E.
coli. All data were collected and processed for statistical analysis.
Results:
There were 111 bacterial isolates obtained from 111 patients, consisting of 20
species of bacteria. The most common bacteria were E. coli (49.5%), K.
pneumonia (15.3%), P. aeruginosa (6.3%), E. faecalis (6.3%), P. mirabilis
(3.6%), and S. aureus (3.6%). This study revealed that there is a high
proportion of bacteria responsible for CAUTI that showed high resistance to
antibiotics. There were 71% od ESBL-producing K. pneumonia dan 59% ESBL-producing
E. coli. There were 43% of P. aeruginosa isolates and 6% of
carbapenem-resistant K. pneumonia isolates. As many as 66% of bacteria that
cause UTIs in patients with catheters at RSUD dr, Moewardi Surakarta are
biofilm producers. There is a significant relationship between the ability of
bacteria to form biofilms and antibiotic resistance. In addition, all E. coli
isolates (48 isolates) had fimH adhesin genes (100%), sfa genes (16%) and papC
(24%).
Conclusion: E.
coli and K. pneumonia were the most common biofilm-producing bacteria isolated
from the patient with urinary catheter. Surveillance of bacterial patterns,
antibiotic sensitivity, and biofilm formation ability of CAUTI-causing bacteria
needs to be conducted periodically. To prevent CAUTI and the spread of
antimicrobial resistance bacteria the implementation of standard precaution and
catheter insertion bundles should be monitor and evaluated.
Keywords:
CAUTI; biofilm; urinary tract infection; adhesin genes; multi-resistant
bacteria.
Kata Kunci : CAUTI; biofilm; urinary tract infection; adhesin genes; multi-resistant bacteria
