PERBANDINGAN RESISTENSI CANDIDA ALBICANS DAN CANDIDA NON ALBICANS TERHADAP FLUKONAZOL DAN NISTATIN (Kajian pada bilasan orofaring penderita Human Immunodeficiency Virus di RSUP DR. Sardjito, Yogyakarta)

NUR FITRI ASTUTI, dr. Satiti Retno Pudjiati, Sp.KK(K)

2013 | Tesis | S2 Kedokteran Klinik

Orang dengan HIV/AIDS sering mengalami infeksi oportunistik. Infeksi oportunistik tersering yaitu kandidiasis orofaring yang disebabkan oleh Candida sp, baik C. albicans ataupun C. non albicans. Penyebab tersering kandidiasis orofaring adalah C. albicans tetapi terdapat pergeseran pada penderita HIV/AIDS, yaitu C. non albicans. Nistatin merupakan lini pertama untuk kandidiasis orofaring pada penderita HIV/AIDS di Indonesia diikuti flukonazol sebagai lini kedua. Perkembangan penggunaan flukonazol dan nistatin seimbang. Beberapa penelitian menunjukan peningkatan resistensi Candidia sp terhadap flukonazol. Belum pernah dilakukan penelitian perbandingan resistensi Candida sp terhadap flukonazol dan nistatin di Indonesia. Untuk mengetahui resistensi C.albicans, C. non albicans dan Candida sp terhadap flukonazol dan nistatin pada bilasan orofaring penderita HIV. Penelitian potong lintang dengan subyek penderita HIV yang berobat ke RSUP DR. Sardjito Yogyakarta. Pengambilan sampel menggunakan metode bilasan orofaring dengan NaCl 0,9% selama 60 detik. Kultur menggunakan agar CHROM. Uji resistensi dengan metode difusi cakram pada media agar sabaroud. Analisis statistik menggunakan chi- square test dengan nilai kemaknaan p< 0,05. Diambil 76 sampel bilasan orofaring penderita HIV yang tumbuh Candida sp sebanyak 50 (65,8%). Dari 50 sampel yang tumbuh teridentifikasi 76 isolat. Jumlah spesies tunggal sebesar 58% dan 42% spesies ganda. Spesies Candida yang tumbuh terdiri dari 34 (44,74%) C. albicans dan 42 (55,26%) C. non albicans. C. glabrata (22,37%) merupakan C. non albicans yang terbanyak ditemukan. Resistensi C. albicans dan C. non albicans terhadap flukonazol sebesar 41,18% dan 57,14%, sedangkan terhadap nistatin sebesar 2,95% dan 7,14%. Tidak terdapat perbedaan bermakna antara resistensi C.albicans dan C.non albicans terhadap nistatin (p = 0,0391). Terdapat perbedaan bermakna antara resistensi C.albicans, C.non albicans dan Candida sp terhadap flukonazol dan nistatin (p = 0,000) Tidak terdapat perbedaan bermakna resistensi C. albicans dan C. non albicans terhadap nistatin. Resistensi C. albicans, C. non albicans dan Candida sp terhadap flukonazol lebih tinggi daripada nistatin pada bilasan orofaring penderita HIV/AIDS di RSUP Dr. Sardjito Yogyakarta

Oropharyngeal candidiasis is the most common opportunistic infection that found among HIV-AIDS patients. Candida albicans had been shifted by C. non albicans as a major cause of oropharyngeal candidiasis in HIV-AIDS patients. Nystatin is the first line therapy in Indonesia to oropharyngeal candidiasis in HIV-AIDS patients. The use of nystatin and fluconazole as treatments for oropharyngeal candidiasis among HIV-AIDS patients are equal in daily practice. Some researches have already showed increasing resistance of Candida sp to fluconazole. There is no studies about resistance comparison of C.albicans, C. non-albicans and Candida sp to fluconazole and nystatin in Indonesia. This study was performed to determine resistance of C.albicans, C. non-albicans and Candida sp to fluconazole and nystatin in oropharyngeal rinse with HIV. This is a cross sectional study. The sample was taken from oropharyngeal rinse of HIV/AIDS patients using 0.9% NaCl solution for 60 seconds. Culture is used an agar CHROM while resistance test used disc diffusion method. The analysis statistic used a chi-square test with significance values p< 0,05. As many as 76 oropharyngeal rinse sample from HIV patients, the growing of Candida sp were 50 (65,8%). The number of species in a culture as a single species was 58%. From 50 sample with the growth of Candida sp, we identified 76 isolates. The number of single species and multiple species are 58% and 42%. Candida sp were grown consisted of 34 (44.74%) C. albicans and 42 (55.26%) C. non albicans. Candida glabrata (22.37%) is the most C.non albicans which were found. Resistance of C. albicans and C.non albicans to fluconazole were 41.18% and 57.14%, while resistance to nystatin were 2.95% and 7.14%. There are no significant differences between resistance of C.albicans and C.non albicans to nystatin (p = 0,0391). There are significant differences between resistance C.albicans, C.non albicans and Candida sp to fluconazole and nystatin (p = 0.000) There are no significant differences between resistance of C.albicans and C.non albicans to nystatin. Resistance of C. albicans, C. non-albicans and Candida sp to flukonazol are higher than nystatin from oropharyngeal rinse taken from HIV-AIDS patients in Dr. Sardjito Hospital, Yogyakarta.

Kata Kunci : HIV, C. albicans, C. non albicans, Candida sp, resistensi, flukonazol, nistatin