ANALISIS PROFIL ALELIK ISOLAT MULTIDRUG- RESISTANT Streptococcus pneumoniae PADA SALURAN NASOFARING PASIEN TERINFEKSI HIV DI JAKARTA MENGGUNAKAN MULTILOCUS SEQUENCE TYPING

TIARA PUTRI, Prof. Drs. Langkah Sembiring, M.Sc., Ph.D.

2013 | Tesis | S2 Biologi

Isolat multidrug-resistant S. pneumoniae pada pasien terinfeksi HIV telah dideteksi untuk ditentukan profil aleliknya. Sampel yang diambil berupa swab nasofaring dari anak-anak dan dewasa yang terinfeksi HIV di Jakarta. Swab tersebut dikultur pada media agar darah kemudian dilakukan serangkaian uji biokimiawi, mikrobiologis, dan molekular untuk identifikasi. Hasil penelitian menunjukkan bahwa serotipe dominan pada pasien anak-anak adalah 19F, 6A/B, dan 19A sedangkan pada pasien dewasa serotipe yang dominan adalah 6A/B, 19F dan 11A. Uji resistensi antibiotik dengan metode disk diffusion menunjukkan bahwa seluruh isolat masih sensitif terhadap amoxicillin dan cefotaxime, namun sebagian bersifat resisten terhadap cefixime dan sulphamethoxazole-trimethoprim. Analisis multilocus sequence typing terhadap 14 isolat multidrug-resistant S. pneumoniae menghasilkan 7 tipe profil alelik, dengan frekuensi kemunculan tertinggi adalah ST320 dan ST271. Seluruh isolat yang tergolong dalam ST320 bersifat resisten terhadap clindamycin dan sulphamethoxazole-trimethoprim. Isolat yang bersifat multidrug-resistant terhadap antibiotik yang sama memiliki profil alelik yang mirip, atau setidaknya berbeda hanya pada satu lokus. Konstruksi pohon filogeni isolat multidrug-resistant berdasarkan sekuens housekeeping genes menunjukkan bahwa pengelompokan clade sesuai dengan profil aleliknya. Berdasarkan hasil penelitian dapat disimpulkan bahwa terdapat kongruensi antara profil alelik isolat multidrug-resistant S. pneumoniae dengan pengelompokan clade dalam pohon filogeni. Selain itu, pola resistensi yang serupa terhadap clindamycin dan sulphamethoxazole-trimethoprim pada kelompok ST320 diharapkan dapat memberikan masukan terhadap penanganan pasien agar di masa mendatang pemberian antibiotik lebih tepat sasaran.

Multidrug-resistant S. pneumoniae isolates in HIV infected patients were studied to determine their allelic profile. Samples were collected from the nasopharyngeal tract of HIV infected children and adults. Nasopharyngeal swabs were then cultured on blood agar medium and series of biochemical, microbiological, and molecular tests were performed to identify S. pneumoniae. Results showed that serotypes 19F, 6A/B, and 19A were predominant in children, while serotypes 6A/B, 19F, and 11A were predominant in adults. Antibiotic susceptibility test using disk diffusion method revealed that all isolates were sensitive to amoxicillin and cefotaxime, but some of them were resistant to cefixime and sulphamethoxazole-trimethoprim. Fourteen multidrug-resistant isolates were subsequently assessed using multilocus sequence typing and 7 allelic profiles were identified. Most prevalent allelic profiles were ST320 and ST271. Similar resistance pattern to clindamycin and sulphamethoxazole-trimethoprim was found in group ST320. Multidrug-Resistant isolates which were nonsusceptible to the same antibiotics shared the same allelic profile, or were at least different at only one single locus. Phylogenetic tree construction of multidrug-resistant isolates based on concatenated sequences of housekeeping genes showed that isolates grouped according to their allelic profiles. It can be concluded that there was a congruence between allelic profiles and clade groups in the phylogenetic tree. Moreover, similar resistance pattern to clindamycin and sulphamethoxazoletrimethoprim found in group ST320 can give suggestions for more appropriate antibiotic treatment in the future.

Kata Kunci : Streptococcus pneumoniae, HIV, multidrug-resistant, profil alelik, multilocus sequence typing