Sensitivitas Diagnostik Metode Combination Disc Test dalam Mendeteksi Klebsiella pneumoniae Penghasil Extended Spectrum Beta Lactamase

LUZ MARIA G.B.W, dr. Osman Sianipar, DMM, MSc., SpPK(K); dr. Usi Sukorini, M.Kes, SpPK(K)

2015 | Tesis-Spesialis | SP ILMU PATOLOGI KLINIK

Kuman ESBL sulit dideteksi karena memiliki kadar berbeda dalam aktivitas melawan cephalosporin, sehingga pemilihan metode pemeriksaan dan agen antimikrobia dalam pemeriksaan sangat penting. Penelitian mengenai metode combination disc test (CDT) banyak dikembangkan, demikian pula dengan cakram antibiotik yang digunakan. Penelitian ini bertujuan menentukan sensitivitas diagnostik combination disc test dalam mendeteksi isolat Klebsiella pneumonia penghasil ESBL. Penelitian ini merupakan penelitian observasional analitik dengan disain potong lintang. Subyek penelitian adalah isolat yang diduga Klebsiella pneumoniae penghasil ESBL. Isolat-isolat tersebut diperiksa menggunakan metode CDT dan Etest. CDT dibandingkan dengan Etest secara independen dan blind. Data dianalisis menggunakan tabel 2x2 untuk menghitung sensitivitas, spesifisitas, nilai duga positif dan negatif serta akurasi. Total isolat yang diduga K. pneumoniae penghasil ESBL adalah 53 isolat. Isolat terbanyak berasal dari darah, urine dan pus, berturut-turut 32,1%, 32,1%, dan 18,9%. Sebagian besar isolat didapat dari ruang perawatan non intensif, memiliki riwayat penggunaan cephalosporin generasi ketiga sebelumnya (83%), dengan lama perawatan 7 hari atau lebih (86,3%). Baik sensitivitas maupun spesifisitas CDT adalah 100%, sehingga dapat disimpulkan, performa metode CDT sama dengan Etest dalam mendeteksi K. pneumoniae penghasil ESBL.

Detection of ESBLs is a challenge in the microbiology laboratory. ESBLs are difficult to detect because they have different levels of activity against cephalosporin, so the detection method and antimicrobial agents in the examination is very important. Research of combined disc test (CDT) method has been developed, as well as antibiotic discs were used. The objective of this study is to determine the sensitivity of combination disc test method in detecting ESBL producing isolates of Klebsiella pneumoniae. This is an observational study with cross-sectional design. Subjects are suspected ESBL producing Klebsiella pneumoniae. They are tested by both CDT method and Etest. CDT is independent and blindly compared with the Etest which is used as reference standard. Data are analyzed by 2x2 table to determine sensitivity, specificity, positive and negatif predictive value, as well as accuracy. Total suspected K. pneumoniae producing ESBL are 53 isolates. They are mostly from blood, urine and pus respectively 17%, 17%, and 10%. Most isolates are isolated from non intensive care unit, historically treated with third generation cephalosporine (83%), length of stay more or equal to 7 days (86,3%). Both sensitivity and specificity are 100%. Therefore, it can be concluded that the performance of CDT method is the same as Etest in detecting K. pneumoniae producing EBSL

Kata Kunci : Infeksi ESBL Klebsiella pneumoniae, combination disc test, E-test