Carbapenem non-susceptible Acinetobacter baumannii (CNSAB) is an important pathogen that causes nosocomial bacteremia among critically ill patients worldwide. The magnitude of antibiotic resistance of A. baumanii in Indonesia is expected to be significant; however, the data available are limited. The aim of this study was to analyze the genetic profiles of CNSAB isolates from patients with bacteremia in Indonesia. CNSAB isolates from blood cultures of bacteremia patients in 12 hospitals in Indonesia were included. The blood cultures were conducted using the BacT/Alert or BACTEC automated system. The CNSAB were identified with either Vitek 2 system or Phoenix platform followed by a confirmation test using a multiplex polymerase chain reaction (PCR) assay, targeting the specific gyrB gene. The carbapenemase genes were detected by multiplex PCR. In total, 110 CNSAB isolates were collected and were mostly resistant to nearly all antibiotic classes. The majority of CNSAB isolates were susceptible to tigecycline and trimethoprim-sulfamethoxazole (TMP-SMX), 45.5% and 38.2%, respectively. The blaOXA-51-like gene was identified in all CNSAB isolates. Out of the total, 83.6% of CNSAB isolates had blaOXA-23-like gene, 37.3% blaOXA-24-like gene, 4.5% blaNDM-1 gene, 0.9% blaIMP-1 gene, and 0.9% blaVIM gene. No blaOXA-48-like gene was identified. The blaOXA-23-like gene was the predominant gene in all except two hospitals. The presence of the blaOXA-24-like gene was associated with resistance to tigecycline, amikacin, TMP-SMX and cefoperazone-sulbactam, while blaOXA-23-like gene was associated with resistance to TMP-SMX and cefoperazone-sulbactam. In conclusion, the blaOXA-23-like gene was the predominant gene among CNSAB isolates throughout Indonesia. A continuous national surveillance system needs to be established to further monitor the genetic profiles of CNSAB in Indonesia.

Biofilm is the unity of microbial cell surface surrounded by a matrix of extracellular polymeric substances (EPS). Bacteria composing the biofilm are heterogeneous in space and time. This biofilm continues to grow influenced by internal and external processes. Moreover, biofilm can be found on the surface of medical devices, as well as in bacterial endocarditis and cystic fibrosis. Biofilm that is already formed can lead to antibiotic resistance.Keywords: infections, bacterial biofilm, antibiotic resistance Abstrak: Biofilm merupakan kesatuan dari permukaan sel mikroba yang dilingkupi oleh matriks substansi polimerik ekstraseluler. Bakteri yag menyusun biofilm bersifat heterogen dalam ruang dan waktu. Biofilm terus berkembang yang dipengaruhi oleh proses internal dan eksternal. Biofilm dapat ditemukan pada permukaan alat-alat medis, endokarditis bakterial, dan kistik fibrosis. Biofilm yang telah terbentuk dapat menyebabkan resistensi antibiotik. Kata kunci: infeksi, biofilm bakterial, resistensi antibiotik

Infections that can be found during the treatment in the ICU are due to contamination of pathogenic bacteria as the source of nosocomial infections. This nosocomial infections appear and show symptoms in patients treated or after being treated in the hospital. This study aimed to determine the sources and patterns of aerobic bacteria that could potentially cause nosocomial infections: in the walls, floors, medical equipment, and in the ambient air of ICU Room, Prof. Dr. R. D. Kandou Hospital, Manado. This was a descriptive study designed with a prospective approach. Samples were bacteria in the walls, floors, medical equipment, and the ambient air of the ICU Room. The results showed that of the 27 samples taken, there were 24 bacteria found: Enterobacter agglomeranse (25%), Bacillus subtilis (25%), Enterobacter cloacae (16.7%), Staphylococcus sp. (8.4%), Gram-negative cocci (16.4%), Serratia rubidaea (4.1%), and Klebsiella pneumonia (4.1%).Keywords: ICU, nosocomial infections, patterns of aerobic bacteriaAbstrak: Infeksi yang dapat ditemukan pada perawatan di ICU karena terkontaminasi dengan sumber bakteri patogen yaitu infeksi nosokomial. Infeksi nosokomial adalah infeksi yang muncul dan menunjukkan gejala selama pasien dirawat atau setelah dirawat di rumah sakit. Penelitian ini bertujuan untuk mengetahui sumber dan pola bakteri aerob yang berpotensi menyebabkan infeksi nosokomial di dinding, lantai, peralatan medis, dan udara di ruang ICU BLU RSUP Prof. dr. R. D. Kandou Manado. Desain penelitian ini bersifat deskriptif dengan pendekatan prospektif. Sampel penelitian ialah bakteri pada dinding, lantai, peralatan medis, dan udara di ruang ICU BLU RSUP Prof. Dr. R. D. Kandou Manado. Hasil penelitian memperlihatkan dari 27 sampel yang diambil, terdapat 24 bakteri yaitu Enterobacter agglomerans (25%), Bacillus subtilis (25%), Enterobacter cloacae (16,7%), Staphylococcus sp. (8,4%), Kokus Gram negatif (16,4%), Serratia rubidaea (4,1%), dan Klebsiella pneumonia (4,1%).Kata kunci: ICU, infeksi nosokomial, pola bakteri aerob

Operating room of a hospital is a place to do both elective and acute surgery. Operating room condition is associated with the risk of disease transmission such as infections. Nosocomial infections are infections that arise in a period of more than 48 hours after being treated in hospital. This research aims to determine the pattern of aerobic bacteria that could potentially cause nosocomial infections in Operating Room of RSAD. Robert Wolter Mongisidi Manado. This research uses descriptive prospective study where samples were taken by acquiring swabs from the walls, floor, bed and also air sample as much as 25 samples. This research found 6 species of bacteria, 3 Gram positive bacterias and 3 Gram negative bacterias. Gram-positive bacteria consisting of Staphylococcus sp (40.3%), Streptococcus sp (3.5%) and Bacillus sp (35.08%), whereas Gram-negative bacteria consisting of Enterobacter agglomerans (5.3%), Proteus sp (12.3 %) and Neisseria sp (3.5%). The most bacteria that could potentially cause nosocomial infections were Staphylococcus sp (40.3%).Keywords: nosocomial infection, operating room, aerobic bacteria. Abstrak: Kamar operasi suatu rumah sakit merupakan tempat untuk melakukan tindakan pembedahan baik secara elektif maupun cito. Kondisi kamar operasi berhubungan dengan resiko penularan penyakit salah satunya melalui infeksi. Infeksi nosokomial adalah infeksi yang timbul dalam kurun waktu lebih dari 48 jam setelah dirawat di rumah sakit. Penelitian ini bertujuan untuk mengetahui pola bakteri aerob yang berpotensi menyebabkan infeksi nosokomial di kamar operasi CITO RSAD Robert Wolter Mongisidi Manado. Penelitian ini menggunakan metode penelitian deskriptif dengan pendekatan prospektif dimana sampel diambil melalui usapan pada dinding, lantai, dan tempat tidur serta pengambilan sampel udara sebanyak 25 sampel. Hasil penelitian ditemukan 6 jenis bakteri, 3 bakteri Gram positif dan 3 bakteri Gram negatif. Bakteri Gram positif terdiri dari Staphylococcus sp (40.3%), Streptococcus sp (3.5%) dan Bacillus sp (35.08%), sedangkan bakteri Gram negatif yaitu Enterobacter agglomerans (5.3%), Proteus sp (12.3%) dan Neisseria sp (3.5%). Bakteri yang berpotensi menyebabkan infeksi nosokomial terbanyak yang ditemukan adalah Staphylococcus sp (40.3%). Kata kunci: infeksi nosokomial, kamar operasi, bakteri aerob.

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is an important pathogenic bacterium that can cause nosocomial infection in hospitalized patients with various manifestations. The purposes of this recent study were to determine the prevalence, antimicrobial susceptibility profiles, carbapenemase-producing phenotypic and genotypic of CRAB in two tertiary care hospitals in Indonesia. Methods: A. baumannii isolates collected from patient’s clinical cultures in two tertiary care hospitals in Malang and Manado were included. Identifications of meropenem-resistant A. baumannii isolates with the vitek2® system results, followed by a sensitivity test using 10 µg imipenem antibiotic disc according to CLSI guidelines to fulfill the criteria as CRAB isolates. We assessed carbapenemase-production using mCIM and eCIM, and determined the presence of blaKPC, blaNDM, blaOXA-23 carbapenemase resistance genes using simplex PCR. Results: 73 CRAB were collected from hospitalized patients, of which 30 CRAB from Manado and 43 CRAB from Malang. The largest number of samples came from sputum and indicates that XDR has also occurred in all CRAB isolates. Carbapenemase-production test using mCIM obtained positive results on 29 samples (96.7%) and 42 samples (97.7%) in Manado and Malang, respectively. The eCIM showed metallo-β-lactamase was dominant in two tertiary care hospitals. The prevalence of carbapenemase resistance genes was obtained blaOXA-23 and blaNDM ranged between 60% - 90.7% and 3.3% - 4.6%, respectively. blaKPC gene was not detected. Conclusions: We showed that CRAB isolates positive result of carbapenemase-production and carbapenemase resistance genes of blaOXA-23 seem to be dominant in two tertiary care hospitals in Malang and Manado, Indonesia. A national prevention and surveillance system should be prepared to reduce and limiting transmission of CRAB isolates.