Resistensi antibiotika telah menjadi masalah kesehatan global. Upaya yang dilakukan untuk mengatasi kegentingan resistensiantibiotika adalah melalui penggunaan antibiotika secara bijak. Salah satu strategi penggunaan antibiotika secara bijak adalah denganmenyusun dan menggunakan antibiogram. Antibiogram menuntun peklinik dalam memilih pengobatan antibiotika empiris terbaiksementara menunggu hasil kultur dan uji kepekaan antibiotika. Antibiogram dapat dijadikan dasar dalam penyusunan pedomanpengobatan antibiotika empiris dan dapat digunakan dalam mendeteksi serta memantau arah resistensi antibiotika. LaboratoriumMikrobiologi Klinik di setiap lembaga pelayanan kesehatan bertanggung jawab dalam menyusun antibiogram, menyebarkannya kepadapeklinik, serta melakukan perbaikan setiap tahun. Telaah pustaka ini bertujuan untuk membahas antibiogram, termasuk cara menyusundan menyajikan antibiogram, sehingga diharapkan dapat membantu setiap lembaga dalam membuatnya.
Angka kematian infeksi aliran darah cukup tinggi, berkisar 20–50%. Patogen penyebab dapat dibuktikan dengan pemeriksaan kulturdarah yang dilanjutkan dengan uji kepekaan antibiotika. Metode pemeriksaan dapat dilakukan secara manual atau automatis baiksemiautomatis ataupun automatis penuh. Metode manual relatif tidak memerlukan biaya yang besar dibandingkan metode automatisasi.Penelitian ini merupakan analisis observasional dengan desain potong lintang. Metode identifikasi manual memakai metode API danuji kepekaan antibiotika metode difusi cakram antibiotika Kirby Bauer. Kedua metode ini dibandingkan dengan metode semiautomatisTDR-300B. Metode automatis penuh VITEK 2 digunakan sebagai metode rujukan untuk menilai kinerja metode konvensional dansemiautomatis. Bakteri penyebab infeksi aliran darah didominasi Gram negatif kebanyakan Eschericia coli dan Klebsiella pneumonia.Ketepatan metode identifikasi API terhadap VITEK 2 sebesar 87,87%, ketepatan identifikasi metode TDR-300B terhadap metode VITEK2 adalah 90,9%. Hasil ketepatan uji kepekaan antibiotika metode konvensional difusi cakram antibiotika Kirby Bauer terhadap metodeVITEK 2 adalah 84,64%. Ketepatan uji kepekaan antibiotika metode TDR-300B terhadap metode VITEK 2 sebesar 82,5%. Ketepatanmetode API terhadap metode TDR-300B sebesar 84,84%. Ketepatan uji kepekaan antibiotika metode konvensional terhadap metodeTDR-300B sebesar 78,21%. Hasil metode identifikasi dan uji kepekaan antibiotika konvensional tidak berbeda bermakna secara statistikdengan metode semiautomatis TDR-300B. Metode identifikasi dan uji kepekaan antibiotika konvensional masih dapat dipercaya terutamauntuk daerah dengan keterbatasan biaya atau pemeriksaan masih sedikit.
Malignant hematology patients in the hospital are particularly susceptible to infection associated with endogenous microorganism originating from their own body. The most common etiology of infection is bacteria from gastrointestinal tract. Escherichia coli is a gram-negative facultative anaerobic bacteria, and part of the intestinal normal flora. However, E. coli is the most common cause of nosocomial infection. Resistance of E. coli to antibiotics has been widely reported. The aim of this study was to identify the development of antibiotic resistant properties of Escherichia coli from rectal swab of malignant hematology pediatric patients. A descriptive study of collected secondary data on sensitivity test results was done in the hematology-oncology pediatric ward, Dr. Soetomo Hospital from October 2012 to March 2013. There were 20 results of antibiotic susceptibility testing on positive Escherichia coli cultures from rectal swabs. The highest resistance levels were found towards cotrimoxazol, ampicillin sulbactam and cefotaxime. Escherichia coli with extended-spectrum b-lactamase (ESBL) was also found. Escherichia coli from rectal swabs of malignant hematology pediatric patients were shown to be resistant to cotrimoxazol, ampicillin sulbactam and ampicillin.
Multi-Drugs Resistance (MDR) is a condition where bacteria are resistant to at least one type of antibiotic from three classes of antibiotics. One of the organisms included in the MDR is an Extended-Spectrum Beta Lactamase (ESBL) producing bacteria. Multi-drug resistance bacteria have been widely reported globally as a cause of severe infections. Still, information on the comparison of Length of Stay (LOS), hospitalization costs, and outcome status of the patients infected with MDR bacteria and infected with non-MDR bacteria is still limited. This study aimed to compare LOS, treatment costs, and outcome status of the BPJS pediatric sepsis patients infected with MDR bacteria and non-MDR bacteria in Dr. Soetomo General Academic Hospital, Surabaya. This study was observational research using medical records of hospitalized pediatric patients with BPJS insurance at the Dr. Soetomo General Academic Hospital from January 2015-July 2018 (n=49). The variables of this study were microbiology culture results and antibiotics sensitivity tests, LOS, INA-CBGs rates provided by BPJS, actual hospitalization cost, and outcome status. Statistical analyses were performed to compare LOS, INA-CBGs, actual cost, and outcome status of patients infected by MDR bacteria (ESBL and non-ESBL) or non-MDR bacteria. The results of this study include the average LOS value of non-MDR, MDR ESBL, and MDR non-ESBL cases, which were 30.55; 46.18; 32.41. Comparison of INA-CBGs and the actual cost of the three were 0.886 and 0.990, respectively, with p>0.05, and each percentage of the mortality patients was 27.3%, 45.5%, and 40.7%. There was no significant difference in the hospitalization cost and outcome status of patients infected by MDR bacteria (ESBL and non-ESBL) and non-MDR bacteria. Each percentage of LOS was also not much different. Still, MDR patients tended to be treated longer, require higher costs, and have a worseprognosis.
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