No abstract

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.

No abstract

The extended-spectrum b-lactamase (ESBL) producer bacteria until now were mostly identified in hospital environment. The aim of this study was to analyze the prevalence of ESBL-producing gut flora and distribution of ESBL encoding genes between hospitalized patient in Tropical Wards of Dr. Soetomo Hospital and patient from a primary health centre (PHC) as community environment in Surabaya. Thiry rectal swab samples from hospital of Dr. Soetomo patients and from PHC (60 samples in total) were collected for this study. Samples were screened in MacConkey agar supplemented with 2 mg/L of cefotaxim, incubated at 37ºC for 24 hours. Then the growing colony were confirmed with Disk Diffusion Synergy test (DDST) for diagnosis of ESBL producer. The identified ESBL producers were then identified the bacteria species by biochemical method. ESBL gene were detected by PCR with specific primers. The results showed that there was not difference of positif nuber of ESBL-producing bacteria gut floral between patients of Dr.Soetomo Hospital, 25/30 (83.3%) and PHC, 11/30 (36.7%) (p=1). The pattern of ESBL gene distributions among samples from hospital showed that SHV was 12%, TEM was 36%, and CTX-M was 80%, and from PHC were SHV 18.2%, TEM 27,3% and CTX-M 81,8%. Statistical analysis showed that the pattern was not significantly different among hospitals and PHC samples as shown by SHV gene (p=0,631), TEM (p= 0.715), and CTX -M (p=1). From each ESBL gene, the dominant genes that found producing ESBL were the CTX-M genes followed by TEM and SHV genes. The prevalence of ESBL producersin intestinal flora of both the hospital (83,3%) and the PHC (36,7%) was very high. There was not significant difference between the prevalence of ESBL producer in gut flora of hospitalized patients compared to PHC. There was found other patterns of ESBL gene combinations in the hospital of SHV+CTX-M genes, TEM+CTX-M, SHV+TEM+CTX-M genes and PHC, the combination pattern of SHV+CTX-M, TEM+CTX-M.

The emergence and spread of Gram-negative bacteria namely Acinetobacter baumannii, is a serious public health challenge worldwide due to antibiotics resistance. Infections caused by this bacterium demonstrated significantly high economic burden. Nevertheless, economic burden of carbapenem resistant-Acinetobacter baumannii (CR-AB) and carbapenem susceptible -Acinetobacter baumannii (CS-AB) infections in Indonesia remain unknown. The aim of the study was to evaluate the cost of hospitalized patients associated with CR-AB and CS-AB infections. Methods: In a retrospective observational case control study, we evaluated the medical records of patients with CR-AB and CS-AB infections hospitalized in the Dr. Soetomo Hospital Surabaya, Indonesia between 2018-2021. Also, we retrieved the data of sex, clinical specimen, dates of admission and discharge. The study outcome was hospital costs such as antibiotic and diagnostic costs including radiology and lab investigations charges from the payer perspective. Results: The antibiotic and diagnostic costs for CR-AB infection was higher than CS-AB infection, US$ 1039.3 versus US$ 492.2 (p < 0.001). It showed that the CR-AB antibiotic cost was higher than CS-AB, US$ 77.2 versus US$ 19.7 (p < 0.001), and the CR-AB diagnostic cost was higher than CS-AB, US$ 882.1 versus US$ 463.1 (p < 0.05).

Extended spectrum β-lactamase (ESBL)-producing Escherichia coli have been found in healthy individuals in Indonesia and Vietnam. The ISEcp1-bla CTX-M transposition unit of ESBL-producing bacterial isolates has been considered responsible for the production of CTX-M type ESBL and it is important for the dissemination of bla CTX-M . This study aimed to characterize the upstream genetic structure (UGS) of E. coli isolates possessing bla CTX-M-1 group and/or bla CTX-M-9 group genes obtained from healthy individuals in Indonesia and Vietnam. A total of 501 CTX-M type ESBL-producing E. coli isolates possessing bla CTX-M-1 group and/or bla CTX-M-9 group genes were obtained from healthy individuals of the two countries in 2018. The UGSs of the ISEcp1-bla CTX-M transposition unit of the 501 ESBL-producing E. coli isolates were amplified by barcode-adaptor-ligationmediated PCR and analyzed using the Nanopore sequencer. The obtained sequence information was used to classify the UGSs of the ISEcp1-bla CTX-M transposition unit. From the 501 ESBL-producing E. coli isolates, 502 UGSs were obtained, which were classified into 85 UGS types based on the sequence. ISEcp1 of 359 (71.5%) of the 502 UGSs was disrupted by gene insertion, and ISEcp1bla CTX-M transposition unit of most (87.1%) of the determined UGSs was confirmed as plasmidic. Only 6 (7.1%) of the 85 UGS types were common to both countries. Our results indicated that many different UGSs of ISEcp1-bla CTX-M transposition units were detected in Indonesia and Vietnam; hence, we suggest that structurally different kinds of plasmids harboring bla CTX-M were separately distributed in the two countries.

Background: Carbapenem resistant-non lactose fermenter (CR-NLF) and Carbapenem resistant-Enterobacteriaceae (CR-E) bacterial infections are likely to be a global threat to people’s health. However, studies on the economic impacts according to the hospital setting are very scarce. The study aimed to explore the impact of CR-NLF (Acinetobacter baumannii = CRAB) & Pseudomonas aeruginosa = CRPA) and CR-E (Escherichia coli = CREC) & Klebsiella pneumoniae = CRKP) infections on hospital costs from a payer perspective among patients admitted to Dr.Soetomo Hospital, Surabaya, Indonesia. Methods: In the retrospective case-control study, medical records of all included patients hospitalized during 2018–2021 were reviewed for CRAB, CRPA, CREC, CRKP, and carbapenem sensitive (CSAB, CSPA, CSEC, CSKP) were collected. We retrieved the data of age, gender, clinical specimen, dates of admission, and discharge status. The outcomes of interest were hospital length of stay and hospitalization cost. Results: The cost for CR-NLFs infections was higher than carbapenem sensitive, $3026.24 versus $1299.28 (p < 0.05). There was no significant difference between CR-E against carbapenem sensitive. It showed that the highest impact of the cost was CRAB, followed by CRPA, CRKP, and CREC. The bed, antibiotics, pharmacy, and diagnostic costs of CR-NLFIs were significantly higher than CR-E. Conclusion: This study showed that the hospital cost and expenditure of CR-NLFs per patient were higher than CS. The hospital cost per patient for CR-NLF was higher than CR-E.

Introduction: Streptococcus constellatus (SC) is commensal bacteria and belongs to Streptococcus anginosus group (SAG). However, SC causes infections especially in patient with underlying diseases. SC empyema is a clinical case that is described in very few studies, especially in Indonesia.Case: A 45-year-old man was admitted to emergency department in Dr. Soetomo General Hospital Surabaya with respiratory insufficiency on November 11th 2020 after 3 months of non-productive cough and a week of weakness. He was diagnosed with empyema on right hemithorax and received chest tube insertion. SC was isolated from pleural fluid sample after first day of culture on Bactec BD bottle. GeneXpert result of pleural fluid was negative for Mycobacterium tuberculosis (MTB). He completed 10 days of intravenous ampicillin-sulbactam and metronidazole. The CT scan reported solid mass of 4.7x7.4x7.8 cm in posterolateral segment of inferior lobe right lung, right pleural effusion, with adenocarcinoma as biopsy result.Discussion: SC is a normal commensal in respiratory tract, however with the presence of a certain factor such as immunocompromised, colonized SAG directly induces an infection after entering normal sterile sites in the body including pleural fluid.Conclusion: Although infection caused by SC is a rare case, it still should be considered in clinical diagnosis and treatment of related infections, particularly in patients with comorbidities. The prognosis was good with appropriate antibiotics and chest tube insertion.