Objective Automated systems are needed for the rapid and accurate diagnosis of Pseudomonas-associated nosocomial infections among critically ill patients admitted to the intensive care unit. We assessed the performance of TDR-300B and VITEK®2 for the identification of P. aeruginosa using VITEK®-MS as the gold standard. Methods This analytical study employed a cross-sectional approach. First, 44 clinical isolates of P. aeruginosa were collected and refreshed. Next, a single colony of oxidase-positive, gram-negative rods (30 samples) was inoculated into a TDR-300B NF-64 card and VITEK®2 GN cassette for each isolate. Finally, bacterial identification was performed using VITEK®-MS for comparative analysis. Results Compared with the results for VITEK®-MS, the congruence rates for TDR-300B and VITEK®2 were 80.76% (21/26) and 92.30% (24/26), respectively. Further, high sensitivity was observed for TDR-300B and VITEK®2 (95.45% and 100%, respectively). In addition, TDR-300B had a lower positive predictive value and accuracy than VITEK®2, albeit without significance. Conclusions Conclusively, there were no significant differences regarding the diagnostic efficiency of TDR-300B and VITEK®2 for P. aeruginosa.
Quick and precise methods have always been needed in the medical field to correctly identify the agent of infection. Automated systems for diagnosis of infectious pathogen such Pseudomonas aeruginosa from critical patients with infections in the Intensive Care Unit is essential. This study aimed to compare the capability of automated biochemistry-based identification system, TDR-300B and VITEK ® 2, to the one of Matrix-Assisted Laser Desorption/Ionization -Time of Flight (MALDI-TOF), VITEK ® -MS, in the identification of P. aeruginosa. Samples were P. aeruginosa isolates collection from Laboratory of Microbiology, Faculty of Medicine and Health Science UNIKA Atma Jaya. These isolates were refreshed; one single colony of oxidase-positive Gram-negative rods was further inoculated in TDR-300BNF-64 cards and VITEK ® 2 GN cassettes. The bacterial identification was also carried out using VITEK ® -MS as gold-standard. Positivity of TDR-300B and VITEK ® 2 in the identification of P. aeruginosa was 87.09% (27/31) and 90.32% (28/31) in the species level, and 87.09%, 96.77% in the genus level respectively. The congruity of TDR-300B/ VITEK ® 2 in the species and genus level was 83.87% and 87.09%. When compared to VITEK ® -MS, congruence of VITEK ® 2 was 93.30% (24/26) and TDR-300B was 80.76% (21/26). Sensitivity value for TDR-300B and VITEK ® 2 was high, 95.45% and 100%, positive predictive value and accuracy were lower in TDR-300B than VITEK ® 2; Fisher' exact value was >0.05, thus there were no significant differences in the capability of TDR-300B and VITEK ® 2 in the identification of P. aeruginosa.
Introduction: Acinetobacter baumannii, a multidrug-resistant Gram-negative opportunist has been known among the cause of nosocomial infection. Risk factors of infection related to A. baumannii have been reported elsewhere. This study aimed to find the association of A. baumannii positive culture and invasive procedures in patients hospitalized in the Intensive Care Unit and Hospital ward in Jakarta. Methodology: This study was a retrospective, 1:1 matched case-control study with total sampling method from in-patients in the ICU and the Internal Medicine Wards (IMW) of a Private Hospital, North Jakarta in 2015 - 2018. Data retrieved were positive culture of A. baumannii. Positive cultures of multi-sensitive bacteria were included as a control group. Antibiotic susceptibility test was carried out as recommended by Clinical and Laboratory Standards Institute. Results: A total of 88 in-patients were studied, and A. baumannii isolates were identified from 44 patients. Most of A. baumannii showed resistant to almost all antibiotics tested, except for colistin. Bivariate analysis showed a significant association of A. baumannii positive culture and the use of ventilator in the ICU (p = 0,039), and with urinary catheters in the IMW (p = 0,022). Multivariate analysis showed that length of stay also has a significant association to A. baumannii positive culture in the ICU. Conclusion: The use of ventilators and urinary catheters showed a significant association with Acinetobacter baumannii positive culture in patients in the ICU and in the IMW respectively. All of the A. baumannii isolates were susceptible to colistin.
BACKGROUND: Antibiotic resistance has become a worldwide problem. Among Asia countries, Indonesia has high prevalence of multi-drug resistant organisms mainly due to Gram-negative bacilli Enterobacteriaceae. This study aimed to find out whether gene family of AmpC and AmpC/ESBL-producing Enterobacteriaceae were present in the Intensive Care Unit (ICU) of Cipto Mangunkusumo Hospital, Jakarta, Indonesia.METHODS: Specimens were obtained from several body sites of adult patients with infection hospitalised in ICU of Cipto Mangunkusumo Hospital. VITEK®2 was used to identify the microorganisms. Antibiotic susceptibility tests were conducted using VITEK®2 and disc diffusion technique according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Double disc synergy (DDS) test method was employed to detect AmpC activity. Gene families of ampC were identified using multiplex polymerase chain reaction (PCR).RESULTS: Forty five isolates were identified as putative AmpC, extended-Spectrum β-lactamases (ESBL) and AmpC/ESBL-producing Enterobacteriaceae. Klebsiella pneumoniae (n=32) were predominant, followed by Escherichia coli (n=6), Enterobacter cloacae (n=5) and Enterobacter aerogenes (n=2). AmpC activity was detected in 9 isolates, in which 4 isolates were AmpC producing and 5 isolates were AmpC/ESBL. In vitro, AmpC-producing Enterobacteriaceae showed good susceptibility to many antibiotic tested, while those of AmpC/ESBL-producing only to Amikacin. The gene families of ampC were DHA, EBC and CIT identified from 6 isolates.CONCLUSION: DHA, EBC and CIT gene families were identified from AmpC and AmpC/ESBL-producing Enterobacteriaceae in the ICU of Cipto Mangunkusumo Hospital. While the AmpC-producing was still susceptible to almost all antibiotics tested, the AmpC/ESBL-producing showed resistant except for Amikacin.KEYWORDS: Enterobacteriaceae, β-lactamases, AmpC, ESBL
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