MULTIDRUG-RESISTANT KLEBSIELLA PNEUMONIAE DAN ESCHERICHIA COLI DI RUMAH SAKIT TERSIER PASCA PANDEMI COVID-19: PREVALENSI, KARAKTERISTIK, DAN POLA KEPEKAAN

Abstract

Klebsiella pneumoniae dan Escherichia coli adalah bakteri Gram negatif dari famili Enterobacteriaceae yang banyak terisolasi di rumah sakit sebagai penyebab infeksi, baik hospital-acquired infections (HAIs) maupun community-acquired infections. Prevalensi resistensi bakteri tersebut semakin meningkat, termasuk resistensi terhadap antibiotik golongan karbapenem dan sefalosporin spektrum luas. Penelitian ini bertujuan untuk mengetahui pola kepekaan                  K. pneumoniae dan E. coli penghasil extended spectrum β-lactamase (ESBL) dan resisten karbapenem terhadap antibiotik yang diisolasi dari pasien rawat inap serta distribusinya berdasarkan usia, jenis kelamin, diagnosis, ruang rawat, lama rawat, status rujukan, dan jenis spesimen. Penelitian ini adalah penelitian deskriptif observasional dengan desain cross-sectional menggunakan data laboratorium dan data rekam medis di Instalasi Laboratorium Sentral dan Instalasi Rekam Medis RSUP Dr. Mohammad Hoesin Palembang periode Juli 2022-Juni 2023. Terdapat 587 isolat K. pneumoniae dan 506 isolat E. coli penghasil ESBL atau resisten karbapenem. Distribusi K. pneumoniae dan E. coli berdasarkan profil resistensinya di RSUP Dr. Mohammad Hosein Palembang, antara lain ESBL-K. pneumoniae (53,6%), ESBL-E. coli (72,1%), CR-K. pneumoniae (8%), CR-E. coli (1,8%), ESBL-CR-K. pneumoniae (2%), dan ESBL-CR-E. coli (1%). Berdasarkan pola kepekaan, isolat penghasil ESBL sensitif terhadap antibiotik piperasilin/tazobaktam, golongan karbapenem, amikasin, nitrofurantoin, dan tigesiklin. Isolat CRE sensitif terhadap amikasin, nitrofurantoin, dan tigesiklin. Isolat Enterobacteriaceae multidrug-resistant (MDR) yang paling banyak di RSUP Dr. Mohammad Hoesin Palembang selama periode penelitian adalah ESBL-E. coli (72,1%), dengan sensitivitasnya yang masih cukup tinggi terhadap piperasilin/tazobaktam, karbapenem, amikasin, nitrofurantoin, dan tigesiklin.

ABSTRACT

Hospital-acquired infections (HAIs) and community-acquired infections are frequently caused by two Gram-negative bacteria from the Enterobacteriaceae family: Escherichia coli and Klebsiella pneumoniae. These bacteria are frequently identified in hospitals. Resistance in bacteria, especially resistance to broad-spectrum cephalosporins and carbapenems, is becoming more common. This study aims to determine the antibiotics sensitivity pattern of ESBL-producing and carbapenem-resistant K. pneumoniae and E. coli isolated from hospitalized patients and its distribution based on age, gender, diagnosis, ward, length of stay, referral status, and specimen type. This research is a descriptive observational study with a cross-sectional design using laboratory and medical record. In this investigation, 587 K. pneumoniae isolates and 506 E. coli isolates that produced ESBL, or carbapenem-resistant, were detected. At Dr. Mohammad Hosein General Academic Hospital Palembang, the distribution of K. pneumoniae and E. coli is determined by their resistance profiles, which include ESBL-K. pneumoniae (53.6%), ESBL-E. coli (72.1%), CR-K. pneumoniae (8%), CR-E. coli (1.8%),                      ESBL-CR-K. pneumoniae (2%), and ESBL-CR-E. coli (1%). The susceptibility pattern showed that ESBL-producing isolates were sensitive to piperacillin/tazobactam, carbapenems, amikacin, nitrofurantoin, and tigecycline. The CRE isolate was sensitive to tigecycline, nitrofurantoin, and amikacin. ESBL-E. coli was the most prevalent multidrug-resistant Enterobacteriaceae in this investigation, with a significant degree of sensitivity to tigecycline, amikacin, carbapenems, nitrofurantoin, and piperacillin/tazobactam.