Gambaran Infeksi Acinetobacter baumannii dan Pola Sensitifitasnya terhadap Antibiotik

I Wayan Gustawan, Hindra Irawan Satari, Idham Amir, Dalima AW Astrawinata

Sari


Latar belakang. Adanya peningkatan insiden infeksi Acinetobacter baumannii yang disertai peningkatan kejadian resistensi antibiotik, peningkatan morbiditas dan mortalitas, dan terbatasnya laporan kejadian infeksi bakteri ini pada pasien anak.
Tujuan. Mengetahui gambaran infeksi Acinetobacter baumannii dan pola sensitifitasnya terhadap antibiotik di Departemen Ilmu Kesehatan Anak RSUPN Dr Cipto Mangunkusumo.
Metode. Merupakan penelitian deskriptif retrosfektif melalui penelusuran data hasil biakan darah di laboratorium dan rekam medis dari Januari-Desember 2012.
Hasil. Didapatkan 47 isolat darah Acinetobacter baumannii dari 32 pasien. Penelusuran rekam medis mendapatkan 24 data pasien lengkap. Semuanya merupakan pasien ruang NICU, sebagian besar laki-laki (18/24) dan neonatus kurang bulan (18/24). Gambaran klinis menunjukkan rerata frekuensi denyut jantung 148 kali/menit, frekuensi napas 55 kali/menit, suhu aksila 37,10C, kadar leukosit 12767,8/mm3, kadar trombosit 58491,3/mm3, kadar procalcitonin 17,6 ng/mL, dan CRP 88,5 mg/L. Rerata lama perawatan sebelum terjadi infeksi 23,9 hari. Sebagian besar pasien menggunakan alat medis seperti ventilator, CPAP, jalur vena sentral, jalur vena perifir, dan pipa nasogastrik dengan rerata lama pemakaian masing-masing 17,9, 4,5, 20,9, 13,3, dan 17,3 hari. Semua pasien mendapat antibiotik sebelum infeksi dengan rerata lama pemberian 22,5 hari. Uji kepekaan antibiotik mendapatkan 23 isolat (23/24) merupakan MDR. Resistensi antibiotik didapatkan pada golongan aminoglikosida, carbapenem, quinolon, sefalosporin, penisilin-beta lactamase inhibitor, dan tigesiklin. Sebagian besar penderita meninggal dalam perawatan (18/24).
Kesimpulan. Semua pasien yang menderita infeksi Acinetobacter baumannii dirawat di ruang NICU, sebagian besar pasien merupakan kasus MDR.


Kata Kunci


infeksi Acinetobacter baumannii; pola resistensi; antibiotik

Teks Lengkap:

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Referensi


Maragakis LL, Perl TM. Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options. Clin Infect Dis 2008;46:1254–63.

Peleg AY, Seifert H, Paterson DL. Acinetobacter baumannii: emergence of a successful pathogen. Clin Microbiol Rev 2008;21:538-82.

Fishbain J, Peleg AY. Treatment of Acinetobacter infections. Clin Infect Dis 2010;51:79–84.

Hosoglu S, Hascuhadar M, Yasar E, Uslu S, Aldudak B. Control of an Acientobacter baumannii outbreak in a neonatal ICU without suspension of service: a devastating outbreak in Diyarbakir, Turkey. Infection 2012;40:11–8.

Kanokorn L, Peninnah O. Acinetobacter baumannii infection and colonization among pediatric patients at Chiang Mai university hospital. Infect Dis Antimicrob Agents 2007;24:63-73.

Balkhy HH, Bawazeer MS, Kattan RF, Tamim HM, Johani SM, Aldughashem FA, dkk. Epidemiology of Acinetobacter spp.-associated healthcare infections and colonization among children at a tertiary-care hospital in Saud Arabia: a 6-year retrospective cohort study. Eur J Clin Microbiol Infect Dis 2012;31:2645–51.

Corbella X, Montero A, Pujol M, Domínguez A, Ayats J, Argerich MJ. Emergence and rapid spread of carbapenem resistance during a large and sustained hospital outbreak of multiresistant Acinetobacter baumannii. J Clin Microbiol 2000;38:4086-95.

Hong KB, Oh HS, Song JS, Lim JH, Kang DK, Son IS, dkk. Investigation and control of an outbreak of imipenem-resistant Acinetobacter baumannii infection in a pediatric intensive care unit. Pediatr Infect Dis J 2012;31: 685–90.

Blot S, Vandewoude K, Colardyn F. Nosocomial bacteremia involving Acinetobacter baumannii in critically ill patients: a matched cohort study. Intensive Care Med 2003;29:471–5.

Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, dkk. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268–81.

Gupta S, Govil D, Kakar PN, Prakash O, Arora D, Das S dkk. Colistin and polymyxin B: a re-emergence. Indian J Crit Care Med 2009;13:49-53.

Sheng WH, Liao CH, Lauderdale TL, Ko WC, Chen YS, Liu JW, dkk. A multicenter study of risk factors and outcome of hospitalized patients with infections due to carbapenem-resistant Acinetobacter baumannii. Int J Infect Dis 2010;14:e764–9.

Seifert H, Dijkshoorn L, Gerner-Smidt P, Pelzer N, Tjernberg I, Vaneechoutte M. Distribution of Acinetobacter species on human skin: comparison of phenotypic and genotypic identification methods. J Clin Microbiol 1997;35:2819–25.

Anunnatsiri S, Tonsawan P. Risk factors and clinical outcomes of multidrug-resistant Acinetobacter baumannii bacteremia at a University Hospital in Thailand. Southeast Asian J Trop Med Public Health 2011;42:693-703.

Sengstock DM, Thyagarajan R, Apalara J, Mira A,Chopra T, Kaye KS. Multidrug- resistant Acinetobacter baumannii: an emerging pathogen among older adults in community hospitals and nursing homes. Clin Infect Dis 2010;50:1611-6.

Abbo A,Venezia SN, Hammer-Muntz O, Krichali T, Siegman-Igra Y, Carmeli Y. Multidrug-resistant Acinetobacter baumannii. Emerg Infect Dis 2005;11:22-9.

Zavascki AP, Goldani LZ, Li J, Nation RL. Polymyxin B for the treatment of multidrug resistant pathogens: a critical review. J Antimicrob Chemother 2007;60:1206-15.

Cai Y, Chai D, Wang R, Liang B, Bai N. Kolistin resistance of Acinetobacter baumannii: clinical report, machanism and antimicrobial strategies. J Antimicrob Chemother 2012;67:1607-15.

Scott P, Deye G, Srinivasan A, Murray C, Moran K, Hulten E, dkk. An outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection in the US Military health care system associated with military operations in Iraq. Clin Infect Dis 2007;44:1577-84.

Paksu MS, Paksu S, Karadag A, Sensoy G, Asilioglu N, Yildizdase D, dkk. Old agent, new experience: colistin use in the paediatric intensive care unit—a multicentre study. Int J Antimicrob Agents 2012;40:140– 4.




DOI: http://dx.doi.org/10.14238/sp16.1.2014.35-40

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