Deteksi Gen Resisten Ctx-M, Shv, Tem, Oxa-48 pada Isolat Klinis Bakteri Escherichia coli dan Klebsiella pneumoniae yang Tergolong Multiple Drug Resistant Organisms

Abstract

Escherichia coli and Klebsiella pneumoniae are gram negative bacteria in the group of Enterobacteriaceae that cause infections such as septicemia, urinary tract infections, pneumonia, meningitis and gastroenteritis. Antibiotic therapy faced a big problem since many bacterium are Multiple Drug Resistant Organisms (MDROs). MDROs occur because the gene encoding resistance such as CTX-M, SHV, TEM and OXA-48 which causes the bacteria to produce enzymes such as Extended Spectrum Beta-Lactamase. The study aims are to detect the CTX-M, SHV, TEM and OXA-48 resistant genes on the Escherichia coli and Klebsiella pneumoniae classified as MDROs, and the pattern determine of antimicrobial susceptibility. This study was conducted in the Installation Diagnostic Laboratory (Unit of Clinical Microbiology) Haji Adam Malik Hospital Center, Integrated Laboratory and Deptartement Microbiology, Faculty of Medicine, USU Medan. Identification of Escherichia coli and Klebsiella pneumoniae MDROs was done using Vitek 2 Compact, and the presence of CTXM, SHV, TEM and OXA-48 genes was observed using PCR method. The results showed total of 85 sampels that 62 (72.94%) of bacteria isolate bearing CTX-M genes, which 31 (36.47%) was in Escherichia coli and 31 (36.47%) was in Klebsiella pneumonia. SHV genes were detected in all isolat, which 41 (48.23%) was in Escherichia coli and 44 (51.77%) Klebsiella pneumonia. TEM genes were detected is 73 (85.88%) isolates, which 37 (43.52%) was in Escherichia coli and 36 (42.35%) was ins Klebsiella pneumonia.OXA-48 genes were detected is 15 (17.64%), which 3 (3.52%) is was Escherichia coli and 12 (14.11%) was in Klebsiella pneumoniae. From this study antibiotics were recommended for therapy of MDROs is imipenem, meropenem, fosfomycin and amikacin.

Escherichia coli dan Klebsiella pneumoniae adalah bakteri gram negatif pada kelompok Enterobacteriaceae yang dapat menyebabkan infeksi seperti septikemia, infeksi saluran kemih, pneumonia, meningitis dan gastroenteritis. Terapi antibiotika menjadi masalah besar yang dihadapi karena bakteri Multiple Drug Resistant Organisms (MDROs). MDROs terjadi karena adanya gen pengkode resistensi seperti CTX-M, SHV, TEM dan OXA-48 yang menyebabkan bakteri dapat memproduksi enzim Extended Spectrum Beta-Lactamase. Penelitian bertujuan untuk mendeteksi gen resisten CTX-M, SHV, TEM dan OXA-48 pada isolat bakteri Escherichia coli dan Klebsiella pneumoniae yang tergolong MDROs dan mengetahui pola kepekaan antimikroba. Penelitian dilaksanakan di Instalasi Laboratorium Diagnostik (Unit Mikrobiologi Klinik) RSUP Haji Adam Malik Medan, Laboratorium Terpadu dan Departemen Mikrobiologi Fakultas Kedokteran USU Medan. Identifikasi Escherichia coli dan Klebsiella pneumoniae MDROs dengan Vitek 2 Compact dan adanya gen CTX-M, SHV, TEM dan OXA- 48 diamati dengan metode PCR. Hasil penelitian menunjukkan bahwa dari total 85 sampel terdapat 62 (72,94%) isolat bakteri yang membawa gen CTX-M, dimana 31 (36,47%) Escherichia coli dan 31 (36,47%) Klebsiella pneumoniae. Seluruh isolat terdeteksi gen SHV, dimana 41 (48,23%) Escherichia coli dan (51,77%) Klebsiella pneumoniae 44. Gen TEM 73 (85,88%), dimana 37 (43,52%) Escherichia coli dan 36 (42,35%) Klebsiella pneumoniae. Gen OXA-48 dideteksi pada 15 (17,64%), dimana 3 (3,52%) Escherichia coli dan 12 (14,11%) Klebsiella pneumoniae. Dari hasil penelitian antibiotika yang disarankan untuk terapi MDROs adalah imipenem, meropenem, fosfomisin dan amikasin.