MICROBIAL PATTERN AND ANTIBIOTIC SUSCEPTIBILITY TEST IN SEMEN GRESIK HOSPITAL 2012

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1 Microbial Pattern and Antibiotic Susceptibility Test in Semen Gresik Hospital 0 (M Abid Fahruddin, Prihatini) MICROBIAL PATTERN AND ANTIBIOTIC SUSCEPTIBILITY TEST IN SEMEN GRESIK HOSPITAL 0 M Abid Fahruddin, Prihatini Resident at the Department of Clinical Pathology, Faculty of Medicine, Airlangga University, Surabaya Department of Clinical Pathology, Faculty of Medicine, Airlangga University, Surabaya ABSTRAK Pola kuman dan kepekaan antibiotika di rumah sakit diperlukan sebagai upaya surveilans, pola penggunaan antibiotika dan pencegahan infeksi.adanya pola kuman dan kepekaan antibiotika ini menjadi dasar manajemen rumah sakit untuk mengatur penggunaan antibiotika dan menyusun langkah pencegahan infeksi di rumah sakit. Penelitian ini bertujuan untuk mendapatkan gambaran pola kuman dan kepekaan terhadap antibiotika dari kultur yang dilakukan di RS Semen Gresik. Data hasil kultur dan kepekaan terhadap antibiotika diambil dari rekam medis pemeriksaan kultur di RS Semen Gresik periode Januari Desember 0. Didapatkan 38 pemeriksaan kultur dari 337 penderita. Kuman yang tumbuh sebanyak 30 isolat. Kuman Gram positif sebanyak 00 isolat (44.) dan Gram negatif sebanyak 30 isolat (6.). Kultur abses ditemukan jenis kuman terbanyak adalah(3 isolat).kultur darah ditemukan kuman Staph. Epidermidis (7 isolat). Kultur urine didapatkan kuman terbanyak adalah (9 isolat). sebanyak isolat paling banyak ditemukan dalam kultur sputum. Sedangkan Strep. viridans, Enterobacter, dan masing-masing satu isolat ditemukan pada swab tenggorok. Hasil tes kepekaan antimikroba memperlihatkan bahwa Pipemidic acid dan Amoxicilin merupakan antimikroba yang paling banyak mengalami resistensi sedangkan golongan Phenems, Aminoglikosida dan Fofomycin masih mempunyai sensitivitas yang tinggi., dan kuman CONS adalah kuman yang paling banyak ditemukan pada pemeriksaan kultur di Rumah Sakit Semen Gresik. Pipemidic acid dan Amoxicilin merupakan antimikroba yang paling banyak mengalami resistensi sedangkan golongan Phenems, Aminoglikosida, dan Fofomycin masih mempunyai sensitivitas yang tinggi.(fmi 04;0:37-4) Kata kunci: pola kuman, uji kepekaan antibiotik, kultur ABSTRAK Microbial pattern and antibiotic susceptibility test in the hospital are needed as surveilance, pattern of antibiotic use, and infection control program. The microbial pattern and antibiotic susceptibility test are used as tools for hospital management to regulate the use of antibiotics and for taking actions to control hospital infection. This research purposes to obtain the microbial pattern and susceptibility test in Semen Gresik Hospital during January- December 0. This was a descriptive study, data were obtained from the patients medical records in the Semen Gresik Hospital. There were 38 culture examinations from 337 patients. Out of these, 30 cultures showed growth, 00 isolates (44.) were Gram(+) and 30 isolates (6.) were Gram ( -). Abscess specimens, showed (3 isolates)is the most common bacteria. In blood cultures found Staphylococcus epidermidis (7 isolates). Sputum cultures showed ( isolates) and from throat swabs, Streptococcus viridans, Enterobacter, and were found. Antibiotic susceptibility test showed that Pipemidic acid and Amoxicillin were the most resistant antibiotics while Phenems, Aminoglycoside and Fosfomycin, still showed a high susceptibility., Escherichia coli and CONS were the most found microbes in this culture examination. Pipemidic acid and Amoxicillin were the most resistant antibiotics while Phenems, Aminoglycoside and Fosfomycin, still showed a high susceptibility. (FMI 04;0:37-4) Keyword: microbial pattern, antibiotic susceptibility test, culture Correspondence: M Abid Fahruddin, Resident at the Department of Clinical Pathology, Faculty of Medicine, Airlangga University, Surabaya, abidfahruddin@gmail.com INTRODUCTION The hospital is a prone place to transmit germs among patients, workers and patients, visitors and patients, and between visitors. The source of infection can be derived from the transmission of microorganisms from other patients or the patient's body (Herm awati & Rejeki 0, Rena et al 00). Infection is a source of morbidity and mortality in patients who are treated. The spread of germs in the hospital can occur through contact between individuals in the hospital. Prevention programs and socialization to workers, visitors, and patients is useful in reducing the risk of spreading germs. Rational antibiotic use is indispensable in dealing with patients who have an infection. Antibiotic treatment only based on empirical and ignoring the data pattern of germs and antibiotic susceptibility testing may lead to resistance of bacteria against antibiotics 37

2 Folia Medica Indonesiana Vol. 0 No. January - March 04 : 37-4 consumption ( Del Favero et al 004). Therefore, the collection of data on patterns of bacteria and antibiotic susceptibility testing is one way to deal with an infection in malignancy thus reduce mortality or morbidity in accordance with the existing patterns of bacteria in hospital. The purpose of this study is to know the patterns of bacteria that grow in blood cultures, urine, abscess, sputum and other swab and to determine antibiotic susceptibility of bacteria in cultures of patients who do culture and antibiotic susceptibility testing in Semen Gresik Hospital period January - December 0. MATERIALS AND METHODS This research is a descriptive study using secondary data in medical records of patients who checks the identification of bacteria and antibiotic susceptibility in laboratory of Semen Gresik Hospital. The samples were all patients who checks the identification of bacteria and antibiotic susceptibility testing in the laboratory of Semen Gresik Hospital from January to December 0. From patients it was collected the room of origin, type of specimen, culture results, and antibiotic susceptibility test results. The data is presented in tabular form. Specimen collection procedures based on predetermined fixed by Semen Gresik Hospital and attached in this research report. Inspection, identification of bacteria and antibiotic susceptibility test execution is also done in accordance with standard operating procedures that have been there. All data entered into the results of the WHO net applications owned by Semen Gresik Hospital, the data retrieved from the WHO net application in June 03 to do this descriptive study. RESULTS The number of isolates sampled in this study were 38 isolates from 337 patients. Type specimens are specimens abscess, phlegm, blood, sputum, throat, stool and urine. Abscess specimens as many as 6 specimens (4.9), Blood 80 (0.8), urine 6 (6.), sputum 4 (6.3), sputum 3 (6), throat, 3 (0.7) and stool (0.3). Full details can be seen in the following table. DISCUSSION The pattern of bacteria in blood culture isolates of 80 patients. 6 isolates were not obtained isolates obtained growth and growth. Most germs are germs growing group of Gram-positive coagulase-negative Staphylococcus. Whereas Gram-negative bacteria that grow only (Table ). The results of blood cultures, found group Staphylococcus coagulase negative bacteria is similar to research conducted in child patients with blood cultures in Pediatric Department Dr Soetomo hospital Surabaya (Wiwin & Rejeki 03). Similar results were also obtained in the study Kalantar 008 in Iran which shows the majority of Gram-positive bacteria are negative coagulase Staphylococcus (Kalantar et al 008). The results of blood cultures showed coagulase negative Staphylococcus this needs to be ascertained whether any pathogens or contaminants. Table. Distribution of Number of Isolates by Specimen Type Specimen Number Types of Isolates Abscess Blood Urine 6 6. Phlegm Sputum 3 6 Throat Feces 0.3 Total Table. Patterns of Bacteria in Blood Culture Germ Type Amount Gram positive 4 7. Stapylococcus sp. Stapylococcus epidermidis Gramnegative:.. No growth 6 8. Total Table 3. Patterns of Bacteria in Urine Culture Germ Types Amount Gram positive 7.3 Stapylococcus aureus Staphylococcus epidermidis Staphylococcus sp Gram negative No growth Total 6 00 Table 4. Patterns of Bacteria in Abscess Culture Germ Types Isolate amount Gram positive 48 Staphylococcus aureus Staphylococcus epidermidis Staphylococcus sp Strept.β haemolyticus Group A Strept.β haemolyticus Streptococcus non haemolyticus

3 Microbial Pattern and Antibiotic Susceptibility Test in Semen Gresik Hospital 0 (M Abid Fahruddin, Prihatini) Gram negative Acinetobacter sp. Citrobacter sp. Klebsiella sp. Moraxella sp. Morganella sp. Proteus (Prov.) rettgeri Proteus miriabilis Proteus sp. Proteus vulgaris Pseudomonas aeruginosa Pseudomonas sp. Salmonella gallinarum Serratia sp Yersinia enterocolitica Yersinia sp No growth 44.9 Total 9 00 Table. Patterns of Bacteria in Feces Culture Germ Types Amount No growth 00 Total 00 Table 6. Patterns of Bacteria in Phlegm Culture Germ Types Amount Gram positive 3 4. Staphylococcus aureus Staphylococcus epidermidis Staphylococcus sp. Streptococcus non haemolyticus Gram negative 7 9. Serratia sp No growth 3. Total 3 00 Table 7. Patterns of Bacteria in Sputum Culture Germ Types Amount Gram positive Staphylococcus aureus Staphylococcus sp. Streptococcus viridans Streptococcus non haemolyticus Gram negative. Alcalgenes faecalis Achromobacter sp..7 No growth Total 3 00 Table 8. Patterns of Bacteria in Swab Throat Culture Germ Types Amount Gram positive 33.3 Streptococcus 33.3 viridans Gram negative Total 3 00 Table 9. Sensitivity Profile and Antimicrobial In Abscess Isolates Amoxicillin (AMX) Amoxiciliin-Clavulanic acid (AMC) Cefoperazone-Sulbactam (CSL) Ampicillin-Sulbactam(SAM) Cefazolin (CZO) Ceftazidime (CAZ) Ceftriaxone (CRO) Cefotaxime (CTX) Cefepime (FEP) Cefadroxil (CFR) Imipenem (IPM) Meropenem (MEM) Amikacin (AMK) Gentamicin (GEN) Tobramycin (TOB) Pipemidic acid (PPA) Ciprofloxacin (CIP) Levofloxacin (LVX) Fosfomycin (FOS) Clindamycin (CLI) Erythromycin (ERY) Chloramphenicol (CHL) Table 0. Sensitivity Profile and Antimicrobial In Blood Isolates Amoxicillin (AMX) Amoxiciliin-Clavulanic acid (AMC). 6. Cefoperazone-Sulbactam (CSL) Ampicillin-Sulbactam(SAM) Cefazolin (CZO) Ceftazidime (CAZ) Cefotaxime (CTX) Cefepime (FEP) Imipenem (IPM) Meropenem (MEM) Amikacin (AMK) Gentamicin (GEN) Tobramycin (TOB) Pipemidic acid (PPA) Ciprofloxacin (CIP) Levofloxacin (LVX) Fosfomycin (FOS) Clindamycin (CLI) Erythromycin (ERY) Chloramphenicol (CHL)

4 Folia Medica Indonesiana Vol. 0 No. January - March 04 : 37-4 Table. Sensitivity Profile and Antimicrobial In Urine Isolates Amoxicillin (AMX) Amoxiciliin-Clavulanic acid (AMC) Cefoperazone-Sulbactam (CSL) Ampicillin-Sulbactam(SAM) 0 4 Cefazolin (CZO) Ceftazidime (CAZ) Ceftriaxone (CRO) Cefotaxime (CTX) Cefepime (FEP) Cefadroxil (CFR) Imipenem (IPM) Meropenem (MEM) Amikacin (AMK) Gentamicin (GEN) Netilmicin (NET) Tobramycin (TOB) Pipemidic acid (PPA) Ciprofloxacin (CIP) Levofloxacin (LVX) Fosfomycin (FOS) Clindamycin (CLI) 0 Erythromycin (ERY) Chloramphenicol (CHL) Table. Sensitivity Profile and Antimicrobial In Phlegm Isolates Amoxicillin (AMX) Amoxiciliin-Clavulanic acid (AMC) Cefoperazone-Sulbactam (CSL) Ampicillin-Sulbactam(SAM) 0 4 Cefazolin (CZO) Ceftazidime (CAZ) Ceftriaxone (CRO) Cefotaxime (CTX) Cefepime (FEP) Cefadroxil (CFR) Imipenem (IPM) Meropenem (MEM) 6 0 Amikacin (AMK) Gentamicin (GEN) Netilmicin (NET) Tobramycin (TOB) Pipemidic acid (PPA) Ciprofloxacin (CIP) Levofloxacin (LVX) Fosfomycin (FOS) Clindamycin (CLI) Erythromycin (ERY) Chloramphenicol (CHL) Table 3. Sensitivity Profile and Antimicrobial In Sputum Isolates Amoxicillin (AMX) Amoxiciliin-Clavulanic acid (AMC) Cefoperazone-Sulbactam (CSL) Ampicillin-Sulbactam(SAM) Cefazolin (CZO) Ceftazidime (CAZ) Ceftriaxone (CRO) Cefotaxime (CTX) Cefepime (FEP) Cefotiam (CTF) Cefadroxil (CFR) Imipenem (IPM) Meropenem (MEM) 8 0 Amikacin (AMK) 8 0 Gentamicin (GEN) Netilmicin (NET) Tobramycin (TOB) Pipemidic acid (PPA) Ciprofloxacin (CIP)...6 Levofloxacin (LVX) 0 4 Fosfomycin (FOS) Clindamycin (CLI) Erythromycin (ERY) Chloramphenicol (CHL) Table 4. Sensitivity Profile and Antimicrobial In Swab Throat Isolates Amoxicillin (AMX) Amoxiciliin-Clavulanic acid (AMC) Cefoperazone-Sulbactam (CSL) Ampicillin-Sulbactam(SAM) Cefazolin (CZO) Ceftazidime (CAZ) Ceftriaxone (CRO) Cefotaxime (CTX) Cefepime (FEP) Cefadroxil (CFR) Imipenem (IPM) Meropenem (MEM) Amikacin (AMK) Gentamicin (GEN) Tobramycin (TOB) Pipemidic acid (PPA) Ciprofloxacin (CIP) Levofloxacin (LVX) Fosfomycin (FOS) Erythromycin (ERY) Chloramphenicol (CHL) The pattern of bacteria in urine culture, sterile examination results of 40 isolates and isolates obtained germ growth. Gram-negative germs still dominates the positive urine culture with a percentage of 4.. Whereas Gram-positive bacteria as much as.3. Most Gram-positive germs found in urine culture is Staphylococcus aureus. Whereas Gramnegative bacteria are most commonly found was (4.) (Table 3). Samirah research in 006 in Wahidin Sudirohusodo Hospital Makassar showed the results are not too different, the most bacteria found were (Samirah et al 004). Abscess cultures showed the dominance of Gramnegative than Gram-positive. Most Gram-negative germs are with a percentage of 6.7, whereas most Gram-positive bacteria are Staphylococcus sp. as much as 7.8 (Table 4). Novialdi Research Hospital at Dr. M. Djamil Hospital in 00 against the neck abscess showed Gram-positive bacteria Streptococcus viridans is the highest, whereas most Gram-negative bacteria in this study were Bacteroides sp. (Novialdi & Pulungan 00). 40

5 Microbial Pattern and Antibiotic Susceptibility Test in Semen Gresik Hospital 0 (M Abid Fahruddin, Prihatini) There is only one demand and stool cultures obtained no growth (Table ). Phlegm culture as much as 3 isolates, 3 isolates were not obtained 0 isolates obtained growth and the growth of germs. Grampositive germs are more common than Gram-negative bacteria. Most germs are Gram positive Streptococcus sp. with 4 isolates, while Gram-negative predominantly with three isolates (Table 6). The pattern of germs in sputum cultures of Gramnegative bacteria also dominated by isolates, or., whereas Gram-positive bacteria were 9 isolates, or 39.. There are only isolates were not obtained growth of germs while isolates contained the growth of germs. Most Gram-positive germs are Staphylococcus sp., Staphylococcus aureus, Staphylococcus viridans and each isolates, respectively. While most Gram-negative bacteria is as much as isolates, or.7 (Table 7). Kumala research at Cipto Mangunkusumo Hospital Jakarta in 008 on sputum showed normal flora isolates were observed, whereas Gram-negative pathogen Klebsiella pneumoniae is the most Gram-positive while most Gram-negative were Staphylococcus aureus (Kumala et al 00). This germ negative germ is in contrast to our results in the Semen Gresik Hospital. Throat swab culture of Gram-negative bacteria Showed by isolates with bacteria that grow are Enterobacter sp. and. Gram-positive germs grow is Streptococcus viridans. The results of the study of Gram-positive bacteria is similar to research by Isnawati in the health center of Jakarta in 999 Showed most Gram-positive bacteria is Streptococcus viridans (Isnawati et al 00). Antibiotic sensitivity pattern in abscess isolates showed carbapenem class of antibiotics still have the highest sensitivity is Imipenem (96.8) and Meropenem (86). The next class of aminoglycosides has the highest sensitivity is Amikacin (79.), Gentamycin (7.) and Tobramycin (7.8). Next is Sulbactam - cefoperazone (70) and Fosfomycin (69.8). While the pattern of antibiotic resistance in isolates abscess can be seen that Pipemidic acid (96.), Amoxicilin (76) and erythromycin (63.3). Research in Dr. Djamil Hospital Padang on the neck abscess showed a different pattern of antibiotic sensitivity. Cefoperazone + Sulbactam, cefoperazone, and Moxyfloxacine have the highest sensitivity while the most resistant antibiotics are cotrimoxazole and Erythromicin (Novialdi & Pulungan 00). Imipenem (00), Amikacin (93.3) and Fosfomycin (80) are the most sensitive antibiotics in blood isolates. While ceftazidime (00), Pipemidic acid (9.3) and Amoxicilin (86.7) were the most resistant to antibiotics like-blood isolates shown in Table 4 above. While research by Wiwin in. Dr. Soetomo Hospital Surabaya in 03 on children in the child hematology showed cotrimoxazole and Amikacin has the highest sensitivity (Wiwin & Rejeki 03). Urine isolates showed the highest antibiotic sensitivity by Imipenem (00), Meropenem (77.8), Amikacin (66.7) and Fosfomycin (60). While m ost high resistance in a row is Pipemidic acid (00), Netilmicin (00), erythromycin (84.6) and Amoxicilin (8.8). Different results can be seen from research in India by Manikandan showed cotrimoxazole, Nalidixic acid, and Amoxicilin is the most resistant antibiotics. While Cephalexin and Ciprofoxacin have enough sensitivity (Manikandan et al 0). Sputum isolates showed antibiotic is Cefotiam most sensitive (00), Meropenem (8), Amikacin (8) and Amociclav (83.3). While Netilmicin (00), Pipemidic acid (00) and Amoxicilin (66.7) had the highest resistance level. Parhusip study showed that the clinic BP4 field Ciprofloxacin and Ofloxacin is most sensitive while Cephalexin antibiotics and Tetracycline become the most resistent (Parhusip 00). The results of antibiotic sensitivity test against throat swab isolates showed a lot of antibiotics are still sensitized which are Amoxicilin, amoxiclav, Chloramphenicol and Ampicillin-Sulbactam. In addition to many antibiotics are still sensitized, there is antibiotic resistant which are Erythromycin, Cefadroxil, and Ciprofloxacin. It showed similar result with Isnawati research in health centers Jakarta in 999 which showed that Amoxicilin have low resistance to throat swab (Isnawati et al 00). CONCLUSION, bacteria and germs CONS are most commonly found on culture examination in Semen Gresik. Pipemidic Amoxicilin acid and is the most experienced antimicrobial resistance while Phenems class, aminoglycosides and Fofomycin still have a high sensitivity. REFERENCES Del Favero A, Bucaneve G, Furno P (004). Choice of empirical therapy and prophylaxis. Hematol J, S3- S8 4

6 Folia Medica Indonesiana Vol. 0 No. January - March 04 : 37-4 Hermawati R and Rejeki IGGA PR (0). Pola Kuman dan Kepekaan Antibiotika Kultur Darah pada Penderita Anak di IRNA Anak RSUD Dr Soetomo Surabaya, Surabaya, Dr Soetomo Hospital Isnawati A, Gitawati R, Herman MJ (00). Pola sensitifitas kuman dari isolat hasil usap tenggorok penderita tonsilo-faringitis akut terhadap beberapa antimikroba di Puskesmas Jakarta Pusat. Bul Penel Kesehatan 30, 39-4 Kalantar E, Motlagh M, Lordnejad H, Beiranvand S (008). The prevalence of bacteria isolated from blood cultures of iranian children and study of their antimicrobial susceptibilities. Jundishapur Journal of Natural Pharmaceutical Products 3, -7 Kumala S, Pasanema DAM, Mardiastuti (00). Pola resistensi antibiotik terhadap isolatbakteri sputum penderita tersangka infeksi saluran nafas bawah. Jurnal Farmasi Indonesia, 4-3 Manikandan S, Ganesapandian S, Singh M, Kumaraguru AK (0). Antimicrobial susceptibility pattern of urinary tract infection causing human pathogenic bacteria. Asian Journal of Medical Sciences 3, 6-60 Novialdi and Pulungan MR (00). Pola Kuman Abses Leher Dalam. Available from ac.id/8384//pola0kuman0abses0leher 0Dalam.pdf. Accessed January, 0 Parhusip RS (00). Hasil Uji Kepekaan Bakteri yang Diisolasi dari Sputum Penderita Infeksi Saluran Nafas Pernafasan Bawah di Poliklinik BP-4 Medan. Available from /346789/34//paru-parhusip.pdf. Accessed January 4, 0 Rena RA, Suega K, Bakta IM (00). Pola kepekaan bakteri pada pasien keganasan hematologi di RSUP Sanglah Denpasar. J Peny Dalam, Samirah, Darwati, Windarwati, Hardjoeno (006). Pola dan sensitivitas kuman di penderita infeksi saluran kemih. Indonesian Journal of Clinical Pathology and Medical Laboratory, 0-3 Wiwin J and Rejeki IGGA PR (03). Pola Kuman dan Kepekaan Antibiotika pada Penderita Anak di Ruang Hematologi-Onkologi Anak RSUD Dr Soetomo Surabaya. Unpublished Article 4