Identifikasi Resistensi Gen Ctx-M dan Oxa Terhadap Bakteri Klebseilla pneumonia dan Acinetobacter baumannii pada Penderita Pneumonia di Rumah Sakit Umum Pusat Haji Adam Malik Medan

Abstract

Meningkatnya prevalensi resistensi antibiotik terhadap pengobatan pneumonia menjadi masalah di dunia. Pengobatan infeksi yang resisten terhadap antibiotik cendrung meningkat disebabkan lamanya pengobatan, penggunaan antibiotik yang tidak rasional, dan tingginya angka kematian akibat resistensi antibiotik. Data yang diperoleh dari Rumah Sakit Umum H. Adam Malik Medan tahun 2018, umumnya Acinotobacter baumannii yaitu 17,6% dan Klebseilla pneumonia sebanyak 16,55%. Tujuan penelian ini untuk menentukan dan menganalisis mutasi gen penyebab resistensi terhadap Acinetobakter baumannii dan Klebseilla pneumonia yang terdapat pada sampel sputum pneumonia di RSUP Haji Adam Malik Medan periode Januari-September 2019. Penelitian ini merupakan penelitian Cross Sectional Prospective Design. prevalensi gen CTX-M dan OXA diperoleh dengan mengektraksi sputum pasien pneumonia menggunakan metode molekuler PCR yang dilanjutkan dengan amplifikasi, elektroforesis gel, dan divisualisasi dengan Gel Documentation. Perubahan pasangan urutan basa DNA dinyatakan dengan base pair. Sebanyak 50 sampel sputum terdiagnosis pneumonia dan 33 sampel (66%) diantaranya mengandung Klebseilla pneumonia sebanyak 16 sampel dan Acinetobacter baumannii 17 sampel. Ekpresi gen resistensi terhadap Kleibseilla pneumonia terdapat persentase gen CTX-M 93,7%, OXA 31,2%, dan diikuti gen yang mengekpresikan kedua-duanya yaitu CTX-M dan OXA sebesar 25%. Acinetobacter baumannii terdapat ekpresi gen yang cukup rendah yaitu ekspresi gen CTX-M 17,6%, gen OXA 23,5%, dan CTX-M-OXA 5,8%. Berdasarkan penelitian tersebut dapat disimpulkan bahwa gen resistensi terhadap golongan sefalosporin generasi ketiga lebih tinggi dibandingkan golongan carbapenem.

The increasing prevalence of antibiotic resistance to pneumonia treatment has become a problem in the world. Treatment of infections are resistant to antibiotics tends to increase due to the length of treatment, irrational use of antibiotics, and Increase mortality due to antibiotic resistance. H. Adam Malik General Hospital Medan 2018, the generally Acinetobacter baumanii was 17.6% and Klebsiella pneumonia was 16.55%. The purpose of study was to determine and analyze the mutation of gen causing resistance to Acinetobacter baumannii and Klebseilla pneumonia found sputum of pneumonia patiens samples in RSUP Haji Adam Malik Medan period January - September 2019. This cross sectional prospective design. Prevalence of CTX-M and OXA genes was obtained by extracting sputum of pneumonia patients and analyzed using molecular PCR method, followed by amplification, gel electrophoresis, and visualized using Gel Documentation. Size were determined DNA by molecular size expressed by base pair. A total of 50 samples pneumonia patiens sputum were diagnosed pneumonia and 33 samples (66%) of them 16 was positive Kleibseilla pneumonia and 17 positive Acinotobacter baumanni. PCR detection showed gen resistant in Kleibseilla pneumonia was CTX-M 93.7%, OXA 31.2%, and Followed CTX-M-OXA was 25%. Acinotobacter baumannii showed presentation low ekpresion genes CTX-M 17.6 %, OXA 23.5% and followed CTX-M-OXA was 5.8%. Based of description above, the concluded that the resistance gene for the third generation cephalosporin group was higher than carbapenem group.