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Abstrak :
Indonesia merupakan negara dengan tingkat resistensi antibiotik yang tinggi. Tingkat resistensi yang tinggi ini terutama didapatkan pada bakteri batang Gramnegatif famili Enterobacteriaceae. Tujuan penelitian ini adalah untuk mengetahui proporsi dan karakteristik Enterobacteriaceae patogen penghasil AmpC di Unit Perawatan Intensif RS Cipto Mangunkusumo Jakarta. Spesimen berasal dari pasien dewasa yang didiagnosis mengalami infeksi organ atau sistem tertentu. Spesimen berupa darah, sekret saluran pernafasan bawah, urin, swab dasar luka, aspirat abses, dan jaringan luka operasi. Identifikasi dilakukan menggunakan VITEK® 2. Pola kepekaan ditentukan dengan VITEK® 2 dan metode difusi cakram sesuai kriteria CLSI tahun 2014. Deteksi AmpC dan ESBL dilakukan menggunakan metode double disc synergy test. Famili gen pengkode AmpC ditentukan dengan metode PCR multipleks. Enterobacteriaceae patogen yang berhasil dikumpulkan berjumlah 45 isolat, terdiri dari Klebsiella pneumoniae (n=32), Escherichia coli (n=6), Enterobacter cloacae (n=5), dan Enterobacter aerogenes (n=2). Proporsi Enterobacteriaceae penghasil AmpC adalah 9 isolat di antara 45 isolat, terdiri dari 4 isolat penghasil AmpC dan 5 isolat penghasil AmpC dan ESBL. Gen pengkode AmpC ditemukan pada 7 isolat, yang terbanyak adalah DHA (n=4) diikuti EBC (n=2) dan CIT (n=1). Secara in vitro, Enterobacteriaceae penghasil AmpC menunjukkan kepekaan yang baik terhadap gentamisin, tobramisin, amikasin, sefepim, meropenem, siprofloksasin, levofloksasin, tetrasiklin, dan kotrimoksasol sementara penghasil AmpC dan ESBL hanya terhadap amikasin. ...... Antibiotic resistance has become a problem in Indonesia, in which the high resistance has been found mainly in Gram-negative bacilli Enterobacteriaceae. This study aimed to find out the proportion and characteristics of pathogenic AmpC-producing Enterobacteriaceae in the ICU of Cipto Mangunkusumo Hospital Jakarta. Spesimens collected were blood, lower respiratory tract secretions, urine, wound swab, abscess aspirate, and soft tissue taken from adult patients with infection. Identification were conducted using VITEK® 2. Susceptibility tests were conducted using VITEK® 2 and diffusion technique according to CLSI 2014 guidelines. Double disc synergy test method were employed to detect AmpC activity. The presence of ampC genes were detected using multiplex PCR. Forty five isolates were collected. Klebsiella pneumoniae was predominant, followed by Escherichia coli, Enterobacter cloacae, and Enterobacter aerogenes. AmpC activity was detectable in nine isolates. Five of the 9 isolates produced both AmpC and ESBL. In vitro, AmpC-producing Enterobacteriaceae showed good susceptibility to gentamicin, tobramycin, amikacin, cefepime, meropenem, ciprofloxacin, levofloxacin, tetracycline, and cotrimoxazole. While the AmpC and ESBL-producing only to amikacin. ampC genes were detected in seven isolates and the most prevalent gene family was DHA (n=4) followed by EBC (n=2) and CIT (n=1).

Abstrak :
Latar Belakang: Prevalensi infeksi yang disebabkan oleh multidrugs resistent microorganism (MDRO), terutama bakteri Enterobacteriaceae penghasil enzim extended-spectum beta-lactamase (ESBL) semakin meningkat. Identifikasi yang cepat dan pemberian antibiotik yang tepat, terutama untuk pasien intensive care unit (ICU), dibutuhkan untuk menurunkan lama rawat dan menurunkan angka mortalitas. Duke clinical score merupakan suatu instrumen stratifikasi risiko untuk memprediksi infeksi bakteri Enterobactericeae penghasil ESBL. Duke clinical score pernah diteliti untuk memprediksi infeksi yang didapat dari komunitas, namun belum pernah diteliti untuk pasien ICU. Metode: Penelitian ini merupakan uji diagnostik dengan design kohort prospektif. Subjek penelitian merupakan pasien ICU RSUPN Dr. Cipto Mangunkusumo (RSCM) yang memenuhi kriteria inklusi selama bulan Januari-Maret 2022. Skrining dengan swab rektum untuk melihat adanya infeksi bakteri Enterobacteriaceae penghasil enzim ESBL dilakukan dalam 24 jam pertama perawatan pasien di ICU. Kultur klinis dilakukan sesuai indikasi. Duke clinical score diperiksa pada awal perawatan pasien di ICU. Pasien yang tidak terinfeksi bakteri Enterobacteriaceae penghasil enzim ESBL di awal perawatan di ICU akan diobservasi dan diambil kembali swab rektum pada akhir perawatan di ICU. Penelitian akan menilai sensitivitas, spesifisitas, positive dan negative predictive value (PPV, NPV), area under curve (AUC) receiver operating characteristic (ROC) Duke clinical score. Hasil: Dari 105 pasien yang memenuhi kriteria inklusi, 55% pasien memiliki swab rektum atau kultur klinis yang positif dengan bakteri Enterobacteriaceae penghasil enzim ESBL dalam 24 jam perawatan pertama di ICU sehingga dieksklusi. Total subjek penelitian 47 pasien yang tidak terinfeksi bakteri Enterobacteriaceae penghasil ESBL pada awal perawatan di ICU. Pada nilai cut-off ≥ 8.5, Duke clinical score memiliki sensitivitas 32%, spesifisitas 89%, PPV 67%, NPV 66%. AUC ROC 0.652. Kesimpulan: Duke clinical score tidak valid sebagai prediktor infeksi bakteri Enterobacteriaceae penghasil enzim ESBL pada pasien ICU RSCM. ...... Background: The prevalence of infections caused by multidrugs resistant microorganisms, especially extended-spectrum-beta-lactamase (ESBL)-producing Enterobacteriaceae, is increasing. Rapid identification and proper administration of antibiotics, especially for intensive care unit (ICU) patients, are needed to reduce length of stay and lower mortality rates. Duke clinical score is a risk stratification instrument for predicting infection caused by ESBL-producing Enterobactericeae. Duke clinical scores have been studied to predict community-acquired infections, but have never been studied for ICU patients. Methods: This study was a diagnostic test with a prospective cohort design. The subjects were patients of ICU Cipto Mangunkusumo general teaching hospital (RSCM) during January-March 2022 who met the inclusion criterias. Screening with a rectal swab to see the presence of infection with the ESBL-producing Enterobacteriaceae was carried out within the first 24 hours of admission in ICU. Clinical culture was carried out according to indications. Duke clinical score was examined at the beginning of the patient's treatment in the ICU. Patients who were not infected with the ESBL-producing Enterobacteriaceae at the beginning of treatment in the ICU would be observed and rectal swab would be taken at the end of treatment in the ICU. The study would assess the sensitivity, specificity, positive and negative predictive value (PPV, NPV), area under curve (AUC) receiver operating characteristic (ROC) Duke clinical score. Results: Of the 105 patients who met the inclusion criteria, 55% of them had a positive rectal swab and/or clinical cultures with ESBL-producing Enterobacteriaceae within the first 24 hours of treatment in the ICU. A total of 47 subjects were identified as patients who were not infected with ESBL-producing Enterobacteriaceae at the beginning of treatment in the ICU. At a cut-off value ≥ 8.5, Duke clinical score have sensitivity 32%, specificity of 89%, PPV of 67%, NPV of 66%. AUC ROC 0.652. Conclusions: Duke clinical score is invalid as a predictor of ESBL-producing Enterobacteriaceae infection in ICU RSCM patients.

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ABSTRAK
Latar belakang: Sakit perut berulang SPB merupakan penyebab terbanyak dari sakit kronis pada anak. Irritable bowel syndrome IBS merupakan salah satu penyebab terbanyak dari SPB, ditandai oleh nyeri/ rasa tidak nyaman pada perut dan perubahan fungsi saluran cerna. Patofisiologi IBS saat ini banyak dihubungkan dengan gangguan pada mikroflora usus. Belum ada data tentang mikroflora usus pada anak dengan IBS di Indonesia.Tujuan: Mengetahui pola mikroflora saluran cerna pada anak penderita IBS dan anak sehat berusia 13-18 tahun di Indonesia.Metode: Penelitian kasus-kontrol dilakukan pada 22 anak penderita IBS dan 28 kontrol pada anak usia 13-18 tahun di SMP dan SMA di Jakarta Pusat. Diagnosis IBS menggunakan kriteria Rome III. Usia, jenis kelamin, pendidikan dicatat saat awal penelitian. Spesimen feses dikumpulkan lalu diperiksa jumlah Bifidobacterium dan Enterobacteriaceae.Hasil: Penderita IBS terbanyak dari perempuan 17/22 dengan median usia 16 tahun. Nilai median Bifidobacterium spp sebesar 138,95 rentang 0,2 ndash;22.735,8 pada kelompok IBS dan 232,5 rentang 1,9 ndash;38.985,6 CFU/gram pada kelompok kontrol. Tidak ada perbedaan bermakna Bifidobacterium antara kedua kelompok p=0,493 . Nilai median Enterobacteriaceae sebesar 58,9 rentang 2,5 ndash;9.577,8 CFU/gram pada kelompok IBS dan 85 rentang 12,1 ndash;3.139,4 CFU/gram pada kelompok kontrol. Tidak ada perbedaan bermakna Enterobacteriaceae antara kedua kelompok p=0,938 .Simpulan: Tidak didapatkan perbedaan bermakna antara jumlah Bifidobacterium dan Enterobacteriaceae pada kelompok IBS maupun kontrol. Terdapat kecenderungan peningkatan jumlah Enterobacteriaceae pada kelompok IBS dan peningkatan jumlah Bifidobacterium pada kelompok kontrol.Kata kunci: irritable bowel syndrome, mikroflora usus, Bifidobacterium, Enterobacteriaceae "hr>" "ABSTRACT
" Background Recurrent abdominal pain RAP is the most frequent cause of chronic pain in children. Irritable bowel syndrome IBS is one of the most occuring type of RAP, marked with abdominal pain discomfort and changes in bowel movement. The current pathophysiology of IBS is associated with alterations of gut microflora. Currently, there is no data about gut microflora in children with IBS in Indonesia.Aim To evaluate gut microflora in healthy children and children with IBS aged 13 18 years old in Indonesia.Methods A case control study was conducted to 22 IBS children and 28 healthy subjects aged 13 18 years old at junior high school and senior high school in Central Jakarta. Irritable bowel syndrome diagnosed using Rome III criteria. Age, sex, and level of education were recorded. Stool samples were collected and investigated for Bifidobacterium and Enterobacteriaceae.Result Most of the IBS subjects were females 17 22 with a median age 16 years old. The median value of Bifidobacterium spp was 138.95 range 0.2 ndash 22,735.8 for the IBS subjects and 232.5 range 1.9 ndash 38,985.6 CFU gram on healthy subjects with no statistical difference p 0,493 . The median value of Enterobacteriaceae was 58.9 range 2.5 ndash 9,577.8 on IBS subjects and 85 range 12.1 ndash 3,139.4 CFU gram on healthy subjects with no statistical difference p 0,938 .Conclusion There was no statistical difference for Bifidobacterium and Enterobacteriaceae on either IBS or healthy subjects. There was an increasing tendency of Enterobacteriaceae on IBS subjects and increasing tendency of Bifidobacterium on healthy subjects.Keywords irritable bowel syndrome, gut microflora, Bifidobacterium, Enterobacteriaceae

Abstrak :
Bioremediasi menggunakan bakteri pendegradasi hidrokarbon, merupakan salah satu solusi alternatif pengendalian pencemaran tanah oleh senyawa hidrokarbon. Isolat bakteri HL8_5 telah diisolasi dari tanah habitat mangrove. Penelitian bertujuan untuk menganalisis kemampuan biodegradasi senyawa hidrokarbon oleh isolat bakteri HL8_5 dan mengetahui karakter fenotipik isolat bakteri. Pengukuran pertumbuhan isolat bakteri HL8_5 dilakukan dengan metode viable plate count, analisis degradasi senyawa hidrokarbon dilakukan dengan gas chromatography/ mass spectrometry (GC/MS), dan karakterisasi isolat bakteri dilakukan melalui pengecatan Gram serta perngamatan karakter morfologi dan biokimia. Hasil penelitian menunjukkan bahwa isolat bakteri HL8_5 mampu tumbuh dalam medium Bushnell-Haas dengan penambahan 1% (v/v) minyak diesel dan mengalami peningkatan jumlah populasi bakteri dari 6,98 x 107 CFU/mL hingga 1,08 x 1010 CFU/mL setelah inkubasi selama 48 jam. Analisis GC/MS menunjukkan bahwa senyawa 9-octadecenoic acid mengalami degradasi terbesar oleh isolat bakteri HL8_5 hingga mencapai 40,33% dalam waktu 48 jam, diikuti oleh senyawa tetracosane (9,43%) dan tricosane (4,94%). Hasil karakterisasi fenotipik menunjukkan bahwa isolat bakteri HL8_5 merupakan bakteri dari famili Enterobacteriaceae. ...... Bioremediation using hydrocarbon degrading bacteria, is one of the alternative solutions for handling soil contamination by hydrocarbons. Bacteria isolate HL8_5 has been isolated from soil mangrove habitat. The objective of this study is to analyze the biodegradation capabilities of bacteria isolate HL8_5 on hydrocarbons and to observe the phenotype characters of bacteria isolate. Growth of bacteria isolate HL8_5 was measured using viable plate count, analysis of hydrocarbon degradation carried out by gas chromatography/ mass spectrometry (GC/MS), and characterization was done by observing Gram reaction and observation of morphological and biochemical characters. The results show that bacteria isolate HL8_5 is able to grow in the Bushnell-Haas medium with addition of 1% (v/v) diesel oil and exhibit increase in the number of bacteria population from 6.98 x 107 CFU/mL to 1.08 x 1010 CFU/mL after 48 hours incubation. The GC/MS analysis shows that 9-octadecenoic acid has the largest degradation by bacteria isolate HL8_5 up to 40.33% within 48 hours, followed by tetracosane (9.43%) and tricosane (4.94%). The phenotypic characterization indicates that bacteria isolate HL8_5 is a bacteria from family Enterobacteriaceae.