Yulian, Inneke (2019) Pola Kepekaan Sefiksim dan Seftriakson Terhadap Neisseria gonorrhoeae Dengan Metode Kirby Bauer di RSUD. Dr. Saiful Anwar Malang. Magister thesis, Universitas Brawijaya.
Abstract
Gonore saat ini masih merupakan penyakit infeksi menular seksual kedua paling sering terjadi di dunia dengan angka kejadian yang semakin meningkat. Di Indonesia sefiksim oral dan seftriakson injeksi sampai saat ini masih direkomendasikan untuk terapi gonore berdasarkan pedoman penanganan infeksi menular seksual tahun 2015. Strain Neisseria gonorrhoeae dengan tingkat resistensi tinggi terhadap seftriakson dan sefiksim sebagai antibiotik lini pertama saat ini telah dilaporkan di Jepang, Prancis, dan Spanyol. Pada penelitian dibeberapa daerah di Indonesia juga dilaporkan adanya resistensi golongan sefiksim dan seftriakson terhadap Neisseria gonorrhoeae. Proses resistensi golongan sefalosporin disebabkan oleh mutasi pada gen penA, yang merupakan PBP2 merupakan determinan utama dari resistensi seftriakson. Perubahan PBP2 menyebabkan penurunan afinitas pada seftriakson. Gen penA yang terganggu dapat dihasilkan dari mutasi atau dari rekombinasi genetik. Selain itu resistensi golongan sefalosporin juga dapat disebabkan oleh perubahan gen penB, mtrR, dan penC. Penelitian oleh Masatoshi Tanaka juga menemukan mekanisme molekuler resistensi terhadap seftriakson pada Neisseria gonorrhoeae. Strain GP853 yang menunjukkan hasil negatif pada produksi laktamase pada penelitian ini menunjukkan fenotipe resistensi multidrug. Penelitian ini bertujuan untuk mengetahui pola kepekaan antibiotik sefiksim dan seftriakson terhadap kuman Neisseria gonorrhoeae dengan metode Kirby Bauer. Penelitian dilakukan di RSUD. DR. Saiful Anwar Malang dengan desain penelitian deskriptif. Subyek penelitian dipilih secara consecutive sampling dan melibatkan 26 pasien yang datang ke Divisi Infeksi Menular Seksual Instalasi Rawat Jalan Kulit dan Kelamin RSUD. Dr. Saiful Anwar Malang serta memenuhi kriteria inklusi dan eksklusi. Pengumpulan subyek penelitian dilakukan pada bulan Juli 2018-Oktober 2018 setelah disetujui komite etik penelitian RSUD. DR. Saiful Anwar Malang dan di lakukan sesuai Desklarasi Helsinski. Semua pasien dengan keluhan duh tubuh dan telah menandatangi informed consent dengan diagnosis gonore diambil sampel duh tubuhnya kemudian ditumbuhkan pada Media Modifkasi Thayer Martin dan dilakukan pemeriksaan uji kepekaan antibiotik sefiksim dan seftriakson. Hasil penelitian dari 26 subyek penelitian didapatkan 80,77% isolat peka terhadap seftriakson dan 19,23% resisten terhadap seftriakson. Hasil uji kepekaan terhadap sefiksim didapatkan 80,77% isolat masih peka terhadap sefiksim dan 19,23% isolate resisten terhadap sefiksim. Perlu penelitian lebih lanjut dengan jumlah sampel yang lebih besar di masyarakat dengan metode baku emas terutama pada kelompok populasi ‘kunci’ yang memiliki risiko tinggi terkena infeksi menular seksual, dan faktor penyebab resistensi Neisseria gonorrhoeae terhadap antibiotik di daerah Malang.
English Abstract
Gonorrhoeae placed as the second most common sexually transmitted disease in the world with significantly increased number. In Indonesia, oral cefixime and intravenous ceftriaxone are both recommended as the first line treatment for gonorrhoeae based on the 2015 sexually transmitted disease therapeutic guideline. The Neisseria gonorrhoeae strains with high resistancies towards ceftriaxone and cefixime have been reported in Japan, France, and Spain. Several studies held in Indonesia were also found the presence of Neisseria gonorrhoeae resistency towards cefixime and ceftriaxone. Resistency of cephalosporins is majorly caused by the mutation on penA gene, a PBP2, the major determinant of ceftriaxone resistance. PBP2 alteration results in decreased of bacterial affinity towards ceftriaxone. Affected penA gene is resulted from genetic mutation or recombination. On the other hand, cephalosporin resistency may also caused by the alteration of penB, mtR and penC genes. Study by Masatoshi Tanaka also found the molecular mechanism of ceftrixone resistency in Neisseria gonorrhoeae. Strain GP853 showing negative lactamase production in this study were all displaying a multidrug resistance phenotype. This study aimed for determining the susceptibility pattern of antibiotic cefixime and ceftriaxone toward Neisseria gonorrhoeae using Kirby Bauer method. This study was held in DR. Saiful Anwar Regional General Hospital Malang. This is a descriptive study and the subjects were collected using consecutive sampling method. Twenty six patients who came to Sexual Transmitted Disease Division of Dermatology and Venereology outpatient clinic and fulfilling the inclusion and exclusion criterias were included into this study. The collection of study subjects was being held between July 2018 to October 2018 after achieving the ethical approval from DR. Saiful Anwar Regional General Hospital Malang and following Helsinki Declaration. All samples collected from patients who complain genital discharge, agree to sign informed consent and diagnosed with gonorrhea, were grew in Thayer Martin modified medium and were tested for antibiotic susceptibility of cefixime and ceftriaxone. The results of this study revealed 80.77% isolates obtained from all 26 subjects were sensitive to ceftriaxone and 19.23% were resistant to cefixime. In addition, the cefixim susceptibility test also showed 80.77% of isolates were still sensitive to ceftriaxone and 19.23% isolates were resistant to ceftriaxone. Further research is needed with a larger number of samples using gold standard methods, especially in ‘key’ population bearing high risk of sexually transmitted disease, and factors to determine the cause of the antibiotic resistance of Neisseria gonorrhoeae in Malang.
Other obstract
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| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | TES/616.951 506/YUL/p/2019/041901504 |
| Subjects: | 600 Technology (Applied sciences) > 616 Diseases > 616.9 Other disease > 616.95 Sexually transmitted diseases, zoonoses > 616.951 Sexually transmitted diseases > 616.951 5 Gonorrhea > 616.951 506 Therapy |
| Divisions: | Profesi Kedokteran > Spesialis Ilmu Kesehatan Kulit dan Kelamin, Fakultas Kedokteran |
| Depositing User: | Budi Wahyono Wahyono |
| Date Deposited: | 21 Jan 2020 03:12 |
| Last Modified: | 21 Oct 2021 03:20 |
| URI: | http://repository.ub.ac.id/id/eprint/178155 |
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