Karakteristik Resistensi Klebsiella pneumoniae Yang Resisten Karbapenem Pada Beberapa Rumah Sakit Di Indonesia Dan Pemeriksaan Laboratorium

I Ketut Harapan; Anneke Tahulending; Michael V.L Tumbol

I Ketut Harapan Jurusan Keprawatan Gigi Poltekkes Kemenkes Manado
Anneke Tahulending Jurusan Keprawatan Gigi Poltekkes Kemenkes Manado
Michael V.L Tumbol Jurusan Analis Kesehatan Poltekkes Kemenkes Manado

Keywords: Klebsiella pneumonia, carbapenem resistance, carbapenemase

Abstract

Nosocomial infection is mostly caused by the bacterium Klebsiella pneumoniae, is cause of urinary tract infection, pneuminoa, septicemia and soft-tissue infections. The main transmission of K. pneumoniae is from the digestive tract and the hands of hospital personnel. This bacterium has the ability to spread rapidly in the hospital environment, it tens to cause nosocomial infections. The strain K. pneumoniae has become resistant to all or almost all antibiotic present today with mortality rates above 50%. The K. pneumoniae resistance to carbapenem is also called Carbapenem-Resistant Klebsiella pneumoniae (CRKP). The CRKP bacteria are capable of producing carbapenemase enzyme encoded by the bla gene on plasmids with a single genetic element (transposon Tn4401). This enzyme has the ability to hydrolize antibiotics of beta-lactam and carbapenem groups. According of the calsification of Ambler, carbapenemase can be classified into 3 classes carbapenemase A, B, C and D. Each class of carbapenemase has different levels of resistance to carbapenem antibiotics.
Since CRKP was discovered in 2001 in the United States, CRKP’s 2012 deployment includes Europe, the Middle East, South America and Asia with mortality rates reaching 56%. In Asia percentage of CRKP distribution is highest at 32.29 %. The CRKP prevalence in Indonesia is the highest prevalence among Asian countries such as Vietnam (3.0%) and Philippines (3.7%). Which reach 5.8%. CRKP cases with the highest resistance levels were found in Pekanbaru found in clinical isolates of UTI patiens, were the Carbapenem resistance level was 68.75%.
Preventions strategies for the spread of CRKP in the hospital are: flagging system, special room for CRKP positive patient, intensive supervision of high risk patient, epidemiology investigation, education and counseling, antibiotic usage policy, early identification of high risk patient.
Laboratory Examination To Detect Activity Bacteria CRKP can be done by method of non-molecular/phenotypic method and molecular/genotype method.