5.

Pattern of Bacterial Resistance against Antibiotics based on Microbiological Data Gathering in FMUI-Cipto Mangunkusumo Hospital Yulia Rosa Department of Microbiology Faculty of Medicine University of Indonesia Antibiotics are one of the drug types used to cure infectious diseases, whether community- or hospital-aqcuired. The use of antibiotics must be precise and rational. There are two indications for antibiotics: prophylaxis and therapy. Therapy with antibiotics are is given to patients that shows symptoms of infections due to bacteria. However, bacterial resistance to antibiotics is currently increasing at a high rate. For example, the drug of choice for Pseudomonas aeruginosa infection are ceftazidime and ampicillin-sulbactame. But the resistance level of these two antibiotics are significantly high right now. The same can be said of ceftriaxone. Most bacteria is already resistant to ceftriaxone because of its widespread use in RSUPNCM. These bacterias are of the Enterobacteriaceae family, such as Klebsiella pneumonia and E.coli that produces the Extended Spectrum Beta-Lactamase (ESBL) enzyme, which will be resistant to third-generation cephalosporins. Based upon studies of endotracheal aspirate samples from patients in the Intensive Care Unit (ICU) of RSUPNCM in 2009, it was found that the bacterias Klebsiella sp. and Acinetobacter sp. ranked highest among the cause of infections. This data shows a shift from Pseudomonas, which until several years ago were the number one culpit. Not only that, but nosocomial infections such as ESBL-producing Klebsiella pneumonia and Methicillin Resistant Staphylococcus Aureus (MRSA) are becoming a concern. There are five MRSA patients in RSUPNCM ICU in December and January. All data of bacterial prevalences and sensitivities are derived from microbiological examinations, not based on direct observation of antibiotic use in the hospital. The data shows that in community-acquired infections, most bacterias are still sensitive to many antibiotics, whereas many bacterias causing nosocomial infections are already resistant. It is often hard to determine the type of infection a patient is having: Is it community- or hospital-acquired? The difficulty is influenced by clinicians that does not include the patients clinical data when sending the samples to microbiology labs.

Besides that, specimen taking also affects identification of the infection and bacterial spread pattern data gathering. A good specimen taking should be done as soon as the patient is admitted into the hospital, before administration of antibiotics. Only after the specimen is taken that empirical therapy with wide spectrum antibiotics could be done while waiting for lab results. When the physicians receive the results, antibiotics should be replaced by sensitive ones. A common mistake by physicians is sending the samples after the therapy failed, causing resistance. Department of Microbiology FMUI-RSUPNCM continues to try and gather data concering microbial spread and its resistance levels, publishing it in book form routinely every year. However, there are many obstacles in this work. One of the most common is in the communication between the laboratory and clinicians. Good communication is essential to support the success of patients therapy, including the gathering of these datas. Right now there is a Antibiotic Resistance Surveillance Committee (ARSC) to monitor the use of antibiotics in RSUPNCM. This ARSC has four pillars: clinical microbiology, therapeutic pharmacology, clinical pharmacy, and the Hospital Infection Surveillance Committee. Clinical microbiology will help to suggest the appropriate antibiotic (high sensitivity) for the bacteria causing the patients infection. While therapeutic pharmacology and clincial pharmacy will decide the dosing, route of administration, and other things of concern from the antibiotic. Department of Microbiology, FMUI-RSUPNCM hopes to prevent the development of bacterial resistance in the furute, with better microbiological examinations that is on time and accurate, such as sending samples before the administration of antibiotics. Besides that, antibiotic administration to patients must be given rationally. If these are done optimally, the patients need of health will be met.