Jurnal Antibiotik Resistensi Pada Kasus OMSK
Jurnal Antibiotik Resistensi Pada Kasus OMSK
Jurnal Antibiotik Resistensi Pada Kasus OMSK
A R T ICL E IN FO A B ST R A C T
Keywords: Introduction: Chronic suppurative otitis media (CSOM) is a chronic inflammation
CSOM of the middle ear and mastoid cavity. It is necessary to identify bacterial patterns
Germ Pattern and antibiotics susceptibility in CSOM. Appropriate administration of antibiotics
Antibiotic Susceptibility is essential to treat infection and prevent widespread resistance. Objective: The
aim of this study is to compare the pattern of germs and antibiotic susceptibility
Bacterial Culture
between CSOM with cholesteatoma and without cholesteatoma. Methods:
Observational study with cross-sectional design. Data collection was carried out
*Corresponding author: using medical record data on 102 subjects who underwent middle ear swab and
Rian Hasni bacterial culture from January to December 2019. Results: From 102 subjects
and 122 bacterial culture results. it was found that Pseudomonas aeruginosa
(36.1%) was one of the most common organisms to cause CSOM. followed by
E-mail address: Staphylococcus haemolyticus. Staphylococcus epidermidis and Staphylococcus
rianhasni86.rh@gmail.com aureus. There was a significant difference between the germ pattern and the type
of CSOM (p = 0.002). Amikacin. meropenem. gentamicin. cefepime. ciprofloxacin
and ceftazidime were found to be the most effective antibiotics for Pseudomonas
All authors have reviewed and approved aeruginosa. The rate of resistance to tigecycline and cefazoline were highest. Age.
the final version of the manuscript. sex. nutritional status and comorbidities were not factors that significantly
influenced the incidence of cholesteatoma in CSOM. Conclusion: There is a
significant difference between the germ pattern in both CSOM groups. Patients
https://doi.org/10.32539/bsm.v5i3.332
that show Gram negative have a significant effect on the incidence of CSOM with
cholesteatoma.
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antibiotic resistance and changes in bacterial CSOM without cholesteatoma. the dependent variable
susceptibility patterns is increasingly widespread.3-5 is the pattern of germs and antibiotic sensitivity and
Treatment of people with CSOM appropriately and confounding variables. namely age. sex. nutritional
adequately needs to know the pattern of germs and status and comorbidities. Processing and data results
their sensitivity to antibiotics. although the pattern of are assisted by SPSS software for windows version
germs and their sensitivity can change from time to 24.0. Statistical analysis to test the comparison of germ
time and from one place to another. Through this patterns and antibiotic sensitivity in CSOM patients
research. it is expected to know the pattern of germs was performed using the Chi-Square test or Fisher's
and their sensitivity to antibiotics in CSOM cases in Dr. exact test.
Mohammad Hoesin (RSMH) so that the administration This study has been considered ethical and
of antibiotics can be adjusted to the existing germ approved by the Health Research Ethics Committee of
patterns until waiting for the results of culture and Dr. Mohammad Hoesin Palembang. Ethical license is
antibiotic sensitivity tests. in the end the infection in implemented in accordance with applicable procedures
CSOM patients can be handled appropriately. This and rules.
study aims to compare the pattern of germs and
antibiotic sensitivity between CSOM with 2. Results
cholesteatoma and without cholesteatoma. The number of study subjects was 102 CSOM
patients consisting of 58 CSOM patients with
1. Method cholesteatoma and 44 CSOM patients without
This study is an observational study with a cross- cholesteatoma. Characteristics based on age obtained
sectional design. The research was conducted at the the age range of the subjects between 6 years and 70
RSMH Medical Record Installation. The research years. The majority of subjects were in the age group
sample was the medical record data of OMSK patients 19-60 years (71.6%).
who had ear swabs at the ENTKL Otology Clinic and The subjects in this study were mostly male. Based
culture and antibiotic sensitivity tests at the RSMH on the nutritional status. it was found that the most
Microbiology Department during the period January to subjects with good nutritional status were 66 people
December 2019 and met the research criteria for (64.7%). 21 people (20.6%) over nutritional status and
analysis. Sampling in this study was carried out by 15 people (14.7%) less nutritional status. Based on the
total sampling. presence or absence of comorbids. out of a total of 102
The inclusion criteria in this study were complete subjects. 23 people (22.5%) were comorbid and 79
medical record data from CSOM patients who had (77.5%) had no comorbids.
middle ear swabs and culture and antibiotic sensitivity The germ patterns were divided into Gram positive
tests conducted at the RSMH Microbiology and Gram negative categories. In this study. 27 types
Department. the middle ear swab culture results of bacteria were identified. consisting of 11 species of
showed that there were germs / bacteria growing. Gram positive bacteria and 16 species of Gram negative
culture results showed germs is registered in the bacteria. Of the 102 study subjects. a total of 122
Clinical and Laboratory Standards Institute (CLSI) bacteria grew. Gram negative bacteria were found more
guidelines at the RSMH Department of Microbiology so frequently. namely 70 (57.4%). while Gram positive
that antibiotic sensitivity tests can be carried out. The bacteria were 52 (42.6%). Based on the type of CSOM.
exclusion criteria were medical records of CSOM 70.3% more Gram negative bacteria were found in the
patients who had middle ear swabs after undergoing CSOM group with cholesteatoma. Pseudomonas
mastoid surgery in the last 6 weeks. aeruginosa was the most common microorganism. This
The variables in this study include independent bacterium was identified in 40 patients. isolated from
variables. namely CSOM with cholesteatoma and 44 specimens and accounted for 36.1% of all cultured
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bacteria. The other most common bacteria found are sensitivity to 10 antibiotics including ciprofloxacin,
Staphylococcus haemolyticus. Staphylococcus levofloxacin, moxifloxacin, gentamicin, tigecycline,
epidermidis and Staphylococcus aureus. The frequency trimetropine / sulfametoxsazole, rifampicin,
and distribution of the other 23 bacteria were only nitrofurantoin, oxacillin and linezolide with a
found in small numbers (less than 10). percentage of 100%. Erythromicin, Clindamicin,
The distribution of antibiotic sensitivity in Vancomicin are also considered quite sensitive with a
Pseudomonas aeruginosa based on their sensitivity to rate of 90.9%. Resistance appears to be the antibiotic
antibiotics can be seen in Table 3. Sensitivity tests were benzylpenicillin. The distribution of antibiotic
carried out for 10 types of antibiotics. Of all the sensitivity in Stapylococcus aureus can be seen in
antibiotics tested, it was found that Pseudomonas Table 6.
aeruginosa had the highest percentage of sensitivity to The data from the analysis showed a p value of
the antibiotics amikacin (93.2%), meropenem (84.15), 0.002. It can be concluded that there was a significant
gentamicin (79.5%), cefepime (77.3%), ciprofloxacin difference between the germ patterns in the 2 CSOM
and ceftazidime ( 72.7). Meanwhile, the level of groups where Gram negative bacteria were more
antibiotic resistance was higher in tigecycline and common in the CSOM group with cholesteatoma.
cefazoline. Analysis of various types of antibiotics against the
A sensitivity test was carried out against 15 types of types of CSOM in the top 4 germs found, namely
antibiotics on Staphylococcus haemolyticus. Of all the Pseudomonas aeruginosa, Staphococcus
antibiotics tested, it was found that Staphylococcus haemolyticus, Staphococcus epidermidis and
haemolyticus was very sensitive to vancomycin, Staphococcus aureus were carried out using the
nitrofurantoin and linezolide antibiotics, each of Fischer exact test and Chi-square Pearson test. From
93.3%. These bacteria are also sensitive to gentamicin, the results of the analysis, all showed that there was
erythromycin, tigecycline, trimethoprim / no significant effect of cholesteatoma on the level of
sulfamethoxazole and rifampicin. Meanwhile, there antibiotic resistance with a p value > 0.05. It can be
was a very high level of resistance to the antibiotics concluded that there is no significant difference
ciprofloxacin, levofloxacin, moxifloxacin, between the types of CSOM on the level of resistance to
benzylpenicillin, oxacillin and tetracycline. The the antibiotics tested.
distribution of antibiotic sensitivity in Staphylococcus In the table showing the sensitivity of 10 antibiotics
haemolyticus can be seen in Table 4. to Pseudomonas aeruginosa, it can be seen that the
The distribution of antibiotic sensitivity in number of all antibiotics that are resistant is higher in
Staphylococcus epidermidis can be seen in Table 5. A the CSOM group with cholesteatoma than in the CSOM
sensitivity test was performed for 15 types of group without cholesteatoma. Although the results of
antibiotics. Of all the antibiotics tested, the highest the analysis showed that none of the antibiotics were
sensitivity percentage was 100% for vancomicin, significantly different between the two CSOM groups,
nitrofurantoin, rifampicin and linezolide antibiotics. both the group with cholesteatoma and the group
The antibiotics gentamicin and tigecycline also had a without cholesteatoma. In the multivariate analysis,
fairly high sensitivity with a percentage of 92.9%. The the dependent variable was cholesteatoma and the
highest level of resistance to benzylpenicillin antibiotics independent variables were age, sex, nutritional status,
(100%), whereas ciprofloxacin, levofloxacin, comorbid and germ groups based on the Gram positive
erythromycin, clindamycin also showed resistance to and Gram negative division, it was found that only the
Staphylococcus epidermidis. germ group variable had a significant effect on the
A sensitivity test was carried out against 15 types of presence of cholesteatoma. OMSK patients who
antibiotics on Staphylococcus aureus with a total of 11 experienced Gram-negative bacterial infection had a
samples. Staphylococcus aureus in this study has high significant effect on experiencing CSOM with
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cholesteatoma (p value 0.003) with a risk of 3.126 and 95% CI (1.482-6.597).
9 20
73
40
32
30 27 26
20 17
10
0
Male Female
Cholesteatoma No Cholesteatoma
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Table 2. Distribution of germ patterns in CSOM (N = 122)
Sensitive antibiotics
Antibiotic group Antibiotics Sensitive Resistant
(%)
Aminoglycosides Amikacin 41 3 93.2
Gentamicin 35 9 79.5
Carbapenem Meropenem 37 7 84.1
Fluoroquinolones Ciprofloxacin 32 12 72.7
Penicillin Piperaciline / 27 17 61.4
Tazobactam
Monobactam Aztreonam 24 20 54.5
Cephalosporins Ceftazidime 32 12 72.7
Cefepime 34 10 77.3
Cefazoline 1 43 2.3
Tetracyclines Tigecycline 0 44 0.0
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Table 4. Distribution of antibiotic sensitivity to staphylococcus haemolyticus (n = 15)
Sensitive antibiotics
Antibiotic group Antibiotics Sensitive Resistant
(%)
Sensitive antibiotics
Antibiotic Group Antibiotics Sensitive Resistant
(%)
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Table 6. Distribution of antibiotic sensitivity to staphylococcus aureus (n = 11)
Sensitive Antibiotics
Antibiotic group Antibiotics Sensitive Resistant
(%)
Table 7. Comparison of germ patterns between CSOM with cholesteatoma and CSOM without cholesteatoma
CSOM
Germ Pattern Total
Cholesteatom No Cholesteatom
Gram positive 19 (36.5) 33 (63.5) 52 (100)
Gram negaitive 45 (64.3) 25 (35.7) 70 (100)
*Chi-square pearson
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can occur in the age group of children because children diseases (heart disease, kidney failure, chronic
often experience upper respiratory tract infections, infections, autoimmune diseases, diabetes mellitus,
immature immunity and the structure of the malignancy) are factors that provide
Eustachian tube which is shorter and more horizontal immunomodulatory effects so that they can contribute
when compared to adults. This study used subject to risk of infection. Patients with comorbidities and
selection with total sampling, the dominance of male multimorbidity have a greater risk of antibiotic
sex may be a coincidence finding, there are no known resistance than patients without comorbidities because
anatomical or genetic differences between men and of their increased susceptibility to infection, more
women associated with ear infections, especially frequent use of antibiotics and more susceptibility to
CSOM.2,6 infection in strains of bacteria that are already resistant
The success of treating bacterial infections is the to antibiotics. Diabetes and chronic lung, kidney and
result of working between antibiotics and the immune vascular disease are all thought to increase a patient's
system. Antibiotic resistance and the immune system susceptibility to bacterial infection or increase the risk
are related to infection, the adaptation of bacteria to the of infection-related harm. However, the level of risk
immune system affects the spectrum of antibiotic varies according to comorbidity, severity of disease and
resistance so that bacteria can become more resistant. how the treatment is managed.11,12
Important determinants of the immune system include Existing research shows Pseudomonas aeruginosa
nutritional status and comorbid diseases. The is the most common bacteria found in CSOM, similar
nutritional status of 102 subjects who were the to the results of this study where Pseudomonas
samples of this study showed that 66 subjects (64.7%) aeruginosa was the most common microorganism
had good nutritional status, 21 subjects with over found. The results of Andrade et al's study in Brazil on
nutritional status and 15 others with less nutritional 83 patients (125 ears) of CSOM, which compared the
status. In this study, nutritional status was determined results of culture. in CSOM with cholesteatoma and
from the medical records of patients both outpatient without cholesteatoma. The results showed that in
and inpatient who had anthropometric data in the form CSOM without cholesteatoma, the most bacteria found
of measurements of body weight, body length or height. were S. aureus, Pseudomonas sp. In CSOM with
Some epidemiological data also show that body weight cholesteatoma, the most frequent findings are
is related to the level of risk of infection. Both obesity anaerobic bacteria and Corynibacterium sp. Frequency
and underweight increase the risk of infection whereas of S. epidermidis, Klebisiela sp. and Streptococcus sp.
normal body weight has the lowest risk of infection. the same between these two diseases. Gram negative
Subjects with obesity or over nutrition have a higher groups are more common in CSOM with cholestetaoma,
risk of infection because obesity contributes to an this strengthens the theory that among the bacteria
increased incidence of chronic inflammation of the fat found, Pseudomonas aeruginosa is considered the
tissue. In addition, there is accumulation of fat in the main cause of the progressive destruction of the middle
lymphoid organs which damages lymphoid tissue, thus ear and mastoid structures due to the toxins and
interfering with the production and distribution of enzymes it produces. The main component of the
leukocytes or anti-inflammatory from lymphoid tissue Gram-negative bacterial cell wall, lipopolysaccharide, is
7-10 also found in higher concentrations in patients with
Based on the presence or absence of comorbids, cholesteatoma and active bone destruction. In the
from a total of 102 subjects in this study, 22.5% were bivariate analysis of the comparison of the pattern of
found to be comorbid and 77.5% had no comorbids. germs between the two CSOM groups, the results of the
Comorbid is one of the variables in the study because analysis showed that Gram negative was found more in
the immune system is also influenced by other the CSOM group with cholesteatoma than without
underlying factors such as chronic or comorbid cholesteatoma, with a value of p = 0.002. It can be
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concluded that there was a significant difference in the 4. Sedyaningsih ER. Regulation of the Minister of
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