Professional Documents
Culture Documents
,PhD,SpMK(K)
Anis Karuniawati
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
KEMENTERIAN KESEHATAN R.I
Masalah Infeksi di Rumah Sakit
Penegakan Penggunaan
Diagnosis Antibiotik
Penanganan
Penanganan
Infeksi Rumah
Limbah Infeksi
Sakit
Penanganan Kasus Infeksi di Rumah Sakit
Infectious Diseases
Specialists
Healthcare Infection Control
Epidemiologists Professionals
Clinical Optimal
Pharmacists Patient Care
Clinical Clinical
Pharmacologists
Microbiologists
Surgical Infection
Experts
5
The Etiologies of AFIRE (Acute Fever Illness
Requiring Hospitalization)
The Etiologies of AFIRE, 2013-2014, INA-RESPOND
Laboratorium Mikrobiologi
• Pemeriksaan mikroskopis
• Biakan dan identifikasi mikroba
• Uji kepekaan antimikroba
• Uji serologi infeksi
• Uji biologi molekuler
• Uji mikrobiologi lingkungan
Pemeriksaan Mikrobiologi Klinik
• Berbeda dengan pemeriksaan laboratorium
lain, pemeriksaan mikrobiologi: “a science of
interpretive judgment”
IDSA Guidelines. Clinical Infectious Diseases Advance Access published July 10, 2013
Essential to all aspects of health care
are Laboratory results that are
• Accurate
• reliable, and
• timely
Complexity of a Laboratory System
Record Keeping
Sample Transport
Quality Control
Testing
Quality In Quality Out
Test ordering
Result transcription
Order transcription
Result delivery
Patient preparation Sample testing
Result review
Specimen collection
Action taken on basis
Specimen identification of result
Specimen transport
laboratory environment
knowledgeable staff
competent staff
reagents and equipment
quality control
communications
process management
occurrence management
record keeping
Laboratory errors cost in
time
personnel
effort
patient
outcomes
Apa yang terjadi di laboratorium mikrobiologi?
Komunikasi
Pengumpulan Data
Pemeriksaan (mikroskopik,
kultur dan identifikasi, dll.)
Diagnosis
Laboratory
Good?
• Appropriate testing
– Specimens handling
– Methods and procedures
– Human resources
• clinically appropriate
• guided in interpretative statements
• evidence based
• concurrent with literature
Interpreting Results
Contamination
Colonization
Infection
Flora Normal
Interpreting results
Contamination Blood culture:
(Coagulase-negative
staphylococci, diptheroids)
• growing organisms
that are not from Urine culture:
the intended site Mixed bacterial growth, low
viable counts
culture
Sterile sites:
(Coagulase-negative
staphylococci, diptheroids)
Interpreting results
Colonisation
• growing organisms that are Throat swabs:
unlikely to cause infection Gram-negative bacilli,
coagulase-negative
• or growing organisms without staph
signs of infection
K.pneu P.aeru
Comment:
Amox R • presence of epithelial cells which
Amox-Clav.acid S may indicate sample
Cefuroxime I contamination with upper airway
flora.
Ciprofloxacin S R
Ceftriaxone S R
Ceftazidime S S
Tri/Sulpha S
Pip/Tazo S S
Imipenem S S
Meropenem S S
Interpreting Result
Infection
30
Hasil lab Mikrobiologi Klinik
Staphylococcus epidermidis
(pada 2 spesimen)
–Penyebab ? atau
–Kontaminan?
31
CLINICAL SIGNIFICANCE OF Staphylococcus
epidermidis
• Pedoman CLSI
• Grup mikroba tertentu, diuji dgn
Grup AB tertentu (CLSI)
• Perhatikan intrinsic resistance:
–Enterobacteriaceae vs Eritromisin
Prinsip pelaporan AST
• Laporkan obat-obat lini pertama dengan
spektrum paling kecil, toksisitas paling rendah
dan harga termurah
Cefepime S
Ciprofloxacin S
Gentamicin S
Pip-tazobactam S
Hindler A. The basics: Using CLSI Antimicrobial Susceptibility Testing Standards. CLSI.
Interpretative Reading CLSI
Hindler A. The basics: Using CLSI Antimicrobial Susceptibility Testing Standards. CLSI.
Uji Kepekaan Antibiotik:
Kapan menggunakan pelaporan selektif?
% Susceptibility
Organisms N AMK GEN TOB AMC FEP CTX CAZ CRO TZP CIP LVX ETP IPM MEM
Acinetobacter
baumanii 92 67 45 47 0 27 8 - 19 35 35 40 0 61 35
Enterobacter
cloacae 36 100 41 30 0 33 22 - 19 33 41 82 63 96 100
Escherichia coli 215 99 62 41 17 18 23 18 13 40 18 19 63 94 95
Klebsiella
pneumoniae 120 86 53 32 22 25 27 27 22 41 26 47 61 90 91
Pseudomonas
aeruginosa 62 71 44 42 0 44 - 75 - 71 34 46 0 71 69
N: number of isolates CTX: Cefotaxime CIP: Ciprofloxacin
AMK: Amikacin CAZ: Ceftazidime LVX: Levofloxacin
GEN: Gentamicin CRO: Ceftriaxone ETP: Ertapenem
TOB: Tobramicin TZP: Piperacilin IPM: Imipenem
AMC: Amoxicilin clav-acid tazobactam MEM: Meropenem
FEP: Cefepime
Simpulan
1. Peran laboratorium mikrobiologi dalam PPRA:
i. Pendukung diagnosis penyakit infeksi
• Kualitas pemeriksaan
• Faster is better, but good interpreting result is
important