Pola Bakteri dan Resistensi Antimikroba pada Infeksi Terkait Fraktur Terbuka di RSUP Prof. Dr. R. D. Kandou Manado
DOI:
https://doi.org/10.35790/ecl.v12i2.54339Abstract
Abstract: Fracture-related infection is a serious complication in orthopedic trauma, both in terms of infection and surgery. The use of antibiotics is a crucial component in the management of fracture-related infection, however, it can also lead to antibiotic resistance. This study aimed to evaluate the patterns of bacteria and antimicrobial resistance in open fracture-related infections at Prof. Dr. R. D. Kandou Hospital in Manado. This was a descriptive study with a cross-sectional design. Samples consisted of patients with open fracture-related infections and had microbiological culture and drug sensitivity data. Secondary data were collected and analyzed using categorical and numerical data. The results obtained 20 subjects with the average age of 42.8±19.0 years, dominated by males (80%), and the most common location of fracture was tibia/fibula (65%). The highest multidrug resistance rates by bacterial type were found in Klebsiella and Enterobacter (medians of 9 and 7, respectively). Based on bacterial type and antimicrobial resistance, the most common bacteria were Staphylococcus aureus and Enterobacter (30%), followed by MRSA and Klebsiella (15%), Acinetobacter baumanni and Pseudomonas (1%). The highest percentage of antibiotic resistance was found in ampicillin-sulbactam, ciprofloxacin, and gentamicin. Meanwhile, the highest distribution of antibiotic sensitivity was found in trimethoprim sulfamethoxazole, amikacin, clindamycin, and meropenem. In conclusion, open fracture cases are most commonly associated with Staphylococcus aureus and Enterobacter. Antibiotic resistance is predominantly observed in ampicillin sulbactam, ciprofloxacin, and gentamicin.
Keywords: infection; open fracture; antibiotics; bacterial resistance
Abstrak: Infeksi terkait fraktur merupakan komplikasi serius dalam trauma ortopedi, baik dari segi infeksi maupun pembedahan. Penggunaan antibiotik menjadi salah satu bagian dalam penatalaksanaan infeksi, namun hal ini dapat mengakibatkan resistensi antibiotik. Penelitian ini bertujuan untuk mengevaluasi pola bakteri dan resistensi antimikroba pada infeksi terkait fraktur terbuka di RSUP Prof. Dr. R. D. Kandou Manado. Jenis penelitian ialah deskriptif dengan desain potong lintang. Sampel penelitian ialah pasien dengan infeksi terkait fraktur terbuka yang memiliki data hasil pemeriksaan kultur mikroba dan sensitivitas obat. Pengumpulan data melalui data sekunder dan dianalisis melalui data kategorik dan numerik. Hasil penelitian mendapatkan 20 subjek, dengan rerata usia 42,8±19,0 tahun. Majoritas subjek ialah laki-laki (80%), dan jenis fraktur terbanyak di tibia/fibula (65%). Hasil multidrug resistance tertinggi menurut jenis bakteri ialah pada Klebsiella dan Enterobacter dengan median masing-masing 9 dan 7. Berdasarkan jenis bakteri dan resistensi antimikroba, yang terbanyak yaitu Staphylo-coccus aureus dan Enterobacter (30%), diikuti MRSA dan Klebsiella (15%), Acinetobacter baumanni dan Pseudomonas (1%). Distribusi resistensi antibiotik tertinggi pada ampicilin-sulbactam, ciprofloxacin, dan gentamisin, sedangkan distribusi sensitivitas antibiotik tertinggi pada trimethoprim sulfomethoxa-zole, amikasin, clindamycin, dan meropenem. Simpulan penelitian ini ialah pada kasus patah tulang terbuka jenis bakteri terbanyak ialah Staphylococcus aureus dan Enterobacter. Resistensi antibiotik didominasi oleh ampicillin sulbactam, ciproflocacin, dan gentamicin.
Kata kunci: infeksi; fraktur terbuka; antibiotik; resistensi bakteri
References
Li J, Wong RMY, Chung YL, Leung SS, Chow SKH, Ip M, et al. Fracture-related infection in osteoporotic bone causes more severe infection and further delays healing. Bone Joint Res. 2022;11(2):49-60. Doi: 10.1302/2046-3758.112.BJR-2021-0299.R1
McNally M, Govaert G, Dudareva M, Morgenstern M, Metsemakers WJ. Definition and diagnosis of fracture-related infection. EFORT Open Rev. 2020;5(10):614-9. Doi: 10.1302/2058-5241.5.190072
Metsemakers WJ, Morgenstern M, McNally MA, Moriarty TF, Mcfadyen I, Scarborough M, et al. Fracture-related infection: a consensus on definition from an international expert group. Int J Care Injured. 2018;49(3):505-10. Doi: 10.1016/j.injury.2017.08.040
Baertl S, Metsemakers WJ, Morgenstern M, Alt V, Richards RG, Moriarty TF, et al. Fracture-related infection. Bone Joint Res. 2021;10(6):351-3. Doi: 10.1302/2046-3758.106.BJR-2021-0167.R1
Walter N, Rupp M, Lang S, Alt V. The epidemiology of fracture-related infections in Germany. Scientific Reports. 2021;11(10443):1-7. Doi: https://doi.org/10.1038/s41598-021-90008-w
Guerra MTE, Gregio FM, Bernardi A, Castro CCD. Infection rate in adult patients with open fractures treated at the emergency hospital and at the ULBRA university hospital in Canoas Rio Grande de Sul Brazil. Rev Brasil Ortopedia. 2017;52(5):544-8. Doi: 10.1016/j.rboe.2017.08.012
Zhang Z, Liu P, Wang W, Wang S, Li B, Li J, et al. Epidemiology and drug resistance of fracture-related infection of the long bones of the extremities: a retrospective study at the largest trauma center in Southwest China. Front Microbiol. 2022;13:923735. Doi: https://doi.org/10.3389/fmicb.2022.923735
Wicaksono Y. Infection profile of post-orthopedic patients between 2009 and 2010 at Dr. Soetomo Hospital Surabaya. 2010.
Foster AL, Moriarty F, Trampuz A, Jaiprakash A, Burch MA, Crawford R, et al. Fracture-related infection: current methods for prevention and treatment. Expert Review of Anti-infective Therapy. 2020;18(4):307-21. Doi: 10.1080/14787210.2020.1729740
Abraham Y, Wamisho BL. Microbial susceptibility of bacteria isolated from open fracture wounds presenting to the err of a black lion hospital Addis Ababa University Ethiopia. Afr J Microbiol Res. 2019;3(12):939-51.
Herlambang. Evaluation of the use of a combination of cefazolin and amikacin in preventing bacterial colonization in the management of patients with type IIIA and IIIB open fractures at Dr Soetomo Surabaya. 2009:42-45.
Taufik A, Wiweko A, Yudhanto D, Wardoyo EH, Habib P, Rizki M, et al. Bacterial infection and antibiotic resistance pattern in open fracture cases in Indonesia. Annals of Medicine and Surgery. 2022;76:103510. Doi: 10.1016/j.amsu.2022.103510
Kavanagh N, Ryan EJ, Widaa A, Sexton G, Fennell J, O’rourke S, et al. Staphylococcal osteomyelitis: disease progression, treatment challenges, and future directions. Clin Microbiol. 2018;31(2):e84-17. Doi: 10.1128/CMR.00084-17
Bassetti M, Garau J. Current and future perspectives in the treatment of multidrug-resistant Gram negative infections. J Antimicrob Chemother. 2021;76(4):iv23-37. Doi: 10.1093/jac/dkab352
Wang B, Xiao X, Zhang J, Han W, Hersi SA, Tang S. Epidemiology and microbiology of fracture-related infection: a multicenter study in Northeast China. Journal of Orthopaedic Surgery and Research. 2021;16(490):1-11. Doi: https://doi.org/10.1186/s13018-021-02629-6
Stevenson MC, Slater JC, Sagi HC, Bedoya FP, Powers-Fletcher MV. Diagnosing Fracture-Related Infections: Where Are We Now? J Clin Microbiol. 2022;60(2):e0280720. Doi: 10.1128/JCM.02807-20
Perlin MH, Lerner SA. High-level amikacin resistance in Escherichia coli due to phosphorylation and impaired aminoglycoside uptake. Antimicrobial agents and chemotherapy (AAC). 1986;29(2):216-24. Doi: https://doi.org/10.1128/aac.29.2.216
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