ETIOLOGI DIARE AKUT DI BANGSAL INFEKSI RS. Dr. KARIADI SEMARANG

Abstract

Acute diarrhoeal is a common problem around the world, and has a high inciden in Indonesia. The causes of acute diarrhoea vary, infectious or non infectious origins. Based on the data of medical repaort departement of Dr. Kariadi Hospital during 1 year ( from October 1999-September 2000), ithas shown that stool cultures were done in 26 of 171 (15,2%) cases with acute diarrhoea, and only four showed postive. Lack of doctor's awareness in requesting fecal examination, and violations of the good procedure for fecal testing were the main possible causes of the low positivity rates of stool cvuktures in the setting. The objective of this study was to identify the enteropathogen causing diarrhoeal disease among adult patients by immplementing the good procedures of microbiological and parasitological examination of the stools. Subject were consisted of 35 adult patients (18 females) with acute diarrhoea fulfiling the intake criteria and admitted to the Departement of Medicine during period of September to December 2000. Stools were collected from all patients for either microbiological or parasitological studies depending on the type of diarrhoea, watery or bloody diarrhoea. All specimen were transported using a special transport mediums (BBLim CulturSwab Plus nw, Becton Dickinson dan Thyoglycolat broth) and direcly sent to the Labortaory of Microbiology of the Dr,Kariadi Hospital in the same day. The most clinical presentation was acute watery diarrhoea that found in 28 (80%) patients, and the remaining was acute bloody diarrhoea in 7 (20%). Etiologic agents were detected in 27 (77,1%) of all stools cultured, consisted of enteropathogenic Escherechia coli (EPEC) in 12 (44,4%), Vibrio cholerae Ogawa in 8 (29,6%), Shigella flexneri in 3 (11,1%), Staphylococcus sp. in 3 (11,1%), and Shigella dysentriae in 1 (3,7%). All isolates (100%) were susceptbles to amikacine, cefotaxime, and dibekacine Forty percent Staphylococcus sp isolates were resinstant to cefepime,cefpirom, fosfomycine, and 66,7% resistant to gentamicine. Twenty-five percent isolates of V.cholerae Ogawa and 50% of EPEC were resistant to the chloramphenicol. All (100%) isolates of S.dysentriae were still susceptible to tetracycline as well as cotrimoxazol.All enteropathogens isolated during this study were resistant to ampicilline. It can be concluded that ahigh degree of antimicrobial resistance was noted among enteropathogenic bacterial isolates especially to ampicilline, but the remaining were variably susceptible to the antibiotics tested. Key word : acute diarrhea, stool eultureisensitivity test Penyakit diare akut masih merupakan problem kesehatan didunia , termasuk di Indonesia dengan angka kejadian yang masih tinggi. Penyakit diare akut bervariasi bisa karenaa infeksi maupun non infeksi. Berdasarkan dari data rekam medik RS Dr Kariadi selama setahun (Oktober 1999-September 2000) terlihat pemeriksaan kultur feses 26 dari 171 kasus (15,2%) hanya 4 hasil yang positif. Masih kurangnya kesadaran dalam permintaan pemeriksaan feses dengan prosedur yang benar, hal ini kemungkinan menyebabkan kepositifan rendah. Tujuan penelitian ini untuk mengetahui kjuman enteropatogen penyebab diare akut pada orang dewasa dengan melakukan prosedur pemeriksaan mikrobiologik maupun parasitologik feses yang benar. Dan 35 penderita (18 perempuan) yang masuk kriteria inklusi di Bagian Penyakit dalam selama periode Oktober-Desember 2000. Semua material (feses) penderita dikumpulkan untuk pemeriksaan mikrobiologik maupun parasitologik tergantung dari bentuk feses (watery bloody diarrhoea). Semua specimen mengandung media transport (BBLTM CulturSwab Plus TM Becton Dickinson ,MD dan Thyoglycolat broth) dan langsunmg dikirim ke Laboratorium Mikrobiologi dan Parasitologi RS Dr Kariadi pada saat itu. Gambaran klinik diare akut dapat berbentuk watery diarrhoea 28 (80%) bloody diarrhoea 7 (20%). Basil yang terdeksteksi sebanyak 27 (77,1%) terdiri dari EPEC 12 (44,4%), V.cholerae Ogawa 8 (29,6%), shigella flexneri 3 (11,1%). Staphylococcus sp. 3 (11,1%) dan shigella dysentriae 1 (3,7%) Semua isolat (100%) ) masih sensitif terhadap amikasin, sefotaksim dan dibekasin. 40 % Staphylococcus sp telah resisten terhadap sefepim, sefpirom, fosfomisin dan 66,7% resisten terhadap gentamisin 25% isolat V.cholerae Ogawa dan 50% EPEC telah resisten terhadap kloramfenikol. Semua (100%) isolat Shigella dysentriae masih sensitif terhadap tetrasiklin dan co-trimoksasol. Semua Inman enteropatogen (100%) dalam penelitian ini telah resisten terhadap ampisilin, tetapi sisanya masih suseptibel secara bervariasi terhadap antibiotika yang diuji. Kata kunci : diare akut, kultur rases, ssesitifitas human terhadap antibiotik