ETIOLOGI DIARE AKUT INFEKTIF DAN SENTIVITAS KUMAN DI BANGSAL PENYAKIT DALAM RS DR KARIADI DAN RSU KOTA DATI II SEMARANG

Abstract

Acute diarrhoea is a common problem around the world, and has a high incidence in Indonesia. The causes of acute diarrhoea vary, infectious or non infectious origins. Based on the data of Medical Record Departement, Dr. Kariadi hospital during 1 year (from October 1999 — September 2000), it has shown that stool cultures were done in 26 of 171 (15,2 %) cases with acute diarrhoea, and only four showed positive. Lack of doctor's awareness in requesting fecal examination, and violation of the good procedures for fecal testing were the main possible causes of the low positivity rates of stool cultures in the setting. The objective of this study was to identify the entropathogen causing diarrhoea disease among adult patients by the implementing the good procedures of microbiological and parasitological examination of the stools. Subject were consisted of 61 adult patients with acute diarrhoea fulfilling the intake criteria and admitted to the Department of Medicine of Dr. Kariadi and KOTA DATI II Hospital Semarang during period of June to November 2003. Stools were collected from all patients for either microbiological and or parasitological studies depending on the type of diarrhoea, watery or bloody diarrhoea. All specimen were transported using a special transport mediums (BBL in' , Cultur Swab Plus 'al , Beckton Dickinson, MD) and directly sent to the Laboratory of Microbiology of the Dr. Kariadi Hospital. The most clinical presentation was acute bloody diarrhoea that found in 54 (89 %) and the remaining was acute bloody diarrhoea 7 (11 %). Etiologic agents were detected in 40 (65,6 %) off all isolates, consisted of Enteropathogenic E. coli 23 (37,7 %), V cholerae ogawa 6 (9,8 %), S. dysentriae 4 (6,6 %), S. aztrezts 4 (6,6 %), Pseudomonas sp 1 (1,6 %), Proteus sp 1 (1,6 %) and Entamoeba colt cyst 1 (1,6 %). All isolates were susceptible to ciprofloxacin, norfioxacin, cefotaxime and ceftriaxone. Eighty seven percent EPEC isolates were resistance to ampicillin, 74 % resistance to cotrimoxazole, 50 % resistance to tetracycline and chloramphenicol were similarly. Eighty three percent of V. cholerae ogawa were resistance to the ampicillin, S. dysentriae were resistance to tetracycline (75 %), S. aureus were resistance to tetracycline (100 %) and ampicillin (75 %). One hundred percent of Pseudomonas isolates resistance to tetracycline, ampicillin, cefotaxime and ceftriaxone. Proteus was resistance to tetracycline, ampicillin, chloramphenicol and cotrimoxazole. Penyakit diare akut masih menipakan problem kesehatan dunia, termasuk di Indonesia dengan angka kejadian yang masih tinggi. Penyakit diare akut bervariasi, bisa karena infeksi maupun non infeksi. Berdasarkan dan data rekam medik RS Dr. Kariadi selama setahun (Oktober 1999 — September 2000) terlihat pemeriksaan kultur feses 26 dan 171 kasus (15,2 %) hanya 4 hasil yang positif Masih kurangnya kesadaran dalam permintaan pemeriksaan dengan prosedur yang benar, hal ini kemungkinan menyebabkan kepositifan yang rendah. Tujuan penelitian ini untuk mengetahui kuman enteropatogen penyebab diare akut pada orang dewasa dengan melakukan pemeriksaan mikrobiologik maupun parasitologik feses secara benar. Dan 61 penderita yang dirawat di Bagian Penyakit Dalam RS Dr. Kariadi dan RSU KOTA DATI II Semarang selama periode Ju.ni — November 2003 masuk kriteria inklusi. Semua feses dikumpulkan untuk pemeriksaan mikrobiologik dan atau parasitologik tergantung dari bentuk feses (waled); atau bloody diarrhoea). Semua spesimen dimasukkan dalam media transport (BBL' Cuimp Swab Plus , Becklon Dickinson, MD) dan langsung dikirim ke Laboratorium Mikrobiologi RS Dr. Kariadi dalam waktu kurang dari 24 jam. Gambaran klinik diare akut dapat berbentuk watery diarrhoea 54 (89 %) atau bloody diarrhoea 7 (11 %). Hasil yang terdeteksi sebanyak 40 (65,6 %), terdiri dan EPEC 23 (37,7 %), V. cholerae ogawa 6 (9,8 %), S. dysentriae 4 (6,6 %), S. aureus 4 (6,6 %), Pseudomonas sp 1 (1,6 %), Proteus sp 1 (1,6 %) dan kista Entamoeba cols 1 (1,6 %). Semua isolat masih sensitif terhadap ciprofloxacin, norfloxacin, cefotaxime dan ceftriaxone. Resistensi EPEC terhadap ampicillin 87 %, cotrimoxazole 74 %, tetracycline dan chloramphenicol hampir sama sekitar 50 %. Resistensi V cholerae ogawa banyak terjadi pada ampicillin (83 %), S. dysentriae dengan tetracycline (75 %), S. aureus dengan tetracycline (100 %) dan ampicillin (75 %). Sedangkan Pseudomonas resisten 100 % dengan tetracycline, ampicillin, cefotaxime dan ceftriaxone. Proteus resisten 100 % terhadap tetracycline, ampicillin, chloramphenicol dan cotrimoxazole.