Early warning: Spreading antibiotic-resistant bacteria in community setting

Abstract

Background: Antibiotic resistance as a global public health problem needs to be solved. Antibiotic-resistant bacteria can spread between bacteria, from the treated patient to other persons, or trough the environment. It is important to mapping antibiotic resistance profile in community setting. The study aims to determine the antibiotic usage, antibiotic resistance profile and the profile of bacteria cause infections in community setting. Methods and materials: This observational study was conducted on infectious patient, take empiric antibiotic prescribing by physician in community setting. The study located at Turi primary health care, Sleman, Yogyakarta. Specimens must be taken before the patients get antibiotic, then process using microbiological techniques and antibiotic sensitivity test for the culture results. Patient medical record is used to retrieve data on antibiotic usage. Results: Bacteria cause infection were Staphylococcus aureus (29%), Escherichia coli (17%), Streptococcus beta hemoliticus (12%), Klebsiella pneumonia (8%), Streptococcus pyogenes (6%), other bacterias in less than 5% (Pseudomonas aeruginosa, Burkholderia cepacia, Seratia marcescens, Salmonella enterica sp Arizona, Proteus mirabilis, Klebsiella oxytoca, Enterobacter fergusoni, Citrobacter freundi, Citrobacter koseri. Infections were urinary tract infection (15%), upper respiratory tract infection (23%), ulcus (56%) and gastroenteritis akut/GEA (4%). Gram negative bacilli (Escherichia coli, Proteus mirabilis) cause urinary tract infection. Clinically, Proteus mirabilis is most frequently a pathogen of the urinary tract, particularly in patients undergoing long-term catheterization. Ulcus infections are cause by Staphylococcus aureus, Salmonella enterica sp Arizona, Pseudomonas aeruginosa, Klebsiella oxytoca, Citrobacter koseri, Citrobacter freundi, Burkholderia cepacia. Staphylococcus aureus is the leading cause of ulcus. Bulcholderia cepacia is an aerobic gram negative basilus, found in various aquatic environments and frequent colonizer of fluids used in the hospital. Antibiotics usage based on diagnoses, based on International Classification of Desease (ICD)10. Antibiotics were amoxicilin in 56%, ciprofloxacin in 38%, cotrimoxazole and doxiciclin in 2%. Result of antibiotic sensitivity test are amoxicilin resistance 64%, tetracyclin 35%, amoxiclav 31%, chloramphenicol 18%, vancomycin 11%, other antibiotic resistance less than 10% (levofloxacin, cotrimoxazole, ciprofloxacin and erythromycin). Conclusion: The current data indicated that antibiotic resistant bacteria found in community setting. It will be an early warning in Indonesian AMR community based, reminding people to do more effort to prevent AMR spreading.