Disertasi

Pengembangan Model Prediktif Escherichia coli Uropatogen ST- 131 sebagai Penyebab Infeksi Saluran Kemih: Peran Pejamu, Karakter Fenotipe dan Genotipe = Development of a Predictive Model of Escherichia Coli Urophatogen ST-131 as the Etiology of Urinary Tract Infection: The Role of the Host, Phenotype and Genotype Character.

Infeksi saluran kemih (ISK) merupakan kasus infeksi yang sering ditemukan di komunitas dengan penyebab paling sering adalah Escherichia coli. E.coli uropatogen ST-131 merupakan subtype E.coli yang mudah menyebar dengan membawa sifat multiresisten dan virulensi dominan. Keberadaannya dapat memicu pengobatan yang memanjang dan luaran klinis yang lebih buruk. Penelitian ini bertujuan untuk mengembangkan model yang dapat memprediksi penyebab ISK komunitas adalah E.coli uropatogen ST-131, sehingga dokter yang merawat dapat segera mengambil keputusan dalam pemilihan tata laksana pada pasien. Penelitian menggunakan desain nested case control dan dilakukan tahun 2019 -2021 di laboratorium mikrobiologi FK UI dan FK UIN Syarif Hidayatullah Jakarta dengan mengumpulkan 326 sampel urin yang diperoleh dari puskesmas dan rumah sakit di kota Tangerang Selatan. Terdapat 102 (31%) sampel di antaranya adalah E.coli dan dilakukan validasi ulang dengan mendeteksi RNA 16S bakteri, serta didapatkan 98 sampel yang benar E.coli. Dari 98 sampel yang terkumpul dilakukan pemeriksaan genotipik berupa deteksi gen virulensi fimH, sfas, hylA, cnf-1 dan papC. Pemeriksaan fenotipik meliputi pewarnaan gram secara langsung pada urin, uji resistensi siprofloksasin, kotrimoksazol dan Extended Spectrum of Beta-lactamase (ESBL). Data jenis kelamin, riwayat diabetes melitus (DM), riwayat rekurensi dalam 6 bulan terakhir, riwayat pemasangan kateter dan riwayat penyakit ginjal. dianalisis menggunakan uji chisquare atau fisher dan uji multivariat dengan analisis regresi logistik. Berdasarkan uji multivariat didapatkan 3 macam model yang dapat diimplementasikan sesuai dengan fasilitas yang tersedia. Model 1 meliputi pemeriksaan genotipik, fenotipik dan faktor pejamu sehingga dapat digunakan di rumah sakit dengan laboratorium mikrobiologi lengkap. Model 2 meliputi interaksi antar pemeriksaan fenotipik dan faktor pejamu sehingga dapat digunakan di layanan primer dengan laboratorium mikrobiologi sederhana dan model 3 digunakan di layanan dengan laboratorium molekular karena berdasarkan pada pemeriksaan genotipe dan faktor pejamu. Skor titik potong pada semua model adalah kurang dari 4, yang berarti < 4 kemungkinan kecil penyebab adalah E.coli uropatogen ST-131, sedangkan nilai ³ 4 probabilitas > 90%. Disimpulkan sistem model dan skoring yang dikembangkan dapat digunakan sesuai fasiltas laboratorium yang dimiliki.
Kata Kunci: Escherichia coli ST-131, faktor virulensi, infeksi saluran kemih, resistensi antimikroba.


Urinary tract infection (UTI) is a case of infection that is often found in the community with Escherichia coli as the most common cause. Uropathogenic E.coli ST-131 is a subtype of E.coli that spreads easily with multi-resistant properties and dominant virulence. Its presence can lead to prolonged treatment and poorer clinical outcomes. This study aims to develop a model that can predict E.coli uropathogen ST-131 as the etiology of community UTIs, , so that clinician can immediately make decisions in selecting treatment for patients. The research used a nested case control design and was carried out in 2019–2021 at the microbiology laboratory of the Faculty of Medicine UI and UIN Syarif Hidayatullah Jakarta by collecting 326 urine samples obtained from primary health centers and hospitals in South Tangerang. There were 102 (31%) samples of which were E.coli and re-validation was carried out by detecting bacterial 16S RNA, and 98 samples were found to be E.coli. From the 98 samples collected, genotypic examination was carried out to detect the virulence genes fimH, sfas, hylA, cnf-1 and papC. Phenotypic examination includes direct gram staining of urine, ciprofloxacin, co-trimoxazole and Extended Spectrum of Beta-lactamase (ESBL) resistance tests. Data on gender, history of diabetes mellitus (DM), history of recurrence within the last 6 months, history of catheter insertion and history of kidney disease were analyzed using chi square or fisher test and multivariate test were conducted using logistic regression analysis. Based on the multivariate test, there are three types of models that can be implemented according to the available facilities. Model 1 includes genotypic, phenotypic and host factor that can be used in a hospital with a fully equipped microbiology laboratory. Model 2 includes the interaction between phenotypic examination and host factors so that it can be used in primary care with simple microbiology laboratories and model 3 is used in laboratory with molecular capability because it is based on genotyping and host factor testing. The score of the intersection of the three models is less than 4, which means < 4 is unlikely to be caused by E.coli uropathogen ST-131, while the value ³ 4 has a probability of > 90%. It was concluded that the developed model and scoring system can be used according to the laboratory facilities.
Key words: antimicrobial resistance, Escherichia coli ST-131, virulence factors, urinary tract infection