Tesis

Pola Gen Penyandi Resistensi terhadap Aminoglikosida pada Isolat MDR Acinetobacter baumannii di Rumah Sakit Universitas Indonesia = Pattern of Aminoglycoside Resistance-Encoding Genes in MultidrugResistant Acinetobacter baumannii Isolates at Universitas Indonesia Hospital.

Latar Belakang : Acinetobacter baumannii multidrug-resistant (MDR) merupakan penyebab utama infeksi nosokomial berat, seperti ventilator-associated pneumonia (VAP) dan bakteremia, dengan prevalensi resistensi aminoglikosida mencapai 27–97,5%. Resistensi ini terutama disebabkan oleh aminoglycoside-modifying enzymes (AMEs) dan 16S rRNA metiltransferase (armA). Penelitian ini bertujuan mendeteksi gen resistensi aminoglikosida pada isolat MDR A. baumannii di Indonesia, yang saat ini data lokal masih terbatas. Metode Penelitian: Penelitian ini dilakukan pada isolat MDR Acinetobacter baumannii tersimpan di Rumah Sakit Universitas Indonesia pada Januari-Desember 2024 dengan disain cross-sectional. PCR konvensional dioptimalkan untuk mendeteksi gen resistensi aminoglikosida berupa aacC1, aphA6, aadA1, aadB, aphA1, aacA4, dan armA. Data demografi dan uji kepekaan antibiotik pasien dikumpulkan dari rekam medis. Hasil Penelitian Dari 29 isolat MDR A. baumannii yang dianalisis, semuanya resisten aminoglikosida. Isolat sebagian besar berasal dari spesimen sputum 1 4/29(48,28%), bronchoalveolar lavage (BAL) 12/29 (41,38%), dan lainnya 3/29 (10,34%). Pada isolat MDR A baumannii terdeteksi gen aphA1, aacA4, armA, aadA1, aacC1, aadB dan aphA6 dengan persentase 100%,100%,100%, 86,21%, 55,17%, 51,72%, 6,9%. Pasien didominasi laki-laki (70%), median usia 51 tahun, dan umumnya memiliki infeksi pernapasan serta komorbiditas seperti penyakit ginjal, diabetes melitus, dan/atau hipertensi. Tingkat mortalitas pasien dari isolat yang dikumpulkan mencapai 80%. Kesimpulan : Keberadaan gen aphA1, aacA4, dan armA yang meluas menunjukkan adanya berbagai mekanisme resistensi pada MDR A. baumannii. Mengingat tingkat resistensi yang tinggi, aminoglikosida tidak boleh digunakan sebagai pengobatan lini pertama dalam kasus seperti ini.
Kata kunci : MDR Acinetobacter baumannii, aminoglikosida, aacC1, aphA6, aadA1, aadB, aphA1, aacA4, dan armA


Background: Multidrug-resistant (MDR) Acinetobacter baumannii is a significant contributor to severe hospital-acquired infections, including ventilator-associated pneumonia (VAP) bloodstream infections. Resistance to aminoglycoside prevalence is ranging from 27–97.5% and is primarily driven by aminoglycoside-modifying enzymes (AMEs) and 16S rRNA methyltransferase (armA). This study aimed to detect aminoglycoside resistance genes in MDR A. baumannii isolates in Indonesia, where local data remain limited. Methods: This cross-sectional study was conducted on stored MDR A. baumannii isolates from Universitas Indonesia Hospital between January and December 2024. Conventional PCR was optimized to detect aminoglycoside resistance genes, including aacC1, aphA6, aadA1, aadB, aphA1, aacA4, and armA. Clinical data and antibiotic susceptibility profiles were obtained from medical records. Results: Of the 29 MDR A. baumannii isolates were analyzed, all were resistant to aminoglycosides. The isolates were mostly derived from sputum 14/29(48,28%), and bronchoalveolar lavage (BAL) 12/29 (41,38%), In aminoglycoside-resistant isolates, aphA1, aacA4, and armA were present in all samples (100%), followed by aadA1 (86.21%), aacC1 (55.17%), aadB (51.72%), and aphA6 (6.9%). Phenotypically, these isolates showed complete resistance to amikacin, gentamicin, and tobramycin. Patients were predominantly male (70%), with a median age of 51 years of age, and commonly had respiratory infections along with comorbidities such as kidney diseases, diabetes mellitus, and/or hypertension. The mortality rate of patients from the collected isolates was 80% Conclusion: The widespread presence of aphA1, aacA4, and armA genes indicates multiple resistance mechanisms in MDR A. baumannii. Given the high resistance levels, aminoglycosides should not be used as frontline treatment in such cases
Keywords: MDR Acinetobacter baumannii, aminoglycosides, aacC1, aphA6, aadA1, aadB, aphA1, aacA4, armA