Microbial Pattern of Diabetic Foot Ulcer Patient in Jemursari Islamic Hospital Surabaya Period 2012Ae2016 Adyan Donastin1.
Aisyah1 Department of Medicine.
Faculty of Medicine.
Nahdlatul Ulama University of Surabaya.
Surabaya.
Indonesia Correspondence:
Aisyah.
Jl.
Jemursari No.
51-57,
Surabaya.
East Java.
Indonesia Zip Code : 60237 Email: aisyahdr@unusa.
Received: February 26, 2019 Revised: March 26, 2019 Accepted: April 1, 2019 Abstract Diabetic foot ulcers (DFU) are complications in people with diabetes mellitus (DM) in the form of wounds or tissue damage resulting in vascular insufficiency and or neuropathy that can develop into an infection.
Early detection of germs of diabetic foot ulcers may be used as a recommendation of empirical therapy before the definitive treatment based on culture results and appropriate antibiotics treatment, which may reduce hospitalization time and amputation events.
According to Riskesdas in 2013, state that the number of antibiotic used without prescriptions in Indonesia about 86.
The study aims to retrospectively analyze the bacterial culture and drug susceptibility test results for patients with diabetic foot ulcers (DFU) in Jemursari Islamic Hospital Surabaya during 2012Ae2016 to help clinicians choose a more appropriate empirical antibiotic treatment for DFU.
This study used crossAe sectional designed with retrospective approaches, which analyzed descriptively and samples were taken by the total sampling of 11 samples.
This research was conducted at Islamic Hospital of Jemursari Surabaya in MayAeSeptember 2017 by using medical record data which are outpatient and inpatients who treatment at Jemursari Islamic Hospital.
The result was found 6 types of bacteria consisting of Staphylococcus aureus .
%).
Staphylococcus nonAe haemolytic .
%).
Klebsiella pneumonia .
%).
Enterobacter aerogenes .
%).
Burkholderia cepacia .
%).
Escheria coli .
%).
The most sensitive antibiotics in the GramAepositive bacteria in this study are Amikacin.
Teicoplanin and Oxacillin and the most resistant to Amoxicillin and Ampicillin whereas the most sensitive antibiotics in the GramAenegative bacteria in this study were Meropenem and the most resistant to Ciprofloxacin and TrimethroprimAesulfamethoxazole.
Keywords Microbial pattern, antibiotics sensitivity pattern, diabetic, foot ulcer, diabetes mellitus Adyan Donastin.
Aisyah
INTRODUCTION
patients with DM compared with nonAeDM Diabetes Mellitus (DM) is one of the .
, and about 85% amputation in DM main problems in public health system that patients associated with DFU .
, can even has increased dramatically over the past 2 end in disability or death .
The current decades and continues to increase .
Ae.
DFU prevalence in Indonesia is 12%, while Based on research by the World Health the prevalence of DFU risk factors in Organization (WHO) in developing countries Indonesia is 55.
4% .
showing the highest increase in DM patients Several studies show that there are in Southeast Asia including Indonesia and it variations in the types of germs that cause is estimated that in the next 1 or 2 decades the DFU, both aerobic and anaerobic germs.
frequency of DM in Indonesia will increase Akbar et al.
in Arifin Achmad Hospital dramatically to rank number 5 in the world for 23 samples received A.
Diabetes mellitus that is not treated .
8%).
2%).
properly will cause complications, as is the .
4%).
7%).
most common and often occurs is diabetic .
3%).
3%), and P.
foot ulcer (DFU).
Damage will arise if in the aeruginosa .
3%).
Research by Akhi et al.
long term there is a decrease in blood flow .
of 60 samples obtained S.
accompanied by nerve damage .
%).
Enterobacteriaceae .
%).
in the legs, thereby increasing the likelihood .
%).
Citrobacter spp.
%).
Enterobacter of DFU.
%), and Staphylococcus spp.
Diabetic foot ulcer is a wound that occurs coagulase .
%).
Enterococcus spp.
%),
in the legs of people with type 1 diabetes and aeruginosa .
%).
Acinetobacter spp.
2, then infection and or tissue damage .
%), and Bacteroides fragilis .
%).
Data from previous studies show that angiopathy .
mpaired blood flow in the leg.
early detection of germs in DFU can be used or both that often become the place of entry as a recommendation for empirical therapy of bacteria into the legs .
Ae.
Gardner .
before definitive therapy based on the results states that around 15% of patients suffering of culture and appropriate antibiotics, so as to from DM will develop into DFU during their reduce the time of hospitalization and the lifetime .
Further infections without good incidence of amputation.
The results of treatment and adequate can be the most Riskesdas in 2013 also stated that the use of common cause of amputation, and based on prescription antibiotics in Indonesia was nonAetraumatic events with the risk of This study aims to retrospectively amputation 10Ae20 times more often in analyze the bacterial culture and drug Ina J Med Lab Sci Tech 2019.
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resulting from neuropathy .
erve disorder.
Adyan Donastin.
Aisyah susceptibility test results for patients with a crossAesectional design with a retrospective diabetic foot ulcers (DFU) in Jemursari Evaluate the results of medical Islamic Hospital Surabaya during 2012Ae2016 records regarding germs that cause DFU and to help clinicians choose a more appropriate the rational use of antibiotics in these cases.
empirical antibiotic treatment for DFU.
RESULTS
DFU patients who were hospitalized at MATERIALS AND METHODS The data collected are secondary data Jemursari Hospital from 2012 to 2016 totaled based on research variables taken from the 291 patients.
Data on DFU patients were then Clinical Pathology Laboratory Installation of compared with data on patients who Jemursari Surabaya Islamic Hospital for the underwent pus culture at Jemursari Hospital.
2012Ae2016 periods.
The population in this The data of the patients taken were 57 data on study was medical records of patients with DFU patients with a history of undergoing a diabetes mellitus with complications of specimens culture of pus at Jemursari diabetic foot ulcers at Jemursari Islamic Hospital.
The inclusion criteria in this study Hospital 2012Ae were medical records of DM patients with December 2016.
The samples in this study DFU who were hospitalized at Jemursari were medical records of patients with Hospital with a complete identity, results of diabetes mellitus with complications of pus culture test, and antibiotic sensitivity test.
diabetic foot ulcers in January 2012Ae Based on the inclusion criteria of this study.
December 2016, which fulfills the inclusion 46 patient data were excluded from the study and exclusion criteria, and samples are taken because there were no forms of pus culture in total sampling.
The inclusion criteria in test results and antibiotic sensitivity tests this study were medical records of DM from the laboratory, so that the samples used patients with DFU who are hospitalized at in this study were 11 patients.
Jemursari Hospital with complete identity.
Distribution of DFU patients according results of pus culture test, and antibiotic age and sex Surabaya January sensitivity test and exclusion criteria were differentiated by age group .
, with the age grade 0 and grade 1 ulcers.
group 1Ae12 years and 12Ae18 years there are descriptively because the observations were no DFU patients, in the age group 18Ae60 carried out according to the conditions as years, 195 patients .
01%), and at age> 60 they were without any direct treatment from years there were 96 patients .
99%), with the researchers on the test subjects and using an average age of 55.
55 years.
In this study.
This Table 1 showed that the results are Ina J Med Lab Sci Tech 2019.
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Adyan Donastin.
Aisyah there were 152 male patients .
23%), while Distribution of pathogenic germs to pus 139 female patients .
77%).
The results of germ culture from pus Table 1.
Distibution of DFU patients according age and sex 1Ae12 years old Percentage (%) > 12Ae18 years old > 18Ae60 years old >60 years old Man Woman Patient Age Sex Freq.
specimens in DFU patients at Jemursari Hospital showed in Figure 1.
It showed that the 11 germ samples obtained two types of germs, namely GramAepositive and GramAe negative germs.
The GramAepositive germs found in this study were Staphylococcus nonhaemolyticus and Staphylococcus aureus, while the GramAenegative germs found in this study were Escherichia coli.
Enterobacter Burkholderia Klebsiella pneumonia.
Fig 1.
Distribution of pathogenic germs to pus specimens The sensitivity pattern of GramAepositive the antibiotics most resistant to GramAe germs to some antibiotics The most sensitive antibiotics used in Amoxycilin Ampicillin.
GramAepositive germs in this study were Amikacin.
Teicoplanin, and Oxacilin, while Ina J Med Lab Sci Tech 2019.
: 22-32
Percentage of sentivity Adyan Donastin.
Aisyah Percentage of sentivity Fig 2.
The sensitivity pattern of GramAepositive germs to some antibiosis Fig 3.
The sensitivity pattern of non haemolytic Staphylococcus antibiotics The sensitivity pattern of GramAenegative Meropenem, while the antibiotic most germs to some antibiotics The most sensitive antibiotic used in GramAenegative bacteria in this study is GramAenegative Ciprofloxacin TrimethroprimAe Ina J Med Lab Sci Tech 2019.
: 22-32
Percentage of sentivity Adyan Donastin.
Aisyah Percentage of sentivity Fig 4.
The sensitivity pattern of the antibiotic Klebsiella pneumonia Fig 5.
The sensitivity pattern of the antibiotic Enterobacter aerogenes Ina J Med Lab Sci Tech 2019.
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Percentage of sentivity Adyan Donastin.
Aisyah Percentage of sentivity Fig 6.
The sensitivity pattern of Escherichia coli antibiotics Fig 7.
The pattern of antibiotic sensitivity of Burkholderia cepacia
DISCUSSION
RSUP dr.
M Djamil Padang in 2007, which Distribution of DFU patients according obtained the highest age group, was 40Ae59 age and sex years as many 65.
8% .
Ae.
The age of The distribution of the age groups of patients suffering from diabetes and age at patients with the most DFU in this study was complications .
ne of them is diabetic ulcer.
18Ae60 years as many as 195 .
01%) with is related, this is in accordance with Tarigan's an average age of 55.
55 years.
Old age is one study at Herna Hospital in Medan in 2009Ae of the factors that influence DM, which can 2010 where the highest DM patients in the cause neuropathy complications in patients age group >40 years as DM age groups the with DFU .
The results of this study are most is 128 .
5%) .
in accordance with DecroliAos research in Ina J Med Lab Sci Tech 2019.
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Adyan Donastin.
Aisyah Based on these studies it can be men .
%) in RSUP Dr.
Djamil Padang, concluded that the age group with the most and in accordance with the Gaol study .
DFU is in the productive age group to old which gets the sex distribution more This could be attributed to people's dominant in men .
%) in Dr.
RSUP M.
lifestyles and eating patterns, especially those Djamil Padang in 2011Ae2013 .
This study that are not good .
Based on the results of was also in accordance with Commons the Basic Health Research (Riskesda.
in research at the Royal Darwin Hospital in 2007, it was found that the proportion of 2015 with data on 177 patients found to be deaths due to diabetes mellitus in the 45Ae54 year age group in urban areas was ranked explained that the incidence of DFU was prevalence of DM based on examination of more prevalent in men .
2%) compared to population gaet >15 years in urban areas is women .
8%).
This study also According This illustrates that DM disease, to Chomi et al.
Diabetic ulcer especially in urban areas are serious and distribution in men can be caused by men impactful problem productive age group compared with women who consult doctors productivity .
Diabetic ulcer often occurs less often, and information given to doctors at the age of >50 years due to decreased tends to be less .
The research conducted by Danmusa .
explained that the incidence decreased insulin secretion or resistance, so of DFU was more prevalent in men .
that the ability of the body to function on high compared to women .
8%).
Jobs for men blood glucose control is less optimal.
spend more time outdoors and do more work Uncontrolled blood sugar levels will result in severe, making it easier for DFU to occur and long chronic complications, both macroAe and micro vascular, one of which is diabetic ulcer Amputation in male DM patients has twice .
the risk .
Ae.
The Danmusa Factors that influence DM complications This research is not in line with Fahmi's and are related to DFU other than age are .
research in Cengkareng Regional In this study, it was found that DFU General Hospital in 2013Ae2014 where patients in Jemursari Hospital were more prevalent in men .
23%) than women Witanto's research at Immanuel Hospital in .
77%).
This study is in line with the Bandung, which had more dominant female research of Decroli .
who obtained a distribution .
%) .
Ae.
Ina J Med Lab Sci Tech 2019.
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6%),
sex distribution that was more dominant in Adyan Donastin.
Aisyah The difference in research between the Cefoxitin.
Levofloxacin, two groups can be overcome if this research TrimethroprimAesulfamethoxazole.
Erythromycin.
aureus was found to be representative sample sizes.
100% resistant to Ofloxacin.
Vancomycin.
Distribution of GramAepositive and GramAe Amoxycilin, and Ampicillin, 50% resistant to negative germs AmoxicilinAeclavulanic acid.
PiperacillinAe Based on this study and other studies it Meropenem.
Cefepime, can be seen that germs found in DFU patients Cefoxitin, at different places and at different times not TrimethroprimAesulfamethoxazole.
exactly the same, but some of the same germs Levofloxacin.
Infection like S.
coli and penicillin as the first therapy and their Enterobacter are obtained.
The GramAe positive germs that were present in the DFU in this study were S.
%) and non methicillinAeresistant S.
aureus, vancomycin haemolytic Staphylococcus .
%).
GramAe glycopeptide is the only uniformly effective negative germs present in DFU in this study were K.
%).
Resistance of vancomycin glycopeptide to S.
%).
%).
%).
In this aureus .
This study is in accordance with study, it was found that infection in DFU was the research of Chaudhry et al.
who still caused by a polymicrobial infection so that the pattern of diabetic foot infection resistant to Penicillin .
%).
Vancomycin specifically could not be ascertained.
Each .
%), and Ampicillin .
%) .
study has different characteristics of germ The sensitivity pattern of GramAenegative patterns depending on the patient's condition germs to some antibiotics and environment so different empirical Staphylococcus infection.
Staphylococcus pneumoniae was found to be most antibiotic therapies are needed as well .
The sensitivity pattern of GramAepositive AmoxicilinAeclavulanic acid.
Cefoperacilin germs to some antibiotics Amikacin.
Gentamycin.
PiperacilinAetazobactam, aureus was found to be 100% sensitive Meropenem.
Ceftriaxone, pneumonia was found to be 100% resistant to Teicoplanin.
Clindamycin.
Azithromycin, the antibiotic moxifloxacin fluoroquinolone.
Linezolid.
Oxacilin, and Chloramphenicol, 50% sensitive to AmoxicilinAeclavulanic acid.
Levofloxacin.
Ofloxacin.
TrimethroprimAe PiperacillinAetazobactam.
Cefepime.
Amikacin.
Meropenem.
Ceftrizoxime.
Ciprofloxacin.
Chloramphenicol.
Ina J Med Lab Sci Tech 2019.
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Adyan Donastin.
Aisyah while 50% were resistant to Cefepime, .
%).
%).
%) The Cefotaxime.
Ceftazidime.
Ceftriaxone, and dominant germ found in diabetic foot ulcer Aztreonam.
patients at Jemursari HospitalI period 2012Ae Akbar et al.
obtained K.
2015 is a GramAenegative germ, namely K.
sensitive to Amikacin antibiotics .
%) .
%).
The .
This study is in accordance with the antibiotics to germs consist of the most research of Chaudhry et al.
who received sensitive antibiotics in GramAepositive germs pneumonia resistant to Ceftazidime in this study were Amikacin .
%), .
%).
Ceftriaxone .
%).
Cefepime Teicoplanin .
%), and Oxacillin .
%), .
%).
Cefotaxime .
%).
Aztreonam and the most resistant to Amoxicillin .
%) .
%), and Chloramphenicol .
%) .
and Ampicillin .
%).
The most sensitive antibiotic used in GramAenegative germs in this study is Meropenem .
%), while the CONCLUSIONS In this research, it can be concluded that the age group of patients with the most DFU is the age group 18Ae60 years as many as 195 antibiotic most resistant to GramAenegative Ciprofloxacin TrimethroprimAesulfamethoxazole .
%).
01%) patients, with an average age of 55 years.
Based on gender, the majority of CONFLICT OF INTEREST DFU patients were men .
23%).
The There are no conflicts of interest.
germs found in this study were S.
%),
nonAehaemolytic Staphylococcus .
%).
%).
REFERENCES