Ecology, Environment and Conservation Paper

THE ANTIMICROBIAL RESISTANCE PATTERN IN COMMUNITY ACQUIRED URINARY TRACT INFECTION: STUDY CASE IN INDONESIAN PRIMARY HEALTH CARE, WHAT IS THE LESSON LEARNT?

Erike A. Suwarsono, Siti Nur Asiyah Jauharoh, Nouval Shahab, Alfii Nur Sholihah, Fairuz Brilliani, Maya Damayanti and Aisyah

Abstract

Urinary tract infection (UTI) is one of the most prevalence infectious disease in community. In Indonesia, there are 90-100 cases per 100.000 in 2014. Within 25-40% of UTI are recurrent cases and recently the main problem of UTI is the high number of antimicrobial resistance (AMR). AMR could lead into untreatable infection, mistreatment and worsen prognosis. Many studies show that AMR easily found in hospital especially multidrug resistant organism (MDRO), however we still lack the data from primary care setting. The study was developed as preliminary study to assess the resistance pattern of AMR in community that had taken place in Primary Health Care of Ciputat district. We collected the midstream urine from patient with clinically suspected as UTI. The urine cultured in Sheep Blood and Mac Conkey agar within 18-24 hours, then identified and did susceptibility testing by using Vitex2ä. All the data were analysis using excel and SPSS 21. The total case during November 2017-Mei 2018 was 32 cases, and 26 cases were confirmed as UTI by culture. The result shown that Escherichia coli as the most prevalence pathogen (38%). The highest resistant antibiotic was ampicillin (43%), the second was trimetrophine-sulfametoxazole (31%), followed by cephazolin (26%), amoxicillin-clavulanat (18%), clindamycin (19%), ciprofloxacin (12%) and even levofloxacin (3%). There were also Multidrug Resistant Organism (MDRO) found in the community. We found 2 E. coli isolates were resistant to all cephalosporin, known as extended spectrum of beta-lactamase (ESBL) and 1 isolate of Staphylococci that resistant to all penicillin derivate. From those isolates more than 50% were resistant to more than one class antibiotics that can be defined as MDRO. The lesson learn from the result is the AMR has developed in community setting, it should be considered as an early warning alarm not only for the general physicians in the primary health care, but also for the ministry of health. The physicians should not to prescribe antibiotics easily and the minister should conduct a deep study in preventing the spreading of antimicrobial resistance in community.