Gene families of AmpC-producing enterobacteriaceae present in intensive care unit of Cipto Mangunkusumo Hospital Jakarta

12/20/2018 12:00:00 AM

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Authors:Lucky H Moehario, Thomas Robertus, Anis Karuniawati, Rudyanto Sedono, Delly Chipta Lestari, Andi Yasmon

Publication date: April 2019, Accepted 19 December 2018

Indonesian Biomedical Journal

Volume:  11 (1): 107-12

Link: https://inabj.org/index.php/ibj/article/view/552

 

 

Abstract

 

 

BACKGROUND: Antibiotic resistance has become a worldwide problem. Among Asia countries, Indonesia   has   high   prevalence   of   multi-drug resistant organisms mainly due to Gram-negative bacilli Enterobacteriaceae.  This study aimed to find out whether gene family of AmpC and AmpC/ESBL-producing Enterobacteriaceae  were  present  in  the  Intensive  Care Unit (ICU) of  Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

METHODS: Specimens were obtained from several body sites of adult patients with infection hospitalised in ICU of  Cipto  Mangunkusumo  Hospital. VITEK®2  was  used to  identify  the  microorganisms. Antibiotic  susceptibility tests were conducted using VITEK®2 and disc diffusion technique according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Double disc synergy (DDS) test  method  was  employed  to  detect  AmpC  activity. Gene  families  of  ampC  were  identified using  multiplex polymerase chain reaction (PCR).

RESULTS: Forty five isolates were identified as putative AmpC, extended-Spectrum β-lactamases (ESBL) and AmpC/ESBL-producing Enterobacteriaceae. Klebsiella pneumoniae (n=32) were predominant, followed by Escherichia coli (n=6), Enterobacter cloacae (n=5) and Enterobacter aerogenes (n=2). AmpC activity was detected in 9 isolates, in which 4 isolates were AmpC producing and

5 isolates were AmpC/ESBL. In vitro, AmpC-producing Enterobacteriaceae showed good susceptibility to many antibiotic  tested,  while  those  of AmpC/ESBL-producing only to Amikacin. The gene families of ampC were DHA, EBC and CIT identified from 6 isolates.

CONCLUSION:  DHA,  EBC  and  CIT  gene  families were identified from AmpC and AmpC/ESBL-producing Enterobacteriaceae in the ICU of Cipto Mangunkusumo Hospital. While the AmpC-producing was still susceptible to almost all antibiotics tested, the AmpC/ESBL-producing showed resistant except for Amikacin.

 

Keywords:  Enterobacteriaceae, β-lactamases, AmpC, ESBL