Wisiva T. Paramaiswari, Indonesia
Eijkman Institute for Molecular Biology Molecular BacteriologyPresenter of 1 Presentation
PREVALENCE OF PNEUMOCOCCAL CARRIAGE AND ANTIMICROBIAL RESISTANCE PROFILE AMONG UPPER RESPIRATORY INFECTIONS OUTPATIENTS IN TABANAN HOSPITAL, BALI (ID 561)
Abstract
Background
Streptococcus pneumoniae is one of the pathogens causing respiratory invasive diseases in children worldwide. Pneumococcus often resides as normal flora in nasopharynx but the balance of pathogens and host usually diminished due to viral infections. We investigated the prevalence of pneumococcal carriage and antimicrobial resistance profile of upper respiratory infections outpatients presenting at Tabanan General Hospital, Bali in 2017.
Methods
We collected 200 nasopharyngeal (NP) swabs from all ages outpatients with upper respiratory infections symptoms. Pneumococcus colonization was evaluated using direct culture. Serotyping was performed by conventional multiplex PCR. Antimicrobial susceptibilities were determined using disk diffusion.
Results
We found 18,5% (37/200) patients were colonized with pneumococcus. The most common serotypes found were PCV-13 vaccine types (54%), including 6A/6B and 19F (18%), 14 (8%), sg18 and 3 (3%). Most pneumococci isolates found were susceptible to Chloramphenicol (87%), followed by Clindamycin (74%) and Macrolides (72%), whereas resistance were mostly found in Cotrimoxazole (59%) and Tetracycline (44%). Multidrug resistance (MDR) were found in 11 isolates (28%), dominated by serotype 19F (18%).
Conclusions
The pneumococcus colonization rate in upper respiratory infection outpatients were less than 20% and still dominated by PCV-13 serotypes. Resistance were shown to most common antibiotics used in Indonesia.
Author Of 6 Presentations
PRELIMINARY RESULTS OF PCV-13 IMPACT STUDY IN HIV-INFECTED PATIENTS IN INDONESIA (ID 893)
Abstract
Background
Reduction in vaccine-type S. pneumoniae carriage can potentially reduce the risk of pneumococcal infection. However, the efficacy of the vaccine in HIV-infected individuals are still debatable.
Methods
HIV-infected patients (n=50) with mean age of 11.3 (6.4-16.8) years old in Jakarta were randomly enrolled into two groups. One group received a single dose of PCV-13 while the control group did not receive PCV-13. Nasopharyngeal (NP) swabs were collected to evaluate the impact of PCV-13 vaccination on S. pneumoniae colonization. The study will follow both groups until 18 months after the vaccination to find the difference of colonization and pneumococcal antibody in both groups at 6, 12, and 18 months period. This abstract reported the first phase of our study.
Results
We found 46% of NP swabs collected at initial phase were positive for S. pneumoniae with no significant difference in carriage rates between control and treatment group (p=0.917). We evaluate potential risk factors and found that school attendance significantly associated to colonization of S. pneumoniae in treatment group with p value = 0.015.
Conclusions
This result provides baseline data for pneumococcal vaccine evaluation in HIV-infected patients. We found 46% subjects were carrier for S. pneumonia and it was at the similar rate as previous studies.
CHARACTERIZATION OF FOLA AND FOLP GENE FROM COTRIMOXAZOLE-RESISTANT STREPTOCOCCUS PNEUMONIAE ISOLATES IN INDONESIA (ID 518)
Abstract
Background
The number of multidrug resistant Streptococcus pneumoniae or pneumococcus isolates have been increasing worldwide, including Cotrimoxazole-resistant isolates. Different pattern of folA and folP polymorphisms from cotrimoxazole-resistant pneumococcus have been previously reported. These genetic variations play important role in cotrimoxazole resistance mechanism. This study was conducted to characterize folA and folP gene mutation variation in cotrimoxazole-resistant pneumococcus isolates in Indonesia.
Methods
We measured cotrimoxazole MIC value from 78 pneumococcus isolates isolated from nasopharyngeal carriage in Indonesia population. Nucleotide sequences of folA and folP translated into amino acid sequences and analysed for genetic polymorphisms.
Results
We found 82% (58/71) of pneumococcus isolates were non-susceptible to cotrimoxazole (MICs ≥4 µg/ml). Ile-100-Leu substitution in dihydrofolate reductase (encoded by folA) sequence and 1-2 amino acids insertion in dihydropteroate synthase (encoded by folP) sequence were found in most cotrimoxazole-resistant isolates. Mutation on folA sequence and both on folA and folP sequences have significant impact to cotrimoxazole resistance level (p<0,05), whereas folP mutations does not have significant effect (p>0,05).
Conclusions
Most mutation variants found in cotrimoxazole-resistant pneumococcus in Indonesia were quite similar to other variants that have been reported in other regions. Mutations in folA sequences have more effect on increasing cotrimoxazole resistance compared to mutation in folP sequences.
ANALYSIS OF ERMB AND MEFA GENES FROM NON-SUSCEPTIBLE ERYTHROMYCIN STREPTOCOCCUS PNEUMONIAE ISOLATES IN INDONESIA (ID 564)
Abstract
Background
Macrolide resistance of Streptococcus pneumoniae has already increased in worldwide. In Asia, >70% of clinical S. pneumoniae isolates was reported as erythromycin resistant. ErmB and mefA genes existence plays a role in resistance mechanism by modification of drug binding site and active efflux of the cell. This study is aimed to analyze macrolide resistant genes (ermB and mefA) associated with prevalence of non-susceptible erythromycin S. pneumoniae isolates in Indonesia.
Methods
Seventy isolates of S. pneumoniae were processed for antimicrobial susceptibility testing according to CLSI. The ermB and mefA genes were detected using duplex PCR. Association between these genes and erythromycin resistance rate was analyzed using Fisher test.
Results
A total of 47 (67%) isolates were nonsusceptible to erythromycin. ErmB was detected in 24 (34.2%) isolates and mefA was detected in 50 (71.4%) isolates. Isolates having both ermB and mefA were 34 (48.5%) isolates. There was association between erythromycin resistance with existence of mefA gene (P < 0.001), ermB (P = 0,045) and both (P = 0,036). The most common resistance isolates were serotype 19F (38,2%) and 23F (31,9%).
Conclusions
The existence of mefA and ermB seems to be associated with erythromycin non-susceptible of S. pneumoniae where mefA is the most associated to resistance.
DIFFERENCES IN SEROTYPE DISTRIBUTION AND RISK FACTORS OF STREPTOCOCCUS PNEUMONIAE COLONIZATION IN CHILDREN UNDER FIVE YEARS OF AGE BETWEEN TWO SEA NOMADS POPULATION IN INDONESIA (ID 1060)
Abstract
Background
S. pneumoniae isolation from indigenous population prior to pneumococcal vaccine introduction is critically important to provide baseline and ensure data representativeness across different regions in Indonesia for vaccine impact evaluation in the future.
Methods
We collected nasopharyngeal swabs from children <5 in Wakatobi, Sulawesi and Kotabaru, Kalimantan from October 2018 – April 2019. S. pneumoniae was identified by optochin-susceptibility and bile-solubility test and serotyped using multiplex PCR.
Results
We isolated 305/499 (61%) of S. pneumoniae in Wakatobi and 180/399 (45%) in Kotabaru. 65% of pneumococcus in Wakatobi were PCV13-types. The rate was lower in Kotabaru with 46%. Most common serotypes in Kotabaru were 6A/B, 15B/C and 19F with 18%, 17% and 16%. 6A/B, 23F and 19F were the most common in Wakatobi with 29%, 16% and 9% respectively. Cigarette smoke exposure was associated to colonization in Kotabaru with OR 1.87. Rhinorrhoea and use of kerosene and wood as fuel for cooking were associated to colonization in Wakatobi with OR 2.0 (95%CI 1.3 – 3.0), 3.6 (95%CI 1.4 – 9.0) and 4.3 (95%CI 1.7 – 10.9) respectively.
Conclusions
Different serotype distribution and risk factors were shown despite both communities were the same tribe (Bajau). This result provides baseline data representing indigenous population in Indonesia.
ANTIMICROBIAL ACTIVITY OF MEDICINAL PLANT EXTRACTS IN INDONESIA AGAINST MULTI-DRUG RESISTANT STRAIN OF STREPTOCOCCUS PNEUMONIAE (ID 513)
PREVALENCE OF PNEUMOCOCCAL CARRIAGE AND ANTIMICROBIAL RESISTANCE PROFILE AMONG UPPER RESPIRATORY INFECTIONS OUTPATIENTS IN TABANAN HOSPITAL, BALI (ID 561)
Abstract
Background
Streptococcus pneumoniae is one of the pathogens causing respiratory invasive diseases in children worldwide. Pneumococcus often resides as normal flora in nasopharynx but the balance of pathogens and host usually diminished due to viral infections. We investigated the prevalence of pneumococcal carriage and antimicrobial resistance profile of upper respiratory infections outpatients presenting at Tabanan General Hospital, Bali in 2017.
Methods
We collected 200 nasopharyngeal (NP) swabs from all ages outpatients with upper respiratory infections symptoms. Pneumococcus colonization was evaluated using direct culture. Serotyping was performed by conventional multiplex PCR. Antimicrobial susceptibilities were determined using disk diffusion.
Results
We found 18,5% (37/200) patients were colonized with pneumococcus. The most common serotypes found were PCV-13 vaccine types (54%), including 6A/6B and 19F (18%), 14 (8%), sg18 and 3 (3%). Most pneumococci isolates found were susceptible to Chloramphenicol (87%), followed by Clindamycin (74%) and Macrolides (72%), whereas resistance were mostly found in Cotrimoxazole (59%) and Tetracycline (44%). Multidrug resistance (MDR) were found in 11 isolates (28%), dominated by serotype 19F (18%).
Conclusions
The pneumococcus colonization rate in upper respiratory infection outpatients were less than 20% and still dominated by PCV-13 serotypes. Resistance were shown to most common antibiotics used in Indonesia.