Dodi Safari, Indonesia
Eijkman Institute For Molecular Biology Molecular BacteriologyPresenter of 1 Presentation
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.
Author Of 11 Presentations
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.
MULTILOCUS SEQUENCE TYPE ANALYSIS OF SEROTYPE 19F OF STREPTOCOCCUS PNEUMONIAE STRAINS PRIOR PNEUMOCOCCAL VACCINATION INTRODUCTION IN INDONESIA (ID 515)
Abstract
Background
Streptococcus pneumoniae serotype 19F is one of the invasive serotypes causing IPD in Indonesia where it is commonly found as multi-drug resistant (MDR). However, relationship between its genetic variation and multi-drug resistant is still not well described. Therefore, we performed multilocus sequence typing on multidrug resistant serotype 19F to describe sequence type of multi-drug resistance serotype 19F in Indonesia.
Methods
We used 25 archived isolates previously described as serotype 19F. Antimicrobial susceptibility testing was performed using disk diffusion according to CLSI guidelines. Multi-locus sequence typing was performed by sequencing targeting seven house-keeping genes; aroE, gdh, gki, recP, spi, xpt, and ddl. Sequence type (ST) was determined by allele number combination of seven house-keeping genes.
Results
S. pneumoniae serotype 19F isolates were resistant to tetracycline (89%), Sulfametoxazole/Trimethophrim (72%), macrolide (52%), and chloramphenicol (60%) where 56% of isolates was MDR. We identified 5 sequence types where ST 9192 as dominant sequence type (44%) while others were ST 320 (20%), ST 242 (16%), ST 236 (12%), and ST 271 (4%) belonged to MDR strain.
Conclusions
Serotype 19F has been resistant to common antibiotic used in Indonesia where sequence type 320, 242, 236 and 271 are sequence type for MDR strain of serotype 19F
COMPARISONS OF STREPTOCOCCUS PNEUMONIA SEROTYPE ON NASOPHARYNGEAL CARRIAGE BETWEEN UNDER-FIVE CHILDREN WITH COMMUNITY ACQUIRED PNEUMONIA AND HEALTHY (ID 1196)
Abstract
Background
Streptococcus pneumonia colonization in nasopharyng consist of many serotypes, strongly related to high morbidity and mortality of pneumonia in children under-five.This study objective is to compare between S. pneumonia serotypes on nasopharyngeal carriage among children with pneumonia infection and healthy.
Methods
We collected the nasopharyngeal (NP) swab among 130 under-five years of age pneumonia children at M. Djamil hospital and healthy children as control from two daycares in Padang, respectively. Demographic and clinical data were recorded during NP swab collection.The isolate of Streptococcus pneumoniae has been performed by culture on 8% sheep-blood agar plate, were identified serotype by PCR methods.
Results
Overall we found that 19F (21%) and untypeable Streptococcus pneumonia serotype (21%) are the most frequent from PCR identification, followed by 6C, 14 and 34 serotype. Comparing pneumonia cases and healthy children, 19F serotype (22%) more frequent among control healthy children than pneumonia cases (17%). We found untypeable and 6B serotype are the most frequent among pneumonia patiens, but not in control group.
Conclusions
We found the same proportion of 19F serotype Streptococcus pneumoniae among pneumonia patiens and healthy, but very high untypeable serotype in pneumonia patiens.
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.
PROPORTION OF PNEUMOCOCCAL PNEUMONIA AND SEROTYPE DISTRIBUTION IN COMMUNITY-ACQUIRED PNEUMONIA PATIENTS WITH UNDERLYING COMORBIDITIES IN JAKARTA, INDONESIA (ID 269)
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.
ANTIMICROBIAL ACTIVITY OF MEDICINAL PLANT EXTRACTS IN INDONESIA AGAINST MULTI-DRUG RESISTANT STRAIN OF STREPTOCOCCUS PNEUMONIAE (ID 513)
STREPTOCOCCUS PNEUMONIA COLONIZATION IN NASOPHARYNGEAL CARRIED BY CHILDREN WITH PNEUMONIA INFECTION AND HEALTHY CHILDREN UNDER FIVE YEARS (ID 1163)
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.
SEROTYPE DISTRIBUTION AND ANTIMICROBIAL SUSCEPTIBILITY OF STREPTOCOCCUS PNEUMONIAE CARRIED BY HEALTHY BAJAU CHILDREN UNDER 5 YEARS OF AGE IN KOTABARU, SOUTH KALIMANTAN (ID 395)
Abstract
Background
The indigenous Bajau people (Sea Nomads) have lived an entirely marine-dependent existence and renowned for their extraordinary breath-holding abilities. Kotabaru in South Kalimantan is one of the island inhabited by Bajau people. We investigated nasopharyngeal carriage of S. pneumoniae in healthy Bajau children <5 in Kotabaru, South Kalimantan, Indonesia.
Methods
Serotyping was performed using Conventional multiplex PCR. Antimicrobial susceptbility test using disk diffusion and microdulution were employed to all pneumococcal and MDR isolates, respectively.
Results
We found 45% (180/399) of S. pneumoniae. Cigarette exposure contributed to colonization of S. pneumoniae (OR = 1,87). The most common serotypes were 6A/6B (18%), 15B/15C (17%) and 19F (16%). We identified 46% (86/185) was vaccine-type and 40% as non-vaccine type (74/185). The majority of 18% (34/185) defined as Multidrug Resistant pneumococcus were 19F serotype (74%), followed by 6A/6B (9%), 19A (9%), 14 (6%), and 23F (3%). Tetracycline (89%), trimethoprim/sulfamethoxazole (79%), cefuroxime (76%), azithromycin (76%) and erythromycin (76%) showed high prevalence of resistance among MDR isolates with MICs90 were 8, 4/76, >4, and >2 μg/mL, respectively.
Conclusions
Almost half of the identified serotype were vaccine type. All of the multidrug resistant isolates were vaccine type and dominated by 19F. Serotype 15B/15C was the second most common serotype.