RESISTENSI ISOLAT

PNEUMOKOKUS INVASIF:
STUDI DARI NEGARA ASEAN

Pratiwi Sudarmono,Dr,PhD,SpMK
 STREPTOCOCCUS
PNEUMONIAE
• Gram positive,diplococci
• Possessing a capsule of polysacharide
• Normal inhabitants of the upper respiratory
tract of humans
• Can cause pneumonia, sinusitis, otitis,
bronchitis, bacteremia, meningitis, and
other infection processes
 PATHOGENESIS
• A.Type of pneumococci :
in adults, type 1-8
are responsible for about 75% of cases of
pneumococcal pneumonia, and
bacteremia. In Children, types 6,14, 19,
and 23 are frequent cases
 PATHOGENESIS
B.PRODUCTION OF DISEASES
- Pneumococci produce disease through their
ability to multiply in the tissue.
- No toxin significance
- The virulence of the organism is a
function of its capsule, which prevents or
delays ingestion of encapsulated cells by
phagocytes
 PATHOGENESIS
• C. LOSS OF NATURAL RESISTANCE
• Since 40 – 70% of humans are at some
time carriers of virulent pneumococci, the
normal respiratory mucosa must possess
great natural resistance to the
pneumococcus: thus predispose to infection
are : abnormalities of the resp.tract of any
kinds
The increasing global incidence
of S.pneumoniae resistance
• Penicillin resistance has increased
dramatically throughout the world
• PRSP: first reported in 1967
• 1977: hospital centered outbreaks in South
Africa
• 1996: proven from 20 countries in the world
that PRSP 10,4% and Pen.intermediate
strains 10,2%
 PEN-I and PRSP : data 1996
• Hongkong : 59,1%
• Riyadh : 55,5%
• Mexico City : 47,1%
• Barcelona : 41,2%
• Johannesburg: 34,9%
• Ohio : 30,3 %
• New York : 28,1 %
• INDONESIA : 20%
 DATA MICRO FKUI 2000
• PEN : 17%
• AMX : 3%
• CEFOTIAM : 5 %
• CEFUROXIM : 0 %
• CEFTAZIDIME : 0%
• CEFTRIAXONE : 11%
 DATA MICRO FKUI :2000
• Erythromycin : 19%
• Azithromycin : 19%
• CIPROFLOXACIN : 35%
• OFLOXACIN : 11%
• LEVOFLOXACIN : 0%
• DATA MICRO-FKUI 2002 :
MOXIFLOXACIN : 0%
 ANSORP STUDY 1996-1997
• From 996 clinical isolates of
S.pneumoniae:
• PRSP found in :
• KOREA 79,7% Taiwan 38,7%
• Japan 65,3% Singapore 23,1%
• Vietnam 60,8% Indonesia 21%
• Thailand 57,9% China 9,8%
• Srilanka 41,2% Malaysia 9%
Bell JM, Turnidge JD, Jones RN; SENTRY
Regional Participants Group.
, Adelaide, Australia

From 1998 to 1999, a large number of

community-acquired respiratory tract
isolates of Streptococcus pneumoniae
(n=566), Haemophilus influenzae
(n=513) and Moraxella catarrhalis
(n=228) were collected from 15 centres
in Australia, Hong Kong, Japan, China,
the Philippines, Singapore, South
Africa and Taiwan through the
SENTRY Antimicrobial Surveillance
Program.
Isolates were tested against 26
antimicrobial agents using the
NCCLS-recommended methods.
Overall, 40% of S. pneumoniae
isolates were resistant to penicillin
with 18% of strains having high-
level resistance (MIC > or =2 mg/l).
• beta-lactamases were, produced by
20% H. influenzae isolates and only
rare strains showed intrinsic
resistance to amoxycillin. Other
beta-lactam agents showed good
activity with rates of resistance less
than 2% and all isolates showed
susceptibility to cefixime, ceftibuten,
cefepime and cefotaxime
The majority (98%) of M. catarrhalis
isolates was found to be beta-lactamase-
positive and resistant to penicillins,
however,
resistance to erythromycin and
tetracycline was also low at 1.8%.
Both H. influenzae and M. catarrhalis
isolates were uniformly susceptible to the
new desfluoroquinolone and tested
fluoroquinolones.
 Esposito et.al,
• In Chemotherapy 2001,Mar-
Apr,47(2):90-6
• From 216 clinical isolate of S.pneumoniae :
all inhibited by moxifloxacin , with MIC
0,06 – 0,25 ug/ml, lowest MIC compare to
other fluoroquinolone in PRSP.
MICRO-UI : is at present conducting the
same surveillance
THANK YOU