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RESEARCH TITLE:

RESEARCH TITLE: COMPARISON OF THE ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF Klebsiella Pneumoniae ISOLATED FROM URINE OF PATIENT HOSPITALIZED AT DR.SAIFUL ANWAR GENERAL HOSPITAL IN YEAR 2009/2010 AND 2010/2011 NAME : VINOTH KUMAR A/L RAMAN NIM : 0910714018

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RESEARCH TITLE:

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  1. RESEARCH TITLE: COMPARISON OF THE ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF KlebsiellaPneumoniaeISOLATED FROM URINE OF PATIENT HOSPITALIZED AT DR.SAIFUL ANWAR GENERAL HOSPITAL IN YEAR 2009/2010 AND 2010/2011 NAME : VINOTH KUMAR A/L RAMAN NIM : 0910714018 GURU PEMBIMBING :1) Dr. Dra. Sri Winarsih Apt. M.Si 2)dr.Harun Al Rasyid Mph Penguji :1)Dr.dr.Endang Sri Wahyuni

  2. Urinary tract infections

  3. Specific Objective

  4. Women are at greater risk for UTI … • relatively short, straight anatomy of the urethra(1.5 inches in women compared to 8 inches in men) • Frequent or recent sexual activity is the most important risk factor for urinary tract infection in young women. • Certain types of contraceptives can also increase the risk of urinary tract infections • Estrogen loss can also reduce certain immune factors in the vagina(helps block KlebsiellaPneumoniae from adhering to vaginal cells)

  5. Men becoming susceptible to urinary tract infections : • after 50 years of age, when they begin to develop prostate problems-enlargement of the prostate gland, can produce obstruction in the urinary tract and increase the risk for infection • Frequent or recent sexual activity is the most important risk factor for urinary tract infection in young women. • weakening of the muscles of the bladder, it will lead to urine retention in the bladder, poor bladder emptying and incontinence, at the end of it causing UTI.

  6. Elderly are prone to urinary tract infections (UTIs) because : • impaired immunity • have incomplete bladder draining due to prostate problems • Postmenopausal women are more likely to have incomplete bladder draining due to bladder prolapse • urine due to anticholinergic medications(antihistamines, tricyclic antidepressants) • more likely to have bladder or bowel incontinence, which can lead to increased chances of contamination of the urethra • more apt to get an indwelling catheter while hospitalized or in a nursing home.

  7. Significant increase of resistance…

  8. Amoxicillin-Clavulanic Acid • hyper production of chromosomal class C β-lactamase • production of inhibitor resistant TEM (Transposable Element) enzymes and deficiency in OMP F and/or OMP C porins. • Hyper production of chromosomal class C β-lactamase causes in increase of TEM-1 β-lactamase causing KlebsiellaPneumoniae to be less sensitive to clavulanate and thus it can hydrolyze amoxycilin. • Deficiency in OMP F and/or OMP C porins causes decrease in intracellular concentration of antimicrobial, thus conferring resistance

  9. aminoglycosides • Kanamycin,netilmycinand amikacin • Reduced drug uptake-due to membrane impermeabilization, but the underlying molecular mechanisms are largely unknown • Membrane protein changes and alteration in the regulation of genes of the anaerobic respiratory pathway in bacteria exposed to aminoglycosides are probably responsible for this phenomenon, which gives a pharmacodynamics rationale for high dosages associated with long intervals between successive administrations

  10. Quinololones • Ciprofloxacin,Nalidixic Acid, Ofloxacin, and Norfloxacin • mechanism of resistance to quinolones is the spontaneous mutation of the gene encoding the A subunit of DNA gyrase (gyrA) so that its action is no longer inhibited • Alterations in norA or its regulation confer resistance by mediating the enhanced efflux of fluoroquinolones • Norfloxacin showed insignificant changes whereas Ofloxacin showed significant increase in sensitivity: • to low usage of Ofloxacin • possibility that the patient had already taken Ofloxacin for therapy before the sensitivity test is conducted

  11. cephalosporins • cephalosporinsused:cefotaxime,ceftriaxone,cefuroximeand cephalotin • cephalosporinshas been correlated with increased incidence of β-lactam resistance in Gram-negative bacteria • increase sensitivity towards cephalotin observed • appropriate changes in antibiotic use can lead to recovery of susceptibility • Ballowand Schentag, observed that increased use of ceftazidime at the Millard Fillmore Hospital in Buffalo, NY, resulted in an increase in cephalosporin resistance among Enterobacter cloacae isolates from 17 to 46% between 1988 and 1990

  12. antimicrobial resistance are complex problems driven by numerous interconnected fac­tors • Patient-related factors are major drivers of inappropriate antimicrobial use. For example, many patients believe that new and expensive medications are more efficacious than older agents • Self-medication with antimicrobials is another major factor contributing to the increase of anti-microbial resistance • Prescribers' perceptions regarding patient expectations and demands substantially influence prescribing practice • The annual report of year 2002 published by World Health Organization (WHO) stated that patient compliance with recommended treatment is another major problem • The combination of highly sus­ceptible patients, intensive and prolonged antimicrobial use, and cross-infection have resulted in nosocomial infections with highly resistant bacterial pathogens

  13. Conclusion • Urinary tract infection caused by KlebsiellaPneumoniae (K.Pneumoniae) shows changes in prevalence • There is a significant increase of resistance on K.Pneumoniaetowards antimicrobial at Dr.Saiful Anwar General Hospital • There is significant increase in resistance of amoxicillin+clavulanicacid,kanamicin,ciprofloxacin and nalidixicacid • There is no significant increase in resistance of Cefotaxime,Ceftriaxone, Cefuroxime,Cephalothin,Gentamicin,Netilmicin,Amikacin,Ofloxacin,Norfloxacin,Meropenem,Tetracyline,Doxycycline,Chloramphenicol,Cotrimaxazole,Sulfonamide and Nitrofurantoin

  14. Suggestions • antimicrobial sensitivity pattern towards K.Pneumoniaebe monitored in years to come • Sensitivity test should be conducted before prescribing antimicrobials drugs to patient • Restrict antimicrobial use for inappropriate indications • Clinician should be more careful in prescribing antimicrobials • Pharmacist should control the sales of antimicrobial drugs so that it is not misused by community • Provide patient education • Medical staffs should obtain complete data of patient and be recorded completely

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