Journal of Clinical Microbiology and Infectious Diseases

Progressivity of in vitro resistance of Klebsiella pneumoniae ESBL to meropenem and amikacin therapy in specimens from the intensive care unit of Saiful Anwar Hospital, Malang

Anistia Tri Irmawati — 2025-11-30

Introduction: Multidrug-resistant organism (MDRO) infections pose a significant global health challenge. The WHO has identified Klebsiella pneumoniae as a high-priority pathogen responsible for such infections. The presence of K. pneumoniae ESBL can lead to higher mortality rates. Currently, antibiotics like meropenem and amikacin are used to treat K. pneumoniae ESBL infections. However, there is no existing research on how antibiotic resistance develops over time. This study aimed to investigate the progression of in vitro resistance of K. pneumoniae ESBL to meropenem and amikacin in samples from the ICU at Saiful Anwar Hospital.

Methods: This study uses the AZDZST method, a novel technique called the Ameri-Ziaei double antibiotic synergism test for assessing antimicrobial synergy. It functions as a disk diffusion test designed for double antibiotic synergy, with inhibition zone diameters providing data similar to other disk diffusion methods. This makes AZDAST simple to perform using the Kirby-Bauer disk susceptibility test. The method is independent and does not require reference tables like CLSI guidelines. Results are interpreted by comparing inhibition zone sizes around single and dual disks; a reduction in zone size indicates resistance. Klebsiella pneumoniae ESBL isolates, confirmed by Vitek 2, were tested for susceptibility to meropenem and amikacin. These isolates were exposed to 10 µg meropenem disks, 30 µg amikacin disks, and a combination of both disks using AZDAST over 14 days. The inhibition zones were measured after 18-24 hours of incubation at 37°C.

Results: Amikacin antibiotics exhibited resistance by the fifth day of exposure, while meropenem showed resistance on the 12th day across three samples, and on the 14th day in one sample. The combination of amikacin and meropenem also exhibited resistance by day 14 of exposure. There was no significant difference in the duration of resistance between monotherapy and the combination therapy of meropenem and amikacin.

Conclusion: Meropenem shows resistance by day 12, while amikacin is resistant from day 5. There is no significant difference in resistance duration between monotherapy and combination antibiotic treatments against Klebsiella pneumoniae ESBL in vitro.

Comparison between cytomegalovirus and HIV viral load among HIV patient who underwent antiretroviral therapy

Andrew Tulle — 2025-11-29

Introduction: Cytomegalovirus (CMV) is one of the most prevalent viral infections in humans. The prevalence is approximately 20 percent among children and nearly 100 percent among adults. Among immunocompetent individuals, CMV infection remains predominantly asymptomatic. However, in immunocompromised patients such as people with HIV (PWH), it can cause end-organ diseases that may be life-threatening. With the increasing administration of antiretroviral therapy (ART), HIV infection can be controlled, and complications from CMV infection have been decreasing. One critical method for monitoring CMV infection is identifying CMV viremia. This study aims to investigate whether CMV viremia persists in PWH undergoing ART and to explore its relationship with HIV viral load. The research seeks to provide insights to guide clinical management of CMV reactivation in this patient population

Methods: This cross-sectional study analysed archived plasma samples to detect and compare CMV viral load and HIV viral load among PWH undergoing ART. The samples were archived biological materials collected for HIV viral load detection. All samples were previously tested by PCR to detect CMV. Data were analysed using the Mann-Whitney test and Spearman correlation test.

Result: Among 67 total samples, seven were identified as CMV positive, displaying various viral load concentrations. Analysis using the Mann-Whitney test demonstrated a statistically significant difference between variables, while the Spearman correlation test showed no correlation between them. This indicated that CMV viremia may not be directly influenced by HIV infection.

Conclusion: Despite the significant difference between variables, the CMV viral load among PWH undergoing ART was not correlated with HIV viral load status. These findings suggest that CMV monitoring should be considered independently of HIV viral load status. However, the limited sample size suggests caution in generalizing these findings.

Identification test of bacterial species and resistance genes from infectious patients using MDR direct flow chip molecular technique compared to conventional techniques

Mario Surjawinata — 2025-12-30

Introduction: Antimicrobial resistance poses a threat to global public health by increasing morbidity and mortality. While resistance development is a natural biological process, antibiotic use has accelerated its rise resistance. This study aimed to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the MDR Direct Flow Chip Kit to detect 5 bacterial species and a total of 55 resistance gene markers.

Methods: The research employed a cross-sectional design, analyzing positive samples determined by the VITEK® 2 system from various specimens, including sputum, pus, and blood. These specimens were collected from sepsis patients at the FKUI Clinical Microbiology Laboratory in 2023. They were stored in Eppendorf tubes with TSB and Glycerol fluids, then cultured on Nutrient Agar Media and incubated overnight. HybriSpot® will analyze the increasing isolates using the MDR Direct Flow Chip, an in vitro diagnostic kit that quickly detects multidrug-resistant bacteria. This kit employs multiplex PCR to identify five bacterial species—Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, and Acinetobacter baumannii—as well as 55 resistance gene markers. These markers include the primary enzymatic mechanisms associated with nine different antibiotic classes.

Result: A total of 40 samples were analyzed with HybriSpot® using the MDR Direct Flow Chip, which identified 5 genus species and detected 31 resistance genes. The same samples were also tested with the VITEK® 2 system, which identified the same 5 genus species and provided antibiotic susceptibility results. The overall sensitivity was 80%, specificity was 94.2%, and conformity was 94.68%.

Conclusion: The MDR Direct Flow Chip assay is a promising method for identifying pathogens in positive blood cultures of infected patients and can aid antimicrobial stewardship programs in hospitals.

Demographic influence on COVID-19 reinfection at the Integrated Laboratory of Syarif Hidayatullah State Islamic University Jakarta

Fiena Febriyana — 2025-11-28

Background: COVID-19 can reinfect the same person, or it can be called reinfection. Reinfection that occurs has a slightly higher severity level, characterised by the need for ventilation and intensive care in the ICU, than the first infection. This study aimed to determine the influence of demographics on COVID-19 reinfection cases in the Integrated Laboratory of the Faculty of Medicine, Syarif Hidayatullah State Islamic University Jakarta, in 2020-2022.

Methods: The study was an observational analytical study using a cross-sectional design conducted on patients in the Integrated Laboratory of the Faculty of Medicine, Syarif Hidayatullah State Islamic University Jakarta, who were selected by consecutive sampling.

Results: The study aims to understand the relationship between gender, age, occupation, blood type, and source of sample with cases of COVID-19 reinfection. This study collected 396 samples. It was found that the majority of samples had the characteristics of women (57.8%), young adults (35.9%), unknown occupation (45.7%), unknown blood type (39.4%), hospital patients (90.2%), and experienced reinfection (31.8%). The results of the bivariate analysis showed a significant relationship between gender and age with cases of COVID-19 reinfection.

Conclusions: A significant relationship was found between gender and age with cases of COVID-19 reinfection at the Integrated Laboratory of the Faculty of Medicine, Syarif Hidayatullah State Islamic University Jakarta.

Outbreak of Candida lusitaniae bloodstream infection in neonatal intensive care unit: case series

Ida Ayu Sri Kusuma Dewi — 2025-11-30

Introduction: Neonatal sepsis remains a significant health challenge, particularly in low- and middle-income countries (LMICs), where inadequate healthcare infrastructure and sanitation contribute to its high incidence. Sepsis is defined as life-threatening organ dysfunction resulting from a dysregulated immune response to infection. Neonates are particularly vulnerable due to immature immune systems. Candida species, especially Candida albicans and Candida parapsilosis, are common pathogens, but Candida lusitaniae has also emerged as a notable cause of neonatal sepsis, with increased resistance to Amphotericin B. This case series highlights an outbreak of Candida lusitaniae bloodstream infections in a neonatal intensive care unit (NICU), emphasizing the diagnostic and management challenges of rare fungal infections.

Case Description: In this report, we describe five neonatal sepsis cases caused by Candida lusitaniae in our NICU. All patients exhibited respiratory distress, pneumonia, and elevated procalcitonin levels, and were treated with Voriconazole. The neonates had varying risk factors, including prematurity, low birth weight, and asphyxia. Blood cultures identified Candida lusitaniae in all cases, with susceptibility testing confirming sensitivity to Voriconazole, Amphotericin B, and Flucytosine. Environmental sampling revealed contamination in the NICU, specifically from a sink, suggesting nosocomial transmission. In response, the NICU was decontaminated, infection control protocols were reinforced, and environmental surveillance was intensified. All patients improved clinically and were discharged without major complications, except for mild encephalopathy in one case.

Conclusion: This outbreak underlines the importance of timely identification and appropriate therapy in managing rare fungal infections in neonates. It also highlights the critical role of environmental sources in nosocomial infections and the need for robust infection control measures in NICUs. Strict infection prevention strategies, including enhanced cleaning, staff training, and surveillance, are essential to preventing such outbreaks in high-risk settings.