extended-spectrum beta laktamasi (esbl)

8/17/2019 Extended-Spectrum Beta Laktamasi (ESBL)

1/21

R E F E R A T

N A M A : M I K H A E L R O B E R T M A R A M P E

N I M : 0 9 6 1 0 5 0 1 4 4

EXTENDED-SPECTRUM BETA LAKTAMASI(ESBL)

PEMBIMBING : !" E#$%&%! P$!'%% S*"A


2/21

PENDAHULUAN

• A+,,.+,/ *$!+%'% ,+$'/% .#$ S,! A#$2%$! F#$',3*%% +% 19 % ,%'%/% *$,,#, 7%3'$!*%/% $+% #%/+%' 7%3 '$'*7%, $'*%+ 8,8,$+% #%/+%' +,3% 8,8, /%!. % %+ ,+!.3$"

• S%#% %+ $+/ *$!#%%% %/+$!, +$!%%* /$!;% %!,%+,,.+,/ $+% #%/+%' ,, %/+$!, '$3%,#/% $&,'7%3 ,$+ $3% $+% #%/+%'%$

• E&,' %*%+ '$!%/ 8,8, $+% #%/+%' %!, *$,,#,$3% ,!.#,, % +%*% 8,8, $+% #%/+%' *$,,#,

'$;%, +,%/ $


3/21

MEKANISME RESISTENSI TERHADAP BETA LAKTAM" DIKUTIP DARI: =OHN

>ILE? @ SONS INC BACTERIAL DRUG RESISTANCE, 004"


4/21

DEFINISI

• ESBL %%#% $&,'-$&,' 7%3 '$7$%/% !$,+$,+$!%%* $2+$$-*$8+!' (3$$!%, /$+,3%) $


5/21

ETIOLOGI

• ESBL *%#,3 %7%/ ,%,#/% .#$E+$!.%8+$!,%8$%$ (+$!+%'%E8$!,8,% 8.#,) % K#$,$##% *$'.,%$"

•

G$ *$3/.$ ESBL *%% %/+$!, *%#,3 %7%/$!%% , *#%', "

• U''7% ESBL $!%%# %!, 3$ TEM-1 TEM-%+% SH-1 7%3 '$3%#%', '+%, %

'$3% /.3!%, %%' %',. , $/,+%!#./%, %/+,< %!, -#%8+%'%$" K$%%%,, '$'%+ *$/+!' %+,,.+,/ -#%8+%'!$+% +$!%%* ,!.#,, .#$ $&,' ,,"


6/21

KLASIFIKASI

• A33.+%


7/21

=ENIS ESBL ?ANG SERING DITEMUKAN ADALAHSEBAGAI BERIKUT :

• SH -#%8+%'%$ (8#% A)

• TEM -#%8+%'%$ (8#% A)

• CTX-M -#%8+%'%$ (8#% A)

• OXA -#%8+%'%$ (8#% D)• ESBL *$! +,*$

• ESBL #%,


8/21

EPIDEMIOLOGI

• S+!%, %/+$!, ESBL ,, +$!$%! #% , $#!,% #$, $!,3 ,%*%+, *%% *$,'$ 7%3$!%%# %!, !'% %/,+ +$+%*, ;3% %*%+

,;'*%, , '%7%!%/%+"• D, USA National Nosocomial Infection

Surveillance (NNIS) '$$'/% $;%/ =%%!,199 %'*%, =, 00 ,%*%+, 61 %!, 6"101,.#%+ Klebsiella neumonia %!, 110 !%3 !%%+,%* ,+$,< !$,+$ +$!%%* $


9/21

• E!.*% *$$#,+,% !eroenem "earl# Suscetibilit#Test Information Collection (M7+,8 S+7) +%00 '$#,%+/% 1 $3%!% ,*$!.#$ /$;%,%

ESBL 56 %!, +.+%# *.*#%,"• A,% $,!, *%% +% 19 ,.#%+ Klebsiella neumonia %!, C,% 7%3 '$3%3 ESBL+/ *$!+%'% /%#, ,#%*.!/%,.#%+ %!, +%199 % 1999 0 ,.#%+ Klebsiella

neumonia % 45 ,.#%+ Esc$ericia coli,/$+%, '$3%,#/% ESBL"


10/21

STRUKTUR DAN MEKANISME KERJA

ESBL

• S$'% ESBL '$',#,/, $!,$ 7%3 +$!#$+%/ , %8+,$,+$ /$8%#, $%3,% /$8,# 8#% B G!* M$+%##. -#%8+%'%$"

• -#%8+%'%$%/% '$7$!%3 ,/%+% %',% , 8,8, -#%8+%' *$,8,##, %8$*%#.*.!, $!+%'$3%,#/% *$,8,##,.,8 %8, % 8$*%#.*.!,8 %8, "

• P#%', 7%3'$',#,/, /!% J 0 K % $!+%333 ;%% +$!%%* *$'%% 3$ ESBL"

•

P%% .!3%,'$ *$3%,# ESBL ;3% $!,3 !$,+$+$!%%* %+,,.+,/ 3.#.3% %',.3#78.,$.!.,.#. +$+!%878#,$ 8#.!%'*$,8.# %#


11/21

• ESBL ;%!%3 +$!;%, , P!.+$ ',!%,#, ,3%*$7$%7% /%!$% *$,$ ,, '$',#,/,/%3% *#%', 7%3 !$%"

•

H%# ,, '$'*$!/%+ +$.!, %% +!%',,ESBL %+%!% %+ .!3%,'$ /$ .!3%,'$ 7%3#%, ,%%7% +$!;%, , *#%',"


12/21

ESBL

T$!/%7%+!%+ B-

L%8+%'

S+,+,%%'%',.

K.3!%,$&,'


13/21

FAKTOR RESIKO INFEKSI


14/21

PENATALAKSANAAN ESBL

• SCREENING

• INFECTION MANAGEMENT

• DRUG OF CHOICE


15/21

SCREENING

• MELALUI PENILAIAN ATAU SCORING

ITALIAN SCORE DAN DUKE MODEL SCORE


16/21


17/21

MANA=EMEN INFEKSI

• A%7% ,+$' /.!,3 %/% %3%+ '$'%+ /#,,, %#%''$3%%*, ,


18/21

• U+/ '$'$%/% %+ ,


19/21

PENDEKATAN NON FARMAKOLOGIS

• P$$/%+% +%*% %+,,.+,/ %#%' '%%;$'$,


20/21

PENDEKATAN FARMAKOLOGIS

• P,#,% %+,,.+,/ *%% *%,$ $3% ,


21/21

extended-spectrum beta laktamasi (esbl)

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