Perbedaan Nilai Hitung Neutrofil Absolut Antara Infeksi Methicillin-Resistant Staphyloccocus aureus yang Berasal dari Rumah Sakit dengan yang dari Komunitas

Kurniyanto Kurniyanto, Widayat Djoko Santoso, Leonard Nainggolan, Juferdy Kurniawan

Abstract

Pendahuluan. Virulensi methicillin-resistant Staphylococcus aureus (MRSA) yang berasal dari komunitas terutama disebabkan keberadaan toksin Panton Valentin Leukocidin (PVL) dan Phenol Soluble Modulin (PSM) yang tidak dimiliki oleh MRSA yang berasal dari rumah sakit. Kedua toksin tersebut diketahui menyebabkan lisis neutrofil yang kemudian menurunkan kadar neutrofil. Penelitian ini bertujuan untuk menilai perbedaan nilai hitung neutrofil absolut antara infeksi MRSA yang didapat dari rumah sakit dengan yang dari komunitas.

Metode. Penelitian in merupakan studi potong lintang yang melibatkan pasien terinfeksi MRSA yang dirawat di RSCM pada kurun waktu 2012-2017. Klasifikasi varian MRSA dilakukan berdasarkan pola kepekaan dan resistensi kuman terhadap antibiotik non beta laktam menjadi community acquired MRSA (resisten ≤ 2 antibiotik non beta laktam) dan hospital acquired MRSA (resisten ≥ 3 antibiotik non beta laktam). Hitung neutrofil absolut diambil pada 24 jam dilakukan kultur yang positif MRSA. Data dianalisis menggunakan program SPSS versi 22 dengan uji T dan Mann-Whitney.

Hasil. Dari penelitian ini didapatkan 62 subjek dengan infeksi MRSA dengan infeksi HA-MRSA (n=35) lebih banyak dibandingkan CA-MRSA (n=27). Median hitung neutrofil absolut CA-MRSA 7.410,7 (11.47,3-26.560,2) dan HA-MRSA 16.198,0 (3.921,6-28.794,1) dengan nilai p < 0,001.

Simpulan. Terdapat perbedaan nilai hitung neutrofil absolut yang signifikan antara infeksi MRSA yang berasal dari rumah sakit dengan yang dari komunitas.

 

Kata Kunci: Hitung neutrofil absolut, MRSA, Panton valentin leukocidin

Comparison of Absolute Neutrophil Count between Hospital and Community Acquired Methicillin-Resistant Staphylococcus aureus Infection

Introduction. The virulence factors from community acquired-methicillin resistant Staphylococcus aureus (CA-MRSA) mainly due to toxins like Panton Valentin Leukocidin (PVL) and Phenol Soluble Modulin (PSM). Both of toxins cause decrease of value through neutrophil lysis. This study aimed to identify different value of absolute neutrophil count between hospital and community acquired MRSA.

Methods. A cross sectional was conducted which included subjects who were infected by MRSA and hospitalized during 2012-2017. Classification of MRSA were divided due to its sensitivity and resistance to non-beta lactam antibiotics. Isolate that resistance to ≤ 2 antibiotics were classified as CA-MRSA. The others with resistance to ≥ 3 antibiotics were classified as hospital acquired MRSA. Absolute neutrophils count (ANC) were collected 24 hours from the positive MRSA culture. Data were analyzed by using independent T test and Mann-Whitney test.

Results.  We collected 62 subjects infected by MRSA which 35 subjects were HA-MRSA and 27 subjects were CA-MRSA. The median of ANC from CA-MRSA was 7,410.7 (1,147.3-26,560.2) and HA-MRSA was 16,198.0 (3,921.6-28,794.1) with p value < 0.001.

Conclusion. There was a different value of absolute neutrophil count in infections due to community and hospital acquired MRSA.

Keywords

Absolute neutrophil count, MRSA, Panton valentin leukocidin

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