Medical Laboratory Technology Journal

Medical Laboratory Technology Journal

4 (1), 2018, 30-34
Received 2018-05-21; Received in revised form 2018-06-24; Accepted 2018-06-29
Available online at : http://ejurnal-analiskesehatan.web.id

Staphylococcus aureus AND Methicillin resistant Staphylococcus aureus

FROM THE DIABETIC ULCER
Leka Lutpiatina, Nisa Nur Agistni Eriana

Medical Laboratory Technology Poltekkes Kemenkes Banjarmasin

Jl Mistar Cokrokusumo Street 4a Banjarbaru, Indonesia.
e-mail: leka.zns@gmail.com

Abstract: Infections of diabetic ulcers may occur because patients with diabetes mellitus have
a weak immune system and the presence of high blood sugar into a strategic place for bacterial
growth one of them is Staphylococcus aureus. Increased resistance of Staphylococcus aureus
to various antibiotics, causing problems for the treatment of this infection. As by Methicillin-
resistant Staphylococcus aureus (MRSA) This study aims to assess the presence of Staphylo-
coccus aureus and Methicillin-resistant Staphylococcus aureus (MRSA) at diabetic ulcer patient
at Banjarmasin city hospital. This research uses descriptive observational research type. The
study sample was patients with grade 2 and three diabetic ulcers with a total of 30 samples.
The result of the research found 14 Staphylococcus aureus bacteria, Staphylococcus epider-
midis nine, Staphylococcus saprophyticus two and 5 Gram-negative bacteria. Of the 14 sam-
ples of Staphylococcus aureus, there were eight samples of cefoxitin-resistant samples. The
conclusion was 47% of Staphylococcus aureus in patients with a diabetic ulcer at Banjarmasin
City Hospital. There was a 57% Methicillin-resistant Staphylococcus aureus in the isolated
Staphylococcus aureus found. Need further research on the resistance of antibiotics oxacillin
and cefoxitin to other Staphylococcus sp bacteria derived from patient diabetic ulcers.
Keywords: Methicillin resistant Staphylococcus aureus; diabetic ulcers

INTRODUCTION may be resistant to some antibiotics, but more Indonesia is a tropical country,
where sensitive to natural ingredients such as bee an infection is still the disease and the
number propolis (Lutpiatina, L., 2015) and leaf kenikir one cause of death. Infection can occur
in pa- (Cosmos caudatus Kunth.) (Lutpiatina, L., Nur tients with diabetes mellitus who have
open Rizqi Amaliah, Ratih Dewi Dwiyanti, 2017). wounds or on diabetic ulcers. The prevalence
The abundance of irrational antibiotics of diabetic ulcer patients in Indonesia is about is one of
the main factors of antibiotic re-
15% with a mortality rate of 32%, as well as sistance (Sun et al., 2011). People infected
the cause of hospital treatment with the most with antibiotic-resistant microorganisms are a
80% for diabetes mellitus (Pendsey, 2010). more frequent hospital and require treatment
Infection can occur because diabetes with second or third-choice drugs that may be mellitus
patients have a weak immune system less effective, more toxic and costly. Is further and high
blood sugar to be a strategic place exacerbated by data showing that approxi-for bacterial
growth one of them is Staphylo- mately 23,000 people die each year due to the coccus aureus
(Hastuti, 2008). The results of bacterial infection that has been resistant to
Akhi et al. (2015), stated that the infection in antibiotics (Sun et al., 2011).
diabetic ulcer sufferers caused by polymicrobi- The prevalence of antibiotic resistance al
consisting of aerobic bacteria one of them is increases every year. Based on a survey con-
Staphylococcus aureus (28%). ducted by the Centers for Disease Control and Staphylococcus
aureus in the hospital Prevention (CDC) in 2013 in the United States, may contaminate the
surrounding environment every year at least 2 million people are ex-including medical devices
such as stetho- posed to bacterial infections that are resistant scopes (Lutpiatina, L., 2017) and
possibly in- to one or more types of antibiotics. fect patients. Hospital-staphylococcus aureus
Copyright © 2018, MLTJ, ISSN 2461-0879
 Medical Laboratory Technology Journal
Based on World Health Organization (WHO) or of the media to yellow. Gram stain has been
data in 2009, Indonesia ranks 8th out of 27 performing on colonies grown on Mannitol Salt
countries with high burden of antibiotic re- Agar medium; Staphylococcus aureus is a pur-
sistance to Multi-Drug Resistance (MDR) bac- ple gram-positive (+) bacteria with a clustered
teria in the world. shaped form like grapes. A biochemical test of
Staphylococcus aureus strains that the confectionary medium has been perform-
have been resistant to antibiotic activity are ing, Staphylococcus aureus fermenting glu-
among the β-lactam groups, including the pen- cose and mannitol. Staphylococcus aureus
icillinase-resistant penicillins (oxacillin, methi- positive (+) catalase test. Coagulase Staphylo-
cillin, nepheline, cloxacillin, dicloxacillin), ceph- coccus aureus positive (+) test.
alosporins, and carbapenem groups (Yuwono, Antibiotic resistance test using Kirby
2012). Result of Mutia (2010) research at Ulin and Bauer method using Mueller Hinton
Banjarmasin Hospital, found the resistance of (Merck) medium with 10 μg oxacillin disc and
Staphylococcus aureus bacteria to cephalo- 30 μg cefoxitin (Clinical Laboratory Standards
sporin group antibiotic. The results of Meta et Institute(CLSI), 2017).
al. (2014) found bacteria Methicillin-resistant
Staphylococcus aureus (MRSA) from diabetic RESULTS AND DISCUSSION
ulcers of degree I and II in the disease in This study conducted on 30 patients
RSUD Arifin Achmad as many as five samples with type II diabetes mellitus who perform ex-
(83.33%). amination and treatment of wounds in Diabetic
It known that the resistance of Staphylo- Foot Poly. Characteristics of respondents can
coccus aureus to cephalosporin, cephalexin be seen in table 1 as follows.
and cefotaxime antibiotics based on Mutia
(2010) study at Banjarmasin City Hospital, but Table 1. Characteristics of Diabetes
in CLSI standard (2017) stated that used as Mellitus Patients
the standard test of β-lactam resistance group
are oxacillin and cefoxitin. Both of these antibi-
otics are also the basis for the identification of
methicillin-resistant Staphylococcus aureus
(MRSA) bacteria, so it is to research the re-
sistance of Staphylococcus aureus derived
from diabetic ulcers against β-lactam group
antibiotics using oxacillin and cefoxitin discs.
The purpose of this study was to assess the
presence of Staphylococcus aureus and
Methicillin-resistant Staphylococcus aureus
(MRSA) in patients with diabetic ulcers in Ban-
jarmasin city hospitals.

MATERIALS AND METHODS The result of bacteria identification on

The type of research used in this re- diabetic ulcus samples found 14 Staphylococ-
search is descriptive observational. The sam- cus aureus bacteria, Staphylococcus epider-
ple of the study was diabetes mellitus patients midis of 9, Staphylococcus saprophyticus as
who had body wounds or diabetic ulcers who much as two, and Gram-negative bacteria of 5
examined in Banjarmasin city hospital. Sam- samples can be seen in the graph as follows
pling technique by purposive sampling that is
wound swab patient of diabetes mellitus grade
2 and 3.
Isolation and identification of Staphylo-
coccus aureus bacteria have taken from pa-
tients' diabetic ulcer swabs by planting on agar
and Mannitol Salt Agar agar medium (Merck).
Staphylococcus aureus has fermented manni- Chart 1. Result of Bacterial Identification on
tol to form a yellow colony and change the col- Sample of Diabetic Ulcer

Copyright © 2018, MLTJ, ISSN 2461-0879

 Medical Laboratory Technology Journal
Table 2. Results of Resistance Examination sensitive ± 22mm) can be used to predict the
on Staphylococcus aureus Isolates from presence of Staphylococcus aureus with the
Diabetic Ulcers MecA gene, whereas for oxacillin it is not rec-
ommended to use disc diffusion results but
can use minimal inhibitory concentrations
(MIC). This study used the disc diffusion meth-
od for both antibiotics, so the oxacillin inhibito-
ry results were not seen by CLSI recommen-
dations 2017. Other studies also suggest that
cefoxitin disc diffusion assays are recommend-
ed for MRSA routine detection and are consid-
ered a better indicator of oxacillin (Ibrahim, O.
M. A., Bilal, N. E., Osman, O. F., & Magzoub,
M. A.2017, RW Smyth 2005, Mimica MJ.,
2007).
Similar studies conducted by Adhikari
R. et al. (2017) were on wound swabs with a
yield of 15.47% found in Staphylococcus aure-
us, of which 39 (35.50%) isolates were identi-
fied as MRSA by disc diffusion method of
cefoxitin. According to Baddour M. M (2006),
Koyama N. (2012), Rehm S. J. (2008), Torimi-
ro N (2013) MRSA is resistant to all β-lactam
classes including cephalosporins and car-
bapenems. MRSA resistance may develop in
quinolones, aminoglycosides, and higher mac-
Chart 1 shows 47% of Staphylococcus rolides.
aureus. What the high infection of diabetic MRSA formed by the presence of mecA
wounds caused by Staphylococcus aureus gene, a meticillin-resistant encoding found in
bacteria can cause by this bacteria is flora of Staphylococcus aureus. This resistant gene
the skin, so if an open wound will become the encodes Penicillin Binding Protein 2a (PBP 2a)
entrance of bacteria and can cause infection if which does not bind meticillin as it should. (Ito
it can not control. Staphylococcus aureus can T., 2001, Grundmann H. 2006). MRSA infec-
produce β lactamase, which will hydrolyze the tions require relatively more difficult, and high-
bonds on the antibiotic-lactam molecule β- er maintenance, so accurate and rapid MRSA
lactam ring and result in antimicrobial inactiva- identification is essential (Johnson A. P. 2011).
tion resulting in resistance to antibiotics
(Pratiwi, 2008). Infection caused by Staphylo- CONCLUSION
coccus aureus could be more if it caused by There is 47% of Staphylococcus aureus
an antimicrobial-resistant strain (Monecke, in patients with the diabetic ulcer in Banjarma-
2011). sin City Hospital. There was a 57% Methicillin-
Incidence of resistance to diabetic resistant Staphylococcus aureus in the isolat-
wounds may have an effect on length of hospi- ed Staphylococcus aureus found.
talization, affecting morbidity and mortality
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