BAKTERI PENYEBAB

INFEKSI SALURAN
DARAH

OLEH:
dr. kartuti Debora SpMK(K)

12/22/21 1
 INTRODUCTION

• Bloodstream infections (BSIs) is condition associated

with high mortality in hospitalized patients.

• Secondary bacterial infection such as in BSI is an

important complication and associated with serious
outcomes in virus infection, such as in influenza

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 DEFINITION

• Bloodstream infection Is the presence of viable

microbes in the bloodstream

• Usually due to the disruption of skin or mucosal

barrier to bacterial invasion

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Classification
TRANSIENT, INTERMITTENT, PERSISTENT BACTEREMIA
 Primary, Secondary BSI

• Primary : Laboratory confirmed bloodstream

Infection (LCBI) that is not secondary to an
infection at another body site.

• Secondary BSI : a BSI that is thought to be

seeded from a site-specific at another body site.
 Nosocomial and
Community-acquired BSI

• Nosocomial BSI is defined as a BSI occurring >48 h

following admission to hospital or <48 h if the patient
has been hospitalized within the previous 2 weeks.

• Community-acquired BSIs are present on admission

(POA).
 Central Line and
Non- Central Line Associated Bloodstream Infection

• Central Line-Associated Bloodstream Infection (CLABSI)

• A laboratory confirmed bloodstream infection where an

eligible BSI organism is identified, and an eligible central
line is present on the LCBI DOE or the day before.

• Non-central Line Associated Bloodstream Infection

• A laboratory confirmed bloodstream infection from other
than central line
 CENTRAL LINE
Non Central line
• Aorta • Arterial catheters
• Pulmonary artery • Arteriovenous fistula
• Arteriovenous graft
• Superior vena cava • Atrial catheters (also known as
• Inferior vena cava transthoracic intra-cardiac catheters,
those catheters inserted directly into the
• Brachiocephalic veins right or left atrium via the heart wall)
• Internal jugular veins • Extracorporeal life support (ECMO)
• Hemodialysis reliable outflow (HERO)
• Subclavian veins
dialysis catheter
• External iliac veins • Intra-aortic balloon pump (IABP)
• Common iliac veins devices
• Peripheral IV or Midlines
• Femoral veins • Ventricular Assist Device (VAD)
• In neonates, the umbilical artery/vein
BSI, Sepsis and Septic Shock
 PENYAKIT INFEKSI SALURAN DARAH

• Sepsis
Kuman di aliran darah

• Meningitis

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MENINGITIS

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14
 MENINGITIS PURULENTA:
AEROB: ANAEROB:
1. STREPTOCOCCUS PNEUMONIAE 1. FUSOBACTERIUM
2. HAEMOPHILUS INFLUENZAE 2. AN AEROBIC COCCI
3. NIESSERIA MENINGITIDIS
4. STREPTOCOCCUS B
HAEMOLYTICUS
5. STAPHYLOCOCCUS AUREUS
6. E. COLI
7. E.AEROGENES
8. PSEUDOMONAS
9. KLEBSIELLA
10. SALMONELLA
11. LISTERIA
12. LEPTOSPIRA 12/22/21 15
 MENINGITIS SEROSA:
CONTOH BAKTERI:

MYCOBACTERIUM tbc

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 BAHAN PEMERIKSAAN: LIQUOR CEREBRO SPINALIS (CSF)

LIQUOR

DIREK SMEAR KULTUR SEROLOGI

- GRAM * AEROB : 5 – 7 HARI ^ F.A.T

. LEPTOSPIRA : 2 MINGGU ^ CAPSULER SWELLING

- BTA . M tbc : 6 – 8 MINGGU ^ C.I.E

^ COAGGLU TINATION

- DARK FIELD * ANAEROB : 7 – 10 HARI ^ LATEX AGGLUTION

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NEISSERIA MENINGITIS= MENINGOCOCCUS

Morfologi:

• Kokus berpasangan seperti biji kopi

• Gram negatif
• Pili [+]
• Kapsul [-] / [+]
SIFAT PERBENIHAN:

• Sukar tumbuh pada media sederhana

• Media yang paling baik: chocolate agar

• Mikro aerophilik: perlu CO2 [ 5 – 10% ]. Candle jar

 SIFAT BIOKIMIA:

• UJI OKSIDASE [+]

• FERMENTASI:
a. GLUKOSA [+]
b.SUKROSA [-]
c. MALTOSA [+]
d.LAKTOSA [-]
 RESISTENSI:

• PEKA TERHADAP:
- BAHAN KIMIA
- PEMANASAN
- ANTIBIOTIKA PENISILIN

• 55 C : 30 ‘ MATI

• RESISTEN TERHADAP SULFONAMIDE

STRUKTUR ANTIGEN:
Berdasar pada capsular polycharida: 10 serogroup
Serogroup a penyakit epidemi
Serogroup b , c penyakit endemi
Serogroup lain carier

VARIASI GENETIK :
- S variant / virulen r variant/ avirulen

Biakan berulang

S variant/avirulen r variant / virulen

Disuntikkan tikus putih

 PATOGENESA

N. MENINGITIDIS :
1. Imunitas baik :
- Carier / tanpa penyakit
[Nasopharynk]

2. Imunitas jelek :
- Meningen [Meningitis]
- kel. Adrenal [acute adrenal insufficiency / water house
– friderichsen syndrome)
- Endotoxin kerusakan
pembuluh darah tromboemboli
Dx LAB :

• BAHAN PEM : - DARAH

- LIQUOR
- SEKRESI NASOPHARYNK

PEWARNAAN GRAM
KULTUR : CHOCOLATE AGAR. Mengandung V dan X Faktor
• PENGOBATAN :

- PENICILLIN : DRUG OF CHOICE

- ERYTHROMYCIN
- CHLORAMPHENICOL

SULFONAMIDE : RESISTEN
 SPECIES NEISSERIA LAIN :

Spesies Glukosa Maltosa Sukrosa

N. CATARRHALIS (TRACT. - - -
RESP)

+ + +
N. SICCA (TRACT. RESP)

- - -
N. FLAVESCENS (TRACT. RESP)
UJI KIMIAWI NEISSERIA NEISSERIA
GONORRHOEAE MENINGITIDIS
Oksidase + +

Katalase + +

Fermentasi KH

+ +
Glukosa
- +
Maltosa
- -

Sukrosa - -

Laktosa
ACINETOBA
CTER
Taksonomi
 Hibridiasi DNA  21 strain/genomic species
/genospecies

 Fenotipik  lebih sederhana  sering digunakan dalam

klinis
 Taksonomi saat ini
 A. calcoaceticus  A. grimontii
 A. baumannii  A. parvus
 A. haemolyticus  A. schindleri
 A. junii
 A. tandoii
 A. johnsonii
 A. lwoffi  A. tjernbergiae

 A. radioresistens  A. towneri
 A. baylyi  A. ursingii
 A. bouvetii  A. venetianus
 A. gerneri
 Acinetobacter spp.
Struktur sel
 Gram negatif, berkapsul dan non motil
 Pada outer cell membran (pada dinding sel): porin dan
efflux channel  resistensi antibiotik
 Porin: kanal protein yang berperan dalam transport

molekul melalui membran dan pengikatan antibiotik

 A. baumannii : porin lebih kecil permeabilitas lebih
kecil  lebih resisten
 Resistensi Antibiotik
 Pompa efluks: memompa antibiotik keluar sel.
 A. baumannii  pompa Tet (A) & Tet (B)tetracycline
 Strain  A. baumannii BM4454  pompa efluks
resistance-nodulation-cell division (RND)
aminoglikosida resistence
 Produksi beta-lactamases (strain tertentu) hidrolisis
Penicillins, Cephalosporins, and Carbapenems
Metabolisme
Epidemiologi
 Acinobacter sebagai flora normal di :
 kulit (terutama kulit yang lembab),
 kavum oris,
 traktus respiratorius,
 traktus gastrointestinal.
 Studi pada kulit dan mukosa individu carier: A. lwoffii (47%), A.
johnsonii (21%) dan A. radioresistens (12%) dan genospecies 3
(11%).
Epidemiologi
 Acinetobacter baumannii :
 2-10 %  dari infeksi bakteri Gram negatif di U.S. dan
Eropa.
 umumnya menyebabkan infeksi pada individu dengan
imunitas yang menurun ( misal:Pasien ICU 
penggunaan ventilator, kateter, drain, kateter
intravena)
Faktor Virulensi
The factors that
contribute to
Acinetobacter
baumannii
environmental
persistence and
host infection
and colonization
(Dijkshoorn,
2007)
Overview of
the
dynamics
between
patients,
bacteria and
the hospital
environment
(Dijkshoorn,
2007)
Patogenesis
 Faktor virulensi relatif terbatas  mengurangi
kemampuan bakteri sebagai patogen oportunistik tanpa
adanya gangguan pertahanan tubuh host.
 Mortalitas dan mobiditas yang disebabkan infeksi
A.baumanii lebih dipengaruhi oleh status imun individu
dibandingkan virulensi bakteri itu sendiri.
Manifestasi Klinis
 Infeksi saluran nafas
 Bakteremia
 Infeksi saluran urogenital
 Infeksi jaringan lunak
 Infeksi Intracranial
 Infeksi lainnya
Diagnosis Laboratorium
 Isolasi kuman:
 media umum (mis:MacConkey agar, cystine lactose
electrolyte–deficient (CLED) agar);
 medium selektifmedium Leeds
 Identifikasi:
 setiap genomospesies tidak dapat dibedakan dgn
karakter fenotipik
Terapi
 Uji kepekaan antibiotik
 MDR–A. baumannii  kombinasi terapi polymyxin B
intravena dengan rifampin, atau imipenem atau
azithromycin.
 Outbreak di rumah sakit: infection control! (misal:
isolasi pasien dan perawatan ventilator)