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Abstrak :
Latar belakang: Neisseria gonorrhoeae (NG) telah mengalami resistensi terhadap berbagai antibiotik. Setidaknya sepuluh negara telah melaporkan kegagalan pengobatan gonore dengan extended-spectrum cephalosporins (ESCs). Pengawasan berkelanjutan penting untuk menentukan pedoman pengobatan lokal. Tujuan: Mengetahui prevalensi NG yang resisten terhadap penisilin, tetrasiklin, levofloksasin, sefiksim, dan seftriakson pada kelompok risiko tinggi di Jakarta serta mengidentifikasi berbagai faktor yang berhubungan. Metode: Sebuah penelitian dengan desain potong lintang dilakukan di Jakarta pada September hingga November 2018. Terdapat 98 laki-laki dan perempuan berisiko tinggi yang memenuhi kriteria penelitian. Sediaan duh tubuh diambil dari uretra atau serviks, disimpan di media transport, kemudian diantarkan ke Laboratorium Mikrobiologi Klinik FKUI untuk biakan dan identifikasi. Uji resistensi dilakukan dengan metode difusi cakram sesuai rekomendasi Clinical and Laboratory Standard Institute (CLSI). Hasil: Dari seluruh spesimen yang dibiakkan, 35 di antaranya menunjukkan pertumbuhan isolat NG. Prevalensi NG yang resisten terhadap penisilin, tetrasiklin, levofloksasin, sefiksim, dan seftriakson pada kelompok risiko tinggi di Jakarta adalah 97,1%; 97,1%; 34,3%; 0%; 0%. Usia, orientasi seksual, riwayat konsumsi antibiotik, berhubungan seksual secara komersial, dan berhubungan dengan pasangan seksual dari luar kota tidak berhubungan dengan NG yang resisten terhadap levofloksasin. Kesimpulan: Tidak ditemukan isolat NG yang resisten terhadap sefiksim dan seftriakson. Hasil tersebut menunjukkan bahwa sefiksim dan seftriakson efektif mengobati gonore di Jakarta. Tidak ada faktor yang berhubungan dengan resistensi pada penelitian ini. ......Background: Neisseria gonorrhoeae (NG) has developed resistance to various antimicrobials. At least ten countries have reported treatment failures with extended-spectrum cephalosporins (ESCs). Continuous surveillance is important to determine local treatment guideline. Objectives: To determine the resistance rates of NG to penicillin, tetracycline, levofloxacin, cefixime, ceftriaxone among the high-risk population in Jakarta, and identify the associated factors. Methods: A cross-sectional study was conducted in Jakarta, Indonesia from September to November 2018. A total of 98 high-risk men and women fulfilled the studies’ criteria. The specimens were collected from urethral or endocervical swabs, put into Amies transport media, and then transported to the Laboratory of Clinical Microbiology Universitas Indonesia for culture and identification. Proven gonococcal isolates were examined for susceptibility to various antibiotics using the disk diffusion method according to Clinical and Laboratory Standard Institute (CLSI) recommendation. Results: Among 98 specimens, 35 were confirmed to be NG. The NG resistance rates to penicillin, tetracycline, levofloxacin, cefixime, and ceftriaxone among high-risk population were 97,1%; 97,1%; 34,3%; 0%; 0%. Age, sexual orientation, history of antibiotic consumption, commercial sexual activities, and sexual activities with partners from other regions were not associated with the resistance to levofloxacin. Conclusion: No resistance to cefixime and ceftriaxone was reported. This finding indicates that they are still effective to treat gonorrhea in Jakarta. There were no associated factors identified in this study.

Abstrak :
Penelitian ini bertujuan untuk mengevaluasi penggunaan metode difusi cakram standar CLSI dan CDS dalam menentukan pola kepekaan Neisseria gonorrhoeae terhadap antibiotik. Pada metode difusi cakram standar CLSI dapat terjadi double zone inhibition yang dapat mempersulit dalam interpretasi zona hambat yang sesungguhnya. Dengan metode difusi cakram standar CDS diharapkan hal tersebut tidak terjadi. Penelitian ini merupakan uji kesetaraan antara hasil uji kepekaan antibiotik metode difusi cakram menurut standar CDS dan standar CLSI yang dibandingkan dengan Etest sebagai baku emas. Dari penelitian ini didapatkan hasil metode difusi cakram standar CDS lebih sesuai dengan Etest daripada standar CLSI pada tiga antibiotik yaitu azitromisin (total agreement 96,7%), seftriakson (total agreement 80,0%) dan penisilin (total agreement 73,3%) sedangkan metode difusi cakram standar CLSI lebih sesuai dengan Etest daripada standar CDS pada dua antibiotik yaitu siprofloksasin (total agreement 73,3%) dan spektinomisin (total agreement 73,3%). Pola kepekaan Neisseria gonorrhoeae terhadap antibiotik di RSCM dan pelayanan kesehatan jejaring menurut metode difusi cakram yang paling sesuai dengan Etest yaitu: dengan standar CDS didapatkan azitromisin 86,7%, seftriakson 76,7%, penisilin 16,7% dan dengan standar CLSI didapatkan siprofloksasin 0% dan spektinomisin 70%. Pola kepekaan Neisseria gonorrhoeae terhadap sefiksim yaitu 46,7% yang hanya diujikan dengan standar CLSI. Pemberian sefiksim dan seftriakson yang merupakan terapi pilihan untuk gonore harus diberikan secara bijak, untuk menghindari kejadian resistensi yang lebih luas.

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This study aimed to evaluate the use of CLSI and CDS standard disc diffusion method in determining the sensitivity patterns of Neisseria gonorrhoeae to antibiotics. In the CLSI standard disc diffusion method can occur double inhibition zone that can complicate the interpretation of the actual inhibition zone. With the CDS standard disc diffusion method expected it does not happen. This study was a test of equivalence between the results of antibiotic susceptibility test disc diffusion method according to CLSI standards and standardized CDS compared with the Etest as gold standard. From this study, compared with Etest, the results of the standard disc diffusion method in accordance with CDS over the CLSI standard than three antibiotics, namely azithromycin (total agreement 96.7%), ceftriaxone (total agreement 80.0%) and penicillin (total agreement 73.3%) whereas the standard disc diffusion method according to CLSI more than CDS standard on the two antibiotics are ciprofloxacin (total agreement 73.3%) and spectinomycin (total agreement 73.3%). Neisseria gonorrhoeae patterns of sensitivity to antibiotics in RSCM and health care networks by disc diffusion method that best suits the Etest are with the standard CDS obtained azithromycin 86,7%, ceftriaxone 76.7%, penicillin 16,7% and with the CLSI standards obtained ciprofloxacin 0% and spektinomisin 70%. Neisseria gonorrhoeae pattern of sensitivity to cefixime is 46.7 % which is only tested with the CLSI standard. Cefixime and ceftriaxone as the drug of choice for gonorrhea should be given prudently to prevent the occurrence of resistance more extensive.

Abstrak :
Resistensi Neisseria gonorrhoeae terhadap antibiotika merupakan masalah global di dunia. Sulitnya pertumbuhan N. gonorrhoeae di laboratorium menyebabkan uji kepekaan antibiotika sulit dilakukan secara reguler. Tujuan penelitian ini untuk mendeteksi N. gonorrhoeae dari spesimen endoserviks dan karakterisasi mutasi gen terkait resistensi terhadap sefiksim dan azitromisin sebagai antibiotika pilihan yang direkomendasikan WHO dan Kemenkes RI. Spesimen endoserviks dari wanita pekerja seks (WPS) dilakukan pewarnaan Gram, kultur, dan uji kepekaan antibiotika. Uji molekuler SYBR green real time PCR digunakan untuk mendeteksi N. gonorrhoeae, mutasi gen penA (Ala501Val/Pro, Gly545Ser) dan 23S rRNA (A2059G, C2611T). Resistensi 9 isolat N. gonorrhoeae terhadap sefiksim, levofloksasin, kanamisin sebesar 11,1%, 33,3%, 77,8% secara berurutan. Tidak ditemukan resistensi terhadap azitromisin dan seftriakson. Sedangkan resistensi terhadap penisilin, tetrasiklin, dan siprofloksasin ditemukan pada semua isolat. Uji SYBR green real time PCR berhasil mendeteksi N. gonorrhoeae dari spesimen endoserviks dan karakterisasi mutasi gen terkait resistensi terhadap sefiksim dan azitromisin. Dibandingkan pewarnaan Gram dan kultur, uji ini meningkatkan tingkat kepositifan sebesar 27% dan 15%. Tidak ditemukan mutasi pada gen penA dan 23S rRNA. ......Antimicrobial resistance in Neisseria gonorrhoeae is a global problem in the world. Due to N. gonorrhoeae is difficult to grow in the laboratory, antimicrobial susceptibility testing cannot be performed regularly. The aim of this study is to detect N. gonorrhoeae from endocervical specimens and to characterize gene mutations associated with cefixime and azithromycin resistance as the drugs of choice recommended by WHO and the Indonesian Ministry of Health. Endocervical specimens from female sex workers (FSW) were examined using Gram staining, culture, and susceptibility testing. Molecular SYBR green real-time PCR were used to detect N. gonorrhoeae and mutations in penA (Ala501Val/Pro, Gly545Ser) and 23S rRNA (A2059G, C2611T). Resistance of 9 isolates N. gonorrhoeae to cefixime, levofloxacin, kanamycin, were 11,1%, 33,3%, 77,8%, respectively. Resistance to azithromycin and ceftriaxone were not found. Whereas resistance to penicillin, tetracycline, and ciprofloxacin were found in all isolates. SYBR green real time PCR was successfully detect N. gonorrhoeae from endocervical specimens and characterize gene mutations associated with cefixime and azithromycin resistance. Compared to Gram and culture, this method could increase positivity rates as much as 27% and 15%. Mutation in penA and 23S rRNA were not found.