Methicillin-Resistant Staphylococcus aureus pada Penderita Dermatitis Atopik dan Sensitivitasnya terhadap Mupirosin Dibandingkan dengan Gentamisin

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) mulai dijumpai pada penderita dermatitis atopik (DA) derajat sedang hingga berat dan bersifat multiresisten terhadap antibiotik topikal. Gentamisin telah digunakan secara luas, sedangkan mupirosin merupakan pilihan utama eradikasi MRSA. Penelitian ini bertujuan untuk mengetahui kolonisasi MRSA pada penderita DA dan sensitivitasnya terhadap mupirosin dibandingkan dengan gentamisin di Poliklinik Departemen Ilmu Kesehatan Kulit dan Kelamin Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung. Survei potong lintang analitik dilakukan selama 19 September–31 Oktober 2011 terhadap 22 penderita DA derajat sedang hingga berat sesuai dengan Scoring Atopic Dermatitis objektif dan 22 individu sehat. Seluruh subjek dilakukan pemeriksaan apusan kulit untuk deteksi MRSA dan uji sensitivitas terhadap mupirosin dan gentamisin. Pada kedua kelompok masing-masing didapatkan 10 laki-laki dan 12 perempuan. Pada kelompok penderita DA didapatkan DA derajat sedang (10/22) dan berat (12/22), dengan lesi akut (14/22) dan kronik (8/22). Pertumbuhan S. aureus didapatkan pada 17/22 penderita DA dengan sensitivitas terhadap mupirosin 14/17 dan gentamisin 11/17 penderita. Pada individu sehat tidak didapatkan pertumbuhan koloni S. aureus. Galur MRSA ditemukan pada 3/17 penderita DA dan dianggap berbeda secara bermakna bila dibandingkan dengan individu sehat (p<0,01), galur ini bersifat sensitif terhadap mupirosin pada 2/3 penderita dan seluruhnya resisten terhadap gentamisin. Simpulan, kolonisasi MRSA perlu dicurigai pada penderita DA derajat sedang hingga berat, sehingga perlu pengobatan tambahan antibiotik topikal mupirosin. [MKB. 2013;45(1):36–44]

Kata kunci: Dermatitis atopik, gentamisin, MRSA, mupirosin

Methicillin-Resistant Staphylococcus aureus in Atopic Dermatitis Patients and Its Sensitivity to Mupirocin Compared to Gentamycin

Methicillin-resistant Staphylococcus aureus (MRSA) is found in moderate to severe atopic dermatitis (AD) and is multiresistant against topical antibiotic. Gentamycin is widely used while mupirocin is the first line therapy to eliminate MRSA. This research is intended to observe the colonization of MSRA case in AD patients and its sensitivity to mupirocin compared to gentamycin in Dermato-venereology Clinic Dr. Hasan Sadikin General Hospital Bandung. An analytical cross sectional survey was intended from 19th September–31st October 2011 in 22 moderate to severe AD patients based on objective Scoring Atopic Dermatitis and 22 healthy persons. All subjects went through skin-scraping, MSRA was detected and sensitivity test was done for mupirocin and gentamycin. The subjects consisted of 10 boys and 12 girls in both group. Based on severity, 10/22 of AD subjects were in moderate AD and 12/22 were severe AD, 14/22 of AD subjects presented with acute lesions and 8/22 subjects had chronic lesions. In the group of AD patients, 17/22 growth of S. aureus were found with sensitivity against mupirocin 14/17 and gentamycin 11/17. In healthy individual group, no  S. aureus growth was found. Methicillin-resistant Staphylococcus aureus strain in AD patients was observed on 3/17 patients, and this was declared significantly different compared to healthy individuals (p <0.01). The isolates in 2/3 patients were sensitive to mupirocin and all patients were resistant to gentamycin. In conclusion, the patients of moderate to severe AD are prone to MRSA colonization and therefore requires mupirocin topical antibiotic treatment.  [MKB. 2013;45(1):35–43]

Key words: Atopic dermatitis, gentamycin, MRSA, mupirocin

DOI: http://dx.doi.org/10.15395/mkb.v45n1.203