The Pattern of Antibiotic Prescription and Antimicrobial Resistance of Gut Flora Escherichia coli at Aisyiyah Hospital, Bojonegoro

Ana Nurlaili Hidayah, Didik Hasmono, Muqoddar Thayyib, K Kuntaman

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Antimicrobial resistance (AMR) is the failure of antibiotic to kill bacteria and becomes ineffective in therapeutic purpose. The AMR bacteria is a major health problem worldwide and Indonesia is not exception. AMR is increased by two factors, higher antibiotic use and low compliance in infection control and prevention.  WHO has recommended 7 bacterial indicators as point of view in surveillance, one of these bacteria is Escherichia coli. This study aimed to analyze the correlation between antibiotic use and resistance pattern of gut flora Escherichia coli. The study was conducted at Aisyiyah Hospital, Bojonegoro from June to October 2017. Total 101 patients from internal medicine and surgery department in this hospital were included in this study. Bacterial gut flora were tested against 12 antibiotics by disk diffusion test at the Department of Clinical Microbiology, Universitas Airlangga.. The results showed that the highest quantity of antibiotic use in internal medicine service was cefepime (40,50 DDD) and the highest resistance rate was ciprofloxacin, whereas in the surgical service it was ceftriaxone (132,75 DDD) with the highest E. coli resistance to amoxicillin-clavulanic acid. The antibiotics use has significant correlation against E. coli resistance on cefotaxime (p=0.046), ceftazidime (p=0.046), ceftriaxone (p=0.017), aztreonam (p=0.024), and cefepime (p=0.010).


Antimicrobial resistance; Escherichia coli; antibiotics

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Alekshun MN, Levy SB (2000). Bacterial drug resistance: Response to survival threats, In: Storz, G., Hengge-Aronis R, eds. Bacterial Stress Responses. Washington, ASM Press, p 323-366

Arce JM, Selva M, Perpinan H, Gubernado M, Armero CC, Quilez AL, Gonzales F, Vanachlocha H (2011). Antimicrobial resistance according to age, gender, culture site and patient location in more than 100.000 Escherichia coli. Journal of Antimicrobial Agents Chemotherapy. DOI: 10.1128/AAC.00765-10

Bartoloni A, Benedetti M, Pallecchi L, et al (2006). Evaluation of a rapid screening method for detection of antimicrobial Resistance in the commensal microbiota of the gut. Trans R Soc Trop Med Hyg, 119-125

Barbosa TM, Levy SB (2000). The impact of antibiotics use on resistance development and persistemce. Drug Resist Update 3, 301-311

Carol KC, Butel JS, Morse SA, Mietzner T (2016). Bacteriology in Jawetz, Melnick & Adelberg's medical microbiology. 27th Ed. New York, McGraw Hill Education, p 159-397

Centers for Disease Control and Prevention (2013). Antibiotic resistance threats in the United States. Available at resistance/threat-report-2013/pdf/ar-threats-2013-508.pdf

Goettsch W, van Pelt W, Nagelkerke N, et al (2000). Increasing resistance to fluoroquinolones in E. coli from urinary tract infection in Netherlands. J. Antimicrob Chemother, 223-228

Kemenkes RI (2015). PMK Nomor 8 Tahun 2015 Tentang Program Pengendalian Resistensi Antimikroba di Rumah Sakit. Jakarta, Kemenkes

Kuntaman K, Lestari E, Severin J, Kershof I, Mertaningsih N, Purwanta M, et al (2005). Fluorokuinolon-resistant Escherichia coli, Indonesia. Emerging Infectious Disease 11, 1363-1369

Lestari ES, Severis JA, Filius PMG, et al (2007). Antimicrobial resisteance among commensal isolates of Escherichia coli and Staphylococcus aureus in the Indonesian population inside and outside hospitals. Eur J Clin Microbiol Infect Di 27, 45-51

Livermore DMR, Hope G, Brick M, Lilie R, Reynolds, BSAC (2008). Working parties on resistance surveillance. Non-susceptibility trends among Pseudomonas aeuginosa and other non-fermentative gram-negative bacteremiaes in UK and Ireland, 2001-06. J. Antimicrob. Chemother 62, ii55-63

Levy SB (2002). Factors impacting on the problem of antibiotic resistance. J. Antimicrob. Chemother 49, 25-30

Li-Yang H, Thean-Yen T, Vincent HT, Andrea K, Dale AF, Tse-Hsien K, The Network for Antimicrobial Surveillance (Singapore) (2010). Surveillance and correlation of antibiotic prescription and resistance of Gram negative bacteria in Singaporean hospital. Antimicrobial Agent and Chemotherapy 54, 1173-1178

Michael CA, Dominey-Howes D, Labbate M (2014). The antimicrobial resistance crisis: Causes, consequences, and management. Infectious Disease 2, 1-8

Pedrera V, Schwarz H, de la Torre MP, Gil-Guillén V, Orozco D, Canelles JM (2004). Analysis of antibiotic use in the community of Valencia (2000-2002). Enferm Infecc Microbiol Clin 22, 385-389

Pottinger P, Reller LB, Ryan KJ (2014). Pathogenic bacteria, in K. J. Ryan, & C. G. Ray, Sherris Medical Microbiology. 6th Ed. New York, McGraw Hill Education, p 253-290

Rice LB (2012). Gastrointestinal bacteria will have its way. The Journal of Infectious Diseases 206, 1334-1335

Rice LB (2016). Mechanism of resistance to antimicrobial agent, in LaPlante, K. L., Cunha, C. B., Morrill, H. J., Rice, L. B, Antimicrobial Stewardship Principle and Practice. 1st Ed.Oxfordshire, CABI, p 39-52

Taur Y, Pamer EG (2013). The intestinal microbiota and susceptibility to infection in immunocompromised patients. Current Opinion in Infectious Diseases 26, 332-337

Todar K (2004). The normal bacterial flora of humans, in Todar’s Online Textbook of Bacteriology. Available at Accessed April 6, 2017

WHO (2012). The evolving threat of antimicrobial resistance: Options for Actions. WHO Patient Safety Programme. Geneva, GPS Publishing, p 1-119

WHO (2014). Antimicrobial resistance. Global Report on Surveillance. Geneva, WHO Publishing, p 1-256


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