Prof. Dr. Kuntaman, dr., MS., Sp.MK-K

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Microbiology and Management of Hospital Infection

diposting oleh kuntaman-fk pada 12 October 2011
di Umum - 1 komentar

Analysis of Microbiology Results

for Managing Hospital Acquired Infection Effectively





Department of  Clinical Microbiology,

School of Medicine Airlangga University-Dr. Soetomo Hospital Surabaya, Indonesia




Hospital acquired infection (HAI) or Hospital Associated Infection is an infection caused by microbes from hospital environment. The HAIs are still a major concern in hospital setting, mainly in developing countries. Two parameters for defining HAI are 1). Infectious disease means entering microbe to host with impact on host immune response; 2). The causative agent is originated from hospital environment, of both patients  or patient’s environment.

The management of HAIs are rather different to non HAI, since HAIs commonly caused by Multiple Drug Resistance (MDR) bacteria. The common irrational use of antibiotic in hospital setting, certainly in developing countries, will aggravate the prevalence of Antimicrobial Resistant (AMR) bacteria in hospital environment, and will results in difficulty on management of HAI. In this situation, the role of microbiology diagnosis is essential.

The principles on management of HAI  is promt diagnosis and then promt treatment, and using antibiotic prudently. Four major common diseases of HAI are phlebitis, surgical site infetion, urinary tract infection and pneumonia. The very important starting point is the awareness of clinicians in recognising these HAIs then as soon as possible deliver empiric antibiotic therapy and apply microbiology examination.

Two main roles of Clinical Microbiologist in this occasion are: 1). Provide an antibiogram periodically, and thus make easier for clinicians to performe empiric antibiotic therapy; 2). Fast running microbiology diagnosis and make microbiology report accordingly to the clinical needed, and thus make easier for clinician to performe definitive antibiotic therapy.

The report of Microbiology laboratory is a crucial point, since a good report should be support by clear and complete symptoms of HAI. Without HAI sign and symptom notes, it is imposible for Clinical Microbiologist make report accordingly. For example,  sputum is aspirated from patient using endotracheal tube. The result finish in three days with diagnosis Pseudomonas aeruginosa and sensitive to only 2 antibiotic drugs fosfomisin and meropenem. Then arise a question mark: is Pseudomonas aeruginosa a causating agent of pneumonia in this patient?; is this patient having pneumonia?;  Is this patient shoul be tretated with one or both of these sensitive antibiotics?. The only answer is close contact the clinicians and clinical microbiologist.

In conclusion: HAIs are still major concern in Indonesia. The same paradign in defining a nosocomial infection (or HAI) is needed. Two base strategies in controling HAI are: 1). As fast as posible to identify HAI, 2). As soon as possible performe antibiotic treatment and send the specimen for microbiology examination. Fast diagnosis in microbiology using modern facility is benefecially. Close contact clinicians and clinical microbiologist is an important starting point, for both microbiologist to make report accordingly as clinician needed and clinicians to performe therapy prudently.



Hospital associated infection, HAI, microbiology examination, antibiotic therapy



Presented in: Annual Scientific Meeting Indonesian Society of Infection Control (ASM-INASIC),  Jakarta, November 22nd, 2008

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