A Qualitative Study About Multidrug-Resistant Acinetobacter baumannii (MDRAB) in Healthcare-Associated Infection (HCAI) and Its Resistance Towards Carbapenem in Indonesia

Abstract

Healthcare Associated Infection (HCAI) caused by Multidrug-Resistant Acinetobacter baumannii (MDRAB) is one of the important public health issues worldwide. Carbapenem as the last line agents showed effectivity derivation for treating MDRAB cases. Because there is a limited data about this in Indonesia, hence the HCAI
caused by MDRAB resistant to carbapenem case needs to be investigated. This was a qualitative study using a case study approach. Purposive sampling technique was chosen and applied to informants consisting of MDRAB patients and their family also healthcare providers. Data were collected from in-depth interview, direct observations, and documents review. An interactive model of Miles and Huberman was used as the
study’s analysis technique. We found that the MDRAB patients had favorably perceived severity and self-efficacy. They found that their treatment was beneficial for them and the existing barrier did not make them stop getting treatment. The patient’s family also gave full support to get the treatment. Healthcare providers had a good experience and understand their role in the hospital. The assembling of local antibiotics guideline was not so easy due to different opinion among the doctors. We also found lack of funding for surveillance of MDRAB and lack of awareness of it’s potential danger among the majority informants. In conclusion, raising awareness of the HCAI caused by MDRAB resistant to carbapenem is an urgent need. The commitment of healthcare providers in following recommended guidelines is still needed some improvement. When all the
elements in the hospital reach the same understanding on this case, funding of the surveillance will no longer become a big problem.



Keywords: HCAI, MDRAB, Acinetobacter baumannii, Carbapenem

References
[1] WHO 2016 The Burden of Healthcare-Associated Infection Worldwide http://www. who.int/entity/gpsc/en/


[2] Allegranzi B, Nejad S B, Combescure C, Graafmans W, Attar H, Donaldson L and Pittet D 2011 Lancet 3(77) 228-41


[3] Charrier L, Argentero P A, Farina EC, Serra R, Mana F and Zotti C M 2014 BMC Public Health 14 558


[4] Ling M M L, Apisarnthanarak A, and Madriaga G 2015 Clin. Infect. Dis. 60(11) 1690-9


[5] Cardoso T, Almeida M, Carratalà J, Aragão I, Costa-Pereira A, Sarmento A E, and Azevedo L 2015 BMC Infect. Dis. 15 565


[6] Cardoso T, Almeida M, Friedman D, Aragao I, Costa-Pereira A, Sarmento A E, and Azevedp L 2014 BMC Med. 12(40) 1-13


[7] See I, Lessa F C, Elata O A, Hafez S, Samy K, El-Kholy A, El Anani M G, Ismail G, Kandeel A, Galal R, Ellingson K and Talaat M 2013 Infect. Control Hosp. Epidemiol. 34(12) 1281-88


[8] Molton J S, Tambyah P A, Ang B S P, Ling M L and Fisher D A 2013 Clin. Infect. Dis. 56(9) 1310–8


[9] Cunha B A 2016 Acinetobacter http://emedicine.medscape.com/article/236891- overview


[10] Nowak-Zaleska A, Wiecczor M, Czub J, Nierwicki L, Katlowski R, Mikucka A and Gospodarek E 2016 J Glob Antimicrob Re. 7 145-9


[11] Peleg A Y, Seifert H and Paterson D L 2008 Clin. Microbiol. Rev. 21(3) 538-82


[12] Pharmacy Departement of DR Moewardi Hospital 2017 Rekapitulasi Pengeluaran Antibiotik Cephalosporin dan Carbapenem (Surakarta: Dr.Moewardi Hospital)


[13] Primaningtyas W 2017 Faktor-Faktor Penyebab Resistensi Acinetobacter baumannii terhadap Antibiotik Carbapenem pada Pasien dengan Healthcare Associated Infection (HCAI) di Rumah Sakit DR Moewardi Surakarta (Indonesia: Sebelas Maret University) chapter 4 pp 35-36


[14] Permenkes No.8 in 2015 Indonesian Health Ministry regulations in antimicrobial resistance


[15] Utomo G C, Joebagyo H and Murti B 2017 Journal of Epidemiology and Public Health 2(3) 186-200


[16] Chen C, Lin L, Chang Y, Chen Y, Chang C and Huang C 2015 Int. J. Environ. Res. Public Health 12 8871-82


[17] Cheon S, Kim M, Yun S, Moon J Y, and Kim Y 2016 Korean J Intern. Med. 31 367-74


[18] Dr Moewardi Hospital 2016 Pola kuman dan pola kepekaan kuman periode tahun 2016 (Indonesia: Microbiology department of Dr Moewardi Hospital) p 4


[19] Huang P Y, Shie S, Ye J, Lin S, Liu T, Wu T, Wu T, Chuang S, Cheng M, Hsieh Y et al 2017 BMC Infect. Dis. 17 598


[20] Rawajfah R N 2014 Nurs Crit Care. 21(2) e20-7.


[21] Castilho S R A, Silva de Miranda G C S M, Guilarde A O, Cardoso J L, Andre M C P, Kipnis A P J, and Kipnis 2017 PLoS ONE 12(5) 1-13


[22] Hasan B, Perveen K, Olsen B, and Zahra 2014 J. Med. Microbiol. 63 50-5