Kuntaman

Depart. of Clinical Microbiology

Faculty of Medicine Airlangga University/
Dr. Soetomo Hospital Surabaya - Indonesia
Hp. 08113410352, kuntaman@mitra.net.id

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Antibiotic use as an inducer for pathogens

Irrational use of antibiotic

Selection Kill commensal

AMR emergence protection <<

Infection with Res M.O.

Problem on Therapy 2
Prevention and control of Nos Inf

1. Eliminate the reservoir of agents

2. Interrupt the transmission of infection
3. Protect the host against the infection
4. Early Diagnosis or Prediction

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Early Diagnosis
Prediction

Marker ?
Biomarker ?

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 Q-A
Nos Inf: what, why, when, how, what next :
What:
Why:
when:
How:
Marker for Nos Inf
Biomarker for Inf / Nos Inf ?

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Factors for Nosocomial Infection

1. Host
Marker ?
2. Agent
3. Environ.
1. H Marker
2. A Marker
3. E Marker
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Factor Marker/ Biomarker
Host - SIRS
- Temp
- Acute response Protein
- Colonization

Agent - MDRO: ESBLs, MRSA

- Oportu/Commensal
Envir. - Bacterial burden
- HS
- UP
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 Nosocomial Pneumonia:
Chest X-ray: ++
Routine Blood: Valuable
Pro-calcitonin is inferior to clinical
variables
Event: higher PCT is more
disease than lower PCT

Dallas et al. Respir Care. 2011 Apr;56(4):412-9. Epub 2011 Jan 21.
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 Case: Therapy ??
Male, 30 yrs old
Renal Failure due to GNC
Peritoneal dialysis a lot of Pus in
peritoneum (Pus Biomarker of Inf.?)
TX: Intraperitoneal Ceph 3rd ??

Micro Lab: Steril

Temperature: 37.5 (Ax) NO Antibiotic
Leucocyte : 11,000
Few Microbiol Biomarkers and
its impact
CTX-M Beta Lact-ses: Gram Neg. bact
that mostly resistant against many ABs
Coloniz.: ++, Potential to be causative
agent of infection
mecA gene: all Beta Lactam antibiotic
useless
ESBL (+): all Pen. group ABs, Ceph
1,2,3,4 are useless; also FQ
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 Few Biomarkers
Blood Routine: Leucocyte > 15.000/dl,
potential septic/Pneumonia
16S and 5S rRNA genes (Legionella pne)
16S rRNA gene (Acinetobacter baumannii)
CRP plus Other Bio-marker, effective
Yeast/candida infection or mucosal
coloniz. indicate the seriously of
opportunistic infection

Bjerrum et al. British Journal of General Practice, September 2004: 659-662 11

 Urine Biomarkers
Urinary D-/L-arabinitol ratios biomarker for
invasive candidiasis in children (Study on:
cardiac diseases)
Infected children: 5
Non Infected Children: 2.6
The sensitivity: 100 %, the specificity 97.2 %, the
pos. predictive value: 78.6 % and neg predictive
value: 100 %.

Teresa et al. Journal of Medical Microbiology (2010), 59, 14901496

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 PCT is superior comparing to ESR
(Ery Sed Rate) and CRP to assess renal
parenchymal damage/Pyelonephritis.
Kotoula A, Gardikis S, Tsalkidis A, et al. Procalcitonin for the early prediction
of renal parenchymal involvement in children with UTI: preliminary results.
International. Urology and Nephrology. 2009;41(2):3939.

high PCT (> 0.5 ng/ml) has shown to

be associated with vesicoureteral reflux
in children.
Leroy S, Romanello C, Galetto-Lacour A, et al. Procalcitonin to reduce the number
of unnecessary cystographies in children with a urinary tract infection: a European
validation study. The Journal of Pediatrics. 2007;150(1):8995

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Lactate in Severe Sepsis / Septic Shock
Initial Lactate
0-2 mmol/L, Normal
>2 (If criteria for sepsis) = Severe Sepsis
>4 (If criteria for sepsis) = Septic shock
After the initial sepsis care duties have been performed (oxygen,
fluids, swabs & cultures, antibiotics, blood tests, urinary catheter
for hourly U/O) the Lactate should be repeated:

Repeat Lactate
0-2 = Normal
>2 4 = Severe Sepsis
> 4 = Septic Shock

Nguyen et al. Journal of Inflammation 2010, 7:6 http://www.journal-

inflammation.com/content/7/1/6
 Fungi as Biomarker
Fungal infection indicate;
seriousness of opportunistic infection
Disturbance of immune status
Need special attention of host protection, in
all aspects: nutrition, immunologic,
instrumentation
Yeast mucosal/gut colonization provide
an early indicator
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Summary
1. Hosp inf can emerge, spread among
patients and HCW.
2. It can be prevented through eliminate
source of infection, interupt transmission
and protect patients and HCW
3. Biomarker for Nos Inf is defferent to
Regular Infection
4. Biomarker would be from: Host, Agent
and Environ

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Summary
5. Bioamarkers are addressed to:
a) Diagnostic of Microb Agent
b) Diagnosis of SIRS
c) Predict AMR
d) Predict Virulence
e) Predict the potential get an infection
f) Predict the severity of infection
6. Biomarkes should be correlated to
Clinical means

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Dank U Well

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