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ANTIMICROBIAL RESISTANCE OF BACTERIAL PATHOGENS ASSOCIATED WITH DIARRHEAL PATIENTS IN INDONESIA

The antimicrobial susceptibility patterns for 2,812 bacterial pathogens isolated from diarrheal patients admitted to hospitals in several provinces in the cities of Jakarta, Padang, Medan, Denpasar, Pontianak, Makassar, and Batam, Indonesia were analyzed from 1995 to 2001 to determine their changing trends in response to eight antibiotics: ampicillin, trimethoprim-sulfamethoxazole, chloramphenicol, tetracycline, cephalothin, ceftriaxone, norfloxacin, and ciprofloxacin. Vibrio cholerae O1 (37.1%) was the pathogen most frequently detected, followed by Shigella spp. (27.3%), Salmonella spp. (17.7%), V. parahaemolyticus (7.3%), Salmonella typhi (3.9%), Campylobacter jejuni (3.6%), V. cholerae non-O1 (2.4%), and Salmonella paratyphi A (0.7%). Of the 767 Shigella spp. isolated, 82.8% were S. flexneri, 15.0% were S. sonnei, and 2.2% were S. dysenteriae (2.2%). The re-emergence of Shigella dysenteriae was noted in 1998, after an absence of 15 years. Shigella spp. were resistant to ampicillin, trimethoprim-sulfamethoxazole, chloramphenicol, and tetracycline. Salmonella typhi and Salmonella paratyphi A were susceptible to all antibiotics tested, while Salmonella spp. showed various resistance patterns according to species grouping. A small number of V. cholerae O1 were resistant to ampicillin, trimethoprim-sulfamethoxazole, chloramphenicol, and tetracycline; however, they were still sensitive to ceftriaxon, norfloxacin, and ciprofloxacin. Similar results were shown for V. cholerae non-O1. Campylobacter jejuni showed an increased frequency of resistance to ceftriaxone, norfloxacin, and ciprofloxacin, but was susceptible to erythromycin. This study shows that except for C. jejuni and V. parahaemolyticus, which appeared to be resistant to ciprofloxacin, the majority of the enteric pathogens tested were still susceptible to fluoroquinolones.

Received July 23, 2002. Accepted for publication February 13, 2003.

Acknowledgments: We thank Drs. Muzahar, Hanifah Ma, Ani Taufik, Eka Putra, Sukarma, Luh Sriwati, and Hilda Handayani, and Bahar Kaso for coordinating sample collection on site. We are very grateful to all the Enteric Diseases Program staff for their contributions towards the study.

Financial support: This study was supported by work unit number 63002A.810.I.2411.

Disclaimer: The opinions or assertions expressed herein are the private views of the authors and are not to be construed as representing those of the U.S. Navy, the Department of Defense, or the Indonesian Ministry of Health.

Authors’ addresses: Periska Tjaniadi, Decy Subekti, Nunung Machpud, Narain Punjabi, James R. Campbell, William K. Alexander, H. James Beecham III, Andrew L. Corwin, and Buhari A. Oyofo, United States Naval Medical Research Unit No. 2, Unit 8132, Box 3, FPO New York, AP 96520-8132, Jakarta, Indonesia, Telephone: 62-21-421-4457/4458, Fax: 62-21-424-4457; E-mail: Oyofoba{at}namru2.med.navy.mil. Murad Lesmana, United States Naval Medical Research Unit No. 2, Unit 8132, Box 3, FPO New York, AP 96520-8132, Jakarta, Indonesia and Medical Faculty Trisakti University, Jakarta, Indonesia. Shinta Komalarini, Sumber Waras Hospital, Jakarta, Indonesia. Wasis Santoso, Friendship Hospital, Jakarta, Indonesia. Cyrus H. Simanjuntak, National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia.

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