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Meningitis dan bakteremia pada bayi prematur yang disebabkan oleh Elizabethkingia meningoseptica di RSUP Sanglah : Laporan kasus pertama yang dipublikasi



Abstract

Introduction: Elizabethkingia meningoseptica (E. meningoseptica) is a non-fermentative gram-negative bacillus that is commonly found in aquatic environments, including adequately chlorinated water reservoirs. E. meningoseptica very rarely causes infection in humans, but is often associated with neonatal meningitis and bacteremia, especially in premature neonates or newborns weighing less than 2,500 g. Infections that occur are often severe and life-threatening or can be cured but with sequelae. The characteristics of E. meningoseptica are its resistance to some antibiotics commonly used for gram-negative bacterial infections, but its susceptibility to antibiotics commonly used for gram-positive bacterial infections; Thus, conventional empiric antibiotics often lead to unfavorable outcomes. Special understanding is needed for clinicians of E. meningoseptica infection to prevent errors in management.

Case report: We report a case of meningitis and sepsis caused by E. meningoseptica in a female preterm infant born at 33 weeks gestation, in which the onset of fever occurred on day 19 of life. The infant received empiric therapy with intravenous ampicillin and amikacin. E. meningoseptica was identified from 2-sided cerebrospinal fluid and blood culture specimens, 3 days after collection. Infants then received definitive antibiotic therapy of intravenous ciprofloxacin for 25 days (4 weeks). The baby's clinical condition showed improvement, which was marked by normalization of cerebrospinal fluid although with hydrocephalus sequelae, and finally the baby was allowed to go home.

Conclusion: Prompt and precise diagnosis in clinical samples and sensitivity testing, appropriate empiric antibiotic therapy, and long-term definitive therapy are key factors in the successful management of E. meningoseptica infection.

 

Pendahuluan: Elizabethkingia meningoseptica (E. meningoseptica) adalah bakteri basil gram-negatif non- fermentatif yang banyak ditemukan di lingkungan air, termasuk penampungan air yang terklorinasi secara adekuat. E. meningoseptica sangat jarang menyebabkan infeksi pada manusia, namun sering dikaitkan dengan meningitis neonatus dan bakteremia, terutama pada neonatus prematur atau bayi baru lahir dengan berat badan kurang dari 2.500 gr. Infeksi yang terjadi seringkali berat dan mengancam jiwa atau dapat sembuh namun dengan sekuele. Karakteristik dari E. meningoseptica adalah resistensinya terhadap beberapa antibiotik yang biasa digunakan untuk infeksi bakteri gram-negatif, namun rentan terhadap antibiotik yang biasa digunakan untuk infeksi bakteri gram-positif; sehingga pemberian antibiotik empiris konvensional sering menyebabkan hasil yang tidak menguntungkan. Perlu pemahaman khusus bagi para klinisi terhadap infeksi E. meningoseptica untuk mencegah kesalahan dalam penatalaksanaan.

Laporan kasus: Kami melaporkan kasus meningitis dan sepsis yang disebabkan oleh E. meningoseptica pada bayi prematur perempuan yang lahir pada usia kehamilan 33 minggu, dimana onset demam terajdi pada hari ke 19 kehidupan. Bayi mendapatkan terapi empiris ampisilin dan amikasin intravena. E. meningoseptica teridentifikasi dari spesimen kultur cairan serebrospinal dan darah 2 sisi, 3 hari setelah dikoleksi. Bayi kemudian mendapatkan terapi antibiotik definitif siprofloksasin intravena selama 25 hari (4 minggu). Kondisi klinis bayi menunjukkan perbaikan, yang ditandai dengan normalisasi cairan serebrospinal meskipun dengan sekuele hidrosefalus, dan akhirnya bayi diijinkan pulang ke rumah.

Simpulan: Diagnosis yang cepat dan tepat dalam sampel klinis dan pengujian sensitivitas, pemberian terapi antibiotik empiris yang tepat, serta pemberian terapi definitif untuk jangka waktu yang lama merupakan faktor kunci dalam keberhasilan pengelolaan infeksi E. meningoseptica.

Keywords: Kata kunci Elizabethkingia meningoseptica Meningitis neonatus Prematur

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How to Cite

Panggabean, J., Darwinata, A. E., & Tarini, N. M. A. (2023). Meningitis dan bakteremia pada bayi prematur yang disebabkan oleh Elizabethkingia meningoseptica di RSUP Sanglah : Laporan kasus pertama yang dipublikasi. Medicina, 54(2), 38–44. https://doi.org/10.15562/medicina.v54i2.1194
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Juniarta Panggabean
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Agus Eka Darwinata
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Ni Made Adi Tarini
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