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Source :

Staphylococcus aureus nosocomial infections: the role of a rapid and low-cost characterization for the
establishment of a surveillance system Rea Valaperta1, Milvana Rosa Tejada2, Marcello Frigerio1,
Alessandra Moroni 2, Elisa Ciulla1, Sara Cioffi 1, Paolo Capelli 1, Elena Costa1,2 1Research Laboratories,
Molecular Biology, IRCCS Policlinico San Donato, Milan, Italy; 2Clinical Microbiology Laboratory, IRCCS
Policlinico San Donato, Milan, Italy

S. aureus represents one of the most serious gram-positive bacterial infections in nosocomial and
community settings.

Hospitalized patients show a high frequency of S. aureus infections due to their weak immune system
and frequent injections and catheterizations. Moreover, in these kind of patients, S. aureus can lead to
life-threatening infections such as endocarditis and osteomyelitis.

Most of the world literature shows that Staphylococcus aureus is one of the main pathogens responsible
for a number of infections in hospital settings, with considerable morbidity and mortality (Deurenberg et
al., 2008; Cosgrove et al., 2003; Engemann et al., 2003; Ho et al., 2009).

Source :

Nosocomial infections due to methicillin resistant


Staphylococcus Aureus in hospitalized patients
Arif Maqsood Ali1, Shahid Ahmed Abbasi2, Shazia Arif3, Irfan Ali Mirza4

Nosocomial infections have become more frequent over the past 2 to 3 decades and
are now a significant cause of patient morbidity and mortality as well as rising health
care costs.6 The most commonly encountered nosocomial infections involve the
urinary tract, followed in frequency by skin and wound infections, hospital-acquired
pneumonias and bloodstream infections.

Other nosocomial infections (perhaps 10% to 20%) develop following cross-


colonization with microbial organisms, often via the hands or instruments of health
care workers or contact with the hospital environment.7 Person-to-person spread of
infections in the health care setting can occur via direct contact, droplet, airborne,
fecal-oral, and blood-borne routes, though this is relatively uncommon.8
Source :

PENCEGAHAN DAN PENGENDALIAN INFEKSI


DI RSJS MAGELANG
Tanggal : 24-Feb-2017

KEMENTERIAN KESEHATAN REPUBLIK INDONESIA

Angka kejadian HAIs menurut data dari WHO 9% di UK tahun 2006, di Italy tahun 2005 6,7%, di
Perancis tahun 2006 6,7 – 7,4%. Sementara angka kejadian HAIs di Indonesia diambilkan dari 10
RSU Pendidikan yang mengadakan surveillance aktif didapatkan angka 6 – 16% dengan rerata
9,8%.

Berdasarkan surveilans yang dilakukan Depkes RI (2004), proporsi kejadian infeksi nosokomial di rumah
sakit pemerintah lebih tinggi dibandingkan dengan rumah sakit swasta. Penelitian yang dilakukan
Marwoto (2007), menunjukkan bahwa kejadian infeksi nosokomial di lima rumah sakit pendidikan yaitu
di RSUP Dr. Sardjito sebesar 7,94%, RSUD Dr. Soetomo sebesar 14,6%, RS Bekasi sebesar 5,06%, RS
Hasan Sadikin Bandung sebesar 4,60%, RSCM Jakarta sebesar 4,60%

Source :

ISOLASI DAN IDENTIFIKASI BAKTERI AEROB YANG BERPOTENSI MENJADI SUMBER PENULARAN INFEKSI
NOSOKOMIAL DI IRINA A RSUP PROF. DR. R. D. KANDOU MANADO

Yulya Margaretha Longadi1 , Olivia Waworuntu2 , Standy Soeliongan2

Infeksi nosokomial atau Hospital Acquired Infection (HAI) merupakan infeksi yang disebabkan oleh
bakteri, parasit, atau virus di rumah sakit, infeksi ini timbul sekurangkurangnya 72 jam sejak masuk
rumah sakit. Infeksi ini terjadi akibat kurang bersihnya lingkungan perawatan menyebabkan terjadinya
infeksi mikroorganisme dari lingkungan ke manusia, infeksi juga dapat terjadi akibat berpindahnya
mikroorganisme dari pasien yang satu ke pasien yang lain. Pasien ruang rawat inap mempunyai risiko
yang sangat tinggi mendapatkan infeksi nosokomial, hal ini dikarenakan pasien pada ruang rawat inap
memerlukan asuhan, perawatan dan pengobatan secara berkesinambungan lebih dari 24 jam.

Infeksi nosokomial tersering adalah infeksi pada luka operasi, infeksi saluran kemih, infeksi saluran nafas
bawah, dan infeksi pada aliran darah.5

Penelitian di 10 RSU pendidikan Indonesia menunjukkan bahwa infeksi nosokomial paling umum terjadi
adalah infeksi luka operasi (ILO). Hasil penelitian terdahulu menunjukkan bahwa angka kejadian ILO
pada rumah sakit di Indonesia bervariasi antara 2-18% dari keseluruhan prosedur pembedahan.4
Hasil penelitian yang dilakukan di beberapa rumah sakit di Jakarta menunjukkan bahwa sebesar 9,8%
pasien rawat inap mendapat infeksi nosokomial selama dirawat di rumah saikit tersebut.

Perbedaan kelas ruang rawat inap menyebabkan perbedaan tingkat kepadatan yang berbeda pula di
setiap ruangan. 2 Tingkat kepadatan dalam suatu ruang merupakan salah satu faktor risiko terjadinya
infeksi nosokomial. Hal ini dikarenakan jumlah pasien yang lebih banyak dalam suatu ruang menjadi
salah satu penyebab tidak dilakukannya prosedur tindakan septik dan antiseptik yang baik

Pada penelitian sebelumnya di ruang rawat inap bedah RSAM Bandar Lampung, ditemukan bahwa
Staphylococcus sp. merupakan 21,95% penyebab infeksi nosokomial pada luka operasi.

Staphylococcus sp. ditemukan sebanyak dua sampel (9,1%)

Source :
Nosocomial infections: Epidemiology, prevention, control and surveillance
Hassan Ahmed Khan1, Fatima Kanwal Baig2, Riffat Mehboob3*

2.3. Surgical site infections (SSI)


SSIs are nosocomial infections be fall in 2%–5% of patients
subjected to surgery. These are the second most common type of
nosocomial infections mainly caused by Staphylococcus aureus
resulting in prolonged hospitalization and risk of death [13]. The
pathogens causing SSI arise from endogenous microflora of the
patient. The incidence may be as high as 20% depending upon
procedure and surveillance criteria used

source :

Efrida Warganegara, Etty Apriliana, Ryan Ardiansyah. Identifikasi Bakteri Penyebab Infeksi Luka Operasi
(ILO) Nosokomial Pada Ruang Rawat Inap Bedah dan Kebidanan RSAM di Bandar Lampung.

Identifikasi bakteri dilakukan dengan kultur, pewarnaan Gram dan uji biokimiawi. Hasil
penelitian didapatkan 4 jenis bakteri terbanyak, pada ruang rawat inap bedah adalah Pseudomonas
sp (29,27%), Staphylococcus epidermidis (21,95%), dan Klebsiella sp. (14,63%), serta pada ruang rawat
inap kebidanan adalah Pseudomonas sp. (25%), Escherichia coli (19,44%) dan
Klebsiella sp. (16,67%). Hasil penelitian ini dapat disimpulkan bahwa bakteri penyebab infeksi
luka operasi yang terbanyak adalah bakteri Gram negatip batang yang merupakan flora normal dari usus
(Pseudomonas sp,. Escherichia coli dan Klebsiella sp.) selain flora normal dari kulit yaitu bakteri Gram
positif kokus (Staphylococcus epidermidis).
Infeksi luka operasi dapat disebabkan oleh bakteri seperti Staphylococcus aureus, Enterococci,
Escherichia coli, Klebsiella spp, Proteus spp, Pseudomonas aeroginosa, dan C. perfringens (Locke et al.,
2013).

Source :

Bacteriological Profile of Surgical Site Infections and Their Antibiogram: A Study From Resource
Constrained Rural Setting of Uttarakhand State, India

Out of 768 patients, 137 (17.8%) were found to have SSIs and samples were collected from them. Out of
total 137 samples, 132 (96.4%) yielded bacterial growth and 139 bacterial isolates were
obtained. Staphylococcus aureus (50.4%) was the commonest organism followed by Escherichia
coli (23.02%), Pseudomonas aeruginosa (7.9%) and Citrobacter species (7.9%).

Source :

Indian J Pathol Microbiol. 2015 Apr-Jun;58(2):195-200. doi: 10.4103/0377-4929.155313.


A study of organisms causing surgical site infections and their antimicrobial susceptibility in a tertiary
care government hospital.
Mundhada AS1, Tenpe S.

Out of 100 patients, 32 patients got infected post-operatively. Staphylococcus aureus was the most
common organism isolated. None of the strains were Methicillin resistant. Drug resistance was
widespread, especially in Enterobacteriaceae, where the Cefotaxime resistant strains of Escherichia coli
and Klebsiella pneumoniae were ESBL producing. Another concern in recent times is the isolation of
Acinetobacter from surgical wounds. Various patient factors and hospital protocol were analyzed with
regard to the treatment outcome. Judicious use of antibiotics along with evidence-based medicine is the
need of the hour to stop the rise of these superbugs.

Source :

International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 4 Number 9
(2015) pp. 969-974

Aerobic bacteriology of surgical site infection in a tertiary care centre

Sunilkumar Biradar1* and C.Roopa2

Most common bacteria causing SSI is Staphylococcus aureus followed by Pseudomonas aeruginosa, E.
coli & Klebsiella. Gram negative bacteria are more common than Gram positive bacteria

10 cases of these SSI were polymicrobial in origin, so 63 isolates were identified & speciated. The most
common bacteria causing the SSI was found to be Staphylococcus aureus 21(33.36%) followed by
Pseudomonas aeruginosa 16(25.3%), Escherichia coli 11(17.4%), Klebsiella pneumoniae 09(14.2%), CONS
4(6.3%), Enterococcus and Acinetobacter in 1(1.6%) each

Tindakan pembedahan dalam Ilmu Bedah, berdasarkan pada tingkat kontaminasi/ risiko infeksi,
dibagi menjadi empat klasifikasi secara bertingkat, yaitu:

1. Operasi bersih
Operasi pada keadaan prabedah tanpa adanya luka atau operasi yang melibatkan luka
steril dan dilakukan dengan memerhatikan prosedur aseptik dan asntiseptik. Sebagai
catatan, saluran pencernaan atau saluran pernapasan, ataupun saluran perkemihan tidak
dibuka.
Contoh: hernia, tumor payudara, tumor kulit, tulang
Kemungkinan terjadinya infeksi adalah 2-4%
2. Operasi bersih terkontaminasi
Operasi seperti pada keadaan di atas dengan daerah-daerah yang terlibat pembedahan,
seperti saluran napas, saluran kemih, atau pemasangan drain.
Contoh: prostatektomi, apendiktomi tanpa radang berat, kolesistektomi elektif.
Kemungkinan terjadinya infeksi; 5-15%

3. Operasi terkontaminasi
Operasi yang dikerjakan dengan catatan:
 daerah dengan luka yang telah terjadi: 6-10 jam dengan atau tanpa benda asing;
 tidak ada tanda-tanda infeksi namun knta,inasi jelas karena saluran napas, cerna,
atau kemih dibuka;
 tindakan darurat yang mengabaikan prosedur aseptik-antiseptik
Contoh: Operasi usus besar, operasi kulit (luka kulit akibat rudapaksa)
Kemungkinan terjadinnya infeksi: 16-25%

4. Operasi kotor
Operasi yang melibatkan:
 daerah dengan luka terbuka yang telah terjadi lebih dari 10 jam;
 luka dengan tanda-tanda klinis infeksi;
 luka perforasi organ visera
Contoh: luka rudapaksa yang lama, perforasi usus
Kemungkinan terjadinya infeksi: 40-70%

Diagnosis ILO :
Diperlukan keterangan catatan mengenai keadaan prabedah dan keadaan selama operasi
berlangsung (perioperatif), yaitu sebagai berikut:
1. Keadaan prabedah
Gambaran tingkat kondisi jaringan sebelum proses pembedahan (bersih/ terkontaminasi/
kotor)
2. Keadaan perioperatif
Gambaran tentang tingkat kondisi jaringan (steril/ kotor) selama proses pembedahan serta
gambran tentang perlakuan terhadap jaringan selama berlangsungnya tindakan
pembedahan (manipulatif/ eksploratif)

Setelah tindakan pembedahan selesai, dilanjutkan dengan penilaian (observasi dan evaluasi)
terhadap luka pascabedah (luka operasi) dengan dua kemungkinan:

 Tidak terjadi infeksi, yang artinya sembuh perprimam;


 Terjadi infeksi, dengan tanda-tanda lokal berupa keluarnya cairan serosanguinolen, yang
kemudian diikuti dengan keluarnya eksudat (pus), disertai rasa nyeri dan edema (infeksi
luka operasi)
Infeksi luka operasi ada dua macam:

1. Infeksi luka operasi superfisial


Infeksi yang terjasdi pada daerah insisi yang meliputi kulit, subkutan, jaringan lain di atas
fasia
2. Infeksi luka operasi profunda
Infeksi yang terjadi pada daerah insisi yang meliputi jaringan di bawah fasia (termasuk
organ dalam rongga)

Faktor yang mendukung terjadinya infeksi luka operasi:

a. Faktor tingkat kontaminasi yang terkait dengan jenis operasi


b. Faktor waktu, makin lama proses pembedahan berlangsung, peluang terjadinya infeksi
makin besar;
c. Faktor penderita, yaitu adanya faktor predisposisi yang dimiliki penderita;
d. Faktor teknis operasi yang dilakukan oleh tim operasi;
e. Faktor lokasi luka operasi:
 Adanya suplai darah yang buruk ke daerah operasi;
 Pencukuran rambut daerah operasi (cara dan waktu pencukuran);
 Lokasi luka operasi yang mudah tercemar (dekat perineum)
 Devitalisasi jaringan;
 Benda asing

SOURCE : Darmadi 2008

Infeksi Luka Operasi atau Surgical site infeksion (SSI) adalah infeksi pada tempat operasi
merupakan salah satu komplikasi utama operasi yang meningkatkan morbiditas dan biaya
perawatan penderita di rumah sakit, bahkan meningkatkan mortalitas penderita

Epidemiologi
Lama rawat inap meningkat 7–10 hari dan biaya meningkat sekitar 20%. SSI tidak hanya
berkaitan dengan morbiditas akan tetapi juga mortalitas. Sekitar 77% dari kematian pasien bedah
berhubungan dengan infeksi luka operasi (SSI).

SOURCE : M. Alsen, Remson Sihombing, 2014 (MKS)


between 2008 and 2014 there was an overall 17% decrease in SSI in the 10 main surgical
procedures. a multi-state HAI prevalence survey conducted in 2011 estimated that there were
157 000 SSIs related to any inpatient surgery and SSI was ranked as the second most frequently
reported HAI between 2006 and 2008 (14)
Among the 1029 facilities that reported one or more SSI, Staphylococcus aureus was the most
commonly reported pathogen overall (30.4%), followed by coagulase-negative staphylococci
(11.7%), Escherichia coli (9.4%) and Enterococcus faecalis (5.9%).
In a systematic literature review (2000 to 2012) (40) of the burden of HAI in South-East Asia, the pooled
incidence of SSI was 7.8% (95% CI: 6.3–9.3). A study conducted between January and March 2008 in a
tertiary care hospital in Singapore reported an SSI incidence of 8.3% for general, neurologic and
orthopaedic surgical procedures

Penelitian yang dilakukan di amerika serikat antara tahun 2008 dan 2014 secara keseluruhan
mendapatkan adanya penurunan 17% kejadian SSI pada 10 prosedur pembedahan utama. Sebuah
survey HAI multi-state tahun 2011 mengatakan dari 157000 kejadian SSI memiliki hubungan
dengan perawatan di rumah sakit pascabedah. SSI telah menduduki peringkat kedua infeksi
nosokomial yang paling banyak dilaporkan pada tahun 2006 sampai 2008.

Di antara 1.029 fasilitas yang melaporkan satu atau lebih kejadian SSI didapatkan bahwa secara
keseluruhan Staphylococcus aureus adalah patogen yang paling umum dilaporkan (30,4%),
diikuti oleh staphylococci koagulase-negatif (11,7%), Escherichia coli (9,4%) dan Enterococcus
faecalis (5,9%).
Beban HAI di Asia Tenggara berdasarkan tinjauan literatur sistematis dari tahun 2000 hingga
2012 memiliki persentase insidensi SSI 7,8% (95% CI: 6,3-9,3).

Factors increasing the risk of SSI Many factors influence surgical wound healing and determine
the potential for infection (51). These include patient-related (endogenous) and
process/procedural-related (exogenous) variables that affect a patient’s risk of developing an SSI.
Some variables are obviously not modifiable, such as age and gender. However, other potential
factors can be improved to increase the likelihood of a positive surgical outcome, such as
nutritional status, tobacco use, correct use of antibiotics and the intraoperative technique.

Faktor endogen (patient-related)

Faktor eksogen (process/procedural-related)


Modifikasi
- Status gizi
- Merokok
- penggunaan antibiotik
Tidak dapat dimodifikasi
- usia
- jenis kelamin
SOURCE : WHO

SUPERFICIAL INCISIONAL SURGICAL SITE INFECTION


Infection occurs within 30 days after the operation and infection involves only skin and
subcutaneous tissue of the incision and at least one of the following:
1. Purulent drainage with or without laboratory confirmation, from the superficial incision
2. Organisms isolated from an aseptically obtained culture of fluid or tissue from the superficial
incision
3. At least one of the following signs or symptoms of infection: pain or tenderness, localised
swelling, redness, or heat and superficial incision is deliberately opened by surgeon, unless
incision is culture-negative
4. Diagnosis of superficial incisional SSI made by a surgeon or attending physician

DEEP INCISIONAL SURGICAL SITE INFECTION


Infection occurs within 30 days after the operation if no implant is left in place or within one
year if implant is in place and the infection appears to be related to the operation and infection
involves deep soft tissue (e.g. fascia, muscle) of the incision and at least one of the following:
1. Purulent drainage from the deep incision but not from the organ/space component of the
surgical site
2. A deep incision spontaneously dehisces or is deliberately opened by a surgeon when the
patient has at least one of the following signs or symptoms: fever (>38°C), localised pain or
tenderness, unless incision is culture-negative
3. An abscess or other evidence of infection involving the deep incision is found on direct
examination, during reoperation, or by histopathologic or radiologic examination
4. Diagnosis of deep incisional SSI made by a surgeon or attending physician

ORGAN/SPACE SURGICAL SITE INFECTION


Infection occurs within 30 days after the operation if no implant is left in place or within one
year if implant is in place and the infection appears to be related to the operation and infection
involves any part of the anatomy (e.g., organs and spaces) other than the incision which was
opened or manipulated during an operation and at least one of the following:
1. Purulent drainage from a drain that is placed through a stab wound into the organ/space
2. Organisms isolated from an aseptically obtained culture of fluid or tissue in the organ/space
3. An abscess or other evidence of infection involving the organ/space that is found on direct
examination, during reoperation, or by histopathologic or radiologic examination
4. Diagnosis of organ/space SSI made by a surgeon or attending physician.
Source : Reference: Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of
nosocomial surgical site infections, 1992; A modification of CDC definitions of surgical wound infections.
Infection Control Hosp Epidemiol. 1992; 13 606-608.
HPSC July 2008

Adalah infeksi insisi atau organ atau daerah yang muncul setelah prosedur pembedahan. Pasien pascabedah biasanya
memiliki komorbiditas yang lebih kompleks

Greiska Rotti, Elly Sjattar, Budu. Hubungan Fungsi Manajemen Kepala Ruangan Dengan
Pelaksanaan Pencegahan dan Pengendalian Infeksi
di Ruang Rawat Inap Rumah Sakit Umum Pusat Prof R.D Kandou Manado. JST Kesehatan. 2014:1(4).

Informasi tentang angka kejadian infeksi nosokomial di BLU RSUP Prof. DR. R. D. Kandou Manado
bulan Juli-Desember 2012, infeksi daerah luka operasi sebanyak 3,4%, ISK sebanyak 2,7%, infeksi
aliran darah primer sebanyak 6,4%, infeksi dekubitus sebanyak 0,7%.

 Diabetes,
 Malnutrition,
 Smoking,
 Obesity,
 Alcoholism,
 Extremes of age,
 Steroid therapy,
 Chemotherapy, radiotherapy,
 Peripheral vascular disease, skin disease at operation site, pre-existing infection, chronic inflammatory
conditions increase the risk of acquiring SSI

PATHOGENESIS OF SSIs
In most patients, infection does not develop at operative site because innate host defenses are quite
efficient in the elimination of contaminants at the surgical site.26 Pathogens that cause SSI are acquired
either endogenously from the patient’s own flora present on skin or from opened viscus or exogenously
from contact with operative room personnel or the environment. However, the period of greatest risk
remains the time between opening and closing the operating site.27 Prolonged operations that increase
the length of time increases the risk of exogenous contamination.28 In clean surgeries which do not
open the abdomen or genital tract such as cardiothoracic surgeries, neurosurgeries, orthopaedic,
ophthalmic and breast surgeries, Staphylococcus aureus (MRSA) is the predominant pathogen causing
SSI and associated with poor outcome. The emergence of methicillin-resistant strains of S. aureus
(MRSA) have increased the morbidity and mortality from wound infections. Other gram positive
organisms such as coagulase negative staphylococci, enterococci and Streptococcus species, are
involved less frequently.29-32 Surgeries which enter into hollow visera like appendicectomy, colorectal,
gastroduodenal, biliary tract and urologic operations, exposes surrounding tissues to gram negative
bacilli such as Escherichia coli, Klebsiella, Enterobacter, Proteus species, gram positive organism like
Enterococcus, and anaerobes.33-35 In surgeries of the head and neck region, anaerobes such as
Peptostreptococcus, Propionibacterium, Prevotella, Veillonella, Bacteroides, and Clostridium species,
are mainly responsible for SSIs because these organisms are present normally in oropharyngeal region
as commensal and therefore gain access to surgical site easily.36 SSIs can be monomicrobial or
polymicrobial. Polymicrobial infections usually occur at surgeries of oropharyngeal, axilla, perineum and
GIT region because of mixed aerobic and anaerobic organisms. Yeast of Candida species can also be a
part of polymicrobial SSI.37 Development of SSI depends on interplay of four factors: 3.1 Inoculum of
bacteria- procedures involving the sites which are heavily colonized with bacteria such as bowel (103-
104bacteria/ml of distal small bowel contents, 105-106 bacteria/ml in right colon, 1010-1012
bacteria/gm of stool in rectosigmoid colon), female genital tract (106-107bacteria/ml) are at higher risk
of developing SSI as large inoculums of bacteria lodge into wound during the course of operation.37-39
3.2 Virulence of bacteria-The more virulent the bacterial contaminant, the greater the probability of
infection. Staphylococcus aureus, Clostridium perfringens, Streptococcus pyogenes require only a small
inoculum to cause severe necrotizing infection at the surgical site. Bacteroides fragilis and other
Bacteroides species are ordinarily organisms of minimal virulence as solitary pathogens, but when
combined with other oxygen-consuming organisms, they will result in microbial synergism and cause
very significant infection following operations of the colon or female genital tract.

Pada sebagian besar pasien, infeksi tidak berkembang di tempat operasi karena pertahanan
inang bawaan cukup efisien dalam mengeliminasi kontaminan di lokasi operasi.
Patogen yang menyebabkan ILO diperoleh baik secara endogen dari flora pasien sendiri yang
ada di kulit maupun dari rongga terbuka atau secara eksogen berasal dari kontak dengan
petugas di ruang operasi atau lingkungan.
Namun, waktu antara membuka dan menutup tempat/ daerah operasi masih merupakan
periode risiko terbesar.
Perpanjangan lamanya waktu operasi meningkatkan risiko kontaminasi eksogen.
Dalam operasi bersih yang tidak membuka perut atau saluran genital seperti operasi
kardiotoraks, bedah saraf, bedah ortopedi, bedah mata dan payudara, Staphylococcus aureus
(MRSA) adalah patogen dominan yang menyebabkan SSI dan biasanya menyebabkan kondisi
yang buruk. Munculnya strain resisten methicillin dari S. aureus (MRSA) telah meningkatkan
morbiditas dan mortalitas dari infeksi luka. Organisme gram positif lainnya seperti
Staphylococci koagulase negatif, Enterococci, dan Streptococcus sp. jarang terlibat.
Operasi yang masuk ke organ dalam berongga yang kosong ,seperti apendiktomi, bedah
kolorektal, gastroduodenal, saluran empedu dan bedah urologi, menyebabkan jaringan
sekitarnya terekspos oleh bakteri basil gram negatif, seperti seperti Escherichia coli, Klebsiella,
Enterobacter, Proteus sp. serta organisme gram positif seperti Enterococcus dan bakteri
anaerobe lainnya.
Dalam operasi di daerah kepala dan leher, anaerob seperti Peptostreptococcus,
Propionibacterium, Prevotella, Veillonella, Bacteroides, dan Clostridium sp. adalah organisme
yang terutama bertanggung jawab menjadi penyebab ILO. Hal ini dikarenakan organisme
tersebut biasanya terdapat di daerah orofaring sebagai komensal dan oleh karena itu mudah
mendapatkan akses ke tempat/ daerah bedah. ILO dapat berupa monomikrobial atau
polimikrobial. Infeksi polimikroba biasanya terjadi pada operasi orofaringeus, aksila, perineum
dan traktus gastrointestinal karena adanya campuran organisme aerob dan anaerob. Ragi
Candida sp. juga dapat menjadi bagian dari penyebab ILO polimikrobial.

Pengembangan SSI tergantung pada interaksi empat faktor:


3.1 Inokulum bakteri
prosedur yang melibatkan situs yang sangat dijajah dengan bakteri seperti usus (103-
104bacteria / ml distal isi usus kecil, 105-106 bakteri / ml di usus kanan, 1010-1012 bakteri / gm
tinja di kolon rectosigmoid), saluran kelamin perempuan (106-107bakteria / ml) berada pada
risiko tinggi mengembangkan SSI sebagai inokulum besar dari bakteri menjadi luka selama
operasi.

3.2 Virulensi bakteri


Semakin ganas kontaminan bakteri, semakin besar kemungkinan infeksi. Staphylococcus aureus,
Clostridium perfringens, Streptococcus pyogenes hanya memerlukan inokulum kecil untuk
menyebabkan infeksi nekrosis parah di situs bedah. Bacteroides fragilis dan Bacteroides sp.
lainnya biasanya merupakan organisme dengan virulensi minimal sebagai patogen soliter,
tetapi ketika dikombinasikan dengan organisme pengonsumsi oksigen lainnya, mereka akan
menghasilkan sinergi mikroba dan menyebabkan infeksi yang sangat signifikan setelah operasi
pada kolon atau saluran genital wanita.

Acute surgical wounds normally proceed through an orderly and timely reparative process
resulting in sustained restoration of anatomic and functional integrity. If an acute wound fails to
heal within six weeks, it can become a chronic wound. Early inflammation (the first 24 hours)
begins with haemostasis through vasoconstriction, thrombin formation by activation of
complement proteins and platelet aggregation. Platelets release cytokines and many growth
factors stimulates angiogenesis and promotes extracellular matrix synthesis.
PMNs are also a major source of cytokines early during inflammation, release proteases such as
collagenases. Following functional activation neutrophils scavenge necrotic debris, foreign
material, and bacteria. PMNs do not survive longer than 24 hours. If wound contamination
persists or secondary infection occurs, continuous activation of the complement system and
other pathways provides a steady supply of chemotactic factors, resulting in a sustained influx of
PMNs into the wound. Sterile incisions will heal normally without the presence of PMNs. By
about 24 hours after creation of the surgical wound, monocytes enter the surgical site.
When microbial contamination has been minimal and the early arriving neutrophils have been
able to adequately control the bacteria that are present, then monocytes produce local chemical
signals to regulate the wound-healing process. if microbial contamination and proliferation
overwhelm the initial neutrophil infiltration, the monocyte assumes the role of a
proinflammatory cell with the release of potent cytokines. (TNF)-alpha upregulate vigorous
neutrophil activity within the wound. TNF-alpha-stimulated neutrophils consume microbes, and
lysosomal vacuoles may release reactive oxygen intermediates and acid hydrolases into the
extracellular space from its lysosomal vacuoles, Interleukin (IL)-1, IL-6, and other
proinflammatory serve as endocrine signals responsible for fever, stimulation of acute phase
reactants, and other responses. Serotonin is released from mast cells which causes vasodilation
and increased vascular permeability. During late inflammation (24-72hrs), by increased
permeability of the microvasculature, followed by stasis, accumulation of leucocytes along the
vascular endothelium migrate through the vascular wall into the interstitial tissue.
The combination of intense vasodilation and increased vascular permeability leads to clinical
findings of inflammation, rubor (redness), tumor (swelling), calor (heat), anddolor (pain).
THIS phase of wound healing is to ensure that the wound bed is free of bacteria and other
contaminants and to create the optimum environment for the production of granulation tissue
and for epithelialisation.
the next few days increase in fibroblast and endothelial cell mitogenic activity, epithelial cell
migration and synthesis of collagen.
Maturation is the final phase of wound healing which can take upto two years to complete. In
this phase, granulation tissue gradually matures into scar tissue, which over time pale, shrinks
and thins.
Source :
Surgical Site Infections: Classification, Risk factors, Pathogenesis and Preventive Management Rajvir
Singh 1, *, Pooja Singla 1 , Uma Chaudhary 2

bakteri gram negatif memiliki dinding selnya terdiri dari peptidoglikan tipis yang dibungkus oleh lapisan
lipoprotein atau lipoposakarida

Staphylococcus aureus is a bacterium found primarily on the skin and in the nose of humans. S.
aureus belongs to the coccus family of bacteria. These bacteria have a spherical shape and
appear as large round yellow clusters similar to grapes. S. aureus is an important human
pathogen which causes a range of diseases ranging from minor issues such as minor skin
infections to severe toxin mediated diseases. Individuals most at risk of S. aureus infection are
those who are frequently treated with antibiotics, as this produces opportunities for the
development of multi–drug resistant S. aureus
Staphylococcus aureus is a Grampositive spherical bacteria found in small clusters which
produce yellow coloured colonies (Online Textbook of Bacteriology, 2008). They are facultative
anaerobes that can grow by aerobic respiration or lactic acid fermentation of glucose. S. aureus is
catalase positive and can survive in NaCl concentrations of up to 15 percent (Online
Textbook of Bacteriology, 2008). While most Staphylococci are coagulase-negative, S. aureus is
coagulase positive. S. aureus produces several virulence factors, some of
which affect the immune system (Online Textbook of Bacteriology, 2008).
Toxins and Pathogenicity
S. aureus toxins can be categorized into the following groups: pyrogenic toxin superantigens
(PTSAgs), exfoliative toxins, leukocidins, and other toxins. PTSAgs also involve staphylococcal
enterotoxins (SE), SE-like toxins, and toxic shock syndrome toxin-1 (TSST-1) (Verkaik et al.,
2009). These superantigens allow for the crosslinking of histocompatibility class II molecules to
antigen presenting cells and T cell receptors. This in turn leads to over proliferation of T cells
and cytokine release, resulting in the disproportionate inflammatory activity believed to cause
food poisoning and toxic shock syndromes (Verkaik et al., 2009).
Exfoliative toxins are believed to be the cause of illnesses such as staphylococcal scalded skin
syndrome and bullous impetigo. Leukocidal toxins are pore forming toxins made up of two
components (S and F proteins), and the toxic effects depend on the interaction of these proteins
with neutrophils and erythrocytes (Verkaik et al., 2009). Members of this toxin family include
LukD, LukE, LukM, γ hemolysin, and Panton-Valentine leukocidin (PVL). PVL is responsible
for necrotizing pneumonia, bone and joint infections, and abscesses. This toxin belongs to the
‘epidermal cell differentiation inhibitor’ group of toxins. These toxins function by inactivating
GTPases, and by blocking chemotaxis and phagocytosis which are important immune cell
functions (Verkaik et al., 2009).
Several pathogenicity factors of S. aureus are believed to be controlled by regulatory systems
involving two component regulatory mechanisms. An important gene in these systems is agr,
which is involved in quorum sensing and in the activity of transcription factors for genes such as
the superantigen genes tst and seb. These regulatory genes are believed to act in a time and
population density dependant manner (Novick, 2003).

Source : yg ga ada judul

The species named aureus, refers to the fact that colonies (often) have a golden colour when
grown on solid media, whilst CoNS form pale, translucent, white colonies
(Howard and Kloos, 1987).

The cell wall of S. aureus is a tough protective coat, which is relatively amorphous in
appearance, about 20-40 nm thick (Shockman and Barrett, 1983). Underneath the cell wall is the
cytoplasm that is enclosed by the cytoplasmic membrane. Peptidoglycan is the basic component
of the cell wall, and makes up 50% of the cell wall mass
Peptidoglycan and teichoic acid together only account for about 90% of the weight of the cell
wall, the rest is composed of surface proteins, exoproteins and peptidoglycan hydrolases
(autolysins). Some of these components are involved in attaching the bacteria to surfaces and are
virulence determinants. Finally, over 90% of S. aureus clinical strains have been shown to
possess capsular polysaccharides
S. aureus is considered to be a major pathogen that colonises
and infects both hospitalised patients with decreased
immunity, and healthy immuno-competent people in the
community. This bacterium is found naturally on the skin
and in the nasopharynx of the human body. It can cause
local infections of the skin, nose, urethra, vagina and
gastrointestinal tract, most of which are minor and not
life-threatening The environment within a hospital also
supports the acquisition of resistant S. aureus strains. The
same study found 81% of the infections were caused by S.
aureus, and 61% of these were methicillin resistant.
The skin and mucous membrane are excellent barriers
against local tissue invasion by S. aureus. However, if
either of these is breached due to trauma or surgery, S.
aureus can enter the underlying tissue, creating its
characteristic local abscess lesion (Elek, 1956), and if it
reaches the lymphatic channels or blood can cause septicaemia
(Waldvogel, 1990). The basic skin lesion caused
by an S. aureus infection is a pyogenic abscess. However,
S. aureus can also produce a range of extracellular toxins,
such as enterotoxin A-E, toxic shock syndrome toxin-
1 (TSST-1) and exfoliative toxins A and B

AN INTRODUCTION TO STAPHYLOCOCCUS AUREUS, AND TECHNIQUES FOR


IDENTIFYING AND QUANTIFYING S. AUREUS ADHESINS IN RELATION TO
ADHESION TO BIOMATERIALS: REVIEW
L.G. Harris1,2*, S.J. Foster 2, and R.G. Richards1
1AO Research Institute, Clavadelerstrasse, CH 7270 Davos, Switzerland; 2Dept. Molecular
Biology and
Biotechnology, University of Sheffield, Firth Court, Sheffield, S10 2TN, UK.
40
L.G. Harris et al S. aureus adhesins
plasmic membrane. Peptidoglycan is the basic component
of the cell wall, and makes up 50% of the cell wall mass

Source : AN INTRODUCTION TO STAPHYLOCOCCUS AUREUS, AND TECHNIQUES


FOR
IDENTIFYING AND QUANTIFYING S. AUREUS ADHESINS IN RELATION TO
ADHESION TO BIOMATERIALS: REVIEW
L.G. Harris1,2*, S.J. Foster 2, and R.G. Richards1
Staphylococcus aureus adalah bakteri gram positif dengan diameter 0,5-1,0 mm, berbentuk
serangkaian buah anggur, tidak membentuk spora dan tidak bergerak (BSN 2015). Foster (2008)
menambahkan bahwa Staphylococcus adalah bakteri berbentuk kokus, gram-positif dan memiliki
diameter 0,5-1,0 mm, berkelompok, berpasangan dan kadang berantai pendek.

Aource :
KARAKTERISTIK Staphylococcus aureus YANG DI ISOLASI DARI IKAN ASAP
PINEKUHE HASIL OLAHAN TRADISIONAL KABUPATEN SANGIHE
Characteristics of Staphylococcus aureus Isolated Smoked Fish Pinekuhe from Traditionally
Processed from Sangihe District
Ely John Karimela*, Frans G. Ijong, Henny A. Dien

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