DEPARTMENT OF INTERNAL

MEDICINE
HASANUDDIN UNIVERSITY
50 year-old Women with Mastoid Abscess ec MRSA
and Diabetes Meliitus Type 2

RIZKYASTARI

PEMBIMBING
Dr. dr. Risna Halim, Sp. PD, K-PTI

Divisi Penyakit Tropik Infeksi Departemen Ilmu Penyakit Dalam

Fakultas Kedokteran Universitas Hasanuddin
Identitas

Nama : Ny. R
Gender : Perempuan
Umur : 51 th
Tanggal Lahir : 31-3-1972
RM : 1023094
Ruangan : Lontara THT
KJS INTROP : Dr. dr. Risna Halim, Sp. D, K-PTI

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 Identitas

Pasien dikonsul dengan hasil kultur MRSA

Riwayat Penyakit Sekarang :
- Benjolan di bawah telinga kiri dirasakan sejak 1 bulan. Awalnya hanya benjolan
kecil dengan borok kecil diujungnya, kemudian menjadi membesar dan bernanah.
Saat ini.
- Nyeri ada di telinga kiri. Tidak ada cairan keluar dari telinga kiri, Tidak ada
ganguuan pendengaran, tidak ada kuping berdengunh.
- Nyeri di bagian leher sebelah kiri ada. Nyeri meluas sampai dada tidak ada.
- Demam ada hilang timbul sejak 1 minggu yang lalu.
- Batuk, sesak napas tidak ada. Mual muntah tidak ada.

7
Identitas

Riwayat Penyakit dahulu

- Riwayat DM diketahui sejak 3 tahun yang lalu, tidak pernah berobat
- Riwayat HT tidak ada
- Riwayat sakit telainga tidak ada
- Riwayat sakit gigi tidak ada

Riwayat pengobatan di RS sebelumnya

Inj Meropenem 1gr/intravena (H5)
Inj Metronidazole 500mg/intravena (H5)

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 PHYSICAL Leher:
EXAMINATION
tampak massa di pre dan retroauricula
sinistra, kemerahan, batas tidak tegas, perabaan
hangat, pus ada, luka vetor
Konjungtiva pucat I : Simetris kedua hemithorax saat statis dan
tidak ada. dinamis
P : Taktil Fremitus sama dikedua Hemithorax
Proptosis tidak P : Sonor dikedua Hemithorax
ada A : Bronkovesikuler, suara napas menurun di
hemithoraks dekstra setinggi ICS 5
Abdomen : datar, peristaltik Cor : BJ I/II Murni, Reguler. Murmur tidak ada
kesan normal, hepar dan lien
tidak teraba

: 100/60 mmhg
: 110 x/i, regular Ekst :
: 26 x/i Superior : edema tidak ada
: 38.5Ç Bawah : edema tidak ada, teraba
SpO2 : 99% tanpa modalitas hangat, CRT <2dtk.
PARAMETER 8/7/23 NILAI NORMAL
WBC 33.000 4.00-11.00 103/uL
HGB 11.6 12.0-16.0 g/dl
MCV 75 80.0-97.0 fL
MCH 25 26.5-33.5 pg
PLT 484.000 150-400 103/uL
NEUT 86.1 52.0-75.0 %
LYM 10,3 20.0-40.0 %
MONO 3.5 2.00-8.00 %
EO 0 1.00-3.00 %
BASO 0.1 0.00-1.00 %
PARAMETER 8/7/23
Prokalsitonin 0.05

GPT 18 U/L

GOT 11 U/l

Ur 10 mg/dl

Cr 0,39 mg.dl

Na 135 mmol/L

K 3.2 mmol/L

Cl 103 mmol/L

HBsAg Non reactive

HbA1C 15,9
Clinical Finding
Sinus Tachycardia
Heart rate 130 bpm
Regular
Normal axis
P wave 0,08 sec
QRS complex 0,08 sec
PR interval 0,12 sec
No ST-T changes
U wave: absent
.
Foto Thorax 9/7/23

- Cardiomegaly disertai dilatatio et

atherosclerosis aortae
- Efusi pleura kanan
NO ANTIBIOTIK HASIL
1. Cefoxitin :Resisten
2. Erythromycin :Resisten
3. Linezolid :Sensitif
4. Oxacillin :Resisten
5. Penicillin G :Resisten
6. Rifampicin :Sensitif
7. Tetracycline :Resisten
8. Trimethoprim-Sulfamethoxazole :Resisten
9. Vancomycin :Sensitif.

Bakteri : Methicillin Resistant Staphylococcus Aureus

 Diagnosis
Abses Mastoid ec Methicillin Resistand Staphylococcus Aureus

Diabetes Mellitus Type 2 obese

CAP PSI Score 70

Efusi pleura Dekstra

Infeksi Tropis

• TerapiVancomycin 1 gr / 12 jam EMD

IV (7 hari)
• Plan Terapi:- Diet DM 1700
THT kkal/hari
• Ryzodeg 16-0-16 IU/SC
• Metronidazole 500mg/8 jam / iv
• Ranitidin 50mg/12 jam/ iv
• Ketorolac 30mg/8 jam /iv
PARAMETER 22/7/23 NILAI NORMAL
WBC 11.400 4.00-11.00 103/uL
HGB 11,7 12.0-16.0 g/dl
MCV 76 80.0-97.0 fL
MCH 25 26.5-33.5 pg
PLT 158.000 150-400 103/uL
NEUT 70,7 52.0-75.0 %
LYM 19.8 20.0-40.0 %
MONO 5.5 2.00-8.00 %
EO 0 1.00-3.00 %
BASO 0.1 0.00-1.00 %
DISKUSI & TEXTBOOK READING
• MRSA is a type of bacteria that's resistant to
several widely used antibiotics. This means
infections with MRSA can be harder to treat than
other bacterial infections.
• MRSA is any strain of Staphylococcus aureus that
has developed through the process of natural
selection,
• resistance to beta-lactam antibiotics, which
include the penicillins (methicillin, dicloxacillin,
nafcillin, oxacillin, etc.) and the cephalosporins
Types of MRSA
• HA-MRSA : HA-MRSA is
associated with infections
that are contracted in
medical facilities such as
hospitals or nursing
homes.
• CA-MRSA : CA-MRSA is
associated with infections
that are transmitted
through close personal
contact with an infected
person or through direct
contact with an infected
wound.
Symptoms of MRSA
• Symptoms of HA-MRSA
• HA-MRSA is generally more likely to
cause serious complications, such as
pneumonia, urinary tract infections
, and sepsis. It’s important to see your
doctor right away if you notice any of
the following symptoms:
• Symptoms of CA-MRSA
• CA-MRSA usually causes skin
infections. Areas that have increased
body hair, such as the armpits or back
of the neck, are more likely to be
infected.
 RISK FACTORS
Risk factors for HA-MRSA
• Being hospitalized. MRSA remains a concern in hospitals, where it can attack those most
vulnerable — older adults and people with weakened immune systems.
• Having an invasive medical device. Medical tubing — such as intravenous lines or urinary
catheters — can provide a pathway for MRSA to travel into your body.
• Residing in a long-term care facility. MRSA is prevalent in nursing homes. Carriers of MRSA have
the ability to spread it, even if they're not sick themselves.

Risk factors for CA-MRSA

• Participating in contact sports. MRSA can spread easily through cuts and abrasions and skin-to-
skin contact.
• Living in crowded or unsanitary conditions. Outbreaks of MRSA have occurred in military
training camps, child care centers and jails.
• Men having sex with men. Homosexual men have a higher risk of developing MRSA infections.
 Treatment

• The selection of empiric • SSTIs: trimethoprim/

antibiotic therapy for the
treatment of MRSA infection
depends on the type of disease,
local S. aureus resistance
patterns, availability of the drug,
side effect profile, and individual
patient profile
sulfamethoxazole, tetracyclines,
• Vancomycin and daptomycin are
considered adequate empiric
therapy according to the
Infectious Diseases Society of
America guidelines of 2011.
 Treatment
• Endocarditis: The 2015 American Heart Association
(AHA) guidelines recommend intravenous vancomycin
as the first line treatment for endocarditis. For patients
who cannot tolerate vancomycin, intravenous
daptomycin should be used. Recommended duration of
treatment for native valve endocarditis is six weeks.
Thank You