Molecular typing and antifungal susceptibility study of Aspergillus spp. in intensive care unit (ICU) patients in Indonesia

  • Anna Rozaliyani Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia https://orcid.org/0000-0002-6616-8565
  • Rudyanto Sedono Department of Anesthesiology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Ridhawati Sjam Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • Mulyati Tugiran Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • Robiatul Adawiyah Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • Findra Setianingrum Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia https://orcid.org/0000-0002-2763-3807
  • Anwar Jusuf Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia/Persahabatan Hospital, Jakarta, Indonesia
  • Saleha Sungkar Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • Ferry Hagen Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands https://orcid.org/0000-0002-5622-1916
  • Jacques F Meis Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands https://orcid.org/0000-0003-3253-6080
  • Retno Wahyuningsih Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Keywords: Aspergillus, molecular typing, susceptibility

Abstract

Introduction: Aspergillus exhibits a wide variation of susceptibility against antifungals according to genetic and environmental factors. Identification to the species level is necessary for appropriate treatment. Our objective was to determine the Aspergillus species involved in invasive pulmonary aspergillosis (IPA) among ICU patients in Jakarta, Indonesia.

Methodology: The incidence of IPA in ICU patients at six hospitals in Jakarta from October 2012 – January 2015 was investigated. It involved a collection of endotracheal aspirates (ETA), nasal swabs and environmental samples around the hospitals, phenotypic screening, molecular characterization, and antifungal susceptibility testing.

Results: Of the 405 patients investigated, 31 patients (7.7%) were diagnosed with putative IPA, from whom 45 Aspergillus isolates were collected. Aspergillus isolates were identified from pulmonary secretions in 24 patients, from nasal swabs in 7 patients and from both pulmonary secretions and nasal swabs in 7 patients. The phenotypic method showed 33 isolates of Aspergillus flavus (73.4%), nine Aspergillus fumigatus (20%), two Aspergillus niger (4.4%), and one Aspergillus nidulans (2.2%) isolate. Molecular identification showed 27 isolates of A. flavus (60.0%), eight isolates of A. fumigatus (17.8%), two isolates of A. niger (4.4%) and one isolate of A. nidulans (2.2%), while seven isolates (15.6%) were cryptic species or mixed isolates.

Conclusions: Susceptibility testing showed all isolates were susceptible to amphotericin B, azoles and micafungin. Aspergillus flavus was the main causative organism in IPA cases in Jakarta, followed by A. fumigatus.

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Author Biographies

Anna Rozaliyani, Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

Dr. Anna Rozaliyani, M.Biomed., Sp.P. Head of Dept. of Parasitology

Rudyanto Sedono, Department of Anesthesiology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia

dr. Rudyanto Sedono, Sp.An-KIC

Ridhawati Sjam, Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

Dra. Ridhawati Sjam, M.Biomed

Mulyati Tugiran, Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

Dra. Mulyati Tugiran, M.S

Robiatul Adawiyah, Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

Dr. dr. Robiatul Adawiyah, M. Biomed

Findra Setianingrum, Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

dr. Findra Setianigrum, M.Sc., Ph.D

Anwar Jusuf, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia/Persahabatan Hospital, Jakarta, Indonesia

Prof. dr. Anwar Jusuf, SpP(K)

Saleha Sungkar, Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

Prof. dr. Saleha Sungkar, DAP&E, MS, Sp.ParK

Retno Wahyuningsih, Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

Prof. Dr. Retno Wahyuningsih, M.S

Published
2021-07-31
How to Cite
1.
Rozaliyani A, Sedono R, Sjam R, Tugiran M, AdawiyahR, Setianingrum F, Jusuf A, SungkarS, Hagen F, Meis JF, Wahyuningsih R (2021) Molecular typing and antifungal susceptibility study of Aspergillus spp. in intensive care unit (ICU) patients in Indonesia. J Infect Dev Ctries 15:1014-1020. doi: 10.3855/jidc.13135
Section
Original Articles

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