Antibiotic Susceptibility Pattern of Corynebacterium diphtheriae Isolated from Outbreaks in Indonesia 2010-2015

Kambang Sariadji, Sunarno Sunarno, Nelly Puspandari, Masri Sembiring


BACKGROUND: Diptheria cases are treated with both anti-diphtheria serum (ADS) and antibiotics. Penicillin and erythromycin are the primary choices for any Corynebacterium diphtheriae (C. diphtheriae) infection. Antibiotic susceptibility pattern of C. diphtheriae has not been reported in Indonesia since 1982. The improper use of antibiotics, as well as, the consumption of antibiotics without prescription, will increase the resistance of C. diphtheriae. This study aims to determine the susceptibility pattern and the effectiveness of C. diphtheriae to several antibiotics.

METHODS: A total of 57 C. diphtheriae isolates were recultured by using Blood Agar (BA) and Cystine Tellurite Blood Agar (CTBA). Afterward, these isolates were identified by using API Coryne. The antibiotic susceptibility pattern was determined by using Kirby Bauer Method based on CLSI M45-A2.

RESULTS: These studies revealed that as the primary choice of diphtheria cases, 10.5% of C. diphtheriae isolates were resistant to Penicillin and 5.3% were resistant to erythromycin. Seven isolates (12%) showed resistance to more than one antibiotics, such as tetracycline and clindamycin, vancomycin and clindamycin, penicillin and tetracycline, also penicillin and vancomycin. Moreover, 4 isolates (7%) were resistant to 3-5 antibiotics. All isolates were susceptible to moxifloxacin and linezolid.

CONCLUSION: Some C. diphtheriae isolates were resistant to penicillin and erythromycin, which are known as the primary choice for the treatment of C. diphtheriae infection. Even though, all isolates susceptible to moxifloxacin and linezolid.

KEYWORDS: Corynebacterium diphtheriae, resistance, antimicrobial

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Fricchione MJ, Deyro HJ, Jensen CY, Hoffman JF, Singh K, Logan LK. Non-toxigenic penisilin and cephalosporin-resistant corynebacterium diphtheriae endocarditis in a child: A case report and review of the literature. J Pediatric Infect Dis Soc. 2014; 3: 251-4, CrossRef.

Guilfoile PG. Deadly diseases and epidemics: diphtheria. New York: Chelsea House Publishers; 2009.

Rudi HP, Sariadji K, Sunarno, Roselinda. Corynebacterium diphtheriae Diagnosis Laboratorium Bakteriologi. 1st edition. Jakarta: Yayasan Pustaka Obor Indonesia; 2014.

De Zoysa A, Efstratieu A. Corynebacterium spp. In: Gillespie SH, Hawkey PM, editors. Principles and Practice of Clinical Bacteriology. 2nd edition. USA: John Wiley & Son; 2006. p.113-28, CrossRef.

Lumio J. Studies on the epidemiology and clinical characteristics of diphteria during the russian epidemic of the 1990s [Dissertation]. Finlandia: University of Tampere; 2003, article.

Pereira GA, Pimenta FP, Santos FR, Damasco PV, Hirata Júnior R, Mattos-Guaraldi AL. Antimicrobial resistance among Brazilian Corynebacterium diphtheriae strains. Mem Inst Oswaldo Cruz. 2008; 103: 507-10, CrossRef.

Mina NV, Burdz T, Wiebe D, Rai JS, Rahim T, Shing F, et al. Canada's first case of a multidrug-resistant Corynebacterium diphtheriae strain, isolated from a skin abscess. J Clin Microbiol. 2011; 49: 4003-5, CrossRef.

Rockhill RC, Sumarmo, Hadiputranto H, Siregar SP, Muslihun B. Tetrasiklin resistance of Corynebacterium diphtheriae isolated from diphtheria patients in Jakarta, Indonesia. Antimicrob Agents Chemother. 1982; 21: 842-3, CrossRef.

Clinical and Laboratory Standards Institute. Methods for Antimicrobial Dilution and Disk Susceptibility Testing of Infrequently Isolated or Fastidious Bacteria. CLSI document M45-A2. Wayne, PA: Clinical and Laboratory Standards Institute; 2010, article.

Clinical and Laboratory Standards Institute. Performance Standars for Antimicrobial Susceptibility Testing, Twenty Fifth Informational Supplement. CLSI document M100-S25. Wayne, PA: Clinical and Laboratory Standards Institute; 2015, article.

Efstratiou A, George RC. Laboratory guidelines for the diagnosis of infections caused by C.diphtheriae and C. ulcerans. Commun Dis Public Health. 1999: 2: 250-7, PMID.

Efstratiou A, Engler KH, Mazurova IK, Glushkevich T, Vuopio-Varkila J, Popovic T. Current approaches to the laboratory diagnosis of diphtheria. J Infect Dis. 2000; 181(Suppl 1): S138-45, CrossRef.

Efstratiou A, Maple PAC. WHO Manual for the Laboratory Diagnosis of Diphtheria. Copenhagen: WHO Region Office for Europe; 1994, article.

Pana M. Antibiotic Resistant Bacteria – A Continuous Challenge in the New Millennium. Croatia: InTech; 2012, CrossRef.

Pratiwi ST. Mikrobiologi Farmasi. Jakarta: Erlangga; 2012.

Farfour E, Badell E, Zasada A, Hotzel H, Tomaso H, Guillot S, Guiso N. Characterization and comparison of invasive corynebacterium diphtheriae isolates from France and Poland. J Clin Microbiol. 2012; 50: 173-5, CrossRef.

Burkovski A. Corynebacterium diphtheria and Related Toxigenic Species. Netherland: Springer; 2014, NLMID.

Roca I, Akova M, Baquero F, Carlet J, Cavaleri M, Coenen S. The global threat of antimicrobial resistance: science for intervention. New Microbe and New Infect. 2015; 6: 22-9, CrossRef.

Ventola Lee C. The antibiotic resistance crisis. P&T. 2015; 40: 277-83, PMID.

Bell M. Antibiotic misuse a global crisis. JAMA. 2014; 174: 1920-1, CrossRef.


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