Vol.1 , No. , 202 , p -6 2 December 2 15 23 DOI: 10.5454/mi.1 . .6 2 15-23 Multidrug Resistance and Extensively Drug-Resistance in Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus haemolyticusand CLIFF CLARENCE HALIMAN , DIMAS SETO PRASETYO , CONNY R TJAMPAKASARI , 1 2 2 AND T MIRAWATI SUDIRO*JAHJANI 2 1 Program of Clinical Microbiology Residency, Faculty of Medicine, Universitas Indonesia, Jakarta 10320, Indonesia; 2 Department of Clinical Microbiology, Faculty of Medicine, Universitas Indonesia - dr. Cipto Mangunkusumo Hospital, Jakarta 10320, Indonesia Antimicrobial resistance in bacteria has become a leading global public health issue. hasStaphylococcus sp. an efficient mechanism to deal with antimicrobial agents that make them hard to treat in hospital-acquired and community-acquired infections. This study was conducted due to limited data about multidrug resistance and extensively drug resistance in . in Indonesia. This study was a descriptive retrospective studyStaphylococcus sp using a cross-sectional design to get the prevalence and antimicrobial susceptibility of ,S. haemolyticus S. aureus, and The data w secondary data extracted from WHONET 2022 software. This study's data wereS. epidermidis. ere from bacteria from samples sent to UKK LMK FKUI, Jakarta from 2017 to 2021 for routine diagnostic. In this study, we found that the prevalence of methicillin-resistant was 24.9%, methicillin-resistantS. aureus S. epidermidis S. haemolyticus S. aureuswas 65,5%, and methicillin-resistant was 86.8%. The prevalence of MDR is less than and respectively. MDR consistently above 85%S. epidermidis S. haemolyticus, S. haemolyticus was each year, while was above 50% and was below 50%. XDR Staphylococcus was onlyS. epidermidis S. aureus found in and , i.e. three and seven XDR isolates ofS. aureus S. haemolyticus S. aureus and S. haemolyticus respectively during 2017-2021. Although we could not find any pan-resistant isolates from all samples, we found methicillin-resistant and isolates that were also resistant to vancomycin and linezolid.S. aureus S. haemolyticus S. haemolyticus S. epidermidis coagulase-negative Staphylococcusdan were an important species that can't be neglected due to the high percentage of MDR and the discoveries of XDR in so that they have theS. haemolyticus potential to disseminate resistance plasmids to the more virulent bacteria. Therefore we need to control the use of antimicrobial agent to prevent this resistance. Key words: Indonesia, Jakarta, MDR, ,methicillin resistant Staphylococcus aureus, Staphylococcus epidermidis Staphylococcus haemolyticus,, XDR Resistensi antimikroba adalah salah satu masalah kesehatan utama di dunia. . memilikiStaphylococcus sp mekanisme yang efisien dalam mengatasi antimikroba sehingga menyebabkan sulitnya pengobatan infeksi baik di maupun Penelitian ini dilakukan karena keterbatasanhospital acquired infection community acquired infection. data mengenai prevalensi multidrug resistance (MDR) dan extensively drug resistance (XDR) Staphylococcus sp., di Indonesia. Penelitian ini menggunakan data sekunder yang diambil dari perangkat lunak WHONET 2022 dan merupakan penelitian deskriptif retrospektif dengan pendekatan potong lintang untuk mengetahui prevalensi dan pola kepekaan antimikroba dari danStaphylococcus haemolyticus, Staphylococcus aureus Staphylococcus epidermidis. Sampel yang dianalisis merupakan sampel yang dikirim ke UKK LMK FKUI, Jakarta pada tahun 2017 sampai dengan 2021 untuk diagnosis rutin. Dari hasil penelitian ini ditemukan prevalensi methicillin resistant S.aureus methicillin resistant S.epidermidis methicillin resistantadalah 24,9%, adalah 65,5% dan S.haemolyticus S.aureus S.epidermidisadalah 86,8%. Prevalensi yang merupakan MDR lebih sedikit daripada dan yaitu berturut-turut konsisten diatas 85% tiap tahun, konsisten di atas 50% dan konsisten diS.haemolyticus, bawah 50%. Staphylococcus yang merupakan XDR, hanya ditemukan pada dan , yaituS.aureus S.haemolyticus berturut turut pada sebanyak tiga isolat dan pada sebanyak tujuh isolat selama tahunS.aureus S.haemolyticus 2017-2021. Walaupun dari keseluruhan sampel, tidak ditemukan pan-resistensi, ditemukan danS.aureus S.haemolyticus S.haemolyticus S.resisten metisilin yang juga resisten terhadap vankomisin dan linezolid. dan epidermidis coagulase negative Staphylococcusmerupakan yang perlu diperhatikan, karena tingginya persentase MDR dan ditenukannya XDR pada , sehingga berpotensi dapat mendiseminasikanS.haemolyticus plasmid resistensi kepada organisme yang lebih virulen sehingga diperlukan adanya pengendalian penggunaan antimikroba untuk mencegah penyebaran resistensi tersebut. Kata kunci: Indonesia, Jakarta, MDR, ,methicillin resistant Staphylococcus aureus, Staphylococcus epidermidis Staphylococcus haemolyticus,, XDR MICROBIOLOGY INDONESIA Available online at http://jurnal.permi.or.id/index.php/mionline ISSN 1978-3477, eISSN 2087-8575 * C o r r e s p o n d i n g a u t h o r : P h o n e ;: + 6 2 E - m a i l :- mrwtsoediro@gmail.com leading global public health issue due to its ineffective treatment of Hospital Acquired or community-acquired infections. (Magiorakos 2012; Patel 2011)et al. et al. Antimicrobial resistance in bacteria has become a Staphylococcus sp. has an efficient mechanism to deal with antimicrobial agents that make them hard to treat, especially in life-threatening diseases. (Almanaa et al. 2 0 2 0 ; K a u r a n d C h a t e , 2 0 1 5 ) A m o n g a l l Staphylococcus species, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcusand haemolyticus are the most common species in nosocomial infection. (De Giusti 1999; Dzenet al. et al. 2005; Graham 2000; Heilmann 2019; Kimet al. et al. and Jang, 2017; Takeuchi 2005; Suhartonoet al. et al. 2019) is the major pathogenStaphylococcus aureus species for humans. (Riedel 2019, p.205)et al. Staphylococcus haemolyticus inhabits human skin as commensal species, at first not considered a pathogen, now it is the second most common species after Staphylococcus epidermidis among the Coagulase- negative Staphylococcus group that can be isolated in nosocomial infection.(De Giusti 1999; Dzenet al. et al. 2005; Graham 2000; Heilmann 2019; Kimet al. et al. and Jang, 2017; Takeuchi 2005)et al. Staphylococcus haemolyticus has genomic flexibility that facilitates the survival mechanism to the antimicrobial agents and can be disseminated to other species in the Staphylococcus group. (Kim 2012; Takeuchi 2005)et al. et al. . In the previous study in Aceh, Staphylococcus haemolyticus infection prevalence in hospital is 32 2%,. and among the isolate, 96 6% is. Methicillin-resistant Staphylococcus haemolyticus. et al.(Suhartono 2019) While in a global study of multi drugs resistance to Staphylococcus haemolyticus that involved eight countries, the prevalence is 77 7%, where multi drugs. resistance is defined as resistance to at least three antimicrobial agents. (Cavanagh 2014; Czekajet al. et al. 2015). Due to limited data about multidrug resistance and extensively drug resistance in .Staphylococcus sp especially in Indonesia. This study aims to determine the prevalence of multidrug resistance and extensively drug resistance in , andS. haemolyticus S. epidermidis, S. aureus from secondary data obtained from clinical isolates during routine diagnostic in UKK LMK FKUI, Jakarta. MATERIALS AND METHODS S t a p h y l o c o c c u s s p . i d e n t i f i c a t i o n a n d antimicrobial susceptibility were obtained from secondary data extracted from WHONET 2022 software. This study was a descriptive retrospective study using a cross-sectional design to get the prevalence and antimicrobial susceptibility of S. haemolyticus S. aureus, S. epidermidis., and This study's data were from bacteria from samples sent to UKK LMK FKUI, Jakarta from 2017 to 2021 for routine diagnostic. This study has been approved by The Ethics Committee of the Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo H o s p i t a l . ( N o : K E T- 1 2 7 2 / U N 2 . F 1 / E T I K /PPM.00.02/ 2022). Clinical samples were inoculated to blood agar plates, and the plates were incubated for 24 hours in 37 C before being identified by Gram O staining. Blood samples were first inoculated into Bactec blood culture system and positive samples ® were spread onto blood agar plates as above. Identification and drug susceptibility tests were generated using VITEK 2 GP and VITEK 2 AST-GP ® ® 67 (Biomerieux, France) and converted using BacLink Software (WHONET, Boston). Then the data of species and drug sensitivity were extracted and presented in frequency percentage using WHONET 2022 software (WHONET, Boston). GNU PSPP 1.6.2 (Free Software Foundation, Boston) and Microsoft Excel software was used to calculate the percentage that was not calculated in WHONET and make the graph. T h e p h e n o t y p e o f M e t h i c i l l i n r e s i s t a n t Staphylococcus was detected by susceptibility to cefoxitin. (Magiorakos 2012; Riedelet al. et al. 2019,p.215) Multidrug resistance (MDR) was determined by antimicrobial susceptibility test results when the isolate has non-susceptibility to ≥1 antimicrobial agent in ≥3 antimicrobial categories phenotype or has Methicillin resistant phenotype (Magiorakos 2012). While extensively druget al. resistance (XDR) was determined by antimicrobial susceptibility test results when the isolate has non- susceptibility to ≥1 antimicrobial agent in all but ≤ 2 antimicrobial categories phenotype (Magiorakos et al. 2012). A bacteria is determined as pandrug resistant (PDR) when the antimicrobial susceptibility test showed non-susceptibility to all antimicrobial categories (Magiorakos 2012).et al. RESULTS A total of 1099 samples were used to analyse the prevalence and sample characteristics of ,S. aureus S. haemolyticus, S. epidermidis,and which can be seen in Table 1 and Table 2. From all the data mentioned before, a total of 168 other than andS. aureus, S. epidermidis, S. haemolyticus were excluded from antimicrobial susceptibility 16 HALIMAN ET AL. Microbiol Indones Volume 1 , 2026 2 Microbiol Indones 17 Table Characterization of sp. according to the specimen type of origin in 2017-2 Staphylococcus isolates 2021 Table 1 sp. in 2017-2021Number of isolatesStaphylococcus Organism 2017 n (%) 2018 n (%) 2019 n (%) 2020 n (%) 2021 n (%) Total S. aureus 151(53.0) 74(32.5%) 69(27.0%) 42(29.2%) 53(28.5%) 389 S. epidermidis 51(17.9%) 55(24.1%) 70(27.3%) 37(25.7%) 42(22.6%) 255 S. haemolyticus 45(15.8%) 72(31.6%) 80(31.3%) 26(18.1%) 64(34.4%) 287 Other Staphylococcus 38(13.3%)a 27(11.8%)a 37(14.5%)b 39(27.1%)c 27(14.5%)d 168 a S. capitis, S. cohnii, S. hominis, S. lentus, S. ludgunensis, S. pseudintermedius, S. saprophyticus, S. sciuri, S. warneri, S. xylosus. b S. capitis, S. cohnii, S. hominis, S. lentus, S. ludgunensis, S. saprophyticus, S. sciuri, S. warneri c S. capitis, S. cohnii, S. hominis, S. lentus, S. pseudintermedius, S. saprophyticus, S. sciuri, S. simulans, S. warneri, S. xylosus. d S. capitis, S. cohnii, S. hominis, S. lentus, S. ludgunensis, S. pseudintermedius, S. saprophyticus, S. sciuri, S. warneri, S. xylosus Specimen Species S. aureus (n (%)) S. epidermidis (n (%)) S. haemolyticus (n (%)) Other Staphylococcus* (n (%)) Abdominal Fluid 1(0.3%) 1(0.4%) 2(0.7%) 2(1.2%) Abscess and Pus 88(22.6%) 27(10.6% 11(3.8%) 11(6.5%) Blood 34(8.7%) 71(27.8%) 20(7.0%) 55(32.7%) Brain and CSF - 4(1.6%) - 2(1.2%) Bronchoalveolar Lavage and Bronchial Washing 5(1.3%) 7(2.7%) 2(0.7%) 1(0.6%) Cervix - 1(0.4%) 3(1.0%) - Cornea and Eye 3(0.8%) 3(1.2%) 4(1.4%) 5(3.0%) External urethra 1(0.3%) 3(1.2%) 8(2.8%) - Nose 47(12.1%) 12(4.7%) 4(1.4%) 9(5.4%) Semen - 2(0.8%) 19(6.6%) 7(4.2%) Skin Swab 7(1.8%) 23(9.0%) 4(1.4%) 5(3.0%) Sputum 57(14.7%) 43(16.9%) 36(12.5%) 3(1.8%) Throat and Trachea 67(17.2%) 3(1.2%) 2(0.7%) 8(4.8%) Tissue 30(7.7%) 17(6.7%) 9(3.1%) 8(4.8%) Urine 16(4.1%) 19(7.5%) 145(50.5%) 38(22.6%) Vagina 3(0.8%) 5(2.0%) 8(2.8%) - Wound and Ulcer 10(2.6%) 2(0.8%) 4(1.4%) 1(0.6%) Others** 20(5.1%) 12(4.7%) 6(2.1%) 13(7.7%) Total 389 255 287 168 * Other :Staphylococcus S. capitis, S. cohnii, S. hominis, S. lentus, S. ludgunensis, S. pseudintermedius, S. saprophyticus, S. sciuri, S. simulans, S. warneri, S. xylosus. ** Others: specimen less than 1% (Aspirate, bile, bone, central venous catheter, ear, joint fluid, kidney, leg swab, liver, male genital, mediastinum, mouth, no data, placenta, pleural fluid, rectal, sinus, prosthesis) 18 HALIMAN ET AL. Microbiol Indones analysis to specify the antimicrobial susceptibility test only in three species. Therefore, 926 samples were used to analyse the antimicrobial susceptibility profile shown in Table 3, Table 4, and Table 5. In total, methicillin-resistant S. aureus (MRSA) prevalence was 24 9%, methicillin-resistant S.. epidermidis methicillin-(MRSE) was 65 5% and. resistant S. haemolyticus(MRSH) was 86 8%.. From the antimicrobial susceptibility test, we found the prevalence of XDR in andS. aureus, S. haemolyticus were 0 77% and 2 43% respectively. While we could not. . found XDR in . MDR and XDRS. epidermidis phenotypes were found in andS. aureus, S. epidermidis, S. haemolyticus were shown in Table 6 and Fig 1 shows the percentage of ethicillin-resistant phenotype Asm . shown in Fig 2, ancomycin-resistant were found inv S. aureus, S. epidermidis, S. haemolyticusand in methicillin-resistant. In this study, we found that among the methicillin- resistant phenotype, four isolates on wereS. aureus vancomycin and linezolid resistant, and ten S. haemolyticus isolates were vancomycin and linezolid resistant. While in , we did not find anS. epidermidis isolate resistant to vancomycin and linezolid in the methicillin-resistant phenotype. DISCUSSION In this study, we found that S. aureus, S. haemolyticus, S. epidermidisand , respectively, were the most common species that can be isolated from clinical specimens during routine diagnostic tests. S. aureus S. epidermidis S. haemolyticus, , and are important hospital-acquired infection causative pathogens, especially in patients using a venous catheter and medical devices in the Intensive care unit.(Cerca 2007; Daniel 2014; Horanet al. et al. et al. 2008; Klingenberg 2007)et al. . In this study, was commonly found inS. aureus abscesses and pus, oropharynx and tracheal swab, and sputum. was commonly found in blood,S. epidermidis sputum, abscesses, and pus. At the same time, S. haemolyticus was commonly found in urine, sputum, and blood. and Coagulase-negativeS. aureus Staphylococcus are bacteria that colonize human skin, nails, and nares. Hence, they can invade to form pus in the tissue if there is a disruption of human barriers, such as damage to the skin layer, hair follicle trauma, and using medical devices.(Do Carmo Ferreira 2011;et al. Lowy, 1998; Schuenck 2008) Whileet al. S. haemolyticus is associated with infection in the urinary tract. (Gunn and Davis, 1988; Hovelius 1984;et al. John and O'Dell, 1978; Lozano 2015; Ruppet al. et al. S.1992). From a study conducted in Aceh, haemolyticus was predominantly found in the Intensive care unit. (Suhartono 2019) In anotheret al. study conducted in Nepal, wasS. aureus predominantly found from pus in the Intensive care unit, while was predominantly found onS. epidermidis catheter tips in the intensive care unit. (Shrestha et al.2018) In this study, we could not determine whether the Staphylococcus that we isolated were from the intensive care/ hospital ward or outpatient due to lack of data. From the result of antimicrobialS. aureus susceptibility that has been shown before, we found that the prevalence of methicillin-resistant S. aureus (MRSA) was below 40% each year. The highest prevalence was discovered in 2018 and decreased in 2019 and 2021. This prevalence is slightly lower compared to studies conducted in Afghanistan (Naimi et al. et al.2021) and Pakistan (Ullah 2016) but similar to the study conducted in China (Wang 2021).et al. From the antimicrobial susceptibility profile, we found in this study that 90% of is susceptible toS. aureus nitrofurantoin, rifampicin, vancomycin, linezolid, and q u i n u p r i s t i n / d a l f o p r i s t i n , t i g e c y c l i n e , a n d trimethoprim-sulfamethoxazole. While below 90% of S. aureus is susceptible to ciprofloxacin, clindamycin, e r y t h r o m y c i n , g e n t a m y c i n , l e v o f l o x a c i n , moxifloxacin, tetracycline, cefoxitin, oxacillin, and Penicillin G. Penicillin G was the least susceptible antimicrobial agent to Compared to otherS. aureus. studies mentioned before, the resistance to penicillin G of is similar to studies conducted inS. aureus Afghanistan, Pakistan, and China, but slightly different from other antimicrobial agents such as in Afghanistan. They found that is relatively resistant toS. aureus erythromycin and ciprofloxacin, In China, they discovered that is relatively resistant toS. aureus erythromycin and clindamycin and in Pakistan, they found that is relatively resistant toS. aureus erythromycin.(Naimi 2021; Ullah 2016;et al. et al. Wang 2021)et al. . From the result of antimicrobialS. epidermidis susceptibility that has been shown before, we found that the prevalence of methicillin-resistant S. epidermidis was relatively high. This result is similar to the study conducted in Tianjin, China (Xu 2020),et al. which found a high prevalence of methicillin-resistant S. epidermidis. The result we found was slightly lower than their study result, but, in our discovery, S. Volume 1 , 2026 2 Microbiol Indones 19 Table Percentage of antimicrobial sensitivity3 S. aureus * Breakpoints according to EUCAST version 5.0 Table Percentage of antimicrobial sensitivity4 S. epidermidis Antibiotic 2017 (n=51) 2018 (n=55) 2019 (n=70) 2020 (n=37) 2021 (n=42) Total (n=255) Cefoxitin 23.5% 41.8% 52.9% 16.2% 23.8% 34.5% Oxacillin 23.5% 41.8% 52.9% 16.2% 23.8% 34.5% Penicillin G 2.0% 7.3% 37.1% 5.4% 2.4% 13.3% Tetracycline 52.9% 76.4% 91.4% 78.4% 90.5% 78.4% Erythromycin 15.7% 40.0% 54.3% 48.6% 26.2% 38.0% Clindamycin 11.8% 43.6% 50% 43.2% 28.6% 36.5% Ciprofloxacin 33.3% 69.1% 61.4% 45.9% 28.6% 49.8% Moxifloxacin 35.3% 69.1% 61.4% 45.9% 28.6% 50.2% Levofloxacin 33.3% 69.1% 61.4% 48.6% 28.6% 50.2% Trimethoprim/Sulfamethoxazole 31.4% 65.5% 68.6% 40.5% 38.1% 51.4% Gentamycin 39.2% 80.0% 67.1% 70.3% 47.6% 61.6% Nitrofurantoin 100% 98.2% 98.6% 100% 100% 99.2% Vancomycin 86.3% 83.6% 98.6% 97.3% 97.6% 92.5% Rifampicin 86.3% 90.9% 77.1% 83.8% 54.8% 79.2% Tigecycline* 98.0% 98.2% 98.6% 100% 97.6% 98.4% Quinupristin/Dalfopristin* 100% 98.2% 100% 100% 100% 99.6% Linezolid 100% 98.2% 98.6% 100% 100% 99.2% Antibiotic 2017 (n=151) 2018 (n=74) 2019 (n=69) 2020 (n=42) 2021 (n=53) Total (n=384) Cefoxitin 90.7% 60.8% 65.2% 61.9% 73.6% 75.1% Oxacillin 90.7% 60.8% 65.2% 61.9% 73.6% 75.1% Penicillin G 9.9% 5.4% 21.7% 7.1% 20.8% 12.3% Tetracycline 54.3% 73.0% 59.4% 81.0% 75.5% 64.5% Erythromycin 84.1% 77.0% 72.5% 66.7% 71.7% 77.1% Clindamycin 79.5% 79.7% 73.9% 66.7% 69.8% 75.8% Ciprofloxacin 94.7% 78.4% 82.6% 78.6% 83% 86.1% Moxifloxacin 94.7% 79.7% 81.2% 78.6% 83% 86.1% Levofloxacin 94.7% 79.7% 82.6% 78.6% 83% 86.4% Trimethoprim/Sulfamethoxazole 98.7% 90.5% 91.3% 83.3% 90.6% 93.1% Gentamycin 93.4% 82.4% 82.6% 88.1% 90.6% 88.4% Nitrofurantoin 100% 97.3% 95.7% 100%% 100% 98.7% Vancomycin 87.4% 87.8% 92.8% 85.7% 100% 90% Rifampicin 98% 90.5% 87% 95.2% 94.3% 93.8% Tigecycline* 100% 97.3% 100% 97.6% 100% 99.2% Quinupristin/Dalfopristin* 100% 98.6% 95.7% 100% 100% 99.0% Linezolid 100% 97.3% 95.7% 100% 100% 98.7% * Breakpoints according to EUCAST version 5.0 epidermidis isolates were widely resistant to more than one antimicrobial agent. We found that the sensitivity of to Penicillin G was below 10%,S. epidermidis except in 2019,which is similar to several studies conducted in Tianjin, China(Xu 2020), Shanghai,et al. China(Du 2013), and Scotland (Zalewskaet al. et al. 2021) where they have found more than 90% of S. epidermidis are resistant to Penicillin G. In 2019, Penicillin G sensitivity was slightly higher than usual, maybe this finding due to fewer methicillin-resistant phenotype that could be isolated from clinical specimens that year. From the result of antimicrobialS. haemolyticus susceptibility that has been shown before, we found 20 HALIMAN ET AL. Microbiol Indones Table Percentage of antimicrobial sensitivity5 S. haemolyticus Table sp MDR and XDR percentage from 2017-20216 Staphylococcus Antibiotic 2017 (n=45) 2018 (n=72) 2019 (n=80) 2020 (n=26) 2021 (n=64) Total (n=287) Cefoxitin 17.8% 12.5% 12.5% 3.8% 15.6% 13,2% Oxacillin 17.8% 12.5% 12.5% 3.8% 15.6% 13,2% Penicillin G 6.7% 4.2% 1.3% 3.8% 6.3% 4,2% Tetracycline 64.4% 61.1% 65% 53.8% 60.9% 62,0% Erythromycin 20.0% 19.4% 40% 23.1% 21.9% 26,1% Clindamycin 15.6% 13.9% 25% 19.2% 17.2% 18,5% Ciprofloxacin 42.2% 33.3% 52.5% 42.3% 26.6% 39,4% Moxifloxacin 44.4% 37.5% 50% 42.3% 29.7% 40,8% Levofloxacin 44.4% 36.1% 52.5% 38.5% 28.1% 40,4% Trimethoprim/Sulfamethoxazole 66.7% 61.1% 66.3% 50% 73.4% 65,2% Gentamycin 62.2% 63.9% 73.8% 61.5% 51.6% 63,4% Nitrofurantoin 97.8% 94.4% 100% 100% 98.4% 97,9% Vancomycin 91.1% 83.3% 93.8% 76.9% 96,9% 89,9% Rifampicin 75.6% 69.4% 76.3% 69.2% 71.9% 72,8% Tigecycline* 88.9% 87.5% 86.3% 80.8% 84.4% 86,1% Quinupristin/Dalfopristin* 93.3% 83.3% 93.8% 88.5% 98.4% 91,6% Linezolid 93.3% 90.3% 97.5% 96.2% 98.4% 95,1% * Breakpoints according to EUCAST version 5.0 S. aureus S. epidermidis S. haemolyticus MDR XDR MDR XDR MDR XDR 2017 19.2%(29/151) 0% 84.3%(43/51) 0% 86.7%(39/45) 4.4%(2/45) 2018 44.6%(33/74) 1.4%(1/74) 60%(33/55) 0% 94.4%(68/72) 4.2%(3/72) 2019 44.9%(31/69) 2.9%(2/69) 50%(35/70) 0% 88.8%(71/80) 1.3%(1/80) 2020 40.5%(17/42) 0% 86.5%(32/37) 0% 100%(26/26) 0% 2021 41.5%(22/53) 0% 78.6%(33/42) 0% 90.6%(58/64) 1.6%(1/64) Fig 1 Percentage of Methicillin resistant sp. in 2017 to 2021Staphylococcus . that the prevalence of methicillin-resistant S. haemolyticus was over 80% each year. This result is similar to a study conducted in Aceh (Suhartono et al. 2019) and Brazil (Barros 2012), where 96 6 andet al. . 88% of from clinical specimens,S. haemolyticus respectively, were methicillin-resistant. Besides, we found that is widely resistant toS. haemolyticus antimicrobial agents such as erythromycin, c l i n d a m y c i n , c i p r o f l o x a c i n , l e v o f l o x a c i n , moxifloxacin, oxacillin, and penicillin G. This result similar with a study conducted in Aceh, Indonesia (Suhartono 2019) and review from several studieset al. that conducted in Poland (Czekaj 2015), theyet al. found that many are multidrugS. haemolyticus resistant. Another important finding in this study is that we found ancomycin resistan in eachv t S. haemolyticus year, and the highest prevalence was in 2020. This result differs from a study conducted in Brazil (Barros et al. S. haemolyticus2012), where all isolates were susceptible to vancomycin. This finding needs further attention, since the drug of choice in methicillin- resistant Staphylococcal infections is vancomycin, and the drug of choice in vancomycin-resistant Staphylococcal infections is linezolid. (Choo and Chambers, 2016; Loomba 2010) This study foundet al. isolates resistant to vancomycin and linezolid in the methicillin-resistant phenotype. Mainly we found them in and , but we could notS. haemolyticus S. aureus find them in .S. epidermidis We found that andS. epidermidis S. haemolyticus were more resistant to antimicrobial agents than S. aureus S.. This was proven by the MDR percentage in aureus S. epidermidis S.being lower than in and haemolyticus, respectively. Interestingly, from our study, the prevalence of MDR wasS. haemolyticus consistent above 85% each year, while S. epidermidis was S. aureusabove 50% and was below 50% each year. Besides, we found that the XDR phenotype only can be found in and althoughS. aureus S. haemolyticus, the prevalence of XDR is higher. WeS. haemolyticus discovered that only ten isolates have XDR phenotype where seven isolates of the XDR phenotype were S. haemolyticus, S. aureusand three isolates were . In this study, we could not find the PDR phenotype. In conclusion, andS. haemolyticus S. epidermidis were important coagulase-negative Staphylococcus species that can't be neglected, although in earlier times, they were not considered a pathogen species, due to their high prevalence in clinical isolate. Besides, S. haemolyticus are resistant to many antimicrobial agents in a high percentage. Thus, we should worry about their potential ability to disseminate the plasmid to virulent species. (Kim and Jang 2017) Moreover, with the of resistant tofinding S. haemolyticus vancomycin and linezolid, controlling antimicrobial Volume 1 , 2026 2 Microbiol Indones 21 Fig v m2 Percentage of ancomycin resistant sp. among ethicillin resistant Staphylococcus sp. inStaphylococcus 2017 to 2021. agent usage to prevent this resistance is imperative. ACKNOWLEDGMENTS This study has been presented in the International Seminar of the Indonesian Society for Microbiology (12 ISISM) 2022. We Thank dr. R. Fera Ibrahim, th M.Sc., Ph.D., Sp.MK(K)., head of UKK LMK FKUI, for giving access to isolates data. REFERENCES Almanaa TN, Alyahya SA, Khaled JM, Shehu MR, Alharbi NS, Kadaikunnan S, Alobaidi AS, Khalid Alzahrani A. 2020. The extreme drug resistance (XDR) Staphylococcus aureus strains among patients: A retrospective study. Saudi J Biol Sci. 27:1985–1992. Doi: 10.1016/j.sjbs.2020.04.003. Barros EM, Ceotto H, Bastos MCF, Dos Santos KRN, Giambiagi-deMarval M. 2012. 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