Main Article Content
Abstract
Diabetes mellitus is a chronic metabolic disorder that increases susceptibility to bacterial infections, particularly in chronic wounds. This study aims to identify Klebsiella pneumoniae in wound swab samples from diabetic patients and evaluate the antibacterial activity of soursop leaf (Annona muricata L.) extract. Wound swabs were collected aseptically and analyzed through Gram staining, biochemical testing, and selective media to confirm the presence of Klebsiella pneumoniae. The antibacterial effect of the extract was tested at concentrations of 20%, 40%, and 60% using the well diffusion method, with gentamicin and chloramphenicol as positive controls. Phytochemical screening revealed the presence of secondary metabolites such as alkaloids, flavonoids, tannins, saponins, and steroids. Results demonstrated a concentration-dependent inhibition of Klebsiella pneumoniae, with the highest inhibition zone observed at 60%, though smaller than the standard antibiotics. This study highlights the potential of Annona muricata extract as a natural antibacterial agent for diabetic wound infections and supports its role in developing alternative therapies. Further studies are recommended to optimize its efficacy and explore clinical applications.
Keywords
Article Details

This work is licensed under a Creative Commons Attribution 4.0 International License.
References
- DJ M, EJ B. (2021). IDF Diabetes Atlas 10th Edition Scientific Committee. IDF Diabetes Atlas [Internet]. Available from: https://www.idf.org/atlas.
- WHO. (2022). Diabetes [Internet]. Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes [Cited 2024 Nov 14].
- Sani, F. N., Widiastuti, A., Ulkhasanah, M. E., & Amin, N. A. (2023). Gambaran Kualitas Hidup Pada Pasien Diabetes Melitus. Jurnal Penelitian Perawat Profesional, 5(3), 1151-1158.
- Saeedi, P., Petersohn, I., Salpea, P., Malanda, B., Karuranga, S., Unwin, N., ... & IDF Diabetes Atlas Committee. (2019). Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas. Diabetes research and clinical practice, 157, 107843.
- Darwitz, B. P., Genito, C. J., & Thurlow, L. R. (2024). Triple threat: how diabetes results in worsened bacterial infections. Infection and Immunity, e00509-23.
- Mishra, S., Tiwari, P., Yadav, R., & Patel, P. S. (2024). An extensive analysis of diseases associated with diabetes. Journal of Pharma Insights and Research, 2(3), 174-187.
- Reddy, S., Singh, C. D., Kumar, S., & Muthusamy, R. (2024). Prevalence and Antibiotic Resistance of Klebsiella pneumoniae in Diabetic Foot Ulcer. Cureus, 16(8), e67824.
- Alenazi, F., & Khan, M. S. (2025). Novel antimicrobial strategies for diabetic foot infections: addressing challenges and resistance. Acta Diabetologica, 1-19.
- Al-Mousawi, H. M., Jadooa, M. M., & Al-bderee, N. M. (2025). Effectiveness of Green Synthesized ZnO Nanoparticles Against MDR Resistant Klebsiella Pneumoniae Isolated From Diabetic Foot on Some Virulence Factors Genes Expression. Indonesian Journal on Health Science and Medicine, 2(1), 10-21070.
- Depta, J., Małkowska, P., Wysokińska, M., Todorska, K., Sierawska, O., Hrynkiewicz, R., ... & Niedźwiedzka-Rystwej, P. (2022). Therapeutic role of antimicrobial peptides in diabetes mellitus. Biologics, 2(1), 92-106.
- Urama, E. U., Enweani-Nwokelo, I. B., & Achukwu, N. O. (2025). Evaluation of invitro antimicrobial activity of Nauclea latifolia root extracts against multi-drug resistant bacterial isolates from diabetic foot ulcers: Évaluation de l'activité antimicrobienne in vitro d'extraits de racines de Nauclea latifolia contre des isolats bactériens multirésistants provenant d'ulcères du pied diabétique. African Journal of Clinical and Experimental Microbiology, 26(1), 94-101.
- Mutakin, M., Fauziati, R., Fadhilah, F. N., Zuhrotun, A., Amalia, R., & Hadisaputri, Y. E. (2022). Pharmacological activities of soursop (Annona muricata Lin.). Molecules, 27(4), 1201.
- Setyaningrum, L., Purwaningtyas, D., Rosita, A., Wigati, D., Usman, M. R., & Latifah, M. S. (2022). Development and Validation of RP-HPLC Analysis Method for Determination of Total Alkaloid Content of Soursop (Annona muricata L.) Leaf Extract. Eksakta: Berkala Ilmiah Bidang MIPA, 23(03), 175-187.
- AKANJI, O. C. (2023). Antibacterial activity of Annona muricata leaves’ extracts. International Journal of Frontier Research in Science, 2(1), 024-028.
- Silva, R. M. D., Silva, I. D. M. M. D., Estevinho, M. M., & Estevinho, L. M. (2021). Anti-bacterial activity of Annona muricata Linnaeus extracts: a systematic review. Food Science and Technology, 42, e13021.
- Sahrianti, N., & Mastura, A. A. (2023). Skrining Fitokimia Senyawa Metabolit Sekunder Daun Sirsak (Annona muricata L.) di Kabupaten Majene, Mamuju dan Mamuju Tengah. JURNAL ILMIAH FARMASI SIMPLISIA, 3(2), 161-168.
- Sari, C. A. (2023). Toxicity Activity and Total Phenolic Content of Soursop Leaves from Three Regions in South Sulawesi, Indonesia. Journal of Experimental and Clinical Pharmacy (JECP), 3(2).
- Santos, I. L., Rodrigues, A. M. D. C., Amante, E. R., & Silva, L. H. M. D. (2023). Soursop (Annona muricata) properties and perspectives for integral valorization. Foods, 12(7), 1448.
- Zahara, I., Anwar, E., Laksmitawati, D. R., & Rahmat, D. (2023). Antioxidant Activity Cultivated of Soursop (Annona muricata L.) Leaves Extract in Jayasari Village, Pangandaran District, West Java. Journal of Natural Product for Degenerative Diseases, 1(1), 1-7.
- Nguyen, T. L. A., & Bhattacharya, D. (2022). Antimicrobial activity of quercetin: an approach to its mechanistic principle. Molecules, 27(8), 2494.
- Veiko, A. G., Olchowik-Grabarek, E., Sekowski, S., Roszkowska, A., Lapshina, E. A., Dobrzynska, I., ... & Zavodnik, I. B. (2023). Antimicrobial activity of quercetin, naringenin and catechin: Flavonoids inhibit Staphylococcus aureus-induced hemolysis and modify membranes of bacteria and erythrocytes. Molecules, 28(3), 1252.
- Ristanti, A. A., Safita, N., Khairunnisa, R., & Ermawati, S. (2021). Efektivitas gel ekstrak tangkai dan daun talas (Colocasia esculenta) terhadap penyembuhan luka diabetes. In Prosiding University Research Colloquium (pp. 378-388).
- Nurmiati, N., Periadnadi, P., Syahril, S. F., & Edelwis, T. W. (2024). The antimicrobial and antioxidant potentials of Annona species (A. muricata, A. squamosa, and A. reticulata) through leaf infusions. Biodiversitas Journal of Biological Diversity, 25(8).
- Faleye, O. S., Lee, J. H., & Lee, J. (2023). Selected flavonoids exhibit antibiofilm and antibacterial effects against Vibrio by disrupting membrane integrity, virulence and metabolic activities. Biofilm, 6, 100165.
- Macêdo, H. L. R. D. Q., de Oliveira, L. L., de Oliveira, D. N., Lima, K. F. A., Cavalcanti, I. M. F., & Campos, L. A. D. A. (2024). Nanostructures for delivery of flavonoids with antibacterial potential against Klebsiella pneumoniae. Antibiotics, 13(9), 844.
- Murdani, A. P., & Caressa, D. A. (2014). Antimicrobial Effectiveness of Ethanol Extract of Annona Muricata L (Soursop Leaves) Against Escherichia Coli Bacteria In Vitro: english. Indonesian Journal Of Medical Laboratory Technology (Ij-Calory), 1(2), 35-41.
- Coria-Téllez, A. V., Montalvo-Gónzalez, E., Yahia, E. M., & Obledo-Vázquez, E. N. (2018). Annona muricata: A comprehensive review on its traditional medicinal uses, phytochemicals, pharmacological activities, mechanisms of action and toxicity. Arabian Journal of chemistry, 11(5), 662-691.
- Ibrahim, A., Ibrahim, M. S. C., Bakar, K., Bakar, J., Ikhwanuddin, M., & Karim, N. U. (2022). Effects of Annona muricata extraction on inhibition of polyphenoloxidase and microbiology quality of Macrobrachium rosenbergii. Journal of Food Science and Technology, 1-10.
- Makarewicz, M., Drożdż, I., Tarko, T., & Duda-Chodak, A. (2021). The interactions between polyphenols and microorganisms, especially gut microbiota. Antioxidants, 10(2), 188.
- Kresnapati, I. N. B. A., & Sofya, S. W. (2023). Aktivitas Antimikroba Ekstrak Etanol Daun Sirsak (Annona muricata L) Terhadap Bakteri Gram Negatif Eschericia coli. Jurnal Ners, 7(1), 477-483.
- Septiana, S., Anjarani, A. V. P., & Wahyudi, D. (2024). Identifikasi dan Uji Sensitivitas Staphylococcus sp. Terhadap Beberapa Antibiotik pada Ulkus Diabetikum. Media Kesehatan Politeknik Kesehatan Makassar, 19(1), 91-95.
- Labunda, A. I., Fatayati, I., & Slamet, S. (2024). Identifikasi Bakteri Klebsiella pneumoniae pada SWAB Luka Diabetes Mellitus di Klinik Perawatan Luka Kota Pontianak. MAHESA: Malahayati Health Student Journal, 4(2), 598-604.
- Putra, M. D. D., Suarjana, I. G. K., & Tono, K. P. G. (2023). Isolasi dan Identifikasi Klebsiella sp. pada Anjing Kintamani Diare. Buletin Veteriner Udayana Volume, 15(3), 377-382.
- Qonaah, I., Sundari, A. S., Wahyuni, R., & Indriati, D. W. (2024). Bacterial Profile And Antibiotic Susceptibility Test Among Diabetes Mellitus Patients With Gangrene In Surabaya. Journal of Vocational Health Studies, 7(3).
- Zuliana, N. M., Suliati, S., & Endarini, L. H. (2023). Identifikasi Bakteri pada Luka Ulkus Pasien Diabetes Mellitus. JPP (Jurnal Kesehatan Poltekkes Palembang), 18(2), 205-211.
- Zheng, S., Florescu, S., & Mendoza, M. (2020). Klebsiella pneumoniae invasive syndrome in a diabetic patient with gallbladder abscess. Clinical Case Reports, 8(10), 1940-1942.
- Kesuma, S., Saputri, M. J., & Aleksandra, P. (2023). Profil Bakteri Penginfeksi Pus Pada Luka Di Laboratorium Mikrobiologi Rsud Abdoel Wahab Sjahranie Periode Bulan Januari-Juni Tahun 2023. Jurnal Kesehatan Tambusai, 4(4), 6013-6023.
- Holt, R. I., Cockram, C. S., Ma, R. C., & Luk, A. O. (2024). Diabetes and infection: review of the epidemiology, mechanisms and principles of treatment. Diabetologia, 1-13.
- Omar BJ. (2020). Klebsiella pneumoniae as a Rare Cause of Diabetic Foot in a Patient with Uncontrolled Diabetes: A Case Report. International Journal of Science Research. 9(2277):33–4.
- Rajab, A. A., & Hegazy, W. A. (2023). What’s old is new again: Insights into diabetic foot microbiome. World Journal of Diabetes, 14(6), 680.
- Rahman, A., Sardar, S., Niaz, Z., Khan, A., Sheheryar, S., Alrefaei, A. F., ... & Ali, S. (2024). Lipase and Protease Production Ability of Multi-drug Resistant Bacteria Worsens the Outcomes of Wound Infections. Current Pharmaceutical Design, 30(17), 1307-1316.
- Nagendra, L., Boro, H., & Mannar, V. (2022). Bacterial infections in diabetes. Endotext [Internet].
- Homenta, H. (2016). Infeksi biofilm bakterial. eBiomedik, 4(1).
- Guerra, M. E. S., Destro, G., Vieira, B., Lima, A. S., Ferraz, L. F. C., Hakansson, A. P., ... & Converso, T. R. (2022). Klebsiella pneumoniae biofilms and their role in disease pathogenesis. Frontiers in cellular and infection microbiology, 12, 877995.
- Karimi, K., Zarei, O., Sedighi, P., Taheri, M., Doosti-Irani, A., & Shokoohizadeh, L. (2021). Investigation of antibiotic resistance and biofilm formation in clinical isolates of Klebsiella pneumoniae. International Journal of Microbiology, 2021(1), 5573388.
- Orfali, R., Ghaffar, S., AlAjlan, L., Perveen, S., Al-Turki, E., & Ameen, F. (2024). Diabetes-related lower limb wounds: Antibiotic susceptibility pattern and biofilm formation. Saudi Pharmaceutical Journal, 32(6), 102069.
- Faisal, Z. S. S., & Permana, D. (2020). Sensitivitas Antibiotik Paten dan Generik Terhadap Beberapa Bakteri Penyebab Konjungtivitis. Yarsi Journal of Pharmacology, 1(2), 69-77.
- Gavamukulya, Y., Wamunyokoli, F., & El-Shemy, H. A. (2017). Annona muricata: Is the natural therapy to most disease conditions including cancer growing in our backyard? A systematic review of its research history and future prospects. Asian Pacific journal of tropical medicine, 10(9), 835-848.
- Zubaidi, S. N., Mohd Nani, H., Ahmad Kamal, M. S., Abdul Qayyum, T., Maarof, S., Afzan, A., ... & Mediani, A. (2023). Annona muricata: Comprehensive review on the ethnomedicinal, phytochemistry, and pharmacological aspects focusing on antidiabetic properties. Life, 13(2), 353.
- Porras, G., Chassagne, F., Lyles, J. T., Marquez, L., Dettweiler, M., Salam, A. M., ... & Quave, C. L. (2020). Ethnobotany and the role of plant natural products in antibiotic drug discovery. Chemical reviews, 121(6), 3495-3560.
- Sudirman PB. (2020). Menghambat Pertumbuhan Bakteri Salmonella typhi secara In vitro. Jurnal Medika Udayana. 9(9).
- Krishnan K, Marimuthu A, Sagarika M, Ayyar P, Subbiah R. (2024). Decoding the Phytochemical and Antimicrobial Properties of Annona spp. Against Pathogens: A Review. 13(2):83–95.
- Ullah, A., Munir, S., Badshah, S. L., Khan, N., Ghani, L., Poulson, B. G., ... & Jaremko, M. (2020). Important flavonoids and their role as a therapeutic agent. Molecules, 25(22), 5243.
- Zahid, M. D., Jamil, A., & Rahman, S. A. (2022). Antioxidant and Antimicrobial Properties of Annona Muricata Leaf and Pulp Methanolic Extract. Journal of Pharmaceutical Negative Results, 75-82.
- Abdel-Rahman, T., Hussein, A. S., Beshir, S., Hamed, A. R., Ali, E., & El-Tanany, S. S. (2019). Antimicrobial activity of terpenoids extracted from Annona muricata seeds and its endophytic Aspergillus niger strain SH3 either singly or in combination. Open Access Macedonian Journal of Medical Sciences, 7(19), 3127.
- Sakul, G., Simbala, H. E., & Rundengan, G. (2020). Uji Daya Hambat Ekstrak Etanol Daun Pangi (Pangium edule Reinw. ex Blume) Terhadap Bakteri Staphylococcus aureus, Escherichia coli dan Pseudomonas aeruginosa. Pharmacon, 9(2), 275-283.
- Haido, M. H., Matti, A. H., & Taher, S. M. (2024). Optimization of extraction conditions of bioactive compounds from Kurdistan species Urtica dioica. Cureus, 16(5), e61146.
- Bitwell, C., Indra, S. S., Luke, C., & Kakoma, M. K. (2023). A review of modern and conventional extraction techniques and their applications for extracting phytochemicals from plants. Scientific African, 19, e01585.