POLA PENGGUNAAN ANTIBIOTIK EMPIRIS DAN POLA RESISTENSI BAKTERI PADA PASIEN ANAK DENGAN HOSPITAL ACQUIRED PNEUMONIA (HAP) DI RSUP DR. SARDJITO PERIODE JANUARI 2010 - DESEMBER 2015

ARTHA WORO UTAMI, Prof. Dr. Djoko Wahyono, SU., Apt.; dr. Titik Nuryastuti, M.Si., Sp., MK., Ph.D

2016 | Tesis | S2 Ilmu Farmasi

HAP merupakan salah satu infeksi yang menjadi penyebab kematian di berbagai negara. Tatalaksana terapi pneumonia salah satunya adalah pemberian antibiotika secara empiris sampai hasil uji kultur ditemukan. Akan tetapi penggunaan antibiotika empiris terkadang tidak terkendali sehingga timbul resistensi terhadap antibiotik empiris yang sering digunakani. Penelitian ini bertujuan untuk mendeskripsikan penggunaan antibiotika empiris dan resistensi bakteri terhadap antitibiotik pada pasien anak dengan HAP di RSUP Dr. Sardjito Yogyakarta. Penelitian dilakukan di RSUP Dr. Sardjito Yogyakarta dengan desain deskriptif observasional. Peneltian dilakukan secara retrospektif menggunakan rekam medik pasien anak yang dirawat di ruang Pediatric Intensive Care Unit (PICU) dan bangsal anak selama kurun waktu Januari 2010 � Desember 2015. Subyek penelitian merupakan pasien anak < 18 tahun yang menerima antibiotik empiris baik oral maupun parenteral. Pengambilan sampel menggunakan metode consecutive sampling. Analisis data berupa identifikasi pola penggunaan antibiotika empiris, pola bakteri yang ditemukan pada pasien, dan pola resistensi bakteri terhadap antibiotik yang berdasarkan hasil uji kultur sensitivitas antibiotik. Subyek penelitian ini sebesar 34 pasien anak yang terdiagnosis HAP dengan 15 pasien anak didapati hasil uji kultur dan sensitivitas antibiotik. Antibiotik empiris yang digunakan antara lain Seftriakson (23,53%), Seftazidim (14,71%), Meropenem (17,65%), Siprofloksasin (11,76%), Sefotaksim (2,94%), Azithromisin (5,88%), Klindamisin (2,94%), Imipenem (2,94%), Kloksasilin (2,94%), Seftazidim + Siprofloksasin (8,82%), Siprofloksasin + Klindamisin (2,94%), dan Meropenem + Azithromisin (2,94%). Bakteri yang ditemukan pada spesimen saluran nafas adalah S. viridans 47,37%, K.pneumoniae 15,79%, P. aeruginosa 10,53%, A. baumanii 5,23%, S. coagulase negative 5,23%, S. haemoliyticus 5,23%, S. marcesens 5,23% dan E. aerogenes 5,23 %. Sedangkan bakteri yang berasal dari darah antara lain K. pneumoniae (25%), B. cepalia (25%), E.coli (25%), dan S.coagulase negative (25%). Sebanyak 5 isolat gram negatif yang berasal dari spesimen saluran nafas dan 2 isolat bakteri dari kultur darah menunjukkan resistensi 100% terhadap Seftazidim dan Seftriakson. Kedua antibiotik tersebut merupakan antibiotik yang paling banyak digunakan dalam terapi empiris.

HAP is one infection that cause death in many countries. Management of HAP therapy is the administration of antibiotics empirically until culture test results found. However, use of empiric antibiotics sometimes uncontrollable that arise empirical antibiotic resistance is often used. This study aimed to describe the use of empiric antibiotics and bacterial resistance to antibiotic in pediatric patients with HAP in RSUP Dr. Sardjito Yogyakarta. The study was conducted at RSUP Dr. Sardjito with descriptive observational design. The study was conducted retrospectively using medical records of pediatric patients admitted to the Pediatric Intensive Care Unit (PICU) and the pediatric ward during the period January 2010 - December 2015. The subjects of research were the pediatric patients < 8 years old who receive empirical antibiotics both oral and parenteral. Consecutive sampling method was used. The data analysis consist of identification empirical antibiotic usage patterns, patterns of bacteria found in the patient, and the pattern of bacterial resistance to antibiotics based on the results of antibiotic sensitivity culture test. The subjects of this study was 34 pediatric patients diagnosed with HAP with 15 pediatric had the test results of culture and antibiotic sensitivity. Empirical antibiotic were used include Ceftriaxone (23.53%), Ceftazidime (14.71%), Meropenem (17.65%), Ciprofloxacin (11.76%), Cefotaxime (2.94%), azithromycin (5, 88%), Clindamycin (2.94%), Imipenem (2.94%), Cloxacillin (2.94%), Ceftazidime + Ciprofloxacin (8.82%), Ciprofloxacin + Clindamycin (2.94%), and Meropenem + Azithromycin (2.94%). Bacteria was found in respiratory tract specimens were S. viridans (47.37%), K.pneumoniae (15.79%), P. aeruginosa (10.53%), A. baumannii (5.23%), S. coagulase negative (5.23%), S . haemoliyticus (5.23%), S. marcesens E. aerogenes (5.23%) and (5.23%). While the bacteria from the blood culture are K. pneumoniae (25%), B. cepalia (25%), E. coli (25%), and S.coagulase negative (25%). A total of 5 isolates gram-negative bacteria from respiratory tract specimens and 2 isolates gram-negative bacteria from the blood showed 100% resistance against Ceftriaxone. A total of 6 isolates gram-negative bacteria from respiratory tract specimens and 2 gram-negative bacterial isolates from blood showed 100% resistance to Ceftazidime. Both of these antibiotics were the most often given empirical antibiotic according to the study.

Kata Kunci : pneumonia, HAP, antibiotika empiris, resistensi