HUBUNGAN ANTARA KESESUAIAN TERAPI ANTIBIOTIK EMPIRIS DENGAN MORTALITAS RUMAH SAKIT PADA PASIEN HOSPITAL ACQUIRED PNEUMONIA YANG DIRAWAT DI ICU RSUP DR. SARDJITO YOGYAKARTA

RUSDI ANWAR, Dr. Calcarina Fitriani Retno Wisudarti, Sp.An, KIC.; DR. Dr. Sudadi, Sp.An. KNA. KAR.;

2017 | Tesis-Spesialis | SP ILMU ANESTESIOLOGI DAN REANIMASI

Metode: Data diperoleh dari penelusuran rekam medis pasien. Database komputer di bagian rekam medis ditelusuri dengan memasukkan kriteria inklusi berupa pasien ICU usia 18 tahun keatas dengan periode admisi rumah sakit 1 Juni 2015 - 31 Desember 2016 dan diagnosis berdasarkan format ICD 10 dengan kode j13, j14, j15, j16, j17, dan j18. Kriteria eksklusi adalah pasien dengan HIV positif dan kriteria drop out adalah pasien yang tidak memiliki hasil kultur bakteri. Terapi antibiotik empiris disebut sesuai jika hasil kultur bakteri sensitif atau intermediet terhadap satu atau lebih antibiotik empiris. Variabel yang dinilai adalah hubungan mortalitas dengan kesesuaian antibiotik empiris, umur, jenis kelamin, lama perawatan di ICU, lama penggunaan ventilasi mekanik, jenis kasus (bedah atau medis), dan skor APACHE II (24 jam pertama setelah masuk ICU). Hasil: Sebanyak 81 pasien disertakan dalam penelitian ini. Tiga pasien dieksklusikan dan 9 pasien drop out karena tidak memiliki hasil kultur. Hasil kultur sputum didapatkan pada 59 pasien dan hasil kultur darah pada 10 pasien. Kultur sputum positif pada 44 pasien, kultur sputum negatif pada 15 pasien, dan semua kultur darah hasilnya negatif. Tidak ada perbedaan yang bermakna dengan mortalitas antara umur (p=0,345), jenis kelamin (p=1,000), lama perawatan di ICU (p=0,059), lama penggunaan ventilasi mekanik (p=0,09), jenis kasus (p=0,199), dan skor APACHE II (p=0,331). Tidak ada hubungan yang bermakna antara kesesuaian terapi antibiotik empiris dengan mortalitas rumah sakit (p=1,000). Antibiotik empiris yang paling sering digunakan adalah: ceftazidime (n=30), ciprofloxacin (n=21), dan levofloxacin (n=19). Antibiotik definitif yang paling sering digunakan adalah: amikacin (n=6), meropenem (n=6), dan tygecycline (n=4). Bakteri paling sering tumbuh adalah Acinetobacter baumannii (n=13), Klebsiella pneumonia (n=9), Pseudomonas aeruginosa (n=7), dan Streptococcus viridians (n=7), dimana sebagian besar adalah multi drug resistant (MDR). Kesimpulan: Pada penelitian ini didapatkan tidak ada hubungan yang bermakna antara kesesuaian terapi antibiotik empiris dengan mortalitas rumah sakit pada pasien HAP yang dirawat di ICU RSUP dr. Sardjito Yogyakarta

Objective: To determine the association between appropriateness of empirical antibiotic therapy and hospital mortality in patients with hospital acquired pneumonia (HAP) admitted to ICU RSUP Dr. Sardjito Yogyakarta. Design: Retrospective cohort observational study Methods: Data were collected from patients medical record. The inclusion criteria were ICUs patients aged 18 years old or older who diagnosed HAP. Computer database was extracted within period of June 1, 2015 to December 31, 2016, and diagnosis were traced to ICD 10 codes of j13, j14, j15, j16, j17, j18. Patients with HIV-positive were excluded and those without culture result were dropped out. The empiric antibiotic therapy was considered appropriate when all significant bacteria were susceptible or intermediate to at least one of the antibiotics. Variables determined were association between mortality and appropriateness of empirical antibiotic therapy, age, gender, ICU length of stay, duration of mechanical ventilation (MV), type of case (surgical or medical), and APACHE II scores (within the first 24 hours after ICU admission). Results: Eighty one patients were enrolled. Three patients were excluded and 9 patients were dropped because no bacterial cultures were reported. Sputum cultures were obtained from 59 patients while blood cultures were drawn from 10 patients. The sputum cultures were positive in 44 patients and negative in 15 patients, while all blood culture were negative. No differences in hospital mortality were related to age (p=0,345), gender (p=1,000), length of stay in ICU (p=0,059), duration on MV (p=0,09), type of case (p=0,199), and APACHE II score (p=0,331). No significant association was found between appropriateness of empirical antibiotic therapy and hospital mortality (p=1,000). The most common prescribed empiric antibiotics were ceftazidime (n=30), ciprofloxacin (n=21, and levofloxacin (n=19) while definitive antibiotics were amikacin (n=6), meropenem (n=6), and tygecycline (n=4). The most common bacteria were Acinetobacter baumannii (n=13), Klebsiella pneumoniae (n=9), Pseudomonas aeruginosa (n=7), and Streptococcus viridans (n=7), which most of them were multi drug resistant (MDR). Conclusion: In this study there was no association between appropriateness of empirical antibiotic therapy with hospital mortality in patients with hospital acquired pneumonia (HAP) admitted to ICU RSUP dr. Sardjito Yogyakarta.

Kata Kunci : HAP, kesesuaian antibiotik empiris, mortalitas, ICU, Appropriateness of empirical antibiotic, hospital mortality, hospital acquired pneumonia, ICU