Kesesuaian Pemberian Antibiotik Dengan Menggunakan Panduan Pengecatan Gram Terhadap Hasil Kultur Cairan Abdomen Pada Pasien Infeksi Intraabdomen Di ICU

Pradana BayuRakhmatjati, dr. Bowo Adiyanto, SpAn, KIC.; Dr. Med. dr. Untung Widodo, SpAn, KIC

2023 | Tesis-Subspesialis | SUBSPESIALIS ANESTESIOLOGI DAN TERAPI INTENSIF

Latar Belakang: Infeksi Intra Abdomen merupakan penyebab kematian kedua terbanyak di ICU. Penanganan antibiotik cepat harus dilakukan untuk mengurangi mortalitas dan morbiditas. Di sisi lain, penggunaan antibiotik spektrum luas akan meningkatkan resistensi. Pengecatan Gram berpotensi memperbaiki klinis dan mengurangi angka resistensi pasien. Tujuan: Mengetahui kesesuaian pemberian antibiotik dengan menggunakan panduan pengecatan Gram terhadap hasil kultur cairan abdomen pada pasien IAI di ICU Metode: Studi cross sectional dilakukan pada 33 pasien IAI yang menjalani operasi laparotomi kemudian dirawat di ICU RSUP dr Kariadi yang memenuhi kriteria inklusi dan eksklusi. Setiap pasien diambil sampel saat menjalani operasi untuk dilakukan pengecatan Gram, kemudian diberikan antibiotik yang sesuai berdasarkan guideline peneliti sembari menunggu hasil kultur dan uji sensitivitas. Setelah hasil kultur keluar akan dinilai kesesuaian pemberian antibiotik. Hasil: Hasil penelitian ini menunjukkan lebih banyak pasien menerima antibiotik yang akurat berdasarkan guideline peneliti. Untuk kuman gram negative didapatkan sensitivitas sebesar 93%,Spesifisitas sebesar 63.6 %, dan akurasi 81.4%. Sedangkan untuk kuman gram Positif didapatkan Sensitivitas sebesar 50%,Spesifisitas 63.6?n akurasi 61.5%. Kesesuaian pemberian antibiotik pada penelitian ini sebesar 80%.Kesimpulan: Pemberian antibiotik berdasarkan Pengecatan Gram dengan dipandu Guideline Peneliti pada pasien paska operasi abdomen di ICU sesuai terhadap hasil kultur bakteri.

Background: Intra Abdominal Infection (IAI) is the second most common cause of death in the ICU. Rapid antibiotic treatment must be performed to reduce mortality and morbidity. On the other hand, the use of broad spectrum antibiotics will increase resistance. Gram stain has the potential to improve clinical outcomes and reduce patient resistance rates. Objective: To determine the suitability of giving antibiotics using a Gram stain guide on the results of abdominal fluid microbial isolate in IAI patients in the ICU. Methods: A cross-sectional study was conducted on 33 IAI patients who underwent laparotomy and then treated in the ICU of RSUP Dr. Kariadi who met the inclusion and exclusion criteria. Each patient was taken a sample during surgery for Gram staining, then given appropriate antibiotics based on the researchers guidelines while waiting for microbial isolate and sensitivity test results. After the microbial isolate results come out, the suitability of antibiotics will be assessed. Results: The results of this study indicate that more patients receive accurate antibiotics based on the researchers guidelines. For gram negative bacteria, we obtained sensitivity,specifity and accuracy score as follows : 93%,63.6% and 81.4%. Whereas for positive gram bacteria we obtained sensitivity,specifity and accuracy score as follows : 50%,63.6% and 61.5%. . The suitability of giving antibiotics in this study was 80%. Conclusion: Administration of antibiotics based on Gram stain guided by the Researchers Guideline in post-abdominal surgery patients in the ICU appropriate with the results of bacterial microbial isolate.

Kata Kunci : Infeksi Intra Abdomen,Antibiotik,Pengecatam Gram, Intra Abdominal Infection,Antibiotics,Gram Stain