Faktor Prediktor Kegagalan Antibiotik Lini Pertama Pada Sepsis Neonatorum di RSUP Dr. Sardjito Yogyakarta

Alfa Zudia Meitadevi, Dr. dr. Ekawaty Lutfia Haksari, MPH, Sp.A(K), Dr. dr. Ida Safitri Laksanawati, Sp.A(K)

2023 | Tesis | S2 Kedokteran Klinik

Latar belakang: Tatalaksana utama sepsis neonatorum adalah mengatasi penyebab infeksi yang mendasari. Antibiotik empiris diberikan pada neonatus diduga sepsis meskipun belum diketahui patogen penyebabnya. Kegagalan antibiotik merupakan situasi klinis dimana terapi antibiotik gagal menghilangkan infeksi penyebab sehingga manifestasi klinis tetap ada. Resistensi antibiotik merupakan faktor risiko utama kegagalan antibiotik. Antibiotik empiris lini pertama pada sepsis neonatorum pada penelitian ini yaitu kombinasi ampisilin dan gentamisin.
Tujuan: Untuk mengetahui faktor prediktor kegagalan antibiotik lini pertama pada sepsis neonatorum di RSUP Dr. Sardjito Yogyakarta.
Metode: Penelitian kohort retrospektif dengan subjek adalah neonatus lahir dalam rumah sakit pada Januari 2021-Oktober 2022 dan didiagnosis sepsis (ICD-10 P36), pemilihan sampel secara consecutive sampling. Analisis bivariat menggunakan uji Chi square, variabel bebas dengan nilai p<0>Hasil: Sebanyak 1.733 neonatus lahir dalam rumah sakit selama periode penelitian, 422 (24,3%) didiagnosis sepsis, 113 neonatus dieksklusi dari penelitian. Subjek penelitian 309 neonatus, 168 (54,4%) memenuhi kriteria kegagalan antibiotik. Hasil analisis multivariat menunjukkan usia kehamilan < 32>Simpulan: Neonatus kurang bulan, sepsis awitan dini, nutrisi parenteral, anemia, trombositopenia dan bakteri Gram negatif merupakan faktor prediktor kegagalan antibiotik lini pertama pada sepsis neonatorum.

Background: The main treatment of neonatal sepsis is to treat the underlying cause of the infection. Empirical antibiotics are given to neonates suspected of sepsis even though the causative pathogen is unknown. Antibiotic failure is a clinical situation where antibiotic therapy fails to eliminate the underlying infection, resulting in persistent clinical manifestations. Antibiotic resistance is a major risk factor for antibiotic failure. The first-line antibiotics therapy for neonatal sepsis in this study are a combination of ampicillin and gentamicin.
Aim: To determinate the factors predicting failure of first-line antibiotics therapy in neonatal sepsis at Dr. Sardjito Central General Hospital, Yogyakarta.
Method: A retrospective cohort study was conducted between January 2021 and October 2022 among inborn hostpital neonates with clinical or proven sepsis (ICD-10 P36), using consecutive sampling for samples selection. Bivariate analysis using the Chi-square test, variables with p<0>Results: A total of 1.733 inborn neonates during study period, 422 (24.3%) with clinical or proven sepsis, 113 neonates were excluded from the study. Total subjects were 309 neonates, 168 (54.4%) met the antibiotic failure criteria. Multivariate analysis showed that neonates with gestational age < 32>Conclusion: Premature neonates, early onset sepsis, parenteral nutrition, anemia, thrombocytopenia and Gram negative bacteria are predictors of failure of first line antibiotics therapy in neonatal sepsis.

Kata Kunci : sepsis neonatorum, kegagalan antibiotik empiris, faktor prediktor, bakteri Gram negatif, resistensi antibiotik, neonatal sepsis, empiric antibiotic failure, factors predicting, Gram negative bacteria, antibiotic resistance.