Faktor Risiko Bakteremia Multidrug-Resistant - Difficult-to-Treat Resistance Pasien Sepsis

Intan Pristian Yuliyani, Dr. dr. Andaru Dahesihdewi, M.Kes., Sp.PK., Subsp.P.I(K)., Subsp.Onk.K.(K); Dr. dr. Teguh Triyono, M.Kes., Sp.PK., Subsp.K.V.(K), Subsp.B.D.K.T.(K)

2025 | Tesis | S2 Kedokteran Klinik

Latar Belakang: Peningkatan resistansi bakteri, khususnya difficult-to-treat resistance (DTR), menjadi tantangan dalam penatalaksanaan sepsis. Difficult-to-treat resistance merupakan fenotipe intermediate atau resistan terhadap semua antibiotik yang dilaporkan dalam kategori beta-laktam, karbapenem, beta-lactamase inhibitor, dan fluorokuinolon. Faktor risiko potensial, meliputi riwayat penggunaan antibiotik, tindakan medis/operasi dalam 90 hari terakhir, penggunaan device invasif, dan perawatan intensif. Identifikasi faktor risiko bakteremia DTR di RS Dr. Sardjito menjadi krusial untuk upaya pencegahan dan pengendalian.

Tujuan: Mengevaluasi faktor risiko bakteremia multidrug-resistant - difficult-to-treat resistance pada pasien sepsis di RS Dr. Sardjito.

Metode: Penelitian kasus-kontrol dilakukan pada pasien dewasa sepsis dengan bakteremia multidrug-resistant (MDR) periode Januari 2021-Desember 2024. Subjek dengan hasil kultur patogen polimikrobia atau data tidak dicantumkan lengkap sesuai variabel yang diteliti, dieksklusi. Kelompok kasus adalah pasien bakteremia MDR-DTR dan kontrol adalah bakteremia MDR lain. Faktor risiko yang dianalisis, meliputi riwayat penggunaan antibiotik dan tindakan medis/operasi dalam 90 hari terakhir dan penggunaan device invasif. Analisis menggunakan uji Chi-square dan Fisher’s exact, odds ratio (OR) bivariat dan multivariat, dengan p<0>

Hasil: Sebanyak 120 pasien (60 bakteremia MDR-DTR dan 60 bakteremia MDR lain) dianalisis. Mayoritas berusia 45-64 tahun, dan ?50% memiliki komorbid dan imunokompromais. Sebagian besar memiliki riwayat penggunaan antibiotik (82,5%) dan antibiotik paling banyak digunakan adalah sefalosporin (51,5%). Organisme MDR terbanyak adalah Acinetobacter baumannii (39,2%). Riwayat penggunaan antibiotik 90 hari terakhir (OR 18,73; p=0,007) dan penggunaan device invasif (OR 4,44; p=0,001) terbukti sebagai faktor independen bakteremia MDR-DTR, sedangkan riwayat tindakan medis/operasi 90 hari terakhir tidak bermakna mengindikasikan faktor risiko (OR=1,28; p=0,639)

Simpulan: Riwayat penggunaan antibiotik dalam 90 hari terakhir dan penggunaan >4 device invasif meningkatkan risiko bakteremia MDR-DTR pada pasien sepsis, sedangkan riwayat tindakan medis/operasi 90 hari terakhir tidak berpengaruh signifikan.

Background: Increasing bacterial resistance, especially difficult-to-treat resistance (DTR), is a challenge in the management of sepsis. Difficult-to-treat resistance is an intermediate or resistant phenotype to all reported antibiotics in the beta-lactam, carbapenem, beta-lactamase inhibitor, and fluoroquinolone categories. Potential risk factors include history of antibiotic use, medical/surgical procedures within the last 90 days, use of invasive devices, and intensive care. Identification of risk factors for DTR bacteremia in Dr. Sardjito Hospital is crucial for prevention and control efforts.

Objective: To evaluate the risk factors of multidrug-resistant - difficult-to-treat resistance bacteremia in sepsis patients at Dr. Sardjito Hospital.

Methods: A case-control study was conducted on adult sepsis patients with MDR bacteremia between January 2021 and December 2024. Patients with polymicrobial cultures or incomplete data were excluded. The case group consisted of patients with MDR-DTR bacteremia, while the control group included patients with other MDR bacteremia. Risk factors assessed were antibiotic use, medical/surgical procedures within the last 90 days, and use of invasive devices. Data analysis employed Chi-square, Fisher's exact tests, and logistic regression, with p<0>

Results: The study analyzed 120 patients, with 60 cases and 60 controls. Most patients were aged 45-64 years, and over half had comorbidities or immunocompromised status. Antibiotic use within 90 days was common (82.5%), predominantly cephalosporins (51.5%). Acinetobacter baumannii was the most frequent MDR organism (39.2%). Multivariate analysis showed that recent antibiotic use (OR 18.73; p=0.007) and the use of ?4 invasive devices (OR 4.44; p=0.001) were significant independent risk factors for MDR-DTR bacteremia. Conversely, medical or surgical procedures within 90 days were not statistically significant (OR 1.28; p=0.639).

Conclusion: A history of antibiotic use and multiple invasive devices substantially increases the risk of MDR-DTR bacteremia in sepsis patients, while recent medical or surgical procedures do not.

Kata Kunci : faktor risiko, difficult-to-treat resistance, sepsis, bakteremia