Dampak infeksi Multidrug Resistant Organism terhadap biaya dan lama perawatan pasien di Intensive Care Unit Rumah Sakit Pusat Pertamina

Monica, Prof. Dr. Dra. Erna Kristin, Apt, M.Si; Dr. dr. Andaru Dahesihdewi MKes, SpPK (K)

2025 | Tesis | MAGISTER KEBIJAKAN DAN MANAJEMEN KESEHATAN

Latar belakang : Infeksi Multidrug-Resistant Organism (MDRO) menjadi tantangan serius dalam pelayanan kesehatan, terutama di Intensive Care Unit (ICU), karena berkaitan dengan peningkatan morbiditas, mortalitas, dan biaya perawatan. Peningkatan angka MDRO di Rumah Sakit Pusat Pertamina terbanyak dari ruang perawatan intensif periode Juli 2022 hingga Desember 2023 salah satunya terjadi peningkatan resistensi patogen ESBLs (Extended-spectrum beta-lactamases) yaitu Escherichia Coli ESBL dari 51% menjadi 59% di tahun 2023. Tujuan : Menganalisis dampak infeksi MDRO terhadap biaya dan lama perawatan pasien di ICU. 
Metode : Penelitian ini dilakukan di Intensive Care Unit dan Laboratorium Mikrobiologi Rumah Sakit Pusat Pertamina dengan total sampel 189 pasien hasil kultur terinfeksi/ MDR dan kultur tidak terinfeksi/non-MDR. Pasien diamati mulai dari masuk ICU hingga keluar dari ICU dalam kondisi diperbolehkan pulang atau pindah ke ruang perawatan biasa. Menggunakan desain cross sectional secondary data dari rekam medis.
Hasil : Organisme terbanyak yang ditemukan pada kelompok MDR adalah Klebsiella pneumoniae (ESBL) sebanyak 32,3?n Acinetobacter baumanni sebanyak 30,2%. Dan di kelompok Non-MDR adalah Stenotrophomonas maltophilia sebanyak 20,4%. Berdasarkan cross sectional secondary data membandingkan lama perawatan pasien pasien MDR dan Non MDR dalam penelitian ini rata-rata lama rawat pasien MDR lebih tinggi (14.19 hari) dibandingkan Non-MDR (11.38 hari). Berdasarkan Mann-Whitney test, terdapat perbedaan yang signifikan pada parameter lama rawat dan biaya perawatan pasien ICU antara kelompok MDR dan Non-MDR dengan nilai signifikansi p<0>Kesimpulan : Hasil analisis biaya dan lama perawatan pasien di ICU RSPP terhadap Multidrug Resistant Organism menimbulkan dampak terhadap lama perawatan tetapi tidak terhadap biaya perawatan. Faktor lain yang mempengaruhi lama perawatan pasien adalah sebagian besar pasien usia lanjut, pasien menggunaan alat invasif serta tindakan invasif yang dilakukan terutama memberikan support pernapasan selama pasien menjalani perawatan di ICU. Pelatihan tenaga kesehatan, Program pengendalian resistensi antimikroba, kebijakan tentang penerapan penggunaan antibiotik serta monitoring dan evaluasinya perlu menjadi perhatian untuk menurunkan angka MDRO di Rumah Sakit.

Background: Multidrug-Resistant Organism (MDRO) infections pose a serious challenge in healthcare, particularly in the Intensive Care Unit (ICU), as they are associated with increased morbidity, mortality, and treatment costs. The highest increase in MDRO rates at Pusat Pertamina Hospital was in the intensive care unit from July 2022 to December 2023. One example is the increase in resistance of ESBLs (Extended-spectrum beta-lactamases) pathogens, namely Escherichia coli ESBL, from 51% to 59% in 2023
Objective: To analyze the impact of MDRO infections on the cost and length of stay of patients in the ICU.
Methods: This study was conducted in the Intensive Care Unit and Microbiology Laboratory of Pusat Pertamina Hospital, with a total sample of 189 patients with infected/MDR and uninfected/non-MDR cultures. Patients were observed from ICU admission to discharge, with discharge or transfer to a regular ward. A cross-sectional design was used, and data were obtained from medical records.
Results: The most common organisms found in the MDR group were Klebsiella pneumoniae (ESBL) at 32.3% and Acinetobacter baumanni at 30.2%. And in the Non-MDR group was Stenotrophomonas maltophilia at 20.4%. Based on cross-sectional secondary data comparing the length of treatment for MDR and non-MDR patients, in this study the average length of treatment for MDR patients was higher (14.19 days) compared to non-MDR patients (11.38 days). Based on the Mann-Whitney test, there were significant differences in the length of stay and cost of ICU patient care between the MDR and Non-MDR groups with a significance value of p<0>Conclusion: The analysis of costs and length of stay for patients in the RSPP ICU for Multidrug-Resistant Organisms impacts length of stay but not costs. Other factors that influence the length of patient care are that most patients are elderly, patients use invasive devices, and invasive procedures are carried out, especially providing respiratory support while the patient is undergoing treatment in the ICU. Health worker training, antimicrobial resistance control programs, policies on the implementation of antibiotic use, and their monitoring and evaluation need to be considered to reduce MDRO rates in hospitals.

Kata Kunci : Multidrug-Resistant Organism (MDRO), biaya perawatan, lama perawatan, Intensive Care Unit (ICU), Sepsis.