Biakan dan uji sensitifitas bakteri pada peritonitis di Rumah Sakit Sardjito tahun 2004

SUDIYANTO, Bernard Agung Baskoro, dr. Hendro Wartatmo, SpB-SpBD

2005 | Tesis | PPDS I Ilmu Bedah

Latar belakang: Peritonitis adalah keadaan akut abdomen akibat radang peritoneum parietale dan viscerale rongga abdomen. Berdasar proses terjadinya dikenal peritonitis primer, sekunder, dan tersier. Peritonitis sekunder adalah infeksi hasil dari proses intraperitoneal seperti penyakit radang pelvis (pelvic inflammatory disease/PID), perforasi hollow viscus, iskemia usus, dan penyakit sistem bilier. Angka mortalitas peritonitis sekitar 20-80%. Penatalaksanaan dengan penanganan sumber infeksi, pembedahan koreksi penyebab, pembersihan cavitas peritoneal dan pemakaian antibiotik. Tujuan penelitian untuk mengetahui pola bakteri dan sensitivitasnya terhadap beberapa macam antibiotika, serta membandingkan sensitifitas ceftriaxone dibanding ampisilin dan gentamisin. Metode penelitian: Pengumpulan data dari kasus peritonitis dewasa di RS Sardjito tahun 2004 yang menjalani operasi laparotomi eksplorasi. Bahan biakan diambil dari cairan peritoneum dan sensitivitas tes dilakukan di laboratorium mikrobiologi fakultas kedokteran Universitas Gadjah Mada. Data yang diambil meliputi umur, jenis kelamin, penyebab peritonitis, hasil kultur dan sensitivitas mikrobiologi. Kemudian dilakukan uji statistik untuk menilai perbandingan sensitifitas ceftriaxone dibanding ampisilin dan gentamisin dengan interval kepercayaan 95%. Hasil: Tahun 2004 terdapat 34 kasus peritonitis dewasa yang menjalani operasi laparotomi eksplorasi. Jenis kelamin adalah 20 laki-laki dan 14 wanita. Umur tertua 80 tahun termuda 17 tahun dengan rerata 47,6±19,4 tahun. Penyebab terbanyak adalah perforasi appendiks 38,2%, disusul perforasi ileum 20,6% dan gaster 17,6%. Bakteri anaerob penyebab adalah Bacteroides fragilis 77,8% dan Peptostreptococcus 22,2% yang masih sensitif terhadap metronidazole. Bakteri aerob penyebab mayoritas adalah Eschericiae coli 41,9%, Streptococcus sp. 25,8%, Enterococcus 12,9% Klebsiella 9,1%, Bacillus sp 3,2%, Enterobacter 3,2%, Stapilococcus sp 3,2%. Dari penelitian diperoleh angka mortalitas 12%. Hasil sensitivitas bakteri aerob terhadap ampisilin 19,4%, gentamisin 58,1%, dan ceftriaxone 87,1%. Dari uji stastistik Pearson Chi-Square, ceftriaxone lebih sensitif dibanding ampisilin dan gentamisin (p<0,000). Kesimpulan: Metronidazole masih sensitif untuk bakteri anaerob penyebab peritonis. Ceftriaxone lebih sensitif dibanding ampisilin dan gentamisin, yang secara statistik sangat bermakna.

Background: Peritonitis is an acute abdominal condition due to parietal and visceral peritoneal inflammation in the abdominal cavity. Based on the pathological mechanism, there are primary, secondary and tertiary peritonitis. Secondary peritonitis is a result of infection from pelvic inflammatory disorder (PID), hollow viscous perforation, intestinal ischemia, and biliary system disorder. The mortality rate of peritonitis ranges from 20% to 80%. The management with infection source treatment, causative correctional surgery, peritoneal cavity washing and the use of antibiotics. Objectives: To understand the bacterial pattern and their sensitivities to various antibiotics, and comparing ceftriaxone to ampicillin and gentamycin. Methods: Data collections were from adult peritonitis cases in Sardjito General Hospital in year 2004, which had undergone explorative laparotomy surgery. The specimens were taken from peritoneal fluids and sensitivity tests were done in the Microbiology Laboratory, Gadjah Mada University Faculty of Medicine. The data taken included age, sex, etiology of peritonitis, culture results and microbiological sensitivity tests. Statistical analyzes were then done to assess bacterial sensitivity to ceftriaxone compared to ampicillin and gentamycin with 95% confidence interval. Results: There were 34 cases of peritonitis in adults in year 2004, which had undergone explorative laparotomy surgeries. Twenty of them are males and 14 are females. The oldest patient is 80 years old and the youngest is 17 years old, with mean age 47.6 ± 19.4 years old. The most frequent etiology is appendiceal (38.2%), followed by ileal (20.6%), and gastric perforation (17.6%). The causative anaerobic bacteria were Bacteroides fragilis (77.8%) and Peptostreptococcus sp. (22.2%), which were still sensitive to metronidazole. The majority causative aerobic bacteria were Eschericiae coli (41.9%), Streptococcus sp. (25.8%), Enterococcus (12.9%), Klebsiella sp. (9.1%), Bacillus sp. (3.2%), Enterobacter sp. (32%), and Staphyllococcus sp. (3.2%). The study revealed that the mortality rate was 12%. The aerobic bacteria sensitivity test to ampicillin was showed to be19.4%, gentamycin 58.1%, and ceftriaxone 87.1%. Pearson’s Chisquare test indicated that the bacteria are more sensitive to ceftriaxone as compared to ampicillin and gentamycin. Conclusion: The anaerobic bacteria causatives of peritonitis are still sensitive to metronidazole. Furthermore, their sensitivities to ceftriaxone are higher as compared to their sensitivities to ampicillin and gentamycin, which were statistically shown as significant.

Kata Kunci : Peritonitis Sekunder,Pola Bakteri,Ampisilingentamisin