Evaluasipenggunaan antibiotika profilaksis pada luka operasi bersih dan bersih terkontaminasi di Rumah Sakit Umum Daerah Prof.Dr. WZ. Johanes Kupang periode Oktober-Desember 2004

BLEGUR, Fatmawati, Prof.Dr. Lukman Hakim, M.Sc.,Apt

2006 | Tesis | S2 Ilmu Farmasi (Magister Farmasi Klinik)

Infeksi luka operasi merupakan infeksinosokomial nomer 2 terbanyak dan penderita yang menjalani pembedahan merupakan penderita yang mempunyai risiko tinggi untuk terkena infeksi tersebut. Pemberian antibiotika profilaksis sebelum dilakukan pembedahan diharapkan mampu mencegah terjadi infeksi. Penelitian ini bertujuan untuk mengevaluasi penggunaan antibiotika profilaksis dalam pencegahan infeksi luka operasi serta mengevaluasi sejauh mana keamanan pemakaian obat yang diberikan pada penderita yang menjalani operasi dengan luka operasi bersih dan bersih kontaminasi di RSUD Prof. Dr WZ Johanes Kupang. Penelitian ini dilakukan secara prospektif dengan rancangan cross sectional, yaitu dilakukan pengamatan klinis pada penderita yang menjalani pembedahan dengan luka bersih dan bersih terkontaminasi selama periode Oktober – Desember 2004. Analisa dan evaluasi data meliputi diskripsi angka kejadian infeksi luka operasi juga karakteristik penderita yang mengalami ILO, melihat hubungan antara penggunaan antibiotika profilaksis dengan kejadian ILO , mengevaluasi kesesuaian penggunaan antibiotika profilaksis dengan stadar serta mengevaluasi keamanan penggunaan obat – obatan yang diterima penderita. Jumlah penderita yang menjalani pembedahan dengan luka bersih dan bersih terkontaminasi sebanyak 66 penderita, 45 penderita diantaranya (68,18 %) mendapat antibiotika profilaksis dan 21 penderita (31,82 %) tidak mendapat antibiotika profilaksis. Infeksi luka operasi terjadi pada 9,09%. Kejadian ILO seluruhnya pada perempuan yaitu sebanyak 11,1%.Umur 15 – 60 tahun paling banyak menjalani pembedahan dan keseluruhan ILO terjadi pada usia tersebut . Penderita yang menjalani lama perawatan sebelum operasi > 3 hari kejadian ILO lebih banyak (25%)dari pada lama perwatan
3 hari (5,6%). Ronde operasi ke  3 terkena ILO sebanyak 22,2 % sedangkan ronde ke 1 dan 2 masing – masing 4,2 %. Penderita yang menjalani bedah elektif, mengalami ILO 10% dan yang non elektif sebanyak 6,3%. Jenis luka operasi bersih kontaminasi kejadian ILO paling banyak yaitu 16,7% sedangkan luka operasi bersih adalah 2,8 %. Penderita yang menjalani lama operasi
1 jam persentase ILO 4,4 % dan > 1 jam sebesar 21,1 %. Keseluruhan ILO terjadi pada penderita yang tidak memiliki riwayat penyakit penyerta. Berdasarkan analisa statistik tidak terdapat hubungan kejadian infeksi luka operasi pascabedah bersih dan bersih terkontaminasi antara penderita yang diberikan dan yang tanpa antibiotika profilaksis. Kesesuaian penggunaan antibiotika profilaksis dengan standar meliputi: Ketepatan indikasi sebanyak 42,2% dari keseluruhan yang mendapat antibiotika diantaranya mendapat ampisilin yang sesuai 24,4% dan sefotaksim 17,8%. Pemilihan jenis antibiotika profilaksis ampisilin 24,4% sesuai dengan standar dan 6,7% pemakaian sefotaksim juga sudah sesuai. Sebanyak 2,2% kasus mendapatkan ampisilin dengan dosis sesuai dan 6,7 % kasus mendapat sefotaksim dengan dosis yang sesuai. Rute durasi dan frekuensi pemberian antibiotika profilaksis sudah sesuai dengan standard. Secara keseluruhan pemberian antibiotika profilaksis sebelum pembedahan sudah sesuai yang dipersyaratkan yaitu pemberiannya 2 jam sebelum operasi. Terdapat 43,9% kasus yang berpotensial terjadi interaksi obat, hal ini menggambarkan ketidak amanan terapi sehingga perlu diwaspadai dan diminimalkan kejadiannya.

Surgical site infection is the second greatest nosocomial infection and patients having surgery have high risk of such infection. The supply of prophylaxis antibitiotics prior to surgery is expected to be able to prevent infection. The study was meant to evaluate use of prophylaxis antibiotics to prevent surgical site infection and to evaluate safety in use of drugs given to patients having surgery with clean surgical and clean contaminated site at Prof. Dr. WZ. Johanes Hospital, Kupang. This was a prospective study with cross sectional design. Clinical observation to patients having surgery with clean and clean contaminated site was conducted from October to December 2004. Data analysis and evaluation consisted of description of surgical site infection occurence and characteristics of patients having surgical site infection, identification of relationship between use of prophylaxis antibiotics and occurence of surgical site infection, evaluation of relevance of prophylaxis antibiotic use with standard and evaluation of safety in use of drugs by patients. As many as 66 patients had clean and clean contaminated site, 45 of them (68.18%) got prophylaxis antibiotics and 21 (31.82%) did not get prophylaxis antibiotics. Occurrence of surgical site infection was as much as 9.09%. Surgical site infection occured to female patients as much as 11.1%. Those having surgery were mostly at age 15 – 60 years old and surgical site infection all occured at that age group. Patients being in care more than 3 days prior to surgery tended to have as much as 25% of surgical site infection and those having less than 3 days had as much as 22.2% whereas those having only once or twice had as much as 4.2%. patients having elective surgery had surgical site infection as much as 10% and those having non elective had surgical site infection as much as 6.3%. Occurrence of surgical site infection in clean contaminated site was as much as 16.7% whereas in clean site was 2.8%. Patients having operation less than an hour had 4.4% of surgical site infection and those having more than an hour had 21.1%. Surgical site infection occurred to patients who did not have inherent disease history.There was no relationship in occurence of clean post surgical site infection and clean contaminated post surgical site infection between patients who got and did not get prophylaxis antibiotics. Relevance in use of prophylaxis antibiotics with standard comprised occuracy of indication as much as 42.2% from those having antibiotics, some of them got ampicillin (24.4%) and sefotaxim (17.8%), Preference to ampicilin prophylaxis antibiotics was 24.4% relevant with standard and sefotaxim was 6.7% also relevant with standard. As much as 2.2% of case got ampicillin with suitable dosage and 6.7%got sefotaxim with suitable dosage. Duration and frequency of supply of prophylaxis antibiotics were relevant with standard. In general the supply of prophylaxis antibiotics prior to surgery was relevant with the requirement, i.e. it was given 2 hours before operation. There was 43.9% of cases potentially causing drug interaction. This indicated unsafety of therapies so that occurence of such interaction should be kept aware and minimized.

Kata Kunci : Antibiotika Profilaksis,Operasi Bersih dan Bersih Terkontaminasi, surgical site infection, prophylaxis antibiotics