Hubungan pemakaian antibiotik dengan kejadian infeksi sectio caesarea pada pasien di RSUD Abepura Jayapura Papua

EMMA, Nani, dr. Ova Emilia, SpOG,M.M.Ed,Ph.D

2010 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang: Jumlah operasi sectio caesarea di dunia telah meningkat tajam 20 tahun terakhir. Peningkatan kebutuhan operasi SC meningkatkan permasalahan yang berkaitan proses pembedahan. Sekitar 2% sampai 16% terjadi infeksi setelah operasi sectio caesarea. Kejadian infeksi post SC terkait dengan beberapa faktor antara lain pemberian antibiotik profilaksis, lama persalinan, lebar luka membran, lama monitoring perawatan luka dan jumlah dari sectio caesarea. Kejadian infeksi SC terkait dengan pengunaan antibiotik sebelum maupun setelah operasi SC. Kejadian infeksi meningkat 3 kali pada pasien yang tidak diberikan antibiotik sebelum operasi SC. Pengunaan antibiotik profilaksis pada operasi SC signifikan menurunkan indiden kejadian infeksi. Tujuan: Mengetahui pengaruh antibiotik sesuai SOP dengan kejadian infeksi pada ibu sectio caesarea. Metodologi: Penelitian ini merupakan penelitian analitik dengan rancangan cross sectional. Penelitian dilakukan di Rumah Sakit Umum Daerah Abepura. Populasi adalah seluruh ibu yang melahirkan melalui sectio caesarea di RSUD Abepura Jayapura. Pengambilan sampel dilakukan dengan sistematic random sampling. Besar sampel sebanyak 44 sampel. Instrumen yang digunakan dalam penelitian adalah kuesioner. Pengumpulan data dilakukan dengan wawancara dan telaah dokumen. Analisis data dengan uji chi-square dan regresi logistik, risk prevalence dengan confident interval (CI) 95% dengan tingkat kemaknaan p <0,05. Hasil: Sebagian besar subjek tidak terjadi infeksi SC 56,82%, pemakaian antibiotik sesuai prosedur 59,09%, status gizi buruk 47,73%, jenis operasi emergensi 54,55%, dan mengalami anemia dan tidak anemia 50%;50%. Rata-rata lama operasi SC 2.26±1,38 jam. Terdapat hubungan yang signfikan antara pemakaian antibiotik, status gizi, kadar Hb, dan jenis operasi dengan kejadian infeksi SC p= < 0.05. Analisis multivariabel menunjukkan bahwa terdapat hubungan yang signifikan antara pemakaian antibiotik, status gizi, jenis operasi dengan kejadian infeksi. Status obesitas lebih dominan berrisiko terhadap kejadian infeksi SC (RP=2,36; 95% CI=1,45-3,38) dimana pemakaian antibiotik, status gizi dan jenis operasi dapat memprediksi kejadian infeksi SC 11,6%. Kesimpulan: Peluang kejadian infeksi SC lebih kecil pada pemakaian antibiotik yang sesuai setandar operational prosedur dibanding dengan pemakaian antibiotik tidak sesuai standart operasional prosedur. Terdapat hubungan yang signifikan antara pemakaian antibiotik, status gizi, kadar Hb dan jenis operasi dengan kejadian infeksi.

Background: The number of caesarean section (CS) operations in the world has increased sharply within the last 20 years. Increase of the need for CS operations also increases the problem related to surgical process. Infection happens about 2% to 16% after CS operation. The incidence of post CS is associated with some factors such as supplementation of prophylaxis antibiotics, duration of childbirth, width of membrane wound, duration of surgical nursing monitoring and number of CS. CS infection associated with antibiotic use occurs before or after CS operation. The incidence increases 3 times in patients that do not use antibiotics before CS operation. Use of prophylaxis antibiotics in CS operation significantly minimizes the incidence of infection. Objective: To identify antibiotic use according to standard operational procedure to the incidence of infection in CS mothers. Method: The study was analytical with cross sectional design, undertaken at Abepura Local Hospital. Population were all mothers who gave birth through CS at the hospital. Samples were taken using systematic random sampling technique as many as 44 samples. Data were obtained through questionnaire, interview and document studies and analyzed using chi square and logistic regression test, risk prevalence at confidence interval (CI) 95% and significance p<0.05. Result: The majority of subject (56.82%) had no infection; 59.09% used antibiotics according to the procedure; 52.27% had good nutrition status; 54.55% had emergency operation; 50% had anemia. Average length of CS operation was 2.26 +1.38 hours. There was significant association between antibiotic use, nutrition status, Hb level, and types of operation and the incidence of CS infection (p<0.05). The result of multivariate analysis showed there was significant association between antibiotic use, nutrition status, types of operation and the incidence of infection. Use of antibiotic brought dominant risk for the incidence of CS infection (PR=2.36; 95% CI=1.45-3.38) whereby antibiotic use, nutrition status and types of operation could predict the incidence of CS infection as much as 10.7%. Conclusion: The majority of subject had no infection and used antibiotic according to the procedure. The probability for the incidence of CS infection was greater in antibiotic use irrelevant with the procedure. Factor most dominantly affecting the incidence of CS infection was antibiotic use irrelevant with the procedure.

Kata Kunci : pemakaian antibiotik, seksio casaerea, kejadian infeksi, antibiotic use, caesarean section, incidence of infection