HUBUNGAN PENINGKATAN TNF-α DAN LEUKOSIT DENGAN KEJADIAN INFEKSI LUKA OPERASI PASCA OPERASI MAYOR DI RSUP Dr. SARDJITO

Sri Utami, dr. Supomo, Sp.B(K)BTKV.

2013 | Tesis | S2 Ilmu Bedah

Infeksi luka operasi (ILO) merupakan salah satu komplikasi operasi yang sering terjadi. Infeksi luka operasi didefinisikan sebagai adanya cairan nanah, abses atau selulitis yang meluas pada tempat luka yang muncul dalam 30 hari setelah operasi atau dalam 1 tahun pada kasus implan. Dari keseluruhan infeksi nosokomial yang dilaporkan diberbagai penjuru dunia 20%-25% adalah ILO. Untuk menegakkan adanya infeksi bakterial selama ini yang banyak digunakan adalah data klinis, jumlah leukosit, dan kultur darah atau pus yang memerlukan waktu lama sehingga sering terjadi keterlambatan terapi. Oleh karena itu dibutuhkan metode diagnosis lain yang cepat dan bisa menjadi petunjuk adanya infeksi luka operasi (ILO). Penelitian ini adalah penelitian deskriptif analitik dengan rancangan prospektif observational. Pasien yang menjalani operasi mayor antara Oktober sampai dengan Desember 2011, dilakukan informed consent, pemeriksaan klinis dan jumlah leukosit pre operasi, pasien yang memenuhi kriteria diikuti sampai 30 hari pasca operasi. Pada hari ke-3 post operasi dilakukan pemeriksaan jumlah leukosit dan kadar TNF-α serum, pasien yang masuk dalam kriteria infeksi luka operasi (ILO) sesuai kriteria Centers for Disease Control (CDC) United State of America dilakukan pemeriksaan kultur dari luka operasi. Tujuan penelitian ini adalah untuk mengetahui hubungan antara peningkatan kadar TNF-α serum dan jumlah leukosit dengan terjadinya ILO. Sebanyak 45 pasien memenuhi kriteria inklusi, terdiri dari 20 orang lakilaki dan 25 perempuan. Ditemukan 16 kasus (36%) terjadi ILO, terdiri dari 12 kasus ILO tipe superficial dan 4 kasus ILO tipe deep. Pemeriksaan laboratorium hari ke- 3 pasca operasi, ditemukan 11 pasien memiliki jumlah leukosit abnormal, 7 pasien diantaranya mengalami ILO. Didapatkan nilai sensitivitas kadar leukosit dalam mendiagnosis infeksi luka operasi sebesar 43,8% dan spesifisitas 86,2%. Terdapat 31 pasien yang memiliki kadar TNF-α serum abnormal, 12 diantaranya mengalami ILO. Terdapat hubungan antara jumlah leukosit dengan kejadian ILO dengan P=0,035 dan OR 4,861 (IK 95% 1,145-20,632), tidak terdapat hubungan antara kadar TNF-α dengan kejadian ILO dengan P=0,738 dan OR 1,579 (IK 95% 0,403- 6,191). Berdasarkan analisis kurva ROC nilai kadar TNF-α 7,455 pg/ml adalah cut of point optimal untuk predictor terjadinya ILO.

Surgical site infection (SSI) is one of surgical complication which mostly happens. Surgical site infection is defined as a condition where pus, abscess or expanding cellulitis is found on the surgical site within 30 days post-operatively or within 1 year after implant surgery. Among all nosocomial infections reported around the world, 20-25% of them are surgical site infections. To diagnose a bacterial infection, it mostly uses clinical data, white blood count, blood culture, or pus culture, which needs a long time to proceed and cause a delayed therapy. Thus, we need another diagnostic method which results faster to indicate any surgical site infection (SSI). This study was a descriptive analysis with an observational prospective design. Patients who underwent major surgeries during October 2011 until December 2011, were informed consent and had their clinical condition and white blood count examined before surgery. Patients who were included in the criteria were followed up to 30 days after surgery. On the third day after surgery, the patients had their white blood count and serum TNF-α checked. Patients who were included in to the SSI criteria based on Centers for Disease Control (CDC) United State of America underwent culture examination from their surgical wound. The purpose of this study was to understand the correlation between the increase of serum TNF-α and white blood count with the incidence of SSI. There were 45 patients included in the criteria, which consisted of 20 males and 25 females. We found 16 cases (36%) of SSI, which consisted of 12 cases superficial type-SSI and 4 cases deep type-SSI. Laboratory examination on the third day after surgery showed that there were 11 patients with abnormal white blood count; seven of them were having SSI. The sensitivity of white blood count in diagnosing surgical site infection was 43.8% with specificity of 86.2%. There were 31 patients who had abnormal serum TNF-α; twelve of them were having SSI. There was a correlation between white blood count and the incidence of SSI with P value = 0.035 and odd ratio = 4.861 (CI=95% 1.145-20.632), and there were no correlation between serum TNF-α and the incidence of SSI with P=0.738 and odd ratio 1.579 (CI=95% 0.403-6.191). Based on ROC curve analysis, the TNF-α serum level of 7.455 pg/ml was the optimal cut of point to predict the incidence of SSI.

Kata Kunci : Kadar TNF-α serum, Jumlah leukosit, Infeksi luka operasi (ILO)