Rasionalitas Penggunaan Antibiotik Empirik dan Definitif pada Pasien Sepsis di Intensive Care Unit RSUP. Dr. Sardjito
Mayada Rakhmima Karizki(1), Ika Puspitasari(2*), Rizka Humardewayanti Asdie(3)
(1) Magister Farmasi Klinik, Fakultas Farmasi UGM
(2) Faculty of Pharmacy, Universitas Gadjah Mada
(3) Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM
(*) Corresponding Author
Abstract
Sepsis merupakan penyakit mengancam jiwa berupa disfungsi organ yang berhubungan dengan infeksi. Hingga saat ini sepsis menjadi sebab utama kematian di Intensive Care Unit (ICU). Penanganan yang diberikan pada 1 jam pertama akan menentukan keberhasilan terapi selanjutnya, salah satunya antibiotik. Penggunaan antibiotik yang rasional berkaitan dengan luaran klinik pasien. Tujuan dari penelitian ini adalah mengetahui hubungan rasionalitas antibiotik dengan luaran klinik pasien sepsis di ICU RSUP Dr. Sardjito tahun 2018-2019. Penelitian dilakukan secara observasional-analitik dengan desain kohort retrospektif. Dari 59 pasien yang memenuhi kriteria inklusi, diperoleh 138 antibiotik dengan rincian 112 antibiotik empirik dan 26 antibiotik definitif. Kriteria Gyssens digunakan untuk evaluasi rasionalitas antibiotik dilanjutkan analisis hubungan rasionalitas antibiotik dan variabel perancu dengan luaran klinik menggunakan uji Chi-square atau Fisher's Exact. Masing-masing uji menggunakan tingkat kepercayaan sebesar 95%. Persentase penggunaan antibiotik secara rasional (kategori 0) sebesar 13,6% (23 antibiotik) untuk antibiotik empirik dan 21,6% (8 antibiotik) untuk antibiotik definitif. Total persentase antibiotik tidak rasional (kategori I-V) dari antibiotik empirik dan definitif secara berurutan sebesar 86,4% (146 antibiotik) dan 78,4% (29 antibiotik). Terdapat hubungan yang tidak signifikan antara rasionalitas antibiotik dengan luaran klinik pasien sepsis di ICU RSUP Dr. Sardjito tahun 2018-2019 (p>0,05).
Keywords
Full Text:
PDFReferences
Angus, D.C. dan Van Der Poll, T., 2013. Severe Sepsis and Septic Shock. New England Journal of Medicine, 369: 840–851. Avni, T., Lador, A., Lev, S., Leibovici, L., Paul, M., dan Grossman, A., 2015. Vasopressors for the Treatment of Septic Shock: Systematic Review and Meta-Analysis. PLOS ONE, 10: 1–17. Blot, S.I., Pea, F., dan Lipman, J., 2014. The Effect of Pathophysiology on Pharmacokinetics in The Critically Ill Patient — Concepts Appraised by The Example of Antimicrobial Agents. Advanced Drug Delivery Reviews, 77: 3–11. Brook, I., Wexler, H.M., dan Goldstein, E.J.C., 2013. Antianaerobic Antimicrobials: Spectrum and Susceptibility Testing. Clinical Microbiology Reviews, 26: 526–546. Caınzos, M., 2008. Review of The Guidelines for Complicated Skin and Soft Tissue Infections and Intra-Abdominal Infections—are They Applicable Today? European Society of Clinical Microbiology and Infectious Diseases, 14: 9–18. Chen, C.-M., Cheng, K.-C., dan Yu, W.-L., 2014. Age May Not Influence the Outcome of Patients with Severe Sepsis in Intensive Care Units. International Journal of Gerontology, 8: 22–26. Christophe, A., 2007. Influence of Gender on the Outcome of Severe Sepsis. Critical Care Medicine, 132: 1786–1793. Dellinger, R.P., Levy, M.M., Rhodes, A., Annane, D., Gerlach, H., Opal, S.M., dkk., 2013. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012. Critical Care Medicine and Intensive Care Medicine, 41: 580–637. Freitas, F.M., Zamoner, W., Souza Garms, D.S., Oliveira, M.G., Balbi, A.L., dan Ponce, D., 2016. The Use of Antimicrobials in Septic Patients with Acute Kidney Injury. Antimicrobials in critical patients, 39: 323–328. Genga, K.R. dan Russell, J.A., 2017. Update of Sepsis in the Intensive Care Unit. Journal of Innate Immunity, 9: 441–455. Gushka, H., 2015. 'Evaluasi Penggunaan Antibiotika pada Pasien Sepsis di Ruang ICU Rumah Sakit Umum Daerah Serang'. Tesis, M.Sc., Fakultas Farmasi, Universitas Gadjah Mada, Yogyakarta. Kemenkes RI, 2015. Peraturan Menteri Kesehatan Republik Indonesia, Nomor 8 Tahun 2015, Tentang Program Pengendalian Resistensi Antimikroba Di Rumah Sakit. Jakarta, Kementrian Kesehatan Republik Indonesia. Kumar, A. dan Singh, N.P., 2015. Antimicrobial Dosing in Critically Ill Patients with Sepsis‑Induced Acute Kidney Injury. Indian Journal of Critical Care Medicine, 19: 99–106. Lertwattanachai, T., Montakantikul, P., Tangsujaritvijit, V., Sanguanwit, P., Sueajai, J., Auparakkitanon, S., dkk., 2020. Clinical Outcomes of Empirical High-Dose Meropenem in Critically Ill Patients with Sepsis and Septic Shock: A Randomized Controlled Trial. Journal of Intensive Care, 8: 1–10. Levy, M.M., Evans, L.E., dan Rhodes, A., 2018. The Surviving Sepsis Campaign Bundle: 2018 Update. Intensive Care Medicine, 44: 925–928. Liang, S.Y. dan Kumar, A., 2015. Empiric Antimicrobial Therapy in Severe Sepsis and Septic Shock: Optimizing Pathogen Clearance. Current Infectious Disease Reports, 17: 36. Llor, C. dan Bjerrum, L., 2014. Antimicrobial Resistance: Risk Associated with Antibiotic Overuse and Initiatives to Reduce the Problem. Therapeutic Advances in Drug Safety, 5: 229–241. Martin, G.S., Mannino, D.M., dan Moss, M., 2006. The Effect of Age on The Development and Outcome of Adult Sepsis. Crit Care Med, 34: 15–21. Mayr, V.D., Dünser, M.W., Greil, V., Jochberger, S., Luckner, G., Ulmer, H., dkk., 2006. Causes of Death and Determinants of Outcome in Critically Ill Patients. Critical Care, 10: R154. Pietropaoli, A.P., Glance, L.G., Oakes, D., dan Fisher, S.G., 2010. Gender Differences in Mortality in Patients with Severe Sepsis or Septic Shock. Gender Medicine, 7: 422–437. Pradipta, I.S., 2009. 'Evaluasi Penggunaan Antibiotik pada Pasien Sepsis di Bangsal Rawat Inap Penyakit Dalam RSUP DR. Sardjito Yogyakarta Periode September-November 2008'. Universitas Gadjah Mada, Tesis, M.Sc., Fakultas Farmasi, Universitas Gadjah Mada, Yogyakarta. Razazi, K., 2017. Frequency, Associated Factors and Outcome of Multi-Drug-Resistant Intensive Care Unit-Acquired Pneumonia Among Patients Colonized with Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae 7. Rhee, C., Jones, T.M., Hamad, Y., Pande, A., Varon, J., O’Brien, C., dkk., 2019. Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality in US Acute Care Hospitals. Critical Care Medicine, 2: 1–14. Rhodes, A., Evans, L.E., Alhazzani, W., Levy, M.M., Antonelli, M., Ferrer, R., dkk., 2017. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Medicine, 43: 304–377. Sakr, Y., Jaschinski, U., Wittebole, X., Szakmany, T., Lipman, J., Ñamendys-Silva, S.A., dkk., 2018. Sepsis in Intensive Care Unit Patients: Worldwide Data from the Intensive Care over Nations Audit. Open Forum Infectious Diseases, 5: 1–9. Seok, H., Jeon, J.H., dan Park, D.W., 2020. Antimicrobial Therapy and Antimicrobial Stewardship in Sepsis. Infection & Chemotherapy, 52: 19. Shah, S., Barton, G., dan Fischer, A., 2015. Pharmacokinetic considerations and dosing strategies of antibiotics in the critically ill patient. Journal of the Intensive Care Society, 16: 147–153. Singer, M., Deutschman, C.S., Seymour, C.W., Shankar-Hari, M., Annane, D., Bauer, M., dkk., 2016. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 315: 801–810. Timsit, J.-F., Soubirou, J.-F., Voiriot, G., Chemam, S., Neuville, M., Mourvillier, B., dkk., 2014. Treatment of Bloodstream Infections in ICUs. BMC Infectious Diseases, 14: 1–11. Zhou, X., Su, L.-X., Zhang, J.-H., Liu, D.-W., dan Long, Y., 2019. Rules of Anti-Infection Therapy for Sepsis and Septic Shock. Chinese Medical Journal, 132: 589–596.
DOI: https://doi.org/10.22146/farmaseutik.v1i1.62045
Article Metrics
Abstract views : 2774 | views : 6793Refbacks
- There are currently no refbacks.