Tesis

Analisis Kesesuaian Kriteria Candida Score dan Hasil Kultur Darah dengan Pemberian Antijamur Pada Pasien Sepsis di ICU RSCM Maret 2015 – Oktober 2015 = The Analysis of The Conformity between Candida Score Criteria and Blood Culture Results With The Antifungal Administration in Sepsis Patients in the ICU of Dr. Cipto Mangunkusumo General Hospital from March to October 2015.

Pendahuluan: Pasien yang dirawat di ICU berisiko tinggi terserang kandidiasis invasif. Pemberian antijamur empirik dini dapat memperbaiki kondisi klinis pasien dan menurunkan angka kematian. Candida Score dari Leon mempunyai sensitifitas dan spesifisitas yang cukup baik untuk menggolongkan pasien ICU yang memang benar membutuhkan terapi empirik antijamur. Penelitian ini menganalisis kesesuaian kriteria Candida Score dan hasil kultur darah dengan pemberian antijamur pada pasien sepsis di ICU RSCM. Metodologi: Studi potong lintang dilakukan pada pasien sepsis yang dirawat di ICU RSCM pada Maret 2015 sampai dengan Oktober 2015. Dilakukan kultur pada sampel berupa darah, urin, dan sekret saluran nafas, selanjutnya dibiakkan. Karakteristik pasien dan riwayat klinisnya dicatat. Candida Score dihitung pada setiap pasien kemudian diuji asosiasinya dengan terapi yang didapatkan. Hasil: Dari 100 pasien 57 pasien mendapatkan antijamur. Proporsi pasien yang mendapat antijamur yaitu 50%, 17%, 57%, 83%, dan 100% pada kelompok pasien dengan Candida score 0-4 berturut-turut. Dalam penelitian ini tidak kami dapatkan pasien dengan Candida score=5. Hasil kultur darah positif Candida didapatkan pada 4 orang pasien dengan angka kematian sebesar 100%. Tiga pasien kandidemia dengan Candida score >3 mendapatkan antijamur setelah hasil kultur darah positif Candida. Kesimpulan: Terdapat asosiasi bermakna antara kriteria Candida score dengan pemberian antijamur pada pasien sepsis di ICU RSCM (p3 tidak mendapatkan terapi empirik.
Kata kunci: Candida Score, kandidiasis invasif, antijamur, ICU


Introduction: Prompt empirical antifungal therapy is essential for controling invasive candidiasis and has been shown to reduce mortality. Candida Score, established by Leon, has a good sensitivity and specivicity to distinguish critically ill patients whose invasive candidiasis is highly probable. This study analyzed the conformity between candida score criteria and blood culture results with the antifungal administration in patients with sepsis at the ICU of Dr. Cipto Mangunkusumo General Hospital (RSCM), Methods: A cross sectional study was conducted from March-October 2015 at the ICU of RSCM. Critically ill patients who exhibited sepsis were included in this study. The urine, blood, and respiratory secrete were collected and were cultured in the microbiology laboratory. Each patient’s characteristics and medical history were also recorded. The candida score was calculated and then tested for their association with treatment obtained. Results: Of the 100 patients, 57 patients received antifungal therapy, with the proportion of 50%, 17%, 57%, 83%, and 100% in the patients group broken by the Candida Score of 0 to 4 respectively. There’s no patient with Candida Score of 5. Candida positive blood culture results (candidaemia) were observed in 4 patients, with a mortality rate of 100%. Three of which had the score of >3 but received antifungal therapy after the positive blood culture results obtained. Conclusion: There is a significant association between Candida Score criteria with antifungal administration in septic patients in the ICU of RSCM (p 3 did not get empiric antifungal therapy.
Keywords: Candida Score, Invasive Candidiasis, Antifungal, ICU