Tesis

Analisis Faktor Risiko Infeksi Jamur Invasif Pascaoperasi Digestif di Unit Perawatan Intensif RSCM dan RS Fatmawati = Risk Factor Analysis in Invasive Fungal Disease Post Abdominal Surgery in ICU

Latar belakang: Infeksi jamur invasif meningkatkan morbiditas dan mortalitas pasien yang dirawat di UPI. Penelitian ini bertujuan mengetahui hubungan antara tindakan intervensi dengan infeksi jamur invasif pada pasien bedah pascaoperasi abdomen yang dirawat di UPI. Metode penelitian: Desain penelitian adalah studi kasus kontrol berpasangan. Kasus adalah pasien dengan infeksi jamur invasif yang dirawat di UPI pascaoperasi abdomen di RSCM dan RS Fatmawati di Jakarta 2013-2016. Perbandingan kasus dan kontrol ditetapkan 1:1 berdasarkan waktu dan lokasi perawatan di UPI. Identifikasi hubungan antara intervensi medis (nutrisi parenteral total, tipe operasi, ventilator, pemasangan kateter vena sentral, pemakaian drain, kateter urin dan pemberian antibiotik sebagai faktor risiko terjadi infeksi jamur invasif. Analisis statistik dengan menggunakan analisis bivariat dan multivariat. Hasil penelitian: Terdapat 37 kasus infeksi jamur invasif. Jenis jamur yang teridentifikasi adalah: ragi (37,8%), Candida Albicans (26,7%), Candida Tropicalis (26,7%), Candida Parapsilosis (8,8%). Pada analisis bivariat didapatkan faktor risiko (p 8 hari), durasi dan pemakaian ventilator (>2 hari), penggunaan dan durasi pemberian TPN (>3 hari), durasi penggunaan kateter urin (>9 hari), durasi penggunaan drain, lama rawat di UPI, dan jumlah penggunaan antibiotik. Pada analisis multivariat didapatkan faktor independen adalah durasi penggunaan kateter urin (OR 1,113, 95%CI: 1,016–1,218), durasi nutrisi parenteral total (OR 1, 95%CI : 1,73–8,78), dan penggunaan ventilator (OR 3,35, 95%CI : 0,997-11,2). Kesimpulan: Penggunaan ventilator, durasi pemasangan kateter urin dan nutrisi parenteral total merupakan faktor signifikan terjadinya infeksi jamur invasif pascaoperasi abdomen di UPI sehingga penggunaannya harus dimonitor secara ketat.
Kata kunci: infeksi jamur invasif, operasi abdomen, Unit Perawatan Intensif


Background: Invasive fungal infections increase the morbidity and mortality of patients treated in ICU. This study to investigate the association between intervention and incidence of invasive fungal disease post abdominal surgery in ICU Method: A multi-institutional case-control study was undertaken. Case taken were patients who develop invasive fungal disease whom was admitted in ICU after abdominal surgery in Cipto Mangunkusumo Hospital and Fatmawati Hospital in Jakarta during 20132016. Cases were frequency matched on a 1:1 ratio based on time and place the patient admitted in the ICU. Outcomes of interest were correlation of medical interventions (total parenteral nutrition, type of surgery, mechanical ventilation, central venous catheters, body cavity drainage tubes, catheters, antibiotics treatment) as risk factor of invasive fungal disease. Statistical analysis using bivariate and multivariate analysis were performed. Results: There are 37 cases of ICU invasive fungal infection were analyzed. The fungi identified were: yeasts (37.8%), C. albicans (26.7%), C. tropicalis (26.7%), C. parapsilosis (8.8%). In the bivariate analysis, risk factors (P < 0.05) of developing ICU invasive fungal disease were CVC and duration of use (> 8 days), mechanical ventilation and duration of use (> 2 days), TPN and duration of use (> 3 days), duration of urinary catheter use (> 9 days), duration of drainage tubes, length of stay in ICU, and numbers antibiotic in use. In the multivariate analysis, independent factors significantly associated with invasive fungal disease were duration catheter use (OR 1.113, 95% CI: 1.016–1.218), duration of total parenteral nutrition (OR 1, 95% CI: 1.73–8.78), use ventilator (OR 3,35, 95% CI: 0.997-11.2). Conclusions: Mechanical ventilator, duration of catheter and TPN use was a significant risk factor for invasive fungal infection post abdominal surgery in ICU, and its use should be monitored closely.
Keywords: invasive fungal infection, abdominal surgery, ICU