Tesis

Evaluasi Tingkat Kepatuhan Terhadap Pedoman Antibiotika Pada Tata laksana Sepsis Neonatorum = Evaluation of Adherence to Antibiotic Guidelines on the Management of Neonatal Sepsis.

Latar Belakang. Sepsis neonatorum diagnosisnya sulit ditegakkan karena gejala klinis dan laboratorium yang tidak spesifik. Pengobatan utama sepsis neonatorum adalah antibotik untuk menurunkan mortalitas, namun penggunaan antibiotik sering berlebihan, sehingga menyebabkan resistensi bahkan meningkatkan mortalitas. Objektif. Mengetahui tingkat kepatuhan dokter penanggung jawab pasien (DPJP) terhadap pedoman antibiotika pada tata laksana sepsis neonatorum, faktor-faktor yang mempengaruhi keputusan DPJP untuk memulai pemberian antibiotik, proses evaluasi pemberian dan penghentian antibiotik, kepatuhan pemilihan antibiotik empirik serta mengetahui faktor-faktor risiko apa saja yang dipakai dalam menegakkan diagnosis sepsis neonatorum awitan dini (SNAD) maupun sepsis neonatorum awitan lambat (SNAL). Metode. Studi dengan uji potong lintang menggunakan kuesioner wawancara pada subyek, data sekunder rekam medik serta melakukan Indepth Interview pada DPJP. Sampel penelitian adalah semua bayi baru lahir baik di RSCM maupun dari luar, diputuskan mendapat terapi antibiotik empirik lalu diberi stempel antibiotik periode bulan Desember 2017-Februari 2018 di divisi Neonatologi RSCM. Sebanyak 113 subyek dengan 167 kejadian dilakukan analisis. Hasil. Terdapat keragaman pemeriksaan septic screening awal yaitu 1-6 jam setelah lahir dan pemeriksaan ulangan rerata 56,45±37,40 jam pada SNAD dan pada SNAL 72,00±50,91 jam, antibiotik yang dilanjutkan sesuai antara klinis dan laboratorium pada SNAD 43 (52,43%) dari 82 subyek, dan SNAL 7 (50%) dari 14 subyek, namun 100% patuh pada regimen antibiotik empirik ampisilin dan gentamisin untuk tatalaksana SNAD ringan pada 86 (51,49%) kasus, rerata hari konsul ke divisi Infeksi adalah 9,53±5,39 pada SNAD dan 9,63±3,89 pada SNAL. Dan tidak didapatkannya hubungan antara faktor risiko dengan kesesuaian laboratorium dan klinis sepsis (p=0.869). Kesimpulan. Terdapat perbedaan pertimbangan para DPJP dalam mendiagnosis sepsis, sehingga menyebabkan ketidak patuhan terhadap pedoman antibiotik yang ada.
Kata kunci: Sepsis Neonatorum, Sepsis neonatorum awitan dini, Sepsis neonatorum awitan lambat, Pedoman antibiotika, Tingkat kepatuhan, Dokter penanggung jawab pasien


Background. Establishing diagnosis of neonatal sepsis is difficult due to nonspecific clinical symptoms and laboratorial results. The key management for neonatal sepsis is antibiotic administration, decreasing mortality rate. However, over administration of antibiotic may lead to resistance and even increasing the mortality rate. Objectives. To evaluate the adherence of attending physicians to the neonatal sepsis guideline; To know factors that influence the attending physicians' decision in administrating the antibiotics; And to know risk factors that are considered by attending physicians to diagnose both early-onset neonatal sepsis (EOS) and lateonset neonatal sepsis (LOS) Methods. Cross-sectional study was performed using questionnaire taken from the subjects, secondary data in form of medical records, and in-depth interview on the attending physicians. Data collection was done in December 2017 - February 2018, in Cipto Mangunkusumo Hospital Neonatologi Division. Total subjects of the research was 113, with 167 cases recorded, were then analyzed. Results. Various results were found regarding the early screening (1-6 hours after birth) and follow-up screening for EOS 56,45±37,40 hours and LOS 72,00±50,91 hours. Appropriate administration of antibiotic, based on clinical and laboratorial data, are found in 43 (52,43%) from 82 case of EOS and 7 (50%) from 14 cases of LOS. All of attending physicians followed the guidelines regarding empirical antibiotic regiments for mild EOS, which is Ampicillin and Gentamicin on 86 cases (51.49%). Average management time before attending physicians started to ask for consultation for EOS and LOS are 9,53 ± 5,39 days and 9,63 ± 3,89 days respectively. No relation were found between risk factors with laboratorial results and clinical sepsis (p=0.869). Conclusion. Low level of adherence toward the antibiotic guideline is due to different considerations of attending physicians in diagnosing neonatal sepsis.
Keyword: Neonatal Sepsis, Early-Onset Neonatal Sepsis, Late-Onset Neonatal Sepsis, Antibiotic Guidelines, Adherence Rate, Attending Physicians