Tesis

Hubungan Kesesuaian Pemilihan Antibiotik Empirik Menurut Panduan Infectious Disease Society of America/ American Thoracic Society 2007 dan Hasil Kepekaan Antibiotik dengan Keberhasilan Pengobatan Pneumonia Komunitas Dewasa = Association of Initial Empirical Antibiotic Choices According to Infectious Disease Society of America/ American Thoracic Society 2007 and Antibiotic Susceptibility Result with Outcomes of Community Acquired Pneumonia Patients.

Latar Belakang : Pneumonia komunitas masih menjadi masalah besar di dunia dan di Indonesia khususnya dengan tingkat mortalitas yang cukup tinggi. Kegagalan terapi antibiotik inisial dapat mempengaruhi keberhasilan pengobatan dan mortalitas pada pneumonia komunitas. Pemilihan antibiotik empirik banyak berdasarkan panduan dari berbagai organisasi kesehatan. Namun penggunaan panduan tersebut belum tentu sesuai dengan pola bakteri lokal. Tujuan : Mengetahui hubungan kesesuaian pemilihan jenis antibiotik empirik berdasarkan panduan Infectious Disease Society of America (IDSA)/ American Thoracic Society (ATS) 2007 dan pemilihan jenis antibiotik empirik berdasarkan hasil kepekaan antibiotik dengan keberhasilan pengobatan pneumonia komunitas dewasa. Metode : Penelitian kohort retrospektif ini menggunakan data sekunder dari rekam medis, data prospektif penelitian sebelumnya dan data hasil kepekaan antibiotik yang dikeluarkan oleh laboratorium Mikrobiologi Universitas Indonesia. Pasien yang dirawat di Rumah Sakit Cipto Mangunkusumo, Rumah Sakit Umum Daerah Budhi Asih, Rumah Sakit Pusat Angkatan Darat Gatot Soebroto pada bulan September 2016 hingga November 2017 yang memenuhi kritera inklusi dan eksklusi diikutsertakan dalam penelitian. Uji statistik dengan menggunakan chi-square dilakukan dengan Statistical Package for the Social Sciences (SPSS) versi 21.0 untuk menentukan hubungan antar variabel. Hasil : Terdapat 169 subyek dengan mean usia 53,4 tahun, terbanyak berjenis kelamin laki-laki (62,1%), kriteria Pneumonia Severity Index (PSI) I-III sebanyak 68%, lama perawatan median 6 hari, komorbid terbanyak Diabetes Melitus (20,7%). Klebsiella pneumoniae (24,3%) merupakan bakteri terbanyak yang ditemukan dan golongan sefalosporin generasi III (39 %) merupakan antibiotik terbanyak yang digunakan. Tidak terdapat hubungan yang bermakna antara penggunaan antibiotik empirik sesuai dengan kriteria IDSA/ATS 2007 dengan keberhasilan pengobatan pneumonia komunitas dewasa RR 0,875 (IK 95% 0,6871,114) nilai p 0,225. Penggunaan antibiotik empirik sesuai dengan hasil kepekaan antibiotik berhubungan dengan perbaikan klinis dalam 5 hari RR 2,117 (IK 95% 1,037-4,321) nilai p 0,005. Simpulan : Terdapat hubungan yang bermakna secara statistik antara kesesuaian pemilihan jenis antibiotik empirik sesuai hasil kepekaan antibiotik dengan keberhasilan pengobatan pneumonia komunitas dewasa.
Kata kunci : antibiotik empirik, hasil kepekaan antibiotik, keberhasilan terapi


Background: Community acquired pneumonia (CAP) is a national and global health problem. Mortality due to CAP in Indonesia is high. Therapeutic failure of initial antibiotic is one of the factors that affecting the outcome and mortality of patients with CAP. Health organizations have recommended several guidelines regarding to the empirical antibiotics for CAP. However, the recommendation may not suitable with local pathogen. Objective: Determine whether the appropriateness of empirical antibiotic choices according to Infectious Disease Society of America (IDSA)/ American Thoracic Society (ATS) 2007 guideline and antibiotic susceptibility result is associated with clinical stability in patients with CAP. Methods: This cohort retrospective study using secondary data collected from medical record, previous prospective study result and antibiotic susceptibility result from University of Indonesia Microbiology Laboratory. Patients from Cipto Mangunkusumo National Hospital, Budhi Asih District Hospital, and Gatot Soebroto Army Central Hospital from September 2016 until November 2017 who met the inclusion and exclusion criteria were recruited. Chi-square test using Statistical Package for the Social Sciences (SPSS) version 21.0 was done to analyse the association between variables. Results: There were 169 subjects with the mean age of 53.4 years old and most were male (62.1%). Majority of the subjects had kriteria Pneumonia Severity Index (PSI) score I-III (68%). The median length of hospital stay was 6 days. The most frequent comorbidity was diabetes mellitus (20.7%). Klebsiella pneumoniae (24.3%) was the most frequent pathogen found in this study. The most common empirical antibiotic choice was third generation cephalosporin (39%). We found no significant association between initial empirical antibiotic choices according to IDSA/ ATS 2007 guideline with clinical stability of patients with CAP (RR 0.875, 95% CI: 0.687-1.114) p-value 0.225. There was significant association between initial empirical antibiotic choices according to antibiotic susceptibility result with clinical stability in 5 days (RR 2.117, 95% CI: 1.037-4.321) p-value 0.005. Conclusions: There was significant association between initial empirical antibiotic choices according to antibiotic susceptibility result with clinical stability of patients with CAP.
Keywords: empirical antibiotic, antibiotic susceptibility result, clinical stability