Tesis

Faktor risiko kejadian kandidemia pada anak di RS. Dr. Cipto Mangunkusumo tahun 2012 – 2017 = Risk factors of childhood candidemia in Dr. Cipto Mangunkusumo Hospital 2012-2017.

Latar belakang. Diagnosis kandidemia masih mengalami kesulitan di Indonesia sehingga terapi antijamur empiris umum dilakukan. Faktor risiko kandidemia pada anak di Indonesia perlu diketahui agar terapi empiris dapat diberikan berdasarkan pertimbangan yang tepat. Tujuan. Mengetahui prevalens kandidemia pada anak dan faktor risiko yang memengaruhinya. Metode. Penelitian retrospektif ini menggunakan uji kasus-kontrol di RS. Dr. Cipto Mangunkusumo (RSCM) periode 2012 – 2017. Subjek kasus adalah anak berusia satu bulan – 18 tahun yang memiliki hasil biakan darah kandida positif saat dirawat, sementara subjek kontrol diambil dari pasien yang dirawat tanpa menderita infeksi jamur invasif dengan perbandingan 2:1. Faktor risiko klinis diamati pada kedua kelompok yang selanjutnya dianalisis secara multivariat. Hasil. Penelitian ini menginklusi 55 subjek kasus dan 110 subjek kontrol. Hasil penelitian menunjukkan prevalens kandidemia pada anak di RSCM sebesar 0,32% dengan Candida albicans adalah penyebab terbanyak (51%). Kandidemia terbanyak diderita anak berusia di bawah satu tahun, dengan rerata lama demam 24,5 hari, anemia (rerata Hb 9,04 g/dL), trombositopenia (median 72000/µL), dan hipoalbuminemia (rerata 3,15 g/dL). Faktor risiko independen terhadap terjadinya kandidemia adalah pemakaian akses vena sentral (OR 5,89, 95% CI 1,31-26,56), pemberian nutrisi parenteral total (OR 6,96, 95% CI 1,3535,98), adanya neutropenia (OR 10,26, 95% CI 1,77-59,48), dan pemakaian antibiotik selama lebih dari 14 hari (OR 16,37, 95% CI 4,72-56,71). Kesimpulan. Pasien anak dengan klinis kecurigaan kandidemia terutama dengan faktor risiko pemasangan akses vena sentral, pemberian nutrisi parenteral total, neutropenia, atau pemakaian antibiotik selama lebih dari 14 hari dapat dipertimbangkan untuk diberikan terapi antijamur empiris.
Kata kunci: anak, faktor risiko, kandidemia, prevalens


Background. Diagnosis of candidemia is still a problem in Indonesia, therefore empiric antifungal therapy is often administered. Risk factors of childhood candidemia in Indonesia needs to be explored in determining the rationale of empiric antifungal therapy. Objective. To evaluate the prevalence and risk factors of childhood candidemia in Indonesia. Methods. This retrospective study was a case-control study in Dr. Cipto Mangunkusumo Hospital (CMH) during 2012 – 2017. Subjects were children aged a month until 18 years old who had positive candida blood culture during hospitalization. Controls were patients who had no diagnosis of invasive fungal infection at hospitalization and taken in 2:1 comparison. Risk factors were assessed by multivariate analysis. Results. Fifty five subjects and 110 controls were involved. Prevalence of childhood candidemia in CMH was 0.32% and the most common etiology was Candida albicans (51%). Children below 1-year-old was the most affected age group, with mean fever duration of 24.5 days, anemia (mean Hb 9.04 g/dL), thrombocytopenia (median 72000/µL), and hypoalbuminemia (mean 3.15 g/dL). Independent risk factors of candidemia were central venous catheter (OR 5.89, 95% CI 1.31-26.56), total parenteral nutrition (OR 6.96, 95% CI 1.35-35.98), neutropenia (OR 10.26, 95% CI 1.77-59.48), and use of antibiotics for more than 14 days (OR 16.37, 95% CI 4.72-56.71). Conclusion. Empiric antifungal therapy is justified to be given to clinically suspected candidemia children especially with the presence of risk factor: central venous catheter, total parenteral nutrition, neutropenia, or use of antibiotics for more than 14 days.
Keywords: candidemia, children, prevalence, risk factors