Tesis

Faktor yang Memengaruhi Infeksi Bakteri Multidrug-Resistant di Departemen Ilmu Kesehatan Anak Rumah Sakit Cipto Mangunkusumo = Risk factors of multidrug-resistant bacteria infection in pediatric patients at Cipto Mangunkusumo General Hospital.

Latar belakang: Resistensi antibiotik merupakan masalah penting dan ancaman bagi kesehatan manusia di hampir seluruh negara. Dampak infeksi bakteri multidrugresistant (MDR) berupa luaran pasien lebih buruk, biaya perawatan lebih besar, dan penggunaan antibiotik spektrum luas yang berpotensi meningkatkan prevalensi resistensi. Surveilans healthcare-associated infection (HAI) dan identifikasi faktor risiko diharapkan bisa menurunkan laju resistensi. Tujuan: Menilai kekuatan pengaruh dari komorbiditas, riwayat pengobatan dengan antibiotik intravena 15 hari terakhir, tindakan bedah, penggunaan lebih dari 2 indwelling medical device, dan rawat inap lebih dari 7 hari terhadap terjadinya infeksi bakteri MDR pada pasien anak. Metode: Penelitian retrospektif di Rumah Sakit Cipto Mangunkusumo Jakarta terhadap pasien berusia 1 bulan-18 tahun dengan pertumbuhan bakteri pada hasil kultur. Data diperoleh dari electronic health record yaitu data demografi, komorbid, riwayat terapi antibiotik, tindakan bedah, medical device, lama rawat inap, data mikrobiologi, dan luaran akhir perawatan. Hasil: Proporsi bakteri MDR pada penelitian ini sebesar 76,3%. Analisis bivariat tidak menunjukkan adanya hubungan antara komorbiditas, riwayat terapi antibiotik, tindakan bedah, dan penggunaan lebih dari 2 indwelling medical device, dengan infeksi bakteri MDR pada pasien anak. Namun rawat inap lebih dari 7 hari akan meningkatkan risiko pasien anak mengalami infeksi bakteri MDR (OR 2,755; 95% IK 1,107-6,857; P = 0,036). Simpulan: Pasien anak dengan rawat inap lebih dari 7 hari memiliki risiko hampir 2,7 kali lipat untuk mengalami infeksi bakteri MDR dibanding pasien anak dengan rawat inap 7 hari atau kurang.
Kata Kunci: Anak, bakteri multidrug-resistant, faktor risiko


Background: Antibiotic resistance is an important problem and threats to human health worldwide. Multidrug-resistant (MDR) bacteria infection is associated with poor outcome, higher treatment cost, and higher rate of broad spectrum antibiotic use which may lead to subsequent antibiotic resistance. Healthcare-associated infection surveillance and identification of risk factors can provide effort to control the development of antibiotic resistance. Objective: Measure the strength of association between comorbidity, intravenous antibiotic use within the last 15 days, surgery procedure, use of more than two indwelling medical devices, and hospital stay more than 7 days, with MDR bacteria infection in pediatric patient. Methods: Restrospective study in 1 month - 18 years old pediatric patient at Cipto Mangunkusumo Hospital Jakarta who had bacteria growth on microbiological culture. Demographic data, comorbid condition, history of antibiotic use, surgery, indwelling medical device use, length of hospital stay, microbiological data, and mortality were collected from the electronic health record. Results: Rate of MDR bacteria infection in this study was 76,3%. Bivariate analysis showed no relationships between comorbidity, intravenous antibiotic use in prior 15 days, surgery, and use of more than two indwelling medical devices, with MDR bacteria infection. Pediatric patients with hospital stay longer than 7 days were more likely to have MDR bacteria infection (OR 2,755; CI 95% 1,107-6,857; P = 0,036) compared to those with hospital stay 7 days or less. Conclusion: Hospital stay longer than 7 days increase risk pediatric patient to contract MDR bacteria infection by 2,7 fold.
Keywords: Children, multidrug-resistant bacteria, pediatric, risk factor