Tesis

Pengaruh Infeksi Multidrug-resistant Organism terhadap mortalitas pada pasien luka bakar di RSUPN dr. Cipto Mangunkusumo = The Effect of Multidrug-Resistant Organism on mortality of burn patients in dr. Cipto Mangunkusumo hospitals.

Latar belakang. Potensi infeksi meningkat pada pasien luka bakar disebabkan oleh kerusakan integritas kulit dan penurunan sistem imun sehingga memudahkan infiltrasi patogen. Kerentanan terhadap infeksi dan peningkatan resistensi antibiotik menempatkan pasien luka bakar pada risiko infeksi yang disebabkan oleh multidrug-resistant organism (MDRO), kondisi ini dapat berlanjut menjadi sepsis yang dapat meningkatkan tingginya morbiditas dan mortalitas. Prevalensi yang disebabkan oleh infeksi MDRO mencapai 18,2%. Pentingnya melakukan penelitian untuk menganalisa infeksi MDRO pada pasien luka bakar yang dapat menyebabkan tingginya biaya perawatan dan pemilihan antibiotik saat awal sebagai antisipasi terhadap kejadian mortalitas. Metode. Penelitian kohort retrospektif menggunakan data rekam medis pasien yang di rawat di RSUPN dr. Cipto Mangunkusumo pada periode Januari 2020 sampai Juni 2022. Pasien dibagi menjadi dua kelompok yaitu pasien infeksi MDRO dan Non MDRO, analisis bivariat dilakukan terhadap dua variabel yang diduga berhubungan, data non parametrik menggunakan uji Chi square dan data parametrik menggunakan uji Mann whitney. Uji regresi logistik multivariat dilakukan untuk menganalisis variabel perancu. Hasil. Total 160 subjek dalam kurun waktu penelitian dengan usia < 60tahun sebanyak 82,5%, didominasi 62,5% berjenis kelamin laki-laki, sumber infeksi terbanyak berasal dari kulit dan jaringan lunak sebanyak 100%, memiliki komorbid 16,88%, penyebab terbanyak luka bakar adalah api 86,25%, penggunaan alat medis sebanyak 90,63% dengan median lama rawat 14hari. Patogen MDRO tersering Gram negatif adalah K. pneumoniae (29,91%), Enterobacter sp (22,32%) dan Acinetobacter (20,54%), pasien infeksi MDRO yang meninggal sebanyak 45%. Pada analisis bivariat ditemukan infeksi MDRO meningkatkan mortalitas pasien luka bakar (RR 1,103; IK 95% 1,004-1,211,; p=0,046). Setelah di-adjusted dengan variabel perancu yaitu: usia, komorbid, TBSA, penggunaan alat medis, lama rawat dan dianalisis multivariat ditemukan variabel perancu yang berpengaruh terhadap mortalitas infeksi MDRO adalah lama rawat dan usia. Simpulan. Infeksi MDRO meningkatkan mortalitas pasien luka bakar. Mortalitas pasien luka bakar akibat infeksi MDRO dua kali lebih besar (45%) dibandingkan dengan Non MDRO (21,43%). Patogen MDRO Gram negatif tersering adalah K.pneumoniae.
Kata kunci: Multidrug-Resistant Organism (MDRO), Mortalitas, Luka bakar.



Background. The probability of acquiring infection increases in burn patients due to damage of skin integrity and weakening of the immune system, thus facilitating the infiltration of bacteria. Susceptibility to infection and increased antibiotic resistance put burn patients at risk of infection caused by multidrug-resistant organisms (MDRO), this condition can progress to sepsis which can increase morbidity and mortality. The prevalence caused by MDRO infection reached 18.2%. Therefore, this signifies the importance of conducting research to analyze MDRO infection in burn patients which can lead to high treatment costs and the selection of antibiotics at the early stage in anticipation of mortality events. Methods. This retrospective cohort study used data from medical records of patients treated at RSUPN dr. Cipto Mangunkusumo from January 2020 to June 2022. Patients were divided into two groups, namely patients with MDRO and Non-MDRO. Bivariate analysis was carried out on two variables that were thought to be related, non-parametric data were analyzed using Chi square and parametric data were assessed using the Mann-Whitney test. Multivariate logistic regression test was performed to analyze confounding variables. Results. A total of 160 subjects within the study period that is comprised of age < 60 years were 82,5%, dominated by 62.5% male, the most sources of infection came from skin and soft tissue as much as 100%, samples having comorbidities are 16.88%, the most common cause of burn was 86.25% fire, the use of medical devices was 90.63% with a median length of stay of 14 days. The most common Gram-negative MDRO pathogens were K. pneumoniae (29.91%), Enterobacter sp (22.32%) and Acinetobacter (20.54%), MDRO infected patients who died were 45%. Bivariate analysis MDRO infection was found to increase the mortality of burn patients (RR 1,103; 95% CI 1,004-1,211, p=0.046). After adjusting for the confounding variables, namely: age, co-morbidities, TBSA, use of medical devices, length of stay and multivariate analysis, it was found that the confounding variables that had an effect on MDRO infection mortality were length of stay dan age. Conclusion. MDRO infection increases mortality in burn patients. Mortality of burn patients due to MDRO infection is greater (45%) compared to Non MDRO (21.43%). The most common Gram-negative MDRO pathogen is K.pneumoniae.
Keywords. Multidrug-Resistant Organism (MDRO), Mortality, Burns.