Tesis

Validasi Skor DRIP (Drug Resistance in Pneumonia) sebagai Prediktor Kegagalan Antibiotik Empirik pada Pasien Community Acquired Pneumonia (CAP) di RSUPN DR. Cipto Mangunkusumo Jakarta = Validation of Drug Resistance in Pneumonia (DRIP) Score as Empirical Antibiotic Failure Predictor in Community Acquired Pneumonia Patients in Cipto Mangunkusumo Hospital.

Latar Belakang: Community Acquired Pneumonia (CAP) yang diakibatkan oleh patogen resisten obat (PRO) memiliki tingkat keparahan yang lebih tinggi. Ketepatan pemberian antibiotik dapat meningkatkan keberhasilan terapi pada CAP dan mencegah timbulnya resistensi bakteri terhadap berbagai macam antibiotik. Penggunaan skor DRIP dapat mencegah terjadinya kegagalan antibiotik dan mengurangi lamanya masa rawat inap, namun diperlukan validasi agar skor DRIP dapat digunakan sesuai pada populasi dan karakteristik pasien di Indonesia terutama di RSUPN Dr. Cipto Mangunkusumo Jakarta. Tujuan: Penelitian ini dilakukan untuk mengetahui performa dan hubungan skor DRIP sebagai instrumen dalam memprediksi kegagalan antibiotik empirik pada CAP di RSUPN Dr. Cipto Mangunkusumo Jakarta. Metode: Penelitian ini menggunakan desain kohort retrospektif. Subyek penelitian adalah pasien CAP yang dirawat di RSUPN Dr. Cipto Mangunkusumo pasa periode Januari 2019 hingga Juni 2020. Penelitian dilakukan dengan mengambil data rekam medis pasien CAP yang dirawat inap. Performa skor dianalisis dengan menentukan nilai kalibrasi dan diskriminasi menggunakan uji Hosmer-Lemeshow dan AUROC. Hasil: Sebanyak 480 subyek yang memenuhi kriteria pemilihan diikutkan dalam penelitian. Terbagi dalam kelompok skor DRIP < 4 (low risk) 331 pasien (69%) dan skor DRIP > 4 (high risk) 149 pasien (31%). Hasil analisis kalibrasi skor DRIP dengan uji Hosmer-Lemeshow didapatkan nilai p=0.667 (p > 0.05). Sementara untuk analisis diskriminasi skor DRIP dan kurva ROC didapatkan nilai AUC 0.651 (IK95%; 0.601-0.700), memiliki sensitivitas 38,52% dan spesifisitas 79,70%, nilai prediksi positif 73,15 dan nilai prediksi negatif 47,43. Simpulan: Skor DRIP memiliki performa yang cukup baik untuk memprediksi kegagalan antibiotik empirik pada pasien CAP dan tidak berhubungan dengan lama rawatan di rumah sakit.
Kata kunci: skor DRIP, antibiotik empirik, CAP



Background: Community acquired pneumonia (CAP) caused by drug-resistant pathogens (DRP) has higher severity. Accurate administration of antibiotics can increase the success of therapy in community acquired pneumonia and prevent the emergence of bacterial resistance to various types of antibiotics. The use of the DRIP score can prevent antibiotic failure and reduce the length of stay, but validation is needed so that the DRIP score can be used according to the population and patient characteristics in Indonesia, especially at Cipto Mangunkusumo Hosipital Jakarta. Objective: This study aims to determine the performance and correlation of the DRIP score as an instrument in predicting empiric antibiotic failure in community pneumonia patients at Cipto Mangunkusumo National Central Hospital, Jakarta. Methods: This study using a retrospective cohort design. The research subjects were community pneumonia patients who were hospitalized at Cipto Mangunkusumo National Central Hospital from January 2019 to June 2020. The study was conducted by taking medical records of community pneumonia patients who were hospitalized. Performance scores were analyzed by determining calibration and discrimination values using the Hosmer-Lemeshow and AUROC tests. Results: A total of 480 subjects who met the selection criteria were included in the study. The subjects divided into group of DRIP score < 4 (low risk) 331 patients (69%) and DRIP score > 4 (high risk) 149 patients (31%). The results of the DRIP score calibration analysis with the Hosmer-Lemeshow test obtained a value of p = 0.667 (p > 0.05). Meanwhile, for the discrimination analysis of the DRIP score and the ROC curve, an AUC value of 0.651 (95% CI; 0.601-0.700) was obtained. At a score > 4, the DRIP score had a sensitivity of 38.52% and a specificity of 79.70%, a positive predictive value of 73.15 and a negative predictive value of 47.43. Conclusions: DRIP score has good performance to predict empirical antibiotic failure in community acquired pneumonia patients and not related to the length of stay in the hospital.
Key words: DRIP score, empiric antibiotics, community acquired pneumonia