Tesis

Proporsi pemberian antibiotik berdasarkan alur Gyssens pada pasien penyakit paru obstruktif kronik (PPOK) eksaserbasi derajat sedang dan berat yang dirawat di RS Persahabatan Pusat Respirasi Nasional = Proportion of antibiotic administration based on Gyssens flowchart in patients with moderate and severe exacerbations of chronic obstructive pulmonary disease (COPD) treated at Persahabatan Hospital National Respiratory Center.

Pendahuluan: Pasien penyakit paru obstruktif kronik (PPOK) yang mengalami eksaserbasi akan meningkatan angka morbiditas dan mortalitas. Berdasarkan Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD), PPOK derajat sedang dan berat dapat diberikan antibiotik sebagai tata laksananya. Salah satu cara menilai ketepatan pemberian antibiotik adalah dengan menggunakan alur Gyssens. Penelitian ini bertujuan melihat proporsi ketepatan pemberian antibiotik berdasarkan alur Gyssens dan hubungannya dengan mortalitas, perbaikan klinis, kebutuhan ventilasi mekanis invasif dan perawatan berulang dalam satu tahun. Metode: Penelitian ini merupakan studi observasional dengan menggunakan desain penelitian kohort restrospektif. Sebanyak 161 pasien PPOK derajat sedang dan berat yang dirawat di RS Persahabatan Pusat Respirasi Nasional pada Januari 2022 hingga Desember 2023 mendapatkan terapi antibiotik. Pasien yang mendapatkan antibiotik selama perawatan dinilai ketepatannya sesuai alur Gyssens. Hasil: Berdasarkan ketepatan pemberian antibiotik sesuai alur Gyssens, sebanyak 93 subjek (62,8%) laki-laki dan lima subjek (38,5%) perempuan dengan rerata usia 64,34 (±9,62) tahun. Sebagian besar memiliki status merokok indeks Brinkman berat dengan kelompok PPOK grup E dan derajat esksaserbasi sedang. Hipertensi merupakan komorbiditas yang paling sering ditemukan. Terdapat hubungan bermakna antara ketepatan pembrian antibiotik dengan rerata lama rawat (p= < 0,001). Proporsi ketepatan pemberian antibiotik sesuai alur Gyssens sebesar 60,9%. Antibiotik yang paling seering digunakan adalah levofloxacin. Hasil analisis bivariat menunjukkan tidak terdapat hubungan yang bermakna antara ketepatan pemberian antibiotik berdasarkan alur Gyssens dengan mortalitas, lama perbaikan klinis, penggunaan ventilasi mekanis invasif dan perawatan berulang dalam satu tahun. Kesimpulan: Proporsi pemberian antibiotik sesuai alur Gyssens pada pasien PPOK eksaserbasi derajat sedang dan berat sebesar 60,9%. Tidak terdapat hubungan yang bermakna secara statistik antara ketepatan pemberian antibiotik sesuai alur Gyssens dengan mortalitas, lama perbaikan klinis, penggunaan ventilasi mekanis invasif dan perawatan berulang dalam satu tahun.
Kata kunci: alur Gyssens, antibiotik, eksaserbasi, penyakit paru obstruktif kronik


Introduction: Patients with chronic obstructive pulmonary disease (COPD) experiencing exacerbations will increase morbidity and mortality rates. According to the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD), moderate and severe COPD can be treated with antibiotics. One way to assess the appropriateness of antibiotic administration is by using the Gyssens flowchart. This study aims to examine the proportion of appropriateness of antibiotic administration based on the Gyssens flowchart and its relationship with mortality, clinical improvement, need for mechanical ventilation and readmission within one year. Method: This study is an observational study using a retrospective cohort design. A total of 161 moderate and severe COPD patients treated at Persahabatan Hospital National Respiratory Center from January 2022 to December 2023 received antibiotic therapy. The appropriateness of antibiotic administration during treatment was assessed according to the Gyssens flowchart.. Results: Based on the appropriateness of antibiotic administration according to the Gyssens flowchart, there were 93 male subjects (62.8%) and five female subjects (38.5%) with a mean age of 64.34 (±9.62) years. Most of them had a heavy Brinkman smoking index with COPD group E and moderate exacerbation. Hypertension was the most commonly found comorbidity. There is a significant relationship between the appropriateness of antibiotic administration and length of stay (p= < 0.001). The proportion of appropriateness of antibiotic administration according to the Gyssens flowchart was 60.9%. Levofloxacin was the most frequently used antibiotic. Bivariate analysis results showed no significant relationship between the appropriateness of antibiotic administration based on the Gyssens flowchart with mortality, duration of clinical improvement, use of invasive mechanical ventilation and readmission within one year. Conclusion: The proportion of antibiotic administration according to the Gyssens flowchart in patients with moderate and severe exacerbations of COPD is 60.9%. There is no statistically significant relationship between the appropriateness of antibiotic administration according to the Gyssens flowchart and mortality, duration of clinical improvement, use of invasive mechanical ventilation and readmission within one year.
Keywords: antibiotic, exacerbation, chronic obstructive pulmonary disease, Gyssens flowchart