Tesis

Analisis Dampak Jamur di Udara dan Pengaruh Faktor Risiko Terhadap Kejadian Infeksi Jamur Invasif di ICU RS Cipto Mangunkusumo = Analysis of the Impact of Air Fungi and the Influence of Risk Factors on the Incidence of Invasive Fungal Infections in the ICU of Cipto Mangunkusumo Hospital.

Latar Belakang: Kualitas udara di ruang rawat ICU perlu mendapatkan perhatian khusus terkait potensinya menjadi sumber infeksi. Ditemukannya jamur udara menjadi penanda buruknya kualitas udara di ICU, yang berkaitan dengan meningkatnya kejadian infeksi jamur invasif pada paru pasien dengan imunitas yang menurun. Metode: Penelitian ini merupakan studi desain potong lintang dengan pengambilan sampel secara konsekutif. Suhu dan kelembapan diukur menggunakan Digital Hygrometer-Thermometer. Pengambilan spesimen udara menggunakan instrumen MAS-100 NT portabel dengan media pertumbuhan jamur Sabouraud Dextrose Agar (SDA) ditambah kloramfenikol. Penghitungan jumlah koloni dikonversi ke tabel Feller. Identifikasi jamur kapang menggunakan metode uji slide culture. Identifikasi dan uji kepekaan jamur ragi dari BAL, mengunakan uji Vitek2. Faktor risiko dicatat dari rekam medik. Hasil dan Pembahasan: Rerata suhu di kedua ICU yaitu 22,36 ± 0,44oC dan kelembaban 54,25 ± 5,08 %, masih dalam batas nilai standar yang disarankan oleh Kemenkes RI. Walaupun demikian masih ditemukan pertumbuhan jamur udara yang berpotensi menjadi penyebab infeksi jamur invasif di paru antara lain yang terbanyak adalah Aspergillus spp. dan Penicillium spp. Aspergillus spp tumbuh pada 123 cawan petri yang diperiksa pada semua rentang suhu dan kelembaban. Sementara Penicillium spp tumbuh pada suhu rentang 21,8 – 23,1ºC kelembaban rentang 51 – 59 %. Jumlah koloni jamur udara tertinggi adalah 44 CFU/m3. Jamur yang ditemukan di udara berpotensi menjadi penyebab infeksi jamur invasif di paru. Ketidaksesuaian hasil yang didapat dari kultur BAL, dimungkinkan karena pasien sudah mendapatkan terapi anti jamur atau kualitas spesimen yang kurang adekuat. Faktor risiko yang ditemukan pada 102 pasien yaitu penggunaan ventilator, keganasan hematologi, transplantasi organ, dan pengobatan dengan agen imunosupresif. Dari 41 pasien dengan dugaan infeksi jamur invasifdi paru, ditemukan 27 pasien meninggal dengan jumlah koloni jamur udara yang lebih banyak Kesimpulan: Suhu mempengaruhi jumlah koloni jamur udara pada kedua ICU dengan korelasi lemah. Jamur udara yang ditemukan dapat tumbuh disemua rentang suhu dan kelembapan adalah Aspergillus spp. Faktor risiko dan kepadatan koloni jamur di udara mempengaruhi luaran pasien dengan dugaan infeksi jamur invasif paru.
Kata Kunci: Jamur udara, sampling udara, intensive care unit


Background: Air quality in ICU rooms requires special monitoring due to its potential to be a source of infection. The presence of air fungi in the ICU indicates poor air quality, which is related to an increased prevalence of invasive fungal infections in the lungs of patients with decreased immunity. Method: Design of this study is a cross-sectional with consecutive sampling. Temperature and humidity were measured using a Digital Hygrometer-Thermometer. Air specimens were collected using a portable MAS-100 NT instrument and cultured on Sabouraud Dextrose Agar (SDA) media plus chloramphenicol. The number of colonies was converted using the Feller table. Mold fungi were identified using the slide culture method. Identification and sensitivity testing of yeast fungi that isolated from BAL, were conducted using the Vitek2. Risk factors were recorded from medical records. Results and discussion: The average temperature and humidity in both ICUs were 22.36 ± 0.440C and 54.25 ± 5.08%, respectively, still within the Indonesian Ministry of Health's recommended standards. However, the growth of air fungi has been shown to have the potential to induce invasive fungal infections in the lungs, including Aspergillus and Penicillium species as the most prevalent. Aspergillus spp. grew in 123 petri dishes tested at various temperatures and humidity prevalent levels. While Penicillium spp. were found at temperatures ranging from 21.8 to 23.1ºC and humidity levels of 51-59%. The maximum amount of air fungal colonies was 44 CFU/m3. Fungi in the air can cause invasive fungal infections in the lungs. The disparity results from BAL culture could be correlated with the patient has had antifungal medicine, or poor quality of the specimens. Risk factors in 102 cases were ventilator use, hematologic malignancy, organ transplantation, and immunosuppressive treatment. Of the 41 patients with suspected invasive fungal infection in the lungs, 27 died on the increased number of air fungal colonies. Conclusion: Temperature had a weakly correlated effect on the number of air fungal colonies in both intensive care units. The air fungi that grew on all temperature and humidity ranges was Aspergillus spp. Risk factors and density of air fungal colonies influenced the outcome of patients with suspected invasive pulmonary fungal infections.
Keywords: Air fungi, intensive care unit, risk factors