Tesis

Faktor yang berhubungan dengan terjadinya healthcareassociated infection pada pasien di ruang rawat intensif rumah sakit Dr. Cipto Mangunkusumo = Factors related to the occurrence of healthcare-associated infections in patients in the intensive care unit of Dr. Cipto Mangunkusumo Hospital.

Latar belakang : Secara global berdasarkan laporan tentang healthcare-associated infection (HAI) oleh WHO tahun 2019, terdapat seratus juta pasien terkena dampak HAI setiap tahun. Tingkat terjadinya infeksi pada pasien di ICU mencapai 5 hingga 7 kali lipat lebih tinggi sebesar 20-25% dari seluruh HAI di rumah sakit. Penelitian ini dilakukan guna mengetahui faktor-faktor yag berhubungan dengan kejadian HAI di ruang rawat intensif RS Dr. Cipto Mangunkusumo. Metode : Desain penelitian cohort restrospektif. Sampel penelitian berupa sputum, darah, BAL, cairan pleura dan urin. Identifikasi dan uji kepekaan antimikroba dilakukan untuk mendapatkan patogen penyebab berupa bakteri aerob dan jamur. Sedangkan untuk penelusuran faktor risiko didapat dari rekam medis RSCM. Hasil : Sebanyak 63 pasien yang memenuhi kriteria inklusi dengan jumlah 41 pasien (65,1%) terdiagnosis HAI. Kasus HAI terbanyak adalah Ventilator-Associated Pneumonia (31,7%), Hospital-Acquired Pneumonia (26,9%) dan Surgical Site Infection (11,1%), sedangkan Catheter-Associated Urinary Tract Infection hanya 4,8% dan tidak didapatkan kasus Central Line-Associated Bloodstream Infection. Insidensi HAI pada ruang ICU IGD terdiri dari VAP = 15,27 kasus/1000 hari ventilator, HAP = 5,18 kasus/1000 hari pasien dan CAUTI = 1,48 kasus/1000 hari kateter. Pada ruang ICU Kanigara insidensi antara, yaitu VAP = 5,92 kasus/1000 hari ventilator dan HAP = 11,85 kasus/1000 hari pasien. Basil Gram negatif, terutama Klebsiella pneumoniae (38,5%) dan Acinetobacter baumannii (17,7%), paling banyak mejadi penyebab HAI dengan resistansi tinggi terhadap sefalosporin generasi 3-4 (misalnya, ceftriaxone 89,5% pada K. pneumoniae) dan karbapenem (meropenem 76,3% pada K. pneumoniae dan 94,4% pada A. baumannii). Pada analisis multivariat didapatkan hasil p-value = 0.008 pada kombinasi variabel independen (riwayat prosedur operasi dan penggunaan alat medis) yang secara kolektif mempengaruhi kejadian HAI dengan signifikan. Kesimpulan : Kasus HAIdi ICU RSCM memiliki angka kejadian yang tinggi, terutama VAP, dengan penggunaan alat medis invasif merupakan faktor yang berhubungan dengan terjadinya HAI di ICU RSCM dan patogen penyebab didominasi oleh bakteri Gram negatif yang resistan terhadap antibiotik.
Kata kunci : Healthcare-associated infection; faktor risiko; VAP; HAP; CAUTI; CLABSI;


Background: Globally, based on the report on Healthcare-associated infection (HAI) by WHO in 2019, there are one hundred million patients affected by HAI every year. The rate of infection in patients in the ICU is 5 to 7 times higher, at 20-25% of all HAIs in hospitals. This study was conducted to determine the relationship between risk factors and the incidence of HAI in the intensive care unit of Dr. Cipto Mangunkusumo Hospital. Methods: The study design was a retrospective cohort study. The study samples were sputum, blood, BAL, pleural fluid and urine. Identification and antimicrobial susceptibility testing were carried out to obtain causative pathogens in the form of aerobic bacteria and fungi. Meanwhile, the risk factor tracing was obtained from the RSCM medical records. Results: A total of 63 patients met the inclusion criteria with 41 patients (65.1%) diagnosed with HAI. The most HAI cases were Ventilator-Associated Pneumonia (31.7%), Hospital-Acquired Pneumonia (26.9%) and Surgical Site Infection (11.1%), while Catheter-Associated Urinary Tract Infection was only 4.8% and there were no cases of Central Line-Associated Bloodstream Infection. The incidence of HAI in the ICU ER consisted of VAP = 15.27 cases/1000 ventilator days, HAP = 5.18 cases/1000 patient days and CAUTI = 1.48 cases/1000 catheter days. In the Kanigara ICU, the incidence was between, namely VAP = 5.92 cases/1000 ventilator days and HAP = 11.85 cases/1000 patient days. Gram-negative bacilli, especially Klebsiella pneumoniae (38.5%) and Acinetobacter baumannii (17.7%), were the most common causes of HAI with high resistance to 3rd-4th generation cephalosporins (eg, ceftriaxone 89.5% in K. pneumoniae) and carbapenems (meropenem 76.3% in K. pneumoniae and 94.4% in A. baumannii). Multivariate analysis showed a p-value = 0.008 for the combination of independent variables (history of surgical procedures and use of medical devices) which collectively significantly influenced the incidence of HAI. Conclusion: HAI cases in the RSCM ICU have a high incidence rate, especially VAP, with the use of invasive medical devices being a factor associated with the occurrence of HAI in the RSCM ICU and the causative pathogens being dominated by Gramnegative bacteria that are resistant to antibiotics.
Keywords: Healthcare-associated infection; risk factor; VAP; HAP; CAUTI; CLABSI; SSI.