Skripsi

Deteksi Jamur Pada Alat Kesehatan Dan Kaitannya Dengan Kondisi Klinis Pasien Di Ruang Rawat Intensif = Detection Of Fungi Isolated From Medical Devices And Their Association With Clinical Condition In Intensive Care Unit Patients.

Latar Belakang Infeksi jamur invasif nosokomial merupakan masalah serius di ruang rawat intensif (intensive care unit - ICU) dengan mortalitas tinggi. Kontaminasi pada alat kesehatan berpotensi menjadi sumber infeksi, namun data di Indonesia masih terbatas. Metode Penelitian deskriptif observasional ini dilakukan di ICU Rumah Sakit Persahabatan dengan kultur jamur dari swab bed rail dan ventilator (N=13) serta data rekam medis pasien ICU (N=23). Identifikasi jamur dilakukan melalui kultur dan pemeriksaan mikroskopis. Analisis deskriptif dan uji Fisher digunakan untuk menilai keterkaitan antara temuan jamur pada alat, penggunaan antibiotik atau antijamur, serta hasil biakan jamur positif pada pasien. Hasil Hasil kultur jamur pada bed rail dan ventilator menunjukkan hasil 26,9% ragi dan 15,4% kapang. Spesies yang paling sering ditemukan adalah Candida parapsilosis (19,2%), disusul Candida glabrata (3,8%), Rhodotorula sp. (3,8%), serta Aspergillus flavus (3,8%). Hasil kultur jamur dari bed rail menunjukkan beban koloni lebih tinggi (median 326 [8–420]) dibanding ventilator (108 [1–390]). Terdapat tiga pasien (13%) dengan kultur jamur positif dari sampel pasien, namun tidak ditemukan kesesuaian langsung antara spesies yang terdeteksi pada alat dan isolat pasien. Analisis paparan ventilator maupun antibiotik tidak signifikan (p ≥ 0,13), meskipun terdapat kecenderungan risiko pada levofloksasin dan flukonazol. Mortalitas pasien ICU mencapai 56,5%, dengan lama rawat ICU lebih panjang dan kadar hemoglobin lebih rendah pada kelompok meninggal. Kesimpulan Isolasi jamur dari alat kesehatan ICU menunjukkan keberadaan Candida parapsilosis sebagai spesies dominan, terutama pada bed rail. Tidak ditemukan kesesuaian langsung dengan isolat pasien. Mortalitas yang tinggi menekankan pentingnya upaya kebersihan pada permukaan berisiko tinggi serta perlunya penelitian lanjutan dengan ukuran sampel lebih besar dan analisis molekuler untuk memetakan potensi transmisi.
Kata Kunci: Jamur, ICU, alat kesehatan, Candida parapsilosis, infeksi nosokomial


Background Nosocomial invasive fungal infections are a major concern in intensive care unit (ICU) with high mortality rates. Contamination of medical devices may serve as a potential source of infection, yet data from Indonesia remain limited. Methods This observational descriptive study was conducted in the ICU of Persahabatan Hospital. Fungal cultures were obtained from swabs of bed rails and ventilators (N=13), while clinical data were collected from ICU patients (N=23). Fungal identification was performed by culture and microscopy. Descriptive analysis and Fisher’s exact test were applied to evaluate associations between fungal contamination, antimicrobial exposure, and positive fungal culture in patients. Results Fungi were detected in 26.9% of yeast cultures and 15.4% of mold cultures. The most frequently isolated species was Candida parapsilosis (19.2%), followed by Candida glabrata (3.8%), Rhodotorula sp. (3.8%), and Aspergillus flavus (3.8%). Bed rails showed a higher colony burden (median 326 [8–420]) compared with ventilators (108 [1 – 390]). The positivity rate of fungal culture from clinical samples is 13% (3/23) of patients, but no direct concordance was observed between environmental and clinical isolates. No significant associations were found between device exposure or antimicrobial therapy and fungal disease (p ≥ 0.13), although a trend was noted for levofloxacin and fluconazole exposure. ICU mortality reached 56.5%, with longer ICU stays and lower hemoglobin levels among non-survivors. Conclusion Fungal isolation from ICU medical devices revealed Candida parapsilosis as the predominant species, particularly on bed rails. No direct concordance with patient isolates was found. The high mortality highlights the need for targeted cleaning of high-touch surfaces and further studies with larger samples and molecular typing to clarify transmission pathways.
Keywords: Fungi, ICU, medical devices, Candida parapsilosis, nosocomial infection