RASIONALITAS ANTIBIOTIK EMPIRIS PADA PASIEN HOSPITAL ACQUIRED PNEUMONIA (HAP) DI RSUD PROVINSI NTB
Keywords:
Antbiotik, Empiris, HAP, Rasionalitas.Abstract
Penyakit infeksi masih tetap merupakan masalah kesehatan utama di Indonesia. Tingginya prevalensi penyakit infeksi di Indonesia disebabkan karena penggunaan antibiotik yang secara luas dan tidak tepat/tidak rasional. Salah satu indikator mutu program pengendalian resistensi antimikroba di rumah sakit adalah evaluasi penggunaan antibiotik secara kualitatif maupun kuantitatif. Penelitian ini bertujuan untuk mengevaluasi rasionalitas penggunaan antibiotik empiris pada pasien HAP di RSUD Provinsi NTB dan melihat pengaruh karakteritik terhadap outcome. Penelitian ini menggunakan metode penelitian deskriptif analitik dengan rancangan penelitian cross sectional dan pengambilan data secara retrospektif dari data rekam medik pasien pada Januari 2019-Desember 2020. Kriteria inklusi meliputi pasien ICU dengan diagnosa HAP, usia ≥ 15 tahun, memiliki catatan medis lengkap meliputi usia, hasil lab seperti leukosit, sputum, riwayat pengobatan, hasil pemeriksaan x-ray thorax dan parameter outcome klinik seperti TTV. Sedangkan kriteria Eksklusi yaitu pasien ibu hamil, pasien pulang paksa dan hari perawatan di ICU < 48 jam. Analisis data menggunakan chi square dan regresi logistik multivariate. Pada penelitian ini didapatkan 64 pasien HAP yang masuk dalam kriteria inklusi. Hasil analisis rasionalitas penggunaan terapi antibiotik empiris menunjukkan 17,2 % masuk kategori rasional dan tidak rasional (82,8%). Hal ini menunjukkan bahwa rasionalitas antibiotik hasil analisis hubungan rasionalitas terhadap outcome klinik adalah terdapat hubungan yang signifikan antara rasionalitas penggunaan antibiotik empiris terhadap outcome klinik (p <0,05) dan pengaruh yang signifikan LOS dan kategori gyssens terhadap outcome klinis dengan nilai p <0,05, OR = 1,73 (95% CI 1,11-3,41) dan p <0,05, OR = 2,50 (95% CI 1,22-5,14)
References
Wells BG, DiPiro JT, Schwinghammer TL, DiPiro C V. Pharmacotherapy Handbook,Tenth Edition. Tenth Edit. McGraw-Hill Companies. United States: McGraw-Hill Education; 2017.
2. Reviono. PNEUMONIA : Edisi 1. Surakarta: UNS Press; 2017.
3. Irawan R, Reviono H. Korelasi Kadar Copeptin dan Skor PSI dengan Waktu Terapi Sulih Antibiotik Intravena ke Oral dan Lama Rawat Pneumonia Komunitas. J Respirologi Indones. 2019;39(1).
4. Kemenkes RI. Hail Utama RISKESDA 2018. Kemenkes RI. Jakarta: Kemenkes RI Badan Penelitian dan Pengembangan Kesehatan; 2018.
5. SUMARYANA 2016. EVALUASI KESESUAIAN PENGGUNAAN ANTIBIOTIK EMPIRIS PADA PASIEN RAWAT INAP HOSPITAL-ACQUIRED PNEUMONIA (HAP) DI RSUP Dr. SARDJITO YOGYAKARTA SERTA ANTIBIOGRAMNYA [Internet]. Universitas Gadjah Mada; 2016. Available from: http://etd.repository.ugm.ac.id/home/detail_pencarian/98682
6. Rusmini. Gambaran Penggunaan Antibiotik Pada Pasien Pneumonia Dengan Menggunakan Metode Gyssens Di Rawat Inap Rumah Sakit Umum Daerah (RSUD) H. Abdul Moeloek Tahun 2015. J Med Malahayati [Internet]. 2016;3(2):61–4. Available from: http://ejurnalmalahayati.ac.id/index.php/medika/article/view/2009/1267
7. Halim. ANALISIS BIAYA TERAPI DAN RASIONALITAS PENGGUNAAN ANTIBIOTIK PADA PASIEN PNEUMONIA RAWAT INAP DI RSUP DR. WAHIDIN SUDIROHUSODO MAKASSAR BULAN OKTOBER 2010 - OKTOBER 2011 [Internet]. Universitas Hasanuddin; 2014. Available from: http://digilib.unhas.ac.id/opac/detail-opac?id=5962
8. Rumende CM, Chen LK, Karuniawat A, Bratanata J, Falasiva R, Sitorus TP, et al. Hubungan Antara Ketepatan Pemberian Antibiotik Berdasarkan Alur Gyssens dengan Perbaikan Klinis Pasien pada Pneumonia Komunitas. J Penyakit Dalam Indones. 2019;6(2):71.
9. Kemenkes RI. PERATURAN MENTERI KESEHATAN REPUBLIK INDONESIA NOMOR 8 TAHUN 2015 TENTANG PROGRAM PENGENDALIAN RESISTENSI ANTIMIKROBA DI RUMAH SAKIT. Jakarta: Kemenkes RI; 2015.
10. Ilmi T, Yulia R, Herawati F. EVALUASI PENGGUNAAN ANTIBIOTIK PADA PASIEN PNEUM. J Inov Farm Indones. 2020;1(2):102–12.
11. WHO. Global action plan on antimicrobial resistance [Internet]. World Health Organization. World Health Organization; 2020. 1–28 p. Available from: https://ahpsr.who.int/publications/i/item/global-action-plan-on-antimicrobial-resistance
12. Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. IDSA-Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63(5):e61–111.
13. LINDSAY GM. Kucers’ THE USE OF ANTIBIOTICS A Clinical Review of Antibacterial, Antifungal, Antiparasitic, and Antiviral Drugs. U.S: CRC Press Taylor & Francis Group; 2018.
14. Lacy CLL et al. Drug Information Handbook 26th Edition. 26th Editi. Ohio: Lexy-Comp; 2017.
15. Anonim. World Population Prospects: The 2017 Revision [Internet]. New York: United Nations, Department of Economic and Social Affairs; 2017. Available from: https://population.un.org/wpp/publications/files/wpp2017_keyfindings.pdf
16. Cillóniz C, Rodríguez-Hurtado D, Torres A. Characteristics and Management of Community-Acquired Pneumonia in the Era of Global Aging. Med Sci. 2018;6(2):35.
17. Halim.S AZ. Profil Klinis Pasien Hospital Acquired Pneumonia di Ruang Rawat Penyakit Dalam. J Ebers Papyrus. 2014;20(1).
18. Avci M, Özgenç O, Coşkuner A, Bozca B, Levent K, Mermut G, et al. Hospital-acquired pneumonia in nonintensive care unit wards. Turkish J Med Sci. 2010;40(3):357–63.
19. Il A’la NM, Suardi AU, Turbawati DK. Impact of Comorbidity on Length of Stay of Hospitalized Pneumonia in Children. Althea Med J. 2017;4(1):42–6.
20. PDPI. Pneumonia Covid-19 Diagnosis & Penatalaksanaan di indonesia. Jakarta: Perhimpunan Dokter Paru Indonesia; 2020.
21. Faizah AK, Putra ON. Evaluasi Kualitatif Terapi Antibiotik pada Pasien Pneumonia di Rumah Sakit Pendidikan Surabaya Indonesia. J Sains Farm Klin. 2019;6(2):129.
22. Chou CC, Shen CF, Chen SJ, Chen HM, Wang YC, Chang WS, et al. Recommendations and guidelines for the treatment of pneumonia in Taiwan. J Microbiol Immunol Infect. 2019;52(1):172–99.
23. Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and treatment of adults with community-acquired pneumonia. Am J Respir Crit Care Med. 2019;200(7):E45–67.
24. Park SY, Park HJ, Moon SM, Park KH, Chong YP, Kim MN, et al. Impact of adequate empirical combination therapy on mortality from bacteremic Pseudomonas aeruginosa pneumonia. BMC Infect Dis [Internet]. 2012;12(1):1. Available from: BMC Infectious Diseases
25. Sitompul F, Radji M, Bahtiar A. Evaluasi Penggunaan Antibiotik dengan Metode Gyssens pada Pasien Stroke Rawat Inap di RSUD Koja secara Retrospektif (Periode KJS dan BPJS). J Kefarmasian Indones [Internet]. 2016 Sep 8;6(1):30–8. Available from: http://ejournal.litbang.kemkes.go.id/index.php/jki/article/view/5467
26. Bestari MP, Karuniawati H. Evaluasi Rasionalitas dan Efektifitas Penggunaan Antibiotik pada Pasien Pneumonia Pediatrik di Instalasi Rawat Inap Rumah Sakit Pusat Jawa Tengah. Pharmacon J Farm Indones [Internet]. 2019 Mar 14;14(2):62–71. Available from: http://journals.ums.ac.id/index.php/pharmacon/article/view/6524
27. Suter-Widmer I, Christ-Crain M, Zimmerli W, Albrich W, Mueller B, Schuetz P, et al. Predictors for length of hospital stay in patients with community-acquired Pneumonia: Results from a Swiss Multicenter study. BMC Pulm Med. 2012;12(May).
28. Cillóniz C, Liapikou A, Ceccato A, Torres A. Risk factors for community-acquired pneumonia in adults. Minerva Pneumol. 2017;56(3):206–16.
29. Tambun SH, Puspitasari I, Laksanawati IS. Evaluasi Luaran Klinis Terapi Antibiotik pada Pasien Community Acquired Pneumonia Anak Rawat Inap. J Manaj DAN PELAYANAN Farm (Journal Manag Pharm Pract. 2019;9(3):213.
30. Dwi Rahayu Y, Wahyono D, Mustofa D. Evaluasi Rasionalitas Penggunaan Antibiotik Terhadap Luaran Pada Pasien Anak Penderita Pneumonia Antibiotics Use Rationality Evaluation in Children With Penumonia Outcomes. 2014;4(1):4.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Majalah Farmasi dan Farmakologi
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The copyright to this article is transferred to Universitas Hasanuddin (UNHAS) if and when the article is accepted for publication. The undersigned hereby transfers all rights in and to the paper including without limitation all copyrights to UNHAS. The undersigned hereby represents and warrants that the paper is original and that he/she is the author of the paper, except for material that is clearly identified as to its original source, with permission notices from the copyright owners where required. The undersigned represents that he/she has the power and authority to make and execute this assignment.
We declare that:
- This paper has not been published in the same form elsewhere.
- It will not be submitted anywhere else for publication prior to acceptance/rejection by this Journal.
- A copyright permission is obtained for materials published elsewhere and which require this permission for reproduction.
Furthermore, I/We hereby transfer the unlimited rights of publication of the above-mentioned paper in whole to UNHAS The copyright transfer covers the exclusive right to reproduce and distribute the article, including reprints, translations, photographic reproductions, microform, electronic form (offline, online) or any other reproductions of similar nature.
The corresponding author signs for and accepts responsibility for releasing this material on behalf of any and all co-authors. This agreement is to be signed by at least one of the authors who have obtained the assent of the co-author(s) where applicable. After submission of this agreement signed by the corresponding author, changes of authorship or in the order of the authors listed will not be accepted.
