Faktor Risiko Infeksi Luka Operasi (ILO) dan Rasionalitas Antibiotik Profilaksis Bedah di RSUP Dr. Sardjito Yogyakarta

https://doi.org/10.22146/farmaseutik.v1i1.53094

Rosylianti Rosylianti(1), Ika Puspitasari(2*), Rizka Humardewayanti Asdie(3)

(1) Magister Farmasi Klinik, Fakultas Farmasi, Universitas Gadjah Mada
(2) Faculty of Pharmacy, Universitas Gadjah Mada
(3) Departemen Penyakit Dalam FKKMK UGM
(*) Corresponding Author

Abstract


Healthcare assoicated infections (HAIs) merupakan merupakan infeksi yang didapatkan pasien ketika menerima pelayanan kesehatan di fasilitas kesehatan. Salah satu jenis HAIs yang dapat dicegah adalah infeksi luka operasi (ILO), yakni melalui pemberian antibiotik profilaksis bedah (APB). Penelitian ini bertujuan untuk mengetahui besar kejadian ILO selama periode penelitian, besar ABP rasional, pengaruh pemberian APB rasional terhadap ILO, dan faktor risiko yang meningkatkan risiko ILO. Penelitian dilaksanakan di RSUP Dr. Sardjito Yogyakarta dengan rancangan cohort prospektif pada subjek dengan kriteria inklusi usia ≥18 tahun, menjalani bedah obstetri-ginekologi, digestif dan tumor dengan kelas operasi bersih/bersih-terkontaminasi, dan menerima ABP. Subjek dieksklusi jika didiagnosis infeksi sebelum operasi dan menjalani pemasangan implan. Pengamatan luka operasi dilakukan hingga 30 hari pascabedah. Sejumlah 95 pasien bersedia menjadi subjek penelitian. Terdapat 96 pemberian ABP selama periode penelitian. ILO dialami oleh 17,9% (IK 95% 10,2-25,6%) subjek. Ditemukan 13 pemberian antibiotik tidak tepat indikasi. Dari 83 pemberian ABP dengan indikasi, hanya ditemukan 1,2% pemberian ABP rasional menurut algoritma Gyssens (kategori 0). Jenis ketidakrasionalan paling tinggi yaitu kategori IIa (tidak tepat dosis) 95,1%. Penelitian ini tidak dapat menentukan pengaruh pemberian antibiotik profilaksis terhadap penurunan kejadian ILO. IMT >27 kg/m2 secara bermakna meningkatkan risiko ILO dengan OR 5,91 (IK 95% 1,20-18,37; p<0,05).

Kata kunci: antibiotik profilaksis, analisis Gyssens, ILO


Keywords


antibiotik profilaksis; analisis Gyssens; ILO

Full Text:

PDF


References

ACOG, 2018a. Prevention of Infection After Gynecologic Procedures: ACOG Practice Bulletin, Number 195. Wolters Kluwer Health, Inc, 131: e172–e189. ACOG, 2018b. ACOG Practice Bulletin No. 199: Use of Prophylactic Antibiotics in Labor and Delivery. Wolters Kluwer Health, Inc, 132: e103–e119. Alldredge, B.K., Corelli, R.L., dan Ernst, M.E., 2012. Koda-Kimble and Young’s Applied Therapeutics: The Clinical Use of Drugs. Lippincott Williams & Wilkins. Allegranzi, B., Nejad, S.B., Combescure, C., Graafmans, W., Attar, H., Donaldson, L., dkk., 2011. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. The Lancet, 377: 228–241. Al-Qurayshi, Z., Walsh, J., Owen, S., dan Kandil, E., 2019. Surgical Site Infection in Head and Neck Surgery: A National Perspective. Otolaryngology–Head and Neck Surgery, 161: 52–62. ASHP, 2011. AHFS Drug Information. American Society of Health-System Pharmacists. Atkinson, R.A., Jones, A., Ousey, K., dan Stephenson, J., 2017. Management and cost of surgical site infection in patients undergoing surgery for spinal metastasis. Journal of Hospital Infection, 95: 148–153. Bağhaki, S., Soybir, G.R., dan Soran, A., 2014. Guideline for Antimicrobial Prophylaxis in Breast Surgery. The Journal of Breast Health, 10: 79–82. Berríos-Torres, S.I., Umscheid, C.A., Bratzler, D.W., Leas, B., Stone, E.C., Kelz, R.R., dkk., 2017. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surgery, 152: 784–791. Bratzler, D.W., Dellinger, E.P., Olsen, K.M., Perl, T.M., Auwaerter, P.G., Bolon, M.K., dkk., 2013. Clinical practice guidelines for antimicrobial prophylaxis in surgery. American Journal of Health-System Pharmacy, 70: 195–283. e Castro, P. de T.O., Carvalho, A.L., Peres, S.V., Foschini, M.M., dan Costa Passos, A.D., 2011. Surgical-site infection risk in oncologic digestive surgery. The Brazilian Journal of Infectious Diseases, 15: 109–115. Giordano, M., Squillace, L., dan Pavia, M., 2017. Appropriateness of Surgical Antibiotic Prophylaxis in Pediatric Patients in Italy. Infection Control & Hospital Epidemiology, 38: 823–831. Glaysher, M.A. dan Cresswell, A.B., 2017. Management of common surgical complications. Surgery (Oxford), 35: 190–194. Jasim, H.H., Sulaiman, S.A.S., Khan, A.H., Dawood, O.T., Abdulameer, A.H., dan Usha, R., 2017. Incidence and Risk Factors of Surgical Site Infection Among Patients Undergoing Cesarean Section. Clinical Medicine Insights: Therapeutics, 9: 1–7. Kasatpibal, N., Whitney, J.D., Dellinger, E.P., Nair, B.G., dan Pike, K.C., 2016. Failure to Redose Antibiotic Prophylaxis in Long Surgery Increases Risk of Surgical Site Infection. Surgical Infections, 18: 474–484. Lyden, J.R. dan Dellinger, E.P., 2016. Surgical Site Infections. Hospital Medicine Clinics, 5: 319–333. Megawati, S., Rahmawati, F., dan Wahyono, D., 2015. Evaluasi Penggunaan Antibiotik Profilaksis Pada Pasien Bedah. Jurnal Manajemen dan Pelayanan Farmasi (Journal of Management and Pharmacy Practice), 5: 127–134. Mellin-Olsen, J., McDougall, R.J., dan Cheng, D., 2017. WHO Guidelines to prevent surgical site infections. The Lancet Infectious Diseases, 17: 260–261. Molina-Cabrillana, J., Valle-Morales, L., Hernandez-Vera, J., López-Carrió, I., García-Hernández, J.A., dan Bolaños-Rivero, M., 2008. Surveillance and risk factors on hysterectomy wound infection rate in Gran Canaria, Spain. European Journal of Obstetrics and Gynecology and Reproductive Biology, 136: 232–238. Olowo-Okere, A., Ibrahim, Y.K.E., Sani, A.S., dan Olayinka, B.O., 2018. Occurrence of Surgical Site Infections at a Tertiary Healthcare Facility in Abuja, Nigeria: A Prospective Observational Study. Medical sciences (Basel, Switzerland), 6: 60. Omar, A.A. dan Al-Mousa, H.H., 2012. Surgical site infection complicating breast cancer surgery in kuwait. ISRN preventive medicine, 2013: 295783–295783. Pathak, A., Mahadik, K., Swami, M.B., Roy, P.K., Sharma, M., Mahadik, V.K., dkk., 2017. Incidence and risk factors for surgical site infections in obstetric and gynecological surgeries from a teaching hospital in rural India. Antimicrobial Resistance and Infection Control, 6: 66. SIGN, 2008. Antibiotic Prophylaxis in Surgery: A National Clinical Guideline. Scottish Intercollegiate Guidelines Network, Edinburgh. Talbot, T.R., 2015. Surgical Site Infections and Antimicrobial Prophylaxis, dalam: Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, Updated Edition. Elsevier/Saunders, Philadelphia, PA, hal. 3492-3504.e3. Tanner, J., Khan, D., Ball, J., Aplin, C., Pickard, J., dan Bankart, J., 2011. The rate, risk factors and cost of surgical site infections in primary breast surgery. Journal of Infection Prevention, 12: 204–209. van Kasteren, M.E.E., Mannien, J., Ott, A., Kullberg, B.-J., de Boer, A.S., dan Gyssens, I.C., 2007. Antibiotic Prophylaxis and the Risk of Surgical Site Infections following Total Hip Arthroplasty: Timely Administration Is the Most Important Factor. Clinical Infectious Diseases, 44: 921–927. Wahyuningtyas, Y., 2015. 'Evaluasi Rasionalitas Penggunaan Antibiotik Profilaksis Terhadap Kejadian Infeksi Luka Operasi Di Bangsal Bdah Dewasa RSUP Dr. Soeradji Tirtonegoro Klaten', Tesis, Universitas Gadjah Mada. WHO, 2017. Global Guidelines for the Prevention of Surgical Site Infection. World Health Organization Press, Switzerland. Yerushalmy, A., Reches, A., Lessing, J.B., Schechner, V., Carmeli, Y., dan Grisaru, D., 2008. Characteristics of microorganisms cultured from infected wounds post-hysterectomy. European Journal of Obstetrics & Gynecology and Reproductive Biology, 141: 169–172. Young, O.M., Shaik, I.H., Twedt, R., Binstock, A., Althouse, A.D., Venkataramanan, R., dkk., 2015. Pharmacokinetics of cefazolin prophylaxis in obese gravidae at time of cesarean delivery. American Journal of Obstetrics and Gynecology, 213: 541.e1-541.e7.



DOI: https://doi.org/10.22146/farmaseutik.v1i1.53094

Article Metrics

Abstract views : 2394 | views : 6069

Refbacks

  • There are currently no refbacks.


Majalah Farmaseutik Indexed by:

   
 
Creative Commons Licence
 
 
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.