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Abstract
Background: In ICU (Intensive Care Unit), sepsis is the most common cause of death, with pneumonia being the most common source of infection. The management of sepsis pneumonia is determined by the therapy used. One of the supporting aspects in the successful treatment of sepsis pneumonia is appropriate empiric antibiotic therapy.
Objective: Determine the relationship between the appropriateness of empirical antibiotics based on ATS/IDSA (American Thoracic Society/ The Infectious Disease Society of America) with clinical outcome and LOS (Length Of Stay) in ICU patients with sepsis pneumonia.
Method: An observational study with a retrospective cohort design in ICU patients with sepsis pneumonia from January 2019-December 2020 at RS X Jakarta. The study involved 99 patients who were divided into two groups based on appropriate and inappropriate with ATS/IDSA. Data were analyzed using bivariate and multivariate for reducing the confounding factor.
Results: The appropriateness of empirical antibiotics was found to be appropriate in 48.48% (48 patients), while 51.52% (51 patients) were inappropriate with ATS/IDSA. There was a relationship between empirical antibiotic appropriateness and clinical outcome (p=0.042; RR=1.430; 95%CI=1.039-1.969) based on the chi-square test, but no relationship with LOS (p=0.629) based on the Mann Whitney test. The multivariate analysis showed that there were no confounding factors affecting the clinical outcome (p>0.05).
Conclusion: There is a relationship between empirical antibiotic appropriateness based on ATS/IDSA with clinical outcomes but not related to the length of stay in sepsis pneumonia patients in the ICU.
Keywords: sepsis pneumonia, antibiotic empiric, clinical outcome, LOS
Intisari
Latar belakang: Sepsis merupakan penyebab kematian terbanyak di ICU (Intensive Care Unit), dengan sumber infeksi tertinggi adalah pneumonia. Keberhasilan pengobatan sepsis pneumonia bergantung pada terapi yang diberikan. Pemberian terapi antibiotik empirik yang sesuai merupakan salah satu faktor penunjang keberhasilan pengobatan sepsis pneumonia.
Tujuan: Mengetahui hubungan kesesuaian antibiotik empirik berdasarkan ATS/IDSA (American Thoracic Society/ The Infectious Disease Society of America) dengan outcome klinik dan lama waktu rawat pasien sepsis pneumonia di ICU.
Metode: Penelitian observasional dengan rancangan kohort retrospektif pada pasien ICU dengan diagnosis sepsis pneumonia periode 1 Januari 2019-31 Desember 2020 di RS X Jakarta. Penelitian melibatkan 99 pasien yang terbagi dalam kelompok sesuai dan tidak sesuai ATS/IDSA. Data dianalisis dengan uji bivariat serta multivariat untuk mereduksi variabel pengganggu.
Hasil: Kesesuaian antibiotik empirik diperoleh sebesar 48,48% (48 pasien) telah sesuai dan 51,52% (51 pasien) tidak sesuai ATS/IDSA. Berdasarkan hasil uji chi-square terdapat hubungan kesesuaian antibiotik empirik dengan outcome klinik (p=0,042; RR=1,430; 95%CI=1,039-1,969) dan berdasarkan uji mann whitney tidak terdapat hubungan antara kesesuaian antibiotik empirik dengan lama waktu rawat (p=0,629). Hasil analisis multivariat menunjukkan tidak ada faktor pengganggu yang mempengaruhi outcome klinik (p>0,05).
Kesimpulan: Kesesuaian antibiotik empirik berdasarkan ATS/IDSA pada pasien sepsis pneumonia di ICU memiliki hubungan dengan outcome klinik namun tidak berhubungan dengan lama waktu rawat.
Kata kunci: sepsis pneumonia, antibiotik empirik, outcome klinik, lama waktu rawat
Keywords
Article Details
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References
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References
Chen, C.-M., Cheng, K.-C., Chan, K.-S., & Yu, W.-L. (2014). Age May Not Influence the Outcome of Patients with Severe Sepsis in Intensive Care Units. International Journal of Gerontology, 8. https://doi.org/10.1016/j.ijge.2013.08.004
Dewi, R. S., Radji, M., & Andalusia, R. (2018). Evaluation of Antibiotic Use Among Sepsis Patients in an Intensive Care Unit: A cross-sectional study at a referral hospital in Indonesia. Sultan Qaboos Univ Med J, 18(3), e367-e373. https://doi.org/10.18295/squmj.2018.18.03.017
Ellen, M. (2014). The Impact of Acute Care Clinical Practice Guidelines on Length of Stay: A Closer Look at some Conflicting Findings. Journal of Hospital Administration, 3(4), 25. https://doi.org/10.5430/jha.v3n4p25
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., McIntyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Wiersinga, W. J., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., Belley-Cote, E., Burry, L., Cecconi, M., Centofanti, J., Coz Yataco, A., De Waele, J., Dellinger, R. P., Doi, K., Du, B., Estenssoro, E., Ferrer, R., Gomersall, C., Hodgson, C., Møller, M. H., Iwashyna, T., Jacob, S., Kleinpell, R., Klompas, M., Koh, Y., Kumar, A., Kwizera, A., Lobo, S., Masur, H., McGloughlin, S., Mehta, S., Mehta, Y., Mer, M., Nunnally, M., Oczkowski, S., Osborn, T., Papathanassoglou, E., Perner, A., Puskarich, M., Roberts, J., Schweickert, W., Seckel, M., Sevransky, J., Sprung, C. L., Welte, T., Zimmerman, J., & Levy, M. (2021). Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Intensive Care Med, 47(11), 1181-1247. https://doi.org/10.1007/s00134-021-06506-y
Ferrer, R., Martin-Loeches, I., Phillips, G., Osborn, T. M., Townsend, S., Dellinger, R. P., Artigas, A., Schorr, C., & Levy, M. M. (2014). Empiric Antibiotic Treatment Reduces Mortality in Severe Sepsis and Septic Shock from The First Hour: Results from A Guideline-based Performance Improvement Program. Crit Care Med, 42(8), 1749-1755. https://doi.org/10.1097/ccm.0000000000000330
Fleischmann, C., Scherag, A., Adhikari, N. K., Hartog, C. S., Tsaganos, T., Schlattmann, P., Angus, D. C., & Reinhart, K. (2016). Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations. Am J Respir Crit Care Med, 193(3), 259-272. https://doi.org/10.1164/rccm.201504-0781OC
Giuliano, K. K., & Baker, D. (2020). Sepsis in the Context of Nonventilator Hospital-Acquired Pneumonia. American journal of critical care : an official publication, American Association of Critical-Care Nurses, 29(1), 9-14. https://doi.org/10.4037/ajcc2020402
Hannam, J. A., Borrat, X., Trocóniz, I. F., Valencia, J. F., Jensen, E. W., Pedroso, A., Muñoz, J., Castellví-Bel, S., Castells, A., & Gambús, P. L. (2016). Modeling Respiratory Depression Induced by Remifentanil and Propofol during Sedation and Analgesia Using a Continuous Noninvasive Measurement of pCO2. J Pharmacol Exp Ther, 356(3), 563-573. https://doi.org/10.1124/jpet.115.226977
Hu, A.-M., Zhong, X.-X., Li, Z., Zhang, Z.-J., & Li, H.-P. (2021). Comparative Effectiveness of Midazolam, Propofol, and Dexmedetomidine in Patients With or at Risk for Acute Respiratory Distress Syndrome: A Propensity Score-Matched Cohort Study. Frontiers in Pharmacology, 12, 1-9. https://doi.org/10.3389/fphar.2021.614465
Hu, A. M., Shan, Z. M., Zhang, Z. J., & Li, H. P. (2021). Comparative Efficacy of Fentanyl and Morphine in Patients with or At Risk for Acute Respiratory Distress Syndrome: A Propensity Score-Matched Cohort Study. Drugs R D, 21(2), 149-155. https://doi.org/10.1007/s40268-021-00338-3
Kalil, A. C., Metersky, M. L., Klompas, M., Muscedere, J., Sweeney, D. A., Palmer, L. B., Napolitano, L. M., O'Grady, N. P., Bartlett, J. G., Carratalà, J., El Solh, A. A., Ewig, S., Fey, P. D., File, T. M., Jr., Restrepo, M. I., Roberts, J. A., Waterer, G. W., Cruse, P., Knight, S. L., & Brozek, J. L. (2016). 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, 63(5), e61-e111. https://doi.org/10.1093/cid/ciw353
Katu, S., Suwarto, S., Herdiman, P., & Abdullah, M. (2017). Faktor-Faktor yang Mempengaruhi keberhasilan Terapi Antibiotik Empirik pada Pasien Sepsis Berat dan Syok Sepsis di Bangsal Rawat Inap Penyakit Dalam Rumah Sakit Cipto Mangunkusumo. Jurnal Penyakit Dalam Indonesia, 2(2), 96. https://doi.org/10.7454/jpdi.v2i2.72
Lee, S. H., Hsu, T. C., Lee, M. G., Chao, C. C., Lee, W. C., Lai, C. C., & Lee, C. C. (2018). Nationwide Trend of Sepsis: A Comparison Among Octogenarians, Elderly, and Young Adults. Crit Care Med, 46(6), 926-934. https://doi.org/10.1097/ccm.0000000000003085
Levy, M. M., Evans, L. E., & Rhodes, A. (2018). The Surviving Sepsis Campaign Bundle: 2018 update. Intensive Care Med, 44(6), 925-928. https://doi.org/10.1007/s00134-018-5085-0
Manik, M. P., Asdie, R.H. and Puspitasari, I. (2020). Evaluation of Empirical AntibioticUsage and Cost Analysis of Patients with Nosocomial Pneumonia in ICU of RSUP Dr. Sardjito, Yogyakarta. Indonesian Journal of Pharmacology and Therapy, 1(2). https://doi.org/https://doi.org/10.22146/ijpther.573
Martin-Loeches, I., Guia, M. C., Vallecoccia, M. S., Suarez, D., Ibarz, M., Irazabal, M., Ferrer, R., & Artigas, A. (2019). Risk Factors for Mortality in Elderly and Very Elderly Critically Ill Patients with Sepsis: A Prospective, Observational, Multicenter Cohort Study. Ann Intensive Care, 9(1), 26. https://doi.org/10.1186/s13613-019-0495-x
Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Brozek, J., Crothers, K., Cooley, L. A., Dean, N. C., Fine, M. J., Flanders, S. A., Griffin, M. R., Metersky, M. L., Musher, D. M., Restrepo, M. I., & Whitney, C. G. (2019). Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med, 200(7), e45-e67. https://doi.org/10.1164/rccm.201908-1581ST
Nainggolan, J. J., Kumaat, L.T. and Laihad, M.L. (2017). Gambaran Sumber terjadinya Infeksi pada Penderita Sepsis dan Syok Septik di ICU RSUP Prof . Dr . R . D . Kandou Manado Jurnal e-Clinic, 3-7.
Prebil, S., Esper, A., & Martin, G. (2011). Comorbidity and Outcomes In Severe Sepsis. Journal of General Internal Medicine, 26, A4676-A4676. https://doi.org/10.1164/ajrccm-conference.2011.183.1_MeetingAbstracts.A4676
Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J. E., Sprung, C. L., Nunnally, M. E., Rochwerg, B., Rubenfeld, G. D., Angus, D. C., Annane, D., Beale, R. J., Bellinghan, G. J., Bernard, G. R., Chiche, J. D., Coopersmith, C., De Backer, D. P., French, C. J., Fujishima, S., Gerlach, H., Hidalgo, J. L., Hollenberg, S. M., Jones, A. E., Karnad, D. R., Kleinpell, R. M., Koh, Y., Lisboa, T. C., Machado, F. R., Marini, J. J., Marshall, J. C., Mazuski, J. E., McIntyre, L. A., McLean, A. S., Mehta, S., Moreno, R. P., Myburgh, J., Navalesi, P., Nishida, O., Osborn, T. M., Perner, A., Plunkett, C. M., Ranieri, M., Schorr, C. A., Seckel, M. A., Seymour, C. W., Shieh, L., Shukri, K. A., Simpson, S. Q., Singer, M., Thompson, B. T., Townsend, S. R., Van der Poll, T., Vincent, J. L., Wiersinga, W. J., Zimmerman, J. L., & Dellinger, R. P. (2017). Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med, 45(3), 486-552. https://doi.org/10.1097/ccm.0000000000002255
Sari, E., Rumende, C., & Harimurti, K. (2017). Faktor–Faktor yang Berhubungan dengan Diagnosis Pneumonia pada Pasien Usia Lanjut. Jurnal Penyakit Dalam Indonesia, 3(4), 183. https://doi.org/10.7454/jpdi.v3i4.51
Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., Bellomo, R., Bernard, G. R., Chiche, J. D., Coopersmith, C. M., Hotchkiss, R. S., Levy, M. M., Marshall, J. C., Martin, G. S., Opal, S. M., Rubenfeld, G. D., van der Poll, T., Vincent, J. L., & Angus, D. C. (2016). The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Jama, 315(8), 801-810. https://doi.org/10.1001/jama.2016.0287
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