Hubungan Koinfeksi Pasien COVID-19 Derajat Berat Dan Kritis Di Ruang Intensif dengan Nilai Leukosit, Neutrofil, CRP, Prokalsitonin, Dan Lama Rawat Inap

Prayitno, dr. Harman and Dr. dr. Yani Jane Sugiri,, Sp.P(K) and dr.Tri Wahju Astuti,, MKes, Sp.P(K) and dr. Arie Zainul Fatoni,, SpAn KIC and dr. Nurima Diyah Puji Hastuti,, MKed.Klin.SpMK (2022) Hubungan Koinfeksi Pasien COVID-19 Derajat Berat Dan Kritis Di Ruang Intensif dengan Nilai Leukosit, Neutrofil, CRP, Prokalsitonin, Dan Lama Rawat Inap. Magister thesis, Universitas Brawijaya.

Abstract

Pendahuluan dan Tujuan Infeksi Coronavirus Disease (COVID-19) derajat parah atau sakit kritis dikaitkan dengan perawatan di unit perawatan intensif (ICU) yang meningkatkan koinfeksi dan memperburuk prognosis. Penelitian ini bertujuan untuk mengetahui hubungan koinfeksi bakteri dan jamur pada COVID-19 dengan nilai leukosit, neutrofil, CReactive Protein (CRP), prokalsitonin, lama rawat inap dan keluaran klinis. Metode Penelitian Penelitian ini merupakan kohort retrospektif. Data diperoleh dari rekam medis pasien yang dirawat di ICU RSU Saiful Anwar Malang sejak Agustus 2020 hingga Agustus 2021 yang terkonfirmasi positif COVID-19. Subyek yang memenuhi kriteria inklusi x sebanyak 352 subjek. Hasil Koinfeksi ditemukan pada 22,2% pasien kami dengan bakteri (66/84,61%), jamur (9/11,53%) dan bakteri dan jamur (3/3,84%). Kami menemukan ratarata lama rawat pasien tanpa koinfeksi adalah 6 hari dibandingkan dengan 13 hari dengan koinfeksi. Kami juga menemukan peningkatan persentase kematian koinfeksi dengan 71,8% dibandingkan dengan 31% pada non koinfeksi. Koinfeksi bakteri, jamur, atau keduanya pada COVID-19 berkorelasi positif dengan Leukosit (p = 0,001; r = 0,356), Neutrofil (p = 0,001 r = 0,438), CRP (p = 0,003; r = 0,164) dan Prokalsitonin (p = 0,001; r = 0,192) dan korelasi positif dengan lama rawat (p = 0,001) dan korelasi negatif dengan hasil (p = 0,001). Koinfeksi sebagian besar disebabkan oleh bakteri gram negatif dengan etiologi yang umum adalah Acinetobacter baumanii diikuti oleh Klebsiella pneumoniae, dan bakteri gram positif Enterococcus faecalis. Koinfeksi jamur disebabkan oleh Candida albicans, Candida glabrata, Candida tropicalis, dan Candida lusitaniae. Kesimpulan Koinfeksi hanya ditemukan sekitar seperlima pasien COVID-19. Kami merekomendasikan resep antimikroba hanya jika ada indikasi kuat. Identifikasi awal koinfeksi bakteri dan jamur diperlukan untuk mengidentifikasi pasien berisiko tinggi dan menentukan intervensi yang tepat untuk mencegah tinggal di rumah sakit lebih lama dan mengurangi kematian.

English Abstract

Introduction and Purpose Severe or critical ill Coronavirus Disease (COVID–19) infection is associated with intensive care unit (ICU) admission which increases coinfection and lead to worsening prognosis. This study aims to determine the correlation between coinfection bacterial and fungal in COVID-19 with the value of the leukocyte, neutrophil, C-Reactive Protein (CRP), procalcitonin, length of stay and outcome whether it is discharge from ICU to ward or the patients passed away. Methods This study is a retrospective cohort study. Data was obtained from medical record of patients admitted in ICU Saiful Anwar General Hospital Malang from August 2020 until August 2021, who were confirmed positive for COVID-19. There were 352 subjects that met the inclusion criteria. Results Coinfection was found in 22,2% of our patients with bacterial (66/84,61%), fungal (9/11,53%) and both bacterial and fungal (3/3,84%). We found mean length of stay patients without coinfection was 6 days compared to 13 days with coinfection. We also found increased in mortality percentage of coinfection with 71.8% compared to 31% in non coinfection. Coinfection of bacterial, fungal, or both in COVID-19 have a positive correlation with Leucocyte (p = 0.001; r = 0.356), Neutrophil (p = 0.001 r = 0.438), CRP (p = 0.003; r = 0.164) and Procalcitonin (p = 0.001; r = 0.192) and positive correlation with length of stay (p = 0.001) and negative correlation with the outcome (p = 0.001). Coinfection mostly were caused by gram negative bacteria with the common etiology were Acinetobacter baumanii followed by Klebsiella pneumoniae, and gram positive bacteria Enterococcus faecalis. Fungal coinfection were caused by Candida albicans, Candida glabrata, Candida tropicalis, and Candida lusitaniae.. Conclusions Coinfection was only found around one fifth of COVID-19 patients. We recommend antimicrobial prescription only if there was strong indication. Early identification of bacterial and fungal coinfection was necessary to identify high risk patients and determined appropriate interventions to prevent longer hospital stay and reduce mortality.

Other obstract

Item Type:	Thesis (Magister)
Identification Number:	0422060155
Uncontrolled Keywords:	COVID –19, Koinfeksi, Lama Rawat Inap, Mortalitas
Subjects:	600 Technology (Applied sciences) > 616 Diseases > 616.2 Diseases of respiratory system > 616.24 Diseases of Lungs / Lungs--Diseases
Divisions:	Profesi Kedokteran > Spesialis Pulmonologi dan Kedokteran Respirasi, Fakultas Kedokteran
Depositing User:	Endang Susworini
Date Deposited:	08 May 2023 01:07
Last Modified:	08 May 2023 01:07
URI:	http://repository.ub.ac.id/id/eprint/198790

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