Kuswiyono, dr. and dr. Arie Zainul Fatoni, Sp.An,KIC and dr. Taufiq Agus Siswagama,, Sp.An,KMN (2022) Hubungan Parameter Klinis Dan Laboratoris Terhadap Kejadian Infeksi Sekunder Pada Pasien Pneumonia Covid 19 Di Intensive Care Unit (Icu) RSUD Dr. Saiful Anwar Malang. Magister thesis, Universitas Brawijaya.
Abstract
Latar belakang: Infeksi sekunder pada pasien COVID-19 dapat berupa koinfeksi maupun superinfeksi. Infeksi sekunder bakteri dan jamur pada pasien Covid-19 akan meningkatkan kebutuhan akan perawatan intensif dan peningkatan mortalitas. Terdapat beberapa prediktor dari infeksi sekunder pada pasien COVID-19 diantaranya kebutuhan akan ventilasi mekanis invasif, penggunaan Tocilizumab, nilai CRP tinggi saat masuk dan pengobatan dengan faktor piperacillin/ tazobactam serta nilai limfopenia yang berat. Tujuan: Mengetahui hubungan parameter klinis dan laboratoris terhadap kejadian infeksi sekunder pada pasien Pnemonia Covid 19 di ruang rawat inap intensif RSUD Dr. Saiful Anwar Malang. Metode: Penelitian merupakan studi satu senter, kohort retrospektif observasional. Diambil sampel pasien COVID-19 yang dirawat di ICU RSSA mulai dari bulan Agustus 2020 sampai dengan Agustus 2021 dengan sumber data dari rekam medis. Data yang dikumpulkan antara lain karakteristik demografis, hasil kultur sputum dan / atau darah dan / atau urine, dan data laboratorium Limfosit, Leukosit, Neutrofil, CRP dan Procalcitonin Hasil: Didapatkan 195 subyek setelah melalui proses inklusi dan eksklusi. Dari 195 subjek penelitian, mayoritas mengalami infeksi sekunder selama rawat inap di ICU dengan insidensi sebanyak 143 dari 195 pasien (73,3%). Sebagian besar pasien menderita superinfeksi (infeksi bakteri/jamur >48 jam setelah dirawat di rumah sakit) sebanyak 113 pasien (79,02%), sedangkan 30 pasien (20,98%) menderita koinfeksi (infeksi bakteri/jamur dalam 24-48 jam setelah dirawat di rumah sakit. Agen penyebab infeksi sekunder terbanyak adalah bakteri Gram negatif yang ditemukan pada 113 sampel kultur (59,47%), terutama bakteri Gram negatif non-fermentasi Acinetobacter baumanii yang ditemukan pada 44 sampel. Kultur dengan hasil bakteri Gram positif terdapat pada 58 sampel (30,53%) yang didominasi oleh Enterococcus faecalis (22 sampel) dan Staphylococcus coagulase negative strain (19 sampel). Infeksi sekunder yang disebabkan fungi hanya terdapat pada 19 sampel (10,0%), dengan agen kausa terbanyak adalah Candida albicans pada 11 sampel. Dari seluruh parameter laboratorium, tidak ada yang berhubungan signifikan terhadap infeksi sekunder pada pasien COVID-19 yang dirawat di ICU. Penggunaan antibiotik ceftriaxone berhubungan signifikan dengan kejadian infeksi sekunder (p<0,05), dengan semua 13 pasien (100,0%) yang menerima ceftriaxone menderita infeksi sekunder. Kesimpulan : Terapi antibiotik cephalosporin golongan ketiga ceftriaxone berhubungan signifikan terhadap kejadian infeksi sekunder pada pasien COVID-19 di RSUD Dr. Saiful Anwar, Malang. Parameter klinis jenis kelamin, usia, penyakit komorbid, penggunaan tocilizumab, terapi TPK, terapi IVIG, penggunaan ventilator mekanik invasif dan Skor SOFA serta parameter laboratoris tidak berhubungan signifikan terhadap kejadian infeksi sekunder pada pasien COVID-19 di RSUD Dr. Saiful Anwar, Malang.
English Abstract
Background: Secondary infection in COVID-19 patients can be in form of coinfection or superinfection. Secondary bacterial and fungal infections in Covid-19 patients will increase the need for intensive care treatment and also can increase mortality. There are several predictors of secondary infection in COVID-19 patients including the need for invasive mechanical ventilation, use of Tocilizumabs, high CRP values and treatment with antibiotics like piperacillin/tazobactam factors and severe lymphopenia values. Objective: To determine the relationship between clinical and laboratory parameters to the incidence of secondary infection in patients with Pneumonia Covid 19 in the intensive care unit of RSUD Dr. Saiful Anwar Malang. Methods: The study was a one-centre, retrospective observational cohort study. Samples were taken from COVID-19 patients who were treated in the ICU RSSA from August 2020 to August 2021 with data sources from medical records. The data collected included demographic characteristics, sputum and/or blood and/or urine culture results, and laboratory data for lymphocytes, leukocytes, neutrophils, CRP and procalcitonin. Results: There were 195 subjects after going through the inclusion and exclusion process. Of the 195 study subjects, the majority experienced secondary infections during hospitalization in the ICU with an incidence of 143 out of 195 patients (73.3%). Most of the patients had superinfection (bacterial/fungal infection >48 hours after hospitalization) as many as 113 patients (79.02%) while 30 patients (20.98%) had co-infection (bacteria/fungal infection within 24-48 hours). after hospitalization. The most common causative agent of secondary infection was Gram negative bacteria found in 113 culture samples (59.47%), especially non-fermenting Gram negative bacteria Acinetobacter baumanii found in 44 samples Cultures with Gram positive bacteria were found in 58 samples (30.53%) dominated by Enterococcus faecalis (22 samples) and Staphylococcus coagulase negative strain (19 samples).Secondary infections caused by fungi were only found in 19 samples (10.0%), with the most common causal agent being Candida albicans in 11 samples. Of all laboratory parameters, none were significantly associated with secondary infection in COVID-19 patients admitted to the ICU. The use of antibiotics ceftriaxone was significantly associated with the incidence of secondary infection (p<0.05), with all 13 patients (100.0%) receiving ceftriaxone developing secondary infection. Conclusion : The third class cephalosporin antibiotic therapy ceftriaxone was significantly related to the incidence of secondary infection in COVID-19 patients at Dr. Saiful Anwar, Malang. Clinical parameters gender, age, comorbid disease, use of tocilizumab, TPK therapy, IVIG therapy, use of invasive mechanical ventilators, SOFA scores and laboratory parameters were not significantly related to the incidence of secondary infection in COVID-19 patients at RSUD Dr. Saiful Anwar, Malang.
Other obstract
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| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | 0422060163 |
| Uncontrolled Keywords: | COVID-19, infeksi sekunder, parameter klinis, parameter laboratoris |
| Subjects: | 600 Technology (Applied sciences) > 617 Surgery, regional medicine, dentistry, ophthalmology, otology, audiology > 617.9 Operative surgery and special fields of surgery > 617.96 Anesthesiology |
| Divisions: | Profesi Kedokteran > Spesialis Anestesiologi dan Terapi Intensif, Fakultas Kedokteran |
| Depositing User: | Endang Susworini |
| Date Deposited: | 08 May 2023 03:37 |
| Last Modified: | 08 May 2023 03:37 |
| URI: | http://repository.ub.ac.id/id/eprint/198875 |
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