ANALISIS FAKTOR RISIKO DAN LUARAN DARI PENGGUNAAN TERAPI ANTIBIOTIK EMPIRIK JANGKA PANJANG PADA BAYI DENGAN BERAT LAHIR SANGAT RENDAH DALAM KONDISI SEPSIS
DOI:
https://doi.org/10.21776/ub.majalahkesehatan.2019.006.04.4Keywords:
antibiotik, neonatus, sepsisAbstract
Terapi antibiotik berkepanjangan pada neonatus menyebabkan beberapa konsekuensi negatif meliputi resistensi antibiotik, sepsis awitan lambat, enterocolitis nekrotikan (EKN), lama rawat lebih panjang, dan peningkatan mortalitas. Semua faktor tersebut mempengaruhi efisiensi biaya pelayanan rumah sakit di era Jaminan Kesehatan Nasional. Penelitian ini bertujuan untuk menganalisis faktor risiko dan luaran dari terapi antibiotik berkepanjangan pada bayi berat lahir sangat rendah (BBLSR) dengan sepsis. Desain penelitian adalah studi retrospektif pada BBLSR dengan sepsis di Neonatal Intensive Care Unit (NICU), RSUD Dr. Soetomo, Surabaya sejak Januari-Desember 2017 dilakukan dengan membandingkan luaran antara kelompok I yang mendapat terapi antibiotik empirik kurang dari sama dengan 2 minggu dengan kelompok II yang mendapat terapi antibiotik empirik lebih dari 2 minggu empirik. Dari 87 bayi yang termasuk ke dalam studi, 37 bayi termasuk dalam kelompok I dan 50 bayi dalam kelompok II. Rerata durasi terapi antibiotik pada kelompok I dan kelompok II adalah 9,2±2,5 dan 17,9±3,2 hari, dengan lama rawat inap 19,7±8,5 dan 27,2±13,1 hari. Analisis faktor risiko menunjukkan bahwa BBLSR terutama 1000 gram (p < 0,001), ventilasi mekanik invasif (p < 0,001), ventilasi mekanik non-invasif (p < 0,001), korioamnionitis (p = 0,003), penyakit maternal (p = 0,004), kehamilan multipel (p = 0,03) merupakan faktor risiko mendapatkan terapi antibiotik empirik berkepanjangan. Luaran dari terapi antibiotik empirik berkepanjangan adalah 41 (47%) bayi mengalami sepsis awitan lambat, 15 (17%) bayi dengan EKN, dan 11 (12%) bayi meninggal. Mortalitas bayi dengan sepsis awitan lambat (p < 0,001) dan EKN (p = 0,02) lebih tinggi pada kelompok II dibandingkan kelompok I. Kesimpulannya, terapi antibiotik empirik berkepanjangan meningkatkan angka kejadian sepsis awitan lambat, enterocolitis nekrotikan, lama rawat, dan mortalitas BBLSR di NICU yang berdampak meningkatkan biaya pelayanan rumah sakit.
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