Angka Kejadian dan Faktor-Faktor yang Mempengaruhi Infeksi Paska Pemasangan Kateter Vena Sentral di Rumah Sakit Dr. Soetomo

*Eka Seprianti Widiastuti -  Bagian Anestesiologi dan Terapi Intensif, Fakultas Kedokteran, Universitas Airlangga/ RSUD Dr. Soetomo Surabaya, Indonesia
Bambang Wahjuprajitno -  Bagian Anestesiologi dan Terapi Intensif, Fakultas Kedokteran, Universitas Airlangga/ RSUD Dr. Soetomo Surabaya, Indonesia
Published: 1 Mar 2014.
Open Access
Citation Format:
Article Info
Section: Penelitian
Language: ID
Full Text:
In Vol 6, No 1 (2014): Jurnal Anestesiologi Indonesia
Statistics: 1194 172
Abstract

Latar Belakang : Setiap tahun lebih dari 150 juta kateter intravena digunakan , dimana 5 juta dari mereka dipasang pada vena sentral . Sayangnya , lebih dari 500.000 infeksi yang terkait dengan pemasangan alat secara intravaskular melalui aliran darah terjadi di AS setiap tahun , 7-20 % disebabkan oleh central venous catheter - related blodstream infection ( CR - BSI ) . CR - BSI terkait dengan perpanjangan lama tinggal di rumah sakit , meningkatkan biaya dan kematian. Beberapa faktor yang mempengaruhi terjadinya CR - BSI seperti tempat penyuntikan, prosedur pemasangan yang steril maksimal, dressing transparan, perawatan tanpa teknik aseptik, penggunaan nutrisi parenteral dan inotropikik katekolamin, kondisi pasien , dan banyak lagi. Belum ada data tentang kejadian CR - BSI dan faktor-faktor yang mempengaruhinya di Rumah Sakit Umum Dr Soetomo, .

Tujuan : Menghitung angka kejadian CR - BSI dan menganalisis faktor-faktor yang mempengaruhinya di Dr Soetomo Surabaya .

Metode : Prosedur penelitian dimulai sejak CVC dipasang pada pasien, data dasar dicatat seperti identitas, kondisi awal, komorbiditas , dan teknik pemasangan. Pasien diikuti untuk mengevaluasi teknik perawatan CVC, pemakaian antibiotik sistemik, penggunaan nutrisi parenteral dan inotropikik katekolamin, serta dugaan CR - BSI. Kultur darah dilakukan bila dicurigai infeksi timbul ( baik secara klinis dan menggunakan Skor IPS), dan kemudian diagnosis CR - BSI dibuat . Semua data dicatat sampai CVC telah dilepas dan pasien keluar dari rumah sakit .

Hasil : Ada 15 kasus CR - BSI pada 139 pasien, total durasi pemakaian CVC adalah 1.751 hari, sehingga tingkat CR - BSI 8.57 kasus per 1000 hari penggunaan CVC. Tingkat tertinggi adalah di bangsal neurologi, 35,71 kasus per 1000 hari penggunaan CVC. Lama tinggal di rumah sakit ( p = 0,032 ), durasi penggunaan CVC ( p = 0,002 ), penggunaan nutrisi parenteral ( p = 0,000 ), penggunaan inotropikik katekolamin ( p = 0,041 ), skor APACHE II ( p = 0,000 ), infeksi sebelum pemakaian CVC ( p = 0,039 ) dan infeksi di tempat lain ( p = 0,033 ) merupakan faktor signifikan yang mempengaruhi kejadian CR - BSI . Namun, jika faktor-faktor ini diperiksa bersama-sama, durasi penggunaan CVC ( p = 0,030 ), penggunaan nutrisi parenteral ( p = 0,005 ), dan skor APACHE II ( p = 0,006 ) memberikan pengaruh yang dominan terhadap CR - BSI .

Kesimpulan : Angka kejadian CR - BSI di Dr Soetomo Rumah Sakit Umum tinggi, sedangkan durasi CVC digunakan, penggunaan nutrisi parenteral , dan skor APACHE II sebagai faktor paling dominan yang mempengaruhi kejadian infeksi tersebut .

Keywords
kateter vena sentral; infeksi kateter terkait aliran darah vena sentral; nutrisi parenteral; APACHE II Score

Article Metrics:

  1. Jarvis WR, Murphy C, Hall KK, Fogle PJ, Karchmer TB, Harrington G, Salgado C, Giannetta ET, Cameron C, Sherertz RJ. Health care-associated bloodstream infections associated with negative- or positive-pressure or displacement mechanical valve needleless connectors. Clin Infect Dis. 2009;49(12):1821-7
  2. McGee DC, Gould MK. Preventing Complications of Central Venous Catheterization. N Engl J Med. 2003; 348(12):1123-33
  3. Graham AS, Ozment C, Tegtmeyer K, Lai S, Braner DA. Videos in clinical medicine. Central venous catheterization. N Engl J Med. 2007;356(21):e21.
  4. Crnich CJ, Maki DG. Infections caused by intravascular devices: epidemiology, pathogenesis, diagnosis, prevention, and treatment. In: Association for Professionals in Infection Control and Epidemiology. APIC Text of Infection Control and Epidemiology. 2nd ed. Vol 1. Washington DC: Association for Professionals in Infection Control and Epidemiology; 2005. p.1–24.26
  5. McConnel SA, Gubbins PO, Anaissie EJ. Do Antimicrobial-impregnated Central Venous Catheter Prevent Catheter-related Bloodstream Infection?. Clin Infect Dis. 2003;37(1):65-72
  6. Warren DK, Zack JE, Elward AM, Cox MJ, Fraser VJ.. Nosocomial Primary Bloodstream Infections in Intensive Care Unit Patients in A Nonteaching Community Medical Centre: A 21-month Prospective Study. Clin Infect Dis. 2001; 33(8):1329-35
  7. Orsi GB, Di Stefano L, Noah N. Hospital-acquired, laboratory-confirmed bloodstream infection: increased hospital stay and direct costs. Infect Control Hosp Epidemiol. 2002;23(4):190-7
  8. Yahav D, Rozen-Zvi B, Gafter-Gvili A, Leibovici L, Gafter U, Paul M. Antimicrobial Lock Solutions for the Prevention of Infections Associated with Intravascular Catheters in Patients Undergoing Hemodialysis: Systematic Review and Meta Analysis of Randomized, Controlled Trials. Clin Infect Dis. 2008;47(1):83-93
  9. Oncü S, Ozsüt H, Yildirim A, Ay P, Cakar N, Eraksoy H, Calangu S. Central venous catheter related infections: Risk factors and the effect of glycopeptide antibiotics. Ann Clin Microbiol Antimicrob. 2003;2:3
  10. Marra AR, Opilla M, Edmond MB, Kirby DF. Epidemiology of Bloodstream Infections in Patients Receiving Long Term Total Parenteral Nutrition J Clin Gastroenterol. 2007;41(1):19-28
  11. Collins CJ, Fraher MH, Bourke J, Phelan D, Lynch M. Epidemiology of Catheter Related Bloodstream Infections in Patients Receiving Total Parenteral Nutrition. Clin Infect Dis. 2009;49(11):1769-70
  12. Freestone P, Haigh R, Lyte M. Cathecolamine Inotrope Resuscitation of Antibiotic-Damage Staphylococci and Its Blockade by Spesific Receptor Antagonists. J Infect Dis. 2008;197(7):1044-52
  13. Kallen AJ, Patel PR, O’Grady NP. Preventing Catheter-Related Bloodstream Infections outside the Intensive Care Unit: Expanding Prevention to New Settings. Clin Infect Dis. 2010;51(3):335-41
  14. O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, et al. Guidelines for The Prevention of Intravascular Catheter-Related Infections. Am J Infect Control. 2011;39(4 Suppl 1):S1-34.
  15. Merrer J, De Jonghe B, Golliot F, Lefrant JY, Raffy B, Barre E, et al. Complication of Femoral and Subclavian Venous Catheterization in Critically Ill Patients. JAMA. 2001;286(6):700-7
  16. Betjes MGH. Prevention of catheter-related bloodstream infection in patients on hemodyalisis. Nat Rev Nephrol. 2011;7(5):257-65
  17. Centers for Disease Control and Prevention / National Healthcare Safety Network (CDC/NHSN) Guidelines Device-associated Module CLBSI. 2012;4:1-10
  18. Ferroni A, Moumile K. Evaluation of the gram strain-acridine orange leucocyte cytospin test for diagnosis of catheter-related bloodstream infection in children on long-term parenteral nutrition. Eur J Clin Microbiol Infect Dis. 2006;25:199-201
  19. Anderson MT, Armstrong SK. The Bordatella Bfe System: Growth and Transcriptional Response to Siderophores, Catechols, and Neuroendocrine Catecholamine. J Bacteriol. 2006;188(16):5731-40

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