Pola Kuman Pasien Pneumonia di Instalasi Rawat Intensif Anak (IRIA) RSUP Dr. Sardjito

Abstract

Bacterial pattern of pneumonia patient admitted in pediatric intensive care unit (PICU) Dr. Sardjito General Hospital

Background: Pneumonia is an inflammation of the lung parenchyma. The causative agent of pneumonia is difficult to determinate. This study was to attemp the pattern of bacteria and antibiotic sensitivity of pneumonia, and to see the risk of pneumonia mortality by age and bacteria obtained from cultures.

Methods: Data of tracheal aspirate and blood cultures and its sensitivity to antibiotics of pneumonia patients who admitted to PICU of Sardjito General Hospital Yogyakarta in January-June 2011 were collected retrospectively from medical records. Analyzed by using chi-square test and the relative risk is expressed by odds ratio.

Results: Ninety-four isolates of bacteria were obtained. There are 63 of tracheal aspirate and 32 of blood specimens. Gram (+) were 39.36% and gram (-) were 60.64%. The most cultures of tracheal aspirate was Pseudomonas, which the sensitivity of imipenem, amikacin, fosfomisin, netilmisin were 81.25%, 80.95%, 76.19%, 68.42%. The sensitivity of Klebsiella pneumoniae to fosfomisin, imipenem, amikacin were 92.31%, 84.62%, 76.92%. All isolates of coagulase negative Staphylococcus (CONS) were resistant to cephalosporin, likely 100% were sensitive to vancomisin. The sensitivity of Pseudomonas aeruginosa in the blood to ciprofloxacin, chloramphenicol, amikacin, cefepime and ceftazidim, gentamicin netilmisin and imipenem were 93.75%, 87.50%, 81.25%, 75%, 68.75%. The odds ratio (OR) of pneumonia death of age <1 year was 1.6, as well as the OR of pseudomonas was 2.5.

Conclusion: The bacteria found were Pseudomonas aeruginosa, Klebsiella pneumoniae and CONS. The sensitivity of imipenem, amikacin, fosfomisin and ciprofloxacin were good to the three kind of bacteria. Patient under 1 year old and Pseudomonas aeruginosa are risk factors for death in pneumonia.

Keywords: Pneumonia, culture, antibiotics

ABSTRAK

Latar belakang: Pneumonia adalah peradangan pada parenkim paru-paru. Penentuan penyebab pneumonia adalah sulit, Tujuan penelitian ini adalah melakukan pemetaan pola kuman dan kepekaan antibiotik pada pneumoni, melihat risiko kematian pneumonia berdasarkan umur dan kuman yang didapatkan dari kultur.

Metode: Data kultur aspirat trakeal dan darah beserta kepekaan terhadap antibiotik pasien pneumonia yang dirawat di Instalasi Rawat Intensif Anak (IRIA) RSUP Dr. Sardjito Yogyakarta Januari- Juni 2011 diambil secara retrospektif dari catatan medik. Data dianalisis menggunakan uji x 2, risiko relatif dinyatakan dengan rasio odd.

Hasil: Didapatkan 94 isolat kuman. Aspirat trakeal ada 63, isolat spesimen darah 32 isolat. Bakteri gram (+) 39,36% dan gram (-) 60,64%. Dari kultur aspirat trakeal terbanyak Pseudomonas, kepekaan terhadap Imipenem 81,25%, amikasin 80,95%, fosfomisin 76,19%, netilmisin 68,42%. Kepekaan Klebsiella pneumonia terhadap fosfomisin 92,31%, imipenem 84,62%, amikasin 76,92%. Semua isolat Staphylococcus coagulase negative (CONS) resisten terhadap sefalosporin, namun 100% peka dengan vancomisin. Kepekaan Pseudomonas aeruginosa dalam darah: ciprofloxacin 93,75%, kloramfenikol 87,50% amikasin, cefepime, ceftazidim 81,25%, gentamisin dan netilmisin 75%, imipenem 68,75%. Rasio odd (RO) kematian pasien pneumonia umur <1 tahun 1,6, RO kematian karena kultur pseudomonas 2,5.

Simpulan: Kuman utama adalah Pseudomonas aeruginosa, Klebsiella pneumonia dan CONS. Kepekaan imipenem, amikasin, ciprofloksasin dan fosfomisin baik terhadap ketiga kuman tersebut. Umur <1 tahun dan pseudomonas merupakan faktor risiko kematian pada pneumoni