Penggunaan Antibiotik untuk Penanganan Ulkus dan Gangren Diabetikum Pasien Rawat Inap di Rumah Sakit

Riyan Stiyanto, Iin Suhesti

Abstract


Penyakit Diabetes melitus yang tidak dikelola dengan baik dapat menyebabkan komplikasi dan membahayakan kehidupan pengidapnya. Salah satu komplikasi diabetik yang sering terjadi adalah neuropati (kerusakan syaraf) di kaki yang menyebabkan ulkus kaki, infeksi, dan bahkan keharusan untuk amputasi kaki. Penelitian ini bertujuan untuk mengidentifikasi persentase penggunaan antibiotika empiris yang rasional serta pengaruhnya terhadap outcome terapi pada pasien Diabetes melitus dengan ulkus dan gangren di RSUD Dr Moewardi Surakarta dan RSUD Bagas Waras Klaten. Penelitian ini merupakan penelitian observasional dengan pengambilan data pada penelitian dilakukan secara retrospektif dan prospektif selama periode Januari sampai Agustus 2018. Ketidakrasionalan penggunaan antibiotika empiris dievaluasi dengan metode Gyssens. Sebanyak 36 pasien yang memenuhi kriteria inklusi 75% pasien mendapatkan terapi antibiotika empiris yang rasional dan 25% pasien mendapatkan terapi antibiotika empiris yang tidak rasional. Uji Chi Square dengan taraf kepercayaan 5% (p < 0,05) digunakan untuk membandingkan rasionalitas pengunaan antibiotika terhadap outcome terapi. Hasil Fisher’s Exact Test (Two Tailed) menunjukkan bahwa ada hubungan/pengaruh antara rasionalitas penggunaan antibiotika empiris dengan outcome terapi tetapi pemberian antibiotika empiris tidak berpengaruh pada angka leukosit bagi pasien, baik di RSUD Bagas Waras Klaten maupun RSUD dr. Moewardi Surakarta.


Diabetes mellitus that is not managed properly can cause complications to endanger life. One of the diabetic complications that often occurs is foot neuropathy (nerve damage) inducing foot ulcers, infections, and even the necessity for a leg amputation. This study aims to determine the percentage of rational use of empirical antibiotics and their effects on outcomes therapy of diabetes mellitus patient with ulcers and gangrene in RSUD dr. Moewardi Hospital Surakarta and Bagas Waras Hospital Klaten. This study is an observational study with data collection in the study carried out retrospectively and prospectively from January to August 2018. The irrationality of using empirical antibiotics evaluated by the Gyssens method. Thirty six patients were enrolled and 75% of them treated with rational and empirical antibiotic therapy,. Chi-Square Test with a confidence level of 5% (p <0.05) used to compare the rationality of antibiotic use to the therapeutic outcome, the results of the Fisher Exact Test (Two-Tailed) indicated that there were relationship/influence between the rationality of using empirical antibiotics and outcomes therapy, but there was no influence between the rationality of using empirical antibiotics and leucocyte both in RSUD Bagas Waras Klaten and RSUD dr. Moewardi Surakarta.

Keywords: Diabetes mellitus, therapeutic outcome, empirical antibiotic rationality


Keywords


Diabetes mellitus; outcome terapi; rasionalitas antibiotika empiris

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References


ADA. (2018). Standards Of Medical Care In Diabetes — 2018. Diabetes Care, 41(January).

Akbari, R., Javaniyan, M., Fahimi, A., & Sadeghi, M. (2017). Renal function in patients with diabetic foot infection ; does antibiotherapy affect it ? Nickan Research Institute, 6(2), 117–121. https://doi.org/10.15171/jrip.2017.23

Ali, N., Rehman, S., Imran, M., Hussian, I., Shehbaz, N., Jamshed, H., … Mj, A. (2009). The In-Practice Prescribing Pattern for Antibiotics in the Management of Diabetic Foot : Needs Much More to be done ! J Young Pharmacist, 1 no 4, 375–378. https://doi.org/10.4103/0975-1483.59331

APHA. (2009). Drug Information Handbook, 17th Edition. Lexi Comp Inc.

Blume, P., Ciaramello, B., Kaufman, M., & Reynolds, S. (2017). Top 10 Antibiotics For Managing Diabetic Foot Infections _ Podiatry Today. Podiatry Today Vol.30-Issue 8.

BNF. (2011). British National Formulary edition 61.

Embil, J. M., Albalawi, Z., Bowering, K., & Trepman, E. (2018). Foot Care, Diabetes Canada Clinical Practice Guidelines Expert Committee. Canadian Journal of Diabetes, 42, 222–227.

Fish, D. N., Pendland, S. L., & Danziger, L. H. (2008). Chapter 114 : Skin and Soft-Tissue Infections. (J. T. Dipiro, Ed.) (7th ed.). The McGraw-Hill Companies, Inc.

Gist, S., & Tio-matos, I. (2009). Wound care in the geriatric client. Dovepress : Clinical Interventions in Aging, 4, 269–287.

IDF. (2017). Idf diabetes atlas.

IHS Antibiotics Stewardship Workgroup. (2018). Inpatient-ASP-Guidelines-Feb-2018-guideline AB..pdf.

Infodatin. (2014). Situasi dan Analisis Diabetes. Kementerian Kesehatan RI.

Infodatin. (2018). HARI DIABETES SEDUNIA TAHUN 2018.

Joehaimey, J., B, M. A., A, M. A. H., Mk, K., Jaya, S. P., Saadon, I., & P, C. H. (2016). Pattern of Organisms and Antibiotics Used in Treating Diabetes Foot Infection, 15(1).

Kartika, R. W. (2017). Pengelolaan Gangren Kaki Diabetik. CDK-248, 44(1), 18–22.

Kurniawan, H. D. (2014). Hubungan Albumin serum Awal Perawatan dengan Perbaikan Klinis Infeksi Ulkus Kaki Diabetik di Rumah Sakit di Jakarta. Tesis.

Leekha, S., Terrell, C. L., Edson, R. S., Dmjojdbm, J., Jo, T., Vtf, X., … Jt, B. (2011). General Principles of Antimocrobial Therapy. Mayo Clinic Proceedings, 86(2), 156–167. https://doi.org/10.4065/mcp.2010.0639

Lipsky, B. A., Berendt, A. R., Cornia, P. B., Pile, J. C., Peters, E. J. G., Armstrong, D. G., … Senneville, E. (2012a). 2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections a. Clinical Infectious Disease, 54, 1679–1684. https://doi.org/10.1093/cid/cis460

Lipsky, B. A., Berendt, A. R., Cornia, P. B., Pile, J. C., Peters, E. J. G., Armstrong, D. G., … Senneville, E. (2012b). 2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections a. CID, 54((15 June)), 132–173. https://doi.org/10.1093/cid/cis346

Pendsey, S. P. (2007). Insulin in Diabetic Foot. Supplement, 55(July), 2007.

PERKENI. (2015). Konsensus Pengelolaan dan pencegahan diabetes melitus tipe 2 di indonesia 2015 (1st ed.). PB PERKENI. Retrieved from https://pbperkeni.or.id/wp-content

SIGN. (2017). Management of diabetes, Quick Reference Guide. Healthcare Improvement Scotland, (November).

Susanti, I., Arianto, B., & Purnamayanti, A. (2016). Antibiotics Efficacy Analysis on Diabetic Foot Ulcer Inpatients. International Journal of Pharma Medeicine and Biological Sciences, 5(4), 232–236. https://doi.org/10.18178/ijpmbs.5.4.232-236

WHO. (2018). GLOBAL REPORT ON DIABETES.

Williams, A. D. T., Hilton, J. R., Harding, K. G., Williams, D. T., Hilton, J. R., & Harding, K. G. (2016). Diagnosing Foot Infection in Diabetes, 39.

Zubair, M., Malik, A., & Ahmad, J. (2015). Microbiology of diabetic foot ulcer with special reference to ESBL infections. American Journal of Clinical Experimental Medicine, 3(1), 6–23. https://doi.org/10.11648/j.ajcem.20150301.12




DOI: http://dx.doi.org/10.20527/jps.v7i2.8578

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