Penggunaan dan Resistensi Antibiotik di Instalasi Rawat Intensif Rumah Sakit Umum Daerah di Bali: Studi Ekologikal selama 3 Tahun
Abstract
Resistensi bakteri yang terjadi di Intensive Care Unit (ICU) disebabkan oleh banyak faktor, salah satunya adalah penggunaan dan pemilihan antibiotik yang tinggi dan selektif. Perlu dilakukan studi tentang tingkat penggunaan antibiotik dan resistensi bakteri terhadap antibiotik di ICU yang dapat menjadi dasar evidence untuk merencanakan program guna mengontrol tingkat penggunaan antibiotik yang berdampak terhadap resistensi bakteri di ICU. Penelitian ini merupakan penelitian ekologikal yang dilakukan di rumah sakit umum daerah di Bali dengan menggunakan data retrospektif selama tahun 2017–2019. Data yang digunakan yaitu data penggunaan antibiotik sistemik (dinyatakan dalam defined daily doses (DDD) per 100 hari rawat), dan data persentase sensitivitas bakteri di ICU. Analisis statistik dilakukan dengan menggunakan korelasi rank Spearman. Segmen penggunaan antibiotik terbanyak ditetapkan menggunakan drug utilization 90% (DU90%) dan kategori fenotipik bakteri ditetapkan berdasarkan Centers for Disease Control and Prevention (CDC). Hasil penelitian menunjukkan terdapat tujuh antibiotik yang masuk dalam segmen DU90%, yaitu levofloksasin, seftriakson, ampisilin, sefotaksim, siprofloksasin, ampisilin-sulbaktam, dan gentamisin. Enam bakteri Gram-negatif terbanyak di ICU yaitu: Acinetobacter baumannii, Enterobacter cloacae, Enterococcus faecalis, Escherichia coli, Klebsiella pneumonia dan Pseudomonas aeruginosa. Terdapat lima bakteri dengan kategori multi drug resistant (MDR) yaitu A. baumannii, E. cloacae, E. coli, K. pneumonia dan P. aeruginosa. Terdapat dua spesies bakteri yang termasuk dalam kategori carbapenem resistant (CR) dan extended-spectrum cephalosporin-resistant (ESCR) yaitu A. Baumannii dan E. cloacae. Hanya bakteri E. coli yang menunjukkan korelasi yang signifikan dengan arah negatif antara penggunaan antibiotik dan persentase sensitivitas bakteri di ICU (r=–0,543; p=0,024). Dapat disimpulkan bahwa semakin tinggi penggunaan antibiotik menyebabkan penurunan sensitivitas bakteri terhadap antibiotik.
Kata kunci: Carbapenem resistant, DDD, extended-spectrum cephalosporin-resistant, MDR, resistensi bakteri, studi ekologikal
Antibiotic Use and Resistance at Intensive Care Unit of a Regional Public Hospital in Bali: A 3-Year Ecological Study
Abstract
Antibiotic resistance at Intensive Care Unit (ICU) has been impacted by several factors, including high utilization and selectivity. The consumption rate and its selective pressure appear very extensive, with regular opportunities for cross-transmissions. In addition, ICU patients are susceptible to carriage acquisition and subsequent infections with high resistant bacteria. Therefore, this study investigates the relationship between the use and resistance of antibiotics in the ICU of a regional public hospital. The results potentially serve as confirmations for planning programs necessary to control ICU-related antibiotic consumption levels. This ecological analysis was also based on inpatient retrospective data from a regional public hospital in Bali from 2017–2019. Subsequently, the amount of intake expressed as daily doses (DDDs) per 100 patient days, and percentage of resistant bacterial isolates were examined using Spearman rank correlation. The largest segment of the antibiotics was determined by drug utilization 90% (DU90%) and the phenotypic class was defined by Centers for Disease Control and Prevention (CDC). Similarly, the most predominantly applied antibiotics were levofloxcacin, ceftriaxone, ampicillin, cefotaxime, ciprofloxacin, ampicillin-sulbactam and gentamycin. Meanwhile, the major gram-negative bacteria were Acinetobacter baumannii, Enterobacter cloacae, Enterococcus faecalis, Escherichia coli, Klebsiella pneumonia and Pseudomonas aeruginosa. Furthermore, 5 multi drug resistant (MDR) bacteria were observed, including A. baumannii, E. cloacae, E. coli, K. pneumonia and P. aeruginosa, while A. baumannii and E. cloacae occurred as carbapenem resistant (CR) and extended-spectrum cephalosporin-resistant (ESCR), respectively. However, only E. coli showed a negative significant correlation between antibiotic utilization and the percentage of ICU bacterial sensitivity (r=–0,543; p=0,024). Therefore, higher consumption of antibiotics decreases its percentage susceptibility.
Keywords: Antibiotic resistance, carbapenem resistant, DDD, ecological study, extended-spectrum cephalosporin-resistant, MDR
Keywords
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DOI: https://doi.org/10.15416/ijcp.2021.10.3.180
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