Karakteristik Klinik dan Pola Antibiotik pada Pasien Rawat Inap Coronavirus Disease 2019 di Rumah Sakit Wava Husada Malang

Abstract

Coronavirus Disease 2019 (COVID-19) disebabkan oleh infeksi virus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) yang mengakibatkan manifestasi klinik pneumonia. Pneumonia pada COVID-19 utamanya disebabkan virus, namun bakteri dapat berperan sebagai penyebab ko-infeksi sehingga meningkatkan risiko kematian. Studi serial kasus ini menyajikan karakteristik klinik dan gambaran regimen antibiotik yang diberikan pada pasien COVID-19 di Rumah Sakit Wava Husada Malang dengan menggunakan data rekam medik. Sebanyak 21 pasien yang terpilih selama periode bulan Maret–Agustus 2020 menunjukkan tingkat keparahan sedang-berat yang selanjutnya dilakukan analisis secara deskriptif. Rata-rata usia pasien yaitu 52±13 tahun dan sebanyak 62% adalah pria. Gejala yang paling banyak ditemukan yaitu sesak (81%) dan batuk (76,2%). Selain itu, beberapa gejala lain yang ditemukan antara lain demam (57,1%), diare (19%), mual/muntah (33,3%), pusing (14,3%) dan anoreksia (4,8%). Seluruh pasien memiliki gambaran radiologi pneumonia dengan sebagian besar menunjukkan jumlah leukosit normal dan jumlah limfosit yang rendah. Sebesar 76,2% (16 pasien) mendapatkan antibiotik tunggal dan 23,8% (5 pasien) mendapatkan kombinasi. Levofloksasin merupakan antibiotik yang paling sering diberikan baik dalam bentuk tunggal maupun kombinasi dengan nilai tengah durasi pemberian antibiotik yaitu 11 hari. Lama rawat inap pasien yaitu antara 12–24 hari dengan kondisi membaik sebesar 71,4% sementara 28,6% meninggal. Pengukuran prokalsitonin perlu diupayakan di rumah sakit tempat pengambilan data sebagai strategi penatalayanan penggunaan antibiotik pada pasien COVID-19.

Kata kunci: Antibiotik, COVID-19, karakteristik klinik, ko-infeksi bakteri

Clinical Characteristic and Antibiotic Patterns among Coronavirus Disease 2019 In-patient Wava Husada Hospital Malang

Abstract

Coronavirus Disease 2019 (COVID-19) is an infection caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), which resulted in the clinical manifestation of pneumonia. A virus mainly causes pneumonia COVID-19, but bacterial co-infection plays a role in increasing mortality. This case series aimed to identify clinical characteristics and antibiotic use in treating COVID-19 patients at Wava Husada Hospital Malang. Data of a total sample of 21 patients selected from March to August 2020 showed moderate to severe infection and was further analyzed descriptively. The mean age of patients was 52±13 years, and 62% were men. Meanwhile, the most common symptoms were shortness of breath and cough with 81% and 76.2%, respectively. Several symptoms found include fever, diarrhea, nausea/vomiting, dizziness, and anorexia at 57.1%, 19%, 33.3%, 14.3%, and 4.8%. The patients had radiological features of pneumonia, where most of them had normal leukocyte and low lymphocyte counts. Additionally, 76.2% or 16 patients received antibiotic monotherapy, and 23.8% or 5 patients received the combination. Levofloxacin is the most commonly administered antibiotics, either single or combined, with a median duration of 11 days. Patients' length of stay ranged from 12 to 24 days; where 71.4% were discharged home, and 28.6% died. Procalcitonin measurement should be attempted as a stewardship strategy for using antibiotics in COVID-19 patients.

Keywords: Antibiotic, bacterial co-infection, clinical characteristics, COVID-19