Evaluasi Kesesuaian Antibiotik berdasarkan Metode Gyssens pada Peresepan Pasien Covid-19 disertai Koinfeksi Pneumonia di Rumah Sakit “X” Kota Denpasar

Rr Asih Juanita, Nyoman Budiartha Siada, Dwi Arymbhi Sanjaya, Herleeyana Meriyani, Ni Putu Nadya Kirana Wulandari

Abstract

Koinfeksi bakteri penyebab pneumonia pada individu dengan Covid-19 berpotensi memperburuk kondisi klinis serta meningkatkan risiko morbiditas dan mortalitas apabila tidak memperoleh penanganan yang adekuat.Terapi antibiotik yang diberikan harus sesuai dengan derajat keparahan pneumonia yang diukur dengan skor Pneumonia Severity Index (PSI). Ketidaktepatan terapi antibiotik dapat meningkatkan risiko terjadinya resistensi. Oleh karena itu, evaluasi penggunaan antibiotik sangat penting dilakukan untuk meminimalkan risiko ketidaktepatan terapi yang dapat menyebabkan terjadinya resistensi bakteri terhadap antibiotik. Namun, penelitian mengenai evaluasi kesesuaian antibiotik pada peresepan pasien Covid-19 disertai koinfeksi pneumonia masih terbatas. Penelitian ini dilakukan dengan tujuan untuk mengevaluasi kesesuaianantibiotik pada peresepan pasien Covid-19 disertai koinfeksi pneumonia di Rumah Sakit “X” Kota Denpasar. Penelitian dilakukan menggunakan desain cross sectional dengan pendekatan retrospektif. Data penelitian dikumpulkan dari rekam medis pasien kemudian dievaluasi secara kualitatif menggunakan metode gyssens, secara kuantitatif dengan Prescribed Daily Dose (PDD), serta hubungan kesesuaian penggunaan antibiotik dengan perbaikan derajat keparahan dianalisis secara statistik menggunakan uji Fisher. Evaluasi kesesuaian antibiotik secara kualitatif menunjukkan sebesar 87% termasuk kategori IVA (ada alternatif antibiotik yang lebih efektif), 3% kategori IIIA (penggunaan antibiotik terlalu lama), dan 10% kategori 0 (penggunaan antibiotik tepat). Hasil evaluasi secara kuantitatif menunjukkan nilai PDD yaitu cefepime (6 gram/hari); cefotaxime (4,2 gram/hari); cefuroxime, ceftazidime, cefoperazone + sulbactam (3 gram/hari); cefoperazone (2,67 gram/hari); ceftriaxone (1 gram/hari); levofloxacin (0,75 gram/hari), azithromycin (0,5 gram/hari), dan moxifloxacin (0,4 gram/hari).Kesesuaian penggunaan antibiotik tidak memiliki hubungan terhadap perbaikan derajat keparahan pasien Covid-19 disertai koinfeksi pneumonia (p = 1,000).

Keywords

Covid-19 disertai koinfeksi Pneumonia; Derajat keparahan; Gyssens; PDD

References

Al-Safi, M. T. (2023). Detection of the Test Gene and Determining the Relationship Between the Presence of the mecA Gene and Antibiotic Resistance of Staphylococcus aureus Isolated from some Hospital in Dhi Qar province. Journal of Population Therapeutics & Clinical Pharmacology, 30(4), 202–210. https://doi.org/10.47750/jptcp.2023.30.04.020

Ali, N. (2020). Role of Vitamin D in Preventing of COVID-19 Infection, Progression and Severity. Journal of Infection and Public Health, 13(10), 1373. https://doi.org/10.1016/j.jiph.2020.06.021

Alipoor, S. D., Jamaati, H., Tabarsi, P., & Mortaz, E. (2020). Immunopathogenesis of Pneumonia in COVID-19. National Research Institute of Tuberculosis and Lung Disease, 19(2), 79–82. https://pmc.ncbi.nlm.nih.gov/articles/PMC7680509/

Amer, S., & van Bree, S. H. (2022). Community-acquired pneumonia. Anaesthesia and Intensive Care Medicine, 1–7. https://doi.org/10.1016/j.mpaic.2022.07.001

Anderson, D. C., & Grimes, D. S. (2020). Vitamin D Deficiency and COVID-19. Clinical Medicine, Journal of the Royal College of Physicians of London, 20(6), 1–13. https://doi.org/doi: 10.3390/nu12092757

Annunziato, G. (2019). Strategies to Overcome Antimicrobial Resistance (AMR) Making Use of Non-Essential Target Inhibitors: A Review. International Journal of Molecular Sciences. 20. 1-25. https://doi.org/10.3390/ijms20235844

Blejan, I. E., Diaconu, C. E., Arsene, A. L., Udeanu, D. I., Ghica, M., Drăgănescu, D., Dragomiroiu, G. T. A. B., Rădulescu, M., Maltezou, H. C., Tsatsakis, A. M., Papasavva, M., Drakoulis, N., & Popa, D. E. (2020). Antibiotic Resistance in Community-Acquired Pneumonia: A Romanian Perspective. Farmacia, 68(3), 512–520. https://doi.org/10.31925/farmacia.2020.3.17

Burhan, E., Isbaniah, F., Susanto, A., Aditama, T., Sartono, T., & Sugiri, Y. (2020). Pneumoia COVID-19 : Diagnosis & Penatalaksanaan di Indonesia. Perhimpunan Dokter Paru Indonesia.

Corica, B., Tartaglia, F., D’Amico, T., Romiti, G. F., & Cangemi, R. (2022). Sex and Gender Differences in Community-Acquired Pneumonia. Internal and Emergency Medicine, 17(6), 1575–1588. https://doi.org/10.1007/s11739-022-02999-7

Dabela, G. A., Tesfaye, B. T., Yizengaw, M. A. (2022). Risk Factors for Inappropriate Antimicrobial Therapy Among Patients with Hospital-Acquired Infection at Jimma Medical Center: A Prospective Observational Study. Infection and Drug Resistance. 15. 837-850. https://doi.org/10.2147/idr.s349358

Dzakirah, I. (2021). Pengaruh Pemberian Vitamin C Dalam Pengobatan COVID-19. Jurnal Medika Hutama, 03(01), 1633–1637. https://jurnalmedikahutama.com/index.php/JMH/article/view/329

Ejaz, H., Alsrhani, A., Zafar, A., Javed, H., Junaid, K., Abdalla, A. E., Abosalif, K. O. A., Ahmed, Z., & Younas, S. (2020). COVID-19 and comorbidities: Deleterious impact on infected patients. Journal of Infection and Public Health, 13(12), 1833–1839. https://doi.org/10.1016/j.jiph.2020.07.014

Erdem, H. A., Korkmaz, P. E., Çağlayan, D., Işikgöz Taşbakan, M., Yamazhan, T., Taşbakan, M. S., Sayiner, A., & Gökengin, D. (2021). Treatment of SARS-Cov-2 Pneumonia with Favipiravir: Early Results from the Ege University Cohort, Turkey. Turkish Journal of Medical Sciences, 51(3), 912–920. https://doi.org/10.3906/sag-2008-33

European Centre for Disease Prevention and Control. (2017). Summary of the latest data on antibiotic consumption in the European Union. Ecdc, 19(November), 1–13. https://www.ecdc.europa.eu/en/publications-data/summary-latest-data-antibiotic-consumption-eu-2017

Fadlilah, U., Hasmono, D., Wibisono, Y. A., Melinda, M., Airlangga, U., & Hospital, M. W. (2016). Antibiogram Study And Antibiotic Use Evaluation Using Gyssen Method in Patients with Diabetic Foot. Folia Medica Indonesiana, 52(3), 198–208. https://doi.org/10.20473/fmi.v52i3.5452

Fathi, F., Sami, R., Mozafarpoor, S., Hafezi, H., Motedayyen, H., Arefnezhad, R., & Eskandari, N. (2020). Immune System Changes During COVID-19 Recovery Play Key Role in Determining Disease Severity. International Journal of Immunopathology and Pharmacology, 34. https://doi.org/10.1177/2058738420966497

Guan, W. J., Liang, W. H., Zhao, Y., Liang, H. R., Chen, Z. S., Li, Y. M., Liu, X. Q., Chen, R. C., Tang, C. L., Wang, T., Ou, C. Q., Li, L., Chen, P. Y., Sang, L., Wang, W., Li, J. F., Li, C. C., Ou, L. M., Cheng, B., … He, J. X. (2020). Comorbidity and Its Impact on 1,590 Patients with Covid-19 in China: A Nationwide Analysis. European Respiratory Journal, 55(5), 1–14. https://doi.org/10.1183/13993003.00547-2020

Hu, C., Li, J., Xing, X., Gao, J., Zhao, S., & Xing, L. (2021). The Effect of Age on the Clinical and Immune Characteristics of Critically Ill Patients with COVID-19: A Preliminary Report. PLOS ONE, 16(3), e0248675. https://doi.org/10.1371/JOURNAL.PONE.0248675

Ilma, D. L., Wahyono, D., & Sari, I. P. (2019). Perkiraan Kadar Seftazidim dalam Darah pada Pasien Pneumonia dengan Gangguan Fungsi Ginjal. JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice), 9(3), 143–150. https://doi.org/10.22146/jmpf.37624

Ito, A., Ishida, T., Tachibana, H., Tokumasu, H., Yamazaki, A., & Washio, Y. (2019). Azithromycin combination therapy for community-acquired pneumonia: propensity score analysis. Scientific Reports, 9(1), 3–10. https://doi.org/10.1038/s41598-019-54922-4

Ivashchenko, A. A., Dmitriev, K. A., Vostokova, N. V., Azarova, V. N., Blinow, A. A., Egorova, A. N., Gordeev, I. G., Ilin, A. P., Karapetian, R. N., Kravchenko, D. V., Lomakin, N. V., Merkulova, E. A., Papazova, N. A., Pavlikova, E. P., Savchuk, N. P., Simakina, E. N., Sitdekov, T. A., Smolyarchuk, E. A., Tikhomolova, E. G., … Ivachtchenko, A. V. (2021). Favirapir for Treatment of Patients With Moderate Coronavirus Disease 2019 (COVID-19): Interim Results of a Phase II/III Multicenter Randomized Clinical Trial. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 73(3), 531. https://doi.org/10.1093/CID/CIAA1176

Jain, N. (2022). ­­­­­Cefotaxime: A reappraisal for use in lower respiratory tract infections. F1000Research, 11, 350. https://doi.org/10.12688/f1000research.74850.1

Kementerian Kesehatan RI, (2015). Peraturan Menteri Kesehatan Republik Indoneia Nomor 8 Tahun 2015 Tentang Program Pengendalian Resistensi Antimikroba di Rumah Sakit. Kemenkes RI, 25.

Kim, B., et al. (2018). Trends and correlation between antibiotic usage and resistance pattern among hospitalized patients at university hospitals in Korea, 2004 to 2012. Journal of Medicine. 97(51). 1-8. https://doi.org/10.1097/MD.0000000000013719

Kumari, P., Dembra, S., Dembra, P., Bhawna, F., Gul, A., Ali, B., Sohail, H., Kumar, B., Memon, M. K., & Rizwan, A. (2020). The Role of Vitamin C as Adjuvant Therapy in COVID-19. Cureus, 12(11), 10–13. https://doi.org/10.7759/cureus.11779

Kuzman, I., Bezlepko, A., Topuzovska, I. K., Rokuz, L., Ludina, L., Marschall, H., and Petri, T. (2014). Efficacy and Safety of Mozifloxacin in Community-acquired Pneumonia: A Prospective, Multicenter, Observational Studi (CAPRIVI). BMC Pulmonary Medicine. 105. 2-14. http://www.biomedcentral.com/1471-2466/14/105

Lai, C. C., Chen, C. C., Lu, Y. C., Chuang, Y. C., & Tang, H. J. (2019). In Vitro Activity of Cefoperazone and Cefoperazone-Sulbactam Against Carbapenem-Resistant Acinetobacter baumannii and Pseudomonas aeruginosa. Infection and Drug Resistance, 12, 25–29. https://doi.org/10.2147/IDR.S181201

Lardo, S., Chen, L., Santoso, W., & Rumende, C. (2020). Hubungan Kualitas Penggunaan Antibiotik Menggunakan Alur Gyssens dengan Keberhasilan Pengobatan pada Sepsis MDR Gram Negatif di Rumah Sakit Tersier. Jurnal Penyakit Dalam Indonesia, 7(4), 221–227. https://doi.org/10.7454/jpdi.v7i4.468

Luan, Y., Sun, Y., Duan, S., Zhao, P., & Bao, Z. (2018). Pathogenic Bacterial Profile and Drug Resistance Analysis of Community-Acquired Pneumonia in Older Outpatients With Fever. Journal of International Medical Research, 46(11), 4596–4604. https://doi.org/10.1177/0300060518786915

Mahendra, Nuchin, A., Kumar, R., Shreedhar, & Mahesh, P. (2021). Predictors of mortality in patients with severe COVID-19 pneumonia — a retrospective study. Advances in Respiratory Medicine, 89(2), 135–144. https://doi.org/10.5603/ARM.a2021.0036

Mahmoodpoor, A., Shadvar, K., Sanaie, S., Hadipoor, M. R., Pourmoghaddam, M. A., & Saghaleini, S. H. (2021). Effect of Vitamin C on Mortality of Critically Ill Patients With Severe Pneumonia in Intensive Care Unit: A Preliminary Study. BMC Infectious Diseases, 21(1), 1–7. https://doi.org/10.1186/S12879-021-06288-0/TABLES/2

Manabe, T., Kambayashi, D., Akatsu, H., & Kudo, K. (2021). Favipiravir for the Treatment of Patients with COVID-19 : A Systematic Review and Meta-Analysis. BMC Infectious Diseases, 21(489), 1–13. https://doi.org/https://doi.org/10.1186/s12879-021-06164-x

Manggau, M. A., & Djaharuddin, I. (2022). Evaluasi Penggunaan Terapi Antibiotik Empiris Terhadap Luaran Klinis Pasien Pneumonia Komunitas Rawat Inap. Original Article MFF, 26(1), 19–25. https://doi.org/10.20956/mff.v26i1.18888

Mengist, B., Tesfa, M., & Kassie, B. (2020). Time to Recovery and Predictors of Severe Community-Acquired Pneumonia Among Pediatric Patients in Debre Markos Referral Hospital, North West Ethiopia: A Retrospective Follow-up study. PLoS ONE, 15(9 September), 1–15. https://doi.org/10.1371/journal.pone.0239655

Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Brozek, J., Crothers, K., Cooley, L. A., Dean, N. C., Fine, M. J., Flanders, S. A., Griffin, M. R., Metersky, M. L., Musher, D. M., Restrepo, M. I., & Whitney, C. G. (2019). Diagnosis and treatment of adults with community-acquired pneumonia. American Journal of Respiratory and Critical Care Medicine, 200(7), E45–E67. https://doi.org/10.1164/rccm.201908-1581ST

Miryala, S. K., Anbarasu, A., & Ramaiah, S. (2019). Systems Biology Studies in Pseudomonas aeruginosa PA01 to Understand Their Role in Biofilm Formation and Multidrug Efflux Pumps. Microbial Pathogenesis, 136(August), 103668. https://doi.org/10.1016/j.micpath.2019.103668

Ngurah, G., Priyaka, K., Made, N., Tarini, A., Nengah, N., Fatmawati, D., Klnik, M., & Sanglah, R. (2019). Deteksi Molekuler Gen AmpC Pada Isolat Klinis Klebsiella pneumoniae Penghasil ESBL di RSUP Sanglah Denpasar. Medika Udayana, 8(11), 2597–8012. https://ojs.unud.ac.id/index.php/eum/article/view/55097

Padda and Nagali. (2022). Cefotaxime. NCBI Bookshelf. URL: https://www.ncbi.nlm.nih.gov/books/NBK560653/. Diakses tanggal 2 Februari 2023.

Ramatillah, D. L., & Isnaini, S. (2021). Treatment Profiles and Clinical Outcomes of COVID-19 Patients at Private Hospital in Jakarta. PLoS ONE, 16(4 April), 1–11. https://doi.org/10.1371/journal.pone.0250147

Rokhmah, N. N., Manuel, Y. G. P., Putri Kusuma, E. N., & Nurdin, N. M. (2022). The Rationality of Antibiotics Use on Acute Diarrhea to Pediatric Inpatients in the Fatmawati Hospital for 2018-2019 Period. Jurnal Farmasi Galenika (Galenika Journal of Pharmacy) (e-Journal), 8(1), 10–21. https://doi.org/10.22487/j24428744.2022.v8.i1.15684

Rumende, C. M., Chen, L. K., Karuniawat, A., Bratanata, J., Falasiva, R., Sitorus, T. P., & Susanto, E. C. (2019). Hubungan Antara Ketepatan Pemberian Antibiotik Berdasarkan Alur Gyssens dengan Perbaikan Klinis Pasien pada Pneumonia Komunitas. Jurnal Penyakit Dalam Indonesia, 6(2), 71. https://doi.org/10.7454/jpdi.v6i2.335

Satici, C., Demirkol, M. A., Sargin Altunok, E., Gursoy, B., Alkan, M., Kamat, S., Demirok, B., Surmeli, C. D., Calik, M., Cavus, Z., & Esatoglu, S. N. (2020). Performance of Pneumonia Severity Index and CURB-65 in predicting 30-day mortality in patients with COVID-19. International Journal of Infectious Diseases, 98, 84–89. https://doi.org/10.1016/j.ijid.2020.06.038

Setiadi, A. P., Wibowo, Y. I., Halim, S. V., Brata, C., Presley, B., & Setiawan, E. (2020). Tata Laksana Terapi Pasien dengan COVID-19: Sebuah Kajian Naratif. Indonesian Journal of Clinical Pharmacy, 9(1), 70. https://doi.org/10.15416/ijcp.2020.9.1.70

Sitompul, P. A., Indriani, R., Maemun, S., Rusli, A., Sundari, T., Marlina, R., Rogayah, R., Syahril, M., Rudiatmoko, D. R., Salita, S. K., & Setiawaty, V. (2023). Length of Stay of Pneumonia Patients Associated With Comorbid and Complications Factors in Referral National Infectious Diseases Hospital. Tanzania Journal of Health Research, 24(1), 1–5. https://doi.org/10.4314/thrb.v24i1.8

Suzuki, J., Sasabuchi, Y., Hatakeyama, S., Matsui, H., Sasahara, T., Morisawa, Y., Yamada, T., & Yasunaga, H. (2019). Azithromycin plus β-lactam versus levofloxacin plus β-lactam for severe community-acquired pneumonia: A retrospective nationwide database analysis. Journal of Infection and Chemotherapy, 25(12), 1012–1018. https://doi.org/10.1016/j.jiac.2019.05.027

Tolossa, T., Wakuma, B., Gebre, D. S., Atomssa, E. M., Getachew, M., Fetensa, G., Ayala, D., & Turi, E. (2021). Time to Recovery From COVID-19 and Its Predictors Among Patients Admitted to Treatment Center of Wollega University Referral Hospital (WURH), Western Ethiopia: Survival Analysis of Retrospective Cohort Study. PLoS ONE, 16(6 June), 1–12. https://doi.org/10.1371/journal.pone.0252389

Toombs, J. M., Van den Abbeele, K., Democratis, J., Mandal, A. K. J., & Missouris, C. G. (2021). Pneumococcal coinfection in COVID-19 patients. Journal of Medical Virology, 93(1), 177–179. https://doi.org/10.1002/jmv.26278

Tran, H. Do, Bach Nguyen, Y. T., Thanh Tran, T., Thu Le, T. T., Thu Nguyen, H. T., Minh Nguyen, C., Bach Le, H. T., Ngoc Phan, T. T., Thanh Vo, T. T., Ngoc Bui, H. T., Tuong Mai, V., Yong, N., Nguyen, T., & Tran, H. G. (2022). Community-Acquired Pneumonia-Causing Bacteria and Antibiotic Resistance Rate Among Vietnamese Patients: A Cross-Sectional Study. Medicine (United States), 101(36), E30458. https://doi.org/10.1097/MD.0000000000030458

Tufa, A., Gebremariam, T. H., Manyazewal, T., Getinet, T., Webb, D. L., Hellström, P. M., & Genet, S. (2022). Inflammatory Mediators Profile in Patients Hospitalized with COVID-19: A Comparative Study. Frontiers in Immunology, 13(July), 1–14. https://doi.org/10.3389/fimmu.2022.964179

Vascarya, C., Susanti, R., & Nurmainah. (2016). Evaluasi Penggunaan Antibiotika Berdasarkan Metode Prescribed Daily Dose ( PDD ) Pada Anak Di Rawat Inap Puskesmas Siantan Hilir Pontianak Periode Juli – Desember 2016. Universitas Tanjungpura. https://jurnal.untan.ac.id/index.php/jmfarmasi/article/download/29747/75676579235

WHO. (2013). Guidelines for and DDD assignment. In WHO collaborating centre (16th edition).

Younas, S., Ejaz, H., Zafar, A., Ejaz, A., Saleem, R., & Javed, H. (2018). AmpC beta-lactamases in Klebsiella pneumoniae: An Emerging Threat to the Pediatric Patients. Journal of the Pakistan Medical Association, 68(6), 893–897. https://pubmed.ncbi.nlm.nih.gov/30325907/

Zendehdel, A., Bidkhori, M., Ansari, M., Jamalimoghaddamsiyahkali, S., & Asoodeh, A. (2022). Efficacy of Oseltamivir in the Treatment of Patients Infected with COVID-19. Annals of Medicine and Surgery, 77(February), 103679. https://doi.org/10.1016/j.amsu.2022.103679

Zhan, Y., Zhu, Y., Wang, S., Jia, S., Gao, Y., Lu, Y., Zhou, C., Liang, R., Sun, D., Wang, X., Hou, Z., Hu, Q., Du, P., Yu, H., Liu, C., Cui, M., Tong, G., Zheng, Z., Xu, Y., … Hong, P. (2021). SARS-CoV-2 Immunity and Functional Recovery of COVID-19 Patients 1-year After Infection. Signal Transduction and Targeted Therapy, 6(1), 1–12. https://doi.org/10.1038/s41392-021-00777-z

Zhang, J. jin, Dong, X., Liu, G. hui, & Gao, Y. dong. (2022). Risk and Protective Factors for COVID-19 Morbidity, Severity, and Mortality. Clinical Reviews in Allergy and Immunology, 0123456789. https://doi.org/10.1007/s12016-022-08921-5

Zhao, L., & Zhong, W. (2021). Mechanism of Action of Favipiravir Against SARS-CoV-2: Mutagenesis or Chain Termination? The Innovation, 2(4), 100165. https://doi.org/10.1016/j.xinn.2021.100165

Zulfa, I. M., & Yunitasari, F. D. (2017). Prescribed Daily Dose (PDD) Antibiotik Untuk Penyakit Gigi di sApotek di Surabaya. Journal of Pharmacy and Science, 2(2), 20–23. https://doi.org/10.53342/pharmasci.v2i2.77

Refbacks

  • There are currently no refbacks.