Clean surgery without contamination does not require prophylactic antibiotics, but there are high-risk surgical procedures that may cause infection and/or involve vital organs such as the heart, brain, and lungs, and these indeed require the use of antibiotics. This study aimed to determine the quantity of antibiotic use based on the defined daily dose (DDD) per 100 bed days and the quality of antibiotic use based on the percentage of concordance with The American Society of Health-System Pharmacists (ASHP) therapeutic guidelines (i.e., route of administration, time of administration, selection, dose, and duration). This includes the profiles of surgical site infection (SSI) in surgical patients from January through June 2019. The study subjects were 487 surgical patients from two hospitals who met the inclusion criteria. There were 322 patients out of 487 patients who had a clean surgical procedure. Ceftriaxone (J01DD04) was the most used antibiotic, with a total DDD/100 bed days value in hospitals A and B, respectively: pre-surgery: 14.71, 77.65, during surgery: 22.57, 87.31, and postsurgery: 38.34, 93.65. In addition, 35% of antibiotics were given more than 120 min before incision. The lowest concordance to ASHP therapeutic guideline in hospital A (17.6%) and B (1.9%) was antibiotic selection. Two patients experienced SSI with bacterial growths of Proteus spp., Staphylococcus aureus, Staphylococcus epidermidis, and Escherichia coli. The usage of prophylactic antibiotics for surgical procedures was high and varied between hospitals. Hospital B had significantly lower concordance to antibiotic therapeutic guidelines, resulting to a higher infection rate, compared with hospital A. ASHP adherence components were then further investigated, after which antibiotic dosing interval and injection time was found to be a significant predictor for positive bacterial growth based on logit–logistic regression. Further interventions and strategies to implement antibiotic stewardship is needed to improve antibiotic prescriptions and their use.
Penelitian ini bertujuan untuk mengetahui profil kuantitas penggunaan antibiotik berdasarkan metode DDD/100 patient-days dan kualitas penggunaan antibiotik berdasarkan persentase kesesuaian (indikasi, waktu pemberian, durasi, dosis, dan rute pemberian) terhadap ASHP, PPAB, dan Formularium Rumah Sakit, serta profil Infeksi Daerah Operasi (IDO) pada pasien bedah di RSP NTB periode Januari-Juni 2019. Metode penelitian menggunakan desain penelitian deskriptif dengan pengambilan data secara retrospektif terhadap data rekam medik sampel penelitian. Subyek penelitian adalah pasien bedah periode Januari-Juni 2019 yang memenuhi kriteria inklusi, yaitu sebanyak 323 sampel penelitian. Hasil yang diperoleh dari penelitian ini yaitu kuantitas penggunaan antibiotik periode Januari-Juni 2019 di dominasi oleh antibiotik ceftriaxone (J01DD04) dengan nilai total DDD/100 patient-days pada pre operasi yaitu 77,655, on operasi 87,31, dan post operasi 93,65. Kesesuaian pemilihan antibiotik profilaksis berdasarkan guideline ASHP sebesar 1,9%, PPAB 15,5%, dan Formularium RSP NTB 100%, sedangkan kesesuaian durasi, waktu pemberian, dosis, dan rute pemberian berdasarkan ASHP berturut-turut yaitu 19,2%, 42,7%, 1,5%, dan 100%. Sampel penelitian yang mengalami IDO yaitu 2 dari 323 sampel (0,62%) dengan hasil pertumbuhan bakteri yaitu Proteus sp., Staphylococcus aureus, S. epidermidis, dan E.coli. Uji sensitivitas keseluruhan bakteri penyebab IDO ditemukan masih sensitif terhadap antibiotik seperti chloramphenicol, amoxicillin-clavulanic acid, vancomycin, cefoxitin, dan oxacillin
Tropical and subtropical countries are regions with high incidence of dengue infection. Dengue virus infection is estimated to cause 300 million new infections in one year and approximately 1 million severe cases with 2 + 5% deaths. The case of dengue in Indonesia has continued to increase since 1968 until 1980 where all provinces in Indonesia have been affected by the dengue virus. Dengue virus is a virus carried by the Aedes aegypti mosquito in its salivary gland. The virus which is a family group of Flaviviruses has four homologous serotypes, namely DENV-1, DENV-2, DENV-3, and DENV-4, which can cause dengue infection in individuals. Currently there is a shift in the target population from children to adults. This is a problem that needs to be resolved by the government and the community itself. Solution to overcome this, the government needs early prevention efforts to reduce the severity of dengue infection by developing and researching dengue vaccines. Currently a vaccine has been found that can be used as prophylaxis for dengue virus, namely Dengvaxia. This vaccine has been recommended by the World Health Organization (WHO) as prophylaxis for dengue infection, but Dengvaxia is only used in areas that are very endemic to dengue fever. The Indonesian Food and Drug Supervisory Agency (BPOM RI) has also approved the use of Dengvaxia as an indication of prevention of dengue infection since August 31, 2016. This vaccine has been approved globally only given to individuals aged between 9-16 years.
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