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"ABSTRAKLatar Belakang: Mortalitas pasien perforasi tukak peptik (PTP) masih stabil padaangka 20-50% dimana penyebab terbanyak adalah sepsis. Tantangan ini memicu paraahli bedah untuk meneliti faktor-faktor yang berhubungan dengan mortalitas danmorbiditas penyakit ini. Selain pembedahan untuk kontrol infeksi, antibiotikapreoperatif diketahui menurunkan angka mortalitas. Penelitian ini bertujuanmengetahui hubungan kesesuaian antibiotika empiris dengan hasil kultur sensitifitasantibiotika terhadap ketahanan hidup 30 hari pasien perforasi tukak peptik di RSUPNDr Cipto Mangunkusumo (RSCM) Jakarta. Metode: Studi kohort terhadap pasienPTP sejak Januari 2012 hingga Agustus 2015 di Departemen Bedah FKUI/RSCMJakarta, dimana PTP akibat keganasan dan trauma tembus dieksklusikan. Pola kumandan antibiotika pada pasien PTP disajikan sebagai studi pendahuluan. Hasil: dari 45pasien yang didapat, angka mortalitas pasien PTP di RSCM sebesar 31,1% danketahanan hidup sebesar 68,9%. Pola kuman pada pasien PTP adalah Escherichia colisebagai kuman Gram negatif terbanyak (35,85%) dan Streptococcus alfahemolyticsebagai kuman Gram positif terbanyak (15,09%). Antibiotika lini kedua yang sesuaiuntuk pasien PTP adalah Sulbactam/Ampicillin.Tidak terdapat hubungan antara skor Boey dan ketahan hidup, namun syok preoperatif memengaruhi ketahanan hidup(nilai OR 14,67). Begitu juga dengan komorbiditas memengaruhi ketahanan hidupsebesar 10,54 kali. Lama persiapan operasi tidak bermakna terhadap ketahanan hidup,sedangkan durasi operasi memengaruhi ketahanan hidup sebesar 7,5 kali. Antibiotikaempiris yang sesuai dengan hasil kultur memengaruhi ketahanan hidup sebesar 12,57kali. Kesimpulan: Pemberian antibiotika empiris yang tepat terbukti berhubungandengan ketahanan hidup pasien perforasi tukak peptik.;

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ABSTRACT

Background: Mortality of patients with peptic ulcer perforation (PUP) was stable at

20-50%, which is the most common cause is sepsis. This challenge prompted the

surgeon to examine the factors associated with mortality and morbidity of this

disease. In addition to surgery to control infection, preoperative antibiotics are

known to reduce mortality. This study aims to determine the suitability of empiric

antibiotics relationship with antibiotic sensitivity culture results to the 30 days

survival of perforated peptic ulcer patients in Dr Cipto Mangunkusumo General

Hospital (RSCM) in Jakarta. Methods: A cohort study of patients PUP since January

2012 to August 2015 at Department of Surgery Faculty of medicine/RSCM Jakarta,

where PUP due to malignancy and penetrating trauma were excluded. Patterns of

bacteria and antibiotics in PUP patients presented as a preliminary study. Results:

45 patients were obtained, the mortality rate of patients in RSCM PUP by 31.1% and

amounted to 68.9% survival. Patterns of bacteria in a patient PUP is Escherichia

coli as most Gram-negative bacteria (35.85%) and Streptococcus alfahemolytic as

most Gram-positive bacteria (15.09%). The second line antibiotics are appropriate

for the PUP patients is sulbactam/ampicillin. There was no relationship between

Boey?s score and survivability, but the preoperative shock affect survival (OR 14.67).

Likewise with comorbidities affecting the survival of 10.54 times. Time to surgery on

survival was not significant, while the duration of surgery affecting the survival of 7.5

times. Empiric antibiotics in accordance with the culture results affects survival of

12.57 times. Conclusion: The provision of appropriate empiric antibiotic shown to be

associated with survival in patients with peptic ulcer perforation. ;Background: Mortality of patients with peptic ulcer perforation (PUP) was stable at20-50%, which is the most common cause is sepsis. This challenge prompted thesurgeon to examine the factors associated with mortality and morbidity of thisdisease. In addition to surgery to control infection, preoperative antibiotics areknown to reduce mortality. This study aims to determine the suitability of empiricantibiotics relationship with antibiotic sensitivity culture results to the 30 dayssurvival of perforated peptic ulcer patients in Dr Cipto Mangunkusumo GeneralHospital (RSCM) in Jakarta. Methods: A cohort study of patients PUP since January2012 to August 2015 at Department of Surgery Faculty of medicine/RSCM Jakarta,where PUP due to malignancy and penetrating trauma were excluded. Patterns ofbacteria and antibiotics in PUP patients presented as a preliminary study. Results:45 patients were obtained, the mortality rate of patients in RSCM PUP by 31.1% andamounted to 68.9% survival. Patterns of bacteria in a patient PUP is Escherichiacoli as most Gram-negative bacteria (35.85%) and Streptococcus alfahemolytic asmost Gram-positive bacteria (15.09%). The second line antibiotics are appropriatefor the PUP patients is sulbactam/ampicillin. There was no relationship betweenBoey?s score and survivability, but the preoperative shock affect survival (OR 14.67).Likewise with comorbidities affecting the survival of 10.54 times. Time to surgery onsurvival was not significant, while the duration of surgery affecting the survival of 7.5times. Empiric antibiotics in accordance with the culture results affects survival of12.57 times. Conclusion: The provision of appropriate empiric antibiotic shown to beassociated with survival in patients with peptic ulcer perforation.;Background: Mortality of patients with peptic ulcer perforation (PUP) was stable at20-50%, which is the most common cause is sepsis. This challenge prompted thesurgeon to examine the factors associated with mortality and morbidity of thisdisease. In addition to surgery to control infection, preoperative antibiotics areknown to reduce mortality. This study aims to determine the suitability of empiricantibiotics relationship with antibiotic sensitivity culture results to the 30 dayssurvival of perforated peptic ulcer patients in Dr Cipto Mangunkusumo GeneralHospital (RSCM) in Jakarta. Methods: A cohort study of patients PUP since January2012 to August 2015 at Department of Surgery Faculty of medicine/RSCM Jakarta,where PUP due to malignancy and penetrating trauma were excluded. Patterns ofbacteria and antibiotics in PUP patients presented as a preliminary study. Results:45 patients were obtained, the mortality rate of patients in RSCM PUP by 31.1% andamounted to 68.9% survival. Patterns of bacteria in a patient PUP is Escherichiacoli as most Gram-negative bacteria (35.85%) and Streptococcus alfahemolytic asmost Gram-positive bacteria (15.09%). The second line antibiotics are appropriatefor the PUP patients is sulbactam/ampicillin. There was no relationship betweenBoey?s score and survivability, but the preoperative shock affect survival (OR 14.67).Likewise with comorbidities affecting the survival of 10.54 times. Time to surgery onsurvival was not significant, while the duration of surgery affecting the survival of 7.5times. Empiric antibiotics in accordance with the culture results affects survival of12.57 times. Conclusion: The provision of appropriate empiric antibiotic shown to beassociated with survival in patients with peptic ulcer perforation."

"Latar belakang: Perforasi tukak peptik PTP merupakan komplikasi penyakit tukak peptik yang memiliki angka morbiditas dan mortalitas yang cukup tinggi. Luaran pasien yang maksimal dapat dicapai dengan perawatan optimal disertai alokasi sumber daya yang sesuai dengan statifikasi pasien berdasarkan kelompok risikonya. Skor peptic ulcer perforation PULP merupakan sistem penilaian terbaru untuk prediksi prognosis pasien PTP. Penelitian ini bertujuan untuk mengetahui penerapan skor PULP dalam prediksi mortalitas pasien PTP di Rumah Sakit dr. Cipto Mangunkusumo RSCM. Metode penelitian: Studi potong lintang analitik dilakukan dengan mengambil total sampel 52 pasien PTP yang datang ke RSCM pada periode Januari 2011-Juni 2015. Pasien perforasi gaster/duodenum akibat trauma dan keganasan gaster/duodenum, pasien yang tidak menjalani pembedahan dan pasien yang sudah menjalani pembedahan di luar RSCM dieksklusi. Analisis statistik diolah dengan program SPSS 20 for windows, untuk menilai variabel apa yang secara independen memengaruhi mortalitas pasien PTP dan bagaimana akurasi skor PULP dalam prediksi mortalitas pasien PTP. Hasil penelitian: Variabel syok saat masuk rumah sakit dan awitan penyakit >24 jam merupakan prediktor independen mortalitas pasien PTP dengan nilai kemaknaan masing-masing 0,04 dan 0,03. Nilai area under the curve skor PULP dalam prediksi mortalitas pasien PTP mencapai 71,60 95 IK 53,80 -89,40. Kesimpulan: Penggunaan skor PULP dinilai cukup baik untuk prediksi mortalitas pasien PTP di RSCM. Kata kunci: Perforasi tukak peptik, skor peptic ulcer perforation PULP , mortalitas, syok, awitan penyakit.

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Background: Perforated peptic ulcer PPU is a complication of peptic ulcer disease with high rates of morbidity and mortality. Maximum outcomes could be achieved by optimal care combined with allocation of resources in accordance with patient's risk stratification. Peptic ulcer perforation PULP score is the newest scoring systems for predicting the prognosis of PPU patients. This study aims to determine the application of PULP score in predicting mortality of PPU patient in Cipto Mangunkusumo Hospital.

Method: A cross sectional analytical study carried out by taking the total sample of 52 patients who came with PPU to Cipto Mangunkusumo Hospital in the period of January 2011 June 2015. Those with perforation at stomach duodenum due to trauma and malignancy, those who did not undergo surgery and those who have undergone surgery outside Cipto Mangunkusumo Hospital were excluded. Statistical analysis is processed with SPSS 20 for windows, to determine which variables independently afffect the mortality of PPU patients and how is the accuracy of PULP score in predicting mortality of PPU patients.

Results: Shock on admission and onset of disease 24 hours were independent predictors of mortality in PPU patients p value 0.04 and 0.03 respectively. The value of area under the curve of PULP score in predicting mortality in PPU patients was 71.60 95 CI 53.80 89.40.

Conclusions: PULP score is considered good enough to predict mortality of PPU patients in Cipto Mangunkusumo Hospital. Keywords Perforated peptic ulcer, peptic ulcer perforation PULP score, mortality, shock, onset of disease."