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"Hubungan Ketidaktepatan Pemberian Antibiotika Profilaksis denganKejadian Infeksi Daerah Operasi Post Laparatomi di RSPADGatot Soebroto Tahun 2014-2017Pembimbing : dr. Asri C. Adisasmita MPH., M.Phil., Ph.DInfeksi Daerah Operasi IDO termasuk salah satu dari Healthcare AssociatedInfection rsquo;s HAI 39;s yang paling banyak ditemukan seiring dengan meningkatnya jumlahtindakan operasi. Laparatomi merupakan jenis tindakan operasi yang paling berisikountuk terjadinya infeksi. Salah satu upaya pencegahan infeksi daerah operasi denganpemberian antibiotika profilaksis yang diberikan sebelum, saat dan sampai 24 jam setelahoperasi pada kasus yang secara klinis tidak didapatkan tanda-tanda infeksi. Penelitian ini bertujuan untuk mengetahui hubungan ketidaktepatan pemberian antibiotika profilaksisdengan kejadian infeksi daerah operasi post laparatomi di RSPAD Gatot Soebroto Tahun2014-2017. Desain penelitian menggunakan studi kasus kontrol dengan pengambilan datasecara retrospektif menggunakan 268 sampel dari data rekam medik pasien post operasilaparatomi di RSPAD Gatot Soebroto pada tahun 2014-2017, kasus yaitu 67 pasien yangterjadi IDO dan kontrol 201 pasien tidak terjadi IDO. Analisa data dengan uji regresilogistik dengan conditional matching. Hasil penelitian menunjukkan waktu pemberianantibiotika profilaksis pre operasi tidak tepat memiliki risiko 5.17 kali terhadap kejadianinfeksi daerah operasi OR= 5.17 ; 95 CI=1.85-14.40 setelah dikontrol dengan variabellain. Variabel kovariat yang berhubungan terhadap kejadian infeksi daerah operasi yaitudiagnosis operasi digestif OR=3.51; 95 CI=1.04-11.83 , kadar albumin OR= 3.83;95 CI= 1.30-11.25 dan penyakit penyerta OR = 4.05 ; 95 CI=1.40-11.66 . Hasilpenelitian ini dapat menjadi masukan bagi RSPAD Gatot Soebroto untuk lebihmeningkatkan kepatuhan penggunaan antibiotika profilaksis secara tepat waktu, jenis,dosis dan durasi pemberian sesuai panduan untuk mencegah kejadian infeksi daerahoperasi.

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Correlation of Inappropriate Antibiotic Prophylaxis with PostLaparatomy Surgical Site Infection at Gatot Soebroto Army CentralHospital Year 2014 to 2017Counsellor dr. Asri C. Adisasmita MPH., MPhil., Ph.DSurgical Site Infection SSI is one of the most commonly infection foundHealthcare Associated Infection 39 s HAI 39 s type as surgery procedure increases.Laparotomy is the type of surgery that is the most at risk for infection. One of theprevention efforts of surgical site infection is antibiotic prophylaxis administrationbefore, during and up to 24 hours after surgery in cases of clinically missing signs ofinfection.

This study aims to determine the correlation of inappropriate antibioticsprophylaxis with the post laparatomy surgical site infection in Army Central Hospital RSPAD Gatot Soebroto from 2014 to 2017. The research design was case controlstudy with retrospective data retrieval, using 268 samples from medical record data ofpost laparotomy patient at Army Central Hospital RSPAD Gatot Soebroto from 2014to 2017, cases of 67 patients with SSI and control of 201 patients without SSI. Datawas analyzed using regression logistic conditional matching test.

The result of thestudy showed that the inappropriate timing of antibiotic administration in preoperativetreatment made a risk of 5.17 times higher on the incidence of surgical site infection OR 5.17 95 CI 1.85 14.40 after control of other variables. Covariate variables,related to the incidence of surgical site infection, was digestive operation diagnose OR 3.51 95 CI 1.04 11.83 , albumin level OR 3.83 95 CI 1.30 11.25 and comorbid disease OR 4.05 95 CI 1.40 11.66. The results of this studyhopefully can be an input data for Army Central Hospital RSPAD Gatot Soebroto, to improve adherence of correct timing, type, dose and duration of antibioticsprophylaxis according to guidelines of surgical site infection prevention."

"Surgical site infections are the second most frequent nosocomial infection after catheter infection. They are associated with increase morbidity and mortality, iength of stay in hospital and cost of care. Antibiotic prophylaxis use is addressed to reduce incidence of surgical site infection. The aim of this research was to find out the pattern of antibiotic prophylaxis use; incidence of surgical site infection; association between antibiotic prophylaxis use and incidence of surgical site infection; and other factors that influence the incidence of surgical site infection. This research was carried out in Dr. Cipto Mangunkusumo Hospital Jakarta and it was a retrospective study with cross-sectional design. A total of 220 samples had been taken proportional randomly according to the type of surgery division from 1,841 medical records in 2005. The result showed that the most antibiotic prophylaxis frequently used was cephalosporin (first and third generation). followed by phosphomycin and metronidazole. Most of the patients were given antibiotic prophylaxis in inappropriate time and the duration of use was more than one day. This study found that the incidence of surgical site infection was 8.6% with the highest percentage occurred at orthopedic surgery (23.3%). Statistically, there was no relationship of class. Timing and duration of antibiotic prophylaxis use with incidence of surgical site infection. Adherence of antibiotic prophylaxis use to hospital guideline was not influenced the incidence of surgical site infection. Multivariate analysis with logistic regression analysis showed that the incidence of surgical site infection were influenced by the type of surgery (OR=2.6) and the use of antibiotics during hospitalization prior to surgery (OR=3.2). The conclusion of this research were the incidence of surgical site infection relatively high and class. timing, duration and adherence to hospital guideline of antibiotic prophylaxis use did not influence it. The wound contaminated and the use antibiotics during hospitalization prior to surgery were risk factors for surgical site infection. It was recommended that the hospital management revise the currently used surgical antibiotic prophylaxis guideline which is no longer relevant to the current situation."

"Infeksi luka operasi (ILO) adalah bagian dari infeksi nosokomial dan merupakan masalah dalam pelayanan kesehatan, terjadi pada 2 - 5% dari 27 juta pasien yang dioperasi setiap tahun dan 25% dari jumlah infeksi terjadi di fasilitas pelayanan. Penelitian bertujuan mengetahui hubungan usia, status gizi, jenis operasi, lama rawat prabedah, kadar Hb, transfusi darah, waktu pemberian antibiotik profilaksis, jenis anestesi, lama pembedahan serta lama rawat pascabedah dengan kejadian ILO pada pasien pascabedah sesar di RSUP Dr. Sardjito Yogyakarta. Rancangan desain penelitian studi observasional prospektif dilakukan dengan sampel 154 orang. Data diperoleh melalui observasi menggunakan daftar tilik sejak pasien masuk rumah sakit sampai 30 hari pascabedah. Analisis data meliputi analisis univariat, analisis bivariat dengan menggunakan uji kai kuadrat serta analisis multivariat dengan uji regresi logistik berganda.Hasil penelitian menunjukkan ada hubungan antara waktu pemberian antibiotik profilaksis (OR = 1,16; 95% CI = 1,09 _ 1,37), lama rawat prabedah (OR = 1,12; 95% CI = 1,02 - 1,24) dan lama rawat pascabedah (OR = 1,21; 95% CI = 1,04 - 1,39) dengan kejadian ILO. Faktor lainnya tidak mempunyai hubungan yang signifikan terhadap kejadian ILO. Hasil uji regresi logistik ganda menemukan lama rawat pascabedah merupakan faktor yang paling dominan terhadap kejadian ILO. Identifikasi faktor risiko ILO dapat bermanfaat untuk merencanakan upaya meminimalkan kejadian ILO pada pasien pascabedah sesar.

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Surgical site infection (SSI) is part of health care associated infection and remains a problem in hospital care. SSI occurs in 2 to 5% of the 27 million patients having surgery each year and 25% of infections occur in care facilities. This study aimed to relation various such as age, nutritional status, type of surgery, pre-operative length of stay, hemoglobin level, blood transfusions, timing of antibiotics prophylaxis, type of anesthesia, duration of operation and post-operative length of stay on the incidence of SSI post caesarean section at Dr. Sardjito Hospital Yogyakarta. Prospective observation study was conducted in 154 sample. Data were obtained through observations using checklist since hospital admission up to 30 days post surgery. Data analysis included univariate, chi-square test and multiple logistic regression.

The result showed that time of prophylactic antibiotics (OR = 1.16; 95% CI = 1.09 - 1.37), pre-operative length of stay (OR = 1.12; 95% CI = 1.02 - 1.24) and post-operative length of stay (OR = 1.21; 95% CI = 1.04 - 1.39) were risk factors for SSI. Other factors did not show significant associations with incidence of the SSI. The findings from multiple logistic regression showed post-operative length of stay in hospital as the most dominant factor for incidence of SSI. Identifying SSI risk factors can be used to plan efforts to minimize the occurrence of SSI in post-caesarean section patients."