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"ABSTRAKLatar Belakang:Kandidemia merupakan infeksi aliran darah dengan morbiditas dan mortalitas yang tinggi. Gambaran klinis kandidemia sulit dibedakan dengan pasien sepsis sehingga sering terlambat didiagnosis. Kultur darah sebagai baku emas diagnostik kandidemia memiliki beberapa keterbatasan, sedangkan prediktor yang ada saat ini sulit diaplikasikan dalam praktik klinis sehari-hari. Telah ada penelitian tentang faktor risiko kandidemia di luar negeri dan Indonesia, tetapi belum ada yang membahas khusus pada pasien sepsis dewasa non neutropenia.Tujuan:Mengetahui faktor risiko kandidemia pada pasien sepsis non neutropenia.Metode:Desain kasus kontrol dengan mengambil data rekam medik pasien sepsis sejak Januari 2011 sampai Juli 2015 di Rumah Sakit Cipto Mangunkusumo. Penilaian faktor risiko dilakukan dengan metode Chi-square dan dilanjutkan dengan analisis regresi logistik multivariat dengan mengikutsertakan variabel perancu.Hasil:Dari 51 kasus dan 153 kontrol didapatkan faktor risiko yang berhubungan dengan kejadian kandidemia adalah kateter urin [adjusted OR=5,239 (IK 95% 2,141 ? 12,819), p<0,001], nutrisi parenteral [adjusted OR=2,583 (IK 95% 1,297 ? 5,144), p=0,007], kortikosteroid [adjusted OR=2,183 (IK 95% 1,002 ? 4,755), p=0,049], dan antibiotik spektrum luas [adjusted OR=4,047 (IK 95% 1,178 ? 13,904), p=0,026].Kesimpulan:Kateter urin, nutrisi parenteral, kortikosteroid, dan antibiotik spektrum luas merupakan faktor risiko penting karena dapat meningkatkan risiko kejadian kandidemia pada pasien sepsis non neutropenia.

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ABSTRACT

Background:

Candidemia is a bloodstream infection with high morbidity and mortality. Clinical manifestations of candidemia resemble with sepsis patients so that diagnosis was delayed. Blood culture as a diagnostic gold standard had some limitations, while the current predictors difficult to apply in daily clinical practice. There were studies about risk factors of candidemia in other countries and Indonesia, but no one had studied specifically in adult non-neutropenic sepsis patients.

Objective:

To identify the risk factors for candidemia in non-neutropenic sepsis patients.

Method:

A case-control study from medical records of septic patients was conducted during the period January 2011 ? July 2015 in Cipto Mangunkusumo Hospital. We analyzed risk factors using Chi-square method followed by multivariate logistic regression adjusted with confounding factors.

Results:

A total 51 cases and 153 controls were analyzed to identify the risk factors of candidemia. After adjustment, candidemia was associated with urinary catheter [adjusted OR=5,239 (95% CI 2,141 ? 12,819), p<0,001], parenteral nutrition [adjusted OR=2,583 (95% CI 1,297 ? 5,144), p=0,007], corticosteroids [adjusted OR=2,183 (95% CI 1,002 ? 4,755), p=0,049], and broad spectrum antibiotics [adjusted OR=4,047 (95% CI 1,178 ? 13,904), p=0,026].

Conclusion:

Urinary catheter, parenteral nutrition, corticosteroids, and broad spectrum antibiotics are important risk factors that can increase the risk of candidemia in non-neutropenic sepsis patients."

"Aspergilosis invasif AI merupakan infeksi jamur invasif disebabkan Aspergillus spp sedangkan aspergilosis paru invasif API merupakan manifestasi AI yang sering ditemukan Gejala klinis laboratorium rutin dan radiologis tidak khas sehingga sering terjadi keterlambatan diagnosis dan tatalaksana Pemeriksaan biopsi tidak selalu dapat dilakukan dan berisiko tinggi sedangkan pemeriksaan biakan memiliki keterbatasan sensitivitas dan waktu Deteksi antigen galaktomanan GM merupakan uji penapis AI yang dinilai baik tetapi di Indonesia kit GM tidak rutin tersedia dan mahal sehingga perlu dicari uji diagnostik alternatif antara lain menggunakan deteksi antibodi anti Aspergillus yang sederhana mudah murah dan terjamin ketersediaannya Tujuan penelitian ini membandingkan hasil pemeriksaan deteksi antibodi anti Aspergillus metode immunodiffusion test IDT menggunakan crude antigen Aspergillus dengan deteksi antigen GM serta mengetahui nilai sensitivitas dan spesifisitasnya Penelitian berdisain potong lintang ini merupakan bagian dari penelitian multisenter sebelumnya mengenai insidens API pada 405 pasien ICU di 6 rumah sakit di Jakarta Selanjutnya ditentukan 125 pasien non neutropenia diduga AI yang bahan klinisnya menjalani pemeriksaan uji diagnostik di atas Biakan Aspergillus sp tumbuh pada bahan klinis ekskreta paru yang dimiliki 26 dari 125 pasien tersebut 20 8 Diagnosis AI putative ditegakkan pada 26 pasien 6 2 dari 405 pasien keseluruhan Dari 125 pasien yang diperiksa uji GM positif ditemukan pada 62 pasien 48 6 sedangkan uji IDT positif pada 74 pasien 59 2 Analisis statistik menunjukkan tidak terdapat perbedaan bermakna antara hasil uji GM dan uji IDT tetapi nilai kesetaraannya sangat lemah nilai kappa 0 169 Uji IDT menggunakan crude antigen Aspergillus mempunyai sensitivitas 67 7 dan spesifisitas 49 1

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Invasive aspergillosis IA is an invasive fungal infections caused by Aspergillus spp while invasive pulmonary aspergillosis IPA is the most common manifestation of IA Clinical symptoms routine laboratory and radiological features are not typical and could lead to diagnosis and treatment delayed Biopsy is high risk and not always possible to be performed whereas culture examination has limited sensitivity and time consumed Galactomannan GM antigen detection is good for IA screening but the kit is expensive and not routinely available in Indonesia It is necessary to find an alternative tests such as detection of anti Aspergillus antibody which is simple inexpensive and more available This study aims to determine the sensitivity and specificity of immunodiffusion test IDT for detecting anti Aspergillus antibody using crude antigen compare to GM antigen detection on diagnosis of IA This cross sectional study is part of previous multicenter study on incidence of IA in ICU patients at six hospitals in Jakarta 405 patients Then clinical materials of 125 non neutropenic patients suspected IA were determined to undergo both clinical diagnostic tests Aspergillus sp were isolated from clinical materials of lung excreta from 26 out of 125 patients 20 8 Putative IA was diagnosed in 26 patients 6 2 out of 405 patients From 125 patients examined GM positive test was found in 62 patients 48 6 while IDT test positive in 74 patients 59 2 Statistical analysis showed no significant differences between the results of IDT test compared to GM but the equality value is very weak kappa 0 169 IDT test using crude Aspergillus antigen has a sensitivity of 67 7 and specificity of 49 1 ; Invasive aspergillosis IA is an invasive fungal infections caused by Aspergillus spp while invasive pulmonary aspergillosis IPA is the most common manifestation of IA Clinical symptoms routine laboratory and radiological features are not typical and could lead to diagnosis and treatment delayed Biopsy is high risk and not always possible to be performed whereas culture examination has limited sensitivity and time consumed Galactomannan GM antigen detection is good for IA screening but the kit is expensive and not routinely available in Indonesia It is necessary to find an alternative tests such as detection of anti Aspergillus antibody which is simple inexpensive and more available This study aims to determine the sensitivity and specificity of immunodiffusion test IDT for detecting anti Aspergillus antibody using crude antigen compare to GM antigen detection on diagnosis of IA This cross sectional study is part of previous multicenter study on incidence of IA in ICU patients at six hospitals in Jakarta 405 patients Then clinical materials of 125 non neutropenic patients suspected IA were determined to undergo both clinical diagnostic tests Aspergillus sp were isolated from clinical materials of lung excreta from 26 out of 125 patients 20 8 Putative IA was diagnosed in 26 patients 6 2 out of 405 patients From 125 patients examined GM positive test was found in 62 patients 48 6 while IDT test positive in 74 patients 59 2 Statistical analysis showed no significant differences between the results of IDT test compared to GM but the equality value is very weak kappa 0 169 IDT test using crude Aspergillus antigen has a sensitivity of 67 7 and specificity of 49 1 ; Invasive aspergillosis IA is an invasive fungal infections caused by Aspergillus spp while invasive pulmonary aspergillosis IPA is the most common manifestation of IA Clinical symptoms routine laboratory and radiological features are not typical and could lead to diagnosis and treatment delayed Biopsy is high risk and not always possible to be performed whereas culture examination has limited sensitivity and time consumed Galactomannan GM antigen detection is good for IA screening but the kit is expensive and not routinely available in Indonesia It is necessary to find an alternative tests such as detection of anti Aspergillus antibody which is simple inexpensive and more available This study aims to determine the sensitivity and specificity of immunodiffusion test IDT for detecting anti Aspergillus antibody using crude antigen compare to GM antigen detection on diagnosis of IA This cross sectional study is part of previous multicenter study on incidence of IA in ICU patients at six hospitals in Jakarta 405 patients Then clinical materials of 125 non neutropenic patients suspected IA were determined to undergo both clinical diagnostic tests Aspergillus sp were isolated from clinical materials of lung excreta from 26 out of 125 patients 20 8 Putative IA was diagnosed in 26 patients 6 2 out of 405 patients From 125 patients examined GM positive test was found in 62 patients 48 6 while IDT test positive in 74 patients 59 2 Statistical analysis showed no significant differences between the results of IDT test compared to GM but the equality value is very weak kappa 0 169 IDT test using crude Aspergillus antigen has a sensitivity of 67 7 and specificity of 49 1 "