ABSTRAK
Latar Belakang : Insidens Pneumonia HCAP semakin meningkat dengan angka mortalitas yangtinggi. Tatalaksana optimal dapat menurunkan angka mortalitas , salah satunya Time to First Antibiotic Delivery (TFAD). Pengaruh TFAD pada pasien pneumoniaHCAP belum banyak diteliti. Tujuan : Mendapatkan informasi perbedaan kesintasan 30 hari pasien pneumoniaHCAP dewasa terhadap TFAD. Metode : Penelitian kohort retrospektif berbasis analisis kesintasan pasienpneumonia HCAP RSCM periode Januari 2011-Desember 2014. Dilakukanekstraksi data rekam medis jarak waktu pemberian dosis awal antibiotika di IGD,derajat keparahan pneumonia dan faktor perancu, kemudian dicari data mortalitas30 hari. Derajat keparahan menggunakan Skor CURB-65. TFAD dikelompokkanmenjadi TFAD ≤4 jam dan > 4 jam. Perbedaan kesintasan ditampilkan dalam kurvaKaplan Meier. Perbedaan kesintasan diuji dengan Log-rank test, batas kemaknaan<0,05. Analisis multivariat dengan Cox?s proportional hazard regression untukmenghitung adjusted hazard ratio (dan interval kepercayaan 95%-nya) dengankoreksi terhadap variabel perancu.Hasil : Dari 170 subjek, dalam 30 hari sebanyak 51 subjek (40,5%) meninggal padakelompok TFAD> 4jam dan 4 subjek (9,1%) meninggal pada kelompok TFAD≤4jam. Median kesintasan seluruh subjek adalah 25 hari (IK95% 24-27), kelompokTFAD ≤4jam 29 hari (IK95% 27-31) dan kelompok TFAD > 4 jam 24 hari (IK95%22-26) dengan log rank p 0,01. Kesintasan 30 hari kelompok TFAD ≤4jam sebesar90,9% sedangkan kelompok TFAD > 4 jam 59,5%. Crude HR pada kelompokTFAD > 4 jam 5,293 (IK95% 1,912-14,652). Setelah dilakukan adjustmentterhadap variabel perancu didapatkan fully adjusted HR pada kelompok TFAD> 4jam sebesar 7,137 (IK95% 2,504-30,337) Simpulan : Terdapat perbedaan kesintasan 30-hari pasien HCAP dewasa padakelompok TFAD > 4 jam , semakin lama jarak waktu pemberian antibiotik awal,semakin buruk kesintasan 30-harinya.
ABSTRACT
Background: The incidence of pneumonia HCAP is increasing with a highmortality rate. Optimal management can reduce mortality, one of which Time toFirst Antibiotic Delivery (TFAD). TFAD influence on pneumonia patients withHCAP has not been widely studied. Objective: Obtain information about the differences in 30-day survival adultpatients with pneumonia HCAP against TFAD Methods: A retrospective cohort study based on analysis of the patient's survivalagainst pneumonia HCAP period January 2011 to December 2014. Extraction ofdata from the medical records of the interval initial dose of antibiotics in the ED,the severity of pneumonia and confounding factor, then look for the data in 30-daymortality. Severity using CURB-65 score. TFAD divided into two groups, TFAD ≤4hours and> 4 hours. Differences in survival is shown in Kaplan Meier. Thedifference in survival were tested by the log-rank test, with significance limitp<0.05. Multivariate analysis with Cox's proportional hazards regression tocalculate adjusted hazard ratio (and its 95% CI) with correction for confoundingvariables. Results: Of the 170 subjects, within a period of 30 days by 51 subjects (40.5%) diedin the group TFAD> 4 hours and 4 subjects (9.1%) died in the group TFAD ≤4hours. Mean survival of the whole subject is 25 days (IK95% 24-27), the groupTFAD ≤4jam 29 days (IK95% 27-31) and group TFAD> 4 hours 24 days (IK95%22-26) with a log-rank p 0.01 , 30-day survival in the group TFAD ≤4jam by 90.9%while the TFAD> 4 hours 59.5%. Crude HR group TFAD> 4 hours of 5.293 (1.912to 14.652 IK95%). After adjustment for confounding variables obtained fullyadjusted HR group TFAD> 4 hours amounted to 7.137 (2.504 to 30.337 IK95%) Conclusions: There are differences in 30-day survival of adult patients with HCAPgroup TFAD> 4 hours; the longer the interval initial antibiotic treatment, the worsethe 30-day survival. ;Background: The incidence of pneumonia HCAP is increasing with a highmortality rate. Optimal management can reduce mortality, one of which Time toFirst Antibiotic Delivery (TFAD). TFAD influence on pneumonia patients withHCAP has not been widely studied. Objective: Obtain information about the differences in 30-day survival adultpatients with pneumonia HCAP against TFAD Methods: A retrospective cohort study based on analysis of the patient's survivalagainst pneumonia HCAP period January 2011 to December 2014. Extraction ofdata from the medical records of the interval initial dose of antibiotics in the ED,the severity of pneumonia and confounding factor, then look for the data in 30-daymortality. Severity using CURB-65 score. TFAD divided into two groups, TFAD ≤4hours and> 4 hours. Differences in survival is shown in Kaplan Meier. Thedifference in survival were tested by the log-rank test, with significance limitp<0.05. Multivariate analysis with Cox's proportional hazards regression tocalculate adjusted hazard ratio (and its 95% CI) with correction for confoundingvariables. Results: Of the 170 subjects, within a period of 30 days by 51 subjects (40.5%) diedin the group TFAD> 4 hours and 4 subjects (9.1%) died in the group TFAD ≤4hours. Mean survival of the whole subject is 25 days (IK95% 24-27), the groupTFAD ≤4jam 29 days (IK95% 27-31) and group TFAD> 4 hours 24 days (IK95%22-26) with a log-rank p 0.01 , 30-day survival in the group TFAD ≤4jam by 90.9%while the TFAD> 4 hours 59.5%. Crude HR group TFAD> 4 hours of 5.293 (1.912to 14.652 IK95%). After adjustment for confounding variables obtained fullyadjusted HR group TFAD> 4 hours amounted to 7.137 (2.504 to 30.337 IK95%) Conclusions: There are differences in 30-day survival of adult patients with HCAPgroup TFAD> 4 hours; the longer the interval initial antibiotic treatment, the worsethe 30-day survival. |
SP-Jaka Panca Satriawan.pdf :: Unduh