Lama Rawat Inap Pasien Geriatri dengan Bakteremia Gram Negatif: Sebuah Observasi Analitis

Czeresna Heriawan Soejono

Abstract

Pendahuluan. Lama rawat pasien berkaitan dengan penggunaan sumber daya rumah sakit. Masa rawat pasien geriatri dengan bakteremia gram negatif berpotensi memanjang sehingga perlu ditemu-kenali kondisi yang berkaitan dengan pemanjangan tersebut. Penelitian ini dilakukan untuk mengidentifikasi kondisi yang berkaitan dengan lama rawat pasien geriatri dengan bakteremia gram negatif.

Metode. Deskriptif retrospektif menggunakan rekam medik pasien rawat inap dari 2013 hingga 2019. Kriteria inklusi adalah usia >18 tahun, dengan bakteremia gram negatif; eksklusi jika data tidak lengkap. Selain data demografi, data variabel dependen yang dikumpulkan adalah lama rawat dan kematian. Data variabel independen meliputi status fungsional, status gizi, ada tidaknya diabetes atau keganasan, hemoglobin, albumin, leukosit, neutrofil, kadar ureum, kreatinin, prokalsitonin, dan C-reactive protein (CRP). Data diolah dengan SPSS; uji t-test atau Mann-Whitney tergantung distribusi data. Penelitian ini lolos kaji etik Komite Etik Penelitian Kedokteran FKUI RSCM.

Hasil. Terkumpul 205 dokumen medik kasus bakteremia gram negatif; 33,2% berusia >60 tahun; kuman penyebab terbanyak Acinetobacter dan Klebsiella. Sebanyak 80,7% dari mereka berketergantungan sedang hingga total. Sebanyak 83,6% kadar Hb <11,0 g/dL dan 67,3% disertai hipoalbuminemia. Leukositosis terdapat pada 74,7% (86,4% dengan neutrofil >70%). Peningkatan kadar prokalsitonin terjadi pada 100% kasus dengan median 6,59 ng/mL; sedangkan median kadar CRP adalah 130,0 mg/L.

Pasien geriatri dirawat lebih lama dari pada pasien berusia < 60 tahun (p 0,04) dengan peningkatan kadar prokalsitonin yang lebih rendah (p 0,019). Tidak didapatkan hubungan antara variabel independen lain dengan lama rawat.

Simpulan. Pasien geriatri dengan sepsis gram negatif dirawat lebih lama dari pada pasien dewasa muda; peningkatan kadar prokalsitonin sedikit saja merupakan tanda perlunya kewaspadaan yang lebih tinggi.

 

Kata kunci: Bakteremia, geriatri, gram negatif, lama rawat

 

Length of Stay of Geriatric Patients with Gram-Negative Bacteremia: An Analytical Observation

Introduction. Length of stay is associated with the utilization of hospital resources. Geriatric patients with gram-negative bacteremia have a potential of prolonged length of stay. Thus, conditions related to prolonged stay should be identified. This study aimed to investigate conditions related to the length of stay of geriatric patients with gram-negative bacteremia.

Methods. Retrospective descriptive using the medical records of inpatients from 2013 to 2019. The inclusion criteria were ≥ 18 years of age with gram-negative bacteremia and the exclusion criteria was incomplete data. Other than demographic data, the dependent variables obtained were the length of stay and mortality. Independent variables include functional status, nutritional status, history of diabetes or malignancy, hemoglobin, albumin, leukocyte, neutrophils, level of urea, creatinine, procalcitonin, and C-reactive protein (CRP). The data were processed using SPSS; T-test or Mann-Whitney, depend on the distribution of data. This study had received ethical clearance from the Medical Research Ethical Committee of FKUI RSCM.

Results. There were 205 medical records of gram-negative bacteremia; 33.2% were ≥ 60 years old; the most common causative bacteria were Acinetobacter and Klebsiella. Eighty point seven percent of them showed moderate to total dependence. There were 83.6% with Hb level of < 11.0 g/dL and 67.3% were accompanied with hypoalbuminemia. Leukocytosis was found in 74.7% (86.4% with ≥ 70% neutrophils). Procalcitonin level increase was found in 100% cases with a median of 6,59 ng/mL. Meanwhile, the median CRP level was 130.0 mg/L. Geriatric patients were hospitalized longer than patients aged < 60 years old (p = 0.04) with a lower increase in procalcitonin level (p = 0.019). There was no correlation between other independent variables with length of stay.

Conclusion. Geriatric patients with sepsis due to gram-negative bacteria were hospitalized longer; a little increase of procalcitonin levels is a sign to increase caution

Keywords

Bacteremia, geratric, gram negative, length of stay

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