Isolat Bakteri pada Surveilans Bakterial dan Demam Neutropenia pada Pasien Leukemia Akut Dewasa di Rumah Sakit Cipto Mangunkusumo

Lugyanti Sukrisman

Abstract

Pendahuluan. Kemoterapi intensif pada pasien leukemia akut akan menyebabkan neutropenia berat dan infeksi (demam neutropenia) dengan angka kematian yang tinggi.  Ketersediaan data mengenai organisme patogen penyebab sangat penting dalam menentukan pilihan terapi antibiotik empirik dan umumnya diperoleh dari surveilans bakterial. Penelitian ini bertujuan untuk menilai patogen bakteri pada pasien leukemia akut yang menjalani kemoterapi di Rumah Sakit Cipto Mangunkusumo (RSCM) agar dapat memberikan informasi dalam kebijakan antimikrobial di rumah sakit.

Metode. Penelitian retrospektif dari data surveilans bakterial pada pasien leukemia akut yang menjalani kemoterapi selama tahun 2008-2010 di ruang isolasi (lantai 8) Gedung A Rawat Inap Terpadu RSCM. Data isolat surveilans didapatkan dari hasil kultur dari feses, usap hidung-tenggorok, prepusium, dan lokasi lain (urin, sputum, kulit-sesuai indikasi) pada pasien leukemia akut sebelum dan saat kemoterapi intensif. Kultur darah diambil pada saat pasien mengalami demam saat demam neutropenia, diambil dari kateter vena sentral dan darah tepi menggunakan BactecÒ. Prosedur kultur lain (swab, urine, feses) dilakukan sesuai protokol baku kultur bakteri di laboratorium RSCM. Pengambilan darah/spesimen dilakukan oleh perawat ruang isolasi menggunakan prosedur baku yang telah ditetapkan dan proses kultur dilakukan di divisi mikrobiologi Departemen Patologi Klinik RSCM.

Hasil. Terdapat 1.127 isolat pasien leukemia akut (acute myeloid leukemia – AML atau acute lymphocytic leukemia – ALL) yang dapat dianalisis. Bakteri gram positif secara signifikan lebih tinggi dibandingkan bakteri gram negatif pada saluran nafas (514 dari 675 isolat; 76,1%) dan kultur darah selama demam neutropenia (Staphylococcus epidermidis dan Streptococcus anhemolyticus – 81 dari 103 isolat; 78,7%). Terkait surveilans bakteri pada usus, hanya 8 dari 45 isolat E. coli pada feses yang dapat dianalisis untuk sensitivitas terhadap siprofloksasin/kotrimoksasol dan 37 isolat lainnya sensitif terhadap antimikrobial lain yang tidak digunakan untuk dekontaminasi usus pada AML/ALL. Pola sensitivitas dari isolat lainnya tidak dapat dianalisis terhadap antibiotik yang sesuai pedoman tata laksana demam neutropenia di rumah sakit karena banyaknya jenis antibiotik yang diujikan.

Simpulan. Dari 1.127 isolat pada pasien leukemia akut yang menjalani kemoterapi intensif di RSCM, didapatkan bahwa bakteri gram positif merupakan yang paling banyak ditemukan pada surveilans saluran napas dan kultur darah selama demam neutropenia.

Kata Kunci: demam neutropenia, kemoterapi intensif, kultur bakteri, leukemia akut

The Pattern of Microorganism on Adult Acute Leukemia Patients During Bacterial Surveillance and Febrile Neutropenia at Cipto Mangunkusumo Hospital

Introduction. The standard intensive chemotherapy in acute leukemia patients will cause severe neutropenia and infection (febrile neutropenia) with high fatality rate. The availability of accurate data on causative pathogens is essential to the appropriate selection of empirical therapy and usually obtained from bacterial surveillance. This study was intended to evaluate bacterial pathogens found on surveillance and during febrile neutropenia in acute leukemia patients undergoing chemotherapy at Cipto Mangunkusumo Hospital and to provide information for antimicrobial policy in the hospital.

Methods. A retrospective study from data of bacterial surveillance of acute leukemia patients undergoing chemotherapy during 2008-2010 in isolation room for acute leukemia patients at 8th floor of ‘Gedung A’ Cipto Mangunkusumo Hospital, Jakarta. The isolates for surveillance data were obtained from cultures from feces culture, nasal and throat swab, preputium swab and other sites (urine, sputum, skin infection - as indicated) from acute leukemia patients before and during intensive chemotherapy. Blood sample for blood culture was collected from central venous catheter and peripheral veins using BactecÒduring febrile neutropenia, and the other specimens (swab, urine, feces cultures) were collected  according to the standard laboratory procedure. All specimens were collected by nurses in isolation room and bacterial cultures were performed at microbiology division of Clinical Pathology Department Cipto Mangunkusumo Hospital.

Results. There were 1,127 isolates of acute leukemia patients (acute myeloid leukemia - AML or acute lymphocytic leukemia - ALL) that could be analyzed. Gram positive bacteria was significantly higher than gram negative bacteria from all cultures, from respiratory tract (514 out of 675 isolates; 76.1%) and blood culture (Staphylococcus epidermidis and Streptococcus anhemolyticus – 81 out of 103 isolates; 78.7%). Regarding bacterial surveillance in colon, only 8 out of 45 E. coli isolates from feces can be analyzed for sensitivity to ciprofloxacin/cotrimoxazole and the other 37 isolates were sensitive to other antimicrobials that not commonly used for gut decontamination in acute leukemia. The sensitivity pattern of the other isolates could not be analyzed to the antibiotics recommended for the management of febrile neutropenia due to wide range of antibiotics tested.

Conclusion. From 1,127 isolates found among acute leukemia patients undergoing intensive chemotherapy at Cipto Mangunkusumo Hospital, it was found that gram positive was the most common bacteria found on upper respiratory tract from bacterial surveillance and from blood culture during febrile neutropenia.

Keywords

Acute leukemia, bacterial surveillance, febrile neutropenia, intensive chemotherapy

Refbacks

  • There are currently no refbacks.