•  
  •  
 

Abstract

Sepsis still becomes a major health problem worldwide, with a fairly high mortality rate ranging from 20 to 50%. Antibiotic therapy with rational use can reduce the mortality rate. In contrast, the irrational use of antibiotic therapy will increase the occurrence of resistance, which impacts the increase of morbidity, mortality, and health costs. The objective of this study was to evaluate the quality in the use of antibiotics using the Gyssens method in patients with sepsis. This study was an observational study with a cross-sectional method conducted at Fatmawati Central General Hospital Jakarta from January to December 2020. The research subjects were 110 patients with sepsis who met the inclusion criteria. In this study, 49.09% of patients used rational antibiotics and 50.91% of patients used irrational antibiotics that were found in category VI (0.91%), V (17.28%), IVa (3.63%), IVb (0.91%), IVc (0.91%), IIIa (3.63%), IIIb (20%), IIa (0.91%), and IIb (2.73%). The duration of antibiotic therapy was the only factor that affected the quality of antibiotic use (p = 0.012). There was no difference in mortality between patients with rational and irrational use of antibiotics (p = 0.333, OR = 1.654, 95% CI 0.714-3.829). However, after adjusting for the duration of therapy, irrational use of antibiotics significantly affected mortality (p = 0.017, OR = 3.5, 95% CI 1.255-9.761). In conclusion, the antibiotic use in half of the sepsis patients were irrational. Since irrational use was associated with mortality, efforts need to be taken to improve the quality of antibiotic use.

References

Adani, S. D., Zulfariansyah, A., & Santoso, P. T. R. (2017). Quality assesment of antibiotic prescription for sepsis treatment in Intensive Care Unit at top referral hospital in West Java, Indonesia. Althea Medical Journal, 4(2), 286–292. https://doi.org/10.15850/amj.v4n2.1088.

Adiwinoto, R. P., Sustini, F., Hardiono, Widodo, A. D. W., Hidajat, dan Hadi, U. (2018). Empirical antibiotic therapy assessment of patients diagnosed with sepsis in intermediate care ward of internal medicine departement of Dr. Soetomo general hospital according to gyssens method. Oceana Biomedicina Journal, 1(2), 70 – 78.

Andrajati, R., Tilaqza, A., & Supardi, S. (2017). Factors related to rational antibiotic prescriptions in community health centers in Depok City, Indonesia. Journal of Infection and Public Health, 10(1), 41–48. https://doi.org/10.1016/j.jiph.2016.01.012.

Chaijamorn, W., Srisawat, N., Reungdet, T., Ngarmsaard, N., & Suksangiem, T. (2017). Optimal dosing regimens of meropenem using monte carlo simulations in acute kidney injury patients receiving continuous renal replacement therapy. Kidney International Reports, 2(4), S37. https://doi.org/10.1016/j.ekir.2017.06.119.

Dewi, R. S., Radji, M., & Andalusia, R. (2018). Evaluation of antibiotic use among sepsis patients in an intensive care unit: A cross-sectional study at a referral hospital in Indonesia. Sultan Qaboos University Medical Journal, 18(3), e367–e373. https://doi.org/10.18295/squmj.2018.18.03.017.

Do, S. N., Luong, C. Q., Pham, D. T., Nguyen, M. H., Nguyen, N. T., Huynh, D. Q., Hoang, Q. T. A., Dao, C. X., Le, T. M., Bui, H. N., Nguyen, H. T., Hoang, H. B., Le, T. T. P., Nguyen, L. T. B., Duong, P. T., Nguyen, T. D., Vu, Y. H., Pham, G. T. T., Van Bui, T., … Nguyen, A. D. (2021). Factors relating to mortality in septic patients in Vietnamese intensive care units from a subgroup analysis of MOSAICS II study. Scientific Reports, 11(1), 1–12. https://doi.org/10.1038/s41598-021-98165-8.

Eri, Susanna (2019). Analisis efektivitas penggunaan antibiotik ceftriaxone dan meropenem terhadap pasien sepsis di RSUD Provinsi Nusa Tenggara Barat Tahun 2016 - 2018. Diploma Thesis. Mataram: Universitas Muhammadiyah Mataram.

Giuliano, C., Patel, C. R., & Kale-Pradhan, P. B. (2019). A guide to bacterial culture identification and results interpretation. P and T, 44(4), 192–200.

Gushka, H. (2015). Evaluasi penggunaan antibiotika pada pasien sepsis di ruang ICU Rumah Sakit Umum Daerah Serang. Thesis. Yogyakarta:Universitas Gajah Mada.

Gyssens, I. C. (2005). Audits for monitoring the quality of antimicrobial prescriptions. Antibiotic Policies: Theory and Practice, (Table 1), 197–226. https://doi.org/10.1007/0-387-22852-7_12

Hotchkiss, R. S., Moldawer, L. L., Opal, S. M., Reinhart, K., Turnbull, I. R., & Vincent, J. L. (2016). Sepsis and septic shock. Nature reviews Disease primers, 2, 16045. https://doi.org/10.1038/nrdp.2016.45

Indonesian Lung Doctors Association. (2014). Pneumonia komuniti : Pedoman diagnosis dan penatalaksanaan di Indonesia. Jakarta : PDPI.

Ismaya, A. N., Anggriani, Y & Rianti, A. (2017). Evaluasi penggunaan antibiotik pada pasien neonatus rawat inap di RSUP Fatmawati berdasarkan PCNE dan Gyssens periode : 1 September – 30 November 2014. In Pertemuan Ilmiah Tahunan Ikatan Apoteker Indonesia (pp. 60). Banten : Indonesia.

Kim, H. Il, & Park, S. (2019). Sepsis: Early recognition and optimized treatment. Tuberculosis and Respiratory Diseases, 82(1), 6–14. https://doi.org/10.4046/trd.2018.0041.

Kubo, K., Kondo, Y., Yoshimura, J., Kikutani, K., & Shime, N. (2022). Short- versus prolonged-course antibiotic therapy for sepsis or infectious diseases in critically ill adults: a systematic review and meta-analysis. Infectious Diseases, 54(3), 213–223. https://doi.org/10.1080/23744235.2021.2001046.

Lee, R. A., Centor, R. M., Humphrey, L. L., Jokela, J. A., Andrews, R., & Qaseem, A. (2021). Appropriate use of short-course antibiotics in common infections: best practice advice from the American College of physicians. Annals of Internal Medicine, 174 (6) : 822 - 827. https://doi.org/10.7326/M20-7355.

Martínez, M. L., Plata-Menchaca, E. P., Ruiz-Rodríguez, J. C., & Ferrer, R. (2020). An approach to antibiotic treatment in patients with sepsis. Journal of Thoracic Disease, 12(3), 1007–1021. https://doi.org/10.21037/jtd.2020.01.47.

Ministry of Health of the Republic of Indonesia. (2011b). Peraturan Menteri Kesehatan Republik Indonesia nomor 2406/MENKES/PER/XII tentang pedoman umum penggunaan antibiotik. Jakarta : Kementrian Kesehatan Republik Indonesia.

Ministry of Health of the Republic of Indonesia. (2017). Keputusan Menteri Kesehatan Republik Indonesia nomor HK.01.07/MENKES/2017 tentang pedoman nasional pelayanan kedokteran tata laksana sepsis. Jakarta : Kementrian Kesehatan Republik Indonesia.

Neira, R. A. Q., Hamacher, S., & Japiassu, A. M. (2018). Epidemiology of sepsis in Brazil: Incidence, lethality, costs, and other indicators for Brazilian Unified Health System hospitalizations from 2006 to 2015. PLoS ONE, 13(4), 1–15. https://doi.org/10.1371/journal.pone.0195873.

Novosad, S. A., Sapiano, M. R. P., Grigg, C., Lake, J., Robyn, M., Dumyati, G., Felsen, C., Blog, D., Dufort, E., Zansky, S., Wiedeman, K., Avery, L., Dantes, R. B., Jernigan, J. A., Magill, S. S., Fiore, A., & Epstein, L. (2016). Vital signs: Epidemiology of sepsis: Prevalence of health care factors and opportunities for prevention. MMWR. Morbidity and Mortality Weekly Report, 65(33), 864–869. https://doi.org/10.15585/mmwr.mm6533e1.

Pezzani, M. D., Be, G., Cattaneo, P., Zaffagnini, A., Gobbi, F., Rodari, P., Bisoffi, Z., & Tacconelli, E. (2019). Evidence based review on optimal duration of antibiotic therapy for bacterial infections to support antimicrobial stewardship recommendations WHO secretariat Nicola Magrini, Secretary of the Expert Committee on Selection and Use of Essential Medicines, 1–28.

Rhodes, A., Evans, L.E., Alhazzani, W., Levy, M.M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J.E., Sprung, C.L., Nunnally, M.E., Rochwerg, B., Rubenfeld, G.D., Angus, D.C., Dellinger, R.P. (2017). Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Critical Care Medicine, 45 (3), 486-552.

Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., Bellomo, R., Bernard, G. R., Chiche, J. D., Coopersmith, C. M., Hotchkiss, R. S., Levy, M. M., Marshall, J. C., Martin, G. S., Opal, S. M., Rubenfeld, G. D., van der Poll, T., Vincent, J. L., & Angus, D. C. (2016). The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA, 315(8), 801–810. https://doi.org/10.1001/jama.2016.0287

Spellberg, B., & Rice, L. B. (2019). Duration of antibiotic therapy: Shorter is better. Annals of Internal Medicine, 171(3), 210–211. https://doi.org/10.7326/M19-1509.

Sudat, S. E. K. (2021). Impact of sepsis identification and treatment time on in-hospital mortality, length of stay, and hours in the intensive care unit. Preprints. https://doi.org/10.1101/2021.05.26.21257894.

Sunartejo, B., Fitriani, C., & Kurniawaty, J. (2019). Hubungan antara kesesuaian terapi antibiotik empiris dengan hasil uji kepekaan kuman terhadap angka kematian pada pasien sepsis di ICU RSUP Dr. Sardjito Yogyakarta. Fakultas Kedokteran : Universitas Gadjah Mada, Yogyakarta.

Tim Penyusun. (2019). Buku Pedoman Penggunaan Antibiotik (PPAB) RSUP Fatmawati. Jakarta : Rumah Sakit Umum Pusat Fatmawati

WHO. (2020). Global Report on the epidemiology and burden of sepsis : Current evidence, identifying gaps and future directions.

Wilson, H. L., Daveson, K., & Del Mar, C. B. (2019). Optimal antimicrobial duration for common bacterial infections. Australian Prescriber, 42(1), 5–9. https://doi.org/10.18773/austprescr.2019.001

Download

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.