antibiotik pada icu
TRANSCRIPT
7/25/2019 Antibiotik Pada ICU
http://slidepdf.com/reader/full/antibiotik-pada-icu 1/12
n ens ve are e : –DOI 10.1007/s00134-016-4341-4
FOCUS EDITORIAL
Focus on antimicrobial use inthe era of increasingantimicrobial resistance inICUMatteo Bassetti1, Garypa!!ia "o#!a$o#2 and %ean&'ranois i*sit +,4
DIBAWAKAN OLEH :TASIA MA’UD !!" #"$ ""%%
PembimbingDR. !. H.A. "#$#%&in'"(.An
BAGIAN ANESTESI, PERAWATAN INTENSIF, DAN MANAJEMEN NYERI RSUD KOTA MAKASSAR
FAKULTAS KEDOKTERAN UNIVERSITAS MUSLIM INDONESIA
MAKASSAR
2016
7/25/2019 Antibiotik Pada ICU
http://slidepdf.com/reader/full/antibiotik-pada-icu 2/12
&enatala'sanaan antibioti' (alam)erla*anan )a(a s)ectrum ba'terresisten
P ! ) s e s * !
# n s m i s i
% ) ! i + ) n * # $
s*#n#! ,)n*!)$ ine,si
s#ni*#si
#,ses #i! be!si%
#,ses #n*ibi)*i, #n (em.i#gn)s*i, eng#n ,&#$i*#s *e!#min
(e!#$#n#n #n
mig!#si 1'
Intensive are #nit
2I5
7/25/2019 Antibiotik Pada ICU
http://slidepdf.com/reader/full/antibiotik-pada-icu 3/12
D)sis *inggi #e,&#* s#ng#* (en*ing #$#m *e!#(i (#sien
e!#(i ,)mbin#si is#!#n,#n &n*&, :
1- pasien syo$ septi$ dan ne#tropenia2, pasien resi$o tin..i terseran. /a$teri resisten *#!tianti/ioti$
An*ibi)*i, seb#i,n# ie8#$&#si &$#ng se*e$#% 49-7 #m #n)sisn# i*&!&n,#n.
D&!#si *e!#(i seb#i,n# i,&!#ngi.
s*!#*egi &n*&, meng&!#ngi *e!#(i #n*ibi)*i, ,&!#*i pane! a!i *#!tidisip!in "eranis den.an *etode G3
7/25/2019 Antibiotik Pada ICU
http://slidepdf.com/reader/full/antibiotik-pada-icu 4/12
-- Di #n*#!# b#,*e!i g!#m neg#*i' ineto/ater /a#*ann
*e!&*#m#
meng#$#mi (eneb#!#n i I #n !en*#n men#i m&$*i!esis*en.
- "*!#*egi ,)n*!)$ ine,si #!i b#gi#n ine,si #ropean oiety Intensive Care Mediine 2E"I5 :
•
,ebe!si%#n *#ng#n• ,ebe!si%#n $ing,&ng#n
• s,!ining #,*i
• meng%in#!i ,)n*#,
7/25/2019 Antibiotik Pada ICU
http://slidepdf.com/reader/full/antibiotik-pada-icu 5/12
Pen;eg#%#n*!#nsmisi%)!i+)n*#$#!i b#,*e!i :
< a!oo!i!ore7idine#n*ise(*i, (i$i%#n
(e!*#m# &n*&,(en;eg#%#n ine,si,#*e*e! 6
!ore7idine seb#g#i
#gen *)(i,#$ &n*&,e,)$)nis#si m&$&*#n ,&$i* (#sienm#si% #$#m(e!eb#*#n. 6
i n . # & # n
N ) * )
# n W % e e $ e !
/ 7 1
e,)$)nis#si ,&*meng%#si$,#n
g!#m 2=tapy!oo
vano*yinre
#n##* e,)#s#! !ore7
,)
Pengg&n##n eng#n (enin
,e!en*#n
7/25/2019 Antibiotik Pada ICU
http://slidepdf.com/reader/full/antibiotik-pada-icu 6/12
Tera)i em)iris"*&i sebe$&mn# *e$#% men&n&,,#n b&,*i be!*en*#ng#n *e!,#i* (eng#!&% *#@#$ (## (#sien se(sis' ,e;&#$i ,#s&s (#sien eng#n se(sis be!#* #*#& s),e$#ngs&ng#n %i&( be!g#n*&ng pada inisiasi awal terapi antibiotik efe
• (en;#(#i#n *#!ge* se$#m# *e!#(i eng#n #n*ibi)*i, be*#-$#,,ese$&!&%#n *i#, #e,&#*
• (engg&n##n in&s b)$&s in*e!mi*en 2IB5 meng#,ib#*,#n (e%ingg# 4 ,#$i $i(#* ,e;ene!&ng#n *i#, men;#(#i *#!ge* Pi%#!#(,#n 10.
analisis post hocstu(i DALI+
(engan settingem)iris
• (#sien eng#n se(sis be!#* 2*#n(# (engg#n*i#n gin#$5' (em,)n*in& 2I5 be!,#i*#n eng#n #ng,# (enemb&%#n ,$inis
26 8e!s&s 34<' p 0.0115 #n (en;#(#i#n *#!ge* PK/PD $eib#ning,#n eng#n )sis In*e!mi**en B)$&s &n*&, #n*ibi)11.
"*&i BLI""
• *i#, menem&,#n (e!be##n (enemb&%#n ,$inis 2.4 8e0.65 #n*#!# (embe!i#n #n*ibi)*i, BL eng#n I #n IB 1
s*&i BLIN II
7/25/2019 Antibiotik Pada ICU
http://slidepdf.com/reader/full/antibiotik-pada-icu 7/12
Dosis a(e'uat"*&i DALI *e!,#i* )sis #n*ibi)*i,
(## (#sien I
• 0< (#sien g#g#$ men;#(#i*#!ge* (##n#n )b#* (#$ing,)nse!8#*i se$#m# *e!#(i em(i!is
• $ebi% #!i 40< g#g#$ men;#(#i*#!ge* $ebi% *inggi
•
In&s in*e!mi*en -$#,*#m #n(#sien eng#n (ening,#*#n;$e#!#n;e !en#$ be!,#i*#n eng#n(##n#n )b#* #ng $ebi% !en#%10
s*&i !#n)m )$e% e(## (#sien I e
gin#$ n)!m
• /ase!ine (en;#(#i#n *#!ge!en#% &n*&, me!e,# #n
piperacillin/tazobactammeropenem.
• !#n)mis#si *e!%##( ter*onitorin. 2D5 %#!i#n (!)()!si (#sien $ebi% *ingg
*#!ge*.• Di$#in sisi'(#sien (en#,i*(ening,#*#n *#!ge* be!%&beng#n %#si$ ,$ini, #ng $e
• In&s ,)n*in& -$#,*#m beo#to*e ,$inis $ebi% b#i, (,)n*!)$ !#n)m *e!b#!& 1
• !e,)men#si )sis em(i!is#n*ibi)*i, -$#,*#m &n*&, *#m(#,n# *i#, #e,&#* i e!*imb#n ,#n &$#n 1
7/25/2019 Antibiotik Pada ICU
http://slidepdf.com/reader/full/antibiotik-pada-icu 8/12
• Monitorin. ,e*#* ,)nsen*!#si a*i$ain *#m(#,n(## (#sien I ,#!en# mes,i(&n )sis !oadin.*)*#$ be!#* b##n' *#!ge* #!m#,)in#mi, *i#,33< (#sien.
• Keseimb#ng#n ()si*i ;#i!#n 4 #m i(!ei,si *
*#!ge*' semen*#!# BI !en#% ;ene!&ng be!,##nderdose #mi,#;in 1.
Pengg&n##n#mi,#;in
• s*&i )bse!8#si)n#$ (!)s(e,*i #!i 6 I Pe!#n)asien men(a)at'an 'ombinasi (engan aneng#n *#!ge* ine,si !#m neg#*i #n $%. m
(osis stan(ar. Ang,# ,ebe!%#si$#n 6< (## #ib#ning,#n eng#n s*&i ,$inis (## ine,si bmen&!&n eng#n ,e(#!#%#n (en#,i*' im&n)s&b#,*e!imi#' #n )besi*#s 16.
• m#n#emen #n (en;eg#%#n ine,si - /a#*ani$#,&,#n )$e% b#gi#n ine,si E"I me!e,)men!oadin. ti.ey!ine seb#n#, 00 mg ii,&*i eng&n*&, *e!#(i (ne&m)ni# #n b#,*e!emi# (!ime!
Pengg&n##nti.ey!ine
7/25/2019 Antibiotik Pada ICU
http://slidepdf.com/reader/full/antibiotik-pada-icu 9/12
&ertimbangan de-escalationDe-es,#$#si 2(en&!&n#n5 *e!#(i #n*ibi)*i, me!&(#,#n s*!#*egi &n*&, men&!&n#n*ibi)*i, #n be!*&&#n &n*&, men;eg#% !esis*ensi b#,*e!i g#@#* #!&!#* 19"*&i #ng ## men&n&,,#n ##n# %&b&ng#n #n*#!# e-es,#$#si #n o#to
#!n#;%)-)n*e!) e* #$.
• De-es,#$#si i#!*i,#n eng#n(eng%en*i#n #n*ibi)*i, #*#&(engg#n*i#n #n*ibi)*i, eng#n#n*ibi)*i; s(e,*!&m $ebi% sem(i*1C
• e-es,#$#si %#n# i$#,&,#n (##3< #!i ,#s&s #n be!,#i*#neng#n !esi,) signi?,#n $ebi%!en#% &n*&, ,em#*i#n b#%,#nse*e$#% (enes&#i#n be!#s#!,#n#,*)! !esi,) m)!*#$i*#s
Le)ne e*
• g#g#$ menem)ns(e,*!&m sem(i*(en*ing (## &!
I• mening,#*,#n #n
s&(e!ine,si #nbe!%&b&ng#n en#ng $ebi% $#m# (#n*ibi)*i,
b $ i $, , i i $
7/25/2019 Antibiotik Pada ICU
http://slidepdf.com/reader/full/antibiotik-pada-icu 10/12
#be$ 1 menim(&$,#n ,)m()nen (!insi(#$ s*!#*eI &n*&, (en#*#$#,s#n##n #n (engg&n###n*ibi)*i,.
/omitmen 'e)emim)inan
Im($emen*#si (!)g!#m (en#*#$#,s#n##n #n*ibi)*i,
Im($emen*#si (!#,*e, ,)n*!)$ ine,si
ening,#*,#n ,)m&ni,#si #n*#!# s*# $#b)!#*)!i&m #n ,$inis
Im($emen*#si #*# !esis*ensi $),#$ &n*&, (engemb#ng#n (e)m#n #n*ibi)*i, $),#$
&en(e'atan multi(isi)lin
"&#*& *im m&$*iisi($in me$i(&*i s(esi#$is (en#,i* ine,si' #%$i mi,!)bi)$)gi' #()*e,e!' ),*e! I' #n (e!#@#* %#!&s be!*#ngg&ng #@#b
(en#*#$#,s#n##n #n*ibi)*i, I s(esi?, R)ne %#!i#n &n*&, is,&si ,#s&s
Im)lementasi )en(e'atan )enggunaan antibioti' mo(ern
"#m(e$ mi,!)bi)$)gi eng#n ,&#$i*#s b#i, 2,&$*&! #!#%' s#m(e$ #$&! n##s is*#$' ,&$*&! &!in' s#m(e$ sis*em#*is (## $&,#' ;#i!#n !#in#se
ses&#*& s&s(e, ine,si5 sebe$&m mem&$#i (embe!i#n #n*ibi)*i,
&emilihan antibioti' em)iris ber(asar'an 'on(isi 'linis+ a(an0a fa'tor resi'o untu' mi'roba resisten+ (an e)i(
Pen;#(#i#n (#!#me*e! #!m#,),ine*i,/#!m#,)in#mi, (## #gen #n*ibi)*i, #ng ig&n#,#n 2in&s ,)n*in&/eG*ene' D5
De-es,#$#si sis*em#*is
Pen&!&n#n sis*em#*is &!#si *e!#(i #n*ibi)*i, be!#s#!,#n e8)$&si ,$inis #n ,ine*i, bi)m#!,e! se(e!*i (!),#$si*)nin
Monitoring (an um)an bali'
)ni*)!ing #n*ibi)*i, #ng i!ese(,#n #n ()$# !esis*ensi
L#()!#n !eg&$#! in)!m#si (engg&n##n #n*ibi)*i, #n !esis*ensi ,e(## ),*e!' (e!#@#*' #n s*# #ng !e$e8#n
7/25/2019 Antibiotik Pada ICU
http://slidepdf.com/reader/full/antibiotik-pada-icu 11/12
ERIA KA"IH
7/25/2019 Antibiotik Pada ICU
http://slidepdf.com/reader/full/antibiotik-pada-icu 12/12
Ree!en;es1. H)$mes AH' ))!e L"' "&ns)! A' "*einb#,, ' Regmi "' K#!,e A' &e!in P' Pi);, L 20165 ne!s*#ning
*%e me;%#nisms #n !i8e!s ) #n*imi;!)bi#$ !esis*#n;e. L#n;e* 397:176197.)i:10.1016/"0140673621500473-0
. #!$e* 2015 en *i(s )n %)@ *) @in *%e @#! #g#ins* !esis*#n;e *) #n*ibi)*i;s. In*ensi8e #!e e 41:9CCC01.)i:10.1007/s00134-014-3C4-+
3. B!e*)nniJ!e ' Le)ne ' i$si ' A$$#)&;%i;%e B' A!m#n-Lee8!e L' B#$esi O' B)&#m# L' De;! D' ig&ei!e) "'#&+i* R e* #$ 2015 "*!#*egies *) !e&;e ;&!#*i8e #n*ibi)*i; *%e!#( in in*ensi8e ;#!e &ni*s 2#&$* #n (#ei#*!i;5.
In*ensi8e #!e e 41:119111C6. )i:10.1007/s00134-01-393-7
4. H!#ne; ' R)senbe!ge! LH' "@ens)n B' e*+ge! R' $)%! R' P)$i*#n) AD' Ri;;i) L' P)()8s, KA' "#@e! R2015 Agg!essi8e 8e!s&s ;)nse!8#*i8e ini*i#*i)n ) #n*imi;!)bi#$ *!e#*men* in ;!i*i;#$$ i$$ s&!gi;#$ (#*ien*s @i*%s&s(e;*e in*ensi8e-;#!e-&ni*-#;M&i!e ine;*i)n: # M&#si-eG(e!imen*#$' be)!e #n #*e! )bse!8#*i)n#$ ;)%)!*s*&. L#n;e* Ine;* Dis 1:774790. )i:10.1016/"1473-30CC2157011-
. #!n#;%)-)n*e!) ' Dim)()&$)s ' P)&$#,)& ' A,)8# ' isne!)s ' De W#e$e ' Pe*!)si$$) N' "eie!* H' imsi* '>i$# e* #$ 2015 #s, )!;e )n m#n#gemen* #n (!e8en*i)n ) ineto/ater /a#*annii ine;*i)ns in *%e I.In*ensi8e #!e e 41:0707. )i:10.1007/s00134-01-407C-4
6. im)+ O' L&;e* ' Ke!)!ne ' P#s;#$ ' ")&@eine B' )&e* >' e!;#* A' B)&#m# L' L#s);,i "' A$#n#!i " e* #$2015 ",in #n*ise(sis @i*% ;%$)!%eGiine-#$;)%)$ 8e!s&s ()8i)ne i)ine-#$;)%)$' @i*% #n @i*%)&* s,in s;!&bbing')! (!e8en*i)n ) in*!#8#s;&$#!-;#*%e*e!-!e$#*e ine;*i)n 2LEAN5: #n )(en-$#be$' m&$*i;en*!e' !#n)mise';)n*!)$$e' *@)-b-*@) #;*)!i#$ *!i#$. L#n;e* 396:06C077. )i:10.1016/"0140-67362150044-
7. N)*) ' W%ee$e! AP 2015 ne!s*#ning ;%$)!%eGiine e;)$)ni+#*i)n s*!#*egies. In*ensi8e #!e e 41:131134. )i:10.1007/s00134-01-3946-6
9. B#sse**i ' De W#e$e ' Eggim#nn P' #!n#;%)-)n*e!) ' K#%$me*e! ' eni;%e**i ' Ni;)$#& DP' P#i8# A' &mb#!e$$) ' We$*e ' Wi$;)G ' #%#! R' P)&$#,)& 2015 P!e8en*i8e #n *%e!#(e&*i; s*!#*egies in ;!i*i;#$$ i$$(#*ien*s @i*% %ig%$ !esis*#n* b#;*e!i#. In*ensi8e #!e e 41:7767C. )i:10.1007/s00134-01-371C-+
C. &mb#!e$$) ' !e;#!i;%i E' De R)s# ' i#nne$$# ' i#;)bbe DR' B#sse**i ' L)si*) AR' B#!*)$e**i ' De$ B)n)>' )!;i)ne " e* #$ 2015 Ine;*i)ns ;#&se b KP-(!)&;ing !e/sie!!a pne#*oniae: ie!en;es in *%e!#( #nm)!*#$i* in # m&$*i;en*!e s*&. An*imi;!)b %em)*%e! 70:133143. )i:10.10C3/#;/,8096
10. De W#e$e ' Li(m#n ' A,)8# ' B#sse**i ' Dim)()&$)s ' K#&,)nen ' K)&$en*i D' #!*in ' )n*!#8e!s P' Re$$) e* #$ 20145 Ris, #;*)!s )! *#!ge* n)n-#**#inmen* &!ing em(i!i;#$ *!e#*men* @i*% -$#;*#m #n*ibi)*i;s in ;!i*i;#$$i$$ (#*ien*s. In*ensi8e #!e e 40:1340131. )i:10.1007/s00134-014-3403-9
11. Ab&$-A+i+ H' "&$#im#n H' #*-N)! B' R#i >' W)ng KK' H#s#n "' Ab R#%m#n AN' #m#$ A' W#$$is "' Li(m#n ' "*##*+ E e* #$ 20165 Be*#$#;*#m in&si)n in se8e!e se(sis 2BLI""5: # (!)s(e;*i8e' *@)-;en*!e' )(en$#be$$e!#n)mi+e ;)n*!)$$e *!i#$ ) ;)n*in&)&s 8e!s&s in*e!mi**en*
1. D&$%&n* ' R)be!*s A' D#8is "' Webb "A' Be$$)m) R' )me!s#in&si)n in ;!i*i;#$$ i$$ (#*ien*s @i*% se8e!e se(sis. In*ensi8e #!e
13. ' b&!g% ' P#*e!s)n DL 2015 A m&$*i;en*e! !#n)mi+e *!i$#;*#m in&si)n in se8e!e se(sis. Am Res(i! !i* #!e e 1C:1097O
14. R)be!*s A' P#&$ "K' A,)8# ' B#sse**i ' De W#e$e ' Dim)()&$))n*!#8e!s P e* #$ 20145 DALI: eining #n*ibi)*i; $e8e$s in in*en$#;*#m #n*ibi)*i; )ses s&;ien* )! ;!i*i;#$$ i$$ (#*ien*sQ $in In)i:10.10C3/;i/;i&07
1. De W#e$e ' #!!e**e "' #!$ie! ' "*)8e >' B)e$ens ' $#es ' LDe;!&en#e!e e* #$ 20145 %e!#(e&*i; !&g m)ni*)!ing-b#se me!)(enem: # !#n)mise ;)n*!)$$e *!i#$. In*ensi8e #!e e 43197-
16. e )n*m)$$in E' B)&#m# L' #&$* N' )&!8i$$ie! B' #!i)**e E' W)$ ' ")nne8i$$e R 20145 P!ei;*)!s ) ins&;ien* #mi,#;in (e!e;ei8ing # mg/,g *)*#$ b) @eig%* !egimen. In*ensi8e #!e 014-376-G
17. )n*!#8e!s P' D&()n* H' Be)s P' B!e* P' ige;;$ine !)&( 201(#*ien*s: # m&$*i;en*!e (!)s(e;*i8e )bse!8#*i)n#$ s*& in *%e in*40:C99CC7. )i:10.1007/s00134-014-333-7
19. De P#s;#$e ' )!*&n# "' &mb#!e$$) ' &*&$i "L' >#$$e;);;i# ' N#8#!!# P e* #$ 2 015 Line+)$i ($#sm# #n in*!#(&$m)n#! ;)n;
@i*% 8en*i$#*)!-#ss);i#*e (ne&m)ni#: in*e!mi**en* 8s ;)n*in&)&s41:103110. )i:10.1007/s00134-014-30-
1C. #b#% A' )**# O' #!n#;%)-)n*e!) ' ";%)&*en ' R)be!*s A' #%#! R e* #$ 20165 A ss*em#*i; !e8ie@ ) *%e e?ni*i)ns' e*e#n*imi;!)bi#$ e-es;#$#*i)n in *%e in*ensi8e ;#!e &ni*. $in Ine;*
0. #!n#;%)-)n*e!) ' &*i!!e+-Pi+#!!## A' Es;)!es;#-O!*eg# A' He!!e!#-e$e!) I' O!*i+-Leb# ' S!M&e+->S;#!) A 20145 De-es;#ss);i#*e @i*% $)@e! m)!*#$i* in (#*ien*s @i*% se8e!e se(sis #n40:340. )i:10.1007/s00134-013-3077-7
1. Le)ne ' Be;%is ' B#&ms*#!;, K' Le!#n* ' A$b#nJse ' #be! "'B!&e! N' A$$#)&;%i;%e B e* #$ 20145 Dees;#$#*i)n 8e!s&s ;)n*in*!e#*men* in se8e!e se(sis: # m&$*i;en*e! n)n-b$ine !#n)mi+e40:13CC1409. )i:10.1007/s00134-014-3411-9
. e )ng E' 8#n Oe!s A' Beis%&i+en A' >)s P' >e!meien W' H##sK$&i*e!s ' Kem(e!m#n H e* #$ 20165 E;#; #n s#e* ) (!)&!#*i)n ) #n*ibi)*i; *!e#*men* in ;!i*i;#$$ i$$ (#*ien*s: # !#n)mIne;* Dis. )i:10.1016/"1473-30CC21650003-0