Perbedaan Skor Sepsis Modifikasi Tollner dan Kadar Procalsitonin Serum Sebelum dengan Setelah Pemberian Antibiotik Empiris pada Sepsis Neonatorum
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Latar belakang. Di negara maju maupun berkembang, insiden sepsis neonatorum masih tinggi. Penggunaan antibiotik empiris, pada sepsis neonatorum, perlu pemantauan ketat untuk mencegah toksisitas dan resistensi.
Tujuan. Menentukan perbedaan skor sepsis modifikasi Tollner dan kadar procalcitonin (PCT) serum sebelum dengan setelah pemberian antibiotik empiris serta hubungan perubahan keduanya pasca pemberian antibiotik empiris.
Metode. Penelitian observasional analitik, rancangan one group pre-test and post-test, dilaksanakan Juli−Oktober 2013 di Unit Gawat Darurat dan Rawat Inap Divisi Neonatologi Rumah Sakit Dr. Hasan Sadikin, Bandung. Subjek penelitian terdiri atas 32 neonatus dan 2 dikeluarkan karena meninggal <48 jam. Pada seluruh subjek dilakukan penilaian skor sepsis (nilai >10 masuk ke dalam penelitian) dan pemeriksaan kadar PCT serum sebelum dengan setelah mendapat antibiotik ampisilin dan gentamisin selama 48 jam. Perbedaan skor sepsis modifikasi Tollner dan kadar PCT sebelum dengan setelah pemberian antibiotik empiris dianalisis menggunakan Uji Wilcoxon. Korelasi perubahan skor sepsis dan kadar PCT diuji dengan Uji Rank Spearman. Faktor yang berhubungan dengan skor sepsis dan kadar PCT jenis kelamin, usia ≤48 jam, berat lahir rendah, dan kultur darah negatif dianalisis dengan Uji Mann-Whitney.
Hasil. Skor sepsis dan kadar PCT serum awal (median (rentang)) berturut-turut 11,5 (10,5−16,5) dan 12,6 (0,30−100) ng/mL. Pasca pemberian antibiotik berturut-turut 5,5 (0,5−13,5) dan 2,65 (0,16−37,25) ng/mL. Skor sepsis dan kadar PCT berbeda bermakna sebelum dengan setelah pemberian antibiotik empiris. Terdapat korelasi positif bermakna perubahan nilai skor sepsis modifikasi Tollner dengan perubahan kadar PCT serum pasca pemberian antibiotik empiris selama 48 jam.
Kesimpulan. Skor sepsis modifikasi Tollner dan kadar PCT serum berhubungan dengan pemberian antibiotik empiris pada sepsis neonatorum. Kenaikan perubahan skor sepsis modifikasi Tollner diikuti oleh kenaikan perubahan kadar PCT serum.
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DOI: http://dx.doi.org/10.14238/sp16.3.2014.178-82
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