EVALUATION OF EMPIRICAL AND DEFINITIVE ANTIBIOTICS USE AND ITS EFFECT ON THERAPEUTIC OUTCOMES IN SURGICAL PATIENTS IN DR. HASAN SADIKIN CENTRAL GENERAL HOSPITAL

• Main Author: Fathadina, Annisa
• Format: Theses
• Language: Indonesia
• Online Access: https://digilib.itb.ac.id/gdl/view/61697
• Institution: Institut Teknologi Bandung

Antibiotic resistance is one of the biggest public health problems that is still being faced worldwide. The development of antibiotic resistance can be controlled through the appropriate use of antibiotics. Before improving the use of antibiotics, it is necessary to evaluate the use of antibiotics that have been given. Research related to the use of antibiotics in surgical patients in Indonesia is still limited. From several existing studies, most of the use of antibiotics in surgical patients is still not appropriate. The use of antibiotics in surgical patients is intendeed to prevent (as prophylaxis) or treat infections that occur (as therapy). The use of therapeutic antibiotics includes empirical and definitive antibiotics. Empirical antibiotics are used in cases of infection or suspected infection for which the type and pattern of susceptibility of the bacteria are unknown, while definitive antibiotics are used in cases of infection for which the type and pattern of susceptibility of the bacteria are known. This research was conducted with an observational descriptive analysis study design using retrospective data from 2019 in Hasan Sadikin Central General Hospital to evaluate the use of empirical and definitive antibiotics as well as the relationship between the appropriateness of their use and therapeutic outcomes in surgical patients. Evaluation of the use of antibiotics quantitatively was carried out using the Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) method, through the calculation of DDD/100 patient-days, to determine the highest amount of antibiotics used in surgical patients. The smaller the quantity of antibiotic use indicates the wiser use of antibiotics. A qualitative evaluation of the use of antibiotics was carried out using the Gyssens method, to assess the quality of antibiotic use which could then be used as a recommendation in increasing the wise use of antibiotics in surgical patients. Analysis of the relationship between the appropriateness of antibiotic use and therapeutic outcomes was determined by the Chi-Square statistical test with a significance level of 5% which was processed using the IBM SPSS 23. The results of the quantitative evaluation showed that the highest DDD/100 patient-days was ceftriaxone of 17,39 DDD/100 patient-days. The quantity of ceftriaxone use has decreased compared to studies in 2015 (72,692 DDD/100 patient-days) and 2016 (71,194 DDD/100 patient-days). The results of the qualitative evaluation showed that there were 46,75% of the appropriate use of antibiotics, while 53,25% of the inappropriate use of antibiotics consisted of category VI (4,88%), category V (19,97%), category IVa (7,25%), category IVb (0,3%), category IVc (3,25%), category IVd (0,89%), category IIIa (4,73%), category IIIb (9,47%), category IIa (1,92%), and category IIb (0,74%). The results of statistical analysis showed that there was a significant relationship between the appropriateness of the use of empirical and definitive antibiotics on the outcome of 'cured' therapy in surgical patients (p=0.005). Based on the results of the study, it is advisable to take steps to improve the use of antibiotics so that the use of antibiotics can be wiser and the outcome of therapy in surgical patients with infections can be more optimal in the future.