Penggunaan Sefepim Untuk Demam Neutropenia Pada AML di RSUP Dr. Kariadi Semarang
DOI:
https://doi.org/10.36408/mhjcm.v7i1.423Keywords:
demam neutropenia, leukemia myeloid akut, sefepimAbstract
Latar belakang: Demam neutropenia merupakan salah satu efek samping kemoterapi yang paling serius, karena adanya infeksi dapat berkembang dengan cepat dan dapat mengancam jiwa. Antibiotik yang diindikasikan untuk profilaksis pada pasien demam neutropenia diantaranya adalah sefepim. Penelitian ini bertujuan untuk mengetahui durasi kebutuhan sefepim terhadap perbedaan rejimen kemoterapi AML, serta luaran terapinya di RSUP Dr. Kariadi, Semarang.
Metode: Penelitian ini menggunakan rancangan deskriptif dengan pengambilan data secara restrospektif dari bulan Juni 2018 hingga April 2019 di satu ruangan rawat inap RSUP Dr. Kariadi, Semarang. Kriteria inklusi adalah pasien usia 18-64 tahun dengan diagnosa AML yang mengalami demam neutropenia dengan riwayat pernah menjalani kemoterapi, mendapatkan terapi antibiotik sefepim. Kriteria eklusi dalam penelitian ini yaitu pasien yang alergi terhadap sefepim, yang tidak melanjutkan pengobatannya, dengan program cangkok sumsum tulang dan dengan adanya diagnosa sepsis/septik syok sebelum diberikannya sefepim.
Hasil: Total sebanyak 15 pasien memenuhi kriteria inklusi. Durasi pemberian sefepim yang paling banyak adalah kelompok dengan pemberian 8-14 hari (46,7%), selanjutnya ?7 hari (33,3%), sedangkan pemberian selama >14 hari tidak ditemukan. Pasien yang meninggal pada penelitian ini sebanyak 3 pasien (20%), dengan 2 pasien diantaranya teridentifikasi mengalami sepsis karena sefepim yang resisten akibat patogen ESBL E. coli, sedangkan satu lainnya tidak diketahui patogen penyebabnya.
Kesimpulan: Pasien dengan rejimen intensif rata-rata memerlukan durasi terapi yang lebih lama. Munculnya patogen ESBL khususnya E. coli mempunyai luaran yang jelek dan angka kematian yang lebih tinggi, sehingga kita sarankan untuk menggunakan karbapenem daripada sefepim untuk kondisi ini.
Kata kunci: Demam neutropenia, leukemia myeloid akut, sefepim
Backgound: Febrile neutropenia is one of the most serious side effects of chemotherapy, because the infection can develop rapidly which can be life-threatening. Cefepime is drug of choice that indicated for prophylaxis in patients with febrile neutropenia. The aim of this study was to determine the duration of the cefepime needs of differences in AML chemotherapy regimens, and the outcomes in Dr. Kariadi General Hospital Center, Semarang.
Method: The study used descriptive design with retrospective data collection from June 2018 to April 2019 in an inpatient room at Dr. Kariadi General Hospital Center, Semarang. The inclusion criteria are patients aged 18-64 years old with diagnosis of AML who has febrile neutropenia with a history of having undergone chemotherapy with cefepime prophylaxis. The exclusion criteria in this study were allergy to cefepime, patients who did not continue their treatment, bone marrow transplant programs and diagnosis of sepsis / septic shock before the administration of cefepime.
Result: A total of 15 patients met the inclusion criteria. The most duration of cefepime was in the group with 8-14 days (46,7%), then ?7 days (33,3%), whereas> 14 days were not found. The patients who died in this study were 3 patients (20%), with 2 patients identified as having sepsis due to the pathogen ESBL E. coli cefepime resistant, while the other one did not know the causative pathogen.
Conclusion: Patients with an intensive regimen require a longer duration therapy. The emergence of ESBL pathogens especially E. coli has poor outcomes and a higher mortality rate, so we recommend using carbapenem rather than cefepime for this condition.
Keywords: Febrile neutropenia, acute myeloid leukemia, cefepime
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