kasus serious bacterial infection
DESCRIPTION
Antibiotic Usage in Children. Kasus Serious Bacterial Infection. Unit Kerja Koordinasi Infeksi Penyakit Tropis. Identitas & Anamnesa. HARI PERTAMA perawatan / Hari sakit ke 9. Anak laki-laki 15 bulan,BB : 11 kg Suhu : 40 .8 C detak jantung : 1 40 x/m Kiriman RS luar Smg - PowerPoint PPT PresentationTRANSCRIPT
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Kasus Serious Bacterial Infection
Unit Kerja Koordinasi Infeksi Penyakit Tropis
Antibiotic Usage in Children
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Anak laki-laki 15 bulan,BB: 11 kg
Suhu : 40.8 Cdetak jantung : 140 x/mKiriman RS luar Smg( susp sepsis,DADS)
Kel Ut : demam,diareRPS : 9 hari demam tinggi terus menerusdisertai dengan berak cair,kuning, frek 5x/hrdarah(-), lendir(-) muntah (-),batuk(-),pilek(-).
BAK : lancar, tidak sakit ,kuning, jernih
Pemeriksaan Fisik :Keadaan umum sakit sedang
sadar, lemahKepala : UUB datar, mata pupil
Isokor, R cahaya +/+Dada: retraksi(-) dan Ronkhi basah halus(-)Perut : datar, H/L ttb
Ekstremitas: Refl pat (-). Refl Fisiologis N.
HARI PERTAMA perawatan /Hari sakit ke 9
Riwayat diterapi dengan seftriakson 9 hari
Identitas &Anamnesa
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Riwayat Penyakit Dahulu / Imunisasi dll
• RPD :– Sering sakit batuk-pilek– Pernah diare umur 7
bulan
• Riwayat Imunisasi :– Imunisasi dasar lengkap– Imunisasi ulangan belum
saatnya
• Riwayat Penyakit Keluarga :– Riwayat sakit batuk lama
pada keluarga disangkal– Riwayat alergi pada
keluarga disangkal– Ayah perokok
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PEMERIKSAAN LAB (hari Perwt 1,demam ke PEMERIKSAAN LAB (hari Perwt 1,demam ke 9)9)
Hemoglobin Hemoglobin : 11.6 g/dL: 11.6 g/dL ( 11-15 )HematokritHematokrit : 33 % ( 32-46): 33 % ( 32-46)LekositLekosit : 1: 188.300 /uL ( 6-17).300 /uL ( 6-17)TrombositTrombosit : 353.000/uL (150-400): 353.000/uL (150-400)Hitung JenisHitung Jenis : E 0, B 0, : E 0, B 0, N 66N 66, L 24 M 10, L 24 M 10LEDLED : : 1 jam 14 1 jam 14 ( 3-10)( 3-10)
2 jam 33 2 jam 33 ( 7-20)( 7-20)ElektrolitElektrolit : : Na : 135. K : 4.0. Na : 135. K : 4.0. Feses Feses : amoeba (-), lekosit :2, eritrosit: 0: amoeba (-), lekosit :2, eritrosit: 0 UrinUrin : : Lekosit (-).Eritrosit (-)Lekosit (-).Eritrosit (-)
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Apa Diagnosis Kerjadan
Tatalaksana
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• Diagnosis Kerja :– SIRS curiga SEPSIS– Diare “ akut ” tanpa dehidrasi
• Tatalaksana :– Infus Kaen 3 B 1200/50/12 tts/m– Injeksi Seftazidim 300 mg setiap 8 jam– Po : - Zn So4 + oralit - Parasetamol 1 sendok obat setiap demam > 38 ( tiap
4 jam )Program : Kultur darah, urin dan feses
Konsul THT ( cari fokal infeksi) Periksa serologi Tifoid( Ig M Salmonella) dan
Leptospira ( Lepto Dry Dot )
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Sepsis
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Hari ke 4 Perawatan(demam ke 12 )
• Anak masih demam, makan minum masih sulit, tidak dehidrasi, berak masih cair.
• THT : tak ada kelainan; Lepto (-), Ig M Salm (-)• Kultur Urine : steril• Lab Hasil Kultur feses : ( hari ke 4)
– Kuman : Klebsiela pneumonia ??? ( EPEC - )– Resisten : Tetracyclin– Sensitif : Amikacine, Cefepim Ceftazidim, Meropenem
Cefotaksim.
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Flora Normal
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PEMERIKSAAN LAB (hari Perwt 5,demam ke 13)PEMERIKSAAN LAB (hari Perwt 5,demam ke 13)Anak masih demam dan diareAnak masih demam dan diare
Hemoglobin Hemoglobin : 12.6 g/dL: 12.6 g/dL ( 11-15 )HematokritHematokrit : 36 % ( 32-46): 36 % ( 32-46)LekositLekosit : : 220.300 /uL 0.300 /uL ( 6-17)( 6-17)TrombositTrombosit : 422.000/uL (150-400): 422.000/uL (150-400)
Hitung JenisHitung Jenis : E 5, B 0, N 32, L 51 M 11: E 5, B 0, N 32, L 51 M 11
Kultur Darah : Strep.pneumonia Resisten : Kloramfeniko, Vankomisin, Sefotaxim Sensitif : Seftazidim, Meropenem
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www.themegallery.comPediatrics Vol 117. May 2006
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Kultur Darah (2009)
13
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Diagnosis dan Tatalaksana serta Program ??Mengingat : - Hasil kultur darah - Masih demam dan sulit makan minum hari ke 13
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Diagnosis
• Sepsis• Diare Persisten• Terapi ( Antibiotik ?????)• Program dilakukan1.LP ( karena demam sudah melebihi 10 hari,
belum menunjukkan perbaikan )2.Rontgen Foto Thoraks
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Kategori evaluasi penggunaan antibiotik( Kualitas ) (Gyssens)
I. Penggunaan TEPATII.Tidak tepat oleh karena:
A. tidak tepat dosis B. tidak tepat interval C. tidak tepat cara pemberian.
III.Tidak tepat waktu oleh karena: A. terlalu lama ; B. terlalu singkat
IV.Tidak tepat oleh karena:A. ada obat lain yang lebih effektifB. ada obat lain kurang toksikC. ada obat lain lebih murahD. ada obat lain lebih spesifik
V. Tidak ada INDIKASIVI.Rekam medik tidak lengkap untuk dievaluasi
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Patient Management Recommendations:
• What are the indications for a chest radiograph during the workup of pediatric fever?– Level B recommendations. A chest radiograph should
be obtained in febrile children aged younger than 3 months with evidence of acute respiratory illness.
– Level C recommendations. There is insufficient evidence to determine when a chest radiograph is required in a febrile child aged older than 3 months. Consider a chest radiograph in children older than 3 months with a temperature greater than 39°C (>102.2°F) and a WBC count greater than 20,000/mm3.
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Hasil Pemeriksaan Hari ke 11 perawatan ( hari sakit ke 19)
• Hasil LCS , Warna : agak keruh• Lekosit PMN : 75, Lekosit MN : 2 • Protein : 45( 15-45 ),Glukosa:61(32-82)• Nonne (-) dan Pandy ( 8 % ) : (+)• Pengecatan : Strepccocus (+)• Kultur LCS : Strep.pneumonia dengan :• Resisten : Ampisilin,Erythromisin,Gentamisin.• Sensitif : • Sefotaksim, Ampisilin
Sulbactam, Meropenem , Piperasillin- Tazobactam.
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Diagnosis dan Tatalaksana ???
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Diagnosis dan Tatalaksana
• Diare Persisten• Invasive Pneumoccal Disease ( Sepsis / Meningitis )Tata laksana :Meningitis dosis ditingkatkan dan lama
pemberian 2 minggu.Pilihan Meropenem 40 mg/kgBB/8 jam 400 mg setiap 4 jam.
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40
39
38
37
36
L : 18.300
L : 20.300
Kultur Feses : Kleb.pneumonia
Kultur Darah : Strep.pneumonia
Kultur LCS : Strep.pneumonia
Ceftazidim Meropenem
Perjalanan Penyakit :
L : 17.500 L : 10.000
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Resume : Diagnosis-Tatalaksana