PENGGUNAAN MEROPENEM PADA PASIEN RAWAT INAP: RASIONALITAS BERDASARKAN METODE GYSSENS DAN BIAYA MEDIS LANGSUNG
DOI:
https://doi.org/10.36423/pharmacoscript.v9i2.2886Keywords:
Meropenem, Gyssens, Rasionalitas Penggunaan Antibiotik, Biaya Medis Langsung, Evaluasi Penggunaan AntibiotikAbstract
Penggunaan meropenem sebagai antibiotik golongan karbapenem perlu dilakukan secara rasional untuk menekan resistensi antimikroba dan mengoptimalkan penggunaan antibiotik di rumah sakit. Namun, bukti mengenai ketepatan penggunaan meropenem serta hubungannya dengan biaya medis langsung pada pasien yang menjalani perawatan inap masih terbatas. Penelitian ini bertujuan mengevaluasi rasionalitas penggunaan meropenem menggunakan metode Gyssens serta menganalisis hubungannya dengan biaya medis langsung. Penelitian observasional analitik dengan desain retrospektif melibatkan 297 pasien dewasa dengan berbagai diagnosis klinis yang mendapatkan terapi meropenem selama menjalani perawatan di rumah sakit. Rasionalitas penggunaan antibiotik dievaluasi menggunakan metode Gyssens, sedangkan biaya medis langsung dihitung dari perspektif rumah sakit. Perbedaan biaya antara kelompok rasional dan tidak rasional dianalisis menggunakan uji Mann–Whitney, sedangkan faktor-faktor yang berkaitan dengan total biaya medis langsung dianalisis menggunakan regresi linear multivariat. Hasil penelitian menunjukkan bahwa 226 pasien (76,1%) menerima terapi meropenem secara rasional, sedangkan 71 pasien (23,9%) tergolong tidak rasional, terutama akibat ketidaktepatan pemilihan antibiotik, durasi terapi yang melebihi rekomendasi, dan ketidaktepatan dosis. Pada analisis bivariat, kelompok rasional memiliki median biaya antibiotik yang lebih rendah (Rp378.000 [IQR:331.154] vs Rp590.292 [IQR:615.390]), tetapi median total biaya medis langsung lebih tinggi (Rp12.719.782 [IQR:20.364.548] vs Rp8.608.013 [IQR:13.705.190]). Namun, setelah penyesuaian terhadap faktor perancu, rasionalitas penggunaan meropenem tidak berhubungan secara independen dengan total biaya medis langsung (p=0,446). Penggunaan meropenem yang rasional berkaitan dengan biaya antibiotik yang lebih rendah, tetapi tidak berhubungan secara independen dengan total biaya medis langsung, yang lebih dipengaruhi oleh tingkat keparahan penyakit, kebutuhan tindakan medis, dan kompleksitas pelayanan.
References
Aiesh, B. M., Nazzal, M. A., Abdelhaq, A. I., Abutaha, S. A., Zyoud, S. H., & Sabateen, A. (2023). Impact of an antibiotic stewardship program on antibiotic utilization, bacterial susceptibilities, and cost of antibiotics. Scientific Reports, 13(1). https://doi.org/10.1038/s41598-023-32329-6
Allel, K., Hernández-Leal, M. J., Naylor, N. R., Undurraga, E. A., Abou Jaoude, G. J., Bhandari, P., Flanagan, E., Haghparast-Bidgoli, H., Pouwels, K. B., & Yakob, L. (2024). Costs-effectiveness and cost components of pharmaceutical and non-pharmaceutical interventions affecting antibiotic resistance outcomes in hospital patients: a systematic literature review. BMJ Global Health, 9(2). https://doi.org/10.1136/bmjgh-2023-013205
Barlam, T. F., Cosgrove, S. E., Abbo, L. M., Macdougall, C., Schuetz, A. N., Septimus, E. J., Srinivasan, A., Dellit, T. H., Falck-Ytter, Y. T., Fishman, N. O., Hamilton, C. W., Jenkins, T. C., Lipsett, P. A., Malani, P. N., May, L. S., Moran, G. J., Neuhauser, M. M., Newland, J. G., Ohl, C. A., … Trivedi, K. K. (2016). Implementing an antibiotic stewardship program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. In Clinical Infectious Diseases (Vol. 62, Number 10, pp. e51–e77). Oxford University Press. https://doi.org/10.1093/cid/ciw118
Cortegiani, A., Antonelli, M., Falcone, M., Giarratano, A., Girardis, M., Leone, M., Pea, F., Stefani, S., Viaggi, B., & Viale, P. (2023). Rationale and clinical application of antimicrobial stewardship principles in the intensive care unit: a multidisciplinary statement. Journal of Anesthesia, Analgesia and Critical Care, 3(1). https://doi.org/10.1186/s44158-023-00095-6
D’Onofrio, V., Meersman, A., Magerman, K., Waumans, L., van Halem, K., Cox, J. A., van der Hilst, J. C., Cartuyvels, R., Messiaen, P., & Gyssens, I. C. (2021). Audit of empirical antibiotic therapy for sepsis and the impact of early multidisciplinary consultation on patient outcomes. International Journal of Antimicrobial Agents, 58(3). https://doi.org/10.1016/j.ijantimicag.2021.106379
Dziegielewski, C., Talarico, R., Imsirovic, H., Qureshi, D., Choudhri, Y., Tanuseputro, P., Thompson, L. H., & Kyeremanteng, K. (2021). Characteristics and resource utilization of high-cost users in the intensive care unit: a population-based cohort study. BMC Health Services Research, 21(1). https://doi.org/10.1186/s12913-021-07318-y
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Wiersinga, W. J., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., … Levy, M. (2021). Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Medicine, 47(11), 1181–1247. https://doi.org/10.1007/s00134-021-06506-y
Formularium Rumah Sakit. (2025). Formularium Rumah Sakit Edisi XIII Tahun 2025. www.rsud.tasikmalayakota.go.id
Gyssens IC, VAN DEN BROEK, P. J., KULLBERG, B.-J., HEKSTER, Y. A., & VAN DER MEER, J. W. M. (1992). Optimizing antimicrobial therapy. A method for antimicrobial drug me evaluation. Journal of Antimicrobial Chemotherapy, 30(5), 724–727. https://doi.org/10.1093/jac/30.5.724
Hibbard, R., Mendelson, M., Page, S. W., Ferreira, J. P., Pulcini, C., Paul, M. C., & Faverjon, C. (2024). Antimicrobial stewardship: a definition with a One Health perspective. Npj Antimicrobials and Resistance, 2(1). https://doi.org/10.1038/s44259-024-00031-w
Karizki, M. R., Puspitasari, I., & Asdie, R. H. (2021). Rasionalitas Penggunaan Antibiotik Empirik dan Definitif pada Pasien Sepsis di Intensive Care Unit RSUP. Dr. Sardjito. Majalah Farmaseutik, 17(3). https://doi.org/10.22146/farmaseutik.v1i1.62045
Kementerian Kesehatan Republik Indonesia. (2015). Peraturan Mentri Kesehatan Republik Indonesia Nomor 8 Tahun 2015 Tentang Program Pengendalian Resistensi Antimikroba di Rumah Sakit.
Kementerian Kesehatan Republik Indonesia. (2021). Peraturan Menteri Kesehatan Republik Indonesia Nomor 28 Tahun 2021 Tentang Pedoman Penggunaan Antibiotik.
Kementerian Kesehatan Republik Indonesia. (2023). Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.01.07/Menkes/2147/2023 Tentang Pedoman Nasional Pelayanan Kedokteran Tata Laksana Pnemonia pada Dewasa.
Masyrifah, M., Andrajati, R., & Yudhorini, L. T. (2022). ARTICLE HISTORY Qualitative Evaluation of Antibiotics Use with Gyssens Method in Sepsis Patients at Fatmawati Central General Hospital Jakarta. In Pharmaceutical Sciences and Research (Vol. 9, Number 2). PSR.
Murray, C. J., Ikuta, K. S., Sharara, F., Swetschinski, L., Robles Aguilar, G., Gray, A., Han, C., Bisignano, C., Rao, P., Wool, E., Johnson, S. C., Browne, A. J., Chipeta, M. G., Fell, F., Hackett, S., Haines-Woodhouse, G., Kashef Hamadani, B. H., Kumaran, E. A. P., McManigal, B., … Naghavi, M. (2022). Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet, 399(10325), 629–655. https://doi.org/10.1016/S0140-6736(21)02724-0
Purnamasari, D., Yasin, N. M., & Andayani, T. M. (2025). Evaluasi Penggunaan Antibiotik Empiris pada Pasien Sepsis di Intensive Care Unit RSUD Dr. H. Abdul Moeloek Provinsi Lampung. Jurnal Surya Medika, 11(2), 103–109. https://doi.org/10.33084/jsm.v11i2.8683
Rohman, A. F., Radji, M., Rianti, A., & Rachman, A. (2023). Evaluation of the Use of Antibiotics on Therapy Results of Sepsis Patients in the Intensive Care Unit (ICU) of Fatmawati Hospital, Jakarta. Journal of Medicinal and Chemical Sciences, 7(1), 262–274. https://doi.org/10.26655/JMCHEMSCI.2024.1.25
Schuttevaer, R., Alsma, J., Brink, A., van Dijk, W., de Steenwinkel, J. E. M., Lingsma, H. F., Melles, D. C., & Schuit, S. C. E. (2019). Appropriate empirical antibiotic therapy and mortality: Conflicting data explained by residual confounding. PLoS ONE, 14(11). https://doi.org/10.1371/journal.pone.0225478
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