Pemakaian antibiotika pra bedah pada fraktur terbuka
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Transcript of Pemakaian antibiotika pra bedah pada fraktur terbuka
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PEMAKAIAN ANTIBIOTIKA PEMAKAIAN ANTIBIOTIKA PRA BEDAH PADA PRA BEDAH PADA
FRAKTUR TERBUKAFRAKTUR TERBUKAOlehOleh
Dr.Azharuddin,SpBO-K.Spine FICSDr.Azharuddin,SpBO-K.Spine FICS
Divisi Bedah Orthopaedi FK UNSYIAH/BPK-Divisi Bedah Orthopaedi FK UNSYIAH/BPK-RSUZA Banda AcehRSUZA Banda Aceh
20042004
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Fr terbuka+plating 6 minggu post opFr terbuka+plating 6 minggu post op
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PendahuluanPendahuluan ““AB” Profilaksis pada fraktur terbuka; infeksi.AB” Profilaksis pada fraktur terbuka; infeksi.
Dasar Pemilihan Jenis“AB” ?Dasar Pemilihan Jenis“AB” ? -Kemungkinan kuman patogen yang spesifik.-Kemungkinan kuman patogen yang spesifik. Fraktur terbuka, kuman>> staphylococcusFraktur terbuka, kuman>> staphylococcus ““AB”Ideal pada fr terbuka? AB”Ideal pada fr terbuka? CEFAZOLINCEFAZOLIN
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ALTERNATIF “AB”PROFILAKSISALTERNATIF “AB”PROFILAKSIS ERYTROMYCIN & VANCOMYCIN HCLERYTROMYCIN & VANCOMYCIN HCL
KOMBINASI BENZYL PENICILLIN-KOMBINASI BENZYL PENICILLIN-FLUCOXACILLINFLUCOXACILLIN
LUKA SANGAT KOTOR: KOMBINASIKAN DGNLUKA SANGAT KOTOR: KOMBINASIKAN DGN *GENTAMYCIN &*GENTAMYCIN & *METRONIDAZOLE*METRONIDAZOLE (UTK KUMAN GRAM(-)&ANAEROB)(UTK KUMAN GRAM(-)&ANAEROB)
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CARA PEMBERIAN “AB” CARA PEMBERIAN “AB” PROFILAKSISPROFILAKSIS
SATU KALI PRE OPERASISATU KALI PRE OPERASIDOSIS TINGGIDOSIS TINGGISETENGAH JAM PRE OPERASISETENGAH JAM PRE OPERASI INTRAVENOUSINTRAVENOUS
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PRINSIP PENANGANAN PRINSIP PENANGANAN FRAKTUR TERBUKAFRAKTUR TERBUKA
ASUMSIKAN SEMUA “GRADING” FR ASUMSIKAN SEMUA “GRADING” FR TERBUKA------TERKONTAMINASITERBUKA------TERKONTAMINASI
CEGAH PASIEN MENJADI “INFECTED”CEGAH PASIEN MENJADI “INFECTED” CARA:CARA: 1.WOUND DEBRIDEMENT1.WOUND DEBRIDEMENT 2.”AB” PROFILAXIS2.”AB” PROFILAXIS 3.STABILIZATION OF THE FRACTURE3.STABILIZATION OF THE FRACTURE 4.EARLY WOUND COVER4.EARLY WOUND COVER
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MIP0MIP0
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INSIDEN INFEKSI FR TERBUKA INSIDEN INFEKSI FR TERBUKA ??
KORELASI DENGAN KORELASI DENGAN EXTENT OF SOFT EXTENT OF SOFT TISSUE DAMAGETISSUE DAMAGE
GRADE GRADE II : < : < 1 %1 %GRADE GRADE III : > 10 % III : > 10 %
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KONSEP UMUM INFEKSI KONSEP UMUM INFEKSI MUSKULOSKELETALMUSKULOSKELETAL
GAMBARAN KLINIS?? ------BERVARIASI, GAMBARAN KLINIS?? ------BERVARIASI, TERGANTUNG:TERGANTUNG:
TYPE INFEKSI(ST,BONE,JOINT)TYPE INFEKSI(ST,BONE,JOINT) LOKASI INFEKSILOKASI INFEKSI KUMAN PENYEBAB INFEKSIKUMAN PENYEBAB INFEKSI DELAYED IN DIAGNOSISDELAYED IN DIAGNOSIS DELAYED DELAYED DLM MEMBERIKAN “AB”DLM MEMBERIKAN “AB” HOST FACTORHOST FACTOR
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HAL-HAL YANG PERLU HAL-HAL YANG PERLU DIKETAHUIDIKETAHUI
RIWAYAT TRAUMARIWAYAT TRAUMAKONTAMINASIKONTAMINASIRIWAYAT PENYAKIT LAIN RIWAYAT PENYAKIT LAIN FOTO POLOSFOTO POLOSKULTUR DAN SENSITIVITY TESKULTUR DAN SENSITIVITY TESKULTUR DARAHKULTUR DARAH
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PENGGUNAAN “AB” RASIONAL PENGGUNAAN “AB” RASIONAL PD OPERASIPD OPERASI
INFEKSI PASKA OPERASI → NOSOKOMIAL??INFEKSI PASKA OPERASI → NOSOKOMIAL?? DAMPAK TERHADAP PX:DAMPAK TERHADAP PX: * LAMA OPNAME?* LAMA OPNAME? * * COSTLYCOSTLY * * MENYUSAHKAN PX & KEL.MENYUSAHKAN PX & KEL.
KAMAR OPERASI IDEAL ??KAMAR OPERASI IDEAL ??
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TABEL “AB” PROFILAKSIS KASUS TABEL “AB” PROFILAKSIS KASUS KASUS BEDAHKASUS BEDAH
Surgical procedure Surgical procedure predominant inf microorganismpredominant inf microorganism recommened agent recommened agent dose dose routeroute
___________________________________________________________________________________ ___________________________________________________________________________________ CARDIO THORACIC CARDIO THORACIC Staphylococci CEFAZOLIN 1-2 g Staphylococci CEFAZOLIN 1-2 g iviv
or CEFUROXIME 1,5 g ivor CEFUROXIME 1,5 g iv or VANCOMYCIN or VANCOMYCIN ____________________________________________________________________________________________________________________________________________________________________Non-cardiac Non-cardiac Staphylococci CEFAZOLIN or 1-2 g iv Staphylococci CEFAZOLIN or 1-2 g ivVascular Surgery Vascular Surgery CEFUROXIME 1,5 g iv CEFUROXIME 1,5 g iv______________________________________________________________________________________________________________________________________________________________________ARTHTROPLASTY OF Staphylococci CEFAZOLIN ARTHTROPLASTY OF Staphylococci CEFAZOLIN
1-2 g IV 1-2 g IV JOINT REPLACEMENTJOINT REPLACEMENT
OPEN REDUCTIONOPEN REDUCTIONOF FRACTURESOF FRACTURES
LOWER LIMB AMPUTATIONLOWER LIMB AMPUTATION______________________________________________________________________________________________________________________________________________________________________
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Gastro duodenal Streptococci,Coliforms, CEFAZOLIN 1-2 g Gastro duodenal Streptococci,Coliforms, CEFAZOLIN 1-2 g iv iv
anaerobic bacteria incl.anaerobic bacteria incl. Bacteroides spp Bacteroides spp ________________________________________________________________________________________________________________________________BILIARY TRACT BILIARY TRACT Coli form, enterococci, CEFAZOLIN 2 g Coli form, enterococci, CEFAZOLIN 2 g
ivivFor high risk only anaerobic bact incl. CEFOXITIN 2 g For high risk only anaerobic bact incl. CEFOXITIN 2 g
iviv: > 70 years Bacteroides,clostridia: > 70 years Bacteroides,clostridiaObstr joundiceObstr joundiceAcute cholecystit isAcute cholecystit isAcute cholangitisAcute cholangitisCommon duct stoneCommon duct stoneLow risk…… NO PROPHYLAXISLow risk…… NO PROPHYLAXIS________________________________________________________________________________________________________________________________
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Colon/small bowel Colon/small bowel coliforms,anaerobic CEFOXITIN 2 g iv coliforms,anaerobic CEFOXITIN 2 g iv bacteria incl.bacteroibacteria incl.bacteroi des fragilis des fragilis ____________________________________________________________________________________________________________________APPENDECTOMYAPPENDECTOMY Coliforms,anaerobic CEFOXITIN 2 g iv Coliforms,anaerobic CEFOXITIN 2 g iv bacteria incl.bacteroibacteria incl.bacteroi des fragilisdes fragilis____________________________________________________________________________________________________________________PENETRATING PENETRATING idem CEFOXITIN 2 g iv idem CEFOXITIN 2 g ivABD TRAUMAABD TRAUMA____________________________________________________________________________________________________________________
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VAGINALor abdominalVAGINALor abdominal Coliformes,enterococciCEFAZOLIN 1-2 g Coliformes,enterococciCEFAZOLIN 1-2 g iviv
Hysterectomy Hysterectomy group B streptococci group B streptococci____________________________________________________________________________________________________________________Caesarian secti ionCaesarian secti ion with as for hysterectomy CEFAZOLIN 1 g with as for hysterectomy CEFAZOLIN 1 g
ivivHigh risk e.g prematureHigh risk e.g prematureRupture of membranes CEFOXITIN 2 g ivRupture of membranes CEFOXITIN 2 g iv
Low risk_elective NO PROPHYLAXISLow risk_elective NO PROPHYLAXIS____________________________________________________________________________________________________________________ABORTION ABORTION as for hysterectomy CEFAZOLIN 1 g iv as for hysterectomy CEFAZOLIN 1 g iv____________________________________________________________________________________________________________________PROSTATECTOMY PROSTATECTOMY Coliforms CIPROFLOXACIN 500mg Coliforms CIPROFLOXACIN 500mg
oraloral____________________________________________________________________________________________________________________CNS Shunt CNS Shunt Staphylococci CEFAZOLIN 1 g Staphylococci CEFAZOLIN 1 g
iviv__________________________________________________________ __________________________________________________________
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““AB” DI BIDANG AB” DI BIDANG MUSKULOSKELETALMUSKULOSKELETAL
IDEAL: SETELAH ADA HASIL KULTURIDEAL: SETELAH ADA HASIL KULTUR
LIFE OR LIMB THREATENING AB: LIFE OR LIMB THREATENING AB: SEGERA, SEGERA, BROAD SPECTRUMBROAD SPECTRUM
PROFILAK >< TERAPEUTIK ??PROFILAK >< TERAPEUTIK ??
““AB” LOKAL , TOPIKAL ??AB” LOKAL , TOPIKAL ??
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GUIDE LINE AB PROFILAXIS GUIDE LINE AB PROFILAXIS ORTHO DI INDONESIA?ORTHO DI INDONESIA?
DATA (-)DATA (-)
ORTHO FK UNAIR/RS SUTOMO:ORTHO FK UNAIR/RS SUTOMO:
* GRADE I: CEFALOSPORIN I, 2 Gr* GRADE I: CEFALOSPORIN I, 2 Gr pre op, lanjut 3 x 1-2 gr selama 1 hari.pre op, lanjut 3 x 1-2 gr selama 1 hari.* GRADE II: CEFALOSPORIN I, 2gr* GRADE II: CEFALOSPORIN I, 2gr Pre op, lanjut 3 x 1-2 gr selama 2 hari.Pre op, lanjut 3 x 1-2 gr selama 2 hari.* GRADE III: CEFALOSPORIN I, 2 gr pre op, lanjut 3 x 1-2 * GRADE III: CEFALOSPORIN I, 2 gr pre op, lanjut 3 x 1-2
gr selama 3 hari &gentamycin 2 x 80 mg, 3 hari.gr selama 3 hari &gentamycin 2 x 80 mg, 3 hari.
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KESIMPULANKESIMPULAN DIAGNOSIS PRE OP—PENTINGDIAGNOSIS PRE OP—PENTING PILIH PILIH ABAB ~ PETA KUMAN SECARA EMPIRIS ~ PETA KUMAN SECARA EMPIRIS WAKTU OP:WAKTU OP:GOLDEN PERIODE ?GOLDEN PERIODE ? IDEAL, CEFALOSPORIN I, BILA INFEKSI IDEAL, CEFALOSPORIN I, BILA INFEKSI
MANIFEST; CEF II, III dan GentamycinMANIFEST; CEF II, III dan Gentamycin IDEAL: ~ HASIL KULTUR & S TESIDEAL: ~ HASIL KULTUR & S TES
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CEGAH INFEKSI NOSOKOMIAL !!CEGAH INFEKSI NOSOKOMIAL !!AB AB BUKAN SATU-SATUNYA FAKTOR BUKAN SATU-SATUNYA FAKTOR
YG BISA CEGAH INFEKSI.YG BISA CEGAH INFEKSI.PERHATIKAN HAL-HAL LAIN YG ERAT PERHATIKAN HAL-HAL LAIN YG ERAT
KAITAN TERHADAP KEJADIAN KAITAN TERHADAP KEJADIAN INFEKSI.INFEKSI.
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Thank u doctor , i`m oke !!Thank u doctor , i`m oke !!
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TERIMA KASIHTERIMA KASIH….….