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March 01, 2013 07:00

Staphylococcus aureus merupakan salah satu bakteri penyebab infeksi kulit dan jaringan lunak pada anak dan dewasa. Infeksi ini awalnya dapat diterapi dengan pemberian antibiotik golongan beta-lactam, namun kemudian terjadi resistensi sehingga muncul methicillin resistant Staphylococcus aureus (MRSA).

 

Sebelum terjadi pergeseran infeksi, antibiotik golongan beta-lactam diberikan pada pasien yang dicurigai menderita infeksi Staphylococcus aureus. Dengan adanya MRSA, antibiotik yang diberikan ditargetkan pada methicillin susceptible Staphylococcus aureus (MSSA) dan MRSA pada pasien yang dicurigai mengalami infeksi Staphylococcus aureus. Contoh antibiotiknya adalah vancomycin, clindamycin, trimethoprim/ sulfamethoxazole, dan linezolid.

 

Studi retrospektif di 25 rumah sakit anak di US pada anak dengan infeksi Staphylococcus aureus dilakukan oleh Herigon dan rekan-rekan untuk mengetahui tren antibiotik yang digunakan untuk penatalaksanaan infeksi ini.

 

Hasilnya adalah sebagai berikut:

• Sejumlah 64.813 pasien didiagnosis terinfeksi Staphylococcus aureus.

• Insidens infeksi oleh MRSA meningkat 10 kali lipat dari 2 menjadi 21 kasus per 1.000 rawat inap, sementara angka terjadinya infeksi oleh MSSA masih stabil.

• Antibiotik yang diberikan untuk infeksi MRSA meningkat dari 52% menjadi 79% kasus, sementara untuk infeksi MSSA menurun dari 66% menjadi <30%.

• Terdapat peningkatan penggunaan clindamycin yaitu dari 21% pada tahun 1999 63% pada tahun 2008.

Dari studi di atas, dapat disimpulkan bahwa clindamycin merupakan antibiotik yang sekarang paling sering diberikan untuk pengobatan infeksi Staphylococcus pada anak-anak yang dirawat di rumah sakit.

 

Untuk membandingkan efektivitas clindamycin, trimethoprim/sulfamethoxazole, dan beta-lactam pada infeksi kulit dan jaringan lunak anak, dilakukan studi cohort pada anak usia 0-17 tahun. Outcome yang dinilai adalah kegagalan terapi (dalam waktu 14 hari) dan rekurensi (antara 15 dan 365 hari setelah infeksi kulit dan jaringan lunak). Kesimpulan dari studi ini adalah dibandingkan dengan clindamycin, pemberian trimethoprim-sulfamethoxazole atau beta-lactam berkaitan dengan meningkatnya risiko kegagalan terapi dan rekurensi. Kaitan ini akan lebih kuat pada pasien anak yang tidak dilakukan prosedur drainase.

 

Dua informasi di atas menunjukkan bahwa kejadian infeksi yang disebabkan Staphylococcus aureus terutama MRSA meningkat di US dan tren antibiotik yang sering digunakan di US adalah clindamycin. Pemberian trimethoprim-sulfamethoxazole dan beta-lactam berkaitan dengan meningkatnya risiko kegagalan terapi dan rekurensi pada infeksi kulit dan jaringan lunak anak dibandingkan dengan clindamycin.

 

 

 

Reference:

1. Herigon JC, Hersch AL, Gerber JS, Zaoutis TE, Newland JG. Antibiotic management of Staphylococcus aureus infections in US children’s hospitals, 1999-2008. Pediatrics 2010;125:e1294-300.

2. Williams DJ, Cooper W, Kaltenbach LA, Dudley JA, Kirschke DL, Jones TF, et al. Comparative effectiveness of antibiotic treatment strategies for pediatric skin and soft tissue infections. Pediatrics 2011;128:e479-87.

 

Image: Illustration

Posted in: Doctor News

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