Penilaian Akurasi Italian Score sebagai Prediktor Infeksi Extended-Spectrum Beta Lactamase (Esbl)

Abstract

Extended-spectrum ß-lactamases (ESBLs) are one of Multi Drugs Resistant (MDR) bacteria that produce β-laktamase enzymes that inactivate beta-lactam class of antibiotics such as penicillins and cephalosporins. Mortality due to ESBL infections is two times higher than non-ESBL bacteria infection. It takes a predictor of the presence of ESBL infection that can assist clinicians in providing empirical antibiotics. One of these predictors is based scoring system ESBL infection risk factors known as Italian score. This study aims to assess the accuracy of the Italian Score as a predictor of ESBL infection. Cross-sectional study was conducted from January - August 2014 in RSUP H Adam Malik Medan, in patients with infections. Italian Score was calculated and bacterial cultures were taken from the source of infection. By using a cut off point of ≥7, Italian Score sensitivity of 95.7% was obtained, specificity of 89.1%, positive predictive value of 89.8% and negative predictive value of 95.3%. From the analysis using ROC curves, the Italian Score accuracy was 97,1% (95% CI: 94.3 to 99.9%, p = 0.0001). Antibiotics that can be used against ESBL infections only amikacin, imipenem, ertapenem, meropenem and tigeciclin. Conclusion: Italian Score can be used as predictors of the presence of ESBL infection.

Bakteri Extended-Spectrum β-Lactamase (ESBL) merupakan salah satu bakteri Multi Drugs Resisten (MDR) yang menghasilkan enzim β-laktamase sehingga menginaktivasi antibiotik golongan betalaktam seperti penisilin dan sefalosporin. Angka kematian akibat infeksi ESBL 2 kali lebih tinggi dibandingkan dengan infeksi bakteri non-ESBL. Diperlukan suatu prediktor adanya infeksi ESBL sehingga dapat membantu klinisi dalam memberikan antibiotik empirik. Salah satu prediktor tersebut adalah sistem scoring berbasis faktor resiko infeksi ESBL yang dikenal dengan Italian score. Penelitian ini bertujuan untuk menilai akurasi Italian Score sebagai prediktor infeksi ESBL. Penelitian cross sectional dilakukan mulai Januari 2014- Agustus 2014 di Rumah di RSUP H Adam Malik Medan pada pasien infeksi. Dihitung Italian Score dan dilakukan kultur bakteri dari sumber infeksinya. Dengan menggunakan cut off skor ≥7 didapatkan sensitivitas Italian Score 95,7%, spesifisitas 89,1%, nilai prediksi positif 89,8% dan nilai prediksi negatif 95,3%. Dari hasil analisis menggunakan kurva ROC diperoleh akurasi Italian Score adalah 97,1% (95%CI : 94,3-99,9%, p=0,0001). Antibiotik yang dapat digunakan untuk melawan infeksi ESBL hanyalah amikasin, imipenem, ertapenem, meropenem dan tigecicline. Kesimpulan: Italian Score dapat digunakan sebagai prediktor adanya infeksi ESBL.