Pemakaian antibiotika pra bedah pada fraktur terbuka

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Pemakaian antibiotika pra bedah pada fraktur terbuka

  1. 1. PEMAKAIAN ANTIBIOTIKAPEMAKAIAN ANTIBIOTIKAPRA BEDAH PADAPRA BEDAH PADAFRAKTUR TERBUKAFRAKTUR TERBUKAOlehOlehDr.Azharuddin,SpBO-K.Spine FICSDr.Azharuddin,SpBO-K.Spine FICSDivisi Bedah Orthopaedi FK UNSYIAH/BPK-Divisi Bedah Orthopaedi FK UNSYIAH/BPK-RSUZA Banda AcehRSUZA Banda Aceh20042004
  2. 2. Fr terbuka+plating 6 minggu post opFr terbuka+plating 6 minggu post op
  3. 3. 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
  4. 4. 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)
  5. 5. CARA PEMBERIAN “AB”CARA PEMBERIAN “AB”PROFILAKSISPROFILAKSISSATU KALI PRE OPERASISATU KALI PRE OPERASIDOSIS TINGGIDOSIS TINGGISETENGAH JAM PRE OPERASISETENGAH JAM PRE OPERASIINTRAVENOUSINTRAVENOUS
  6. 6. PRINSIP PENANGANANPRINSIP PENANGANANFRAKTUR TERBUKAFRAKTUR TERBUKA ASUMSIKAN SEMUA “GRADING” FRASUMSIKAN SEMUA “GRADING” FRTERBUKA------TERKONTAMINASITERBUKA------TERKONTAMINASI CEGAH PASIEN MENJADI “INFECTED”CEGAH PASIEN MENJADI “INFECTED” CARA:CARA:1.WOUND DEBRIDEMENT1.WOUND DEBRIDEMENT2.”AB” PROFILAXIS2.”AB” PROFILAXIS3.STABILIZATION OF THE FRACTURE3.STABILIZATION OF THE FRACTURE4.EARLY WOUND COVER4.EARLY WOUND COVER
  7. 7. MIP0MIP0
  8. 8. INSIDEN INFEKSI FR TERBUKAINSIDEN INFEKSI FR TERBUKA??KORELASI DENGANKORELASI DENGAN EXTENT OF SOFTEXTENT OF SOFTTISSUE DAMAGETISSUE DAMAGEGRADEGRADE II : <: < 1 %1 %GRADEGRADE III : > 10 %III : > 10 %
  9. 9. KONSEP UMUM INFEKSIKONSEP UMUM INFEKSIMUSKULOSKELETALMUSKULOSKELETAL 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 DELAYEDDELAYED DLM MEMBERIKAN “AB”DLM MEMBERIKAN “AB” HOST FACTORHOST FACTOR
  10. 10. HAL-HAL YANG PERLUHAL-HAL YANG PERLUDIKETAHUIDIKETAHUIRIWAYAT TRAUMARIWAYAT TRAUMAKONTAMINASIKONTAMINASIRIWAYAT PENYAKIT LAINRIWAYAT PENYAKIT LAINFOTO POLOSFOTO POLOSKULTUR DAN SENSITIVITY TESKULTUR DAN SENSITIVITY TESKULTUR DARAHKULTUR DARAH
  11. 11. PENGGUNAAN “AB” RASIONALPENGGUNAAN “AB” RASIONALPD 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 ??
  12. 12. TABEL “AB” PROFILAKSIS KASUSTABEL “AB” PROFILAKSIS KASUSKASUS BEDAHKASUS BEDAHSurgical procedureSurgical procedure predominant inf microorganismpredominant inf microorganism recommened agentrecommened agent dosedoserouteroute______________________________________________________________________________________________________________________________________________________________________CARDIO THORACICCARDIO THORACIC Staphylococci CEFAZOLIN 1-2 gStaphylococci CEFAZOLIN 1-2 givivor CEFUROXIME 1,5 g ivor CEFUROXIME 1,5 g ivor VANCOMYCINor VANCOMYCIN____________________________________________________________________________________________________________________________________________________________________Non-cardiacNon-cardiac Staphylococci CEFAZOLIN or 1-2 g ivStaphylococci CEFAZOLIN or 1-2 g ivVascular SurgeryVascular Surgery CEFUROXIME 1,5 g ivCEFUROXIME 1,5 g iv______________________________________________________________________________________________________________________________________________________________________ARTHTROPLASTY OF Staphylococci CEFAZOLINARTHTROPLASTY OF Staphylococci CEFAZOLIN1-2 g IV1-2 g IVJOINT REPLACEMENTJOINT REPLACEMENTOPEN REDUCTIONOPEN REDUCTIONOF FRACTURESOF FRACTURESLOWER LIMB AMPUTATIONLOWER LIMB AMPUTATION______________________________________________________________________________________________________________________________________________________________________
  13. 13. Gastro duodenal Streptococci,Coliforms, CEFAZOLIN 1-2 gGastro duodenal Streptococci,Coliforms, CEFAZOLIN 1-2 givivanaerobic bacteria incl.anaerobic bacteria incl.Bacteroides sppBacteroides spp________________________________________________________________________________________________________________________________BILIARY TRACTBILIARY TRACT Coliform, enterococci, CEFAZOLIN 2 gColiform, enterococci, CEFAZOLIN 2 givivFor high risk only anaerobic bact incl. CEFOXITIN 2 gFor high risk only anaerobic bact incl. CEFOXITIN 2 giviv: > 70 years Bacteroides,clostridia: > 70 years Bacteroides,clostridiaObstr joundiceObstr joundiceAcute cholecystitisAcute cholecystitisAcute cholangitisAcute cholangitisCommon duct stoneCommon duct stoneLow risk…… NO PROPHYLAXISLow risk…… NO PROPHYLAXIS________________________________________________________________________________________________________________________________
  14. 14. Colon/small bowelColon/small bowel coliforms,anaerobic CEFOXITIN 2 g ivcoliforms,anaerobic CEFOXITIN 2 g ivbacteria incl.bacteroibacteria incl.bacteroides fragilisdes fragilis____________________________________________________________________________________________________________________APPENDECTOMYAPPENDECTOMY Coliforms,anaerobic CEFOXITIN 2 g ivColiforms,anaerobic CEFOXITIN 2 g ivbacteria incl.bacteroibacteria incl.bacteroides fragilisdes fragilis____________________________________________________________________________________________________________________PENETRATINGPENETRATING idem CEFOXITIN 2 g ividem CEFOXITIN 2 g ivABD TRAUMAABD TRAUMA____________________________________________________________________________________________________________________
  15. 15. VAGINALor abdominalVAGINALor abdominal Coliformes,enterococciCEFAZOLIN 1-2 gColiformes,enterococciCEFAZOLIN 1-2 givivHysterectomyHysterectomy group B streptococcigroup B streptococci____________________________________________________________________________________________________________________Caesarian sectiionCaesarian sectiion with as for hysterectomy CEFAZOLIN 1 gwith as for hysterectomy CEFAZOLIN 1 givivHigh risk e.g prematureHigh risk e.g prematureRupture of membranes CEFOXITIN 2 g ivRupture of membranes CEFOXITIN 2 g ivLow risk_elective NO PROPHYLAXISLow risk_elective NO PROPHYLAXIS____________________________________________________________________________________________________________________ABORTIONABORTION as for hysterectomy CEFAZOLIN 1 g ivas for hysterectomy CEFAZOLIN 1 g iv____________________________________________________________________________________________________________________PROSTATECTOMYPROSTATECTOMY Coliforms CIPROFLOXACIN 500mgColiforms CIPROFLOXACIN 500mgoraloral____________________________________________________________________________________________________________________CNS ShuntCNS Shunt Staphylococci CEFAZOLIN 1 gStaphylococci CEFAZOLIN 1 giviv____________________________________________________________________________________________________________________
  16. 16. ““AB” DI BIDANGAB” DI BIDANGMUSKULOSKELETALMUSKULOSKELETAL 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 ??
  17. 17. GUIDE LINE AB PROFILAXISGUIDE LINE AB PROFILAXISORTHO 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 Grpre 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, 2grPre 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 1-2gr selama 3 hari &gentamycin 2 x 80 mg, 3 hari.gr selama 3 hari &gentamycin 2 x 80 mg, 3 hari.
  18. 18. KESIMPULANKESIMPULAN DIAGNOSIS PRE OP—PENTINGDIAGNOSIS PRE OP—PENTING PILIHPILIH ABAB ~ PETA KUMAN SECARA EMPIRIS~ PETA KUMAN SECARA EMPIRIS WAKTU OP:WAKTU OP:GOLDEN PERIODE ?GOLDEN PERIODE ? IDEAL, CEFALOSPORIN I, BILA INFEKSIIDEAL, CEFALOSPORIN I, BILA INFEKSIMANIFEST; CEF II, III dan GentamycinMANIFEST; CEF II, III dan Gentamycin IDEAL: ~ HASIL KULTUR & S TESIDEAL: ~ HASIL KULTUR & S TES
  19. 19. CEGAH INFEKSI NOSOKOMIAL !!CEGAH INFEKSI NOSOKOMIAL !!ABAB BUKAN SATU-SATUNYA FAKTORBUKAN SATU-SATUNYA FAKTORYG BISA CEGAH INFEKSI.YG BISA CEGAH INFEKSI.PERHATIKAN HAL-HAL LAIN YG ERATPERHATIKAN HAL-HAL LAIN YG ERATKAITAN TERHADAP KEJADIANKAITAN TERHADAP KEJADIANINFEKSI.INFEKSI.
  20. 20. Thank u doctor , i`m oke !!Thank u doctor , i`m oke !!
  21. 21. TERIMA KASIHTERIMA KASIH….….

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