Kejadian Demam Neutropenia pada Anak dengan Keganasan

Abstract

Latar belakang. Demam merupakan salah satu manifestasi awal dari infeksi berat, terutama selama periode neutropenia. Infeksi menjadi penyebab utama morbiditas dan mortalitas pada pasien kanker. Data mikroorganisme tersering beserta sensitivitasnya dapat memberikan pola dan menjadi petunjuk tata laksana pasien anak dengan demam neutropenia. Tujuan. Mengetahui kejadian demam neutropenia pada pasien anak dengan keganasan. Metode. Penelitian potong lintang retrospektif dilakukan pada 65 pasien usia 0-18 tahun dengan penyakit keganasan yang dirawat di Departemen Kesehatan Anak, RSCM Jakarta dalam kurun waktu satu tahun sejak 1 April 2015 sampai dengan 30 April 2016. Diagnosis keganasan ditegakkan berdasarkan aspirasi sumsum tulang atau biopsi tumor. Dilakukan pengumpulan dan analisis data kejadian demam neutropenia, kejadian infeksi, serta pola sensitivitas antibiotik dari isolat patogen. Hasil. Keganasan darah (LLA dan LMA) lebih sering ditemukan daripada tumor padat. Dalam satu tahun terjadi 83 episode rawat karena demam neutropenia. Bakteremia tersering disebabkan oleh bakteri Gram positif (6,4%) dibandingkan Gram negatif (5,7%). Hasil kultur dari sampel darah, urin, tinja, sputum, dan apusan luka tersering adalah steril (55,2%). Luaran pasien demam neutropenia yang meninggal tersering didapatkan pada pasien LMA (18,8%), LLA (17,2%), rabdomiosarkoma (12,5%), limfoma maligna non Hodgkin (LMNH) (10%), diikuti tumor padat lainnya. Sensitivitas antibiotik tertinggi didapatkan pada vankomisin. Incidence of Febrile Neutropenia in Pediatric Patients with Malignancies Sarah Rafika Nursyirwan, Endang WindiastutiBackgrounds. Fever is one of the early manifestations of severe infections, especially during periods of neutropenia. Infection is a major cause of morbidity and mortality in malignancy. Data on microorganisms and their sensitivity could provide patterns and clues to manage patients with febrile neutropenia. Objectives. To report the incidence of febrile neutropenia in pediatric patients with malignancies. Methods. A cross-sectional retrospective study was performed on 65 patients aged 0 to 18 years with malignancies who were treated at the Department of Child Health, RSCM Jakarta within a period of 1 year from April 2015 to April 2016. The diagnosis of malignancy was confirmed by bone marrow aspiration or tumor biopsy. Data on the incidence of febrile neutropenia, the incidence of infection, and antibiotics sensitivity patterns of the pathogen was collected and analyzed. Results. Febrile neutropenia was more common in patients with hematologic malignancies (ALL and AML) than solid tumors. Within 1 year, there were 83 episodes of febrile neutropenia. Bacteremia was caused by Gram-positive bacteria (6.4%) more than Gramnegative bacteria (5.7%). Culture results from samples of blood, urine, feces, sputum, swabs were mainly sterile (55.2%). Patients who died with febrile neutropenia were commonly seen on AML (18.8%), ALL (17.2%), rhabdomyosarcoma (12.5%), non-Hodgkin lymphoma (10%), followed by other solid tumors. The...