Faktor Risiko Prediktor Bakteremia pada Pasien Nekrolisis Epidermal: Evidence-Based Case Report

Shafira  Anindya; Parikesit Muhammad; Windy Keumala Budianti

doi:10.36452/jkdoktmeditek.v28i1.2240

Authors

Shafira Anindya Departemen Dermatologi dan Venereologi, Fakultas Kedokteran Universitas Indonesia, RSUPN dr. Cipto Mangunkusumo, Jakarta, Indonesia
Parikesit Muhammad Departemen Dermatologi dan Venereologi, Fakultas Kedokteran Universitas Indonesia, RSUPN dr. Cipto Mangunkusumo, Jakarta, Indonesia
Windy Keumala Budianti Departemen Dermatologi dan Venereologi, Fakultas Kedokteran Universitas Indonesia, RSUPN dr. Cipto Mangunkusumo, Jakarta, Indonesia

DOI:

https://doi.org/10.36452/jkdoktmeditek.v28i1.2240

Keywords:

bakteremia, nekrolisis epidermal, prediktor

Abstract

Nekrolisis epidermal (NE) yang terbagi atas Sindrom Stevens-Johnson (SSJ) dan nekrolisis epidermal toksik (NET) merupakan reaksi simpang obat berat dengan mortalitas tinggi. Penyebab kematian terbanyak pada NE adalah sepsis, namun gejala sepsis tidak spesifik pada NE dan hasil kultur darah membutuhkan waktu lama. Oleh karena itu penting mengetahui prediktor yang berpengaruh terhadap peningkatan risiko bakteremia pada pasien dengan NE. Evidence-based case report ini bertujuan mengetahui faktor prediktor terjadinya bakteremia pada pasien NE berdasarkan literatur. Pencarian artikel menggunakan basis data PubMed, Cochrane, dan Scopus yang relevan dengan pertanyaan klinis untuk kemudian ditelaah. Didapatkan dua artikel kohort yang sesuai. Studi Koh dkk. mendapatkan tiga prediktor yang berpengaruh terhadap kejadian bakteremia pada pasien NE; yaitu hemoglobin ≤ 10 g/dL (odds ratio [OR] 2,4; interval kepercayaan [IK] 95% 2,2-2,6), luas epidermolisis ≥ 10% (OR 14,3; IK 95% 13,4-15,2) dan penyakit komorbid kardiovaskular (OR 2,1; IK 95% 2,0-2,3). Studi De Prost dkk. mendapatkan tiga prediktor yaitu usia > 40 tahun (hazard ratio [HR] 2,5; IK 95% 1,35-4,63), leukosit > 10.000/mm³ (HR 1,9; IK 95% 0,96-3,61), serta LPB ≥ 30% (HR 2,5; IK 95% 1,13-5,47). Epidermolisis yang lebih luas merupakan faktor prediktor terjadinya bakteremia pada NE di kedua studi. Faktor risiko lainnya memerlukan penelitian lebih lanjut.

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