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DAFTAR ISI

JUDUL ……………………………………………………………...............……. i

LEMBAR PENGESAHAN …...…………………………………………………. ii

PERNYATAAN ..................................................................................................... iii

DAFTAR ISI ...........................................................................................................vi

DAFTAR TABEL ...................................................................................................ix

DAFTAR GAMBAR ............................................................................................... x

DAFTAR SINGKATAN ........................................................................................xi

DAFTAR LAMPIRAN ......................................................................................... xii

INTISARI ............................................................................................................. xiii

ABSTRACT ............................................................................................................xiv

BAB I. PENDAHULUAN ....................................................................................... 1

A. Latar belakang .............................................................................................. 1

B. Perumusan Masalah ..................................................................................... 7

C. Pertanyaan Penelitian ................................................................................... 8

D. Keaslian Penelitian ....................................................................................... 9

E. Manfaat Penelitian ..................................................................................... 10

1. Manfaat Teoritis ................................................................................... 10

2. Manfaat Praktis .................................................................................... 10

F. Tujuan Penelitian ....................................................................................... 10

BAB II. TINJAUAN PUSTAKA ........................................................................... 11

A. Ulkus Kaki Diabetik ................................................................................... 11

1. Epidemiologi ........................................................................................ 11

2. Patogenesis ........................................................................................... 12

1. Neuropati Perifer ....................................................................12

2. Penyakit Arteri Perifer ............................................................13

3. Imunopati ................................................................................14

3. Diagnosis Ulkus Kaki DM ................................................................... 15

4. Klasifikasi Ulkus Kaki Diabetik .......................................................... 16

B. Infeksi Ulkus Kaki Diabetik....................................................................... 19

C. Resistensi Antibiotik .................................................................................. 21

1. Mekanisme Kerja Antibiotik ................................................................ 21

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2. Resistensi Antibiotik ............................................................................ 23

1. Pencegahan akses antimikroba menuju target ........................24

2. Modifikasi target obat .............................................................26

3. Inaktivasi antibiotik ................................................................26

D. Penyebaran Resistensi Antibiotik .............................................................. 27

E. Infeksi MDRO Ulkus Kaki Diabetik dan Faktor Risikonya ...................... 29

1. Infeksi MDRO dan Faktor Risikonya pada Ulkus Kaki Diabetik ....... 29

1. Methicillin Resistant Staphylococcus aureus .........................29

2. Vancomycin Resistant Enterococcus ......................................31

3. Multidrugs resistant basil Gram negatif ................................32

F. Landasan Teori ........................................................................................... 37

G. Kerangka Teori........................................................................................... 39

H. Kerangka Konsep ....................................................................................... 40

I. Hipotesis ..................................................................................................... 41

BAB III. METODE PENELITIAN ........................................................................ 42

A. Rancangan Penelitian ................................................................................. 42

B. Populasi dan Sampel Penelitian ................................................................. 43

1. Populasi Target..................................................................................... 43

2. Populasi Terjangkau ............................................................................. 43

3. Subyek Penelitian ................................................................................. 43

C. Tempat dan Waktu Penelitian .................................................................... 44

D. Besar Sampel .............................................................................................. 44

E. Bahan dan Cara Penelitian ......................................................................... 45

1. Persiapan Penelitian ............................................................................. 45

2. Pengambilan Sampel. ........................................................................... 46

3. Identifikasi Bakteri dan Uji Kepekaan Antibiotik. .............................. 47

4. Penelusuran Faktor Risiko ................................................................... 49

F. Reliabilitas Pengukuran ............................................................................. 49

1. Uji Sterilitas ......................................................................................... 49

2. Uji Kualitas Media ............................................................................... 50

3. Kendali Mutu Cakram Antibiotik ........................................................ 50

4. Kendali Mutu Alat Identifikasi Bakteri dan Uji Kepekaan Antibiotik

Otomatis ............................................................................................... 51

G. Alur Penelitian ........................................................................................... 52

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H. Variabel dan Definisi Operasional ............................................................. 53

I. Analisis Statistik......................................................................................... 56

J. Etika Penelitian .......................................................................................... 57

BAB IV. HASIL DAN PEMBAHASAN .............................................................. 58

A. Kendali Mutu Internal ................................................................................ 58

1. Uji Sterilitas ......................................................................................... 58

2. Kendali Mutu Kualitas Media .............................................................. 59

1. pH media.................................................................................59

2. Pertumbuhan Kuman Kontrol .................................................59

3. Kendali Mutu Cakram Antibiotik ........................................................ 60

3. Kendali Mutu Alat Identifikasi Bakteri dan Uji Kepekaan Antibiotik

Otomatis ............................................................................................... 61

B. Karakteristik Subyek .................................................................................. 62

C. Analisis Bivariat dan Multivariat Faktor Risiko ........................................ 69

D. Profil Mikroorganisme dan Uji Kepekaan Terhadap Antibiotik................ 74

BAB V. SIMPULAN DAN SARAN ..................................................................... 82

A. Simpulan .................................................................................................... 82

B. Saran ........................................................................................................... 82

RINGKASAN ........................................................................................................ 84

DAFTAR PUSTAKA ............................................................................................ 90

LAMPIRAN ........................................................................................................... 96