Pneumonia CAP
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LAPORAN STUDI KASUS
Pneumonia CAP + Sepsis +Hemaptoe + Susp TB-MDR
OLEH:
MAHASISWA PKP APOTEKER
FAKULTAS FARMASI UNIVERSITAS AHMAD DAHLAN YOGYAKARTA
ANGKATAN XXIX
Disusun Oleh:
Sepi M!"! S!"i# S$F!"% &'()(*+&*&
Wi,-! Sis.!"! M!,,!# S$F!"% &'()(*++')
PROGRAM STUDI PROFESI APOTEKER
FAKULTAS FARMASI
UI!ERSITAS AHMAD DAHLA
"OG"AKARTA
#$%&
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Le%/!" Pen0es!h!n
LAPORAN STUDI KASUSPneu%1ni! 2AP 3 Sepsis 3He%!p1e 3 Susp T45MDR
Di RSUD D"$ S!i6ul An.!" M!l!n0
FAKULTAS FARMASI UNIVERSITAS AHMAD DAHLANDI RUMAH SAKIT UMUM DAERAH DR$ SAIFUL ANWAR MALANG
78 O91/e" ' Dese%/e" +(&8;
Oleh :MAHASISWA PROGRAM PROFESI APOTEKER FAKULTAS FARMASI
UNIVERSITAS AHMAD DAHLAN ANGKATAN XXIX
L!p1"!n ini el!h ,iseu
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BAB I
PEDAHULUA
A' Epi(emio)o*i Pneumonia CAP
In6e9si s!lu"!n n!p!s /!.!h %!sih e!p %e"up!9!n %!s!l!h u!%! ,!l!% /i,!n0
9eseh!!n# /!i9 ,i ne0!"! -!n0 se,!n0 /e"9e%/!n0 %!upun -!n0 su,!h %!!$ Insi,ensi pneu%1ni! 91%unii ,i A%e"i9!
!,!l!h &+ 9!sus pe" &((( 1"!n0 pe" !hun ,!n %e"up!9!n pen-e/!/ 9e%!i!n u!%!!9i/! in6e9si p!,! 1"!n0 ,e.!s! ,i ne0!"! iu$ An09! 9e%!i!n !9i/! pneu%1ni! ,i
A%e"i9! !,!l!h &( B$ Di A%e"i9! ,en0!n =!"! inC!si6 pun pen-e/!/ pneu%1ni! h!n-!
,ie%u9!n 8(B$ Pen-e/!/ pneu%1ni! suli ,ie%u9!n ,!n %e%e"lu9!n .!9u /e/e"!p!
h!"i unu9 %en,!p!9!n h!siln-!# se,!n09!n pneu%1ni! ,!p! %en-e/!/9!n 9e%!i!n
/il! i,!9 se0e"! ,i1/!i# %!9! p!,! pen01/!!n !.!l pneu%1ni! ,i/e"i9!n !ni/i1i9!
se=!"! e%pi"is$ H!sil Su"Cei Keseh!!n Ru%!h T!n00! Dep9es !hun +(( pen-!9i
in6e9si s!lu"!n n!p!s /!.!h %ene%p!i u"u!n 9e5+ se/!0!i pen-e/!/ 9e%!i!n ,iIn,1nesi!$ Pneu%1ni! 91%unii %en,u,u9i pe"in09! 9ee%p! ,!n sepuluh pen-!9i
e"/!n-!9 -!n0 ,i"!.! pe" !hun$
B' Epi(emio)o*i Sepsis
Sepsis !,!l!h pen-e/!/ u!%! 9e%!i!n p!,! p!sien -!n0 %en,e"i! s!9i /e"! ,!n
,i"!.! ,i"u%!h s!9i# insi,en sepsis pe"!hun ,i ne0!"! %!
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%en0!9i/!9!n 9e%!i!n hin00! %en=!p!i +((#(((
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BAB II
TI.AUA PUSTAKA
A' PEUMOIA CAP
%' De/inisi
21%%uni- !=ui"e, pneu%1ni!72AP; !,!l!h pneu%1ni! in6e9sius p!,! sese1"!n0
-!n0 i,!9 %en
#' Etio)o*i
!$ 4!9e"i
5 ipi9 : 0"!% p1sii6 %!upun 0"!% ne0!i6# /!9e"i!e"1/%!upun!n!e"1/
5 !ipi9 :%-=1pl!s%!#le0i1nell!# =l!%-,i!#Ci"usin6luen>!e#SARS/$ !%u"
=$ P"11>1!
Tae) I'D!6!"Mi9"11"0!nis%e -!n0 %en-e/!/9!n Pneu%1ni! 7e"e%-# +((@;
0' Pato/isio)o*i
Pneu%1ni! se/!0i!n /es!" /e"!.!l ,!"i !spi"!si 9u%!n !!u pen-e/!"!n l!n0sun0
%el!lui 1"16!"in0$V1lu%e !spi"!si 9e=il e"
%u91s! 1"16!"in0;# n!%un pneu%1ni! ,!p! e"
pe"iC!s=ul!"$ In6e9si !9!n /e"9e%/!n0 %en0!9i/!9!n e"
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7pen0elup!s!n; epiel ,!n !9!n e"/enu9 e9su,! he%1"!0i9$ In6il"!si 9e ine"sii!l
s!n0!
p"e,isp1sisi e"
7L1s=!l>1# et al., +(&(;$
1' Ge2a)a K)inis
Di!0n1sis pneu%1ni! 91%unii ,i,!p!9!n ,!"i !n!%nesis# 0e
!!u le/ih 0e
Pen!!l!9s!n!!n pneu%i1ni! 91%unii ,i/!0i %en
!; Pen,e"i! "!.!
5 4il! p!n!s in00i pe"lu ,i91%p"es !!u %inu% 1/! penu"un p!n!s
5 4il! pe"lu ,!p! ,i/e"i9!n %u91lii9 ,!n e9spe91"!n
Pe%/e"i!n !ni/l1i9 h!"us ,i/e"i9!n 7sesu!i /!0!n; 9u"!n0 ,!"i )
T!np! 6!91" %1,i6i9!si : 01l1n0!n /e! l!9!% 3 !ni /e! l!9!%!se Den0!n 6!91" %1,i6i9!si : 01l1n0!n /e! l!9!% 3 !ni /e! l!9!%se !!u
6lu1"19uin1l1n "espi"!si 7leC16l19s!sin# %19si6l19s!sin# 0!i6l19s!sin; 4il! ,en0!n pneu%1ni! !ipi9 : %!9"1li, /!"u 7"19si1%isin# 9l!"i1%isin#
!>i"1%isin;$
/; Pen,e"i! "!.! in!p ,i "u!n0 "!.! /i!s!Pen01/!!n sup1"i6 si%p1%!i9
5 Pe%/e"i!n e"!pi 19si0en
5 Pe%!s!n0!n in6us unu9 "ehi,"!si ,!n 91"e9si 9!l1"i ,!n ele9"1li
5 Pe%/e"i!n 1/! si%p1%!i9 !n!"! l!in !nipi"ei9# %u91lii9
Pen01/!!n !ni/i1i9 h!"us ,i/e"i9!n 7sesu!i /!0!n; 9u"!n0 ,!"i )
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T!np! 6!91" %1,i6i9!si : 01l1n0!n /e! l!9!% 3 !ni /e! l!9!%!se
in"!Cen! !!u se6!l1sp1"in 0ene"!si +# 0ene"!si in"!Cen! !!u
6lu1"19uin1l1n "espi"!si in"!Cen! Den0!n 6!91" %1,i6i9!si : se6!l1sp1"in 0ene"!si +# 0ene"!si in"!Cen! !!u
6lu1"19uin1l1n "espi"!si in"!Cen! 4il! ,en0!n pneu%1ni! !ipi9 : %!9"1li, /!"u
=; Pen,e"i! "!.! in!p ,i Ru!n0 R!.! Inensi6Pen01/!!n sup1"i6 si%p1%!i9
5 Pe%/e"i!n e"!pi 19si0en
5 Pe%!s!n0!n in6us unu9 "ehi,"!si ,!n 91"e9si 9!l1"i ,!n ele9"1li Pe%/e"i!n
1/!
si%p1%!i9 !n!"! l!in !nipi"ei9# %u91lii9 Pen01/!!n !ni/i1i9 7sesu!i /!0!n$; 9u"!n0 ,!"i )
Ti,!9 !,! 6!91" "esi91 in6e9si pseu,1%1n!s : se6!l1sp1"in 0ene"!si
in"!Cen! !!u 6lu1"19uin1l1n "espi"!si in"!Cen! A,! 6!91" "esi91 in6e9si pseu,1%1n!s : s
5 se6!l1sp1"in !ni pseu,1%1n!s in"!Cen! !!u 9!"/!pene% in"!Cen!
,i!%/!h 6lu1"19uin1l1n !ni pseu,1%1n!s 7sip"16l19s!sin; in"!Cen! !!u
!%in10li91si,! in"!Cen!
5 /il! ,i=u"i0!i ,ise"!i in6e9si /!9e"i !ipi9 : se6!lsp1"in !ni pseu,1%1n!sin"!Cen! !!u 9!"/!pene% in"!Cen! ,i!%/!h !%in10li91si,! in"!Cen!#
,i!%/!h %!9"1li, /!"u !!u 6lu1"19uin1l1n "espi"!si in"!Cen!$
4il! !,! in,i9!si pen,e"i! ,ip!s!n0 Cenil!1" %e9!ni9
7Pe"hi%pun!n D19e" P!"u In,1nesi!# +((;
B' SEPSIS%' De/inisi
Sepsis ,i,e6inisi9!n se/!0!i 9e!,!!n 9linis -!n0 ,i!n,!i 1leh sin,"1% "esp1n
in6l!%!si sise%i9 7SIRS; ,ise"!i !,!n-! /!9e"i p!h10en 7in6e9si; -!n0 ,ie%u9!n
%el!lui 9ulu" !!u pe.!"n!!n 0"!% ,!"i spesi%en u/uh sepe"i ,!"!h# spuu%# 6eses#
u"in ,!n spesi%en u/uh l!inn-! !!u ,ie%u9!n 619us in6e9si sepe"i lu9! ,en0!n pus
pu"ulen !!u !,!n-! u,!"! /e/!s p!,! "1n00! !/,1%en -!n0 ,ie%u9!n p!,! s!!
1pe"!si -!n0 /e"!s!l ,!"i s!lu"!n pen=e"n!!n$
#' Etio)o*i
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Sepsis /i!s!n-! ,ise/!/9!n 1leh in6e9si /!9e"i# Ci"us !!u
aureus, dan Streptococcus pneumonia$ Spesies Ene"1=1==us# Kle/siell!# ,!n
Pseu,1%1n!s !; Pe%/enu9!n "1%/in -!n0 ,ipe"!n!"!i TF
Tranfer factor ,ie9sp"esi9!n p!,! pe"%u9!!n sel en,1el# %1n1si# ,!n pl!ele
9ei9! sel5sel ini ,isi%ul!si 1leh 19sin# si19in !!u %e,i!1" l!in$ A,!n-!en,119sin %en-e/!/9!n penin09!!n /e/e"!p! si19in p"1in6l!%!si sepe"i
tumor necrosisfactor 7TNF;5,!n ine"leu9in 7IL;5*$ Si19in IL5* %e"up!9!n
si19in p"1in6l!%!si -!n0 p!lin0 /e"hu/un0!n ,en0!n 9linis sepsis ,!n
91%pli9!si$Pe%/enu9!n "1%/in -!n0 ,ipe"!n!"!i 1leh TF %e"up!9!n !h!p
penin0 ,!"i p!10enesis sepsis$ Se=!"! 6isi1l10is pe%/enu9!n ini se0e"!
,ih!%/! 1leh !ni"1%/in# n!%un ,en0!n pe%/enu9!n "1%/in -!n0 s!n0!
=ep!
/; G!n00u!n %e9!nis%e !ni91!0ul!n
Te",!p! i0! %e9!nis%e !ni91!0ul!n -!n0 e"0!n00u p!,! sepsis -!iu : Sise% !ni"1%/in
Se=!"! e1"i !ni"1%/in %e%ili9i pe"!n penin0 ,!l!% 9e9!=!u!n 91!0ul!si
p!,! sepsis# ,i/u9i9!n ,en0!n
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P"1ein 2 ,isinesis ,i h!i ,!n ,i!9iC!si %en
-!n0 /e"6un0si ,!l!% %en0h!%/! FVIII ,!n FV$& P!,! sepsis# e"
,ep"esi sise% p"1ein 2 -!n0 ,ise/!/9!n 1leh pen00un!!n -!n0 /e"le/ih!n#
0!n00u!n h!i# pe"e%/es!n C!s=ul!"# ,!n !9iC!si TNF5J$
Tissue factor pathway inhibitor 7TFPI;
Tissue factor pathway inhibitor ,ise9"esi 1leh sel en,1el ,!n /e"6un0si unu9
%en0h!%/! !9iC!si FX 1leh 91%ple9s TF5FVII!$ Penu"un!n TFPI ,!p!
,i
p"1,u9si "1%/1si -!n0 e"0!n00u# penin09!!n pe%!9!i!n %!upun ,es"u9si
!!u se9ues"!si "1%/1si ,i li%p!$
7F!"!ni!# e !l# +(&&;
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Gama, %' Pato/isio)o*i Sepsis
1' Ge2a)a K)inis
Ge
sepe"i ,e%!%# %en00i0il# ,!n 0e
eses l!/1"!1"iu%$ K"ie"i! Di!0n1si9 sepsis %enu"uCC!"SCC# !hun +((& ,!n
$nternational Sepsis %efinitions Conference, !hun +(( :
V!"i!/el U%u% Suhu /!,!n )( 2 !!u *( 2 He!" R!e ?O%eni T!9ipne! Penu"un!n s!us %en!l E,e%! !!u /!l!n=e =!i"!n -!n0 p1sii6 +(%l90+'
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Penin09!!n pl!s%! p"1=!l=i1nin V!"i!/el He%1,in!%i9 Hip1ensi !""i!l 7Sis1li9 ?(%%H0 !!u penu"un!n sis1li9 '(%%H0 ,!"i
se/elu%n-!##ean artrial pressure @(%%H0;
S!u"!si Cen! 7SCO+ @(B; K!",i!9 In,e9s #8 L%%
V!"i!/le Pe"6usi !"in0!n
Se"u% l!9! &%%1lL Penu"un!n 9!pile" "e6il
V!"i!/le Dis6un0si O"0!n
A""i!l hip19se%i! 7P!O+ Fi O+ ((; A9u 1li0u"i! !!u u"ine 1upu (#8 %l90
Hipe"/ili"u/ine%i! 7pl!s%! 1!l /ili"u/in '%0,l
&' Penata)asanaan Te,api
Pen!!l!9s!n!!n !ni/i1i9 e%pi"i9 %enu"u Dipi"1 e,isi 9e u
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Gama, #' Antimi,oa empi,is pa(a sepsis
Gama, 0' A*en 3asop,eso, pa(a s4o5 sepsis
C' HEMAPTOE
%' De/inisi
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4!u9 ,!"!h %e"up!9!n su!u 0e
4!u9 ,!"!h!!u he%1pisis !,!l!h e9spe91"!si ,!"!h !9i/! pe",!"!h!n p!,! s!lu"!n
n!p!s ,i /!.!h l!"in0# !!u pe",!"!h!n -!n0 9elu!" %el!lui s!lu"!n n!p!s /!.!h
l!"in0$
#' Etio)o*i
Pen-e/!/ /!u9 ,!"!h s!n0! /e"!0!% !n!"! l!in :
In6e9si : u/e"9ul1sis# s!ph-l1=1==us# 9le/siell!# le0i1nell!;#
e%6ise%!/ul1s! Ne1pl!s%! : 9!n9e" p!"u# !,en1%! /"1n=hi!l# u%1" %e!s!sis Kel!in!n he%!1l10i : ,is6un0si "1%/1si# "1%/1si1peni!#
,isse%in!e,in"!C!s=ul!" =1!0ul!i1n 7DI2; Kel!in!n #
li%6!n0i10"!6i Kel!in!n sise%i9 : sin,"1% 011,p!su"e# i,i1p!hi= pul%1n!"- he%1si,e"1sis#
sise%i9 lupus e"-e%!1sus# C!s9uliis 70"!nul1%!1sis .!0ene"# pu"pu"!
hen1=hs=h1enlein# sin,"1% =h"u05s"!uss; O/! 19sin : !spi"in# !ni91!0ul!n# penisil!%in# 919!in L!in5l!in : en,1%e"i1sis# /"1n9i1lii!sis# 6isul! /"1n91pleu"!# /en,! !sin0#
he%1pisis9"ip10eni9# !%il1i,1sis
0' Pato/isio)o*i
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1' Ge2a)a K)inis
T!n,!5!n,! e"
/; Te",en0!" !,!n-! 0ele%/un050ele%/un0 u,!"! /e"=!%pu" ,!"!h ,i ,!l!%
s!lu"!n n!p!s=; Te"!s!!sin ,!"!h ,!n 0!!l ,i en001"19!n,; W!"n! ,!"!h -!n0 ,i/!u99!n %e"!h se0!" /e"=!%pu" /uih# /e/e"!p! h!"i
9e%u,i!n .!"n! %en
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6; 4is! /e"l!n0sun0/e/e"!p! h!"i
&' Penata)asanaan Te,api
Pen!!l!9s!n!!n ,il!9u9!n %el!lui i0! !h!p:
!$ P"1e9si
19si0en# 91"e9si 91!0ul!p!i# "esusi!si =!i"!n/$ L19!lis!si su%/e" pe",!"!h!n ,!n pen-e/!/ pe",!"!h!n ,!p! ,ilih! %el!lui h!sil
611 1"!9s# 2T s=!n 1"!9s# !n0i10"!6i# /"1n91s91pi=$ Te"!pi spesi6i9 ,en0!n pe%/e"i!n 1/! ,!n !ni6i/"in1lii9 pen01/!!n pen-!9i
p"i%e"n-!
D' SUSPECT TB-MDR%' De/inisi
T45 Muliple D"u0 "esisen !!u T4 ,en0!n "esisensi 0!n,! !,!l!h 9e!,!!n
,i%!n! /!sil M$ Tu/e"=ul1sis "esisen e"h!,!p "i6!%pisin ,!n is1ni!>i,# ,en0!n !!u
!np! OAT l!inn-!$ T4 ini ,!p! /e"up! "esiensi p"i%e" ,!n "esisensi se9un,e"$
Resisensi p"i%e" -!iu "esisensi -!n0 e"
,i,!p! sel!%! e"!pi p!,! 1"!n0 -!n0 se/elu%n-! sensii6 1/! 7S-!h"ini# +(();$
#' Etio)o*i
A,! /e/e"!p! h!l pen-e/!/ e"
!!u ,ilin09un0!n e"se/u el!h e",!p! "esisensi -!n0 in00i e"h!,!p 1/! -!n0
,i0un!9!n$ Pe%/e"i!n 1/! -!n0 i,!9 e"!u"# %is!ln-! h!n-! ,i%!9!n ,u! !!u i0! %in00u
l!lu /e"heni# seel!h ,u! /ul!n /e"heni 9e%u,i!n /e"pin,!h ,19e" %en,!p!
1/! 9e%/!li sel!%! ,u! !!u i0! /ul!n l!lu /e"heni l!0i# ,e%i9i!n see"usn-!$ Fen1%en! !,,ii1n s-n,"1%e -!iu s!u 1/! ,i!%/!h9!n ,!l!% su!u p!,u!n
pen01/!!n -!n0 i,!9 /e"h!sil$ 4il! 9e0!0!l!n iu e"
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Koloni M. tuberculosis
Mutan resisten
Resisten obat TBsekunder (multipel)
Resistensi obat TB
primer (multipel)
Resistensi obat TBprimer yang lebihbanyak (multipel)
Pen-e,i!!n 1/! -!n0 i,!9 "e0ule"# 9!,!n059!,!n0 e"heni pen0i"i%!nn-!
s!%p!i /e"/ul!n5/ul!n$7S-!h"ini# +(();
0' Pato/isio)o*i
7Lei=h GA# +(((;
1' Ge2a)a K)inis
Ge
e"/!0i %en
&$ Ge
ses!9 n!p!s
n-e"i ,!,!
+$ Ge
De%!%
0e
Mu!siAl!%i!h&
S"!in "isesen !9i/! e"!pi-!n0 i,!9 !,e9u!+
! T"!ns%isise=!"!,1pleInfeksi HIVKontrolinfeksi yang tidakadekuatDiagnostik yang terlambat
T"!ns%isi -!n0 le/ih
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7Pe,1%!n Di!0n1sis ,!n Pen!!l!9s!n!!n Tu/e"9ul1sis ,i In,1nesi!;
Sese1"!n0 ,i9!!9!n %en,e"i! u/e"=ul1sis %uliple ,"u0 91nCe"si ne0!i6$
&' Penata)asanaan Te,api
Ti0! h!l penin0 ,!n pe"lu ,ipe"h!i9!n p!,! pen!!l!9s!n!!n T4 %uliple ,"u0
!,!l!h e9ni9 ,i!0n1si=# pe%/e"i!n 1/! ,!n 9ep!uh!n$ Unu9 ,!p! %en-usun
p!n,u!n -!n0 ep! /!0i sei!p pen,e"i! ,ipe"lu9!n /e/e"!p! in61"%!si %en0en!i
h!sil es "esisensi 9u%!n u/e"=ul1sis# "i.!-! pen01/!!n ,!n p1l! "esiensi 9u%!n
,i lin09un0!n %!s-!"!9! pen,e"i! %ene!p$
Kei9! hen,!9 %e%ul!i e"!pi# -!n0 pe"lu ,iin0! !,!l!h
7/ul!n;
OAT Du"!si
7/ul!n;
OAT
H3S R 3 3 E * R 3 E
H3E3S +
&
R33A%93Ph#
,ii9uiR33Ph
* R3Ph
H 3 R 3 S 5* 3E3Ph3A%93Fn &) E3Ph3FnH 3 R 3 E 3 S 5* 3Ph3A%93Fn32-= &) Ph3Fn32-=
H 3 R 3 3 E 3 S 5* Ph3A%93Fn32-=3P!s &) Ph3Fn32-=
Kee"!n0!n :
H Is1ni!>i, Ph p"1i1n!%i,eehi1n!%i,e
R Ri6!%pisin P!s p5!%in1s!li=-li= !=i,
pi"!>in!%i, A%9 !%i9!sinE e!%/u1l Fn 6lu1"1uin1l1n
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S s"ep1%isin 2-= =-=l1se"ine
Pilih!n e"!pi unu9 "esisensi 1/! -!n0 ,i9e!hui$ i9! ,i!su%si9!n /!n-!9
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STUDI KASUS
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/$ Sepsis=$ He%!p1e,$ M!l Nu"isie$ Susp T4 MDR
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D' HASIL PEMERIKSAA
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Me9!nis%e Ke"
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u/uh# SGPT#
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&$ Pen00un!!n !ni/i1i9 LeC16l1Q!Qin i,!9 /1leh %ele/ihi &' h!"i unu9 %en=e0!he"
/is! %en
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BAB I!
PEMBAHASA
N- EE %!su9 "u%!h s!9i ,en0!n 9eluh!n /!u9 ,!"!h$ P!sien %!su9 ,i Ru%!h
S!9i S!i6ul An.!" p!,! !n00!l ? O91/e" +(&8 %el!lui Ins!l!si G!.! D!"u"! 7IGD;$
P!sien %en0eluh /!u9 ,!"!h -!n0 /!n-!9 se
%en091nsu%si 1/! !niu/e"9ul1sis se
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6i/"in1lii9 ,en0!n %e9!nis%e %en=e0!h ,e0"!,!si ,!"i /en!n0 6i/"in# ,e0ene"!si pl!ele#
penin09!!n 6"!0ili!s pe%/uluh ,!"!h ,!n %e"!n0s!n0 6!91"56!91" 91!0ul!si# se,!n09!n
A,1n! /e9e"
p!sien %en,!p! e"!pi =1,ein -!n0 /e"6un0si se/!0!i coughsupressant sehin00!
%en0u"!n0i pe%i=u e"
1leh penin09!!n leu91si -!n0 %en=!p!i '+$'((ul# ,e%!%# n-e"i ,!,! /il! /!u9# ,!n
pe%e"i9s!!n "h1n9i$ Pneu%1ni! -!n0 ,i!l!%i p!sien /e"!s!l ,!"i 6!91" "esi91# -!iu
u/e"9ul1sis -!n0 9e%u,i!n /e"e%/!n0 %en
pen-e/!/ pneu%1ni! ,en0!n %e%/e"i9!n !ni/i1i9$ P!,! !.!l %!su9 "u%!h s!9i# &(
O91/e"# p!sien ,ie"!pi !ni/i1i9 2e6"i!Q1ne ,!n LeC16l1Q!=in$ K1%/in!si !ni/i1i9
e"se/u %e"up!9!n e"!pi e%pi"is unu9 p!sien pneu%1ni! -!n0 ,i"!.! ,i "u!n0 inensi6
sesu!i ,en0!n Pe,1%!n Di!0n1s! ,!n Pen!!l!9s!n!!n D19e" P!"u In,1nesi!$ P!,! !n00!l
&& O91/e"# pen00un!!n =e6"i!Q1ne ,iheni9!n ,!n ,i0!ni ,en0!n %e"1pene%$ H!l e"se/u
/e",!s!"9!n pe"i%/!n0!n 91n,isi p!sien -!n0 %en0!l!%i sepsis /e"!$ Sel!in e"!pi e"se/u#
p!sien ,ie"!pi ,en0!n 21%/iCen -!n0 %e"up!9!n /"1n91,il!1"# unu9 %en0!!si ses!9
-!n0 ,i!l!%i p!sien$
P!,! !n00!l && O91/e" +(&8 p!sien %en0!l!%i s-19 sepsis -!n0 ,i!n,!i ,en0!n
penu"un!n e9!n!n ,!"!h se=!"! i/!5i/! %en=!p!i )(8( %%H0$ S-19 sepsis e"
,iun
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P!,! !n00!l && O91/e" %!l!%# p!sien ,i,i!0n1s! %en0!l!%i !ne%i! ,en0!n nil!i
H/ 8#( %0,l$ T!n00!l &+ O91/e"# p!sien 9e%u,i!n ,i/e"i "!ns6usi PR2 ,en0!n !"0e H/
&( %0,l$ Te!pi# p!,! !n00!l & O91/e"# H/ p!sien /elu% %en=!p!i !"0e sehin00!
%!sih ,i"!ns6usi PR2$ Ane%i! -!n0 ,i!l!%i p!sien !,!l!h ,ise/!/9!n 1leh /!u9 ,!"!h -!n0
,i!l!%in-! se
P!sien e!p %en,!p! e"!pi l!n
se,!n09!n p!,! lie"!u" pen00un!!n %e"1pene% !np! 0!n00u!n 0in
7 Q seh!"i;$
Ine"!9si 1/! pe"!%! !,!l!h !n!"! =1%/iCen 7!ni91line"0i9; ,en0!n =1,ein
,i%!n! e6e9 19si9 =1,ein !9!n %enin09! 7p1ensi!l;# "esi91 91nsip!si# ,!n penin09!!n
"eensi u"in$ Sel!ni,"i6!%pisin 1le /is! %enu"un ,en0!n !,!n-! "i6!%pisin$
M1ni1"in0 -!n0 inens ,i/uuh9!n unu9 %en=e0!h e"
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BAB !
KESIMPULA
N-$ EE ,en0!n ,i!0n1sis Pneu%1ni! 2AP 3 sepsis 3 he%!p1e 3 suspe= T45MDR
,i9e!hui p!sien %!su9 RS p!,! !n00!l ?5&(5+(&8 ,i"u!n0 H2U (high care unit) p!"u$
K1n,isi p!sien s!%p!i !n00!l &5&(5+(&8 su,!h se%!9in %e%/!i9 ,!n ,ipin,!h9!n 9e
"u!n0 + in6e9si unu9 p"1ses pe%ulih!n$
&$ P!sien %en,!p!9!n "e0i%en pen01/!!n su,!h sesu!i ,en0!n 0ui,eline+$ DRP i,!9 %en,!p!
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DAFTAR PUSTAKA
2en"!l Tu/e"=ul1sis DiCisi1n# Minis"- 16 He!lh !n, F!%il- Wel6!"e$'evised ational
Tuberculosis Control !rogramme %*TS!lus +uidelines .Ne. Delhi$ +(&(Dipi"1# 1seph T e !ll$ Ph!"%!=1he"!p- A P!h1ph-si1l10i= App"1!=h @h e,ii1n# The
M=G"!.5Hill 21%p!nies$ +(()F!"!ni!#T ,99# +angguaan oagulasi pada SepsisSari !ediatri# V1l$ N1$ # O91/e"
+(&&N!i1n!l Sepsis See"in0 21%%iee. Sepsis #anagement ational Clinical +uideline o.
-. /01
Pe"hi%pun!n D19e" P!"u In,1nesi!. !edoman %iagnosis dan !enatalaksanaan di
$ndonesia. //2P"i-!n1"1 K ,99$ +angguan fungsi 3antung pada eadaan Sepsis 3urnal ardiologi
$ndonesia. V1l$ N1$ $ Sepe%/e"5Dese%/e" +(&(R!s%in# Men!l,i$Editorial4 5E#*!T$S$S$ Dep!"e%en Pul%1n1l10i Z Il%u Ke,19e"!n
Respi"!si FKUI5SMF P!"u RSUP Pe"s!h!/!!n.
6urnalrespirologi.org"6urnal"pril/7"HEMOPTISIS8/editorial.pdf
S-!h"ini# Hen"-$ Tuberkulosis !aru 'esistensi +anda$ Dep!"e%en Il%u Pen-!9i D!l!%
R$S$U$P A,!% M!li9 Me,!n F!9ul!s Ke,19e"!n UniCe"si!s Su%!e"! U!"!
+(()
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