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Pemakaian antibiotika pra bedah pada fraktur terbuka

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The document discusses the use of antibiotics for open fractures. It recommends using cefazolin as the ideal antibiotic for prophylaxis due to Staphylococcus being the most common pathogen in open fractures. It provides alternatives like erythromycin, vancomycin, or combinations if the wound is very dirty. Proper administration is a single high dose pre-operatively by intravenous route. The principles of treating open fractures include assuming contamination, preventing infection through debridement, antibiotics, and early wound stabilization and coverage.

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PEMAKAIAN ANTIBIOTIKAPEMAKAIAN ANTIBIOTIKA PRA BEDAH PADAPRA BEDAH PADA FRAKTUR TERBUKAFRAKTUR TERBUKA OlehOleh Dr.Azharuddin,SpBO-K.Spine FICSDr.Azharuddin,SpBO-K.Spine FICS Divisi Bedah Orthopaedi FK UNSYIAH/BPK-Divisi Bedah Orthopaedi FK UNSYIAH/BPK- RSUZA Banda AcehRSUZA Banda Aceh 20042004
Pemakaian antibiotika pra bedah pada fraktur terbuka
Pemakaian antibiotika pra bedah pada fraktur terbuka
Pemakaian antibiotika pra bedah pada fraktur terbuka
Fr terbuka+plating 6 minggu post opFr terbuka+plating 6 minggu post op
PendahuluanPendahuluan ? AB Profilaksis pada fraktur terbuka; infeksi.AB Profilaksis pada fraktur terbuka; infeksi. ? Dasar Pemilihan JenisAB ?Dasar Pemilihan JenisAB ? ? -Kemungkinan kuman patogen yang spesifik.-Kemungkinan kuman patogen yang spesifik. ? Fraktur terbuka, kuman>> staphylococcusFraktur terbuka, kuman>> staphylococcus ? ABIdeal pada fr terbuka?ABIdeal pada fr terbuka? CEFAZOLINCEFAZOLIN
ALTERNATIF ABPROFILAKSISALTERNATIF ABPROFILAKSIS ? 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)
CARA PEMBERIAN ABCARA PEMBERIAN AB PROFILAKSISPROFILAKSIS ?SATU KALI PRE OPERASISATU KALI PRE OPERASI ?DOSIS TINGGIDOSIS TINGGI ?SETENGAH JAM PRE OPERASISETENGAH JAM PRE OPERASI ?INTRAVENOUSINTRAVENOUS
PRINSIP PENANGANANPRINSIP PENANGANAN FRAKTUR TERBUKAFRAKTUR TERBUKA ? ASUMSIKAN SEMUA GRADING FRASUMSIKAN SEMUA GRADING FR TERBUKA------TERKONTAMINASITERBUKA------TERKONTAMINASI ? CEGAH PASIEN MENJADI INFECTEDCEGAH PASIEN MENJADI INFECTED ? CARA:CARA: 1.WOUND DEBRIDEMENT1.WOUND DEBRIDEMENT 2.AB PROFILAXIS2.AB PROFILAXIS 3.STABILIZATION OF THE FRACTURE3.STABILIZATION OF THE FRACTURE 4.EARLY WOUND COVER4.EARLY WOUND COVER
Pemakaian antibiotika pra bedah pada fraktur terbuka
MIP0MIP0
INSIDEN INFEKSI FR TERBUKAINSIDEN INFEKSI FR TERBUKA ?? ?KORELASI DENGANKORELASI DENGAN EXTENT OF SOFTEXTENT OF SOFT TISSUE DAMAGETISSUE DAMAGE ?GRADEGRADE II : <: < 1 %1 % ?GRADEGRADE III : > 10 %III : > 10 %
KONSEP UMUM INFEKSIKONSEP UMUM INFEKSI MUSKULOSKELETALMUSKULOSKELETAL ? 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 ABDLM MEMBERIKAN AB ? HOST FACTORHOST FACTOR
HAL-HAL YANG PERLUHAL-HAL YANG PERLU DIKETAHUIDIKETAHUI ?RIWAYAT TRAUMARIWAYAT TRAUMA ?KONTAMINASIKONTAMINASI ?RIWAYAT PENYAKIT LAINRIWAYAT PENYAKIT LAIN ?FOTO POLOSFOTO POLOS ?KULTUR DAN SENSITIVITY TESKULTUR DAN SENSITIVITY TES ?KULTUR DARAHKULTUR DARAH
PENGGUNAAN AB RASIONALPENGGUNAAN AB RASIONAL PD 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 ??
TABEL AB PROFILAKSIS KASUSTABEL AB PROFILAKSIS KASUS KASUS BEDAHKASUS BEDAH Surgical procedureSurgical procedure predominant inf microorganismpredominant inf microorganism recommened agentrecommened agent dosedose routeroute ______________________________________________________________________________________________________________________________________________________________________ CARDIO THORACICCARDIO THORACIC Staphylococci CEFAZOLIN 1-2 gStaphylococci CEFAZOLIN 1-2 g iviv or CEFUROXIME 1,5 g ivor CEFUROXIME 1,5 g iv or VANCOMYCINor VANCOMYCIN ____________________________________________________________________________________________________________________________________________________________________ Non-cardiacNon-cardiac Staphylococci CEFAZOLIN or 1-2 g ivStaphylococci CEFAZOLIN or 1-2 g iv Vascular SurgeryVascular Surgery CEFUROXIME 1,5 g ivCEFUROXIME 1,5 g iv ______________________________________________________________________________________________________________________________________________________________________ ARTHTROPLASTY OF Staphylococci CEFAZOLINARTHTROPLASTY OF Staphylococci CEFAZOLIN 1-2 g IV1-2 g IV JOINT REPLACEMENTJOINT REPLACEMENT OPEN REDUCTIONOPEN REDUCTION OF FRACTURESOF FRACTURES LOWER LIMB AMPUTATIONLOWER LIMB AMPUTATION ______________________________________________________________________________________________________________________________________________________________________
Gastro duodenal Streptococci,Coliforms, CEFAZOLIN 1-2 gGastro duodenal Streptococci,Coliforms, CEFAZOLIN 1-2 g iviv anaerobic bacteria incl.anaerobic bacteria incl. Bacteroides sppBacteroides spp ________________________________________________________________________________________________________________________________ BILIARY TRACTBILIARY TRACT Coliform, enterococci, CEFAZOLIN 2 gColiform, enterococci, CEFAZOLIN 2 g iviv For high risk only anaerobic bact incl. CEFOXITIN 2 gFor high risk only anaerobic bact incl. CEFOXITIN 2 g iviv : > 70 years Bacteroides,clostridia: > 70 years Bacteroides,clostridia Obstr joundiceObstr joundice Acute cholecystitisAcute cholecystitis Acute cholangitisAcute cholangitis Common duct stoneCommon duct stone Low risk NO PROPHYLAXISLow risk NO PROPHYLAXIS ________________________________________________________________________________________________________________________________
Colon/small bowelColon/small bowel coliforms,anaerobic CEFOXITIN 2 g ivcoliforms,anaerobic CEFOXITIN 2 g iv bacteria incl.bacteroibacteria incl.bacteroi des fragilisdes fragilis ____________________________________________________________________________________________________________________ APPENDECTOMYAPPENDECTOMY Coliforms,anaerobic CEFOXITIN 2 g ivColiforms,anaerobic CEFOXITIN 2 g iv bacteria incl.bacteroibacteria incl.bacteroi des fragilisdes fragilis ____________________________________________________________________________________________________________________ PENETRATINGPENETRATING idem CEFOXITIN 2 g ividem CEFOXITIN 2 g iv ABD TRAUMAABD TRAUMA ____________________________________________________________________________________________________________________
VAGINALor abdominalVAGINALor abdominal Coliformes,enterococciCEFAZOLIN 1-2 gColiformes,enterococciCEFAZOLIN 1-2 g iviv HysterectomyHysterectomy group B streptococcigroup B streptococci ____________________________________________________________________________________________________________________ Caesarian sectiionCaesarian sectiion with as for hysterectomy CEFAZOLIN 1 gwith as for hysterectomy CEFAZOLIN 1 g iviv High risk e.g prematureHigh risk e.g premature Rupture of membranes CEFOXITIN 2 g ivRupture of membranes CEFOXITIN 2 g iv Low 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 500mg oraloral ____________________________________________________________________________________________________________________ CNS ShuntCNS Shunt Staphylococci CEFAZOLIN 1 gStaphylococci CEFAZOLIN 1 g iviv ____________________________________________________________________________________________________________________
AB DI BIDANGAB DI BIDANG MUSKULOSKELETALMUSKULOSKELETAL ? 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 ??
GUIDE LINE AB PROFILAXISGUIDE LINE AB PROFILAXIS ORTHO 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 Gr pre 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, 2gr Pre 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 1-2 gr selama 3 hari &gentamycin 2 x 80 mg, 3 hari.gr selama 3 hari &gentamycin 2 x 80 mg, 3 hari.
KESIMPULANKESIMPULAN ? DIAGNOSIS PRE OPPENTINGDIAGNOSIS PRE OPPENTING ? 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 INFEKSI MANIFEST; CEF II, III dan GentamycinMANIFEST; CEF II, III dan Gentamycin ? IDEAL: ~ HASIL KULTUR & S TESIDEAL: ~ HASIL KULTUR & S TES
?CEGAH INFEKSI NOSOKOMIAL !!CEGAH INFEKSI NOSOKOMIAL !! ?ABAB BUKAN SATU-SATUNYA FAKTORBUKAN SATU-SATUNYA FAKTOR YG BISA CEGAH INFEKSI.YG BISA CEGAH INFEKSI. ?PERHATIKAN HAL-HAL LAIN YG ERATPERHATIKAN HAL-HAL LAIN YG ERAT KAITAN TERHADAP KEJADIANKAITAN TERHADAP KEJADIAN INFEKSI.INFEKSI.
Thank u doctor , i`m oke !!Thank u doctor , i`m oke !!
TERIMA KASIHTERIMA KASIH..

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Pemakaian antibiotika pra bedah pada fraktur terbuka

  • 1. PEMAKAIAN ANTIBIOTIKAPEMAKAIAN ANTIBIOTIKA PRA BEDAH PADAPRA BEDAH PADA FRAKTUR TERBUKAFRAKTUR TERBUKA OlehOleh Dr.Azharuddin,SpBO-K.Spine FICSDr.Azharuddin,SpBO-K.Spine FICS Divisi Bedah Orthopaedi FK UNSYIAH/BPK-Divisi Bedah Orthopaedi FK UNSYIAH/BPK- RSUZA Banda AcehRSUZA Banda Aceh 20042004
  • 5. Fr terbuka+plating 6 minggu post opFr terbuka+plating 6 minggu post op
  • 6. PendahuluanPendahuluan ? AB Profilaksis pada fraktur terbuka; infeksi.AB Profilaksis pada fraktur terbuka; infeksi. ? Dasar Pemilihan JenisAB ?Dasar Pemilihan JenisAB ? ? -Kemungkinan kuman patogen yang spesifik.-Kemungkinan kuman patogen yang spesifik. ? Fraktur terbuka, kuman>> staphylococcusFraktur terbuka, kuman>> staphylococcus ? ABIdeal pada fr terbuka?ABIdeal pada fr terbuka? CEFAZOLINCEFAZOLIN
  • 7. ALTERNATIF ABPROFILAKSISALTERNATIF ABPROFILAKSIS ? 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)
  • 8. CARA PEMBERIAN ABCARA PEMBERIAN AB PROFILAKSISPROFILAKSIS ?SATU KALI PRE OPERASISATU KALI PRE OPERASI ?DOSIS TINGGIDOSIS TINGGI ?SETENGAH JAM PRE OPERASISETENGAH JAM PRE OPERASI ?INTRAVENOUSINTRAVENOUS
  • 9. PRINSIP PENANGANANPRINSIP PENANGANAN FRAKTUR TERBUKAFRAKTUR TERBUKA ? ASUMSIKAN SEMUA GRADING FRASUMSIKAN SEMUA GRADING FR TERBUKA------TERKONTAMINASITERBUKA------TERKONTAMINASI ? CEGAH PASIEN MENJADI INFECTEDCEGAH PASIEN MENJADI INFECTED ? CARA:CARA: 1.WOUND DEBRIDEMENT1.WOUND DEBRIDEMENT 2.AB PROFILAXIS2.AB PROFILAXIS 3.STABILIZATION OF THE FRACTURE3.STABILIZATION OF THE FRACTURE 4.EARLY WOUND COVER4.EARLY WOUND COVER
  • 12. INSIDEN INFEKSI FR TERBUKAINSIDEN INFEKSI FR TERBUKA ?? ?KORELASI DENGANKORELASI DENGAN EXTENT OF SOFTEXTENT OF SOFT TISSUE DAMAGETISSUE DAMAGE ?GRADEGRADE II : <: < 1 %1 % ?GRADEGRADE III : > 10 %III : > 10 %
  • 13. KONSEP UMUM INFEKSIKONSEP UMUM INFEKSI MUSKULOSKELETALMUSKULOSKELETAL ? 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 ABDLM MEMBERIKAN AB ? HOST FACTORHOST FACTOR
  • 14. HAL-HAL YANG PERLUHAL-HAL YANG PERLU DIKETAHUIDIKETAHUI ?RIWAYAT TRAUMARIWAYAT TRAUMA ?KONTAMINASIKONTAMINASI ?RIWAYAT PENYAKIT LAINRIWAYAT PENYAKIT LAIN ?FOTO POLOSFOTO POLOS ?KULTUR DAN SENSITIVITY TESKULTUR DAN SENSITIVITY TES ?KULTUR DARAHKULTUR DARAH
  • 15. PENGGUNAAN AB RASIONALPENGGUNAAN AB RASIONAL PD 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 ??
  • 16. TABEL AB PROFILAKSIS KASUSTABEL AB PROFILAKSIS KASUS KASUS BEDAHKASUS BEDAH Surgical procedureSurgical procedure predominant inf microorganismpredominant inf microorganism recommened agentrecommened agent dosedose routeroute ______________________________________________________________________________________________________________________________________________________________________ CARDIO THORACICCARDIO THORACIC Staphylococci CEFAZOLIN 1-2 gStaphylococci CEFAZOLIN 1-2 g iviv or CEFUROXIME 1,5 g ivor CEFUROXIME 1,5 g iv or VANCOMYCINor VANCOMYCIN ____________________________________________________________________________________________________________________________________________________________________ Non-cardiacNon-cardiac Staphylococci CEFAZOLIN or 1-2 g ivStaphylococci CEFAZOLIN or 1-2 g iv Vascular SurgeryVascular Surgery CEFUROXIME 1,5 g ivCEFUROXIME 1,5 g iv ______________________________________________________________________________________________________________________________________________________________________ ARTHTROPLASTY OF Staphylococci CEFAZOLINARTHTROPLASTY OF Staphylococci CEFAZOLIN 1-2 g IV1-2 g IV JOINT REPLACEMENTJOINT REPLACEMENT OPEN REDUCTIONOPEN REDUCTION OF FRACTURESOF FRACTURES LOWER LIMB AMPUTATIONLOWER LIMB AMPUTATION ______________________________________________________________________________________________________________________________________________________________________
  • 17. Gastro duodenal Streptococci,Coliforms, CEFAZOLIN 1-2 gGastro duodenal Streptococci,Coliforms, CEFAZOLIN 1-2 g iviv anaerobic bacteria incl.anaerobic bacteria incl. Bacteroides sppBacteroides spp ________________________________________________________________________________________________________________________________ BILIARY TRACTBILIARY TRACT Coliform, enterococci, CEFAZOLIN 2 gColiform, enterococci, CEFAZOLIN 2 g iviv For high risk only anaerobic bact incl. CEFOXITIN 2 gFor high risk only anaerobic bact incl. CEFOXITIN 2 g iviv : > 70 years Bacteroides,clostridia: > 70 years Bacteroides,clostridia Obstr joundiceObstr joundice Acute cholecystitisAcute cholecystitis Acute cholangitisAcute cholangitis Common duct stoneCommon duct stone Low risk NO PROPHYLAXISLow risk NO PROPHYLAXIS ________________________________________________________________________________________________________________________________
  • 18. Colon/small bowelColon/small bowel coliforms,anaerobic CEFOXITIN 2 g ivcoliforms,anaerobic CEFOXITIN 2 g iv bacteria incl.bacteroibacteria incl.bacteroi des fragilisdes fragilis ____________________________________________________________________________________________________________________ APPENDECTOMYAPPENDECTOMY Coliforms,anaerobic CEFOXITIN 2 g ivColiforms,anaerobic CEFOXITIN 2 g iv bacteria incl.bacteroibacteria incl.bacteroi des fragilisdes fragilis ____________________________________________________________________________________________________________________ PENETRATINGPENETRATING idem CEFOXITIN 2 g ividem CEFOXITIN 2 g iv ABD TRAUMAABD TRAUMA ____________________________________________________________________________________________________________________
  • 19. VAGINALor abdominalVAGINALor abdominal Coliformes,enterococciCEFAZOLIN 1-2 gColiformes,enterococciCEFAZOLIN 1-2 g iviv HysterectomyHysterectomy group B streptococcigroup B streptococci ____________________________________________________________________________________________________________________ Caesarian sectiionCaesarian sectiion with as for hysterectomy CEFAZOLIN 1 gwith as for hysterectomy CEFAZOLIN 1 g iviv High risk e.g prematureHigh risk e.g premature Rupture of membranes CEFOXITIN 2 g ivRupture of membranes CEFOXITIN 2 g iv Low 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 500mg oraloral ____________________________________________________________________________________________________________________ CNS ShuntCNS Shunt Staphylococci CEFAZOLIN 1 gStaphylococci CEFAZOLIN 1 g iviv ____________________________________________________________________________________________________________________
  • 20. AB DI BIDANGAB DI BIDANG MUSKULOSKELETALMUSKULOSKELETAL ? 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 ??
  • 21. GUIDE LINE AB PROFILAXISGUIDE LINE AB PROFILAXIS ORTHO 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 Gr pre 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, 2gr Pre 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 1-2 gr selama 3 hari &gentamycin 2 x 80 mg, 3 hari.gr selama 3 hari &gentamycin 2 x 80 mg, 3 hari.
  • 22. KESIMPULANKESIMPULAN ? DIAGNOSIS PRE OPPENTINGDIAGNOSIS PRE OPPENTING ? 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 INFEKSI MANIFEST; CEF II, III dan GentamycinMANIFEST; CEF II, III dan Gentamycin ? IDEAL: ~ HASIL KULTUR & S TESIDEAL: ~ HASIL KULTUR & S TES
  • 23. ?CEGAH INFEKSI NOSOKOMIAL !!CEGAH INFEKSI NOSOKOMIAL !! ?ABAB BUKAN SATU-SATUNYA FAKTORBUKAN SATU-SATUNYA FAKTOR YG BISA CEGAH INFEKSI.YG BISA CEGAH INFEKSI. ?PERHATIKAN HAL-HAL LAIN YG ERATPERHATIKAN HAL-HAL LAIN YG ERAT KAITAN TERHADAP KEJADIANKAITAN TERHADAP KEJADIAN INFEKSI.INFEKSI.
  • 24. Thank u doctor , i`m oke !!Thank u doctor , i`m oke !!