Pendidikan :
SMP - SMA : Kolese KANISIUS, 1994
Dokter Umum : FK TRISAKTI, 2002
Spesialis Penyakit Dalam (Internist) : FKUI, 2009
Konsultan Penyakit Tropik & Infeksi : FKUI / PAPDI, 2013
Pekerjaan :
Bendahara Pengurus Besar Perhimpunan Konsultan Penyakit Tropik dan
Infeksi Indonesia (PB PETRI)
RONALD IRWANTO
PP PERDALIN
CLABSI : Central Line
Associated BSIs
Using Central Line BSIs SEPSIS
Primary BSIs
Hospital Settings
Majority causal :
- Gram Negative
MDR / XDR/PDR Gram Negative
(ESBL, Pseudomonas sp,Acinetobacter sp, etc)
- Gram Positive (MSSA/E, MRSA/E)
- Candida sp , Aspergillus sp (SFIs / IFIs)
Non Neutropenic Candidemia
Wenzel RP
M. Falagas
CLABSI : Central Line
Associated BSIs
BSIs Blood Stream Infections Sepsis
Bone et al criteria 1992
(Infection SITE + SIRS)
Chest 1992;101:1644
Criteria of Organ Dysfunction
Aterial hypotension (MAP<70)
SCVO2 >70%
CI>3.5 L/mt/m2
Arterial hypoxemia (PaO2/FiO2 <300)
Acute oliguria (urine output<0.5ml/kg/h for at least 2
hours)
Creatinin increase >0.5mg/dL
Coagulation abnormalites (INR >1.5 or aPTT > 60 sec)
Ileus
Thombocytopenia <100.000/uL
Hyperbilirubinemia >4 mg?dL
Tissue Perfusion
Hyperlactatemia >3 mmol/L
Decrease capilary fill SCCM/ESICM/ACCP/ATS/SIS
International Sepsis Definition Cofence,2001
Emergency Medicine 2010
How To Predict the Etiology of CLABSI?
Bacterial VS Fungal
Clinical parameter :
- Onset
- Progress
Laboratory parameter
- Procalcitonin
- Culture result
Risk Factors for Systemic Fungal Infections
Candida colonization
Prolonged used wide spectrum antibiotics
Iatrogenic : CVC
Ventilators
Urinary catethers
Hemodialysis
Surgery
Host Condition:
Malignancy
HIV-AIDS
Burns
COPD
Fungal infections have become increasingly
more frequent
Immunocompromised patients
AIDS organ transplantation
CANDIDA IS
THE MOST
COMMON
OF
HUMAN FUNGAL
INFECTION
BOTH SUPERFICIAL
OR INVASIVE/
SYSTEMIC
INFECTION
Invasive / Systemic Candida Infection
Risk Factors
Neutrophils count
<500
NEUTROPENIC
COLONIZATION
Febrile Neutropenia
Transplantation, MDS
Candida Post Chemotherapy, etc
Infection HIV/AIDS
Prolonged ICU Stay
>96 hours
NON
CVC
NEUTROPENIC
Broad Spec. AB
Non Immunocompromised GI Surgery, TPN, etc
Immunocompromised :
Primary COLONIZATION
Secondary : HIV/AIDS
Bassetti et al. Critical Care 2010
Non-Neutropenic Candida Infection
Prediction and Treatment Approach
Overtreatment Undertreatment
Successful response
Ben E. dePauw. CID 2005;41:1251-3
Conclusion
CLABSI need to be watch and observe for
every patient using central line device
BSIs showed by clinical symptoms and
conditions that fulfill the diagnosis criteria
Bacterial or fungal is the caused of
CLABSI
A few kind of criteria should be considered
to predict the etiology of CLABSI