NILAI DIAGNISTIK PENGECATAN GRAM SPUTUM PNEUMONIA KOHUNITAS DI DAGIAN PENYAKIT DALAM R S D K DAM RSU KODYA SEMARANG THE DIAGNOSTIC VALUE OF GRAM STAIN IN SPUTUM OF COMMUNITY ACQUIRED PNEUMONIA AT THE INTERNAL DERAREMENT OF KARIADI AND KODYA HOSPITAL SEMARANG

Abstract

BACKGROUND: A rapid, non-invasive and simple diagnostic test is very important to investigate the microorganism as causative agent of pneumonia hence promp treatment of antibiotics could be initiated early, the clini-cal course of pneumonia deteriorate uncertainly. The sensitivity and specificity of Gram stain formerly reported, had a broad varieties. OBJECTIVE: To evaluate the diagnostic value of Gram stain in determining Streptococcus pneumoniae from the sputum of community acquired pneumonia patients. METHODS: During the period of July 1, 1999 through March 31,2000 a cross sectional study was conducted, consisted of 68 patients of community acquired pneumonia treated in Internal Department of Kariadi and Kodya Hospital, Semarang. The data were analyzed descriptively, by 2x2 tables of diagnostic test. RESULTS: Sixty eight patients were enrolled in this study, the most pre-dominant were males, with the ratio between males:females = 1,4:1. The everage age was between 16 - 75 years-old; the most frequent were >/ 60 years-old; 33 (48.5%) patients. The most frequent comorbid were chronic obstructive pulmonary diseases; 29 (42.7%) patients, and smoking 15 (22,1%) patients. Gram stain of sputum expectoration revealed 42 (61.8%) gram positive diploccocus dominant. Among the 68 patients studied, the cultivation of the sputum revealed Streptoccocuspneumoniae in- 35 (51.5%) patients. The sensitivity and specificity of Gram stain againts Strepto-coccus pneumonia were 94.3% and 72,7% respectively. CONCLUTION: Gram stain of sputum had relatively high diagnostic value as an early diagnostic test to identify Streptococcus pneumoniae among the community acquired pneumonia patients. LATAR BELAKANG: Pemeriksaan tidak invasif, mudah dan hasil cepat sangat diperlukan untuk mengetahui mikroorganisme penyebab dan menetapkan pilihan terapi antibiotika pada pneumonia. Terapi harus segera diberikan, karena perjalan penyakit pneumonia dapat memburuk dengan cepat. Nilai akurasi, sensitivitas dan spesifisitas pengecatan Gram yang dilaporkan beberapa peneliti ternyata sangat bervariasi. TUJUAN: untuk mengetahui nilai diagnostik pengecatan Gram terhadap Strep-tokokus7 pneumonia pada sputum ekspektorasi pneumonia komunitas . METODOLOGI- Selama periode 1 Juli 1999 sampai 31 Maret 2000 (9 bulan ) dilakukan penelitian studi potong lintang terhadap 68 penderita pneumonia komunitas yang di rawat di Bagian Penyakit Dalam RSUP Dr.Kariadi dan RSU Kodya Semarang. Data dianalisis secara deskriftif dan analisis dengan tabel 2x2 untuk uji diagnostik. HASIL: Pada 68 penderita yang diteliti, sebagian besar laki-laki dengan ratio laki:perempuan = 1,4:1. Usia berkisar 16-75 tahun, terbanyak usia >/60 tahun 33 (48,5%). Penyakit penyerta (komorbid) terbanyak Penyakit Paru Obstruktif Kronik 29(42,7%), dan merokok 15 (22,1%). Pada pemeriksaan Gram, 42 (61,76%) spesimen dahak menunjukkan diplokokus gram positif dominan Streptokokusrpneumoniae tumbuh pada 35 (51,5%) biakan dari seluruh sampel yang diteliti. Nilai sensitivitas pengecatan Gram terhadap Streptococcus pneumoniae didapatkan 94,3%, spesifisitas 72,7%. KESIMPULAN: Pengecatan Gram sputum ekspektorasi merupakan cara pemerik-saan dengan nilai diagnostik yang cukup baik sebagai pemeriksaan awal dalam mengidentifikasi Streptokokuspleumonia pada penderita pneumonia komunitas.