HUBUNGAN INFEKSI SALMONELLA TYPHI DENGAN KOMPLIKASI INTESTINAL DAN SISTEMIK : A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS
Keywords:
Salmonella Typhi, demam tifoid, perforasi intestinal, vaksin konjugat tifoid, resistensi antimikrobaAbstract
Pendahuluan: Demam tifoid akibat Salmonella enterica serovar Typhi masih menjadi beban kesehatan global signifikan dengan potensi komplikasi intestinal (perforasi ileum, perdarahan enterik) dan sistemik (ensefalopati, syok, hepatitis, miokarditis). Tinjauan sistematis ini bertujuan mensintesis bukti uji acak terkendali (RCT) mengenai hubungan infeksi S. Typhi dengan komplikasi serta modifikasi risiko melalui intervensi antimikroba, kortikosteroid adjuvan, dan vaksinasi.
Metode: Penelusuran dilakukan mengikuti PRISMA 2020. Kriteria inklusi menggunakan kerangka PICOS: populasi tifoid terkonfirmasi kultur atau berisiko di endemis; intervensi antimikroba, kortikosteroid, atau vaksin; komparator aktif/plasebo; luaran komplikasi intestinal dan sistemik. Risiko bias dinilai dengan Cochrane RoB 2, kepastian bukti dengan GRADE.
Hasil: Sebanyak 21 RCT (>315.000 partisipan) diinklusikan. Deksametason dosis tinggi menurunkan mortalitas tifoid berat dari 55,6% menjadi 10,0% (p=0,003). Gatifloksasin superior terhadap sefiksim (HR 0,084; p<0,0001) namun inferior terhadap seftriakson pada galur resisten fluorokuinolon (HR 0,24; p=0,01). Vaksin konjugat tifoid memberikan efikasi 78,3-85% konsisten di Nepal, Malawi, dan Bangladesh. Komplikasi berat tidak terdeteksi sebagai luaran bermakna pada RCT terapi rawat jalan karena insidens rendah.
Diskusi: Resistensi antimikroba telah mengubah lanskap terapi; fluorokuinolon tidak direkomendasikan di wilayah resistensi tinggi. Vaksinasi konjugat merupakan intervensi pencegahan komplikasi dengan bukti terkuat.
Kesimpulan: Vaksin konjugat tifoid dan deksametason pada tifoid berat memiliki bukti acak terbaik. Terapi antimikroba harus dipandu pola kerentanan lokal. Diperlukan RCT kontemporer dengan luaran komplikasi primer.
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