Abses subkutan akibat K. pneumonia pada paha kiri neonatus setelah injeksi vitamin K intramuskular: sebuah laporan kasus langka
Authors: Christisiwi Aprilia , Angelis Astrid , Herdianti Alfarina 
Published: September 2024

Background: A 1 mg intramuscular vitamin K injection is a routine procedure for neonates. It is clinically proven to reduce the incidence of VKDB (Vitamin K Deficiency Bleeding). Numerous research regarding subcutaneous abscesses after intramuscular injection. However, cases of subcutaneous abscesses caused by K. pneumoniae are not widely reported. This study aims to report the incidence of subcutaneous abscess due to Klebsiella pneumoniae in a full-term neonate patient following intramuscular vitamin K injection. 
Case Description: A 22-day-old neonate came to the emergency room with erythematous swelling at the left thigh for the last two weeks that worsened over time. The patient received a 1 mg intramuscular vitamin K injection in the left thigh when he was 1 day old. At the left femoral region, there was erythematous swelling and fluctuation. The swelling was warm and tender, with a diameter of 4 cm. Femoral x-ray showed soft tissue mass at the left femur. Ultrasonography examination showed a hypoechoic lesion with a well-defined margin and regular edge. The lesion was 2.31 2.31 cm x 3.47 cm and showed no fluid collection. Color Doppler examination showed hypervascularization that indicated a left femoral abscess, and bacterial culture showed Klebsiella pneumoniae growth, while anatomical pathology examination showed suppurative acute inflammation. Drainage was done on the first day of admission and yielded 5 ml of purulent fluid. The patient received 1x15 mg of IV gentamicin and 2x150 mg of IV ampicillin-sulbactam during hospitalization.
Conclusion: Subcutaneous abscess after vitamin K injection in neonates can be caused by Klebsiella pneumoniae. Immediate antimicrobial therapy and drainage will improve outcomes.
 
Pendahuluan: Injeksi intramuskular (IM) vitamin K 1 mg pada neonatus merupakan prosedur yang rutin dan terbukti menurunkan kejadian VKDB (Vitamin K Deficiency Bleeding). Beberapa penelitian tentang abses pada neonatus pasca injeksi IM telah banyak umumnya pasca vaksinasi. Namun abses subkutan pasca injeksi vitamin K yang disebabkan oleh K. pneumonie pada neonatus belum banyak dilaporkan. Laporan kasus ini bertujuan untuk melaporkan kejadian abses subkutan karena Klebsiella pneumoniae pada pasien neonatus cukup bulan pasca pemberian injeksi IM vitamin K. 
Kasus: Neonatus usia 22 hari datang ke IGD dengan keluhan bengkak kemerahan pada paha sebelah kiri sejak 2 minggu terakhir dan dirasakan semakin memberat. Pasien pada usia 1 hari, menerima suntikan IM vitamin K 1 mg di paha kiri. Pada regio femur sinistra tampak edema kemerahan, fluktuasi, eritematosa, kalor, teraba keras dengan diameter kurang lebih 4 cm. Pemeriksaan rontgen femur didapatkan massa soft tissue di daerah femur sinistra. Pemeriksaan ultrasonografi  didapatkan lesi hipoekoik batas tegas tepi regular berukuran 2.31 cm x 3.47 cm, tidak tampak koleksi cairan, dan pemeriksaan colour doppler tampak hipervaskuler kesan abses femur sinistra. Hasil kultur pus ditemukan Klebsiella pneumoniae, dan hasil patologi anatomi ditemukan radang akut supuratif. Pasien dilakukan drainase pada hari pertama perawatan didapatkan pus berupa perkejuan dengan jumlah kurang lebih 5 ml, dan diberikan antibiotik gentamisin 1x15 mg iv serta ampisilin sulbaktam 2x150 mg IV selama perawatan.
Kesimpulan: Abses subkutan pasca pemberian injeksi vitamin K pada neonatus dapat disebabkan oleh infeksi Klebsiella pneumoniae. Pemberian antibiotik dan drainase dilakukan segera dapat memberikan hasil yang baik.