Beruflich Dokumente
Kultur Dokumente
Tri Wibawa
Department of Microbiology
Faculty of Medicine – Public Health & Nursing
Universitas Gadjah Mada
AMR: An increasing global threat
requiring global action
• Not a new issue, several previous
initiatives
• Increasingly a global threat to public
health
• Untreatable infections; multiple-drug
resistance
• Desperation over "dry pipeline"
• Growing awareness and commitment
• Political, professional, public
• Global problem requiring a global solution
Growing Awareness & Political
Commitment
Deaths attributable to AMR every year by 2050
Mortality & Economic
impact
• By 2050, lead to 10 million
deaths/year
• Reduction of 2 to 3.5 percent in
GDP
• Costing the world up to $100
trillion
J. O'Neil, 2014. Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations.
Robin McKie
Sunday 8
October
2017
05.59 BST
Bakteri
Resisten Penularan
(CLSI M39-A4)
• Analyse and present a cumulative
antibiogram report at least annually
• Include only final, verified test results.
• Include only species with testing data for ≥ Recommendations
30 isolates for Antibiogram
• Include only diagnostic (not surveillance) Report (1)
isolates
(CLSI M39-A4)
• Eliminate duplicate by reporting only the
first isolate of a species/patients/periods
irrespective body sites and AST profile
• Include only antimicrobial agents routinely Recommendations
tested.
for Antibiogram
• Do not reported supplemented agents
Report (2)
• Report %S and not include %I
(CLSI M39-A4)
• Streptococcus pneumoniae and
cefotaxime/ceftriaxone/penicillin: %S use
meningitis and non-mengitis break point. For
Penicillin: Consider %S using oral break point
Recommendations
• Stretococcus Viridans and peniciliin : List
both %S and %I for Antibiogram
• S. aureus: list the %S for all isolates and the Report (3)
MRSA subsets
(CLSI M39-A4)
Factor May Affect Cumulative
Antibiogram Data
• Patient population
• Culturing practice
• Laboratory antimicrobial
susceptibility testing and
reporting policy
• Temporal outbreaks
Antibiogram Limitations
• It should not be relied upon as the sole tool
for guiding therapy
• Minimum inhibitory concentrations (MICs) are
not included → “MIC creep” will not be
detected
• Data do not take into account patient factors:
• History of antimicrobial use
• Ages
• Underlying medical condition
Antibiogram
Limitations
• Data are the result of single organism-
antimicrobial combinations, therefore
do not show trends in cross-resistance
of an organism to other drugs, nor do
they reveal synergistic properties of
antimicrobials used in combination
• Data may not be generalizable to
specific patient populations or locations
of a healthcare facility if the antibiogram
is compiled using hospital- or healthcare
system-wide data
PPRA : Program
Pengendalian
Resistensi
Antimikroba di
Rumah Sakit
PMK no.8/2015: Pasal 6
1. Setiap rumah sakit HARUS melaksanakan Program Pengendalian
Resistensi Antimikroba secara optimal.
2. Pelaksanaan Program Pengendalian Resistensi Antimikroba
sebagaimana dimaksud pada ayat (1) dilakukan melalui:
a. Pembentukan tim pelaksana Program Pengendalian Resistensi
Antimikroba;
b. Penyusunan kebijakan dan panduan penggunaan antibiotik;
c. Melaksanakan penggunaan antibiotik secara bijak
d. Melaksanakan prinsip pencegahan pengendalian infeksi
Pembentukan
Tim PPRA
• Klinisi perwakilan
SMF/bagian
• Keperawatan
• Instalasi farmasi
• Laboratorium mikrobiologi
klinik
• Komite/tim pencegahan
pengendalian infeksi (PPI)
• Komite/tim farmasi dan
terapi (KFT).
Tugas Pokok Tim PPRA
• Membantu Kepala/Direktur rumah sakit dalam:
• menyusun kebijakan tentang pengendalian resistensi antimikroba;
• menyusun kebijakan dan panduan penggunaan antibiotik rumah sakit;
• melaksanakan program pengendalian resistensi antimikroba di rumah
sakit;
• mengawasi dan mengevaluasi pelaksanaan pengendalian resistensi
antimikoba di rumah sakit;
• Menyelenggarakan forum kajian kasus pengelolaan penyakit infeksi
terintegrasi;
• Melakukan surveilans pola penggunaan antibiotik;
• Melakukan surveilans pola mikroba penyebab infeksi dan kepekaannya
terhadap antibiotik;
• Menyebarluaskan serta meningkatkan pemahaman dan kesadaran tentang
prinsip pengendalian resistensi antimikroba, penggunaan antibiotik secara
bijak, dan ketaatan terhadap pencegahan pengendalian infeksi melalui
kegiatan pendidikan dan pelatihan;
• Mengembangkan penelitian di bidang pengendalian resistensi antimikroba;
• Melaporkan pelaksanaan program pengendalian resistensi antimikroba
kepada Kepala/Direktur rumah sakit.
Tugas Lab/dokter Mikrobiologi Klinik
Melakukan pelayanan pemeriksaan
mikrobiologi
Clinicians should always consider patient-specific information (e.g., prior culture results, recent antimicrobial therapy
and immune status) when selecting therapy
They should also reassess their initial treatment choice (continue, modify, de-escalate, discontinue) once cultures are
available.
An efficient way to develop local empiric antibiotic regimens is to use established national or provincial guidelines,
and/or guidelines from other institutions.
Local guidelines should also be updated regularly as new information becomes available.
Choice of Empiric Antibiotic
Therapy is Based on:
• The site of infection.
• Common pathogens encountered.
• Local epidemiology and resistance
patterns.
• Evidence and clinician consensus.
• Antimicrobial stewardship principles.
• Formulary availability.
• Antimicrobial costs.
De-escalation of Antibiotic Prescription
Diagnosis of bacterial
infection Microbiological
Examination
Empiric Antibiotic
treatment Microbiological
Examination
Result:
Definitive Antibiotic Identification
treatment and AST
Definitive Antibiotic Treatment
Microbiological
culture and AST
Pathogenic
Colonization
/Infection