PROGRAM PENGENDALIAN

RESISTENSI ANTIMIKROBA
DI RUMAH SAKIT
HARI PARATON. dr. SpOGK

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

GLOBAL AMR

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTERIAN KESEHATAN
PENDAHULUAN

When I was asked to chair the Review on

Antimicrobial Resistance (AMR), I was
told that AMR was one of the biggest
health threats that mankind faces now
and in the coming decades. My initial
response was to ask, Why should an
economist lead this? Why not a health
economist? The answer was that many of
the urgent problems are economic, so
we need an economist, especially one versed
in macro-economic issues and the world
economy, to create the solutions.
MASALAH GLOBAL

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTERIAN KESEHATAN
AMR: GLOBAL PROBLEMS
THE AMR IMPACTS
 MASALAH GLOBAL

2013 700.000 / tahun

WHO 2013
10.000.000/tahun
2050
USD. 100 TRILLIUN
(Jim O Neill 2015)
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
KEMENTERIAN KESEHATAN
 AMR: Global problem, Mortality and
Economic impact

EROPA THAILAND USA USA

UNION
Population 70 M
Population 300 M Population 250 M
-Populatin 500 M >38.000 death/
>23.000 death/ >135.000 death/
-25.000 death/ yrs
yrs yrs
year 3.2 Mextra ALOS 2 Mextra ALOS Cost Rp. 56. T
-2,5 Mextra ALOS Cost US$ 1.3 B Cost US$ 20 B
-Cost 1.5 / yrs

WHO, 2007 9
 Child 1.4 Y.o, post operasi Tetralogy Fallot hari 16.
Temp/ 37-39C, PCT > 5, lekosit 23.000.
Pus luka op. Pathogen: Acinotobacter baumannii
Resistance to Cephalosphorine, Meropenem, Amikacin,
Fosfomycin.
 BAGAIMANA INDONESIA

The prevalence of ESBL producing E.coli and RSUD.Dr. Soetomo 204 sample kasus
Klebsiella pneumoniae among hospitals in Jan-Juli 2010
Indonesia six hospitals 2013
N= 554
60 56,39% 56,8% 100.00%
51,69% 52,23% 90.00%
50 45,33% 80.00%
40,83% 70.00%
40 37,82% 60.00%

Persentase
34,31% 32,16% 32,7% 35,02
50.00% %(194)
30 27,94% 26,71% 40.00%
30.00%
20 20.00% 6,50%(36) 4,51%(25)
10.00%
10 0.00%
Jumlah Isolat Jumlah ESBL Jumlah PAN Jumlah
RESISTEN MRSA
0
Macam Isolat

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTRIAN KESEHATAN
 Table. Antibiotic susceptibility (n) pattern of ESBL producing E.coli

RSDS RSSA RSDM RSDK RSSD RSP TOTAL

Cefotaxime 0.17 0.00 NA 1.57 3.31 NA 0,78
Ceftriaxone 0.00 0.00 2.62 5.93 NA 0.00 1,19
Ceftazidime 0.17 0.00 12.07 4.19 8.33 0.00 3,83
Cefepime 0.34 42.06 26.21 9.42 25.62 0.00 12,78
Ciprofloxasin 16.10 29.37 10.00 18.32 7.50 10.42 15,21
Amikacin 97.95 95.24 82.99 96.34 73.33 98.96 92,4
Gentamycin 61.43 69.05 62.15 10.99 56.30 63.54 55,12
Fosfomycin 92.86 100.00 NA 78.57 82.89 NA 90,85
Piperacillin-
49.57 76.19 NA 76.44 65.81 66.67 60,4
tazobactam
Cefoperazone-
53.85 NA 83.33 72.73 57.98 15.63 57,08
sulbactam
Meropenem 99.83 98.41 98.96 95.29 94.96 100.00 98,51
Levofloxacin 20.14 29.37 9.00 21.48 15.38 10.42 17,66
Tigecyclin 78.08 99.21 97.92 99.48 40.63 100.00 94,67

Data surveillance PPRA RSDS-Balitbangkes-WHO 2013

12
ESBL PRODUCING
BACTERIA

PREVALENCE of ESBL in INDONESIA

70
66
60 surveillance
2016
50 45-89%
presentage

40 40
35 WHO/
PPRA ESBL
30 28 26-56%

20 RSDS
RSDS
10 9 AMRIN
0
2000 2005 2010 2013 2016
 THE PROBLEM
ANTIBIOTIC
USE

Blood stream
Pneumonia
HAI AMR UTI
SSI

more difficult to treat

more procedures
high cost
ICU use
failure morbidity and mortality
PEMICU RESISTENSI
SELECTIVE PRESSURE

Hasil
Kategori Sby Semg
(%) (%)
Tidak ada
indikasi 76 53
terapi

Tidak ada
indikasi 55 81
profilaksis

AMRIN STUDY : 2002-2005

15 15
THEORY SELECTIVE PRESSURE

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTRIAN KESEHATAN
 BAKTERI RESISTEN

Rational use

Missuse Efflux
Degradation enz
Overuse
Altering enz
Biofilm
Underuse
 LANGKAH STRATEGIK

5 Strategic
global problem objective
PPRA

peningkatan turunnya
Prevalensi AMR prevalensi AMR
WHO; Global Action Plan

1. Improve awareness and understanding of antimicrobial resistance

through effective communication, education and training
2. Strengthen the knowledge and evidence base through surveillance a
nd research.
3. Reduce the incidence of infection through effective sanitation, hygiene
and infection prevention measures.
4. Optimize the use of antimicrobial medicines in human and ani
mal health.
5. Develop the economic case for sustainable investment that takes acco
unt of
the needs of all countries, and increase investment in new medicines,
diagnostic tools, vaccines and other interventions.
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
KEMENTERIAN KESEHATAN
PRUDENT USE OF ANTIBIOTIC

Prudent use of antibiotics has 3 components,

rational use,
adherence to local guidelines and policies,
avoidance or reversal of upward demographic trends in
antibiotic resistance (Phillips, CID. 2001)

The prudent use of antimicrobials as usage of antimicrobials

which maximizes therapeutic effect and minimizes the
development of antimicrobial resistance (WHO, 2008)
 Pertanian/
Peternakan
Problems /perikanan
Map Growth Cegah
infeksi Regulasi
promotor

Food Kurikulum
Knowledge Residu AB Insentif
(+)

R AB / Training/
OTC/Apotek self AMR R AB/ Knowle Seminar
DR dge
medikasi RS Workshop

Regulasi
Mikro ASP
KM/KFT
klinik

Farmasi TOP
klinik MGT
PPI Klinisi

22
 AMR MENJADI BEBAN
RUMAH SAKIT RUJUKAN

RUMAH RUMAH SAKIT RUMAH

SAKIT SAKIT
 HEALTH RESOURCES IN INDONESIA 2016

Profesion total Facilities total

Hospital 2.415
Specialist 32.280
Health center 9.600
GP 116.900 Drug store 24.000
Dentist 31.360 Medical Faculty 73
Dentistry Faculty 27
Midwife 400.000
Pharmaceutical 127
Nurse 288.000 Faculty
Midwife Academy 720
Pharmacist 54.900. Nurse academy 300 24
 KPRA adalah Forum
Koordinasi AKSELERASI

PPI FARMASI

KEPERA KLINISI
KPRA
WATAN DOKTER
MIKROBI
KFT OLOGI
KLINIK

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTRIAN KESEHATAN
Strategi Utama Penurunan Prevalensi
Bakteri Resisten

PPI, HS,
IMMUNISASI

SURVEILLANCE ANTIBIOTIK
DAN RISET BIJAK

KESADARAN
DAN
AMR INOVASI AB
BARU, RAPID
KESEPAHAMAN
TEST
HARAPAN BERSAMA

PREVALENCE of ESBL in INDONESIA

70
surveillance 66
2016
60 45-89% HARAPAN
KITA
50 BERSAMA
presentage

40 40 40
35
30 30 ESBL
28
20 RSDS 20
RSDS
10 9 AMRIN
0
2000 2005 2010 2013 2016 2017 2018 2019
MENGAPA HARUS TERJADI ?
TERIMA KASIH

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTERIAN KESEHATAN