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
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
 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

9
AMR: GLOBAL PROBLEMS
ESBL PRODUCING
BACTERIA

PREVALENCE of ESBL in INDONESIA

70
66 surveill
60 ance
2016
50 45-89%
presentage

40 40 WHO/
35 PPRA
30 26- ESBL
28 RSD 56%
20 RSD S
S
10 9 AMRI
0 N
2000 2005 2010 2013 2016
PEMICU RESISTENSI
SELECTIVE
PRESSURE

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

Tidak ada
indikasi 55 81
profilaksis

AMRIN STUDY : 2002-2005

12 12
 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
Proble Pertanian/
Peternakan
ms /perikanan
Growth
Map promoto
r
Cegah
infeksi
Regula
si

Food Kurikul
Knowled Residu AB Insent um
ge if
(+)
Training
R AB / R /Semina
OTC/Apat self AMR AB/ Knowle r
ek medikas dge
i RS DR Worksh
op

Regulasi
Mikro ASP KM/K
klinik FT

Farma TOP
si MGT
klinik
PPI Klinis
i
 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 15
 STRATEGI UTAMA
DI RUMAH SAKIT

CEGAH
SELECTIVE CEGAH KENDALI

PRESSURE TRANSMISI LINGKUNGAN

ANTIBIOTIK KEWASPADAAN
DEKOLONISASI
BIJAK UNIVERSAL

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTERIAN KESEHATAN
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
REGULASI SEBAGAI
LANDASAN HUKUM
 KPRA – RS
PERMENKES no 8/2015

pasal 6 Setiap rumah sakit harus melaksanakan

Program Pengendalian Resistensi Antimikroba
secara optimal.
pasal 7 susunan organisasi Komite / Tim Pelaksana
Program Pengendalian Resistensi Antimikroba
pasal 8 Keanggotaan tim pelaksana Program
Pengendalian Resistensi Antimikroba rumah
sakit
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
KEMENTERIAN KESEHATAN
 LANGKAH PRIORITAS
LANGKAH PRIORITAS
1. PPRA Diperlukan di setiap Rumah sakit, untuk
mengendalikan meningkatnya prevalensi AMR
2. KPRA/Tim PRA dibentuk berdasarkan SK Direktur
3. Anggota: Klinisi dokter, Mikrobiologi klinik, PPI,
Keperawatan, Farmasi klinik, KFT, dll
4. Perencanaan program dan implementasi, surveillance
HARAPAN BERSAMA

PREVALENCE of ESBL in INDONESIA

70
surveilla 66
nce 2016 HARAPA
60 45-89% N
KITA
50 BERSA
MA
presentage

40 40 40
35
30 30 ESBL
28 RSD
20 RSD S 20
S
10 9 AMRI
0 N
2000 2005 2010 2013 2016 2017 2018 2019
TERIMA KASIH

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTERIAN KESEHATAN