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PENDIDIKAN :
SMP - SMA : Kolese KANISIUS, 1994
Dokter Umum : FK TRISAKTI, 2002
Spesialis Penyakit Dalam (Internist) : FKUI, 2009
Konsultan Penyakit Tropik & Infeksi : FKUI / PAPDI, 2013
PEKERJAAN :
Bendahara Pengurus Besar Perhimpunan Konsultan Penyakit Tropik dan Infeksi Indonesia (PB PETRI)
Ketua PPRA, RS PONDOK INDAH – PURI INDAH dan RS PONDOK INDAH – BINTARO JAYA
Internist - Konsultan, RS PONDOK INDAH – PURI INDAH dan RS PONDOK INDAH – BINTARO JAYA
Catheter related Blood Stream Infection :
How to Prevent? How to Treat?
Ronald Irwanto
Infectious Disease (ID) Specialist
PERDALIN / INASIC
AGENDA
• Defining & Preventing the Catheter related
Blood Stream Infection (CRBSI)
Wenzel RP
M. Falagas
Preventing Catheter related BSIs
Do we need Prophylaxis?
No Study Established
Just Enhance the Bundles!!!
• CRBSI focused on MRSA infection
How To Predict the Etiology of CLABSI?
• Bacterial VS Fungal
• Clinical parameter :
- Onset
- Progress
• Laboratory parameter
- Procalcitonin
- Culture result
Microorganisms with Drug Resistance That are
Major Problems in Hospitals
Gram-positive Organism Gram-negative Organism
MRSA Klebsiella species ESBL
MRSA (HRV) VRSA Enterobacter species
VRE Pseudomonas aeruginosa
Acinetobacter baumanii
Note: HRV, heterogeneous resistance to vancomycin
Microbiology :
High sensitive to cotrimoxazole
CRBSI???
Might be CA or HA MRSA
Treatment of MRSA
S.Aureus (methicillin-
1250 0.5 0.5 < 0.03 – 8 1 2 0.03 – 8
sensitive)
S.Aureus (methicillin-
1083 0.5 0.5 < 0.06 – 16 1 2 0.06 – 4
resistant)
CNS (methicillin-sensitive) 885 1 2 < 0.06 – 32 2 4 0.06 – 16
CNS (methicillin-resistant) 428 2 4 < 0.125 – 32 2 4 0.125 – 4
s. haemolyticus 279 8 16 < 0.125 – 64 2 4 0.5 – 8
Strep. Agalactiae 127 0.06 0.125 < 0.03 – 0.5 0.25 0.5 0.25 – 0.5
Strep. Pneumoniae
256 0.06 0.125 < 0.03 – 0.5 0.25 0.5 < 0.03 – 1
(penicillin-sensitive)
Strep-pneumoniae
110 0.06 0.125 < 0.06 – 0.5 0.25 0.5 0.125-0.5
(penicillin-resistant)
Strep.pyogenes 196 0.06 0.12 < 0.03 – 0.12 0.5 1 0.25 – 1
Viridans streptococci 86 0.12 0.25 < 0.06 – 1 0.5 1 < 0.25 - 2
• CRBSI : Systemic Invasive / Non Neutropenic
Candidemia
Risk Factors for Systemic / Invasive Fungal
Infections
Candida colonization
Prolonged used wide spectrum antibiotics
Iatrogenic : CVC
Ventilators
Urinary catethers
Hemodialysis
Surgery
Host Condition:
Malignancy
HIV-AIDS
Burns
COPD
Dilemmas in Diagnosis Invasive
Fungal Infections
• Clinical symptoms are not characteristic
• Fungi can be both colonizers and
pathogens, and even laboratory
contamination
• Biopsy is often precluded by co-morbidity
• Objective evidence usually occurs late in
the course of infection
Diagnosis of Invasive Fungal Infection
• Proven/definite Host
factor
Clinical
feature Tissue Mycology
s
Is it VISIBLE for
• developing
Probable country?? Clinical
PLUS
Host
factor feature Mycology
s
High Specificity??
OR
Clinical
• Possible Host
factor
feature
s
Mycology
Invasive
Fungal
Infections
Cooperative
Group
Non-Neutropenic Candida Infection Treatment Approach
High Sensitivity??
Overtreatment Undertreatment
Successful response
Ben E. dePauw. CID 2005;41:1251-3
CRBSI : Key of Treatment Performance
• Fast diagnosis
• Fast Remove catheter
• Fast Broad Spectrum AB (for both gram (+)ve & (-)ve)
+ Antifungal (If necessary) administered with
aggressive approach
• Fast microbiology result
• Fast De-escalation or step down when clinical going
well
Conclusion
• CRBSI should be diagnosed well
• The etiology : Gram (+)ve, Gram (-)ve, fungal
(majority is candida)
• Aggressive approach is needed
• Fast De-escalation should be done when it
proper
Thank You