PROGRAM PENGENDALIAN RESISTENSI

ANTIMIKROBA DI INDONESIA
HASIL CAPAIAN DAN TARGET KE DEPAN

HARI PARATON
KOMITE PENGENDALIAN RESISTENSI
ANTIMIKROBA
 ERA PRE-
ANTIBIOTIK
BEHAVIOUR AMR

ANTIBIOTIC ERA

misuse, HAI, MORBIDITY

MORTALITY,
overuse DISABILITY ALOS,
COST
AMR - GLOBAL PROBLEM
 GLOBAL ACTION
PLAN ON AMR

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,
KOMITE
diagnostic PENGENDALIAN
tools, vaccines and other RESISTENSI
interventions. ANTIMIKROBA
KEMENTERIAN KESEHATAN
REGULASI , PELATIHAN DAN
DUKUNGAN
ANTUSIAS PESERTA PELATIHAN PPRA
 BAKTERI
RESISTEN

MISUSE / OVERUSE

• Resistance is
unresponsiveness to
antimicrobial agents
in standard doses TRANSMISION
 GLOBAL ACTION
PLAN ON AMR

1. Improve awareness and understanding of antimicrobial resistance

through effective communication, education and training
2. Strengthen the knowledge and evidence base through sur
veillance and 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
 AMU SURVEILLANCE
ANTIBIOTIC QUALITATIVE ANALISIS
6 TEACHING HOSPITALS - 2016
100
100
OBGYN SURGICAL
80 80

60 60

40 40
20 20
0 0
0 I II III A IV V VI 0 I II III IV V VI
RS A RS B RS C RS D RS E RS F RS A RS B RS C RS D RS E RS F

100 PENY. ANAK 100 PENY. DALAM

80 80
60 60
40 40
20 20
0 0
0 I II III A IV V VI 0 I II IIIA IV V VI
RS A RS B RS C RS D RS E RS F
RS A RS B RS C RS D RS E RS F

* Data kajian AMR-AMU, KPRA KEMENKES 2016

 AMR Surveillance -2016
Prevalence of E coli & K. pneumoniae (ESBL+)
100%
90% 82%
78% 79%
80%
70%
60% 53% 55% 56%
52% 50%
50%
40% ESBL
30%
19%
20%
10%
0%
ACH MED JAK SEM SOL SUB MAL DPS SWA
SUB

* Data kajian AMR-AMU, KPRA KEMENKES 2016

ESBL PRODUCING
BACTERIA

PREVALENCE of ESBL in INDONESIA

70
surveilans
60 60 2016
50-82%
50
presentage

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

10 9 AMRIN
0
2000 2005 2010 2013 2016
 GLOBAL ACTION
PLAN ON AMR

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 sanitati
on, 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
 MORBIDITAS & MORTALITAS

• IDO RS 11.8% WHO

700.000
(1.2-23.6) 2013

USA
23.000
• HAI > 30% 300 juta
• 40-60% Thailland
preventable 38.000
70 juta
• MDRO INA
135.000
Lyons, WHRA, 2010) 256 juta

• HAI-RS / Indonesia – 7.1% (Deurink et al, 2009)

• Mortalitas HAI 6,9%
 MASALAH AKIBAT AMR

• Kegagalan terapi.
• Kegagalan operasi
canggih, kompleks
• menimbulkan
beban morbiditas,
mortalitas,
kecacatan
• COST
 GLOBAL ACTION
PLAN ON AMR

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 huma
n and animal 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
SELECTIVE PRESSURE
FAKTA PENGUNAAN
ANTIBIOTIK DI RS

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

Tidak ada
indikasi 55 81
profilaksis

AMRIN STUDY : 2002-

19
2005
 AMU SURVEILLANCE
ANTIBIOTIC QUALITATIVE ANALISIS
6 TEACHING HOSPITALS - 2016
100
100
OBGYN SURGICAL
80 80

60 60

40 40
20 20
0 0
0 I II III A IV V VI 0 I II III IV V VI
RS A RS B
Menagapa bisa
RS C RS D RS E RS F RS A RS B RS C RS D RS E RS F

100 PENY. ANAK terjadi ? PENY. DALAM 100

80 80
60 60
40 40
20 20
0 0
0 I II III A IV V VI 0 I II IIIA IV V VI
RS A RS B RS C RS D RS E RS F
RS A RS B RS C RS D RS E RS F

* Data kajian AMR-AMU, KPRA KEMENKES 2016

 PPRA, MENGAPA HARSUS
DILAKSANAKAN DI RUMAH SAKIT

• HAI di RS meningkat.
• Banyak dokter tidak tepat menggunakan
antibiotik 50-80%
• Reservoir bakteri resisten – 60% (50-82)ESBL
• Mortalitas meningkat
 GLOBAL ACTION
PLAN ON AMR
1. Improve awareness and understanding of antimicrobial resistance
through effective communication, education and training
2. Strengthen the knowledge and evidence base through surveillance an
d 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 anima
l health.
5. Develop the economic case for sustainable investment that
takes account ofthe needs of all countries, and increase
investment in new medicines, diagnostic tools, vaccines an
d other interventions.
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
KEMENTERIAN KESEHATAN
 CORE PLAN DI RUMAH SAKIT
• PREVALENSI HAI ? • SARANA LAB MIKRO
• GL KHUSUS HAI • SDM
• SURVEILLANCE

HAI AMR

TRANS
MISI AB • PNPK/PPG/CP
• DALIN • ASP
• CUCI TANGAN • REVIEW
• ISOLASI • HE AB RESTRICTION
HARAPAN Turunnya Prevalensi Bakteri
Penghasil ESBL Nasional

70
60 60
50
presentage

40 40 40
35 ESBL
30
28 25
20
10 9
0
2000 2005 2010 2013 2016 2018 2020
HARAPAN: Peresepan Antibiotik Di
Kalangan Klinisi Semakin bijak
HARAPAN Healthcare-
Associated Infection
Semakin Turun (25%)
 HARAPAN
HIGH QUALITY HEALTH CARE

Cases
save
ALOS
Beaya
Prosedur/IC
U
tenaga/wakt
unsafe u
antibiotic Morbiditas
Mortalitas
Medikolegal
PPRA bukan Revenue Centre, tetapi
Cost Saving
 2013

• Alterations on the Immune System and Related Health Problems

• intestinal overgrowth of common nosocomial pathogens such as Klebsiella
pneumoniae, Staphylococcus aureus and, most frequently, Clostridium difficile (C.
difficile).12-15
• Disrupted Immune Homeostasis and Tolerance
• Antibiotic-induced alterations of the gut microbiota can affect basic immune
homeostasis with body-wide and long-term repercussions.

• The gut microbiota is increasingly considered an important factor in the regulation

of host metabolism, in particular as it relates to energy homeostasis and adiposity
This panorama has changed in the last few years. The classical view indicates that
the selection of resistance can happen in a range of concentrations from the
minimal inhibitory concentration, under which susceptible and resistant bacteria will
grow, to the minimal preventive concentration, which inhibits the growth of
resistant mutants. However, recent information indicates that subinhibitory
concentrations of antibiotics can select antibiotic- resistant microorganisms1
© 2008 by the American College of Surgeons
Published by Elsevier Inc. 1
Antibiotic Resistance and its Impact on
Cancer Patients
Although careful use of antibiotics can result in the emergence of antibiotic-
resistant bacteria, inappropriate use greatly accelerates this process. The
more often bacteria are exposed to antibiotics, the more resistant they
become. Because bacteria reproduce rapidly, these antibiotic-resistant
bacteria can spread efficiently. Unlike higher organisms, bacteria can
transfer DNA to other bacteria that are not their offspring, and even to
members of completely unrelated bacterial species. In effect, bacteria can
teach one another how to outwit antibiotics.
HARAPAN Pemahaman AMR dan
Antibiotik bijak harus semakin
meningkat.
TERIMA
KASIH