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History….

• Sejak Penicillin diproduksi tahun

1940an antibiotik banyak
digunakan untuk pengobatan.
Sudah menyembuhkan banyak
orang sakit.
• Penicillin digunakan pula pada
pembedahan, tidak ada ketentuan
dosis, interval, lamanya pemberian
• JCI. 1977. meminta rumah sakit
untuk membuat standarisasi
penggunaan antibiotik untuk
keperluan pencegahan infeksi.

Westerman, 1984.
 DOCTOR UNDERSTANDING
ABOUT ANTIBIOTIC

• The most of surgeons don't follow the guidelines

a lot. They are based more on the practice and
the experience
• Antibiotic surgical prophylaxis is something
that most of the time the anaesthetist will
remind us because we are very focused on the
operation and it’s something that we usually
forget.
• The most of surgeons don't have expert
knowledge of microbiology. Most surgeons
basically are dogmatic in their prescribing
practices. They prescribe the handful of
antibiotics that they know, and they don't
understand the fundamental clinical science in
what they’re doing.

Charani et al. 2017. Understanding antibiotic decision

making in surgery a qualitative analysis . CMI.
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• Health service: the action to the patient
and family creating the VALUE and risk
control in all step of management.

2. Basic
3. Expected
4. Desire
5. Surprise
6. Unbelievable
1. Crime
 Persepsi operasi

• Sembuh cepat
• Komplikasi (-)
• Nyeri (-)
• Biaya murah
• Perhatian dokter (+)
 Persepsi operasi

• Operasi lancar
• Komplikasi (-)/IDO
• Keluhan nyeri (-)
• Biaya mahal
• Pasien tidak cerewet
 Kasus Usia
Ko-morbid

Status umum Instrumentasi Instrumen

pasien
Air bersih
Sarana OK
Infeksi Daerah Operasi
Koloni OK antiseptik

SDM
Cuci tangan SOP Antibiotik

kompetensi
Operator Linen Pasca operasi

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ANTIBIOTIK PROFILAKSIS

1. digunakan untuk
mencegah komplikasi
infeksi pada tindakan
operasi.
2. diberikan sebelum
operasi, ulangan saat
operasi atau setelah
operasi
3. batasan waktu: tidak
melebihi 24 jam
 INDIKASI PROFILAKSIS

GOLONGAN OPERASI
• bersih
• bersih kontaminasi
• kontaminasi
• kotor
 Surgical Site Infection / IDO

Definition
• superficial 30 hari
• deep 90 hari
• organ space 90 hari
• ortopedi 1 tahun

CDC 2017
 kolonisasi

Antibiotika profilaksis
 Profilaksis Dosis Tunggal v/s Multipel

Fakta Tidak ada

laporan perbedaa
n
signifikan

Single-dose versus multiple-dose antibiotic prophylaxis for

the surgical treatment of closed fractures .
Slobogean.et.al. Acta Orthopaedica 2010; 81 (2): 256–262
Results: A total of 540 patients were recruited; (females73.7% of total ). The performed surgical
procedures were 547. The rate of wound infection was 10.9%. Multivariable logistic analysis
showed that; ASA score > 3; (p= <0.001), wound class (p= 0.001), and laparoscopic surgical
technique; (p= 0.002) were significantly associated with prevalence of wound infection. Surgical
prophylaxis was unnecessarily given to 311 (97.5%) of 319 patients for whom it was not
recommended. Prophylaxis was recommended for 221 patients; of them 218 (98.6 %) were given
preoperative dose in the operating rooms. Evaluation of prescriptions for those patients showed
that; spectrum of antibiotic was adequate for 160 (73.4%) patients, 143 (65.6%) were given
accurate doses, only 4 (1.8%) had the first preoperative dose/s in proper time window, and for
186 (85.3%) of them prophylaxis was extended post-operatively. Only 36 (6.7%) prescriptions
were found to be complying with the stated criteria.
Conclusion: The
rate of wound infection was high and prophylactic
antibiotics were irrationally used. Multiple interventions are
needed to correct the situation.
ANTIBIOTIK TERLALU LAMA
 cara pemberian
AB PROFILAKSIS

• Antibiotik
– Cefazolin 2 g
– Cefuroxime 1,5 g
• i.v/drip dalam 100 ml NS, selama
15 menit
• 30-60 menit sebelum insisi
• Tanpa test
• Di kamar operasi
 BENANG MENGANDUNG ANTISEPTIK

QUALITY OF
RECOMENDATION STRENGHT
EVIDENCE

The panel suggests the use of CONDITIONAL MODERATE

triclosan-coated sutures for

the purpose of reducing the
risk of SSI, independent of the
type of surgery.

WHO, 2016
 ANTISEPTIK KULIT

QUALITY
RECOMENDATION STRENGHT OF
EVIDENCE
recommends alcohol-based Strong Low to
antiseptic solutions based on moderate
Chlorhexidine Gluconate for
surgical site skin preparation in
patients undergoing surgical
procedures.

WHO, 2016
 CUKUR VS KERIK

Elective
Clipping hair just before case is best
Surgical
Procedures Hair Removal Infection Rate
Hair Removal Method
sore / kerok/shaving 5.2 - 8.8%
pagi / kerok 6.4 - 10%
sore / cukur 4 - 7.5%
pagi / cukur 1.8 - 3.2%

Alexander JW, et al. Arch Surg 1983; 118:347-352

 CUKUR BULU/RAMBUT

QUALITY
STRENG
RECOMENDATION OF
HT
EVIDENCE
• patients undergoing any surgical Strong Moderate
procedure, hair should either not be
removed or, if absolutely necessary,
it should be removed only with a
clipper. Shaving is strongly
discouraged at all times, whether
preoperatively or in the OR.

WHO, 2016
 ADVANCED DRESSINGS

QUALITY OF
RECOMENDATION STRENGHT
EVIDENCE

The panel suggests not using CONDITIONAL LOW

any type of advanced dressing

over a standard dressing on
primarily closed surgical
wounds for the purpose of
preventing SSI.

WHO, 2016
ANTIMICROBIAL PROPHYLAXIS IN THE PRESENCE OF A
DRAIN AND OPTIMAL TIMING FOR WOUND DRAIN
REMOVAL

QUALITY OF
RECOMENDATION STRENGHT
EVIDENCE
preoperative antibiotic prophylaxis CONDITIONAL LOW
should not be continued in the
presence of a wound drain for the purpose
of preventing SSI.

The panel suggests removing the wound CONDITIONAL VERY LOW

drain when clinically indicated. No
evidence was found to allow making a
recommendation on the optimal timing of
wound drain removal for the purpose of
preventing SSI.

WHO, 2016
PEMANJANGAN PEMBERIAN ANTIBIOTIK

QUALITY OF
RECOMENDATION STRENGHT
EVIDENCE

The panel recommends against STRONG MODERATE

the prolongation of SAP after

completion of the operation for
the purpose of preventing SSI.

Moderate quality evidence from a high number of RCTs (44 studies included in the
overall meta- analysis) shows that prolonged SAP postoperatively has no benefit in
reducing SSI after surgery when compared to a single dose.

WHO, 2016
ANTIBIOTIC GUIDELINE FOR PROPHYLAXIS
JOHNS HOPKINS 2016
 Evidence
Prosedure Antibiotic Odd.Rt
Level
Prosedur Sectio Cesarea HR 1 0.41
Operasi Histerektomi TAH / TVH
R 1 0.17
& Tonsilectomy NR 1
Antibiotik Luka pada wajah NR 1
profilaksis Partus normal + episiotomi
NR 1

Strumectomy NR 1 -
Ca Mammae R 1
Appendectomy HR 1 0.58
HR= High Recommended
R = Recommended Colorectal surgery HR 1
NR= Not Recomended
Hernia NR 1
TUR prostate HR 1
Arthroplasty HR 1
SIGN 2014 Pemasangan kateter NR 1
OPERASI TIDAK MEMERLUKAN ANTIBIOTIK
 TERIMA KASIH
There Is No Way Home
KITA DAPAT MENCEGAH INFEKSI
TETAPI SULIT MENGHINDARI
RESISTENSI

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

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