PROBLEM

ANTIBIOTIK
DIERA
MDRO
HARI PARATON
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
KEMENTERIAN KESEHATAN RI
Dokter
sudah akrab
dengan
ANTIBIOTIK
Masih Perlu
antibiotik
Ptrophilaksis..?

koq, tidak Guideline

sembuh antibiotik ?
Sepsis, pakai
AB apa

PK / PD
Antibiotik
terbaik apa ya...
BPJS.
LEVOFLOXACIN & LUNG PENETRATION
MASIH EFEKTIF ?

SUDAH RESISTEN ?
 KORELASI PERESEPAN
ANTIBIOTIK DAN TINGKAT RESISTENSI

HSU ET AL, AAC, 2010

MDRO in ASIA PACIFIC / 2015
Enterococcus facium
resistance to aminopenicillins
82-97%
MRSA
Klebsiella pneumonia
82-97%
resistance to ceph. gen 3
6-80% Klebsiella pneumonia
resistance to Carbapenen
Acinetobacter baumanii 3-57%
resist to carpapenem
51-77% Acinetobacter baumanii
Pseudomonas aeruginosa resist to Aminiglikosida
resistance to antibiotic 48-90%
27-57%
SELECTIVE PRESSURE
 PERJALANAN RESISTENSI
DOKTER PETERNAKAN IDO
CAUTI
CLABSI MORBIDITAS
SWA ANTIBOTIK HAP
MEDIKASI
MORTALITAS
E coli E coli DAMPAK HAI
CACAT
MCR-1, ESBL,
NDM-1, CRE
KEGAGALAN
BEAYA
TRANSMISI OOPERASI CANGGIH
KINERJA

AIR KONSUMSI NAKES LINGKUNGAN

 AMR Surveillance -2016
Prevalence of E coli & K. pneumoniae (ESBL+)
8 RUMAH SAKIT PENDIDIKAN
(KPRA – KEMENKES RI)

100% 100
82% 79% 80
78%
80%
60
56%
60% 53% 52% 55% 50%
40
40% 20
20% 0
0 I II IIIA IV V VI
0% RS A RS B RS C RS D RS E RS F
ACH MED JAK SEM SOL SUB MAL DPS
 DAMPAK RESISTENSI
• IDO RS 11.8%
(1.2-23.6)

• HAI > 30%

• 40-60%
preventable
• MDRO

Lyons, WHRA, 2010)

MENGAPA AMR-MDRO MENJADI MASALAH GLOBAL
Mortality:10.000.000 /year, ASIA 4,7M
PARADIGMA MENGATASI BAKTERI MDRO

Mengguna Host Cegah

kan defence Temukan Cegah
normal /Immunita ANTIBIOT Transmisi
AMR Resistensi
flora s IK baru

Save Pro-Pre Lama, PPI/Univers Antibiotik

Normal Cost al
biotik tinggi, precaution Bijak
Flora
ASP, Sulit
Limitasi
Cuci Tangan ASP
Antiseptik
 APA YANG HARUS DILAKUKAN
AMR - PATHOGENS

• KEWASPADAAN • VACCINE
UNIVERSAL • HYGIENE SANITASI
• CUCI TANGAN
• ISOLASI PREVENT
PREVENT
TRANSMI
INFECTION
BACTERI SSION
RESISTANT INFECTION
OPTIMIZING DIAGNOSTIC
USE
• NO MISUSE ANTIBIOTIC TREATMENT
• NO OVERUSE • MIKROBIOLOGY
• ASP • PNPK
• AUDIT • PPK / CP

ANTIBIOTIC USE
 Comparative antimicrobial efficacy of
alcohol-based hand rub and conventional
surgical scrub in a medical center
Ni-Jiin Shen et al 2015

Comparison of traditional hand wash with

alcoholic hand rub in ICU setup
Mona Maliekal, Nanda Hemvani, Usha Ukande, Sanjay Geed, Maitreyee
Bhattacherjee,
Julie George, D. S. Chitnis
ANTIBIOTIK BIJAK
Antibiotik yang digunakan sesuai dengan
guideline dan selalu memperhatikan risiko
resitensi
 ANTIBIOTIK TERAPI

1. Diagnosis infeksi bakteri

2. Severitas
3. Komunitas atau HAI, MDRO
4. Imunokompromis, Source control
5. Pola Bakteri dan sensitivitas RS
6. Jenis antibiotik, dosis, rute,
7. Durasi
Finkelsztein Et Al, Critical Care 2017)
ANTIBIOTIK PROFILAKSIS
1. golongan operasi: bersih dan bersih
kontaminasi
2. antibiotik profilaksis :
• Cefazolin, 2 gram (BB<70kg)
• dilarutkan 100 ml NS/ drip/iv/15
menit, 30-60 menit sebelum insisi
• tanpa skin test, diberikan di kamar
operasi
• diulang: perdarahan >1000-1500ml,
atau lama operasi >3 jam
• maksimum 24 jam.
• Tidak memerlukan pemberian
antibiotik pasca operasi
 Kasus & Prosedure
Antibiotik
Evidence
Level
Odd.Rt

Sectio Cesarea HR 1 0.41

antibiotik Histerektomi TAH / TVH R 1 0.17

profilaksis Tonsilectomy
Luka pada wajah
NR 1
NR 1
Partus normal + episiotomi
NR 1
Strumecomy NR 1 -
Ca Mammae R 1
Appendectomy HR 1 0.58
Colorectal surgery HR 1
Hernia NR 1
TUR prostate HR 1
Arthroplasty HR 1
Pemasangan kateter NR 1
 “The time may come when
penicillin can be bought by
anyone in the shops. Then
there is the danger that the
ignorant man may easily
underdose himself and by
exposing his microbes to non-
lethal quantities of the drug
make them resistant”.
 Diagnosis MDRO
Communitas

Severitas
Immunoko
mpromise

Jenis, Dosis,
Durasi
No Misuse
No Overuse