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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
INDONESIA - NATIONAL ACTION PLAN
ON ANTIMICROBIAL RESISTANCE

1. to improve awareness and understanding of


antimicrobial resistance through effective
communication, education and training
2. to strengthen the knowledge and evidence base
through surveillance and research
3. to reduce the incidence of infection through effective
sanitation, hygiene and infection prevention
measures;
4. to optimize the use of antimicrobial medicines in
human and animal health;
5. to develop the economic case for sustainable
investment that takes account of the needs of all
countries and to increase investment in new
medicines, diagnostic tools, vaccines and other
interventions.
INDONESIA - NATIONAL ACTION PLAN
ON ANTIMICROBIAL RESISTANCE

NATIONAL ONE HEALTH


FOCAL POINT APPROACH

NSCC

NRL

TWG 1-5
• PERMENKES no 8/2015, PPRA RS
• PERMENKES .......... Faskes pratama/Puskesmas
• Sosialisasi organissi profesi/ PERSI/IAI/
• Pelatihan RS rujukan nasional, propinsi, regional, swasta.
• KPRA-SNARS 2018
• Surveilans
AMU SURVEILLANCE
ANTIBIOTIC QUALITATIVE ANALISIS
6 TEACHING HOSPITALS - 2016
100
100
OBGYN BEDAH
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
Mengapa bisa terjadi
RS C RS D RS E RS F RS A RS B RS C RS D RS E RS F

100 PENY. ANAK ? 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
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
ESBL PRODUCING
BACTERIA

PREVALENCE of ESBL in INDONESIA


70
surveilla
60 60 nce 2016
50-82%
50
presentage

40 40 WHO/
35 PPRA
30 26- ESBL
28 56%
20 RSDS
RSDS
10 9 AMRI
0
N
2000 2005 2010 2013 2016
BAKTERI
RESISTEN

MISUSE / OVERUSE

• Resistance is
unresponsiveness to
antimicrobial agents
in standard doses TRANSMISION
AMR MORBIDITY
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
REGULASI , PELATIHAN DAN
DUKUNGAN
Mengapa
klinisi sulit
menggunakan
antibiotik
secara tepat?
PPRA DI RUMAH SAKIT
• PREVALENSI HAI • LAB. MIKRO
? • SDM MK
• GL KHUSUS HAI • SURVEILLANCE

HAI AMR

TRANS
MISI AB • LEADERSHIP
• PNPK/PPG/CP
• DALIN
• ASP
• CUCI TANGAN
• AUDIT
• ISOLASI
• HE AB
RESTRICTION
HARAPAN: Peresepan Antibiotik di
Kalangan Klinisi Semakin bijak
HARAPAN: Healthcare-
Associated Infection
Semakin Turun (25%)
HARAPAN
KENDALI HIGH QUALITY HEALTH CARE

cases
Safe/Quality

ALOS
Beaya
unsafe Prosedur/IC
antibiotic U
tenaga/wakt
u
Morbiditas
Mortalitas
Medikolegal
Sembuh
PPRA bukan Profit Centre,
tetapi Cost Saving
HARAPAN
Pemahaman AMR dan Antibiotik bijak
semakin meningkat diantara klinisi.
HARAPAN: Turunnya Prevalensi AMR
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
TERIMA
KASIH