KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

Common Bacterial Pathogens in HAIs

Kuntaman
Department of Microbiology
Faculty of Medicine - Dr. Soetomo Hospital
Universitas Airlangga -Surabaya
Komite PPRA Kemnterian Kesehatan R.I.

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CASE-1
Wanita, 7 th,
rujukan PPK-2.
•ALL
•Febrile Neutropenia
•T,N. normal
•Selulitis Cruris Sin.

Thx Emp: CAZ Ps aeru: ?

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Day-1:
CASE-1
16.00: Sampling
16.30:
- Gram Staining
- BA & MC
- TSB
20.00: AST
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CASE-1
Day-2: Susp. Pse aeru

AST:
• Sen: SXT, AK,
CN, CAZ

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Infeksi:? Bakteri: ??

Tanda Infeksi:? Gram Neg: ?

Gram Pos: ?

Antibiotika: ??
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Antibiogram
• Sangat penting untuk terapi
empiric
– Jangan memasukkan
kontaminant à memerlukan
data evident
– Skill & Knowledge SpMK
– Skill & Knowledge Clinicians
– Evidence data: ??
Difficult case à Communication
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https://www.alamy.com/stock-photo/ward-round-hospital.html
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Without direct consultation,

recommendation are followed in
39% cases
– Because the clinician will not change
based on a report alone
Diagn. Micro.Infect.Dis, 91;14:157-66
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SBE à Blood
Bakteri tersering: Staph spp; Strept spp
Biasanya: Penghasil Beta laktamase
• Male, 18 y.o.; Adm. To DSHS Case-2
• SBE & Shock Septic
• Blood Culture à Lab Micro:
• Staph hominis
• Sens: AMC, ERY, SXT
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HAIs
1) HAP/VAP
2) SSI
3) UTI
4) BSI
Cermati: m.o. apa yg ada di dalamnya
Baru memikirkan: Apa AB ?? 9
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HAIs
1) HAP/VAP

2) SSI

3) UTI

4) BSI
What bacteria are common:
10
??
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Biasanya: ?
1) HAP/VAP CAP Ab-1 Ab-1

2) SSI HAP Ab-2 Ab-1

VAP Ab-3 Ab-1
3) UTI

4) BSI
What bacteria are common:
11
??
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First time to see the patient:

• Infection: ??
• What m.o. is there:??

• CAP: K pneu; Str pneu à AMC, Lev

• HAP: K pneu, Aciba; Pse aer à Local data:?
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Terapi Empirik:
1. AB yang paling kuat: ??? ß Antibiogram:?
2. Dosis setinggi mungkin: ??
ü Siapa yang menentukan AB terkuat
untuk infeksi tertentu: ??
ü Dan Bgmn memilih: ??
3. Hanya antibiogram à belum cukup: ??
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HAP
Antibiogram ICU, Sputum, 2014, Dr Soetomo Hosp
Microbes Quant %
Ac baumannii/compl. 129 41%
Pseu aeruginosa 67 21%
80% GN
K. pneumoniae 56 18%
E coli 26 98%
Burkholderia cepacia 15
Stenotropo maltophilia 7
Enter cloacae 7
Enter aerogenes 5
Staphy aureus 6 2%
Total 318 14
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Isolat Sputum RSUDDS Jan-April 2018

1289 isolat Sputum:
Aciba: 261 = 20%
K pneu: 244 = 19% 51%
Ps aeru: 148 = 12%
--- ---- ---- --- ---- ----------
Enterobacter spp: 79=6%
Staph spp: 61= 5%
Candida spp: 49 = 4%
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Isolat Sputum RSUDDS Jan-April 2018

1289 isolat Sputum: MEM IMI AK TGC LEV
Aciba: 261 = 20% 51% 51% 54% 13% 37%
K pneu: 244 = 19% 84% 79% 96% 12% 66%
Ps aeru: 148 = 12% 76% 73% 85% 15% 59%
--- ---- ---- --- ---- ----

Referral Hospitals 16
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HAIs
1) HAP/VAP

2) SSI

3) UTI

4) BSI
What bacteria are common: 17??
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Bacterial agents in Wound

542 swab/wound:
E coli: 120 22%
Staph spp: 92 17%
Pse aeru: 65 12%
ESBL Strep spp : 46 9%
K pneu: 42 8%
Aciba: 42 8%
GNB:45% ESBL Entero spp: 14 3%
Others Others
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The magic of Saline

Salt is a natural element that’s been used for centuries to aid in
healing, wounds and otherwise. The therapeutic uses have been
ancient Egyptian and
recorded in both

Roman history. Hippocrates made

medicines containing salt after realizing
the reparative nature of seawater on fishermen’s hands, and
Renaissance doctors recommended salt baths for patients with skin
diseases.

https://advancedtissue.com/2015/11
/the-benefits-of-saline-water/

Make your own saline solution

1/4 teaspoon of salt and boil
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HAIs
1) HAP/VAP

2) SSI

3) UTI

4) BSI
What bacteria are common: 20??
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RSDS, 2018 ISK

Total: 977
E coli: 365 37%
K. pneu: 104 11%
Pse aeru: 77 8%
Aciba: 42 4%
Staph spp: 36 4%
Candida spp: 96 10%
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HAIs
1) HAP/VAP

2) SSI

3) UTI

4) BSI
What bacteria are common: 22??
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HAIs: Blood
Total: 710
Staph 281 40%
K. pneu: 71 10%
Aciba: 46 7%
Pse aeru: 20
Candida: 28
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HAIs: Blood
Staph spp

B-Lact-se

Nov’17- Jan’18:
110 à 100%
Wound, Tertiary Ref Hosp 24
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SUMMARY
1. Diagnosis of Inf Dis: the most important first step
in management of infectious dis.
2. Micro culture à is mandatory à for best
practices in management of Infection
3. Infected patient: à Source?? à Bacterial
pathogens: ??
4. Treat the causative agent à Save the patient

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