9/13/19

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

APA YANG HARUS

DILAKUKAN
DIERA MDRO
SAAT INI

HARI PARATON
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
KEMENTERIAN KESEHATAN RI

HARRY PARATHON 1

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

What is AMR ?
Antimicrobial resistance (AMR) is the ability of
microorganisms that cause disease to withstand
attack by antimicrobial medicines.

In some parts of the world, once powerful

medicines against malaria and tuberculosis have
now become virtually useless.

AMR is rapidly becoming a major public health risk

and is threatening to undo decades of advances in
treating disease.

HARRY PARATHON 2
Source: WHO

1
 9/13/19

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

The more we give,

the more we lose
Penyebab bakteri
menjadi RESISTEN?

• Penggunaan antibiotik
• Overuse dan misuse
• Penjualan bebas di apotek
• Profilaksis –> overuse/misuse
• Antibiotik digunakan pada infeksi virus
• AMR menyebar diantara penghuni RS
• Antibiotik pada pakan ternak

HARRY PARATHON 3

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

• Multi national AMR surveillance indicate, increasing

prevalence of AMR- ESBL/MRSA/CRE/NDM-`1
HARRY PARATHON 4

2
 9/13/19

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

Antimicrobial resistance is a global problem that
needs urgent action

A global problem calls for a global response

2001

All antimicrobial agents have the potential to select drug-

resistant subpopulations of microorganisms. With the
widespread use of antimicrobials, the prevalence of resistance to
HARRY PARATHON 5
each new drug has increased.

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

500.000.000 Inhabitance 300.000.000 Inhabitance

MR: 25.000/Year MR: 23.000/Year
COST: US$ 20 B/Year COST: € 1.5 B/Year

70.000.000 Inhabitance
MR: 38.000/Year
COST: € 1.3 B/Year

• Multi national mortality surveillance showed, incidence

of MR and cost among the countries.
HARRY PARATHON WHO, 2013
6

3
 9/13/19

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

HARRY PARATHON 7

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

HARRY PARATHON 8

4
 9/13/19

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

AMR dan Global

problem
• Morbiditas dan mortalitas
• Kegagalan operasi canggih
• ALOS meningkat
• Terjadi di seluruh negara
• Berpotensi menyebar tanpa batas
• Kematian global
• 700.000/thn (2013)
• 10 Juta/tahun (2050)
• 2050 - Global cost à US $100 T/year
(Jim O Neil, 2015) 2050
HARRY PARATHON 9

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

MAY 2015

1. to improve awareness and understanding of

antimicrobial resistance;
2. to strengthen knowledge through surveillance and
research;
3. to reduce the incidence of infection;
4. to optimize the use of antimicrobial agents; and
5. develop the economic case for sustainable investment
that takes account of the needs of all countries, and
increase investment in new medicines, diagnostic
tools, vaccines and other interventions.
HARRY PARATHON 10

5
 9/13/19

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

• Since 2015 Most countries developed NAP to containment AMR

HARRY PARATHON 11

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

• ESBL
• MRSA
• MCR-1
• NDM-1
• E Coli
O157:H7
AMR Surveillance -2016
Prevalence of E coli & K. pneumoniae (ESBL+) • CRE
100%
82%
78% 79%
• VRE
80% • Pan
56%
60% 53% 52% 55% 50% resicten
40%

20%

0%
ACH MED JAK SEM SOL SUB MAL DPS HARRY PARATHON 12

6
 9/13/19

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

MORTALITAS AKIBAT AMR

AMR:%Global%problem,%Mortality%and%
Economic%impact%

!  EROPA THAILAND USA USA

UNION
• Population 70 M
• Population 300 M • Population 250 M
-Populatin 500 M • >38.000 death/
• >23.000 death/ • >135.000 death/
-25.000 death/ yrs
yrs yrs
year • 3.2 M extra ALOS • 2 M extra ALOS • Cost Rp. 56. T
-2,5 M extra ALOS • Cost US$ 1.3 B • Cost US$ 20 B
-Cost € 1.5 / yrs

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA KEMENTRIAN WHO,%2007%

HARRY PARATHON KESEHATAN 13

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

100

80

KAJIAN 60

ANTIBIOTIK KUALITATIF 40
KPRA KEMENTERIAN KESEHATAN
20
PADA 6 RS. PENDIDIKAN TAHUN 2016
0
0 I II IIIA IV V VI

RS A RS B RS C RS D RS E RS F

SELECTIVE PRESSURE
HARRY PARATHON 14

7
 9/13/19

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

HARRY PARATHON 15

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

Table. Antibiotic susceptibility (n) pattern of ESBL producing E.coli

RSDS RSSA RSDM RSDK RSSD RSP TOTAL
Cefotaxime 0.17 0.00 NA 1.57 3.31 NA 0,78
Ceftriaxone 0.00 0.00 2.62 5.93 NA 0.00 1,19
Ceftazidime 0.17 0.00 12.07 4.19 8.33 0.00 3,83
Cefepime 0.34 42.06 26.21 9.42 25.62 0.00 12,78
Ciprofloxasin 16.10 29.37 10.00 18.32 7.50 10.42 15,21
Amikacin 97.95 95.24 82.99 96.34 73.33 98.96 92,4
Gentamycin 61.43 69.05 62.15 10.99 56.30 63.54 55,12
Fosfomycin 92.86 100.00 NA 78.57 82.89 NA 90,85
Piperacillin-
49.57 76.19 NA 76.44 65.81 66.67 60,4
tazobactam
Cefoperazone-
53.85 NA 83.33 72.73 57.98 15.63 57,08
sulbactam
Meropenem 99.83 98.41 98.96 95.29 94.96 100.00 98,51
Levofloxacin 20.14 29.37 9.00 21.48 15.38 10.42 17,66
Tigecyclin 78.08 99.21 97.92 99.48 40.63 100.00 94,67
Data surveillance PPRA-Balitbangkes-WHO 2013 HARRY PARATHON 16

8
 9/13/19

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

ILUSTRASI SPEKULATIF AMR

RESISTENSI

2000 PENEMUAN
ANTIBIOTIK
BARU

Harapan - GAP

ERA PRA ANTIBIOTIK

HARRY PARATHON 17

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

PARADIGMA MENGATASI BAKTERI MDRO

Menggunakan Host defence Temukan Cegah Cegah

normal flora /Immunitas ANTIBIOTIK baru Transmisi AMR Resistensi

Save Normal Lama, Cost PPI/Universal

Pro-Prebiotik precaution
Antibiotik Bijak
Flora tinggi, Sulit
ASP, Limitasi
Antiseptik
Cuci Tangan ASP

HARRY PARATHON 18

9
 9/13/19

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

APA YANG HARUS DILAKUKAN

AMR - PATHOGENS
• KEWASPADAAN UNIVERSAL
• VACCINE
• CUCI TANGAN
• HYGIENE SANITASI
• ISOLASI

PREVENT PREVENT
TRANSMISSION INFECTION

BACTERI RESISTANT INFECTION

OPTIMIZING USE DIAGNOSTIC
ANTIBIOTIC TREATMENT
• MIKROBIOLOGY
• NO MISUSE
• PNPK
• NO OVERUSE
• ASP
• PPK / CP
• AUDIT

ANTIBIOTIC USE
HARRY PARATHON 19

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

HARAPAN Turunnya Prevalensi Bakteri Penghasil ESBL Nasional

70

60 60

50
presentage

40 40 40
35
30 ESBL
28
25
20

10 9

0
2000 2005 2010 2013 2016 2018 2020

HARRY PARATHON 20

10
 9/13/19

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

HARAPAN:
Peresepan antibiotik di kalangan klinisi
semakin bijak

HARAPAN
Healthcare-associated infection
semakin turun

HARRY PARATHON 21

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

PPRA bukan Revenue Centre, tetapi Cost Saving

HARRY PARATHON 22

11