GLOBAL PROBLEM

RESISTENSI ANTIMIKROBA :
Hasil Hasil Capaian dan Target ke Depan

Hari Paraton, dr.,SpOG(K)

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTERIAN KESEHATAN
HARI PARATON - KPRA KEMENKES R.I 1
 ERA PRE-
ANTIBIOTIK
BEHAVIOUR AMR

ANTIBIOTIC ERA

misuse, HAI, MORBIDITY

MORTALITY,
overuse DISABILITY, ALOS,
COST
HARI PARATON - KPRA KEMENKES 2
HARI PARATON - KPRA KEMENKES 3
AMR - GLOBAL PROBLEM

HARI PARATON - KPRA KEMENKES 4

GLOBAL RESISTANCE: KLEBSIELLA PNEUMONIAE (ESBL+)

60-80%
HARI PARATON - KPRA KEMENKES KPMG LLP - December 2014 5
 NATIONAL PROBLEM OF
ANTIMICROBIAL RESISTANCE
Indonesia ada dimana: ??

Evidence based communication

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTERIAN KESEHATAN
HARI PARATON - KPRA KEMENKES RI 6
 GLOBAL ACTION
PLAN ON AMR
1. Improve awareness and understanding of antimicrobial
resistance through effective communication, education and
training
2. Strengthen the knowledge and evidence base through
surveillance and research.
3. Reduce the incidence of infection through effective
sanitation, hygiene and infection prevention measures.
4. Optimize the use of antimicrobial medicines in human
and animal health.
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.

HARI PARATON - KPRA KEMENKES 7

 GLOBAL ACTION
PLAN ON AMR

NAP-AMR
1.
Improve awareness and understanding
of antimicrobial resistance through
effective
communication, education and training

Indonesia: ???
HARI PARATON - KPRA KEMENKES 8
REGULASI , PELATIHAN DAN
DUKUNGAN

HARI PARATON - KPRA KEMENKES 9

 BAKTERI
RESISTEN

MISUSE /
OVERUSE

• Resistance is
unresponsiveness
to antimicrobial
agents in standard
doses TRANSMISION
HARI PARATON - KPRA KEMENKES 11
 GLOBAL ACTION
PLAN ON AMR
1. Improve awareness and understanding of antimicrobial resistance
through effective communication, education and training

2. Strengthen the knowledge and evidence base through su

rveillance and research.
3. Reduce the incidence of infection through effective sanitation, hygiene
and infection prevention measures.
Bagimana Indonesia: ??
4. Optimize the use of antimicrobial medicines in human and ani
mal health.
5. Develop the economic case for sustainable investment that takes acco
unt of
the needs of all countries, and increase investment in new medicines,
diagnostic tools, vaccines and other interventions.
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
HARI PARATON - KPRA KEMENKES 12
KEMENTERIAN KESEHATAN
 AMU SURVEILLANCE
ANTIBIOTIC QUALITATIVE ANALISIS
6 TEACHING HOSPITALS - 2016
100
100
OBGYN SURGICAL
80 80

60 60

40 40
20 20
0 0

RS A
0 I
RS B
II
RS C
Mengapa bisa terjadi
III A
RS D
IV
RS E
V VI
RS F
0
RS A RS B
I II
RS C
III
RS D
IV
RS E
V
RS F
VI

100
80
PENY. ANAK ? 100
80
PENY. DALAM
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
HARI PARATON - KPRA KEMENKES 13
* Data kajian AMR-AMU, KPRA KEMENKES 2016
 ESBL
PRODUCING
BACTERIA
PREVALENCE of ESBL in INDONESIA
70
surveilans
60 60 2016
50-82%
50
presentage

40 40
35 WHO/
PPRA ESBL
30 28 26-56%
20 RSDS RSDS

10 9 AMRIN
0
2000 2005 2010 2013 2016
 GLOBAL ACTION
PLAN ON AMR
1. Improve awareness and understanding of antimicrobial resistance
through effective communication, education and training
2. Strengthen the knowledge and evidence base through surveillance a
nd research.
3. Reduce the incidence of infection through effective sanitati
on, hygiene and infection prevention measu
res.
4. Optimize the use of antimicrobial medicines in human and ani
mal health.
5. Develop the economic case for sustainable investment that takes acco
unt of
the needs of all countries, and increase investment in new medicines,
KOMITE
diagnostic PENGENDALIAN
tools, vaccines and other RESISTENSI
interventions. ANTIMIKROBA
HARI PARATON - KPRA KEMENKES 16
KEMENTERIAN KESEHATAN
 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%
HARI PARATON - KPRA KEMENKES 18
 GLOBAL ACTION
PLAN ON AMR
1. Improve awareness and understanding of antimicrobial resistance
through effective communication, education and training
2. Strengthen the knowledge and evidence base through surveillance a
nd research.
3. Reduce the incidence of infection through effective sanitation, hygiene
and infection prevention measures.
4.Optimize the use of antimicrobial medicines in
human and animal health.
5. Develop the economic case for sustainable investment that takes acco
unt of
the needs of all countries, and increase investment in new medicines,
diagnostic tools, vaccines and other interventions.

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

HARI PARATON - KPRA KEMENKES 20
KEMENTERIAN KESEHATAN
SELECTIVE PRESSURE

HARI PARATON - KPRA KEMENKES 21

FAKTA PENGUNAAN
ANTIBIOTIK DI RS

Hasil
Kategori
Sby Semg
(%) (%)
Tidak ada
indikasi 76 53
terapi

Tidak ada
indikasi 55 81
profilaksis

AMRIN STUDY : 2002-

HARI PARATON - KPRA KEMENKES 22
2005
 PPRA, MENGAPA HARSUS
DILAKSANAKAN DI RUMAH SAKIT

• HAI di RS meningkat.
• Banyak dokter tidak tepat menggunakan
antibiotik 50-80%
• Reservoir bakteri resisten – 62% (50-82)ESBL
• Mortalitas meningkat
HARI PARATON - KPRA KEMENKES 24
 GLOBAL ACTION
PLAN ON AMR
1. Improve awareness and understanding of antimicrobial resistance
through effective communication, education and training
2. Strengthen the knowledge and evidence base through surveillance an
d research.
3. Reduce the incidence of infection through effective sanitation, hygiene
and infection prevention measures.
4. Optimize the use of antimicrobial medicines in human and anima
l health.
5. Develop the economic case for sustainable investment that
takes account ofthe needs of all countries, and increase
investment in new medicines, diagnostic tools,
vaccines and other interventions.
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
HARI PARATON - KPRA KEMENKES 25
KEMENTERIAN KESEHATAN
 CORE PLAN DI RUMAH SAKIT

• PREVALENSI HAI ? • SARANA LAB

MIKRO
• GL KHUSUS HAI • SDM
• SURVEILLANCE
HAI AMR

TRA • PNPK/PPG/CP
• ASP
• DALIN NSMI AB • REVIEW
• CUCI TANGAN SI • HE AB
• ISOLASI RESTRICTION

HARI PARATON - KPRA KEMENKES 26

HARAPAN Turunnya Prevalensi Bakteri
Penghasil ESBL 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
HARI PARATON - KPRA KEMENKES 27
HARAPAN: Peresepan Antibiotik Di
Kalangan Klinisi Semakin bijak

HARI PARATON - KPRA KEMENKES 28

 HARAPAN Healthcare-
Associated Infection
Semakin Turun (25%)

HARI PARATON - KPRA KEMENKES 30

 HARAPAN
HIGH QUALITY HEALTH CARE

Cases
save

ALOS
Beaya
Prosedur/ICU
tenaga/waktu
unsafe Morbiditas
antibiotic Mortalitas
Medikolegal

HARI PARATON - KPRA KEMENKES 31

PPRA bukan Revenue Centre, tetapi
Cost Saving

HARI PARATON - KPRA KEMENKES 32

HARAPAN Pemahaman AMR dan
Antibiotik bijak harus semakin
meningkat.

HARI PARATON - KPRA KEMENKES 34

 TERIMA
KASIH

HARI PARATON - KPRA KEMENKES 35