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Kuntaman
Department of Microbiology
Faculty of Medicine - Dr. Soetomo Hospital
Universitas Airlangga -Surabaya
Komite PPRA Kemnterian Kesehatan R.I.
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KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
CASE-1
Wanita, 7 th,
rujukan PPK-2.
•ALL
•Febrile Neutropenia
•T,N. normal
•Selulitis Cruris Sin.
Day-1:
CASE-1
16.00: Sampling
16.30:
- Gram Staining
- BA & MC
- TSB
20.00: AST
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KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
CASE-1
Day-2: Susp. Pse aeru
AST:
• Sen: SXT, AK,
CN, CAZ
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KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
Infeksi:? Bakteri: ??
Antibiotika: ??
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KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
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
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
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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KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
HAIs
1) HAP/VAP
2) SSI
3) UTI
4) BSI
Cermati: m.o. apa yg ada di dalamnya
Baru memikirkan: Apa AB ?? 9
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
HAIs
1) HAP/VAP
2) SSI
3) UTI
4) BSI
What bacteria are common:
10
??
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
Biasanya: ?
1) HAP/VAP CAP Ab-1 Ab-1
4) BSI
What bacteria are common:
11
??
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
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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KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
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
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
Referral Hospitals 16
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
HAIs
1) HAP/VAP
2) SSI
3) UTI
4) BSI
What bacteria are common: 17??
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
https://advancedtissue.com/2015/11
/the-benefits-of-saline-water/
HAIs
1) HAP/VAP
2) SSI
3) UTI
4) BSI
What bacteria are common: 20??
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
HAIs
1) HAP/VAP
2) SSI
3) UTI
4) BSI
What bacteria are common: 22??
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
HAIs: Blood
Total: 710
Staph 281 40%
K. pneu: 71 10%
Aciba: 46 7%
Pse aeru: 20
Candida: 28
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KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
HAIs: Blood
Staph spp
B-Lact-se
Nov’17- Jan’18:
110 à 100%
Wound, Tertiary Ref Hosp 24
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
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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KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
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