GLOBAL PROBLEM OF

ANTIMICROBIAL RESISTANCE

HARI PARATON.dr. SpOG(K)

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTERIAN KESEHATAN RI
 ERA PRE-
ANTIBIOTIK
BEHAVIOUR AMR

ANTIBIOTIC ERA

misuse, HAI, MORBIDITY

MORTALITY,
overuse DISABILITY ALOS,
COST
Global Resistance: E.Coli (ESBL+)
GLOBAL RESISTANCE: KLEBSIELLA PNEUMONIAE (ESBL+)

KPMG LLP - December 2014

THE SPREADING OF NDM-1 E.coli
 MASALAH GLOBAL

2013 700.000 / tahun

WHO 2013
10.000.000/tahun
2050
USD. 100 TRILLIUN
(Jim O Neill 2015)
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
KEMENTERIAN KESEHATAN
THE AMR IMPACTS
 AMR - Reduction In GDP in 2050,
by different group
Country Group % of GDP Reduction

Low Income 5.13 – 11.34

Lower Middle Income 3.11 – 6.62

Upper Middle Income 1.41 – 2.65

High Income 0.96 – 1.95

WORLD 1.66 - 3.40

KPMG LLP - December 2014

GLOBAL AMR

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTERIAN KESEHATAN
NATIONAL PROBLEM OF
ANTIMICROBIAL
RESISTANCE

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTERIAN KESEHATAN RI
 BAKTERI RESISTEN
• Bakteri yang tidak dapat dimatikan
atau dihambat oleh antibiotik dengan
dosis standar

• Misuse and overuse

• Transmission
APAKAH BAKTERI RESISTEN MENIMBULKAN
MASALAH ?

• Kegagalan terapi
• Ancaman pada operasi
canggih / kompleks
• Meningkatkan morbiditas,
mortalitas dan cacat
• Meningkatkan pembiayaan
kesehatan, menurunkan GDP
 GLOBAL ACTION
PLAN ON AMR

1.
Improve awareness and understanding
of antimicrobial resistance through
effective
communication, education and training
 PASIEN KASTEMER PARTNER

• pasien ikut • Bisnis • Partnership

kemauan • Patient • Patient
dokter expectation Centered Care
• Litigasi • Profesional
• DOKTER • Competence
PALING PINTAR • DEFENSIVE • MUTUAL
• PATERNALISTIK PRACTICE TRUST AND
FAITH
TENAGA KESEHATAN HARUS UPDATE PENGETAHUAN
TENTANG PROBLEM BAKTERI RESISTEN
Facility total Profession total
Hospital 2.600 Specialist 36.000
Puskesmas 9.700
GP 104.000
Apotek 24.000
Medical Faculty 72 Dentist 23.700
Dentistry Facul 27 Midwife 300.000
Pharaceutical 71
Nurse 250.000
Midwife 400
Nurse 400 Pharmacist 30.000.
MASYARAKAT HARUS MEMAHAMI RISIKO DAN ANCAMAN
BAKTERI RESISTEN, MENGUBAH PERILAKU SWA-MEDIKASI
ANTIBIOTIK.
SELECTIVE PRESSURE
 GLOBAL ACTION
PLAN ON AMR

2.
Strengthen the knowledge and evidence
base through surveillance and research.
 Trend Acoss OECD Countries
Antimicrobial Resistance Growing.
OECD 2016
ESBL PRODUCING
BACTERIA

PREVALENCE of ESBL in INDONESIA

70
Surveilans
60 60 2016
45-82%
50
presentage

40 40
35 WHO/
PPRA ESBL
30 28 26-56%
20 RSDS
RSDS
10 9 AMRIN
0
2000 2005 2010 2013 2016
 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 RSDS-Balitbangkes-WHO 2013

29
 GLOBAL ACTION
PLAN ON AMR

3.
Reduce the incidence of infection through eff
ective sanitation, hygiene and infection pre
vention measures.
 THE PROBLEM
ANTIBIOTIC
USE

• Blood stream
• Pneumonia
HAI AMR • UTI
• SSI

• more difficult to treat

• more procedures
• high cost
• ICU use
• failure  morbidity and
mortality
 Healthcare Associate Infection
• infeksi yang didapat saat pasien dirawat di Rumah
sakit. (tidak sesuai dengan masa inkubasi penyakit)
• Inciden 3.4-12% (negara maju); 5,7-19.1% (negara
berkembang)
• USA 99.000 kematian/tahun
• Biaya $ 6,5 Milyard. (Rp. 84,5 T)
CEGAH TRANSMISI
 GLOBAL ACTION
PLAN ON AMR

4
Optimize the use of antimicrobial me
dicines in human and animal health.
PEMICU RESISTENSI
SELECTIVE PRESSURE

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

Tidak ada
indikasi 55 81
profilaksis

AMRIN STUDY : 2002-2005

35 35
 AMU SURVEILLANCE
ANTIBIOTIC QUALITATIVE ANALISIS
6 TEACHING HOSPITALS - 2016

OBGYN SURGICAL
100 no 100
too long no
90 too long indication 90 indication
80 80
70 70
60 60
50 50
40 40
30 30
20 20
10 10
0 0
0 I II III A IV V VI 0 I II III 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

* Data kajian AMR-AMU, KPRA KEMENKES 2016

• Dokter tahu data pola resistensi
• Pilihan antibiotik tepat
• Antibiotik  Heterogen
• Preventif kolonisasi
• Antibiotik sesingkat mungkin
 ANTIBIOTIC STEWARDSHIP PROGRAM

Infectious Diseases
Specialists
Infection Nurse Infection
Control
OPTIMAL
Professionals
Clinical PATIENT
Pharmacists CARE

KFT - GUIDELINE
Clinical
Microbiologists
Surgical Infection
Experts
 GLOBAL ACTION
PLAN ON AMR

5.
Develop the economic case for sustain
able investment that takes account of
the needs of all countries, and
increase investment in new medicines,
diagnostic tools, vaccines and other
interventions.
HIGH QUALITY HEALTH CARE

kasus

kasus sembuh sembuh

kasus

Harapan Good Outcome ALOS

Beaya
Prosedur/ICU
tenaga/waktu Tanggung
komplikasi Morbiditas jawab
AMR
Mortalitas siapa ?
Medikolegal
 HIGH QUALITY HEALTH CARE
• “the degree to which health services for individuals
and populations increase the likelihood of desired
health outcomes and are consistent with current
professional knowledge.”

• safe, effective, patient-

centered, timely, efficient
and equitable.
TERIMA KASIH