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PROGRAM PENGENDALIAN RESISTENSI ANTIMIKROBA DI INDONESIA
HASIL CAPAIAN DAN TARGET KE DEPAN
HARI PARATON
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
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ERA PRE-ANTIBIOTIK
misuse, overuse
HAI, MORBIDITY MORTALITY,
DISABILITY ALOS, COST
BEHAVIOUR
ANTIBIOTIC ERA
AMR
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AMR - GLOBAL PROBLEM
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INDONESIA - NATIONAL ACTION PLANON ANTIMICROBIAL RESISTANCE
1. to improve awareness and understanding ofantimicrobial resistance through effectivecommunication, education and training
2. to strengthen the knowledge and evidence basethrough surveillance and research
3. to reduce the incidence of infection through effectivesanitation, hygiene and infection preventionmeasures;
4. to optimize the use of antimicrobial medicines inhuman and animal health;
5. to develop the economic case for sustainableinvestment that takes account of the needs of allcountries and to increase investment in newmedicines, diagnostic tools, vaccines and otherinterventions.
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INDONESIA - NATIONAL ACTION PLANON ANTIMICROBIAL RESISTANCE
NATIONAL FOCAL POINT
ONE HEALTH APPROACH
NRL
NSCC
TWG 1-5
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• PERMENKES no 8/2015, PPRA RS• PERMENKES .......... Faskes pratama/Puskesmas• Sosialisasi organissi profesi/ PERSI/IAI/• Pelatihan RS rujukan nasional, propinsi, regional, swasta. • KPRA-SNARS 2018• Surveilans
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0
20
40
60
80
100
0 I II III A IV V VI
RS A RS B RS C RS D RS E RS F
OBGYN
0
20
40
60
80
100
0 I II III IV V VI
RS A RS B RS C RS D RS E RS F
BEDAH
0
20
40
60
80
100
0 I II III A IV V VI
RS A RS B RS C RS D RS E RS F
0
20
40
60
80
100
0 I II IIIA IV V VI
RS A RS B RS C RS D RS E RS F
PENY. ANAK PENY. DALAM
AMU SURVEILLANCEANTIBIOTIC QUALITATIVE ANALISIS
6 TEACHING HOSPITALS - 2016
Mengapa bisa terjadi?
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AMR Surveillance -2016Prevalence of E coli & K. pneumoniae (ESBL+)
82%78%
53%
79%
52% 55%50%
56%
19%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ACH MED JAK SEM SOL SUB MAL DPS SWASUB
ESBL
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PREVALENCE of ESBL in INDONESIA
ESBL PRODUCING
BACTERIA
9
28
3540
60
0
10
20
30
40
50
60
70
2000 2005 2010 2013 2016
pre
sen
tage
ESBL
AMRIN
RSDSRSDS
WHO/PPRA
26-56%
surveillance 201650-82%
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MISUSE / OVERUSE
TRANSMISION
• Resistance is
unresponsiveness to
antimicrobial agents
in standard doses
BAKTERI RESISTEN
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AMR MORBIDITY
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MORBIDITAS & MORTALITAS
• IDO RS 11.8% (1.2-23.6)
• HAI > 30%• 40-60%
preventable• MDRO
Lyons, WHRA, 2010)
WHO2013
700.000
USA300 juta
23.000
Thailland70 juta
38.000
INA256 juta
135.000
• HAI-RS / Indonesia – 7.1% (Deurink et al, 2009)
• Mortalitas HAI 6,9%
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MASALAH AKIBAT AMR
• Kegagalan terapi.
• Kegagalan operasicanggih, kompleks
• menimbulkan bebanmorbiditas, mortalitas, kecacatan
• COST
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REGULASI , PELATIHAN DAN DUKUNGAN
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Mengapaklinisi sulit
menggunakanantibiotik
secara tepat?
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PPRA DI RUMAH SAKIT
• LEADERSHIP
• PNPK/PPG/CP
• ASP
• AUDIT
• HE AB RESTRICTION
• DALIN
• CUCI TANGAN
• ISOLASI
• LAB. MIKRO
• SDM MK
• SURVEILLANCE
• PREVALENSI HAI ?
• GL KHUSUS HAI
HAI AMR
AB TRANSMISI
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HARAPAN: Peresepan Antibiotik di Kalangan Klinisi Semakin bijak
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HARAPAN: Healthcare-Associated Infection Semakin Turun (25%)
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HARAPANKENDALI HIGH QUALITY HEALTH CARE
ALOSBeayaProsedur/ICUtenaga/waktuMorbiditasMortalitasMedikolegal
cases
Safe/Quality
unsafeantibiotic
Sembuh
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PPRA bukan Profit Centre, tetapi Cost Saving
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HARAPANPemahaman AMR dan Antibiotik bijak
semakin meningkat diantara klinisi.
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HARAPAN: Turunnya Prevalensi AMR Nasional
9
2835
40
60
40
25
0
10
20
30
40
50
60
70
2000 2005 2010 2013 2016 2018 2020
pre
sen
tage
ESBL
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TERIMA
KASIH