PROGRAM PENGENDALIAN RESISTENSI ANTIMIKROBA DI INDONESIA

HASIL CAPAIAN DAN TARGET KE DEPAN

HARI PARATON

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

ERA PRE-ANTIBIOTIK

misuse, overuse

HAI, MORBIDITY MORTALITY,

DISABILITY ALOS, COST

BEHAVIOUR

ANTIBIOTIC ERA

AMR

AMR - GLOBAL PROBLEM

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.

INDONESIA - NATIONAL ACTION PLANON ANTIMICROBIAL RESISTANCE

NATIONAL FOCAL POINT

ONE HEALTH APPROACH

NRL

NSCC

TWG 1-5

• 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

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?

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

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%

MISUSE / OVERUSE

TRANSMISION

• Resistance is

unresponsiveness to

antimicrobial agents

in standard doses

BAKTERI RESISTEN

AMR MORBIDITY

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%

MASALAH AKIBAT AMR

• Kegagalan terapi.

• Kegagalan operasicanggih, kompleks

• menimbulkan bebanmorbiditas, mortalitas, kecacatan

• COST

REGULASI , PELATIHAN DAN DUKUNGAN

Mengapaklinisi sulit

menggunakanantibiotik

secara tepat?

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

HARAPAN: Peresepan Antibiotik di Kalangan Klinisi Semakin bijak

HARAPAN: Healthcare-Associated Infection Semakin Turun (25%)

HARAPANKENDALI HIGH QUALITY HEALTH CARE

ALOSBeayaProsedur/ICUtenaga/waktuMorbiditasMortalitasMedikolegal

cases

Safe/Quality

unsafeantibiotic

Sembuh

PPRA bukan Profit Centre, tetapi Cost Saving

HARAPANPemahaman AMR dan Antibiotik bijak

semakin meningkat diantara klinisi.

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

TERIMA

KASIH