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CurrentTrendsofEmergingDiseases

DR.Dr.LatreBuntaranSp.MK(K)
ClinicalMicrobiologistConsultant
SecretaryGeneralofINASIC
IndonesiaCoordinatorofANSORPStudy

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ASIAN DATA (2008 2009)

ASIANDATA(20082009)

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INDONESIA DATA (2008 2009)

INDONESIADATA(20082009)

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ProspectiveMultinationalSurveillanceofHAPandVAPinAdultsinAsianCountries,
20082009,ANSORP

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MDR Pathogens had become real problem

in Indonesia

From:ProspectiveMultinationalSurveillanceofHAPandVAPinAdultsinAsianCountry,2008,ANSORP

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While our Empiric Treatment

might not be Adequate

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Prevalence of nosocomial MRSA

country author (year) % MRSA

China1 Li (2001) 81.8 %

Taiwan2 Hsueh (2004) 77 %

Korea3 Lee (2006) 68 %

USA4 NNIS (2004) 59.5 %

France5 van der Mee-Marquet (2004) 33 %

1LiJ,etal.ZhonghuaYiXueZaZhi.2001;81:816.
2HsuehPR,etal.AntimicrobAgentsChemother. 2004;48:13611364.
3LeeK,etal.YonseiMedJ.2006;47;4354.
4NNISSystem.AmJInfectControl.2004;32:470485.
5vanderMeeMarquetN,etal.JClinMicrobiol.2004;42:56505657.

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DistributionofMRSAinservicesunitsat
ChildrensandMaternityHarapanKitaHospital,
January December2006

WARDS POSITIVE
Thirdclasspediatricward 31(37.4%)
PICU 9(10.8%)
Firstclasspediatricward 7(8.4%)
NICU/LEVELII 7(8.4%)
Secondclasspediatricward 7(8.4%)
VIPclasspediatricward 2(2.4%)
Transitionalneonatalward 2(2.4%)
Surgicalpediatricward 1(1,2%)

Inpatients 66(79,5%)
Outpatients 17(20,5%)

Latre2006

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PrevalensiMRSA
7

4
CAMRSA
3
HAMRSA
2

0
MRSA

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CA-MRSA : an emerging threat in USA

nosocomial
TotalcasesofMRSSAinfections,No.

communityacquiredwithriskfactors
communityacquiredwithoutriskfactors

1990 91 92 93 94 95 96 97 98 99 2000 01 02 03
*14yearstudyatDriscollChildrensHospital,Texas
PurcellKetal.ArchPediatrAdolescMed.159;980985,2005

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CA-MRSA : an emerging threat in USA

3,578isolatesofS.aureus
3 578 isolates of S aureus fromcommunityacquired
from community acquired
infectionsatTexasChildrensHospital(Aug.2001 Jul.2004)

2001-2002 2002-2003 2003-2004 P value

% MRSA 71.5 73.5 76.4 0.008

95.6%ofCAMRSA:Skinandsofttissueinfections
62 % of skin and soft tissue infections : CAMRSA
62%ofskinandsofttissueinfections:CA MRSA

KaplanSLetal.ClinInfectDis.40;178591,2005

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CA-MRSA in Taiwan

464childrenwithS.aureus infectionsbetween19972001inNTUH

IncidenceofCAMRSA:
CAMRSA
CA MRSA/totalcommunityS.aureus
/ total community S. aureus infections59/80(74%)
infections 59 / 80 (74 %)
CAMRSA/totalMRSAinfections59/373(15.8%)

CAMRSAwithriskfactors:only51%ofCAMRSAinfections

MajorinfectionsbyCAMRSA:SSTI(92%),bacteremia(7%),
M j i f ti b CA MRSA SSTI (92 %) b t i (7 %)
osteomyelitis(3%),pneumonia(2%)

FangYHetal.JMicrobiolImmunolInfect.37;29,2004

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Hasil multiplek PCRgenSCCmec typing

pada MRSAdan MSSA

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HasilsimplePCRgenVISApadaMRSAdanMSSA

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KarakteristiksampelklinikdenganSccmectyping,plasmidpub110
dansensitivitasantibiotikbetalaktam

NO. SPESIMEN Scc pub AMC CXM OX CTX CRO CAZ FEP IPM

SAMPEL mec 110

4 URIN IV + R R R R R R R R

9 SPUTUM II + R R R R R R R R

11 USAP II + R R R R R R R R

TENGGOROK

10 PUS II - R R R R R R R R

1 Darah - - S S S S S S S S

2 Darah - - S S S S S S S S

3 Sekret bronkhus - - S S S S S S S S

5 Darah - - S S S S S S S S

6 Urin - - S S S S S S S S

7 Urin - - S S S S S S S S

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KarakteristiksampelklinikdenganSccmectyping,plasmidpub110
dansensitivitasantibiotiknonbetalaktam
NO. SPESIMEN Scc pub SXT CC AN CIP LVFX VA TEC TGC FOS LZ
SAMPEL mec 110

4 URIN IV + R S S S S S S S S S
9 SPUTUM II + R R S R R S S S R S
11 USAP II + R R S R R S S S R S
TENGGOROK
10 PUS II - R R S R R S S S R S
1 Darah - - S S S S S S S S S S
2 Darah - - S S S S S S S S S S
3 Sekret - - R S S S S S S S R S
bronkhus
5 Darah - - R S S S S S S S R S
6 Urin - - S S S S S S S S S S
7 Urin - - S S S S S S S S S S
8 Urin - - S S S S S S S S S

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KARAKTERISASISAMPELKLINIKDANHUBUNGANNYA
DENGANGENVISASERTAPLASMIDpub110
SPESIMEN No. MRSA/MSSA pub 100 vraA vraG vraF vraR fruA fruB

Darah 1 HA-MSSA - + - + + + +

Darah 2 CA-MSSA - + - - - + +

Secret bronchus 3 HA-MSSA - + - - - + +

Urin 4 CA-MRSA
CA MRSA + + + -
- + -
Darah 5 CA-MSSA - + - + + + +

Urin 6 CA-MSSA - + - + + + +

Urin 7 CA-MSSA - - + - - + -

Urin 8 CA-MSSA - + - - - + +

Sputum 9 HA-MRSA + + + + + +
+
Pus 10 HA-MRSA - + + - - + -

Usap tenggorok 11 HA-MRSA + + + - - + -

TOTAL 11 11 27% 91% 45% 36% 36% 100% 64%

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Teicoplanin

Teicoplanin

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MRSAInfectionsAssociatedWithHigher
AttributableMortalityThanMSSAInfections
utable
Mortality (%))
Estimated Attribu
E

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AntibioticCareBundle
AnAdditionalPointtoConsiderWhenSelectingAntimicrobial
Coverage CollateralDamageCausedbyOveruseofAntibiotics

MRSA15

3GCephalosporins VRE6,7

MDRKlebsiella811

Enterobacter1214
MDREnterobacter
MDR
Fluoroquinolones
MDRPseudomonas1519

MDRAcinetobacter1921

KPCLactamase
22
Carbapenems

CDI2326

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AntibioticCareBundle
AnAdditionalPointtoConsiderWhenSelectingAntimicrobial
Coverage CollateralDamageCausedbyOveruseofAntibiotics

MRSA15

3GCephalosporins VRE6,7

MDRKlebsiella811

Enterobacter1214
MDREnterobacter
MDR
Fluoroquinolones
MDRPseudomonas1519

MDRAcinetobacter1921

KPCLactamase
22
Carbapenems

CDI2326

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AntibioticCareBundle
AnAdditionalPointtoConsiderWhenSelectingAntimicrobial
Coverage CollateralDamageCausedbyOveruseofAntibiotics
MRSA15

3GCephalosporins VRE6,7

MDRKlebsiella811

Enterobacter1214
MDREnterobacter
MDR
Fluoroquinolones
MDRPseudomonas1519

MDRAcinetobacter1921

KPCLactamase
22
Carbapenems

CDI2326

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HubunganPemberianABdanMRSA/MSSA (2008 2010)

Isolat S.aureus (+) MRSA(+) MSSA(+)

AB (+) 18(6%) 270(94%)

AB() 0(0%) 23(8%)

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HubunganPemberianABdanMRSA (2008 2010)

Isolat MRSA (+)

HAMRSA(+) CAMRSA(+)
18(6%)

AB (+) 12(67%) 6(33%)

AB() 0(0%) 0(0%)

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HubunganPemberianABdanMSSA (2008 2010)

Isolat MSSA (+)

HAMSSA(+) CAMSSA(+)
270(94%)

AB (+) 108(40%) 162(60%)

AB() 9(39%) 14(61%)

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Proporsi CAMRSAterhadap semua isolat MRSA

Proportion=CAMRSA/CAMRSA+NosocomialMRSA

P
ProporsiCAMRSA:6=33%
i CA MRSA 6 33 %
6+12

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Proporsi CAMRSAterhadap semua isolat komunitas S.aureus

Proportion=CAMRSA/CAMRSA+CAMSSA

P
ProporsiCAMRSA:6=4%
i CA MRSA 6 4%
6+162

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AntibioticStewardship
InfectionPreventionandControlofMDROrganisms
Prevention

Optimalmanagementofvascularandurinarycatheters
Preventionoflowerrespiratorytractinfectioninintubatedpatients
Accuratediagnosisofinfectiousetiologies
Judiciousantimicrobialselectionandutilization

C t l
Control
z Improvedhandhygiene
z UseofContactPrecautionsuntilculturenegativefortargetMDRO
z Activesurveillancecultures
z Education
z Enhancedenvironmentalcleaning
E h d i l l i
z Improvedinter andintrahospital/healthcarefacilitiescommunication
regardingpatientswithMDROs

CentersforDiseaseControlandPrevention.Availableathttp://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf.
AccessedMay10,2009.

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PRACTICE

SummaryofAntimicrobialStewardship

SummaryoftheAntibioticCareBundle

ightdrug
Infection
ight time
ighttime
ightdose
+ Control
ightduration

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