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GLOBAL PROBLEM OF

ANTIMICROBIAL RESISTANCE
Dr.Hari Parathon,Sp.OG(K)
dr. Dani Rosdiana, SpPD
PENGABDIAN MASYARAKAT 2018
ERA PRE-
ANTIBIOTIK BEHAVIOUR AMR

ANTIBIOTIC ERA

HAI, MORBIDITY,
MISUSE MORTALIY, DISABILITY,
OVERUSE COST, ALOS
GLOBAL RESISTANCE of E COLI (ESBL (+))
GLOBAL RESISTANCE of Klebsiella pneumonia (ESBL
(+))
PREVALENSI MDRO 2013 - 2015
90%

80% 82%

Bagaimana 70% 76% 78% MRSA

MDRO di 60%
45%
55%
51%
K.pneumoniae
resisten seftriakson
50%
RSU Arifin 40%
41%
42% K.pneumoniae
resisten meropenem
Achmad? 30% 29%
41%
A.baumanii resisten
meropenem
20% 25% 26% 19% P.aeruginosa resisten
meropenem
10% 16%
11%
0%
2013 2014 2015
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


BAKTERI RESISTEN

Bakteri yang tidak dapat dimatikan atau dihambat oleh antibiotik


dengan dosis standar

Misuse and overuse


SELECTIVE PRESSURE THEORY

Dr. Hari Parathon, SpOG


APAKAH BAKTERI RESISTEN MENIMBULKAN MASALAH ?

• Kegagalan terapi
• Ancaman pada operasi
canggih / kompleks
• Meningkatkan morbiditas,
mortalitas dan cacat
• Meningkatkan pembiayaan
kesehatan, menurunkan
GDP
NAP on AMR Indonesia one-health approach
Submitted to WHO library in May 2017
WHO regulation:
Global Action Plan  National Action Plan
3
Reduce the
Incidence of
Infection
2 4
Surveylence & Optimise the Use of
ASP
Research3 Antimicrobial

1 5
awareness Inovation of new
and
understanding
AMR medicines,
diagnostic tools,
vaccines

AMR : Antimicrobial Resistance


ASP : Antimicrobial Stewardship Program (PPRA)
1. Awareness and understanding
Improve awareness and understanding of antimicrobial resistance
through :Effective communication, education and training

PASIEN KASTEMER PARTNER

• Pasien ikut • Bisnis • Partnership


kemauan dokter • Patient • Patient Centered
• DOKTER PALING expectation Care
PINTAR • Litigasi • Profesional
• PATERNALISTIK • DEFENSIVE • Competence
PRACTICE • MUTUAL TRUST
AND FAITH
• Tenaga kesehatan harus update pengetahuan tentang problem
bakteri resisten
• Masyarakat harus memahami risiko dan ancaman bakteri resisten,
mengubah perilaku swa-medikasi antibiotik
2. Strengthen the knowledge and evidence base through
surveillance and research.
• Surveylens penggunaan antibiotika secara kualitatif dan kuantitatif

SURVEY PENYAKIT DALAM TAHUN 2017


100
90
80
70
60
50
40
30 28
30
21
20
9 9
10 3
0
0
O I II III IV V VI
Penggunaan Antibiotika secara KUANTITATIF

DDD ANTIBIOTIK - IPD


vancomycin 0,00
tigecyclin 0,00
procain benzilpenicillin 0,00
metronidazole 2,01
meropenem 2,52
levofloxacin 3,12
gentamicin 0,41
fosfomycin 0,57
eritromisin 0,51
cotrimoxazole 0,12
clindamycin 0,00
ciprofloxacin 4,16
ciprofloxacin 0,43
ceftriaxone 12,77
ceftizoxime 0,43
ceftazidime 0,47
cefotaxime 1,08
cefoperazone-sulbactam 0,01
cefoperazone 0,01
cefixime 0,64
cefazolin 0,00
cefadroxil 0,34
ampicillin-sulbactam 0,50
amoxicillin 0,00
ampicillin 0,00
amikacin 6,48
0,00 2,00 4,00 6,00 8,00 10,00 12,00 14,00
3. Optimize the use of antimicrobial medicines in human
and animal health
• Campaign Prudent
Antimicrobial
usage
Strategi
• Dokter tahu data pola resistensi
• Pilihan antibiotik tepat
• Antibiotik  Heterogen
• Preventif kolonisasi
• Antibiotik sesingkat mungkin
4. Reduce the incidence of infection through effective
sanitation, hygiene and infection prevention measures

THE PROBLEM

ANTIBIOTIC
USE Blood stream
more difficult to Pneumonia
treat UTI
more procedure SSI
high cost
ICU use
Failure  morbidity
and mortality
HAI AMR
Healthcare Associate Infection
• infeksi yang didapat saat pasien dirawat di Rumah sakit.
(tidak sesuai dengan masa inkubasi penyakit)
• Incidence 3.4-12% (negara maju), 5,7-19.1% (negara
berkembang)
• USA 99.000 kematian/tahun
• Biaya $ 6,5 Milyard. (Rp. 84,5 T)
Bagaimana mencegah transmisi?
5. Develop the economic case for sustainable 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
“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, patientcentered,


timely, efficient and equitable.
TERIMA KASIH

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