You are on page 1of 32

Fendy Matulatan,dr.

,SpB(K)BA

• Ketua III KPRA RSUD Dr.Soetomo


• Wakil Ketua KFT RSUD
Dr.Soetomo
• Staf SMF Ilmu Bedah RSUD
Dr.Soetomo-FKUA
• Pengurus PABI Surabaya
2
ANTIBAKTERI
ANTIBAKTERI
PROFILAKSIS
TERAPI
MENGAPA PERLU PROFILAKSIS ?
dokter takut kalau infeksi
• beban perasaan dokter
• reputasi dokter
• pasien menderita
• beban biaya

dokter ikut pengalaman yang lalu


• operasi = profilaksis
• pelajaran saat PPDS I
• ikut seniorny

Pasien yang meminta Antibiotik


• menggaggu tugas dan penghasilan

4
Kasus Usia
Ko-morbid

Status umum Instrumentasi Instrumen


pasien
Air bersih
Sarana OK
Infeksi Daerah Operasi
Koloni OK antiseptik

SDM
Cuci tangan SOP Antibiotik

kompetensi Linen Pasca operasi


Operator

5
MENGAPA PERLU PROFILAKSIS

• Operasi harus pakai


antibiotik ?
• Luka operasi supaya
cepat kering ?
DULU suntikan oral
Pre op (+) (-)

Post op Sampai flatus 5-7 hari


penggunaan
antibiotik Amoksisilin clav
saat operasi Ampisilin,
Sulbenisilin
Amoksisilin Clav
Sefotaksim,
Jenis Erythromisin
Seftriakson Sefadroksil
Seftasidim
Clindamicin
Gentamisin,
Nitromisin,
Tobramisin
7
Definitions :
Antibiotik yang diberikan sebelum-saat-setelah operasi pada kasus yang
secara klinis tidak terdapat tanda infeksi. Tujuannya untuk mencegah
terjadinya ILO / SSI / IDO dan mencegah kolonisasi

Infection here may cause:

Delayed healing

Hernia
Possible evisceration

Abscess
Fistula
Other procedures needed

8
Keuntungan dan Keterbatasan
penggunaan antibiotik profilaksis

Keuntungan Antibiotik Profilaksis


• Menurunkan infeksi luka operasi dan morbiditas
• Menurunkan biaya perawatan
• Mengurangi lama tinggal di rumah sakit

Keterbatasan Antibiotik Profilaksis


• Meningkatnya resiko kolitis karena Clostridium difficile bila
menggunakan sefalosporin generasi III
• Meningkatnya frekuensi bakteremia pada penderita yang
memakai antibiotik profilaksis lebih dari 4 hari
dibandingkan dengan yang mendapat profilaksis 1 hari
9
ANTIBIOTIK
PROFILAKSIS

1. Antibakteri, yang
digunakan untuk mencegah
komplikasi infeksi pada
tindakan operasi.
2. diberikan sebelum operasi,
ulangan saat operasi atau
setelah operasi
3. batasan waktu: tidak
melebihi 24 jam
INDIKASI
PROFILAKSIS

GOLONGAN OPERASI
• bersih
• bersih kontaminasi
• kontaminasi
• kotor
Surgical Site Infection / IDO

Definition
• superficial 30 hari
• deep 90 hari
• organ space 90 hari
• ortopedi 1 tahun

CDC 2017
kolonisasi

Antibiotika profilaksis
Profilaksis Dosis Tunggal v/s Multipel

Tidak
Fakta ada
laporan perbedaa
n
signifikan

Single-dose versus multiple-dose antibiotic prophylaxis for


the surgical treatment of closed fractures .
Slobogean.et.al. Acta Orthopaedica 2010; 81 (2): 256–262
Results: A total of 540 patients were recruited; (females73.7% of total ). The performed surgical
procedures were 547. The rate of wound infection was 10.9%. Multivariable logistic analysis
showed that; ASA score > 3; (p= <0.001), wound class (p= 0.001), and laparoscopic surgical
technique; (p= 0.002) were significantly associated with prevalence of wound infection. Surgical
prophylaxis was unnecessarily given to 311 (97.5%) of 319 patients for whom it was not
recommended. Prophylaxis was recommended for 221 patients; of them 218 (98.6 %) were given
preoperative dose in the operating rooms. Evaluation of prescriptions for those patients showed
that; spectrum of antibiotic was adequate for 160 (73.4%) patients, 143 (65.6%) were given
accurate doses, only 4 (1.8%) had the first preoperative dose/s in proper time window, and for
186 (85.3%) of them prophylaxis was extended post-operatively. Only 36 (6.7%) prescriptions
were found to be complying with the stated criteria.
Conclusion: The
rate of wound infection was high and prophylactic
antibiotics were irrationally used. Multiple interventions are
needed to correct the situation.
ANTIBIOTIK TERLALU LAMA
cara pemberian
AB PROFILAKSIS

• Antibiotik
– Cefazolin 2 g
– Cefuroxime 1,5 g
• i.v/drip dalam 100 ml NS,
selama 15 menit
• 30-60 menit sebelum insisi
• Tanpa test
• Di kamar operasi
BENANG MENGANDUNG ANTISEPTIK

QUALITY OF
RECOMENDATION STRENGHT
EVIDENCE
CONDITIONAL MODERATE
The panel suggests the use of
triclosan-coated sutures for
the purpose of reducing the
risk of SSI, independent of the
type of surgery.

WHO, 2016
ANTISEPTIK KULIT

QUALITY
RECOMENDATION STRENGHT OF
EVIDENCE
recommends alcohol-based Strong Low to
antiseptic solutions based on moderate
Chlorhexidine Gluconate for
surgical site skin preparation in
patients undergoing surgical
procedures.

WHO, 2016
CUKUR VS KERIK

Elective
Clipping hair just before case is best
Surgical
Procedures Hair Removal Infection Rate
Hair Removal Method
sore / kerok/shaving 5.2 - 8.8%
pagi / kerok 6.4 - 10%
sore / cukur 4 - 7.5%
pagi / cukur 1.8 - 3.2%

Alexander JW, et al. Arch Surg 1983; 118:347-352


CUKUR BULU/RAMBUT

QUALITY
STRENG
RECOMENDATION OF
HT
EVIDENCE
• patients undergoing any surgical Strong Moderate
procedure, hair should either not be
removed or, if absolutely necessary,
it should be removed only with a
clipper. Shaving is strongly
discouraged at all times, whether
preoperatively or in the OR.

WHO, 2016
ADVANCED DRESSINGS

QUALITY OF
RECOMENDATION STRENGHT
EVIDENCE

The panel suggests not using CONDITIONAL LOW

any type of advanced dressing


over a standard dressing on
primarily closed surgical
wounds for the purpose of
preventing SSI.

WHO, 2016
ANTIMICROBIAL PROPHYLAXIS IN THE
PRESENCE OF A DRAIN AND OPTIMAL
TIMING FOR WOUND DRAIN REMOVAL

QUALITY OF
RECOMENDATION STRENGHT
EVIDENCE
preoperative antibiotic prophylaxis CONDITIONAL LOW
should not be continued in the
presence of a wound drain for the purpose
of preventing SSI.

The panel suggests removing the wound CONDITIONAL VERY LOW


drain when clinically indicated. No
evidence was found to allow making a
recommendation on the optimal timing of
wound drain removal for the purpose of
preventing SSI.

WHO, 2016
PEMANJANGAN PEMBERIAN
ANTIBIOTIK

QUALITY OF
RECOMENDATION STRENGHT
EVIDENCE
STRONG MODERATE
The panel recommends against
the prolongation of SAP after
completion of the operation for
the purpose of preventing SSI.

Moderate quality evidence from a high number of RCTs (44 studies included in the
overall meta- analysis) shows that prolonged SAP postoperatively has no benefit in
reducing SSI after surgery when compared to a single dose.

WHO, 2016
ANTIBIOTIC GUIDELINE FOR PROPHYLAXIS
JOHNS HOPKINS 2016
Evidence
Prosedure Antibiotic Odd.Rt
Level
Prosedur Sectio Cesarea HR 1 0.41
Operasi Histerektomi TAH / TVH
R 1 0.17
& Tonsilectomy NR 1
Antibiotik Luka pada wajah NR 1
profilaksis Partus normal + episiotomi
NR 1

Strumectomy NR 1 -
Ca Mammae R 1
Appendectomy HR 1 0.58
HR= High Recommended
R = Recommended Colorectal surgery HR 1
NR= Not Recomended
Hernia NR 1
TUR prostate HR 1
Arthroplasty HR 1
SIGN 2014 Pemasangan kateter NR 1
OPERASI TIDAK MEMERLUKAN ANTIBIOTIK
TERIMA KASIH
There Is No Way Home
KITA DAPAT MENCEGAH INFEKSI
TETAPI SULIT MENGHINDARI
RESISTENSI

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

32