AGENDA

PENELITIAN AMR
DI INDONESIA

HARI PARATON
KOMITE PENGENDALIAN RESISTENSI
ANTIMIKROBA
KEMENTERIAN KESEHATAN RI
MDRO in ASIA PACIFIC / 2015
Enterococcus facium
resistance to aminopenicillins
82-97%
MRSA
Klebsiella pneumonia
82-97%
resistance to ceph. gen 3
6-80% Klebsiella pneumonia
resistance to Carbapenen
Acinetobacter baumanii 3-57%
resist to carpapenem
51-77% Acinetobacter baumanii
Pseudomonas aeruginosa resist to Aminiglikosida
resistance to antibiotic 48-90%
27-57%
 APA DAMPAK MDRO
• Mortality 700.000 people per year
• Limitation of antibiotic use
• difficult of Infection case
• Increase complication case in hospital
• Increase of Fail rate on complex operation (
organ transplant)
• Post antibiotic era
• small wound has potentially of death
• increase of ALOS, Cost
• set back to conventional treatment
 MORBIDITY & MORTALITY
• SSI 11.8% WHO
2013
700.000
(1.2-23.6) USA
23.000
• HAI > 30% 300 juta

• 40-60% Thailland
70 juta
38.000
preventable INA
135.000
• MDRO 256 juta

• HAI-RS / Indonesia – 7.1% (Deurink et al, 2009)

• Mortality of HAI 6,9%
Lyons, WHRA, 2010)
 SURVEILLANCE: ANTIBIOTIC QUALITATIVE
6 TEACHING HOSPITALS - 2016
100 100
80 SURGICAL 80 MEDICAL
60 60
40 40
20 20
0 0
0 I II III A IV V VI
0 I II IIIA IV V VI
RS A RS B RS C RS D RS E RS F RS A RS B RS C RS D RS E RS F

AMR Surveillance -2016

Prevalence of E coli & K. pneumoniae (ESBL+)
100% 82% 78% 79%
53% 52% 55% 50% 56%
50%

0%
ACH MED JAK SEM SOL SUB MAL DPS
ESBL PRODUCING
BACTERIA

PREVALENCE of ESBL in INDONESIA

70 surveill
60 60 ance
50 2016
presentage

45-82%
40 40 WHO/
35 PPRA
30 28 26- ESBL
RSD 56%
20 RSD
S
10 9 AMRI S
0 N
2000 2005 2010 2013 2016
 Table. Antibiotic susceptibility (n) pattern of ESBL producing E.coli
RSDS RSSA RSDM RSDK RSSD RSP TOTAL
Cefotaxime 0.17 0.00 NA 1.57 3.31 NA 0,78
Ceftriaxone 0.00 0.00 2.62 5.93 NA 0.00 1,19
Ceftazidime 0.17 0.00 12.07 4.19 8.33 0.00 3,83
Cefepime 0.34 42.06 26.21 9.42 25.62 0.00 12,78
Ciprofloxasin 16.10 29.37 10.00 18.32 7.50 10.42 15,21
Amikacin 97.95 95.24 82.99 96.34 73.33 98.96 92,4
Gentamycin 61.43 69.05 62.15 10.99 56.30 63.54 55,12
Fosfomycin 92.86 100.00 NA 78.57 82.89 NA 90,85
Piperacillin-
49.57 76.19 NA 76.44 65.81 66.67 60,4
tazobactam
Cefoperazone-
53.85 NA 83.33 72.73 57.98 15.63 57,08
sulbactam
Meropenem 99.83 98.41 98.96 95.29 94.96 100.00 98,51
Levofloxacin 20.14 29.37 9.00 21.48 15.38 10.42 17,66
Tigecyclin 78.08 99.21 97.92 99.48 40.63 100.00 94,67
Data surveillance PPRA RSDS-Balitbangkes-WHO 2013
7
 Surveillance of AMR
The Aim:
1. Set up a national surveillance system for antimicrobial
resistance.
2. Establish a national multicenter surveillance system for
early detection of resistance and monitoring at the
national level.
3. Build laboratory capacity under the supervision of a
National Referral Laboratory (NRL) to ensure high-
quality microbiological data to support surveillance
activities. Surveillance of AMR
Objective 1. Set up a national surveillance system for
antimicrobial resistance
1. NSCC will implement a national AMR surveillance programme that is
representative of the country situation but with limited number of operational
sites (sentinel)
2. NSCC will develop an AMR surveillance plan in humans, animals, food and
aquaculture
3. The NSCC will develop guidelines for AMR Surveillance and prudent use of
antimicrobials
4. The NSCC will identify priority pathogens, sample types, and antimicrobial
sensitivity patters in humans and animals, based on the country’s AMR situation
5. NSCC will train surveillance staff and clinical staff in AMR surveillance and lab
techniques according to GLASS standards
 Objective 2. Build laboratory capacity to produce high-quality
microbiological data for patient and food-safety management and
support surveillance activities

1. The NRLs will coordinate a national network of surveillance

laboratories to monitor AMR in human clinical, animal and food
samples.
2. The NRLs will identify laboratories to implement surveillance and
establish standard operating procedures (SoPs)
3. NRLs will train healthcare personnel, veterinarians, veterinary
paramedics, laboratory analysts, and other personnel involved in
surveillance measures according to international standards
Objective 2.3: Develop a multicenter surveillance system on the national
scale to provide early warning of emerging resistance

1. The NSCC will asses AMR hazard and risk, and communicate their
respective roles and responsibilities
2. The NSCC will frame guidelines and national standards for
systematic collection, sharing, and assessment of AMR hazard
events framed in keeping with international standards
3. The NSCC establishes a data and information unit to store AMR
information that can be utilized by government agencies, the
general public and international community as appropriate in
future
NATIONAL SURVEILLANCE SYSTEM
NATIONAL SURVEILLANCE SYSTEM
 AREA PENELITIAN
AMR AMU
KOMUNITAS 1. CA-AMR 1. Swa medikasi
2. Peternakan 2. perilaku jual beli
3. Bahan makanan asal hewan antibiotik
4. MDRO Human, animal, environment
KLINIK 1. surveilalnace dan tatalaksana HAI 1. kuantitatif AB
2. surveillance di RS 2. kualitatif AB
3. Transmisi 3. ASP
4. Health economic 4. antibiogram
5. pola bakteri / MDRO 5. perilaku peresepan
6. EWS antibiotik
7. Resistance
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 24, No. 8, August 2018
AREA PENELITIAN
 THINK DIFFERENT,
keep health without
antibiotic

Thank You