Global Problem AMR

Strategi Pengendalian:
Hasil Capaian dan Target ke Depan

Anis Karuniawati, Hari Paraton

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTERIAN KESEHATAN R.I
 ERA PRE-
ANTIBIOTIK
BEHAVIOUR AMR

ANTIBIOTIC ERA

misuse, HAI, MORBIDITY

MORTALITY,
overuse DISABILITY, ALOS,
COST
AMR - GLOBAL PROBLEM
GLOBAL RESISTANCE: KLEBSIELLA PNEUMONIAE (ESBL+)

60-80%
KPMG LLP - December 2014
 NATIONAL PROBLEM OF
ANTIMICROBIAL RESISTANCE
Indonesia ada dimana: ??

Evidence based communication

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTERIAN KESEHATAN RI
 GLOBAL ACTION
PLAN ON AMR

1. Improve awareness and understanding of AMR through effective

communication, education and training.
2. Strengthen the knowledge and evidence base through research
and surveillance.
3. Reduce the incidence of infection through effective hygiene and
infection prevention measures.
4. Optimize the use of antimicrobial medicines in human and animal
health.
5. Develop the economic case for sustainable investment that takes
account of the needs of all countries, as well as the case for
investment in new medicines, diagnostic tools, vaccines and other
interventions.
 GLOBAL ACTION
PLAN ON AMR

NAP-AMR
1.
Improve awareness and understanding of
antimicrobial resistance through effective
communication, education and training

Indonesia: ???
REGULASI , PELATIHAN DAN
DUKUNGAN
 BAKTERI
RESISTEN

MISUSE /
OVERUSE

• Resistance is
unresponsiveness
to antimicrobial
agents in standard
doses TRANSMISION
 GLOBAL ACTION
PLAN ON AMR
1. Improve awareness and understanding of AMR through effective
communication, education and training.
2. Strengthen the knowledge and evidence base through research
and surveillance.
3. Reduce the incidence of infection through effective hygiene and
infection prevention measures.
4. Optimize the use of antimicrobial medicines in human and animal
health. Bagaimana Indonesia: ??
5. Develop the economic case for sustainable investment that takes
account of the needs of all countries, as well as the case for
investment in new medicines, diagnostic tools, vaccines and other
interventions.
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
KEMENTERIAN KESEHATAN
 AMU SURVEILLANCE
ANTIBIOTIC QUALITATIVE ANALISIS
6 TEACHING HOSPITALS - 2016
100
100
OBGYN SURGICAL
80 80

60 60

40 40
20 20
0 0
0 I II III A IV V VI 0 I II III 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

Mengapa bisa terjadi ?

100 PENY. ANAK 100 PENY. DALAM
80 80
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

* Data kajian AMR-AMU, KPRA KEMENKES 2016

 AMR Surveillance -2016
Prevalence of E coli & K. pneumoniae (ESBL+)
100%
90% 82%
78% 79%
80%
70%
60% 53% 55% 56%
52% 50%
50%
40% ESBL
30%
19%
20%
10%
0%
ACH MED JAK SEM SOL SUB MAL DPS SWA
SUB

* Data kajian AMR-AMU, KPRA KEMENKES 2016

 ESBL
PRODUCING
BACTERIA
PREVALENCE of ESBL in INDONESIA
70
surveilans
60 60 2016
50-82%
50
presentage

40 40
35 WHO/
PPRA ESBL
30 28 26-56%
20 RSDS RSDS

10 9 AMRIN
0
2000 2005 2010 2013 2016
 GLOBAL ACTION
PLAN ON AMR
1. Improve awareness and understanding of AMR through effective
communication, education and training.
2. Strengthen the knowledge and evidence base through research
and surveillance.
3. Reduce the incidence of infection through effective hygiene and
infection prevention measures.
4. Optimize the use of antimicrobial medicines in human and animal
health.
5. Develop the economic case for sustainable investment that takes
account of the needs of all countries, as well as the case for
investment in new medicines, diagnostic tools, vaccines and other
interventions.
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
KEMENTERIAN KESEHATAN
 MORBIDITAS & MORTALITAS

• IDO RS 11.8% WHO

700.000
(1.2-23.6) 2013

USA
23.000
• HAI > 30% 300 juta
• 40-60% Thailland
preventable 38.000
70 juta
• MDRO INA
135.000
Lyons, WHRA, 2010) 256 juta

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

• Mortalitas HAI 6,9%
 MASALAH AKIBAT AMR

• Kegagalan terapi.
• Kegagalan operasi
canggih, kompleks
• menimbulkan beban
morbiditas, mortalitas,
kecacatan
• COST
 GLOBAL ACTION
PLAN ON AMR
1. Improve awareness and understanding of AMR through effective
communication, education and training.
2. Strengthen the knowledge and evidence base through research
and surveillance.
3. Reduce the incidence of infection through effective hygiene and
infection prevention measures.
4. Optimize the use of antimicrobial medicines in human and animal
health.
5. Develop the economic case for sustainable investment that takes
account of the needs of all countries, as well as the case for
investment in new medicines, diagnostic tools, vaccines and other
interventions.
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
KEMENTERIAN KESEHATAN
SELECTIVE PRESSURE
FAKTA PENGUNAAN
ANTIBIOTIK DI RS

Hasil
Kategori
Sby Semg
(%) (%)
Tidak ada
indikasi 76 53
terapi

Tidak ada
indikasi 55 81
profilaksis

AMRIN STUDY : 2002-

22
2005
 PPRA, MENGAPA HARSUS
DILAKSANAKAN DI RUMAH SAKIT

• HAI di RS meningkat.
• Banyak dokter tidak tepat menggunakan
antibiotik 50-80%
• Reservoir bakteri resisten – 62% (50-82)ESBL
• Mortalitas meningkat
 GLOBAL ACTION
PLAN ON AMR
1. Improve awareness and understanding of AMR through effective
communication, education and training.
2. Strengthen the knowledge and evidence base through research
and surveillance.
3. Reduce the incidence of infection through effective hygiene and
infection prevention measures.
4. Optimize the use of antimicrobial medicines in human and animal
health.
5. Develop the economic case for sustainable investment that takes
account of the needs of all countries, as well as the case for
investment in new medicines, diagnostic tools, vaccines and other
interventions.
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
KEMENTERIAN KESEHATAN
 CORE PLAN DI RUMAH SAKIT

• PREVALENSI HAI ? • SARANA LAB

MIKRO
• GL KHUSUS HAI • SDM
• SURVEILLANCE
HAI AMR

• PNPK/PPG/CP
• ASP
• DALIN TRANSMISI AB • REVIEW
• CUCI TANGAN • HE AB
• ISOLASI RESTRICTION
HARAPAN Turunnya Prevalensi Bakteri
Penghasil ESBL Nasional

70
60 60
50
presentage

40 40 40
35 ESBL
30
28 25
20
10 9
0
2000 2005 2010 2013 2016 2018 2020
HARAPAN: Peresepan Antibiotik Di
Kalangan Klinisi Semakin bijak
 HARAPAN Healthcare-
Associated Infection Semakin
Turun (25%)
 HARAPAN
HIGH QUALITY HEALTH CARE

Cases
save

ALOS
Beaya
Prosedur/ICU
tenaga/waktu
unsafe Morbiditas
antibiotic Mortalitas
Medikolegal
PPRA bukan Revenue Centre, tetapi
Cost Saving
TERIMA
KASIH