Curriculum Vitae

Nama : Dr. Ronald Irwanto Natadidjaja, SpPD – KPTI, FINASIM

Pendidikan :
SMP - SMA : Kolese KANISIUS, 1994
Dokter Umum : FK TRISAKTI, 2002
Spesialis Penyakit Dalam (Internist) : FKUI, 2009
Konsultan Penyakit Tropik & Infeksi : FKUI / PAPDI, 2013

Pekerjaan :
Bendahara Pengurus Besar Perhimpunan Konsultan Penyakit Tropik dan
Infeksi Indonesia (PB PETRI)

SekJen PP. Perhimpunan Pengendalian Infeksi Indonesia (PP. PERDALIN)

Tim Panel Ahli PNPK Sepsis, Kemenkes RI

Staf Pengajar Ilmu Penyakit Dalam, FK TRISAKTI

Ketua PPRA, RS PONDOK INDAH – PURI INDAH

Wakil Ketua Komite Medik, RS PONDOK INDAH – PURI INDAH

Internist - Konsultan, RS PONDOK INDAH – PURI INDAH dan RS PONDOK

INDAH – BINTARO JAYA
Antimicrobial Stewardship Program :
A part of Infection Control

Ronald Irwanto
Indonesian Society of Infection Control
 OVERUSE vs UNDERDOSE
Which the bigger contribution for creating
resistance?
Over use Under Dose
Collateral Mutation / Gen
Damage Expressed

Under Dose is more frequent for creating high MIC-90

than Over Use
Using broad spectrum AB, when in the right indication with de-
escalation method with right dose is NO PROBLEM
But the INDICATION for broad spectrum AB need to be
formulated into guidelines
Disease Severity
Sensitivity of Carmeli Host Risk Stratification
Over Use vs Under Dose

TYPE III
Using Ab with Correct Dose
and Indication

Type II
Sensitivity for
Faster De-Escalation
Microorganism Resistant
TypeI
Using Ab with Correct Dose
and Indication
 Antimicrobial Resistance :
Key Prevention Strategies

Susceptible Pathogen
Antimicrobial-Resistant
Pathogen Pathogen
Prevent Prevent
Transmission Infection

Infection
Antimicrobial
Resistance

Effective Diagnosis
Optimize Use and Treatment
Antimicrobial Stewardship
Program Antimicrobial Use CDC 2002
 Starting the Infection and
Prevention Control Program
INASIC with the 5 STARS PROGRAM
• Policy
Isolation
Precaution • Standard Operating
Antimicrobial Procedure
Surveillance
Resistant Watch
• Implementation &
Socialization
Infection Education • Monitoring &
Prevention & Training Evaluation

THINK BIG
START SMALL
ACT NOW
ANTIMICROBIAL STEWARDSHIP
PROGRAM

PRE-AUTHORIZATION Post Antibiotic Review

RESTRICTION vs NON RESTRICTION

- Person vs System
- AB Classification vs AB Guidelines
(A,B,C)
- Hard to do vs Easy to do

Ronald Irwanto, PERDALIN,2017

HAK CIPTA PONDOK INDAH HEALTHCARE GROUP
Antimicrobial Stewardship Program is not the
same with Broad Spectrum Antibiotic Using
Inhibition !!!
BUT
It’s about how to use antibiotic properly based
on indication
 Antimicrobial
Resistant Watch

• Policy ANTIMICROBIAL RESISTANCE

WATCH COMMITTEE

• Standard Operating ANTIBIOTIC GUIDELINES

Procedure
• Implementation &
Socialization Workshop & IT

DDD : Quantitative
• Monitoring &
Evaluation Gyssens : Qualitative

Financial Support, KNOWLEDGE, SOCIO-BEHAVIORAL,

Information Technology
 Pitfall in Antimicrobial Stewardship Program
(INDONESIA)
The Antimicrobial Resistant Watch-
Antimicrobial Stewardship Program

POLICY + ARW Comm

Many hospitals have any lack of idea
POSITIVE
- “ How to start the Antimicrobial
Stewardship Program (ASP)?”
SOP AB GUIDELINES
NEGATIVE - They have no AB Guidelines

- They have no culture based data,

Implementation & Socialization lack of diagnostic tools
NEGATIVE

Monitoring & Evaluation

NEGATIVE
 Antimicrobial Stewardship Program (ASP) :
Role Model
Pondok Indah Health Care-Hospitals
Jakarta-Private Hospital ASP Role Model
TRIANGLE of KNOWLEDGE
Prudent Antibiotic Use
Guidelines
Workshop
Symposium

Prudent
Antibiotic
Use

Socio-behavioral IT
Restriction
Automatic Stop Electronic Health Report (EHR)
Reward & Punishment Apps

Ronald Irwanto,, SHEA-EUCIC-ISC, Epidemiology Health

Training 2017
The Post Antibiotic Review

Making guidelines Host Factor & Risk Strat.

Antibiotics PK/PD

Microorganism Pattern

Implementing guidelines Workshop and

Socialization

DIGITAL AMS
Evaluation Quantity : DDD
Quality : Gyssens
Ronald Irwanto, INASIC , 2016
Comparison : Culture Based vs Non Culture Based Antibiotic in Soft
Tissue Infection in Cipto Mangunkusumo Hospital, Jakarta

Success Fail Bivariate Multivariate#

OR kotor OR suaian
n % N % p p
(IK95%) (IK95%)

Antibiotic

Culture based 26 57,8 19 42,2 0,120 0,50 (0,20-1,21) 0,085 0,45 (0,18-1,12)

Non Culture Based 33 73,3 12 26,7

Non Significant successful rate between

culture based vs non culture based antibiotic
Ronald Irwanto , Universa Medicina, 2013
 Comparison of Length Of Stay on CAP :
Proper Antibiotic vs Non Proper Antibiotic
Based on Guidelines

LOS
Bivariate Multivariate
< 5 hari > 5 hari
N % n % p OR p OR
Proper 38 38,8 11 11,2
10,65 10,25
Non <0,001 <0,001
(4,18 – 27,13) (3,93 – 26,71)
Proper 12 12,2 37 37,8

Patients with non proper antibiotic ( based on empiric guidelines)

tend to have 10.25x prolonged stay possibility in order to compare
with others who was administered proper antibiotic

Fetri C. Munarsih, Ronald Irwanto, 2016

 Breakdown the Guidelines
HOW the IT works? into the IT System

USER FRIENDLY

Guidelines
Implementation
Identitas
Nama :
Umur :
Jenis kelamin :
Tanggal masuk :
MR :

Masalah Infeksi Bakterial

Host Imunokompeten
Imunokompromised :
Penyakit kronik
Malignancy
HIV
Geriatri
Diabetes melitus
Febrile netropenia
lain-lain, sebutkan.

Fokus Infeksi bakterial Saluran napas atas

Paru-paru
Gastro-intestinal
Intra-abdominal intra bilier
Intra-abdominal extra bilier
Saluran kemih
Kulit dan jaringan lunak, Sebutkan jenis :
abses
selulitis
folikulitis
furunkel / karbunkel
luka terbuka/ulcus/ gangren
lain-lain, sebutkan

Fokus infeksi lain, sebutkan

 Sepsis / Septik syok Ya
Tidak

Setting infeksi Komunitas

Rumah sakit

STRATIFIKASI RISIKO TIPE

Riwayat paparan
Penggunaan antibiotik sebelumnya I (SATU )
Tidak
Ya :
< 30 hari terakhir
<90 hari terakhir ANTIBIOTIK
>90 hari

Perawatan di RS /intalasi kesehatan lainnya

Ceftriaxone /
Tidak
Ya : Cefotaxime / Cefixime
< 30 hari terakhir ATAU
< 90 hari terakhir Ciprofloxacin
> 90 hari
. Alternatif :
Riwayat tindakan invasif Fosfomycin /
Cotrimoxazole
Tidak
Ya :
< 30 hari terakhir
< 90 hari terakhir
> 90 hari
 Conclusion

• Antimicrobial Stewardship Program (ASP) is

not about how to work, but should be
implemented as a value
• ASP value should be realized by knowledge,
socio-behavioral and IT
• ASP should be done faster for reducing the
antimicrobial resistance that be a global issue
Thank You