ANTIBIOTIC PROGRAM PENATAGUNAAN STEWARDSHIP …

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

ANTIBIOTIC

STEWARDSHIP

PROGRAM

Harry Parathon KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

RSUD. DR. SOETOMO SURABAYA / KEMENKES RI

PROGRAM PENATAGUNAAN

ANTIBIOTIK

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Masalah di rumah sakit di Indonesia

Penatagunaan antibiotik / ASP

Kedudukan dan cara kerja PGA

Hasil Pilot project PGA di RSUD.Dr. Soetomo

ASP di SGH - Singapore

Topik Bahasan

Aktivitas PGA / ASP di rumah sakit

Dr. Djovi. RS. Super husada

R/ Meropenem 1 g no XV

/ imm. Ny. Rindu

Ms. Rindu. 46 thn BP110/70, TEMP: 38.5, Leucosit: 14.000. X-Ray Thorax: Pneumonia (+) Diagnose: CAP

Tim PGA Diskusi:

Meronem

Levofloxacin 750

mg/dosis tunggal

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SURVEILLANS • E.COLI (ESBL )

• K.

PNEUMONIA

(ESBL)

SURVEILLANS PENGGUNAAN

ANTIBIOTIK

2005

55-76%

2016

70-80%

SURVEILANS AMR DAN AMU 11 RUMAH SAKIT

PENDIDIKAN

0

20

40

60

80

100

0 I II III IV V VI

40 60 60,4

0

50

100

6 Hosp. 2013

8 Hosp. 2016

!0 Hosp. SS. 2019

ESBL

ESBL

AMU 11 RS PENDIDIKAN

2016

2005

9.0%

201

3

40.0

%

20

16

60.

0%

201

9

60.4

%

MISUSE &

OVERUSE


PENGARUH ASP MENURUNKAN PREVALENSI ESBL

Pena et al, 1998. Epidemiology and Successful Control of a Large Outbreak Due to Klebsiella pneumoniae Producing ExtendedSpectrum β-Lactamases ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Jan. 1998

ASP

https://aac.asm.org/content/42/1/53


INTERVENSI

• Indikasi tepat

• Penggunaan antibiotik TEPAT Jenis, dosis, rute, interval dan durasi.

Ohl CA. Seminar Infect Control 2001;1:210-21.Ohl CA, Luther VP. J. Hosp. Med. 2011;6:S4 Dellit TH, et. al. Clin Infect Dis.

2007;44:159-177

6

PENATAGUNAAN ANTIBIOTIK / ASP

Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, 2016. Implementing an antibiotic stewardship

program: guidelines by the infectious diseases society of America and the society for healthcare epidemiology of America. Clin Infect

Dis.

SYARAT: • Guideline: PPK dan CP • Kelompok antibiotik:

Access, Watch dan Reserve

• Prosedur pengesahan AB

• Monitoring and feedback

• Dukungan Manajemen Tujuan

meningkatkan keselamatan

pasien

IDSA , 2015

PGA

Pasien

mendapat

antibiotik

yang

TEPAT


PMK No.8 th 2015

8

DASAR REFERENSI PENATAGUNAAN ANTIBIOTIK

https://s0.bukalapak.com/img/5548627583/w-1000/20181109_213229_scaled.jpg

TIM PGA berada dalam KPRA / TIM PPRA RS

• Farmasi klinik • Mikrobiologi klinik • Pengendalian dan Pencegahan

Iinfeksi • Klinisi dokter (Minat Infeksi) • Staf RS lainnya • Dikukuhkan SK Direktur RS


PGA: Pembedahan Prophylaxis

Dr. VITA SpOG RS. Super husada

R/ ceftriaxone I g No. II

/ imm. Ny. Susan

Ny. S, 28 th G1P0. ATH. CPD BP110/70, TEMP: 36.5,T3/T4 DBN; Leucosit: 7.000.

Cefazolin 2 gram No

Antibiotik

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PGA: Pembedahan Prophylaxis

Dr. Djovi. SpB KL RS. Super husada

R/ ceftriaxone I g No. II

/ imm. Tn. ABD

Ny. N. 40 yrs Benjolan pada leher; BP110/70, TEMP: 36.5,T3/T4 DBN; Leucosit: 7.000. Diagnose: Struma

No Antibiotic

• Pasien pulang • obat analgetik • Antibiotik oral (-)


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Persetujuan peresepan antibiotik

Pasien

DPJP RESEP

RESERVE

WATCH

ACCES Farmasist

Perawat

PGA Dep.

PGA RS

tidak sesuai

KPRA RSUD Dr.Soetomo 13

ACCESS WATCH RESERVED

• Ampicillin, Amoxicillin

• Gentamycin

• Ampicillin-sulbactam, Amoxicillin-

clavunalat acid

• Cephradin, Cephalexin, Cefadroxil,

Cefazolin

• Cephaclor, Cefuroxime

• Chloramphenicol, Thiamphenicol

• Clindamycin oral

• Erythromycin, Spiramycin,

Clarithromycin

• Ciprofloxacin

• Tetracyclin, Doxicyclin

• Cotrimoxazole oral

• Metronidazole

• Azithromycin

• Cefixime, Cefditoren,

Cefpodoxim-proxetil

• Ceftriaxone, Cefotaxime,

Ceftazidime, Cefoperazon,

Cefoperazon-sulbactam,

Ceftizoxime

• Cefepime, Cefpirome

• Levofloxacin, Ofloxacin,

Moxifloxacin,

• Aztreonam

• Amikacin, Fosfomycin

• Nitrofurantoin, Colistin p.o

• Meropenem, Ertapenem,

Doripenem, Imipenem-

cilastatin

• Vancomycin

• Piperacillin-tazobactam

• Tygecycline

• Linezolide

• Polimixin B inj. (SAS)

• Colistin inj. (SAS)

• Cotrimoxazole inj (SAS)

KEBIJAKAN RESTRIKSI ANTIBIOTIK - AWaRe

DI RSUD DR SOETOMO (SK Direktur No: 188.4 / 237 / 301 /

2018)


1950

1422

1191 1055

1386 1593

937 938

461 363

0

500

1000

1500

2000

2500

MARET APRIL MEI JUNI JULI AGUSTUS SEPTEMBER OKTOBER NOVEMBER DESEMBER

Penggunaan meropenem 1 gram Maret-Desember 2019 (vial)

DAMPAK PENGGUNAAN ANTIBIOTIK RESERVE (MEROPENEM)

SEBELUM DAN SESUDAH PELUNCURAN PGA di RSDS 2019

*Sumber data: pengeluaran unit pelayanan farmasi

Peluncuran PGA


15,63

1,56 6,25

0,00 0,00 1,56

12,50 17,19 14,06 17,19

10,94

3,13

0,00

10,00

20,00

30,00

40,00

50,00

60,00

70,00

80,00

90,00

100,00

Jan Feb Mar Apr Mei Juni Juli Agust Sept Okt Nov Des

Bakteri R karbapenem (%)

peluncuran PGA

Prevalensi E.coli (CRE) 2019 (N= 281)


Apa Yang Dikerjakan Tim ASP - Singapore

16

Dear, Dr, Prof His most recent admission was > 3months ago and hence his pneumonia is CAP If You suspect more resistant organism because of recent therapy, you may use IV Ceftazidime plus PO Levofloxacin or even Piptazo but not Meropenem. Please de-escalate antibiotics ID Specialist

CONTOH FEED BACK TIM ASP

EVALUASI PERESEPAN SETIAP DOKTER


1. Hak pasien mendapatkan pengobatan yang tepat

dan optimal, termasuk antibiotik Meningkatkan

outcome pasien

2. Penggunaan antibiotik masih berpotensi Misuse

dan Overuse

3. Tim PGA/ASP rumah sakit, membantu optimalisasi

penggunaan antibiotik

4. Indikator:

• penurunan prevalensi Misuse dan Overuse

antibiotik

• penurunan prevalensi AMR (ESBL, CRE, CRKP,

CRAB)

• Penurunan insidensi HAI

TAKE HOME

MESSAGE

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TERIMA KASIH

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ANTIBIOTIC PROGRAM PENATAGUNAAN STEWARDSHIP …

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