Masalah Nasional atau Global ?

KOMITE PENGENDALIAN RESISTEN ANTIMIKROBA

KEMENTERIAN KESEHATAN R I
(Hari Paraton)
 MASALAH GLOBAL

PENEMUAN ANTIBIOTIK PENGGUNAAN ANTIBIOTIK HARAPAN PADA MANUSIA

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTRIAN KESEHATAN
Rp
Pencetus
resistensi
Layanan kedokteran

Peternakan

Masyarakat
Di Layanan Medis dan Masyarakat

overuse
misuse
Rational
underuse

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTRIAN KESEHATAN
 di Peternakan

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTRIAN KESEHATAN
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
KEMENTRIAN KESEHATAN
MASALAH RESISTENSi
MENJADI KOMPLEKS
MASALAH GLOBAL
MASALAH GLOBAL
MASALAH GLOBAL
penyebaran NDM-1 E.coli
 Variant ESBL yang berhasil
diidentifikasi
(Davies et. Al, 2010)

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTRIAN KESEHATAN
 MORTALITAS
2013 700.000 / tahun

2050 10.000.000/tahun
WHO 2013
 Angka mortalitas 2050

mortality milion per year

10

6
10
8,2
4

2
1,5
0
AMR CANCER DM

CDC. 2014
 AMR: Global problem, Mortality and
Economic impact

§ EROPA THAILAND USA USA

UNION
• Population 70 M
• Population 300 M • Population 250 M
-Populatin 500 M • >38.000 death/
• >23.000 death/ • >135.000 death/
-25.000 death/ yrs
yrs yrs
year • 3.2 Mextra ALOS • 2 Mextra ALOS • Cost Rp. 56. T
-2,5 Mextra ALOS • Cost US$ 1.3 B • Cost US$ 20 B
-Cost € 1.5 / yrs

17 WHO, 2007
Proble Pertanian/
Peternakan
ms Growth
/perikanan

Map promoto
r
Cegah
infeksi
Regula
si

Food Kurikul
Knowled Residu AB Insent um
ge (+) if
Training
R AB / /Semina
OTC/Apat self AMR R AB/ Knowle r
ek DR dge
medikasi RS Worksh
op

Regulasi ASP
SDM Lab. Regul
SpM mikro asi
K
PNPK TOP
KM/K PPK MGT
FT (-)

IDI/
PDSP/
IAI
 Kecepatan
penemuan
antibiotik

Timbulnya
resistensi
kuman

- Post antibiotic era

- Kembali ke zaman
pra antibiotik
- Peningkatan kematian
karena penyakit infeksi

Bagan Waktu
Spekulatif
19
 Kecepatan
GOAL PPRA
penemuan
antibiotik

Timbulnya
resistensi
kuman

prevalensi
AMR
Surveillance
• standar
• berkelanjutan

Bagan Waktu
Spekulatif 20
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
KEMENTRIAN KESEHATAN
 BAKTERI RESISTEN

Rational use

Missuse • Efflux
• Degradation enz
Overuse
• Altering enz
• Biofilm
Underuse
 2 STRATEGI
CEGAH RESISTENSI
CEGAH
SELECTIVE CEGAH
PRESSURE TRANSMISI

ANTIBIOTIK KEWASPADAAN
BIJAK UNIVERSAL
 Situasi Rumah Sakit Sekarang

• RS Rujukan  70% pasien

mendapat AB
• 50%  tidak perlu AB
• Prevalensi AMR (ESBL, CRE,
MRSA) 30-72%
• Kematian akibat AMR tidak
terungkap

Polk et al. In: PPID, 7th ed. 2010

Luther, Ohl. IDSA Abstract 2011
Peran RUMAH SAKIT
terhadap Penurunan
Prevalensi AMR
 Global action plan on antimicrobial resistance
1. Improve awareness and understanding of
antimicrobial resistance through effective
communication, education and training
2. Strengthen the knowledge and evidence
base through surveillance and research
3. Reduce the incidence of infection through
effective sanitation, 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, and increase
investment in new medicines, diagnostic
tools, vaccines and other interventions
 Strategic Plan of AMR Control in Indonesia 2015-2019

Increasing Public Health quality through

OUTCOME AMR Control Program
(Diagnostic, Antibiotik usage, Infection management, AMR Spreading,
Decreasing AMR Incidence )

Realization of Community Care toward AMR Global Update of AMR Collaboration

To Develop AMR Control Implementation in teaching material
Problem and control between Ministry of
Health Facilities ( in Health
(% understanding of AMR, % antibiotic consumption,% health, ministry of
( % number of Health Facility included) education Agriculture and
decreasing antibiotic OTC))
OUTPUT

(Medical Doctor, vetenerary, ministry of

Pharmacetical, education
Nurse, Midwife)
STRATEGIC IMPLEMENTATION PROCES

Realization Realization of

Avaibility of AMR control Program funds

Realization Realization
of AMR education Realization Realization

Implementation of AMR surveillance

Realization of AMR of AMR
Control system of antibiotic of
of AMR Control in Control in
collaboration of AMR selling collaboration
Control in Primary Private
within Problem and control and between gov.
Hospital Health Practice
profesional control in monitoring and NGO
Facilities setting
organization community
Collaborat
Collaboratio
ion of
Collaborati Collaborati n between
ministry of
on among on of institution
agriculture
Realization of AMR Information system base on Realization of AMR Information system base health medical that
and
health facilities on community setting faculty / profession concern in
vetenerer
university collegium antibiotic
y
use
Existing system of AMR control in Health facilities and community
SUMBER DAYA
KESEHATAN

Avalaible competent health provider in for Facilities support for AMR Control
AMR conrtol program: Gov. Regulation support
(Phycisian, Clinical Microbiologist, Clinical
program :
(National Policy, National
pharmacist, Clinical Pharmacologist, ICN) (Diagnostic, IC, Pharmaceutical
guideline, Clinical guideline)
fascilities)
KESEHATAN

Fasilitas Jumlah Profesi Jumlah

Rumah sakit 2.600 Dokter spesialis 36.000
Puskesmas 9.700
Dokter Umum 104.000
Apotek 24.000
FK 72 Dokter Gigi 23.700
FKG 27 Bidan 250.000
FF 46
Perawat 225.000
AKBID 720
AKPER 300 Farmasis 30.000.
 KEPUTUSAN MENTERI
KESEHATAN REPUBLIK
INDONESIA NOMOR
HK.02.02/MENKES/390/2014
TENTANG PEDOMAN PENETAPAN
RUMAH SAKIT RUJUKAN NASIONAL

KEPUTUSAN MENTERI KESEHATAN

REPUBLIK INDONESIA NOMOR
HK.02.02/MENKES/391/2014

TENTANG PEDOMAN PENETAPAN RUMAH

SAKIT RUJUKAN REGIONAL

36
 Hospital ARCP Pathway 2016

• standardization of Hospital AMR

Program training
AMRCC of MoH
• Training of the Trainer
• research: AMR, Antibiotic use,
sepsis, AMR related infection
cost
34 National and
Provincials Referral • National AB - AMR Surveillance
Hospitals

110 Regional Private and District Primary

Referral Hospitals Hospitals Health Care
Action Without Plan is better than
Plan Without Action
Bets one is Plan and Action