Prevention of

antibiotic
resistance

Dr sukaenah shebubakar Sp.p

Pulmonologist
Background

CDC estimated more

Antimicrobial than 2 million
Prevention of
resistance is a antibiotic resistant
resistance is a global
growing issues and infections and 23000
urgency!
threat to all! related deaths (US)
annually
 Lack of global standards for
antimicrobial resistance surveillances
Antimicrobial
Limitation of surveillance
resistance
Available data did not always represent
surveillance
report 2014
general situation (risk of overestimation)
Regional surveillance: South-East Asia
did not have a systematic efforts to
collect epidemiological data of
antimicrobial resistance. NEVERTHELESS,
data of selected disease and organisms
reveal AMR as a burgeoning and often,
neglected problem.
Selected bacteria: international
concern (WHO, 2014)
• 3rd generation cephalosporins resistance (include resistance
Escherichia coli conferred by extended spectrum beta-lactamases) and
fluoroquinolones

Klebsiella • 3rd generation cephalosporins resistance resistance (include

resistance conferred by extended spectrum beta-lactamases)
pneumonia and carbapenem

Staphylococcus • Beta-lactam antibacterial drugs (MRSA)

aureus
Streptococcus • Penicillin (resistance or non-
pneumoniae susceptibility or both)

Nontyphoidal
• Fluoroquonolones
Salmonella

Shigella sp • Fluoroquionolones

Neisseria • Decreases susceptibility to 3rd

gonorrhoeae generation cephalosporins
 Global Action Plan 2015:
Antimicrobial Resistance (WHO)
– Five strategic objectives:
– Improve awareness and understanding
– Strengthen the knowledge through surveillance and research
– Reduce the incidence of infection
– Optimize use of antimicrobial medicines
– Ensure sustainable investment
CDC recommendation: 12 steps of
antimicrobical resistance prevention
 National strategy: Indonesia

– Health ministry of Indonesia republic’s regulation (Perarturan

Menteri kesehatan republic Indonesia nomor 8 tahun 2015)
– Antimicrobial resistance team is mandatory in every hospital, led
by a clinician
– The team involves representative of all clinical department,
nursing department, pharmacy department, clinical
microbiological laboratorium, Infection control, Prevention
Committee (IPC) and Therapy and Pharmacy Committee (TPC)
– Duties:
– Establishment of antimicrobial resistance control
– Controlling antimicrobial resistance within the hospital
– Evaluate the program
– Monitoring antimicrobial usage pattern and the emerging
resistance
– Educate and raising awareness of antimicrobial resistance
control
– research in the field of antimicrobial resistance
 Program indicators

Quantity improvement of antibiotic usage

Quality improvement of antibiotic usage

Improvement of antibiotic susceptibility pattern and decreased

pattern of antimicrobial resistance

Quality improvement of infection cases through multidisciplinary

management
 Strategies

Prudent usage • Based on microbial pattern or antibiotic susceptibility test

• Careful selection !
of antibiotics

• Hand-hygiene and personal protective equipment optimization

Standard • Proper environmental control -> garbage disposal
• Decontamination of medical equipment
precaution • Cough etiquette
• Proper injection and lumbal puncture technique
Periodical microbial pattern yearly reports -> in out-
patient, non surgical in-patients, surgical in-patients, ICU

Evaluation of antibiotic usage based on medical records

and pharmacology department records (using Gyssens
flowchart classification)
 Refference

Uchil RR, Kohli GS, Katekhaye VM, SWAMI OC. 2014. Strategies to combat antimicrobial resistance.
DOI: 10.7860/JCDR/2014/8925.4529
WHO. 2014. Antimicrobial resistance global report on surveillance.
WHO. 2015. Global action plan on antimicrobial resistance.
Menkes. 2015. Peraturan Menteri kesehatan republic indonesia nomor 8 tahun 2015.