Surveillance:

How to establish an Antibiogram

KPRA KEMENKES R.I

Kuntaman
Depart. of Clinical Microbiology / Infection Control Comm.
School of Medicine Airlangga University/
Dr. Soetomo Hospital Surabaya – Indonesia
kuntaman@fk.unair.ac.net.id, 08113410352

Workshop PPRA & Geriatri, Jakarta, Nov,8-9, 2017

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 Learning Objectives

 Prudent Use of AB
 How to develop Antibiogram as a Pivotal
Role in Management of Inf Dis

2
Concept of Prudent use of AB
in Infection Management

3
 The Basic concept of Prudent
Use of antimicrobial drug
Chain of the principles of rationality
antimicrobial drug use

1. The diagnosis is correct

2. Indication  adherence to G.L.
3. Appropriate to pts physical & physiol.
4. Correct in AB choices & regimen
5. Less side effect
6. It is clearly informed to the pts
7. Evaluation of the clinical outcome
Gyssens, 1996
4
Dep Health RI, 1999
TWO (at least) kinds of AB Use
1.Emp Ther:
① Before available Micro Lab
② Broad range of spectrum AB Base
on AB-gram
2.Def Ther
① After Micro Lab available: MO & AST
② Base on Inf Dis/Clin Micro Expertise
o Gyssen’s flowchart
(Gyssens, 1996)
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Big Issue of Inf Dis Ther in Indonesia
1. Specimen are collected after AB
consumption
2. AB-gram was developed by ‘physically’
collected all the data
3. and thus empiric ther would be bias or
over-interpretative: ?
4. The problem of Hospital without Micro Lab
Facility: What can we do ??

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How to develop Antibiogram as
a Pivotal Role in Management
of Inf Dis

Landborg et al, 2002

Larsson et al, 2000

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 AB-gram:

- a collection of data & table summarizing %

of individual bacterial pathogens susceptible
to different antimicrobial agents

- from isolated (as from a patient's tissues or

body fluids) and subjected to laboratory testing.
- Local hospitals offer more directed help to
their physicians by creating antibiograms, or
tables that chart the resistance
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 How to develop AB-gram
1. Collecting of all the data, and print-out in
Luxury book: ?? or
2. Conduct targeted surveillance directed to
the problem: ??
3. Selected pathogens based on all the data:
??
4. Then make tabulation: design & style ??
To make easier to read and interpretation
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 Problems in Micro Services in INA
1. Not all hospital commit to use one method
for Micro culture for all patients:
automatic vs conventional
2. All data were collected, of both
pathogens vs contaminants
3. More pathogens come from one patient

Make BIAS
Finch et al, 2005
More difficult to use as Clin Micro Services 10
 What Next

1. Do the best way as we have

2. Plan the better steps
3. improve the local data step-by-step, with
increasing the quality of Clin Micro
services,
4. otherwise ????????

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 AB-gram Structure
1. Specify: Ward & Time
2. Base on every dis/specimen
3. Short the pathogens or frequency or both
4. Each pathogen  specify the AB
5. Quantity of pathogens: ?
6. Choose AB base on CLSI – guide the
clinically use (Services on clinical
microbiology)
• S aureus (expl):
 P FOX/OX, ERY DA SXT
 TET/TGC RIF VAN LNZ
 add: LEV/CIP NIT 12
 Number too small: ??

1. Year/s
2. species (grouping)
3. Local data  Hospital/City
4. + data from published AB-gram, in
the past
5. Make any footnote as needed

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 Other Issues: ??

1. Duplicate isolate: ??
2. Data represents for diagnostic
purposes
3. Data is stratified 
 Infection site
 Adult vs pediatric
 ICU vs non-ICU
4. etc
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 Pathogens pattern in ICU Dr Soetomo
Hospital Surabaya, Jan-March 2015

Health Microbes Quant

Services
ICU Staph haemolyticus 94
Urine E coli 46
K. pneumoniae 27
Ac baumannii 26
Entero cloacae 10
Burkholderia cepacia 10
 Pathogens pattern in ICU Dr Soetomo
Hospital Surabaya, Jan-March 2015
Health Services Microbes Quant
ICU Ac baumannii 131
Sputum Pseu aeruginosa 67
K. pneumoniae 56
E coli 26
Burkholderia cepacia 15
Stenotropo maltophilia 7
Enter cloacae 7
Staphy aureus 6
Enter aerogenes 5
Pathogens pattern in Int Med Dr Soetomo Hospital
Surabaya, Jan-Oct 2015
Health Microbes Quant
Services
Inter-Surgery E coli 446
Urine K pneumo 159
Ac baumannii 114
Entero faecalis 98
Staph haemolyticus 89
Pse aeruginosa 73
Entero cloacae 68
Entero aerogenes 22
Staph sciuri 14
Staph aureus 13
 Internal Med : Urine
Bacteria Ac baum Kl.pneumo Ps.aeru Others
n Sen% n Sen% n Sen%
AK 114 72 159 90 72 82
GEN 114 32 89 54 71 48
TOB 114 38 159 25 72 46
CIP 114 27 159 23 72 39
LEVO 114 27 158 37 73 47
CTX 114 8 162 16 73 0
CRO 114 8 162 12 73 0
CAZ 19 89
PTZ 114 24 158 27 73 66
FEP 114 17 161 15 73 45
ERTA 114 0 158 54 73 0
IMI 114 63 158 91 72 65
MEM 114 65 159 89 73 71
TET 114 36 158 34 72 0
SXT 114 50 159 31 72 0
 Pathogens pattern in Int Med Dr Soetomo
Hospital Surabaya, Jan-Oct 2015

90

80

70

60

50

40 Ac ba

30 K pneu
P aeru
20

10

0
AK GEN TOB CIP P aeru
LEV CTX CRO CAZ PTZ FEP Ac ba
MEM TET SXT

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 Cleaning for:
MRSA Carrier Throat: RES
Dr Soetomo Hosp-SBY, 2014
Throat : CIP LEV ERY CLIN TET RIF
n=45
SXT 33= 33= 1= 0=0% 33= 0 =0%
73.33% 73.3% 2.2% 73.3%
CIP 41= 3= 2= 35= 4=
91.1 6.7% 4.4% 77.8% 8.9%
LEV 3= 2= 35= 4=
6.7% 4.4% 77.8% 8.9%
ERY 2= 1= 1=
4.4% 2.2% 2.2%
CLIN 0= 0% 1=
2.2%
TET 4=
8.9%
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 SUMMARY
① AB-gram should be directed into the
clinical need toward the prudent use of AB
② Should be design base on pathogens
causative/s, not a contaminants
③ Specify place, time and disease/specimen
④ Attention the quantity of each pathogen
⑤ For guide the clinician for AB choices and
Ther
⑥ Easy to use with wide-range of thinking
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 Patient safety is the first

Guideline

Thank you for your attention 24