CURRICULUM VITAE

Dr. GERY DALA PRIMA BASO, SpPD

TTL : Makassar, 04 Oktober 1985

Alamat : Jalan Kesehatan No.3, Dok 2 Jayapura Papua

Status Pernikahan : Menikah

Pendidikan
• Sp Ilmu Penyakit Dalam, Universitas Indonesia (2018)
• Pendidikan Dokter, Universitas Hasanuddin (2009)
• SMA Negeri 2, Jayapura (2003)
• SMP Kr. Kalam Kudus, Jayapura (2000)
• SD Kr. Kalam Kudus, Jayapura (1997)
• SD Harapan Bunda, Jakarta (1993)
Jabatan/Pekerjaan
• Staf bagian Ilmu Penyakit Dalam RSU
Jayapura
• Ketua Komite PPRA RSU Jayapura
• Kepala Unit TB – HIV RSU Jayapura
 PENGGUNAAN ANTIBOTIK BIJAK
PROGRAM PENGENDALIAN
RESISTENSI ANTIMIKROBA

Dr. Gery Dala P. Baso, SpPD

Komite Pengendalian Resistensi Antimikroba RS Jayapura
Bagian Penyakit Dalam RS Jayapura
RESISTENSI ANTIBOTIK

• Unresposiveness to
Antimicrobial Agents in
STANDARD DOSES
Dreamstime.com
HOW IT HAPPENS…
MISUSE OVERUSE TRANSMISSION
AMR-Review.com
Data menunjukkan
Pola dan Perilaku yang sama
Pada Peternakan di Indonesia

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AKIBATNYA …
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Apapun Sakitnyaa….
- CEFTRIAXONE -

Grandreviewsearch.com
AKIBAT RESISTENSI ANTIBOTIK

Kegagalan Terapi

Komplikasi pasca Tindakan

Biaya Pengobatan

Peningkatan Morbiditas &

Mortalitas
WHAT CAN WE DO ?

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WHAT CAN WE DO ?

AMR-Review.com
PERMENKES no.8/2015
ProgNas – SNARS
2018/JCI

SK Direktur RSU
Komite PPRA
KEBIJAKAN RS
PERESEPAN/PENGGUNAAN
ANTIBIOTIK

AMR-Review.com
SK Pembentukan KOMITE PPRA
RSU Terkait
PENANGANAN OLEH RS

Antibiotic Optimalisasi Penggunaan

Stewardship (Benar Jenis, Dosis, Interval, Jangka Waktu)
Program

Benar Indikasi

Benar Prosedur
ALUR PERESEPAN/PENGGUNAAN
ANTIBIOTIK DI RS

Antibiotic Guideline
Stewardship Sesuai Pola KUMAN RS
Program
Panduan AB
Melalui CP / PPK

Profilaksis Operasi, Prosedur

Tindakan
ALUR PERESEPAN/PENGGUNAAN
ANTIBIOTIK DI RS

Kebijakan AB RSUD dr Soetomo

ALUR PERESEPAN/PENGGUNAAN
ANTIBIOTIK DI RS JAYAPURA
Pasien Infeksi
Penegakkan
Diagnosa

Perlu Pembedahan (Bedah) Tanpa Pembedahan (Non Bedah)

1. Antibiotik Profilaksis
2. Tanpa AB Profilaksis
3. Antibiotik Empiris (pasien bedah dengan infeksi) Infeksi Berat dan Sepsis Infeksi Lainnya

Pemeriksaan Mikrobiologi
(KULTUR SENSITIVITAS)

1. Spektrum bias monoterapi/kombinasi. 1. Faktor Risiko

2. Berdasarkan pola bakteri/kepekaan lokal. 2. Pola Kuman Lokal
Pemilihan Antibiotik Empiris 3. Tata Laksana Penyakit
3. Segera diberikan 1-6 jam setelah
diagnosis

Evaluasi setiap 3-5 hari, dengan memperhatikan :

Evaluasi Penggunaan 1. Respon klinis membaik/memburuk
Antibiotik 2. Perlu tidaknya terapi tambahan
3. Perlu tidaknya penggantian antibiotik

1. Jenis, spektrum antibiotik

Pemantauan 2. Optimalisasi dosis & cara pemberian
Penggunaan Antibiotik 3. Informasi penggunaan yang benar dan adanya efek samping

Evaluasi Perkembangan Setelah ada hasil kultur (terapi definitif) dilakukan eskalasi /
Penyakit deeskalasi dan streamline antibiotik
PERESEPAN/PENGGUNAAN
ANTIBIOTIK DI RS
Evaluasi Penggunaan AB
Kewenangan DPJP selain Lini 3
Penggunaan AB yang dianggap kurang tepat/irasional akan mendapatkan saran/advis
dari tim PPRA : - Penggunaan AB Lama (>2minggu)
- Tatalaksana Definitif kasus Infeksi Sulit
- Target Perawatan/ “Care Plan” pasien
 Kasus Sulit dapat diajukan untuk “Pertemuan Kasus Sulit Komdik – Tim PPRA”
 Komite PPRA : Evaluasi Berkala Pemberian AB di setiap unit-ruangan-DPJP
Pelaporan kepada Komdik – Direktur RS - Komite PPRA Pusat
ALUR PERESEPAN/PENGGUNAAN
ANTIBIOTIK DI RS
Peresepan AB Lini 3
Atas Persetujuan Komite PPRA
- dr Duma SpAN, KIC ; dr James T SpA, K ; dr Victor M SpP ; dr Dala SpPD
- Setiap Dept/unit akan mempunyai perwakilan Komite PPRA
Persetujuan :
- Konsultasi
- CITO : Komunikasi Elektronik  CAP/TTD Konfirmasi
- Bukti Persetujuan KPRA  Farmasi akan Mengeluarkan AB
ALUR PERESEPAN/PENGGUNAAN RSU JAYAPURA

ANTIBIOTIK DI RS

Pedoman Penggunaan Antibiotik

RS Jayapura
ALUR PERESEPAN/PENGGUNAAN
ANTIBIOTIK DI RS

Kebijakan AB RSUD dr Soetomo

ALUR PERESEPAN/PENGGUNAAN
ANTIBIOTIK DI RS JAYAPURA
Lini Jenis Antibiotik PJ
A. Penisilin : Amoksisilin, Ampisilin Dokter Umum
B. Penisilin+penghambat lactamase : Ampisilin Sulbactam, Amoxicillin
clavulanat PPDS
C. Kombinasi Trimetropim/Sulfametoxazol : Cotrimoxazole (PO) DPJP
D. Aminoglikosida : Gentamycin
E. Gol. Imidazole : Metronidazole
Lini 1 F.
G.
Cefalosporin (gen 1,2) : Cefadroxil Cefuroxime, Cefazolin
Phenicol : Chloramphenicol, Thiamphenicol
H. Gol. Linkosamide : Clindamycin
I. Gol. Makrolida : Eritromisin, Azitromycin, Spiramycin, Clarithromycin
J. Gol. Quinolone : Ciprofloxacin
K. Gol. Tetrasiklin : Tetracycline, Doxicyclin

A. Cefalosporin (gen 3) : Cefixime, Ceftazidim, Ceftriaxone, Cefotaxime, PDJP atau PPDS

Cefoperazon/Sulbactam, Cefpirom
dibawah supervisi
B. Gol. Fluoroquinolone : Levofloxacin, Ofloxacin
Lini 2 C.
D.
Monobactam : Aztreonam
Aminoglikoside : Amikasin
DPJP

E. Golongan lain : Colistin oral, Fosfomycin

A. Cefalosporin (gen 4) : Cefepime DPJP

B. Gol. Fluoroquinolone : Moxifloxacin,
(Berdasar klinis dan
C. Carbapenem injeksi : Meropenem, Imipenem, Ertapenem
D. Vancomycin injeksi kultur) dan atas
Lini 3 E.
F.
Piperacillin tazobactam injeksi
Linezolid injeksi
Persetujuan KPRA

G. Tygecillin injeksi
H. Cotrimoxazole injeksi
I. Colistin injeksi
 PROFILAKSIS ANTIBIOTIK BIJAK
DALAM PRAKTEK
PROGRAM PENGENDALIAN
RESISTENSI ANTIMIKROBA

Dr. Gery Dala P. Baso, SpPD

Komite Pengendalian Resistensi Antimikroba RS Jayapura
Bagian Penyakit Dalam RS Jayapura
ANTIBIOTIK PROFILAKSIS

Antibiotik yang diberikan Sebelum – Saat – Setelah operasi pada kasus

yang secara klinis terdapat tanda infeksi
Dengan Tujuan untuk mencegah terjadinya SSI (Surgical Site Infection)/
ILO/ IDO dan mencegah kolonisasi

BUKAN UNTUK MEPERCEPAT PENYEMBUHAN LUKA

Antibiotik Profilaksis. Fendi Matulatan

INDIKASI PEMBERIAN ANTIBOTIK
PROFILAKSIS
Pada Operasi dengan High Risk Infection

Antibiotik Profilaksis. Fendi Matulatan

SURGICAL SITE INFECTION / IDO

Antibiotik Profilaksis. Fendi Matulatan

SURGICAL SITE INFECTION / IDO

CDC 2017
• Superfisial  30 hari
• Deep  90 hari
• Organ Space  90 hari
• Ortopedi  1 tahun

Antibiotik Profilaksis. Fendi Matulatan

WHAT CAN WE DO ?

Leeds et al. Ann Surgery 2017

 GLOBAL GUIDELINES FOR THE
PREVENTION OF SURGICAL SITE
INFECTION:
An introduction

Launched 3 November 2016

Why surgical site infection prevention?
It is estimated that hundreds of millions of patients are affected
by health care-associated infections (HAI) worldwide, each
year. At present, no country is free from the burden of disease
caused by HAI.
Allegranzi B et al. Surgical site infections (SSI) are potential
Lancet 2011;377:228-41
complications associated with any type of
Published on 5 May 2011
procedure and are among the most
http://www.who.int/gpsc/en/ preventable HAI.

SSI is the most frequent type of HAI in

low- and middle-income countries
(affecting on average 11% of patients who
undergo a surgical procedure) and the
second or third most frequent type of HAI
in the United States and Europe.
 SSI burden worldwide
 In Europe, SSI are the second most frequent type of HAI
(19.6%) – 543 149 (298 167-1 062 673) SSI episodes/year
(HAI prevalence survey 2011)
 In the US, the overall SSI rate was 0.9% in 2014 (data from
3654 hospitals over 2 417 933 surgical procedures)
 SSI are the most frequent type of HAI on admission (67% in
US, 33% in Europe)
 Surgical sepsis accounts for approximately 30% of all
septic patients
Main reasons for developing surgical site
infection prevention guidelines
High global epidemiological burden

Highly preventable infection

No recent evidence-based guidelines

Need for a global perspective

Need for taking into account balance between

benefits and harms, evidence quality level, cost
and resource use implications, and patient values
and preferences
 Nine strong recommendations –
preoperative measures (1)
Patients with known nasal carriage of S. aureus should receive
perioperative intranasal applications of mupirocin 2% ointment with or
without a combination of CHG body wash.

MBP alone (without the administration of oral antibiotics) should NOT

be used in adult patients undergoing elective colorectal surgery.

In patients undergoing any surgical procedure, hair should either NOT

be removed or, if absolutely necessary, should only be removed with a
clipper. Shaving is strongly discouraged at all times, whether
preoperatively or in the operating room.

Surgical antibiotic prophylaxis (SAP) should be administered before the

surgical incision, when indicated.
 Nine strong recommendations –
preoperative measures (2)
SAP should be administered within 120 min before
incision, while considering the half-life of the antibiotic.

Surgical hand preparation should be performed either

by scrubbing with a suitable antimicrobial soap and
water or using a suitable alcohol-based handrub before
donning sterile gloves.

Alcohol-based antiseptic solutions based on CHG for

surgical site skin preparation should be used in patients
undergoing surgical procedures.
 Nine strong recommendations –
intra & postoperative measures
Adult patients undergoing general anaesthesia with
endotracheal intubation for surgical procedures should
receive 80% fraction of inspired oxygen intraoperatively
and, if feasible, in the immediate postoperative period for
2–6 h.

Surgical antibiotic prophylaxis administration should not

be prolonged after completion of the operation
WHO Global Guideline SSI Prevention
WHO Global Guideline SSI Prevention
WHO Global Guideline SSI Prevention
WHO Global Guideline SSI Prevention
WHO Global Guideline SSI Prevention
 RISKS OF PROLONGED
SURGICAL PROPHYLAXIS
• A meta-analysis of 44 RCTs demonstrated that prolonged
postoperative antibiotic prophylaxis had no benefit when
compared to a single dose of antibiotic prophylaxis in
reducing surgical site infections after surgery
• The odds of not receiving guideline concordant antibiotic
prophylaxis were 6.7 times higher (95% CI: 2.9, 15.5) among
those patients who developed an infection
with C. difficile compared to those who did not.

Royal Australasian College of Surgeons

 RISKS OF PROLONGED
SURGICAL PROPHYLAXIS
• Harbarth et al. compared the effect of short (<48 h) versus
prolonged (>48 h) perioperative antibiotic prophylaxis on surgical
site infections and acquired antimicrobial resistance in an
observational 4-year cohort study in 2,641 patients who underwent
coronary artery bypass graft surgery.
• After adjustment for possible confounding factors, prolonged
perioperative antibiotic prophylaxis was not associated with a
decreased risk of surgical site infections (adjusted odds ratio
(OR): 1.2; confidence interval (CI): 0.8-1.6)
• It was correlated with an increased risk of isolation of
enterobacteriaceae or enterococci with acquired resistance to
the administered prophylactic agent (i.e. cephalosporins or
vancomycin) (adjusted OR: 1.6; CI: 1.1-2.6)

Royal Australasian College of Surgeons

WHAT CAN WE DO ?
IMPROVING PRACTICE
Procedural Post-Operative
Indication Is it needed at all? Is it still needed?

Drug Considerations: colonisation (eg MRSA); screening;

allergies; guidelines; pre-existing infection; recent
antibiotic use; prolonged hospitalisation. What is
available in theatre (imprest)?
Time Admin within 60 mins Defined documented
knife to skin duration
Route Supported by evidence – not topical administration
(irrigation, pastes, cement and washes)
Infection Control Always

Dose Blood loss/long Patient’s weight

procedure (consider (consider larger dose)
repeat dosing) Weight
(consider larger dose)
Royal Australasian College of Surgeons
WHAT CAN WE DO ?
IMPROVING PRACTICE
Opportunities for improving practice can be achieved by
All Clinicians including:
• Surgeons/Anaesthetists/Medical Team
• Prescribe procedural prophylaxis according to guidelines
• Nurses
• Facilitate the administration of procedural prophylaxis at the optimum time
• Pharmacists
• Review the duration of post-procedural prophylaxis and discuss with the medical team if it does
not follow guidelines
• Antimicrobial Stewardship Teams
• Provide timely multidisciplinary advice for patients who may not fit local guidelines eg: resistant
organisms

Royal Australasian College of Surgeons

PRE-OPERATIVE & PRE-PROCEDURE
ANTIBIOTIC PROPHYLAXIS

• IV / Drip dalam NS 100  15 menit

• 30-60 menit sebelum insisi
• Tanpa TEST
• Sebaiknya di OK

Johns Hopkins Antibiotic Guideline. 2016

PRE-OPERATIVE & PRE-PROCEDURE
ANTIBIOTIC PROPHYLAXIS

Johns Hopkins Antibiotic Guideline. 2016