Ppra Jambi

PENGGUNAAN ANTIBIOTIK PROFILAKSIS
UNTUK MENCEGAH
INFEKSI DAERAH OPERASI
Nuswil Bernolian
DIVISI FETOMATERNAL DEPARTEMEN OBSTETRIK DAN GINEKOLOGI

FK UNSRI/RSUP DR MOHAMAD HOESIN PALEMBANG
SOSIALISASI UPDATE INFEKSI DALAM KEHAMILAN DAN RASIONALISASI PENGGUNAAN ANTIBIOTIK BAGI ANGGOTA POGI CABANG JAMBI
HOTEL ASTON JAMBI, 28 APRIL 2019
SOSIALISASI UPDATE
SOSIALISASI INFEKSI
UPDATE DALAM
INFEKSI KEHAMILAN
DALAM DAN
KEHAMILAN DANRASIONALISASI PENGGUNAAN
RASIONALISASI PENGGUNAAN ANTIBIOTIK
ANTIBIOTIK BAGIBAGI ANGGOTA
ANGGOTA POGI CABANG
POGI CABANG SUMBAR JAMBI
HOTEL
HOTEL ASTONBEACH
PANGERAN JAMBI, 28 APRIL
PADANG, 2019 2019
21 APRIL
Definisi antibiotik & bakteri resisten
“ Antibiotik adalah bahan kimia yang

memicu terjadinya resistensi pada
bakteri”
“Bakteri resistensi adalah, bakteri yang

tidak dapat di lemahkan atau dimatikan
oleh antibiotik yang dulu pernah
digunakan”.
WHO
•Antimicrobial resistance (AMR) is the ability

of a microorganism (like bacteria, viruses,
and some parasites) to stop an antimicrobial
(such as antibiotics, antivirals and
antimalarials) from working against it.
ERA MDRO in ASIA PACIFIC
Enterococcus facium
resistance to aminopenicillins
82-97%
MRSA
82-97%
Klebsiella pneumonia
resistance to ceph. gen 3
6-80% Klebsiella pneumonia
resistance to
Carbapenem
Acinetobacter baumanii 3-57%
resist to carbapenem
51-77% Acinetobacter baumanii
resist to Aminoglikosida
Pseudomonas aeruginosa
resistance to antibiotic 48-90%
27-57%
ANCAMAN PENYEBARAN DAN KEMATIAN
Mortality:10.000.000 /year, ASIA 4,7M

APA DAMPAK MDRO
• Kematian 700.000 orang / tahun
• Kemampuan antibiotik terbatas
• sulit mengatasi infeksi
• komplikasi akibat resisten meningkat
• ancaman gagal pd operasi kompleks
(transplan organ, kembar siam,dll)
• Ancaman post antibiotic era
• luka kecil berakibat kematian
• ALOS, Cost meningkat
• kembali ke pola terapi konvensional 
amputasi
MENGAPA TERJADI MDRO
• Penyebab MDRO
– Selective pressure akibat paparan
antibiotik .
• penggunasalahan antibiotik: Misuse dan
Overuse
– Transmisi bakteri atau genetik (MCR-1)
Karam et al. Critical Care

(2016) 20:136 Antibiotic
strategies in the era of
multidrug resistance
MENGAPA MUNCUL AMR
“The time may come when penicillin can

be bought by anyone in the shops. Then there is
the danger that the ignorant man may easily under
dose himself and by exposing his microbes to
non-lethal quantities of the drug make them
resistant”.
Here is a hypothetical illustration. Mr. X. has a sore throat. He buys some
penicillin and gives himself, not enough to kill the streptococci but enough
to educate them to resist penicillin. He then infects his wife. Mrs. X gets
pneumonia and is treated with penicillin. As the streptococci are now
resistant to penicillin the treatment fails. Mrs. X dies. Who is primarily
responsible for Mrs. X’s death? Why Mr. X whose negligent use of
penicillin changed the nature of the microbe. Moral: If you use penicillin,
use enough. (Fleming 1945)
MORBIDITAS & MORTALITAS
• IDO RS 11.8% WHO

700.000
(1.2-23.6) 2013
USA
• HAI > 30% 23.000
300 juta
• 40-60%
preventable Thailland
38.000
• MDRO 70 juta
INA
135.000
Lyons, WHRA, 2010) 256 juta
• HAI-RS / Indonesia – 7.1% (Deurink et al, 2009)

• Mortalitas HAI 6,9%
kasus langka.
2016, Post SC hari ke 7. di RS. L.

10/3/2018. post SC RS.W.
Fascitis Necroticans.
Fascitis Necroticans.
meninggal hari ke 4, post debridemant
Death on Arrival Kultur: E.coli, Pan-resistance
GLOBAL ACTION
PLAN ON AMR
1. awareness and understanding of

AMR problem  education, training
2. Surveillance and research
3. Infection prevention
4. Optimizing use of antibiotic
5. Investment, new medicine, rapid
diagnostic, Vaccine
Strategi Pengendalian AMR
(PMK no.8 th 2015, pasal 3)
Antibiotik BIJAK
mencegah
“selective pressure” AB Rasional +
Cegah resistensi
mencegah kewaspadaan
“spreading” Standar
PPI
SOSIALISASI UPDATE INFEKSI DALAM KEHAMILAN DAN RASIONALISASI PENGGUNAAN ANTIBIOTIK BAGI ANGGOTA POGI
KPRA RSDS-KEMENKES 20 CABANG JAMBI
PMK no.8/2015
Pasal 6
1. Setiap rumah sakit HARUS melaksanakan Program
Pengendalian Resistensi Antimikroba secara optimal.
2. Pelaksanaan Program Pengendalian Resistensi Antimikroba
sebagaimana dimaksud pada ayat (1) dilakukan melalui:
a. pembentukan Tim pelaksana pengendalian resistensi
• antimikroba;
b. penyusunan kebijakan dan panduan penggunaan antibiotik;
c. melaksanakan penggunaan antibiotik secara bijak
d. melaksanakan prinsip pencegahan pengendalian infeksi
• KPRA RSDS-KEMENKES 21
Standar 4.1 PPRA
Rumah sakit melaksanakan kegiatan pengendalian
resistensi antimikroba
MAKSUD DAN TUJUAN Standar 4.1

Rumah sakit melaporkan perbaikan pola sensitivitas antibiotik dan
penurunan mikroba resisten sesuai indikator bakteri multi-drug
resistant organism (MDRO), antara lain:
– bakteri penghasil extended spectrum beta-lactamase (ESBL),
– Methicillin resistant Staphylococcus aureus (MRSA),
– Carbapenemase resistant enterobacteriaceae (CRE)
– dan bakteri pan-resisten lainnya.
(Lihat PPI.6)
KPRA RSDS-KEMENKES
SOSIALISASI UPDATE INFEKSI DALAM KEHAMILAN DAN RASIONALISASI PENGGUNAAN ANTIBIOTIK BAGI ANGGOTA POGI
22 CABANG JAMBI
Lini pertama atau Unrestricted
Antibiotik boleh diresepkan oleh Dokter umum,
PPDS-I, PPDS-II, dokter spesialis (DPJP)
• Aminoglikosida: Gentamycin
• Penicillin: Ampicillin, Amoxicillin, Ampisilin + Sulbactam, Amoxicillin +
Clavulanic Acid
• Cephalosporin G-I: Cefazolin, Cefadroxil, Cefalexin, Cefradin
• Cephalosporin G-II: Cefuroxime, Cefactor.
• Phenicol: Chloramphenicol, Tyamphenicol
• Lincosamide: Clindamycin
• Macrolide: Erythomycin, Spiramycin, Clarithromycin, Azythromycin.
• Quinolone: Ciprofloxacin
• Tetracyclin: Tetracyclin, Doxicyclin
• Kombinasi Trimethroprim/sulfametoxazole: Cotrimoxazole oral.
• Imidazole: Metronidazole
26
Lini kedua atau Restricted,
Antibiotik boleh diresepkan oleh PPDS atas supervisi DPJP atau DPJP mendapat
persetujuan konsultan infeksi
• Cephalosporin G-III oral: Cefixime, Cefditoren, Cefodoxime,
Proxetil.
• Cephalosporin G-III injeksi: Ceftriaxon, Cefotaxime,
Ceftazidime, Cefoperazone, Cefoperazone-sulbactam,
Ceftizoxime.
• Cephalosporin G-IV injeksi: Cefepime, Cefpirome.
• Fluoroquinoline G-III-IV: Levofoxacin, Ofloxacine,
Moxifloxacine.
• Monobactam: Aztreonam.
• Aminogicoside: Amikacin, Fosfomycin
• Nitrofurantoin: Colistin oral.
KPRA KEMENKES
SOSIALISASI UPDATE INFEKSI DALAM KEHAMILAN DAN RASIONALISASI PENGGUNAAN ANTIBIOTIK BAGI ANGGOTA27POGI CABANG JAMBI
Lini ketiga atau Reserved
Antibiotik dalam pengendalian khusus. Boleh diresepkan DPJP, atau PPDS
dalam supervisi DPJP dan mendapat persetujuan penggunaan oleh tim PGA-
KPRA.
• Carbapenem: Meropenem, Ertapenem, Doripenem.

• Vancomycin
• Piperacillin-tazobactam
• Tygecyclin
• Linezolide
• Polimixin B injeksi
• Colistin injeksi
• Cotrimoxazole injeksi
KPRA KEMENKES
SOSIALISASI UPDATE INFEKSI DALAM KEHAMILAN DAN RASIONALISASI PENGGUNAAN ANTIBIOTIK BAGI ANGGOTA28POGI CABANG JAMBI
WHAT IS ANTIBIOTIC
PROPHYLAXIS ?
Right Right
Agent Time
Narrowest spectrum of Antimicrobial High Dose, Short time

activity Prophylaxis
Right Right
Duration Dose
SOSIALISASI UPDATE INFEKSI DALAM KEHAMILAN DAN RASIONALISASI PENGGUNAAN ANTIBIOTIK

BAGI ANGGOTA POGI CABANG JAMBI
Antibiotik Profilaksis
ANTIBIOTIC PROPHYLAXIS ON INTRAPARTUM
Approximately 30% of women in the antepartum period are

colonized with group B Streptococcus (GBS)
After the implementation of intrapartum antibiotic
prophylaxis, the estimated rates of early GBS infection were
reduced by 83%
Recently, 4 or more hours of intrapartum antibiotic prophylaxis
prior to delivery has been shown to be the most effective
treatment for preventing early-onset GBS disease
Turrentine M. Intrapartum antibiotic
prophylaxis for group B Streptococcus:
has the time come to wait more than 4
hours? AJOG, 2014
THE PREVENTION OF EARLY-ONSET NEONATAL
GROUP B STREPTOCOCCAL DISEASE
Recommendations.....
Recommended antibiotic regimens for intrapartum
prophylaxis
• 1. Penicillin G 5 million units IV, then 2.5 to 3.0 million every 4 hours until
delivery or
• 2. If the woman is allergic to penicillin but has a low risk of anaphylaxis:
cefazolin 2 g IV then 1 g every 8 hours until delivery or
• 3. If the woman is allergic to penicillin and at risk of anaphylaxis:
clindamycin 900 mg IV every 8 hours until delivery (if isolate is susceptible
to clindamycin with no inducible resistance) or vancomycin 1 g IV every 12
hours until delivery
ANTIBIOTIC PROPHYLAXIS FOR TERM OR NEAR-TERM
PREMATURE RUPTURE OF MEMBRANES
In women with latency longer than 12 hours,

prophylactic antibiotics are associated with
significantly lower rates of chorioamnionitis by
51% and endometritis by 88%
Saccone G, Berghella V. Antibiotic prophylaxis for term or

near-term premature rupture of membranes: metaanalysis
randomized trials. Am J Obstet Gynecol 2015;212:627.e1-9
Antibiotic prophylaxis in prelabor spontaneous
rupture of fetal membranes at or beyond 36 weeks of
pregnancy
The routine use of prophylactic antibiotics in women

with prelabor spontaneous rupture of fetal
membranes at or beyond 36 weeks of pregnancy does
not reduce the risk of neonatal and maternal
infection-related morbidity
A.F. Nabhan et al. International Journal of Gynecology and

Obstetrics 124 (2014) 59–62
When to administer ?Antibiotic prophylaxis
for cesarean delivery
Always before
skin incision
Camann W et al. International Journal of Obstetric

Anesthesia (2011) 20, 1–2
In obese women.....
• Higher adipose concentrations of cefazolin were observed after

the administration of an increased prophylactic dose
• This concentration-based pharmacology study supports the use
of 3 g of cefazolin at the time of cesarean delivery in obese
women
• Normal and overweight women (BMI <30 kg/m2) reach
adequate cefazolin concentrations with the standard 2-g dosing
Swank ML, Wing DA, Nicolau DP, et al. Increased 3-gram
cefazolin dosing for cesarean delivery prophylaxis in
obese women. Am J Obstet Gynecol 2015;213:415.e1-8
Antibiotic choices for cesarean prophylaxis
ACOG practice bulletin No.120. Use of prophylactic antibiotics

in labor and delivery. Obstet Gynecol 2011;117(6):1472–83.
• Single dose within 60 minutes of incision:

• Cephalosporin (preferably first-generation because of cost and
equivalent efficacy with later generations) or
• Ampicillin (shorter half-life than cefazolin)
• If penicillin allergic:
• Clindamycin / aminoglycoside
• Consider adding vancomycin if known MRSA carrier.
• Addition of azithromycin for adjunctive therapy is under
investigation.
ANTIBIOTIC PROPHYLAXIS ON POST
CAESAREAN
• Increasing the use of extended-spectrum antibiotic

prophylaxis over 3 time periods was associated with a
decreasing trend in postcesarean incisional wound infection
Tita ATN et al. Impact of extended-spectrum antibiotic

prophylaxis on incidence of postcesarean surgical wound
infection. Am J Obstet Gynecol 2008;199:303.e1-303.e3
Antibiotic prophylaxis on hysterectomy
Prophylactic antibiotic
use is associated with decreased
Surgical Site Infection rates after
hysterectomy
El-Nashar SA et al. Extended antibiotic prophylaxis for prevention of

surgical-site infections in morbidly obese women who undergo
combined hysterectomy and medically indicated panniculectomy: a
cohort study. Am J Obstet Gynecol 2010;202:306.e1-9
• Cefazolin plus metronidazole appears to reduce the risk
for surgical site infection after hysterectomy compared
with cefazolin or second generation cephalosporin alone
Antibiotic prophylaxis on abdominal
hysterectomy
There was no difference between the use of single-dose

preoperative ceftriaxone and cefazolin in preventing infectious
morbidity among patients undergoing hysterectomy
N. Phoolcharoen et al. A randomized controlled trial comparing

ceftriaxone with cefazolin for antibiotic prophylaxis in
abdominal hysterectomy. International Journal of Gynecology
and Obstetrics 119 (2012) 11–13
ANTIBIOTIC PROPHYLAXIS IN GYNECOLOGIC
PROCEDURES
SOGC Guidelines
J Obstet Gynaecol Can 2017;39(9):p293-299
Antibiotic prophylaxis for hysteroscopy evaluation
of uterine cavity
• Diagnostic office hysteroscopy should not be recommended antibiotic prophylaxis
Kasius JC et al. Fertility and

Sterility.95(2): 2011
ANTIBIOTIC PROPHYLAXIS FOR SELECTED
GYNECOLOGIC SURGERY
Antibiotic prophylaxis may be beneficial in first-trimester suction

curettage and laparotomy
No advantage was found for loop electrosurgical excision,

hysteroscopy, or laparoscopic gynecologic surgery
M.Y. Morrill et al. Antibiotic prophylaxis for selected

gynecologic surgeries. International Journal of Gynecology and
Obstetrics 120 (2013) 10–15
(American Journal of Obstetrics & Gynecology AUGUST 2017)
• 6 perioperative measures that were independently associated with SSI
risk:
• Appropriate selection of prophylactic antibiotics;
• Postoperative normothermia (temperature > 98.6F);
Oral antibiotics with mechanical bowel prep;
• Postoperative day #1 glucose 140 mg/dL;
• Minimally invasive approach; and
• Short operative time < 100 minutes
Impact of Treating > 48hrs:
• More resistant bugs
Prolonged • Higher cost
Antibiotic
Prophylaxis • 2,641 op by past art. Coronarius jantung
• Group 1 <48 jam of antibiotics
• Group 2 >48 jam of antibiotics
• SSI rates
• Group 1 9% (131/1,502)
• Group 2 9% (100/1,139)
• Odds ratio 1.0 (95% CI: 0.8–1.3)
• Peningkatan resitensi pada group 2:
• Odds ratio 1.6 (95% CI: 1.1–2.6)
CABG = coronary artery bypass grafting; CI = confidence interval.
Harbarth S et al. Circulation. 2000;101:2916–2921.
Hair Removal
Hair Removal Infection Rate

Method
sore / kerok/shaving 5.2 - 8.8%
pagi / kerok 6.4 - 10%
sore / cukur 4 - 7.5%
pagi / cukur 1.8 - 3.2%
Alexander JW, et al. Arch Surg 1983; 118:347-352
• Tidak mencukur rambut sama sekali (pre-op atau di OK), atau jika mutlak
diperlukan, hanya boleh dengan clipper.
Clipping hair just before case is best
SOSIALISASI UPDATE INFEKSI DALAM KEHAMILAN DAN RASIONALISASI PENGGUNAAN ANTIBIOTIK BAGI
ANGGOTA POGI CABANG JAMBI
SOSIALISASI UPDATE INFEKSI DALAM KEHAMILAN DAN RASIONALISASI PENGGUNAAN ANTIBIOTIK BAGI ANGGOTA
POGI CABANG JAMBI
Persiapan Lokasi Insisi
• Preparasi kulit insisi dengan menggunakan cairan antiseptic berbasis alkohol (berbasis
CHG), pada pasien yang akan menjalani pembedahan.
• Meta analisa: alcohol-CHG lebih baik dalam menurunkan risiko SSI dibanding alcohol-
povidone iodine
Cuci Tangan Sebelum Operasi
• WHO merekomendasikan: scrubbing
menggunakan sabun antimikroba dan air,
atau handrub menggunakan alcohol sebelum
memakai sarung tangan steril.
• Untuk meminimalisasi kontaminasi pada
lapangan operasi, jika ada lubang pada
sarung tangan
• WHO guidelines on hand hygiene in health
care (2009)
SOSIALISASI UPDATE INFEKSI DALAM KEHAMILAN DAN
RASIONALISASI PENGGUNAAN ANTIBIOTIK
Support Nutrisi Preoperatif
• WHO merekomendasikan pemberian suplementasi nutrisi (oral atau
par enteral) untuk menurunkan risiko SSI pada pasien underweight
yang akan menjalani operasi major.
• Suplemen nutrisi yang mengandung kombinasi arginine, glutamin,
asam lemak omega-3, dan nukleotida.

Glucose control
• Implement perioperative glycemic control and
use blood glucose target levels < 200 mg/dL in
diabetic and non-diabetic surgical patients
(Category 1A)
– No recommendation can be made regarding the
safety and effectiveness of lower or narrower
blood glucose target levels and SSI. (No
Recommendation/unresolved issue)
– No recommendation can be made regarding
hemoglobin A1C target levels and the risk of
surgical site infection in diabetic and non-diabetic
patients. (No recommendation/unresolved issue)
Disclaimer: The findings and conclusions are draft and have been presented at HICPAC but have not been
formally disseminated by the CDC and should not be construed to represent any agency determination or
policy.
Postoperative Hyperglycemia
and SSI in General Surgery
Patients
Relative SSI Rate
14
10,5
3,5
0
< 110 111-140 141-180 181-220 >220
Glucose Value in first 48 hr
Ata A, et al. Arch Surg 2010; 145: 858-64.
Elective
Surgical
Procedures  80 mg/dl> Gluc. Darah <110mg/dl akan
Prevention of menurunkan:
Hyperglycemia  ICU mortality (8%-4.6%)
 Sepsis (46%)
 ARF requiring HD (41%)
 RBC transfusion (50%)
 Polyneuropathy (44%)
 Independent variable with conventional care
Volume 345:1359-1367 November 8, 2001 Number 19
Intensive Insulin Therapy in Critically Ill Patients
Greet Van den Berghe, M.D., Ph.D., Pieter Wouters, M.Sc., Frank Weekers, M.D.,
Charles Verwaest, M.D., Frans Bruyninckx, M.D., Miet Schetz, M.D., Ph.D.,
Dirk Vlasselaers, M.D., Patrick Ferdinande, M.D., Ph.D., Peter Lauwers, M.D.,
and Roger Bouillon, M.D., Ph.D.
Glucose control (200 mg/dl)
decreases infection rate
SSIs and Glucose Levels CTS pts

8
6.7%
Deep Infection Rate, %

7
6
P=0.002
5
4
2.5%
3
1.3% 1.6%
2
1
0
100–150 150–200 200–250 250–300
Zerr KJ et al. Glucose control lowers the risk of wound infection in diabetics
after open heart operations, page 360. Reprinted from The Annals of Thoracic
Day 1 Blood Glucose (mg/dL)
Surgeons, Vol. 63.
Perioperative
hyperglycemia
was associated
with adverse
outcomes in
general surgery
patients with and
without diabetes.
Ann Surg 2013; 257:8–14.
Mempertahankan Normothermia
• WHO merekomendasikan penggunaan bahan/alat penghangat di
kamar operasi dan selama operasi untuk menghangatkan tubuh
pasien, untuk mengurangi risiko SSI.
• Pertahankan suhu tubuh normal selama operasi (1A)
• Keuntungan lain: menurunkan risiko kejadian myokard, kehilangan
darah, dan kebutuhan transfusi.
• Target suhu badan core > 36oC

Normothermia
• Maintain perioperative normothermia
(Category 1A)
– No recommendation can be made regarding
the safety or effectiveness of strategies to
achieve and maintain normothermia, the
lower limit of normothermia, or the optimal
timing and duration of normothermia.
policy.
Elective • 200 CRS patients
Surgical • Control: Routine intraoperative
thermal care
Procedures (mean temperature 34.7°C)
Perioperative
• Treatment: Active warming
Normothermia (mean temperature 36.6°C)
• Incidence of SSI
Warm Patient Strategies:
•Start with warm room • Control 19% (18/96)
•Use Bair Hugger
•Cool room for procedure • Treatment 6% (6/104); P=0.009
•Use 40o irrigation cold patients
•Warm room on closing had 3x infection
GOAL : >36oC (98.6oF) rate
Kurz A et al. N Engl J Med. 1996;334:1209–1215.
Oxygenation
• For patients with normal pulmonary function
undergoing surgery with general anesthesia
with endotracheal intubation, administer
increased fraction of inspired oxygen (FiO2)
intraoperatively and post-extubation in the
immediate postoperative period in
combination with strategies to optimize
tissue oxygen delivery through maintenance
of perioperative normothermia and adequate
volume replacement. (Category 1A)
policy.
Oksigenasi Perioperatif
• WHO merekomendasikan pasien yang akan mendapat anestesi
general dengan intubasi endotrakeal harus mendapat oksigenasi 80%
Fi02 intraoperatif, dan jika memungkinkan dalam 2-6 jam pasca
operasi.

J Eval Clin Pract. 2009; 15:360-5.
Elective
Surgical • 500 CRS patients
Procedures • 80% or 30% inspired oxygen during
Supplemental operation and for 2 hours post surgery
Oxygen • All patients received prophylactic antibiotics
• Results
• Arterial and subcutaneous PO higher in2
80% oxygen group

• Lower incidence of SSIs with higher
supplemental oxygen (5.2% vs 11.2%;
Oxygen Strategy: P=0.01)
•Supplemental O2 for Low O2 2x infection rate
2hrs in RR
Greif et al. N Engl J Med. 2000;342:161–167.

J Eval Clin Pract. 2009; 15:360-5.
Elective
Surgical • 500 CRS patients
Procedures • 80% or 30% inspired oxygen during
Supplemental operation and for 2 hours post surgery
Oxygen • All patients received prophylactic antibiotics
• Results
• Arterial and subcutaneous PO higher in 2
Oxygen Strategy: 80% oxygen group

•Supplemental O2 for • Lower incidence of SSIs with higher
2hrs in RR supplemental oxygen (5.2% vs 11.2%;
P=0.01)
low O2 2x infection rate
Greif et al. N Engl J Med. 2000;342:161–167.
Skin Preparation
• Require patients to shower or bathe (full body)
with an antimicrobial or non-antimicrobial
soap or antiseptic agent on at least the night
before the operative day. (Category 1B)
– No recommendation can be made regarding the
optimal timing of the preoperative shower or bath
or the total number of soap or antiseptic agent
applications for the prevention of surgical site
infection. (No recommendation/ unresolved
issue) Disclaimer: The findings and conclusions are draft and have been presented at HICPAC but have not been
policy.
Skin Preparation
• Perform intraoperative skin preparation with
an alcohol-based antiseptic agent, unless contraindicated.
(Category 1A)
• Do not use an antimicrobial sealant following
intraoperative skin preparation and prior to
skin incision for the prevention of surgical site infection.
(Category IA)
• Use of plastic adhesive drapes with or
without antimicrobial properties, is not
necessary for the sole purpose of the
prevention of surgical site infection.
(Category II) Disclaimer: The findings and conclusions are draft and have been presented at HICPAC but have not been
policy.
SOSIALISASI UPDATE INFEKSI DALAM KEHAMILAN DAN RASIONALISASI PENGGUNAAN ANTIBIOTIK BAGI ANGGOTA POGI CABANG SUMBAR
HOTEL PANGERAN BEACH PADANG, 21 APRIL 2019
2017 HICPAC –CDC
Guidelines for
Preventing SSI
2017 HICPAC –CDC Guidelines for Preventing SSI
Penggunaan Ceftriaxon 1 gram Injeksi
Jumlah Vial Ceftriaxon (CFX), LASA 1 gram
Injeksi, 2017
8.000 7.7
100.334.000 18
IDR
6.0
00
4.0
00 - 68.263.000
2.4
IDR 67
2.0
00 32.071.000
0
IDR
Janu Febru Mar Apr M Ju Ju Agust Septem Oktob
ari ari et il ei ni li us ber er
PPRA, RSHS, Jan.

2018.
20180416 Rapat Kerja Pokja Infeksi POGI
Penggunaan Antibiotik Profilaksis, Cefazolin 1 gram
PPRA, RSHS, Jan.

20180416 Rapat Kerja Pokja Infeksi POGI
2018.
TAKE HOME
MESSAGES
Kasus & Prosedure
Antibiotik
Evidence
Level
Odd.Rt
antibiotik Sectio Cesarea HR 1 0.41
profilaksis Histerektomi TAH / TVH R 1 0.17

Soft tissue tumor NR 1
Luka pada vulva vagina NR 1
Partus normal +
NR 1
episiotomi
Currettage AB spontan NR 1 -
Myomectomy R 1
Cystectomy R 1 0.58
KA/KP R 1
Hernia NR 1
Pemasangan IUD NR 1
MOW R 1
Pemasangan kateter NR 1
THANK YOU
Centers for Disease Control and Prevention’s National Healthcare Safety Network classification for surgical site infection (SSI)
SOSIALISASI UPDATE INFEKSI DALAM KEHAMILAN DAN RASIONALISASI PENGGUNAAN ANTIBIOTIK BAGI ANGGOTA POGI CABANG BENGKULU
HOTEL SANTIKA BENGKULU, 17 FEBRUARI 2019
Antibiotic prophylaxis
Prevent outcome infection

!!
Suggest to obese
women

v
(American Journal of Obstetrics & Gynecology AUGUST 2017)
Microbiology findings for patient with infection
El-Nashar SA et al.
Am J Obstet Gynecol
2010;202:306.e1-9
Antibiotic prophylaxis in obstetric procedures
SOGC Guidelines
Antibiotic prophylaxis in obstetric procedures
SOGC Guidelines
HOW to administered ???
SOGC Guidelines
THE PREVENTION OF EARLY-ONSET NEONATAL
GROUP B STREPTOCOCCAL DISEASE
Antibiotic Prophylaxis in Gynecologic Procedures
SOGC Guidelines
ANTIBIOTIC PROPHYLAXIS IN GYNECOLOGIC
PROCEDURES
SOGC Guidelines

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PENGGUNAAN ANTIBIOTIK PROFILAKSIS

DIVISI FETOMATERNAL DEPARTEMEN OBSTETRIK DAN GINEKOLOGI

“ Antibiotik adalah bahan kimia yang

“Bakteri resistensi adalah, bakteri yang

•Antimicrobial resistance (AMR) is the ability

Mortality:10.000.000 /year, ASIA 4,7M

Karam et al. Critical Care

“The time may come when penicillin can

• IDO RS 11.8% WHO

• HAI-RS / Indonesia – 7.1% (Deurink et al, 2009)

2016, Post SC hari ke 7. di RS. L.

1. awareness and understanding of

MAKSUD DAN TUJUAN Standar 4.1

• Carbapenem: Meropenem, Ertapenem, Doripenem.

Narrowest spectrum of Antimicrobial High Dose, Short time

SOSIALISASI UPDATE INFEKSI DALAM KEHAMILAN DAN RASIONALISASI PENGGUNAAN ANTIBIOTIK

Approximately 30% of women in the antepartum period are

In women with latency longer than 12 hours,

Saccone G, Berghella V. Antibiotic prophylaxis for term or

The routine use of prophylactic antibiotics in women

A.F. Nabhan et al. International Journal of Gynecology and

Camann W et al. International Journal of Obstetric

• Higher adipose concentrations of cefazolin were observed after

ACOG practice bulletin No.120. Use of prophylactic antibiotics

• Single dose within 60 minutes of incision:

• Increasing the use of extended-spectrum antibiotic

Tita ATN et al. Impact of extended-spectrum antibiotic

El-Nashar SA et al. Extended antibiotic prophylaxis for prevention of

There was no difference between the use of single-dose

N. Phoolcharoen et al. A randomized controlled trial comparing

Kasius JC et al. Fertility and

Antibiotic prophylaxis may be beneficial in first-trimester suction

No advantage was found for loop electrosurgical excision,

M.Y. Morrill et al. Antibiotic prophylaxis for selected

Hair Removal Infection Rate

SOSIALISASI UPDATE INFEKSI DALAM KEHAMILAN DAN RASIONALISASI PENGGUNAAN ANTIBIOTIK

SSIs and Glucose Levels CTS pts

Deep Infection Rate, %

SOSIALISASI UPDATE INFEKSI DALAM KEHAMILAN DAN RASIONALISASI PENGGUNAAN ANTIBIOTIK

Kurz A et al. N Engl J Med. 1996;334:1209–1215.

SOSIALISASI UPDATE INFEKSI DALAM KEHAMILAN DAN RASIONALISASI PENGGUNAAN ANTIBIOTIK

80% oxygen group

Greif et al. N Engl J Med. 2000;342:161–167.

Oxygen Strategy: 80% oxygen group

PPRA, RSHS, Jan.

20180416 Rapat Kerja Pokja Infeksi POGI

PPRA, RSHS, Jan.

antibiotik Sectio Cesarea HR 1 0.41

profilaksis Histerektomi TAH / TVH R 1 0.17

Prevent outcome infection

El-Nashar SA et al. Extended antibiotic prophylaxis for prevention of

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