Kebijakan Antibiotik Rumah sakitforlabinfeksi.or.id/wp-content/uploads/2018/01/7... · 2018. 1....
Transcript of Kebijakan Antibiotik Rumah sakitforlabinfeksi.or.id/wp-content/uploads/2018/01/7... · 2018. 1....
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Fendy Matulatan,dr.,SpB(K)BA
• Ketua III KPRA RSUD Dr.Soetomo
• Wakil Ketua KFT RSUD Dr.Soetomo
• Staf SMF Ilmu Bedah RSUD Dr.Soetomo-FKUA
• Pengurus PABI Surabaya
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ANTIBAKTERI
TERAPI
ANTIBAKTERI
PROFILAKSIS
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MENGAPA PERLU PROFILAKSIS ? dokter takut kalau infeksi • beban perasaan dokter • reputasi dokter • pasien menderita • beban biaya
dokter ikut pengalaman yang lalu • operasi = profilaksis • pelajaran saat PPDS I • ikut seniorny
Pasien yang meminta Antibiotik • menggaggu tugas dan penghasilan
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Infeksi Daerah Operasi
Kasus
antiseptik
SDM
Instrumen
Linen
Sarana OK
Ko-morbid Usia
Status umum pasien
Pasca operasi
Air bersih
Koloni OK
Antibiotik
Instrumentasi
SOP Cuci tangan
kompetensi Operator
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MENGAPA PERLU PROFILAKSIS
• Operasi harus pakai antibiotik ?
• Luka operasi supaya cepat kering ?
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DULU
penggunaan antibiotik
saat operasi
suntikan oral
Pre op (+) (-)
Post op Sampai flatus 5-7 hari
Jenis
Amoksisilin clav Ampisilin,
Sulbenisilin Sefotaksim, Seftriakson Seftasidim
Gentamisin, Nitromisin, Tobramisin
Amoksisilin Clav
Erythromisin Sefadroksil Clindamicin
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Definitions : Antibiotik yang diberikan sebelum-saat-setelah operasi pada kasus yang
secara klinis tidak terdapat tanda infeksi. Tujuannya untuk mencegah
terjadinya ILO / SSI / IDO dan mencegah kolonisasi
Delayed healing
Hernia Possible evisceration
Abscess Fistula
Other procedures needed
Infection here may cause:
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Keuntungan dan Keterbatasan penggunaan antibiotik profilaksis
Keuntungan Antibiotik Profilaksis • Menurunkan infeksi luka operasi dan morbiditas • Menurunkan biaya perawatan • Mengurangi lama tinggal di rumah sakit Keterbatasan Antibiotik Profilaksis • Meningkatnya resiko kolitis karena Clostridium difficile bila
menggunakan sefalosporin generasi III • Meningkatnya frekuensi bakteremia pada penderita yang
memakai antibiotik profilaksis lebih dari 4 hari dibandingkan dengan yang mendapat profilaksis 1 hari
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ANTIBIOTIK
PROFILAKSIS
1. Antibakteri, yang digunakan untuk mencegah komplikasi infeksi pada tindakan operasi.
2. diberikan sebelum operasi, ulangan saat operasi atau setelah operasi
3. batasan waktu: tidak melebihi 24 jam
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INDIKASI
PROFILAKSIS
GOLONGAN OPERASI
• bersih
• bersih kontaminasi
• kontaminasi
• kotor
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Surgical Site Infection / IDO
Definition • superficial 30 hari
• deep 90 hari
• organ space 90 hari
• ortopedi 1 tahun
CDC 2017
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Antibiotika profilaksis
kolonisasi
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Profilaksis Dosis Tunggal v/s Multipel
Single-dose versus multiple-dose antibiotic prophylaxis for the surgical treatment of closed fractures .
Slobogean.et.al. Acta Orthopaedica 2010; 81 (2): 256–262
Fakta
laporan
Tidak ada
perbedaan
signifikan
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Results: A total of 540 patients were recruited; (females73.7% of total ). The performed surgical procedures were 547. The rate of wound infection was 10.9%. Multivariable logistic analysis showed that; ASA score > 3; (p=
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ANTIBIOTIK TERLALU LAMA
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cara pemberian
AB PROFILAKSIS
• Antibiotik
– Cefazolin 2 g
– Cefuroxime 1,5 g
• i.v/drip dalam 100 ml NS, selama 15 menit
• 30-60 menit sebelum insisi
• Tanpa test
• Di kamar operasi
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BENANG MENGANDUNG ANTISEPTIK
RECOMENDATION STRENGHT QUALITY OF EVIDENCE
The panel suggests the use of triclosan-coated sutures for the purpose of reducing the risk of SSI, independent of the type of surgery.
CONDITIONAL MODERATE
WHO, 2016
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ANTISEPTIK KULIT
RECOMENDATION STRENGHT QUALITY
OF
EVIDENCE
recommends alcohol-based
antiseptic solutions based on
Chlorhexidine Gluconate for
surgical site skin preparation in
patients undergoing surgical
procedures.
Strong
Low to
moderate
WHO, 2016
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Elective Surgical
Procedures Hair Removal
Clipping hair just before case is best
Hair Removal
Method
Infection Rate
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
CUKUR VS KERIK
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CUKUR BULU/RAMBUT
RECOMENDATION STRENG
HT
QUALITY OF
EVIDENCE
• patients undergoing any surgical
procedure, hair should either not be removed or, if absolutely necessary, it should be removed only with a clipper. Shaving is strongly discouraged at all times, whether preoperatively or in the OR.
Strong Moderate
WHO, 2016
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ADVANCED DRESSINGS
RECOMENDATION STRENGHT QUALITY OF EVIDENCE
The panel suggests not using any type of advanced dressing over a standard dressing on primarily closed surgical wounds for the purpose of preventing SSI.
CONDITIONAL LOW
WHO, 2016
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ANTIMICROBIAL PROPHYLAXIS IN THE PRESENCE OF A DRAIN AND OPTIMAL TIMING FOR WOUND DRAIN REMOVAL
RECOMENDATION STRENGHT QUALITY OF EVIDENCE
preoperative antibiotic prophylaxis
should not be continued in the presence of a wound drain for the purpose of preventing SSI. The panel suggests removing the wound drain when clinically indicated. No evidence was found to allow making a recommendation on the optimal timing of wound drain removal for the purpose of preventing SSI.
CONDITIONAL
CONDITIONAL
LOW
VERY LOW
WHO, 2016
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PEMANJANGAN PEMBERIAN
ANTIBIOTIK
RECOMENDATION STRENGHT QUALITY OF EVIDENCE
The panel recommends against the prolongation of SAP after completion of the operation for
the purpose of preventing SSI.
STRONG MODERATE
Moderate quality evidence from a high number of RCTs (44 studies included in the overall meta- analysis) shows that prolonged SAP postoperatively has no benefit in reducing SSI after surgery when compared to a single dose.
WHO, 2016
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ANTIBIOTIC GUIDELINE FOR PROPHYLAXIS
JOHNS HOPKINS 2016
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Prosedur Operasi
& Antibiotik profilaksis
Prosedure Antibiotic Evidence
Level Odd.Rt
Sectio Cesarea HR 1 0.41
Histerektomi TAH / TVH R 1 0.17
Tonsilectomy NR 1
Luka pada wajah NR 1
Partus normal + episiotomi NR 1
Strumectomy NR 1 -
Ca Mammae R 1
Appendectomy HR 1 0.58
Colorectal surgery HR 1
Hernia NR 1
TUR prostate HR 1
Arthroplasty HR 1
Pemasangan kateter NR 1
HR= High Recommended R = Recommended NR= Not Recomended
SIGN 2014
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OPERASI TIDAK MEMERLUKAN ANTIBIOTIK
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TERIMA KASIH
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There Is No Way Home
KITA DAPAT MENCEGAH INFEKSI
TETAPI SULIT MENGHINDARI RESISTENSI
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA