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

2

ANTIBAKTERI

TERAPI

ANTIBAKTERI

PROFILAKSIS

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 ?

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

INDIKASI

PROFILAKSIS

GOLONGAN OPERASI

• bersih

• bersih kontaminasi

• kontaminasi

• kotor

Surgical Site Infection / IDO

Definition • superficial 30 hari

• deep 90 hari

• organ space 90 hari

• ortopedi 1 tahun

CDC 2017

Antibiotika profilaksis

kolonisasi

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

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=

ANTIBIOTIK TERLALU LAMA

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

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

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

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

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

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

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

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

ANTIBIOTIC GUIDELINE FOR PROPHYLAXIS

JOHNS HOPKINS 2016

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

OPERASI TIDAK MEMERLUKAN ANTIBIOTIK

TERIMA KASIH

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There Is No Way Home

KITA DAPAT MENCEGAH INFEKSI

TETAPI SULIT MENGHINDARI RESISTENSI

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA