Antibiotic Use and Resistance at Intensive Care Unit of a Regional Public Hospital in Bali: A 3-Year Ecological Study

Abstract

Antibiotic resistance at Intensive Care Unit (ICU) has been impacted by several factors, including high utilization and selectivity. The consumption rate and its selective pressure appear very extensive, with regular opportunities for cross-transmissions. In addition, ICU patients are susceptible to carriage acquisition and subsequent infections with high resistant bacteria. Therefore, this study investigates the relationship between the use and resistance of antibiotics in the ICU of a regional public hospital. The results potentially serve as confirmations for planning programs necessary to control ICU-related antibiotic consumption levels. This ecological analysis was also based on inpatient retrospective data from a regional public hospital in Bali from 2017–2019. Subsequently, the amount of intake expressed as daily doses (DDDs) per 100 patient days, and percentage of resistant bacterial isolates were examined using Spearman rank correlation. The largest segment of the antibiotics was determined by drug utilization 90% (DU90%) and the phenotypic class was defined by Centers for Disease Control and Prevention (CDC). Similarly, the most predominantly applied antibiotics were levofloxcacin, ceftriaxone, ampicillin, cefotaxime, ciprofloxacin, ampicillin-sulbactam and gentamycin. Meanwhile, the major gram-negative bacteria were Acinetobacter baumannii, Enterobacter cloacae, Enterococcus faecalis, Escherichia coli, Klebsiella pneumonia and Pseudomonas aeruginosa. Furthermore, 5 multi drug resistant (MDR) bacteria were observed, including A. baumannii, E. cloacae, E. coli, K. pneumonia and P. aeruginosa, while A. baumannii and E. cloacae occurred as carbapenem resistant (CR) and extended-spectrum cephalosporin-resistant (ESCR), respectively. However, only E. coli showed a negative significant correlation between antibiotic utilization and the percentage of ICU bacterial sensitivity (r=–0,543; p=0,024). Therefore, higher consumption of antibiotics decreases its percentage susceptibility.

Edukasi Penggunaan Antibiotik Rasional Pada Masyarakat

“…Penerapan penggunaan antibiotik secara bijak dikenal sebagai penatagunaan antibiotik (antibiotic stewardship) yang bertujuan meningkatkan outcome pasien secara terkoordinasi melalui perbaikan kualitas penggunaan antibiotik yang meliputi penegakan diagnosis, pemilihan jenis antibiotik, dosis, interval, rute, dan lama pemberian yang tepat. Salah satu faktor yang menyebabkan kesalahan penggunaan antibiotik adalah kurangnya pengetahuan akan antibiotik itu sendiri (Meriyani, et al, 2021). Edukasi tentang penggunaan antibiotik yang tepat dan mencegah terjadinya infeksi merupakan hal yang penting.…”

Profil Pengetahuan dan Persepsi Orang Tua terhadap Penggunaan Antibiotik pada Anak di Apotek Bangkalan

“…Persentase terbanyak hambatan yang dirasakan adalah kelupaan dalam mengkonsumsi obat (Kosiyaporn et al, 2020). Penelitian lainnya juga mendukung mengenai barrier diatas, hambatan yang dirasakan orang tua dalam pengobatan anaknya adalah kelupaan dan sulitnya dalam manajemen waktu (Meriyani, et al, 2021).…”

“…Tabulasi silang antara pengetahuan dan perceived threat orang tua pasien anak di Apotek Bamara Medika menunjukkan hasil bahwa responden yang berpengetahuan cukup memiliki perceived threat yang cukup dengan persentase terbanyak yakni 51%, hal ini menunjukkan responden yang mengetahui tentang antibiotik memiliki persepsi ancaman bahaya yang cukup dalam penggunaan antibiotik artinya responden masih sadar mengenai adanya konsekuensi dalam penggunaan antibiotik. Penelitian sebelumnya menunjukkan bahwa mereka yang memiliki pengetahuan mengenai bahaya dari penggunaan antibiotik yang tidak rasional namun mereka tetap tidak sadar dan tidak yakin mengenai konsekuensi jangka penjangnya (Meriyani, et al, 2021). Penelitian ini menunjukkan ketidaksesuaian dengan responden di Apotek Bamara Medika mengenai kepercayaannya tentang konsekuensi jangka panjang dari penggunaan antibiotik yang tidak rasional.…”

Analysis of the Antimicrobial Stewardship Program Policy on Inpatients Antibiotics Use

“…WHO states that the criteria for rational drug use are as follows in which according to the patient's disease indication; based on anamnesis of the condition and the results of an accurate physical examination of the patient; dosage calculation based on age, body weight, and disease course; the right way of giving; timely interval of administration; exact duration of administration; for certain cases provided within a certain period; the quality of the drug is guaranteed and effective; according to the patient's condition and does not expire; available and affordable; the price is relatively low and not hard to come by; allergies and minimal drug side effects. There are two strategies to prevent the increase in resistant bacteria, i.e., for the selection of pressure to be controlled wisely in the use of antibiotics (prudent use of antibiotics); while the spread of resistant microbes across the plasmid is prevented by applying standard precautions (universal precaution) (Indonesia, 2015;Meriyani et al, 2021).…”