Page 63 - Proceeding of Plenary Abstract of Parallel Symposim

INFEKSI & PENYAKIT TROPIS

Antimicrobial Resistance & Covid-19: Intersections and Implication

Anggraini Alam
Departement of Child Health, Faculty of Medicine, Universitas Padjadjaran /Hasan Sadikin National Hospital, Bandung, West Java, Indonesia
Abstract
Background Severe acute respiratory syndrome coronavirus (SARS-CoV)-2 has caused over 226 million cases
and 4,658,000 deaths worldwide. Based on the experience from other respiratory viral infections, such as
pandemic influenza H1N1, SARS and Middle East respiratory syndrome (MERS), bacterial and/or fungal
co-infections are likely to play a major role in increasing mortality. Covid-19 patients with a co-infection are
more likely to die than patients who do not have co-infections. The World Health Organization (WHO)
recommends against indiscriminate use of antibiotics in patients with coronavirus disease 2019 (Covid-19),
unless there is clinical suspicion of a bacterial infection and recommends to consider antimicrobial use only if
a bacterial superinfection is likely and/or for patients with major co-morbidities who are at high risk of severe
complications from untreated bacterial infections. However, overuse of empirical antibiotics prescription in
Covid-19 patients has been widely documented. Objective Superinfections with difficult-to-treat bacterias,
such as MRSA, Enterobacteriacea and MDR non-fermenting rods, have been reported as a major complication
of clinical course of Covid-19 patients. Patients with multiple comorbidities and severe to critical forms of
Covid-19 are prone to require prolonged hospitalization, intensive care support and multiple invasive devices,
thus being at higher risk of nosocomial infections by difficult-to-treat pathogens. Antimicrobial resistance
is still a major public health threat, which will likely persist after Covid-19, and may even potentially be
exacerbated by this pandemic. Conclusion In pandemic situation, microbiological diagnosis should always
be pursued in case of rapid change in clinical conditions and laboratory or imaging results, before introducing
broad-spectrum antibiotics. The antimicrobial choice should be used in context antimicrobial stewardship
principles.

The Role of Vaccines in Combatting Antimicrobial Resistance

Dominicus Husada
Department of Child Health, Faculty of Medicine Universitas Airlangga/Dr Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
Abstract
Background The vaccine is one of two the most successful program in public health all over the world.
Vaccine contributes many good things for humanity. Discussion One of the vaccine's benefits is its ability
to reduce antimicrobial resistance in at least three ways. First, the vaccine reduces the incidence of many
bacterial infectious diseases. Because antimicrobial resistance mainly happens after the antimicrobe exposures,
reducing these exposures will decrease the resistance possibility significantly. The second way is because many
physicians are actually in doubt while making a diagnosis. Many patients with a viral infection will also get
antimicrobials because simply the differential diagnosis is a bacterial disease. Most of the limited setting areas
do not have additional methods for precise diagnosis; thus, the diagnosis will solely be based on the clinical
signs and symptoms. By reducing the incidence of this bacterial disease, those physicians will also stop giving
the antimicrobe. The third way is by directly tackle the multi-resistant microbe. The vaccine will prevent this
microbe from infecting humans or animals. A good example for the first way is after the implementation of the
pneumococcal conjugate vaccine for Streptococcus pneumoniae. This vaccine combat invasive pneumococcal
disease, pneumonia and otitis media, carriage, and certainly also the rate of resistance. The same things are also
seen for the rotavirus vaccine and influenza vaccine. The second way has happened after the implementation
of the typhoid vaccine in the setting where the clinician provides antibiotics for most fever illnesses. The
current problem with vaccines is because the number is too limited. There are only fewer than 40 vaccines in
the world at this moment, and the coverage of those vaccines is not satisfactory, especially in the limited and
middle-income countries. More vaccines are on the way, and by having many vaccines in the future, with high
coverage implementation, the incidence of antimicrobial resistance will be lesser and lesser.

48 Abstract