The UK and Indonesia have signed a Memorandum of Understanding on health cooperation and its Joint Action Plan. The two countries have also signed a Grant Agreement for the Fleming Fund partnership on antimicrobial resistance (AMR) surveillance in Indonesia.
Case Study: Surveillance of antimicrobial use and stewardship in Indonesia hospital
Tri Pudy Asmarawati, a Fleming Fund Fellow in Human Health, mentored by Erasmus University, focused on the surveillance of antimicrobial use and the implementation and sustainability of antimicrobial stewardship (AMS) for a hospital in Indonesia.
The Fleming Fellowship provided extensive knowledge and practical experience in antimicrobial resistance (AMR), which included conducting a local surveillance study on urology patients at the Dr Soetomo General Academic Hospital in Surabaya, Indonesia. Tri Purdy monitored the use of prophylactic antibiotics in urology to evaluate the existing guidelines for prophylactic antibiotic use in urological surgeries.
(Above image): Collaborative project preparation involving stakeholders, local sampling coordinator, farmers, and primary healthcare staff.
The findings were published in an international journal, highlighting the importance of rational antibiotic use in surgical settings. This was followed by a meeting attended by the Antimicrobial Stewardship Committee from the Hospital and the Radboudumc University in the Netherlands to discuss prophylaxis antibiotics. The study aligns with Radboudumc’s AMS plan, led by mentor Prof Heiman Wertheim, which started on a small scale to ensure the implementation was successful.”
Implementing AMS in hospitals involves more than collecting data on antibiotic use and ensuring the rational use of antibiotics; it also requires evaluating the policies implemented by the Antibiotic Stewardship Committee and preventing the underuse or misuse of antibiotics.
Tri Pudy Asmarawati, Fleming Fund Fellow, Human Health.
We are very grateful to have staff who participated in the Flemming Fellowship and the invaluable knowledge and experience they gained. Tri Pudy, as part of the Committee in Dr Soetomo General Academic Hospital, plays an active role in our work plans and has proved particularly useful in improving the quality of its activities.”
Dr Musofa, Head of the Antimicrobial Resistance Action Committee, Dr Soetomo General Academic Hospital
Fleming Fund Fellow Tri Pudy with field sampling team in Blitar, Indonesia.
Interconnecting AMR: hospital to community
In addition to hospital-based work, Tri Pudy participated in a collaborative community project, in Blitar, the QUINDO project in East Java, Indonesia, on quinolone antibiotic resistance across human, livestock, and aquaculture sectors using a One Health approach. This study involved collecting data from E. coli and S. aureus isolate samples and whole genome sequencing data analysis, demonstrating the interconnectedness of AMR across different sectors and the need for a comprehensive methodology to combat it.
In this multidisciplinary project, Tri Pudy played a pivotal role in collecting data for the collection and interpretation of data on antibiotic consumption in rural communities.
Dr Juliëtte Severin, Clinical Microbiologist, and mentor at Erasmus MC
The collaborative project revealed several challenges in tackling AMR in Indonesia:
Low knowledge and awareness
- There is a significant lack of awareness about antibiotic use, especially in rural communities.
Access issues
- Easy access to antibiotics without prescriptions and lack of access in certain health facilities lead to misuse and untreated infections.
Irrational use in hospitals
- Hospitals face issues with irrational antibiotic use, compounded by manual data recording and reporting systems that require trained and committed human resources.
The study showed the importance of collaboration between human, animal, and environmental health sectors.
A mutual understanding of the issues in each sector and expanding networks to involve relevant stakeholders is essential in addressing AMR effectively within the One Health framework.
Tri Pudy Asmarawati, Fleming Fund Fellow, Human Health.
Tri Pudy questionnaire sampling in communities.
Tri Pudy at technical meeting involving local sampling coordinator, farmers, and primary healthcare staff.
Antibiotic stewardship strategies
Based on the project results, the need for increased public awareness on the issue of AMR is clear.
The fellowship illustrated the multi-faceted approach required to combat antimicrobial resistance and the importance of continuous education, collaboration, and policy evaluation in achieving sustainable antibiotic stewardship.
Tri Pudy Asmarawati, Fleming Fund Fellow, Human Health.
Tri Pudy plans to engage in community service to promote the rational use of antibiotics and prevent the spread of AMR. Currently part of the AMR committee in three hospitals in Surabaya, her Fleming Fund Fellowship has been invaluable in implementing antibiotic stewardship strategies. This includes building and enhancing AMR Committee activity in hospitals, especially, performing continuous surveillance on AMR and antibiotic use, infectious disease case discussion, monitoring, and AMR programme evaluation.
Additionally, Tri Pudy is involved in the Tricycle project, which focuses on the surveillance of ESBL-producing E. coli in humans, animals, and the environment in Surabaya. This project was a collaboration between the National Institute of Infectious Disease, Japan, and Universitas Airlangga, Surabaya, Indonesia. She is involved as part of the research team and continues her doctoral studies on ESBL-producing E. coli bacteremia at the Dr Soetomo General Academic Hospital.
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The UK aid Fleming Fund Country Grant to Indonesia (FFCGI) enters its second phase of support to Indonesia, providing technical assistance to the country’s government in addressing the threat of antimicrobial resistance (AMR) - with a new investment of GBP 5.8 million/IDR 120 billion from 2024-2026.