News and Opinions  –  2023

When Doctor Rianto suffered from antibiotic resistance as a patient

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Professor Rianto Setiabudy, a clinical pharmacology specialist and professor from the School of Medicines at Universitas Indonesia shares his personal story as a patient suffering from a resistant bacterial infection.

Professor Rianto at the hospital suffering from a serious infection caused by Acinetobacter. Image: Pao

Got fever suddenly – infected with Acinetobacter

Rianto, remembers how, one night, he suddenly became ill after celebrating his wedding anniversary. He caught a fever and was admitted to the Dr. Cipto Mangunkusumo Hospital (RSCM), the teaching hospital in Jakarta, Indonesia. The laboratory test results did not indicate any worrying signs initially. He was soon discharged.

At home, Rianto’s wife, who worked as a laboratory personnel, helped her husband with another blood test and the result showed a possible thrombocytopenia, which means the platelet count in your blood is too low. He was taken back to the same hospital and treated for suspected dengue-fever.

Rianto remembers:

On the third day, a colleague, who had treated many patients with dengue fever, felt a bit worried about my case. Something was off. My fever was so high that I was shivering heavily, and the bed was shaking,”

Further tests were done, and the results from the blood culture test revealed that he suffered from a serious infection caused by Acinetobacter, a pathogenic gram-negative bacteria.

Sepsis – a syndromic response to infection

  • Sepsis is not an infection in itself, but is rather an extreme and dysfunctional bodily response to an infection. Previously it was also described as “blood poisoning”.
  • Sepsis is a life-threatening condition and has a high mortality even in well-resourced health care structures.
  • The medical consequences may include organ failure, septic shock and death. A variety of infections – bacterial, viral, parasitic and fungal – may lead to sepsis, including common conditions like pneumonia and urinary tract infections. Bacterial infection is commonly the root cause of the condition, and prompt treatment with effective antibiotics is then essential for survival.
  • Sepsis disproportionately affects vulnerable populations: newborns, pregnant women and people living in low-resource settings.
  • Significant regional disparities in sepsis incidence and mortality exist; Approximately 85.0% of sepsis cases and sepsis-related deaths occur in low- and middle-income countries.

Rianto believes that the infection in his blood was acquired in the hospital. “Because cases from outside the hospital are very uncommon,” Rianto explains.

His condition worsened

As his condition worsened, he shivered more and more. Lab results as well as his clinical condition indicated a serious infection and he was admitted to the intensive care unit. “In the intensive care unit, I was given several types of antibiotics though it was understood that none of them were effective for my condition.” “Well, after a blood culture with a sensitivity tests, it turned out that the Acinetobacter was resistant to all antibiotics available at RSCM hospital,”  says Rianto.

Acinetobacter are a group of bacteria that often spread in health care structures and that quite often are resistant to several antibiotics.

Did not know what was happening

He does not remember for how many days he was there. Rianto says that he did not know what was happening to him. He told his colleague, who was treating him in the intensive care unit, that he accepted his condition, but was keen to know how likely it was for him to survive. His doctor refused to respond to the question. It is impossible to know the risk of death for an individual patient.

His doctor said: “What we can do is try our best to cure your illness.”

“I respected that. They have done their best. I thank them deeply for the attention they gave to me.” says Rianto.

After several days, his condition improved and he was grateful for having escaped the critical phase when released from the intensive care unit.

Bacteria can enter bloodstream via catheters – oral medication better when possible

Multidrug resistant bacteria. Biofilm of bacteria Acinetobacter baumannii, the common causative agent of hospital-acquired infections 3D illustration. Photo: Shutterstock.

Rianto later learned that deaths are increased two to threefold when infections are resistant to antibiotics. Bacteria can enter the bloodstream through intravenous catheters, when routines for safe injections are lacking or not followed. This is one reason why it is suggested that if an intravenous administration is not needed, patients are better off taking oral medication, as it could be safer.

Occurrence of bacteria entering the bloodstream through intravenous catheters is quite common, not only in RSCM hospital. Sometimes bacteria can be transmitted when a doctor or a nurse touches one patient after another without washing their hands. Infections like this are called “health care acquired infections” and the impact of those when it comes to resistance bacteria on people’s lives is incalculable. But with good Infections prevention and control programs, for example correct practices when it comes to IV catheters can reduce these infections with 70% according to WHO.

Professor Rianto. Image: Pao.

Save antibiotics for when we really need them

As a pharmacologist, Professor Rianto knows the importance of antibiotics and rarely uses them. Viral infections such as the common cold does not need to be treated with antibiotics.

“I only use antibiotics when there is a bacterial infection. For example I don’t use antibiotics for a runny nose or a cough, a headache, or a bone pain.”

Many people think that medicines alone cure diseases. Instead, it is actually a combination of the body’s immune system and the role of the respective medicines. When a life-threatening infection occurs, the body still has an internal defense mechanism to counter it.

Lessons learned

There are some invaluable lessons learned from Rianto’s experience. He says: “Antibiotics in the hospital must be used carefully, not excessively. Secondly, there must be a distinction between different of antibiotics –  for an improved antibiotic stewardship. And some so called broad antibiotics needs to be reserved and only used when absolutely necessary.”


This concept has been developed by the WHO as part of its “AWaRE” classification. AWaRe is the acronym for “Access” i.e., antibiotics that can be obtained and given by all doctors; “Watch” for the second type of antibiotics that require special permits, hence, “must be used sparingly,”; and “Reserve” for the third group of antibiotics to be used only for life-threatening infections cause by multi-resistant bacteria.

The AWaRe Classification of antibiotics was developed in 2017 by the WHO Expert Committee on Selection and Use of Essential Medicines as a tool to support antibiotic stewardship efforts at local, national and global levels, Antibiotics are classified into three groups, Access, Watch and Reserve.

Find WHO AWaRe classification

The WHO AWaRe antibiotic book

Rianto continues: “We should avoid any unnecessary use of antibiotics. Antibiotics should be only taken as prescribed by health professionals.”

Professor Rianto strongly emphasizes the need to use antibiotics properly and correctly because the medicines are like a double-edge sword. If used properly and correctly, it will be useful. But the sword can also injure us if not used properly. To raise awareness about antibiotic resistance both for health care providers and patients can be a challenge.“We will only be awakened when we are diagnosed with a certain disease and learn that a medicine that used to be effective is no longer working.”

Different antibiotic treatments for different bacterial infections

The administration of antibiotics is often quite short and depends on the type of bacterial infection. Certain diseases only require one dose to cure, such as gonorrhoea. But some infections do require weeks, even months of treatment, such as tuberculosis treatment that should last for at least six months but can become much longer if it is caused by resistant bacteria.

It is very important to continue antibiotic treatment course to the end, unless the doctor prescribes something else. This also goes for tuberculosis – do not stop the treatment course until the six-month timeframe or according to the doctor’s instructions.

Learn when to contact health care

Professor Rianto emphasizes the importance of improving health literacy and learning to identify the symptoms of self-limiting diseases. For example, common cold and most diarrhoea and other viral infections should not be treated with antibiotics.

As an individual it is impossible to know when the body has been infected with resistant bacteria. it is important to contact health care for advice.

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