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INFEKSI SALURAN KEMIH

PADA
KEHAMILAN
Rasyad Wicaksono | 1111103000072
Sarah At-Tauhidah | 1111103000098
Pembimbing
SpOG

: dr. H. Setyo Hermanto,

ISK dan Kehamilan


Pregnancy is a state associated with physiological,
structural, and functional urinary tract changes
which promote ascending infections from the urethra.
Joanna
Joanna ME,
ME, Jolanta
Jolanta M,
M, Monika
Monika W.
W. Urinary
Urinary tract
tract infections
infections in
in pregnancy:
pregnancy: old
old and
and new
new unresolved
unresolved
diagnostic
diagnostic and
and therapeutic
therapeutic problems.
problems. Arch
Arch Med
Med Sci
Sci 2015;
2015; 11,
11, 1:
1: 6777
6777

After anemia, UTIs are the second common


complications in pregnant women, which if not
controlled well, can adversely affect the health of
infant or the pregnant mother
Mittal
Mittal P,
P, Wing
Wing DA.
DA. Urinary
Urinary tract
tract infections
infections in
in pregnancy.
pregnancy. Clin
Clin Perinatol.
Perinatol. 2005;32(3):74964.
2005;32(3):74964.

The antibiotic
maternal and

regiment should have a good


fetal safety profile.

Daniele
Daniele M,
M, Gianluca
Gianluca A,
A, Daniele
Daniele C,
C, Alessandro
Alessandro C,
C, Giovanni
Giovanni M.
M. Urinary
Urinary tract
tract infections
infections in
in women:
women:
etiology
and
treatment
options.
International
Journal
of
General
Medicine
2011:4
333343
etiology and treatment options. International Journal of General Medicine 2011:4 333343

ISK dan Kehamilan


Faktor Risiko
ISK sebelum kehamilan
Penggunaan kateter
Usia kehamilan > 6 minggu
Aktivitas seksual
Lansia
Multiparitas
Kelainan struktur saluran kemih
Diabetes
Kovavisarach
Kovavisarach E,
E, Vichaipruck
Vichaipruck M,
M, Kanjarahareutai
Kanjarahareutai S.
S. Risk
Risk factors
factors related
related to
to asymptomatic
asymptomatic bacteriuria
bacteriuria in
in pregnant
pregnant
women.
J
Med
Assoc
Thai
2009;
92:
606-10.
women. J Med Assoc Thai 2009; 92: 606-10.

ISK dan Kehamilan


Komplikasi
Hipertensi
Anemia
Amnionitis
Kelahiran preterm
BBLR
Septicemia

Nicole
Nicole MG,
MG, Macones.
Macones. Urinary
Urinary Tract
Tract Infection
Infection as
as
Challenges,
and
a
Global
Call
to
Action.
Global
Challenges, and a Global Call to Action. Global

a
a Preventable
Preventable Cause
Cause of
of Pregnancy
Pregnancy Complications:
Complications: Opportunities,
Opportunities,
Advances
In
Health
And
Medicine
September
2013;
Advances In Health And Medicine September 2013; 2(5):
2(5): p59-69
p59-69

PATOFISIOLOGI

Volume plasma Jumlah urin


Tonus otot polos
Dilatasi urethra
Penekanan oleh uterus Gangguan aliran
urin
Pemecahan AA & hormon pH urin
Glukosuria
pertumbuhan bakteri

Marziyeh
Marziyeh A
A et
et al.
al. Prevalence
Prevalence of
of Urinary
Urinary Tract
Tract Infection
Infection Among
Among Pregnant
Pregnant Women
Women and
and its
its Complications
Complications in
in Their
Their
Newborns
During
the
Birth
in
the
Hospitals
of
Dezful
City,
Iran,
2012
2013.
Iran
Red
Crescent
Med
J.
2015
Newborns During the Birth in the Hospitals of Dezful City, Iran, 2012 - 2013. Iran Red Crescent Med J. 2015
August; 17(8): e26946.

ETIOLOGI

Eschericia coli (63-85%)


Proteus sp (15%)
Klebsiella pneumoniae (~8%)
Staphylococcus aureus (~8%)
Group B streptococci (2-7%)

Wagenlehner
Wagenlehner FM,
FM, Weidner
Weidner W,
W, Naber
Naber KG.
KG. An
An update
update on
on uncomplicated
uncomplicated urinary
urinary tract
tract infections
infections in
in women.
women. Curr
Curr
Opin
Urol
2009;
19:
368-74.
Opin Urol 2009; 19: 368-74.

ANTIBIOTIK

Gupta
Gupta et
et al.
al. International
International Clinical
Clinical Practice
Practice Guidelines
Guidelines for
for the
the Treatment
Treatment of
of Acute
Acute Uncomplicated
Uncomplicated Cystitis
Cystitis and
and
Pyelonephritis
in
Women:
A
2010
Update
by
the
Infectious
Diseases
Society
of
America
and
the
Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European
European
Society
Society for
for Microbiology
Microbiology and
and Infectious
Infectious Diseases.
Diseases. Clinical
Clinical Infectious
Infectious Diseases
Diseases 2011;52(5):e103e12
2011;52(5):e103e12

Bakteriuria Asimtomatik
Komplikasi
Risiko pyelonefritis (30-40%) tetap diobati
Risiko BBLR dan preterm?
Diagnosis
>100.000 CFU/ml pada 2x sampel urin mid-stream
>100 CFU/ml pada sampel urin kateter
1 kali per trimester, lebih pada risiko tinggi
Kultur ulang 1-2 minggu setelah terapi
Jumlah koloni bakteri sukses
Persisten/rekuren tanpa faktor risiko ubah dosis
Persisten/rekuren dengan faktor risiko profilaksis

Bakteriuria Asimtomatik
Profilaksis
Postcoital
Nitrofurantoin 50-100 mg PO
Cephalexin 250-500 mg PO
Harian
Nitrofurantoin 50-100 mg PO

Uretritis/Sistitis
Manifestasi Klinis
Urin keruh
Disuria
Frekuensi BAK
Urgency
Nyeri (Abdomen, suprapubik, atau punggung bawah)
Bakteriuria (>100 CFU/ml)
Follow Up
Hilangnya gejala
Kultur ulang 1-2 minggu setelah terapi
Jumlah koloni bakteri sukses
Persisten/rekuren tanpa faktor risiko ubah dosis
Rekuren dengan faktor risiko profilaksis postcoital

Tatalaksana

Gupta
Gupta et
et al.
al. International
International Clinical
Clinical Practice
Practice Guidelines
Guidelines for
for the
the Treatment
Treatment of
of Acute
Acute Uncomplicated
Uncomplicated Cystitis
Cystitis and
and
Pyelonephritis
in
Women:
A
2010
Update
by
the
Infectious
Diseases
Society
of
America
and
the
Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European
European
Society
Society for
for Microbiology
Microbiology and
and Infectious
Infectious Diseases.
Diseases. Clinical
Clinical Infectious
Infectious Diseases
Diseases 2011;52(5):e103e12
2011;52(5):e103e12

Pyelonefritis
Manifestasi Klinis
Demam > 38ooC
Nyeri punggung bawah
Nyeri tekan CVA
Nyeri tulang/sendi
Mual/muntah
LUTS
>100.000 CFU/ml pada sampel urin mid-stream
Komplikasi
Anemia (23%)
Septicemia (17%)
Gangguan fungsi ginjal akut (7%)
Gangguan pernapasan (2%)

Pyelonefritis
Tatalaksana
Rawat inap dalam 48 jam pertama
Awasi tanda komplikasi
Awasi balans cairan
Pemberian antibiotik

TERIMA KASIH