Infeksi Saluran Kemih Bagian Bawah: Edwin Bonaville
Infeksi Saluran Kemih Bagian Bawah: Edwin Bonaville
BAGIAN BAWAH
Edwin Bonaville
Universitas UKRIDA
PENDAHULUAN
Difinisi:
adalah infeksi saluran kemih bagian bawah
dengan bakteriuria minimal 100.000 cfu/ml urin
Pelvic relaxation,
40
hospitalization
Etc.
30
20
Onset of
Sexual intercourse
Child bearing
10
10
20
30
40
Age in year
50
60
70
80
PATOGENESIS
SEBAGIAN
PATHOGENESIS
THE PATHOGENESIS OF URINARY TRACT INFECTION HAS BEEN
POSTULATED TO INVOLVE THREE PRIMARY MECHANISM:
HEMATOGENOUS,LYMPHATIC,ASCENDING EXTENSION OF ORGANISME
DIRECTLY
ETIOLOGI
80-90 %
10%
5%
= E COLI
= Klebsiella, Protius, Pseudomonas
Enterobacter.
= Staph aureus,Entereococcus
Chlamydia, Fungus, TB,. Other.
Uropathogenic E. coli
Selected O-, H-, K-Clones
fimbriae
hemolysin
aerobactin
K
antigen
serum resistant
uroepithelial adherence
cytotoxic; Fe liberating
Fe scavenger
antiphagocytic
survival
in blood
GAMBARAN KLINIS
frekuensi
Disuria
Urgensi
nokturia
Kencing tidak puas*
Hematuria.
Rasa tak nyaman supra pubik
Hooton TM.Recurrent urinary tract infection in women. Int J Antimicrob Agent 2001;17;259-268.
DIAGNOSIS
DIAGNOSIS DITEGAKKAN BERDASARKAN :
GEJALA KLINIS
URINALISIS DAN KULTUR URIN
PENANGANAN
GOAL PENANGANAN ISK ADALAH:
HILANGKAN INFEKSI
HINDARI EFEK SAMPING
CEGAH INFEKSI BERULANG
HASIL TERAPI ?
Period of
treatment
INFREQUENT INFECTION
REINFECTION
RELAPSE
PERSISTENCE
Days
Positive urine culture (same strain) Positive urine culture (different strai
Negative urine culture
Natural history of urinary tract infection.(from karram mm;lower urinary tract infection.in oste
Bent AE(eds): Urogynecology and urodynamics Baltimore,1991,Williams & wilkins)
intrinsic factors
extrinsic factors
sexual activity
diaphragm + spermicide
COLONIZATION
WITH UROPATHOGENS
ENTRANCE OF
BACTERIA
INTO BLADDER
DEFECT IN
LOCAL HOST
DEFENSE
Mickey M Karram. Lower Urinary Tract Infection. In Clinical Urogynecology copyright 1993 by mosby-year .310-27
THREE APPROACHES
TO ANTIBIOTIC THERAPY
MANAGEMENT.
A.Single dose
1.trimethoprim sulfamethoxazole DS for 2 tablets
2.Sulfisoxazole 2 g
3.Trimethoprim 400 mg
4.Amoxicillin 3g
5.ciprofloxacin 250-500mg
6.Norfloxacin 400mg.
B.Short course(3-5days)
1.TMP-SMS DS PO bid
2.Sulfisoxasole 500 mg qid
3. Amoxicillin 500mg tid
4.Nitrofurantoin 100 mg qid
5.Macrobid 100mg.bid
Management : UTI Prophylaxis
A. Continuous UTI Prophylaxis ( average course: 6 months)
1. Nitrofurantoin 50 mg qd
2. Trimethoprim Sulfamethoxazole 40/200 qd or 3 x/ week
3. Cephalexin 125 mg qd
B. Postcoital Prophylaxis
1. Trimethoprim Sulfamethoxazole 80/400
2. Nitrofurantoin 100 mg
3. Cephalexin 250 mg
C. Home antibiotics to start at first symptom onset.
RELAPSE
Seek occult source of infection or
urologic abnormality
Treat longer (2-6 wk)
RECURRENT
CYSTITIS
REINFECTION
If woman uses diagphragm and
spermicide,
Consider changing contraceptive method
Urologic evaluation not routinely indicated
>3 UTI/yr
< 3 UTI / yr
No relation
to coitus
Temporally related
to coitus
Daily or thrice
weekly prophylaxis
Postcoital
prophylaxis
( recommended regimens:
Trimethoprim-sulfamethoxazole 40/200
mg;
Cephalexin 250 mg; nitrofurantoin 50100 mg )
Upper
tract
Lower tract
Persistent or relapsed
Reinfection
Clinical assessment
Figure 13.3
Approach to management of reccurent UTI in womwn
Review:
Catheter care, bowel care,
Hydration, avoid long term
antibiotics
Lynch 2004
PROPHYLAXIS OF RECURRENT
CYSTITIS
daily or after intercourse
nitrofurantoin
trimethoprim
TMP-SMZ
50-100 mg/day
50-100 mg/day
40/200 mg/day
125-500 mg/day
KESIMPULAN