REFERAT

“ISK”
OLEH :
FLORENSIA WODA SEKU ERO
(42170131)

D P K : D R . S A P TO P R I AT M O , S P. P D

K E PA N I T E R A A N K L I N I K P E N YA K I T D A L A M
RUMAH SAKIT BETHESDA
P E R I O D E 3 0 J U L I – 6 O K TO B E R 2 0 1 8
FA K U LTA S K E D O K T E R A N U N I V E R S I TA S K R I S T E N D U TA WA C A N A
Y O G YA K A RTA
2018
 DEFINISI

  ISK adalah istilah umum yang menunjukkan keberadaan mikroorganisme (MO) dalam urin.
 Bakteriuria bermakna (significant bacteriuria) menunjukkan pertumbuhan mikroorganisme
(MO) lebih dari colony forming units (cfu/m7) pada biakan urin.
 Bakteriuria bermakna mungkin tanpa disertai presentasi klinis ISK dinamakan bakteriuria
asimtomatik (covert bacteriuria).
 Sebaliknya bakteriuria bermakna disertai presentasi klinis ISK dinamakan bakteriuria
bermakna simtomatik.
 Pada beberapa keadaan pasien dengan presentasi klinis ISK tanpa bakteriuria bermakna
 ISK sederhana (uncomplicated UTI)  ISK tanpa kelainan anatomi & fungsional saluran
kemih

 ISK tdk sederhana (complicated UTI)  ISK dg kel. Anatomi & fungsional saluran kemih

 ISK berulang (rekuren UTI)  reinfeksi sal. Kemih oleh bakteri yang berbeda

 ISK resistensi / relaps  reinfeksi sal. Kemih oleh bakteri yg sama

 Urosepsis  sepsis yg disebabkan bakteri sal. kemih

KLASIFIKASI
Atas
Lokasi
Bawah

Uncomplicated
Klinis
Complicated

Komunitas
Etiologi
Nosokomial
 ETIOLOGI
Famili Genus Species

Bakteri Gram Enterobacteriaceae Escherichia coli

Negatif Klebsiella pneumontae
oxytasa
Proteus mirabilis
vulgaris
Enterobacter cloacae
aerogenes
Providencia rettgeri
stuartii
Morganella morganil
Citrobacter freundii
diversus
Serratia morcescens

Pseudomonadaceae Pseudomonas aerugtnosa

Bakteri Gram Micrococcaceae Staphylococcus aureus

Positif
Streptococceae Streplococcus fecalis
enterococcus
E Faktor Virulensi E. Coli
Coli Penentu virulensi Alur
Fimbriae Adhesi
Pembentukan jaringan ikat (scaring)
Kapsul antigen K Resisten terhadap pertahanan tubuh
Perlengketan (attachmenr)
Lipopolysaccharide side Resistensi terhadap fagositosis
chains (O antigen)
Lipid A (endotoksin) Inhibisi peristalsis ureter
Pro-inflamatori
Membran protein Kelasi besi
lainnya
Antibiotika resisten
Kemungkinan perlengketan
Hemolysin Inhibisi fungsi fagosit
Sekuestrasi besi
PATOGENESI
S
MANIFESTASI
KLINIK
 DIAGNOSIS
  Kriteria Diagnosis ISK :
1. Bakteriuria lebih dari colony forming units (cfu/m7) pada biakan urin.
2. Piuria ≥ 10 WBC/hpf
3. Symptom :
 Disuria, Urgensi, Frequency
 Perubahan pada urin ( keruh, darah, berbau)
 Demam
 Nyeri suprapubik, nyeri pinggang
 Inkontinensia
 Perubahan status mental
PYELONEPHRI
TIS
Definition:

 It is an bacterial infections that involves both the parenchyma

and the pelvis of the kidney, it may affect one or both kidneys.

 It is frequently secondary to ureterovesical reflux

 It may be acute or chronic when it is chronic the kidneys are

scarred, contracted and non-functioning
Clinical Findings of Acute peylonephritis
A. Symptoms :
1. Chills, moderate to high fever.
2. Constant loin pain unilateral or bilateral.
3. Symptoms of cystitis :
- frequency
- nocturia
- urgency
- dysuria
4. Nausea, vomiting and diarrhea are common.
5. Young children complain of abdominal discomfort.
B. Signs :
1. The patient appears quite ill.
2. Intermittent chills with fever ranging 38.5 - 40C.
3. Tachycardia (90 beat/m : 140 beat/m).
4. Abdominal distention.
Chronic Pyelonephritis
Pathology of Chronic Pyelonephritis
 Repeated attacks of acute pyelonephritis may lead to chronic pyelonephritis
 The kidney shows atrophy of variable degree depending upon the severity of the
involvement. In minimal involvement, the kidney shows scarring in the renal
surfaces while in extensive involvement, there is a fibrosis specially in the pelvic
mucosa.
Clinical manifestations of chronic peylonephritis
 It does not have symptoms of infection
 Fatigue
 headache
 Poor appetite
 Polyuria
 Excessive thirst
 Weight loss
Complications of Chronic Pyelonephritis
 ESRD

 Bacteremia

 Hypertension

 Renal stones
Pathology o f chronic cystitis
In chronic cystitis, the bladder mucosa becomes move edematous, erythematous and
friable. It may lead to ulceration of the bladder mucosa then fibrosis and becomes
inelastic and thick.
Clinical manifestations of chronic cystitis
 Severe ,irritable voiding at day and night

 Frequency

 Nocturia

 Urgency

 Pain “ suprapubic pressure

 Irritable bowl syndrome

 Chronic tension type headache

TUJUAN TERAPI
Tujuan Terapi Jangka Pendek :
Eradikasi bakteri penyebab infeksi saluran kemih
Menghilangkan gejala dengan cepat
Meningkatkan kadar hemoglobin untuk mencegah keparahan anemia.
Tujuan Terapi Jangka Panjang :
Mencegah terjadinya infeksi ulangan (rekurensi)
Mencegah komplikasi dari penyakit infeksi saluran kemih yang kronis
Mengurangi morbiditas dan mortalitas.
Indication Antibiotic Dose Interval Duration
Lower tract infection Trimetroprim-sulfamethaxazole 2 DS tablets Single dose 1 day
Uncomplicated 1 DS tablet Twice a day 3 days
Ciprofloxacin 250 mg Twice a day 3 days
Norfloxacin 400 mg Twice a day 3 days
Levofloxacin 250 mg Once a day 3 days
Amoxicillin 6 x 500 mg Single dose 1 day
500 mg Twice a day 3 days
Amoxicillin-clavulanic 500 mg Every 8 hours 3 days
Trimethoprim 100 mg Twice a day 3 days
Nitrofurantoin 100 mg Every 6 hours 3 days
Fosfomycin 3 gr Single dose 1 day
Complicated Trimetroprim-sulfamethaxazole 1 DS tablet Twice a day 7-10 days

Trimetroprim 100 mg Twice a day 7-10 days

Norfloxacin 400 mg Twice a day 7-10 days
Ciprofloxacin 250-500 mg Twice a day 7-10 days
Levofloxacin 250 mg Once a day 7-10 days
Amoxicillin-clavulanic 500 mg Every 8 hours 7-10 days
Recurrent infections Nitrofurantoin 50 mg Once a day 6 months
Trimetroprim 100 mg Once a day 6 months
Trimetroprim-sulfamethaxazole ½ SS tablet Once a day 6 months
Acute urethral syndrome Trimetroprim-sulfamethaxazole 1 DS tablet Twice a day 3 days
Failure of Trimetroprim- Azithromycin 1 gr Single dose
sulfamethaxazole
Doxycycline 100 mg Twice a day 7 days
Acute pyelonephritis Trimetroprim-sulfamethaxazole 1 DS tablet Twice a day 14 days
Ciprofloxacin 500 mg Twice a day 14 days
Levofloxacin 250 mg Once a day 14 days
Amoxicillin-clavulanic 500 mg Every 8 hours 14 days
KOMPLIKASI
 Recurrent infection , especially in women who experience three or more UTIs
 Permanent Kidney Damage from an acute or chronic kidney infection
(pyelonephritis) due to an untreated UTI
 Urethral narrowing (stricture), in men from recurrent urethritid, previously seen with
gonococcal urethritis
 Sepsis, a potentially life-threatening complication of an infection, especially if the
infection works its way up your urinary tract to your kidneys.
THANK YOU
