Cystitis (ISK)

Prasyarat -anat syst urinarium

-fisio, mekanis berkemih
-mikrobio etiologi
-praanalitik
DB -Cystitis Acuta Uncomplecated
-Cystitis Acuta Complecated
DK Cystitis Acuta Uncomplecated
Definisi -ISK : infeksi pd sist urinarius, shingga
timbul sindrom inflame akbt invasi
mikroorganisme yg ditandai adanya
mikoorg. pnybb ISK pd urine

-Cystitis : infeksi vesica urinaria dgn

GK :
Polakisuria, urgency, tenderness &
pain over the area of the bladder,
nocturia, dysuria, tenesmus, enuresis
nocturnal sekund, krng enak badan,
kelainan pd urinalisis
Klasifikasi 1. ISK/UTI brdsrkan lokasi
a. Bag atas
-Pielonefritis (pielum ginjal
-Abses intra/perirenal
b. Bawah
-Sistitis
-Uretritis
-Prostatitis
2. ISK mnrut IDSA
-Acute uncompli. (lower) UTI in
women
-Acute uncompli pyelonef
-Complicated UTI & UTI ini men
 -Asymptomatic bacteriuria
-Recurrent UTI
3. ISK brdsrkn saat terjadinya
-Primary/recurrent
-Community-Acqui.
Infection/Hospital –Acqui Infection
-Asymptomatic/Sympto.
-Uncomplicated/complic.
4. ISK brsrkn GK
-Uncomplic. UTI
-Complicated UTI
-Community Acqu. UTI
-Hospital Acqu. UTI
-Asymp. UTI/Asymp bacteriuria
(ASBI)
-Recurrent UTI
5. Cystitis
-Traumatic cystitis
-Sistitis interstitial
-Sistitis radiasi
-Sistitis hemoragik
Etiologi -Infeksi bakteri gol.
Enterobactericeae (batang gram
negative) terutama E. coli (>85%) &
bbrp gram positif

a. Uncomp UTI
1. E. coli 80-90%
2. Staphylococcus
saprophyticus/coagulase negative
Staphylococcus 10-15%
3. Klebsiella, serratia,
enterobacter, proteus sp,
 Pseudomonas aeruginosa,
staphylococcus aureus, grup B & D

b. Complicated UTI
1.E. coli
2.Klebsiella pneumonia
3.Proteus mirabilis
4.Enterococcus sp
5.Pseudomonas aeruginosa

-Kasus jarang (DM) : Candida albicans

-Sexually active women :
Staphylococcus saprophyticus
-Hematogen: Myrobacterium
tuberculosis, Salmonella sp,
staphylococcus aureus
Faktor Risiko -Sist urinary abnormal
-obstruksi/aliran urine lmbat
-uncircumsited
-wanita hamil
-DM
-imunosupresif
-post menopause
-kateter
-neurogenic bladder
-vesicoureteral reflux
-lain:aktiv sex, obstruk sal kemih
Epidem Insidensi -ISK:semua usia
-infeksi terutama E. coli
-UPECpenybab ISK tersering, >85%
& 80% pd anak2
-Sistitispaling sering, terutama
wanita (Acute Uncomp. UTI)
 -meningkat pd anak perempuan usia
sekolah
-wanita>pria
-pernah dialami >50% wanita
-10% dlm 1 thn pernah ISK
GK -Disuria
-polakisuria
-urgency
-nyeri suprapubik
-nocturia
-urine keruh
-malodorous
-bakteriuria
-kadang hematuria
PP -Urinalisis rutin
-Hematologi rutin
-Kultur urine: uji sensitivitas
antibiotic, hitung kuman
-Kimia klinik: kreatinin, ureum, as
urat  f ginjal
-USG  cek mukosa V.U 
penebalan & iregularitas mukosa V.U.
-BNO-IVP  cek apakah ada
obstruksi atau batu
-Cystografi, MRI
-Commercial Screening System : Dip
stick urine test, leukosit esterase
*baca lgi

DIAGNOSIS ISK GOLD STANDAR:

-kultur urine “significant bacteriuria”
scr kuantitatif  100.000 CFU/ml
urine
 -ISK pd >1/3 wanita dgn GK dysuria
akut dgn jumlah bakteri 102-104
CFU/ml urine

*baca gambaran2 khasnya

Penata TUJUAN :
-eliminasi dan mencegah urosepsis
-hilangkan GK ISK akut
-Pencegahan rekurensi ISK dan
komplikasi

a. Non farko
-minum air putih 8 gls/hari
-Edukasi :
-jgn menahan BAK
-cebok yg benar
-jaga hygiene
-hindari alcohol, kopi, the
(↓sensitivitas vesi urinaria)
-diet kaya vit A & C (jus buah
cranberry)

b. Farko
-Kotrimoksazol tab 480mg no.
XXX
2dd tab II pc
-Cyprofloxacine kap 500mg no.
XIV
2dd kap I pc
-Levofloxacine kap 500mg no. VII
1dd kap I pc
Pencegahan -meningkatkan kebersihan
-banyak minum air putih
 -jgn menahan BAK
-Hindari konsum alcohol, kopi, teh
-BAK sebelum dan sesudah seks
-vaksinasi ISK (sdg dikembangkan)
Komplikasi -Recurrent Cystitis
-Vesicolithiasis
-Reflux Vesico-Urethral
-Hidronefrosis
-Pielonefrosis
-Insufis. Ginjal s/d gagal gjl
Prognosis -QAV : ad bonam
-QAF : ad bonam
-QAS : dubia ad bonam