DIAGNOSIS

ISK

dr Shahrul Rahman, Sp.PD FINASIM

Departemen Ilmu Penyakit Dalam

Fakultas Kedokteran
Universitas Muhammadiyah Sumatera Utara
DIAGNOSA
ANAMNESE

ISK ATAS ISK BAWAH

NYERI PINGGANG POLAKISURIA
DEMAM DISURIA
MENGGIGIL NYERI SUPRA PUBIK
MUAL
MUNTAH
HEMATURI
PEMERIKSAAN FISIS

FEBRIS
NYERI TEKAN SUPRA PUBIK
NYERI KETOK SUDUT KOSTOVERTEBRA
UTI Signs and Symptoms in Elderly
Very difficult to assess and recognize, even when present in the older adult.
Signs & Symptoms that indicate further evaluation for UTI elicited from H&P:

New or increased urgency, frequency, dysyuria:

> in younger patients, still can be present in elderly
These complaints can be common & chronic without bacteriuria
Requires careful interpretationmay not be due to UTI
Change in character of
urine
One study found cloudy, bloody, or malodorous urine in >85%
symptomatic UTIs
Others less predictive
Midthun, 2004
Signs and Symptoms, contd

Clarity of urine
Clear no bacteria; cloudy, milky or turbid bacteriuria
Cloudiness, however, can occur in normal urinemucus, epithelial cells
Cloudy character, alone or with (+) dipstick analysis further lab analysis
Study by Loeb et al. (2001) as consensus criteriacloudy urine not an indication
for antibiotics
Bloody
Hematuria not always indicative of infection; possibly
irritation or medication related
Malodorous
Not a valid indicatormay be caused by bacteria, but
could be hygiene-related
Often considered an indicator, however
Midthun, 2004
Diagnostic Criteria
Pyuria
A host response to infecting bacteria causing an increase of
white blood cells or pus in the urine
Associated with presence of both symptomatic and
asymptomatic UTIs in elderly
Level of pyuria is when infected with a gram negative
organism
Most research finds this is so common that it has questionable
value in UTI detection and as an indicator for Rx in the absence
of clinical symptoms
McGeer et al. (one of the most commonly used consensus criteria in LTCF
for UTI detection in Canada) rejects it as being a reliable predictor of
bacteriuria or symptomatic infection
Midthun, 2004
Juthani-Mehta,, 2005
 Screening/Diagnosis

Asymptomatic Bacteriuria

No universally accepted criteria for the diagnosis,

treatment, or surveillance of UTI, specifically in LTCF
residents

Treatment of ASB is associated with adverse

antimicrobial effects, re-infection with organisms or
increasing resistance
Nicolle, et al., 2005
Screening/Diagnosis
Infectious Disease Society of America:
Guidelines for Dx & Rx of ASB in adults

1. ASB Dx based on results of a culture from clean-catch

specimen (* important to minimize contamination)
Women: bacteriuria = 2 consecutive voided urine samples
w/isolation of same strain in cfu/mL >100,000
Men: bacteria = single, clean-catch specimen with 1
bacterial species isolated in > 100,000 cfu/mL
Both: single catheterized urine specimen with 1 bacterial
species isolated in a count of > 1,000 cfu/mL
Screening/Diagnosis
Guidelines, continued

2. Pyuria accompanying ASB not an indication for

antimicrobial Rx (A-2)
3. Pregnant women should be screened in early pregnancy, at
least once & treated if positive (A-1)
4. Screening of ASB & Rx if positive before these urological
procedures:
Transurethral resection of prostate (A3)
Procedures anticipated to cause possible mucosal
bleeding (A-3)
Screening/Diagnosis
Guidelines, continued

5. No screening for ASB: (A-1 & A-2 strongly recommended via research
evidence)
Pre-menopausal, non-pregnant women (A-1)
Diabetic women (A-1)
Community older adults (A-2)
Institutionalized elderly (A-1)
Spinal cord injury (A-2)
Indwelling-catheterized patients (A-1)
6. Antimicrobial Rx of asymptomatic women with catheter-acquired bacteriuria
persisting 48 hrs after removed, should be considered (B-1/good)
7. No screening or Rx of ASB renal transplant or solid organ transplant
recipients (C-3/weak)
Infectious Disease Society of America, 2005
Nicolle et al. 2005
www.guideline.gov/summary/summary
Mid Stream Urina (MSU) / Urine Pancaran Tengah (UPT)

WANITA
-Telanjang badan bagian bawah
-Jongkok dengan kaki terbuka lebar
-Bersihkan Genitalia dgn kapas basah pakai air hangat
3x dari depan ke belakang
-Buka labia
-Ambil aliran tengah

PRIA
- 1, 2 idem
-Buka preputium
-Cuci glans penis dan orificium urethra sda
-Ambil aliran tengah
 Urine Culture and Sensitivity

Traditional gold standard for significant bacteriuria

>100,000 cfu/mL of urine. Some argue criteria for
bacteriuria is only 100 cfu/mL of a uropathogen in
symptomatic females or 1,000 in symptomatic males.

Bacterial identification from urine C&S, key in males and

females with complicated UTIs.
 Other Laboratory Tests
Complete Blood Count with Differential
Indicated to R/O bacterial infection supports treatment plan
Careful evaluation of WBC & differential (left shift)
Electrolytes
R/O dehydration & if IV fluids replacement needed
BUN, Creatinine
Determine renal function for nephrotoxic medications
Blood Culture
Identify bacteremic organism in suspected urosepsis