INFEKSI

SALURAN
KEMIH
URINARY TRACT INFECTION

Praluki Herliawan
FK UNISBA 2018
Definisi • ISK meliputi banyak variasi entitas klinis,
termasuk didalamnya asymptomatic
bacteriuria (ASB), cystitis, prostatitis, dan
pyelonephritis.
• ASB: Terdapat bakteri pada urinary tract,
disertai dengan adanya WBC dan
inflammatory cytokines pada urine namun
tidak disertai adanya gejala dan biasanya
tidak membutuhkan pengobatan.
• ISK: Symptomatic disease yang
membutuhkan antimicrobial therapy.
 Infeksi • Upper urinary tract Infections:

Saluran
– Pyelonephritis
• Lower urinary tract infections:
Kemih – Cystitis (“traditional” UTI)
– Prostatitis
Istilah • ISK sederhana (uncomplicated UTI): ISK
pada wanita yang tidak hamil tanpa
kelainan anatomi dan fungsi ginjal
• ISK tidak sederhana (complicated UTI):
ISK dengan kelainan anatomi dan fungsi
saluran kemih
• ISK berulang (recurrent UTI): reinfeksi
saluran kemih, biasanya dengan bakteri
yang berbeda
• Urosepsis: sepsis yang disebabkan oleh
bakteri saluran kemih
Epidemiologi • ISK lebih sering terjadi pada perempuan
dibandingkan laki-laki.
dan Faktor • Sebanyak 50-80% perempuan pernah
Risiko menderita ISK minimal satu kali sepanjang
hidupnya-ISK sederhana menjadi kasus
yang paling sering.
 Gejala pada • Dysuria
Infeksi Saluran • Increased frequency
Kemih • Urgency
• Hematuria
• Fever
• Nausea/Vomiting (pyelonephritis)
• Flank pain (pyelonephritis)
Pathogenesis
 Lower Urinary • Uncomplicated (Simple) cystitis

Tract Infection - – In healthy woman, with no signs of systemic

disease
Cystitis • Complicated cystitis
– In men, or woman with comorbid medical
problems.
• Recurrent cystitis
Uncomplicated • Definition
– Healthy adult woman (over age 12)
(simple) – Non-pregnant
Cystitis – No fever, nausea, vomiting, flank pain
• Diagnosis
– Dipstick urinalysis (no culture or lab tests needed)
• Risk factors
– Sexual intercourse
• May recommend post-coital voiding or
prophylactic antibiotic use.
Complicated • Definition
– Females with comorbid medical
Cystitis conditions
– All male patients
– Indwelling foley catheters
– Urosepsis/hospitalization
 Anatomical • Any condition that permits urinary stasis or
obstruction predisposes the individual to UTI.
and Foreign bodies such as stones or urinary catheters
provide an inert surface for bacterial colonization
Functional and formation of a persistent biofilm. Thus,

Abnormalities
vesicoureteral reflux, ureteral obstruction
secondary to prostatic hypertrophy, neurogenic
bladder, and urinary diversion surgery create an
environment favorable to UTI. In persons with such
conditions, E. coli strains lacking typical urinary
virulence factors are often the cause of infection.
Inhibition of ureteral peristalsis and decreased
ureteral tone leading to vesicoureteral reflux are
important in the pathogenesis of pyelonephritis in
pregnant women.
Special cases of • Indwelling foley catheter
• Leukocytes on urinalysis
Complicated • Patient’s with indwelling catheters are frequently
cystitis colonized with great deal of bacteria.

• Candiduria
– Frequently occurs in patients with indwelling foley.
 • Infection of the kidney

Pyelonephritis • Associated with constitutional symptoms – fever, nausea,

vomiting, headache
• Mild pyelonephritis can present as low-grade fever with
or without lower-back or costovertebral-angle pain,
whereas severe pyelone- phritis can manifest as high
fever, rigors, nausea, vomiting, and flank and/or loin
pain. Symptoms are generally acute in onset, and
symptoms of cystitis may not be present.
• Diagnosis:
• Urinalysis, urine culture, CBC, Chemistry
• Complications:
– Perinephric/Renal abscess:
• Suspect in patient who is not improving on antibiotic
therapy.
• Diagnosis: CT with contrast, renal ultrasound
• May need surgical drainage.
– Nephrolithiasis with UTI
• Suspect in patient with severe flank pain
• Need urology consult for treatment of kidney stone
• Emphysematous pyelonephritis is a particularly
severe form of the disease that is associated with
the production of gas in renal and perinephric
tissues and occurs almost exclusively in diabetic
patients
• Xanthogranulomatous pyelone-
phritis occurs when chronic urinary
obstruction (often by stag- horn
calculi), together with chronic
infection, leads to suppurative
destruction of renal tissue.
Prostatitis
• Symptoms:
– Dysuria, frequency, and pain in the prostatic pelvic or
perineal area. Fever and chills are usually present, and
symptoms of bladder outlet obstruction are common.
– Pain in the perineum, lower abdomen, testicles, penis, and
with ejaculation, bladder irritation, bladder outlet obstruction,
and sometimes blood in the semen
• Diagnosis:
– Typical clinical history (fevers, chills, dysuria, malaise,
myalgias, pelvic/perineal pain, cloudy urine)
– The finding of an edematous and tender prostate on
physical examination
– Will have an increased PSA
– Urinalysis, urine culture
• Risk Factors:
– Trauma
– Sexual abstinence
– Dehydration
Culture in • Positive Urine Culture = >105 CFU/mL
• Most common pathogen for cystitis,
UTI prostatitis, pyelonephritis:
– Escherichia coli
– Staphylococcus saprophyticus
– Proteus mirabilis
– Klebsiella
– Enterococcus
• Chlamydia trachomatis
• Neisseria Gonorrhea
Diagnostic
Flowchart
Evaluation
of UTI