Download - Fadhil
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PENGERTIAN
Infeksi saluran kemih (ISK) adalah infeksi akibat terbentuknya koloni kuman di saluran kemih. Kuman mencapai saluran kemih melalui cara hematogen dan ascending.
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Faktor resiko:
Kerusakan atau kelainan anatomi saluran kencing berupa obstruksi internal oleh jaringan parut, endapan obat intratubular, refluks, instrumentasi saluran kemih, konstriksi arteri-vena, hipertensi, analgetik, ginjal polikistik, kehamilan, DM, atau pengaruh obat-obat estrogen.
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ISK sederhana / tak berkomplikasi :
ISK yang terjadi pada perempuan yang tidak hamil dan tidak terdapat disfungsi structural ataupun ginjal.
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ISK berkomplikasi:
ISK yang berlokasi selain di vesika urinaria, ISK pada anak-anak, laki-laki atau ibu hamil.Pengelolaan menjadi sulit karena faktor pemberat (DM, Obstruksi, batu, imunodefisiensi)
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DIAGNOSIS
Anamnesis : ISK bawah frekwensi, disuria terminal, polakisuria, nyeri suprapublik.
ISK atas : nyeri pinggang, demam, menggigil, mual dan muntah, hematuria.
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Pemeriksaan fisik : febris, nyeri tekan suprapublik, nyeri ketok sudut kostoverbrata
Laboratorium: lekositosis, lekosituria, kultur urin (+): bakteriuria >105/mL urin.
DIAGNOSIS BANDING ISK sederhana, ISK berkomplikasi
PEMERIKSAAN PENUNJANG DPL, urinalisis, kultur urin dan tes resistensi
kuman, tes fungsi ginjal, gula darah, foto BNO-IVP, USG ginjal
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KEJADIAN ISK PADA KEHAMILAN The National Birth Defect Prevention
Study (Amerika Serikat → 4.760 ibu hamil → 3.690 menderita ISK → 70% kelainan jantung)
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TERAPI
Farmakologis : Antimikrobia berdasarkan pola kuman yang ada;
Bila hasil tes resistensi kuman sudah ada, pemberian antimikrobia disesuaikan.
Ampicillin / Cphalosporin → 7 hari Fosfomycin → single dose Kultur ulang → 2 minggu (bila perlu) → iradikasi infeksi Trimethoprin sulfate, Tetracyclines → kontraindikasi →
cacat janin
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Antibiotika
Amoxicillin Larotid, Amoxil Approved B L1
Aztreonam Azactam Approved B L2
Cefadroxil Ultracef, Duricef Approved B L1
Cefazolin Ancef, Kefzol Approved B L1
Cefotaxime Claforan Approved B L2
Cefoxitin Mefoxin Approved B L1
Cefprozil Cefzil Approved C L1
Lactation Risk Categories Pregnancy Risk Categories L1 (safest) L2 (safer) L3 (moderately safe) L4 (possibly hazardous) L5 (contraindicated)
A (controlled studies show no risk) B (no evidence of risk in humans) C (risk cannot be ruled out) D (positive evidence of risk) X (contraindicated in pregnancy)
NR: Not Reviewed. This drug has not yet been reviewed by Hale.
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CeftazidimeCeftazidime, Fortaz, Taxidime
Approved B L1
Ceftriaxone Rocephin Approved B L2
Ciprofloxacin Cipro Approved C L3
Clindamycin Cleocin Approved B L3
ErythromycinE-Mycin, Ery-tab, ERYC, Ilosone
Approved BL1
L3 early postnatal