Download - modul isk
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INFEKSI SALURAN KEMIH (ISK)
MODUL XVIII
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INFEKSI SALURAN KEMIH (ISK)
DEF : - Terdapatnya mikro organisme
patogen dlm sal. Kemih, dg CFU
(Colony Forming Unit) > 105/cc urin,
atau lekosituri > 10 /LPB
- Bakteriuria + reaksi radang dr host,
dg atau tanpa gejala klinis
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EPIDEMIOLOGI
- Sering ♀ - uretra pendek & dekat vagina
- hamil : insiden - Insiden dg umur
- Diperkirakan 1/3 wanita usia 24 thn pernah ISK
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- LOKASI - atas - ginjal - pielonefritis- pielitis- ureteritis
- bawah- sistitis- uretritis
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ETIOLOGI
- Kuman sal. Cerna (E. Coli), + > 80 %- strain uro patogen (E. Coli patogen ekstr intestinal)
- E Coli pylogenic grup B2 & D
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BACTERIAL ISOLATE FROM URINE AT MICRO 2002
E Coli 19 %Kleb Pnemoni 13 %Alkaligenes fecalis 11 %Staph. Epidermis 10 %d.s.t
(Pratiwi Sudarmono) 2004- Disamping mikro org diatas, ISK bisa di sbbkan :
- M. tbc- Jamur- Virus
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FAKTOR RISIKO ISK
1. Umur tua - inkontinensia
- penggunaan kateter
- Renal insuf
2. Wanita - uretra pendek & dekat vagina /
Perineum
3. Riwayat ISK berulang
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4. Anatomi - uretra : striktur
5. Faktor kebiasaan
- Delayed micturition after intercourse
6. Pengobatan - terlalu sering mendapat Antibiotik
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FK RISIKO ISK BERAT
1. Kelainan anatomi, fgs atau defek metabolik- semua faktor yg menghambat “urin flow”
2. Umur (muda / tua)- < 15 th & 65 th
3. Wanita4. Hamil – statis urin, proteinuria, glukosuria5. Post menopause
- estrogen gangguan sal kencing bawah
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6. Imunosuppresion
- HIV – AIDS
7. Peny penyerta - DM
8. Pemakaian kateter
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PATOGENESIS
Infeksi Asending tipe- Bakteri sal cerna (E Coli) berkembang biak di sekitar perineum, vagina, uretra- Sewaktu miksi, uretra terbuka dan E coli secara aktif akan naik keatas - Setelah selesai miksi, akan ada sebagian
kecil urine kembali ke vesika urinaria, (reflux)
yg diikuti oleh E. Coli
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GEJALA
1. Disuria – Nyeri – Panas 2. Polakisuria – dg volume urin sedikit3. Urgency - rasa terdesak kencing4. Nokturia5. Supra pubic pain6. L.B.P7. Nyeri perut bag bawah8. Hematuria
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Pada yg berat / ISK tdk sederhana 9. Nyeri C.V.A10. Nyeri perut yg hebat11. Demam, keringat, gigil12. Mual, muntah, diare13. Anoreksia14. Urosepsis
Gejala klinis tdk selalu lengkap, bahkan ada yg tanpa gejala (BTG = Bakteriuria tanpagejala)
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LABORATORIUM
1. Darah : lekositosis2. Urin : proteinuria
piuria (penting) - lekosituria > 10 / mm3 urin 24 jam - lekosituria > 5 / LBB
3. Biakan Indikasi - ISK berulang
- ISK berat - Imunokompromise - Gej. Menetap
stlh 3 hari terapi
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PENGOBATAN
ISK SEDERHANASistitis Akut
- Menurut IDSA (infectious disease society of America)
- First line treatment : - 3 hari dg trimetofrin – sulfa metoxazole atau amok, as klavulanat, fluorokuinolon, fosmisin
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PENCEGAHAN
Banyak minumKencing bila terdesakBersihkan anus dr depan ke belakangHindari pemakaian “feminime hyegine spray”Bersihkan genitalMinum “cranberry juice”
- mengandung hipuric acid, antiseptik yg menurunkan bakteri uria
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Terima Kasih
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