Leukosituria , Bakteriuria dan pengecatan gram urin sebagai kriteria diagnostik infeksi saluran kemih pada anak

Abstract

Urinary tract infection (UTI) in children is mostly caused by invasion and multiplication of bacteria in the urinary tract , in which the complications could be prevented by early diagnosis and prompt treatment. Objective : The urine culture with significant bacteriuria is the gold standard , which is expensive and time consuming , so another method for early diagnosis is needed in which the precision of leukocyturia , bacteriuria , urine gram stained compared to urine culture with significant bacteriuria with a sensitivity (Se) of > 80 % and likelihood ratio positive (LR +) of >1,5. Design : A diagnostic test was performed in 85 children aged 4 months to 14 years old, admitted at the Ambulatory Clinic Department of Child Health Medical Faculty Diponegoro University - Dr. Kariadi Hospital Semarang from September 2000 until February 2001, without previous antibiotic treatment . Method : Examination of leukocyturia ( bacteriuria ( ?_100.000/m1) were done using uncentrifuged and unstained fresh urine with Neubauer improved modification of Kova/ Fuch Rosenthal counting chamber. Examination of gram stained urine bacteriuria was done by counting the number of bacteria per oil immersion field ( negative gram bacilli or positive gram cocci). All properties of diagnostic test were calculated, and the correlation between two variables were analyzed by chi square test. Results : The sensitivity of leukocyturia was only 39,3 % having LR + 2,29 , the sensitivity of unstained bacteriuria was moderate 57,1 % having LR + 16,27 , but the sensitivity of gram stained bacteriuria was high 89,3 % having LR + 12,72 . Conclusion : The gram stained bacteriuria could be used as the UTI diagnostic criteria in children. Key —words : Leukocyturia-bacteriuria-UTI Infeksi saluran kemih (ISK) sering dijumpai pada anak akibat masuk dan berkembangbiaknya kuman di dalam saluran kemih,yang berbagai penyulitnya dapat dicegah dengan diagnosis dini dan pengobatan tepat. Tujuan penelitian : Bakteriuria bermakna pada biakan win (BUB) sebagai bake emas ISK mahal, perlu waktu lama,sehingga diperlukan metode lain untuk menegakkan diagnosis dini ISK berdasarkan ketepatan leukosituria,bakteriuria,pengecatan gram urin dengan BUB dengan sensitivitas (Se) > 80% dan likelihood ratio positif (LR +) >1,5. Jenis penelitian : Uji diagnostik ISK dilakukan pada 85 anak umur 4 bulan-14 tahun dengan keluhan ISK atau demam > 3 hari tanpa sebab jelas. di Instalasi Rawat Jalan Bagian IKA FK UNDIP-RSUP Dr.Kariadi Semarang September 2000 - Februari 2001, tanpa pengobatan antibotika sebelumnya. Metoda Dilakukan pemeriksaan leukosituria (?10/mm3) dan bakteriuria (100.000/m1 ) pada win segar tanpa disentrifus dan tidak dicat dengan bilik hitting Neubauer improved modifikasi Kova / Fuch Rosenthal. Dengan pengecatan gram ditentukan bakteriuria per lapangan pandang minyak emersi (z I bakteriuria batang gram negatif atau kokus gram positif) .Dilakukan perhitungan uji diagnostik dan hubungan dua variabel dianalisis dengan uji kai kuadrat. Basil : Leukosituria temyata sensitivitasnya rendah yaitu 39,3% dengan LR + 2,29, bakteriuria mempunyai sensitivitas cukup yaitu 57,1 % dengan LR+ 16,27 , sedangkan bakteriuria pada pengecatan gram mempunyai sensitivitas tinggi yaitu 89,3% dengan LR + 12,72 . Kesimpulan :Bakteriuria pada pengecatan gram urin dapat digunakan sebagai kriteria diagnostik ISK pada anak Kata kunci : Leukosituria- bakteriuria - ISK