PEMERIKSAAN MIKROSKOPIK URINE UNTUK DIAGNOSIS INFEKSI SALURAN KEMIH PADA NEONATUS

Abstract

Urinary tract infection ( UTI ) is a major problem in the newborn because lack of specific manifestation. Definitive diagnosis of neonatal UTI is urine culture with significant bacteriuria, is expensive and time consuming. Another method for early diagnosis is needed to give prompt treatment to prevent the complications. Objective : To determine a simple, inexpensive, quick and accurate method by urine microscopic examination for leucocyturia, bacteriuria and Gram stained bacteria compared with urine culture with significant bacteriuria to diagnose urinary tract infection in the newborn. Subjects : Newborn in High Risk Baby Ward and Neonatal Intensive Care Unit, admitted at the Department of Child Health Kariadi General Hospital, Semarang between December 2001 until June 2002 that fulfilled the inclusion criteria : all newborn ( age from 1 day to 30 days ), without considering birth weight, gestational age, gender and, with or without cilinical manifestation. Newborns receiving antibiotic therapy were excluded from the study. Methods: A diagnostic test was perfomed to urine microscopic examination for leucocyturia (10/mm3) and bacteriuria ( 100.000/m1) on Neubauer improved modification of Kova / Fuch Rosenthal counting chamber using uncentrifuged and unstained fresh urine. Examination of Gram stained bacteria were perfomed on all specimens using uncentrifuged urine by counting the number of bacteria per oil immersion filed ( 1 negatif Gram bacilli or positive Gram cocci ). The overall variables of diagnostic test were calculated and statistical analysis was perfomed using Chi —square test for significancy and the results were considered if the sensitivity >80% and likelihood ratio positive > 1,5. Results : A total of 85 neonates, aged 1 day to 30 days, were included in the study ( 57 male and 28 female ) Four neonates (4,7%) had a positive urine culture. Escherichia coli was the most common isolated agent ( 13,0%). The sensitivity of leucocyturia was 100%, with 82,7% specificity, having p = 0,029, likelihood ratio +5.64, and 95% CI of 1,28 - 135,88. The sensitivity of unstained bacteriuria was 100% with 100% specificity, having p = 0,000, likelihood ratio +32,26 and 95% CI of 0,9 — 9,3. The sensitivity of Gram stained bacteriuria was 100%, the specificity was 77,8%, having p = 0,04, likelihood ratio +9,52 with 95% CI of 0,9 — 99,6. Conclusion : Gram stained bacteriuria could be used as a quick and accurate UTI diagnostic test in neonates. Key word : Urinary tract infection , urine microscopic examination , neonates Infeksi saluran kemih pada neonatus merupakan masalah karena gejalanya sering tidak spesifik. Diagnosis infeksi saluran kemil menggunakan baku emas biakan urine membutubkan waktu lama dan biaya maim!. Diperlukan metode untuk deteksi dini infeksi saluran kemih neonatus, agar neonatus dapat segera diberi pengobatan sehingga tidak mengakibatkan komplikasi. Tujuan : Menentukan metode sederhana yang mudah, cepat, akurat dan murah yaitu dengan pemeriksaan nalcroskopik urine untuk leukosit, bakteri dan pengecatan Gram bakteri dibandingkan bakteriuria bermakna dalam biakan urine, untuk diagnosis infeksi saluran kemih pada neonatus. Subyek : Neonatus di Bangsal Bayi Risiko Tinggi dan 'Neonatal Intensive. Care Unit' Bagian Ilmu Kesehatan Anak - RSUP Dr. Kariadi Semarang yang dirawat antara Desember 2001 — Juni 2002, dan memenuhi kriteria inklusi yaitu semua neonatus usia 1 bari — 1 bulan, tanpa memandang berat badan, umur kehamilan, jenis kelamin, baik dengan atau tanpa gejala klinis infeksi. Kriteria eksklusi : neonatus yang mendapat antibiotika sebelumnya. Metode: Digunakan uji diagnostik dengan pemeriksaan mikroskopis leukosituria (..>_10/mm3) dan bakteriuria ( .100.000/m1) dengan menggunakan urine segar tanpa disentrifus dalam bilik hitung Neubauer improved modifikasi Kova/Fuch Rosenthal. Pengecatan Gram bakteri dengan menghitung jumlah bakteri setiap oil immersion field ( 1 bakteri Gram negatif atau positif ). Semua variabel tes diagnostik tersebut dianalisis dengan tabel 2 x 2 dan digunakan Chi — square test untuk menghitung kemaknaan. Hasil tes diagnostik yang digunakan adalah sensitivitas >. 80% dan likelihood ratio positif > 1.5. Hasil Penelitian : Pada 85 neonatus usia 1 — 30 hari yang diteliti ( 57 laki — laki dan 28 perempuan ), 4 ( 4,7% ) neonatus biakan urine positif, :dengan penyebab terbanyak Eschericia coil ( 13,0%). Pada pemeriksaan milcroskopis leukosituria didapatkan sensitivitas 100% dan spesifisitas 82,7%, p = 0,029, likelihood ratio +5.64 dengan 95% CI 1,28 - 135,58. Balcteriuria tanpa pengecatan menunjuldcan sensitiyitas 100%, spesifisitas 100%, p = 0.090, likelihood ratio +32,26 dSt 95% CI 0,9 — 9,3. Pengecatan Gram bakteri menunjukkan sensitivitas 100%, spesifisitas 77,8%, p=0,04, likelihood ratio +9.52. dengan 95% CI 0,9 — 99,6. Kesimpulan Pengecatan Gram bakteri dapat digunakan sebagai uji diagnostik infeksi saluran kemih yang cepat dan akurat pada neonatus