Akurasi Pemeriksaan Uji Dipstik Urin dalam Mendiagnosis Infeksi Saluran Kemih (ISK) Nosokomial Simptomatik dan Pola Resistensi ISK Nosokomial di Rumah Sakit Umum Pusat (RSUP) Haji Adam Malik Medan

Abstract

Pendahuluan : Infeksi saluran kemih (ISK) merupakan penyebab infeksi nosokomial terbanyak dan sering dihubungkan dengan resisten antimikroba. Saat ini, kultur urin digunakan sebagai gold standard dalam mendiagnosis ISK. Penggunaan dipstik urin sebagai pemeriksaan awal untuk mendiagnosis ISK nosokomial simptomatik telah banyak digunakan namun dengan tingkat akurasi yang berbeda-beda. Tujuan: Menilai akurasi pemeriksaan dipstik urin dalam mendiagnosis ISK nosokomial simptomatik dibandingkan dengan kultur urin sebagai gold standard, mengetahui jenis mikroorganisme dan tingkat sensitifitas antimikroba terhadap mikroorganisme penyebab ISK nosokomial simptomatik di RSUP Haji Adam Malik Medan. Metode : Penelitian dilakukan dengan metode design uji diagnostik dengan reference standar kultur urin terhadap 151 pasien dengan tanda dan gejala ISK nosokomial. Hasil : Dari 151 pasien, 75 pria (49,66%) dan 76 wanita (50,33%). Sensitifitas, spesifisitas, positive predictive value (PPV) dan negative predictive value (NPV) pemeriksaan dipstik urin dalam menengakkan ISK nosokomial simptomatik sebesar 89.28%, 56.71%, 72.11% dan 80.85% secara berturut-turut. Sebanyak 91 isolat (60.26%) berhasil diisolasi dari sampel urin dengan prevalensi tertinggi Escherichia coli 35 isolat (38.48%), diikuti oleh Enterococcus spp. 18 isolat (19.76%), Klebsiella pneumonia 13 isolat (14.28%), Pseudomonas aeruginosa 7 isolat (7.69%), Acinetobacter baumanii 4 isolat (4.39%) dan mikroorganisme lainya 14 isolat (15.3%). Antimikroba empiris dengan tingkat sensitifitas di atas 80% terhadap semua mikroorganisme penyebab ISK nosokomial simptomatik adalah amikacin dan fosfomycin. Kesimpulan : Pemeriksaan dipstik urin dapat menyingkirkan ISK nosokomial simptomatik sehingga mengurangi kebutuhan terhadap kultur urin dan menghindari peresepan antimikroba yang tidak perlu. Kuman penyebab ISK nosokomial simptomatik terbanyak adalah Escherichia coli. Hanya amikacin dan fosfomycin antimikroba yang masih baik digunakan sebagai terapi empiris ISK nosokomial simptomatik.

Introduction: Urinary tract infections (UTI) is one of the most common nosocomial infections and many of these infections are associated with microorganisms that are resistant to antimicrobial. Currently, urine culture considered to be a gold standard to diagnose UTI. The usage of urine dipstick as a screening tool for patients suspected with symptomatic nosocomial UTI has been used widely but performance characteristic of dipstick is still questionable. Objective : To determine accuration of dipstick urine test compared with urine culture for diagnosis of symptomatic nosocomial UTI as a gold standard, identify etiological microorganisms and antimicrobial drug resistance rate in bacterial pathogens causing symptomatic nosocomial UTI. Methods : The study design is diagnostic test with standard reference urine culture that involved 151 patients with signs and symptoms of nosocomial UTI. Results : From 151 samples, 75 male (49.66%) and 76 female (50.33%). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of dipstick urine test in diagnosing symptomatic nosocomial UTI was found to be 89.28%, 56.71%, 72.11% and 80.85% respectively. A total 91 isolates (60.26%) were successfully isolated from urine samples with highest prevalence of Escherichia coli 35 isolate (38.48%) followed by Enterococcus spp. 18 isolate (19.76%), Klebsiella pneumonia 13 isolates (14.28%), Pseudomonas aeruginosa 7 isolate (7.69%), Acinetobacter baumanii 4 isolate (4.39%) dan others 14 isolate (15.3%). Antimicrobial empiric for symptomatic nosocomial UTI with level of resistance under 20% are amikacin and fosfomycin. Conclusion : The urine dipstick test can to be useful as a screening test to role-out symptomatic nosocomial UTI and can reduce the need urine culture and avoid the prescription of ineffective antimicrobial. The most germ cause symptomatic nosocomial UTI is Escherichia coli. The empirical therapy with favourable sensitivity for all bacterial pathogens only amikacin and fosfomycin.