URINARY TRACT INFECTION

(UTI) -- GENERAL

Subjective

Objective

Assessmen
t

Dysuria, urgensi, frekuensi

Tanda pyelonepritis (nyeri
pinggang, nyeri tekan
costovertebrae angle,
demam, nausea & vomit)
Hematuria
Risk factor : DM, sex
intercourse, bacterial
prostatitis, urine
catheterization, impaired
bladder innervation,
pregnancy, spermicidal use,
recent antimicrobial use,
prostate hypertrophy,
urinary tract obstruction
CVA tenderness
Urethral discharge
Tender prostate on DRE
Lab : leucocyte esterase +
(>10/lp, pria >5/lp), nitrites
+ (>> gram negative rods),
WBC & RBC ++,
microhematuria, pyuria,
>105 CFUs/ml

Tentukan :
- Infeksi pertama kali
- Bakteriuria yang tidak
teratasi selama terapi

ACUTE UNCOMPLICATED
CYSTITIS
-

Acute onset : dysuria,

frekuensi, urgensi,
suprapubic pain
No fever
Mild symptom

Lab : same as UTI

general + Bacteriuria
105 (Chlamydia, N.
Gonorrhoeae, Herpes
simplex, Candida a.,
Trichomonas v.)

Empiric antibiotic :
- TrimethoprimSulfomethoxazole
(avoid pregnant)

RECURRENT ACUTE
UNCOMPLICATED
CYSTITIS
- Repeated infection
(reinfeksi atau
persisten)
- History of previous
infection
- Frequency (3 or
more /year, 2 or more /
6 months)

Lab : same as UTI

general + Bacteriuria
105 (Chlamydia, N.
Gonorrhoeae, Herpes
simplex, Candida a.,
Trichomonas v.)

Antibiotic profilaksis :
- TrimethoprimSulfomethoxazole
(avoid pregnant)

ACUTE UNCOMPLICATED
PYELONEPHRITIS IN
WOMEN
- Tanda pyelonepritis
(nyeri pinggang, nyeri
tekan costovertebrae
angle, demam, nausea &
vomit)

Lab : same as UTI

general + Bacteriuria 105
- Pathology : dilated
tubule with neutrophils
and adjacent interstitial
inflammation
- Imaging : CT Scan with
contrast lower density
due to infection and
edema (ginjal bengkak)
Outpatient 3 days oral
treatment :
- Fluoroquinolone (Cipro
500mg 2x1)

Planning

UTI berulang : reinfeksi

atau persisten

Antibiotik :
- TrimethoprimSulfomethoxazole
- Sulfonamide
- Nitrofurantoin
- Fluoroquinolone (jika
resisten)

160/800mg 2x1/3 day,

or
- Nitrofurantoin 100mg
2x1/5 day, or
- Fosfomycin 3000mg
1x1/5 day, or
- Fluoroquinolone
(Ciprofloxacin 100250mg 2x1/3 day)
- Cefpodoxime proxetil
100mg 2x1/3 day
KIE (hygiene + drink more
water)

40/200mg daily, or
Nitrofurantoin 100mg
daily
Antibiotic profilaksis
postcoitus :
- TrimethoprimSulfomethoxazole
(avoid pregnant)
40/200mg 1x1, or
- Nitrofurantoin 100mg
1x1
KIE

Assess symptom 2wk

- No symptom : no urine
culture
- Symptom : urine culture
+ empiric antibiotic
sesuai suspect pathogen
Urine culture : treat with
antibiotic 7-14 day (sesuai
pathogen)
Urologic evaluation
Correct reversible risk factor

Stop treatment after 6 months

If pattern returns : longer
treatment >1thn

TMP-SFX 160/800mg
2x1
- Cefpodoxime 200mg
2x1
- Amoxicillin 500mg 3x1
Hospitalized 3 days parenteral
treatment
- Imipenem-cilastatin 250500mg 3x1
- Ceftriaxone 10002000mg 1x1
- Cipro 200-400mg 2x1
- Gentamicin 35mg/kgBB 1x1
KIE
Improvement after 3 days :
Yes :
- outpatient continue
oral treatment 5-7 days
fluoroquinolone
- hospitalized switch to
oral treatment 7-12 days
No :
- review antimicrobial
susceptibility pattern
- urologic evaluation
- correct reversible risk
factor
- hospitalize if necessary
- revise treatment plan as
appropriate 14 days

Subject

ACUTE CYSTITIS IN
HEALTHY ADULTS WITH
POSSIBLE OCCULT RENAL
OR PROSTATIC
INVOLVEMENT
- UTI Symptoms
- Involve occult renal or
prostatic infection
- DM and pregnancy
special attention

CATHETER ASSOCIATED
INFECTION

Risk Factor : Aging, DM,

immunocompromised,
long usage of catheter
(>30 days)
Symptom UTI + infection

SPINAL CORD INJURY

Objective

Lab: same as UTI general

+ Bacteriuria (S.aureus in
hospitalized px)

Assessment

Correct underlying
anatomic, functional, or
metabolic defect

History of recurrent UTI

History of catheter usage
Fever, chills, fatigue,
autonomic instability,
muscular spasm
Sulit dalam pengosongan
bladder
Pyuria (cloudy + smelly)

Universal bacteriuria with

multiple antibiotic
resistant flora
Catheter obstruction
Stone formation
Local genitourinary
infection
Fistula formation and
bladder cancer
Lab : Bacteriuria

Lab : bacteriuria
CT abdomen + USG
renal + IVP Bladder
over distention, stone in
urinary tract,
vesicourethral reflux

Treat infection and

symptomatic
Correct reversible risk

Empiric antibiotic if UTI

sign and symptoms
appear

PROSTATITIS

Fever, chills,
myalgias
- Dysuria,
urgency,
frequency,
obstructive
voiding
symptoms
- Pyuria
- Lab :
Bacteriuria
(Gram
negative
bacilli, E.coli,
P.aeruginosa)
- Urine culture
++
- DRE
Prostate
tender and
swollen
Severe
hospitalization and
parenteral antibiotic

Planning

Empiric therapy
fluoroquinolone, TMP
Urine culture
Treat for 7-10 days + KIE

factor
Removal catheter 10-14
day selama tx
KIE
Avoid catheter usage if
possible
Sterile insertion
Prompt removal
Strict adherence to a
closed collecting system

(Fluoroquinolones)
KIE

Antibiotic prophylaxis
(short term) : TMP-SFX,
Nitrofurantoin

Outpatient
Fluoroquinolone
KIE : treatment 30
days

Subject

Objective

Assessment

Planning

RENAL ABCESS UTI

- Fever, chills, abdominal pain
- Riwayat pyelonephritis akut yg
tidak sembuh dg ab empiris

ASYMPTOMATIC BACTERIURIA
- Pyuria
- Risk factor : DM, Pregnancy,
UTI in elderly px, anatomy
malformation, immune
deficiency

Lab : Bacteremia
USG + CT contrast abcess renal
CVA Tenderness

Drainage pus
Urine culture
Initial tx: Empiric antibiotic (IV
Penicillin, Cefalosporin,
Fluoroquinolone, Aminoglycoside)
- IV Ab sesuai culture sampai 1-2
hari setelah symptom membaik
- Switch to oral (2-4 wk) if symptom
improve
Referral Nephrectomy

Sign of obstruction, urolithiasis,

flank mass, urosepsis
CT contrast >> renal infection
USG stone and abscess
Urinalysis + urine culture
bacteriuria
Prophylaxis antibiotic if
symptom UTI appear (7-14 days)
: TMP-SFX, Nitrofurantoin
Catheter-associated UTI :
removal of indwelling catheter
followed by 10-14 day course of
ab tx

Monitor with urine culture

CYSTITIS
- Dysuria, frequency,
urgency
- Nocturia, pyuria,
hematuria
- Suprapubic pain
and tenderness
- Older px :
incontinence,
confusion,
behavioral
changes, lethargy,
anorexia, fever,
hypotermia
- Hyperemic and
hemorrhage of
bladder mucoa