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MIKROBIOLOGI
INFEKSI SALURAN
URINARIA (UTI)
Microbiology of Community-Acquired
Urinary Tract Infection
Dysuria-Pyuria Sydrome in Females
Children
Adults
More frequent
. Escherichia coli
. Escherichia coli
. Staphylococus
saprophyticus (young,
sexually active patient)
Less Frequent
. Other Enterobacteriaceae
. Enterococci
. Streptococcus agalactiae
. Other Enterobacteriaceae
. Enterococci
Adults
More frequent
. Escherichia coli
. Escherichia coli
Less Frequent
. Other Enterobacteriaceae
. Enterococci
. Other Enterobacteriaceae
. Enterococci
. Escherichia coli
Less Frequent
. Other Enterobacteriaceae
. Pseudomonas Spp.
. Staphylococcus epidermidis
. Providencia stuartii
. Pseudomonas Spp.
. Escherichia coli
. Other Enterobacteriaceae
Less Frequent
. Staphylococcus epidermidis
GENERAL INFORMATION
Urine dpt terkontaminasi oleh Mo yang
terdpt di uretra/ Periuretral Proliferasi
Misleading
Pasien Simptomatik : 1 spesimen utk
diagnosis, & 1 spesimen diambil setelah
terapi 48 72 jam.
Pasien asimptomatik (2-3 spesimen).
Renal Tuberculosis spesimen diambil 3
hari berturut2 (pagi hari).
Pengumpulan spesimen
Sampel urine diambil pd pagi hari, utk
memperoleh bakteri tahan asam, fungi & Mo
patogen lain.
Continue
Pediatric: diambil dr kantung urine kultur
segera mungkin.
Urine dikumpulkan menggunakan tempat yg
steril, & tahan bocor.
Continue.
Hindari Kontaminasi
Pasien Simptomatik / Asimptomatik:
Interpretasi kultur kuantitatif , dan
perhitungan spesimen urine
SPECIMEN TRANSPORT
Segera (1-2 jam) tanam pd medium
transport
Jika transportasi terlambat, maka spesimen:
disimpan di lemari es: tidak lebih 24 jam
Inokulasi: medium primer sbl medium
transport
ditambahkan larutan pengawet
Perhitungan koloni dinyatakan Invalid jika
spesimen tdk diproses selama 30 menit
PROSES SPESIMEN
100,000 CFU/ml Infeksi UTI.
Pasien Simptomatik, perhitungan
dibawah < 100.000 CFU/ ml sering
di validasikan dgn leukosit pd spesimen
Kultur Anaerob sulit diperiksa, Jika
diduga (suspected) suprapubic
bladder aspiration
Continue
Foley catheter tidak bisa di kultur
Sampel Urin kantung kateter dgn
menggunakan syringe & jarum utk
Aspirasi, melalui sampling port stl di
desinfektan
Sampling
Port
TRANSPORT MEDIA
Urine specimen is
best collected
Soon after a
patient wakes
when Organisms
have had the
opportunity
to multiply over
several hours.
Urine container criteria :
Sterile, dry, wide-necked,
leak proof
+1
+2
+3
+4
RESULT
Urinary Tract infection Module05 ..
Agar Endo
MacConkey Agar
A differential medium for detection, isolation and
enumeration of coliform and intestinal pathogen in
water, dairy product and biological specimens.
This agar is particularly recommended for the
cultivation of pathogens which may be present in
a variety of specimens such as urine, faeces and
wound swabs.
MacConkey agar should be used in parallel with other
selective indicator media such as Desoxycholate
Citrate Agar, Bismuth sulphite agar, Briliant
Green Agar and Brilliant Green bile broth, and non
selective medium such as Blood Agar.
Number of
colonies
Number of bacterial
per ml
< +1
50
5.000
+1
100
10.000
>+1
150
15.000
+2
200
20.000
>+2
250
25.000
+3
300
30.000
>+3
500
50.000
+4
1000
100.000
> +4
> 1000
> 100.000
Diagnostic
significance
Significant
bacteriuria
Gram Stain
Escherichia coli
Microscopic :
Gram negative rod
C.L.E.D Medium
(Cystine-Lactose-Electrolyte Deficient)
This medium recommended for urinary bacteriology,
supporting the growth of all urinary pathogens. The present
of important contaminants such as diphtheroids, lactobacilli
and micrococci is also clearly elicited giving indicate and
indication of the degree of contamination.
This medium prevent the swarming phenomenon by
having the low electrolyte content.
Discrete colonies of motile and non motile bacteria
may thus be urinary bacteriology where motile
species, notably Proteus spp. may be present a
problem in identifying the species responsible to UTI.
Proteus
This species causes urinary infection, especially following
catheterization or cystoscopy.
Mostly Proteus strains produce a characteristic swarming growth
over the surface of blood agar and several other culture media.
Proteus culture have a distinctive smell.
In laboratory C.L.E.D medium (electrolyte deficient) provide for
plate culture of urinary organisms for prevents the swarming
phenomenon
Proteus spp. posses urease which produces ammonia in
the urine. This raises the the pH and causes precipitation
of phosphate crystals, leading to stone formation.
Urinary Tract System Module05 ..
Ureasa test
Test the ability of microorganisms to
metabolize urea and produce ammonia
using urease (indicator: methyl red)
Result :
Positive pink
Negative yellow
NOVOBIOCIN TEST
This test using for differentiated between Staphylococcus
epidermidis and Staphylococcus saprophyticus from
Urine specimens.
A. Staphylococcus epidermidis (sensitive-Novobiocin),
occasionally cause of urinary infection in hospital,
sometimes associated with catheterization.
B. Staphylococcus saprophyticus (resistant-Novobiocin),
it causes cystitis in young women patients in general
practice beside Escherichia coli
Gram Stain
Staphylococcus sp.
Microscopic :
Gram positive cocci
of uniform size
That occur
characteristically in groups
but also singly and in pairs
Pseudomonas
Pseudomonas aeruginosa:
This species causes urinary infection, usually following
catheterization or associated with chronic urinary
infections.
This species is usually resistant to many antibiotics
and is particularly associated with recurrent urinary
tract infection in hospital patients.
candida albicans
on sabouraud agar
Gram Stain
Candida sp.
Microscopic :
Gram positive
BIOCHEMICAL TEST
Carbohydrate fermentation
Commercially identification
The API 20Etm (produced by Biomerieux) system for bacteria such as coliform
(ONPG : orthonitrophenyl- -D-galactopyramoside; VP : Voges-Proskauer)
E.
B.
F.
C.
G.
D.
H.
Gentamycin (CN)
: 12 - 15
Chloramphenicol (C) : 12 - 18
Penicillin (P)
: 28 - 29
R (Resistant) ; I (Intermediate) ; S
(Sensitive)
Staphylococcus aureus
CN
CN
E-test strip