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Sistematika Presentasi
Indikasi Pemeriksaan Kultur Urin Sampel Pemeriksaan Makroskopis Pemeriksaan Mikroskopis Kultur Tes sensitivitas
1. 2. 3. 4. 5.
Women with a UTI with complicating features All pregnant women Men with suspected UTI Suspected acute pyelonephritis Prostatitis
Complicating features in women include: Abnormal urinary tract e.g. stone, reflux, catheter Impaired host defences e.g. pregnancy, diabetes, immunosupression, Impaired renal function, Suspicion of pyelonephritis, More than three UTIs in one year, or UTI recurrence within two weeks.
All UTIs in men are considered complicated, therefore a urine culture is indicated, even if the urine dipstick is negative.
Dipstick testing of the urine may be useful if clinical findings are equivocal Antibiotics should be commenced while waiting for culture results
Post-treatment urine cultures are recommended one to two weeks after antibiotic therapy
Acute Prostatitis
Signs and symptoms of acute prostatitis include fever, dysuria, pelvic or perineal pain, and cloudy urine Urine culture should be performed If urine culture is negative, STIs (C. trachomatis, N. gonorrhoea) should be excluded.
Chronic Prostatitis
Chronic prostatitis should be considered in men with dysuria and frequency, no signs of acute prostatitis, and with recurrent UTIs. Gram-negative bacilli are most common cause, but enterococci and Chlamydia have been associated with chronic infection.
Sistematika Presentasi
Indikasi Pemeriksaan Kultur Urin Sampel Pemeriksaan Makroskopis Pemeriksaan Mikroskopis Kultur Tes sensitivitas
Sampling
Urine - General
Collection method must avoid contamination
Clean catch, midstream voided Catheterized urine Suprapubic aspiration
Quantity of specimen
To fill line in transport tube (~20 mL).
Storage
At room temperature unless delay is inevitable; it must be refrigerate or mixed with preservative like boric acid.
5. 6.
7.
Sistematika Presentasi
Indikasi Pemeriksaan Kultur Urin Sampel Pemeriksaan Makroskopis Pemeriksaan Mikroskopis Kultur Tes sensitivitas
Specimen processing
Initial report
The use of dipstick designed to detect the presence of urine nitrite and to indirectly estimate the number of segmented neutrophiles through the detection of leukocyte esterase activity. Rationale for the nitrate test is that most urinary tract infections are caused by nitrate reducing members of the family Enterobacteriaceae.
Leukocyte esterase (LE) is produced by segmented nutrophiles; this test when performed alone correlated with ten or more white blood cells per high power field in the urine with a sensitivity in the range 88% and specificity 94%.
Pyuria
Pyuria: the increased number of WBC in urine sample. sterile pyuria: is a condition arises when there is an elevated in WBC in urine and negative culture.
Screening test
As many as 60% to 80% of all urine specimens received for culture by the acute care medical Center laboratory may contain no etiological agents of infection. Procedure developed to identify quickly those urine specimens that will be negative on culture, thus to circumvent excessive use of media, technologist time, and the overnight incubation period. The gram stain is the easiest, least expensive, and probably the most sensitive and reliable screening method for identifying urine specimens that contain greater than 10^5 CFU/ml. A drop of well-mixed urine is allowed to air dry. The smear is stained and examined under oil immersion (1000x). Presence of at least one organism per oil immersion field. ( examining 20 fields ) corelates with significant bacteriuria (>10^5 CFU/ml).
Sistematika Presentasi
Indikasi Pemeriksaan Kultur Urin Sampel Pemeriksaan Makroskopis Pemeriksaan Mikroskopis Kultur Tes sensitivitas
Culturing Procedure
Mix the urine sample to re-suspend microorganism present. Dip a 1 l or 10 l calibrated loop in vertical position in the urine and remove the loop and use the collected fluid to inoculate Nutrient, Blood and MacConkey agars respectively.
Culturing Procedure
Colony counting
Sistematika Presentasi
Indikasi Pemeriksaan Kultur Urin Sampel Pemeriksaan Makroskopis Pemeriksaan Mikroskopis Kultur Tes sensitivitas
No of colonies: up to 3
4 - 10
11 - 20
21 -50
over 50
UTI-SET SYSTEM
NOVAmed Ltd
DipStreak
Interpretation