URINARY TRACT INFECTION ACUTE UNCOMPLICATED
(UTI) -- GENERAL CYSTITIS
Subjective - 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
Objective - 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
Assessmen Tentukan :
t - Infeksi pertama kali
- Bakteriuria yang tidak
teratasi selama terapi
RECURRENT ACUTE ACUTE UNCOMPLICATED
UNCOMPLICATED PYELONEPHRITIS IN
CYSTITIS
- Acute onset : dysuria, - Repeated infection
frekuensi, urgensi, (reinfeksi atau
suprapubic pain persisten)
- No fever - History of previous
- Mild symptom infection
- Frequency (3 or
more /year, 2 or more /
6 months)
- Lab : same as UTI - Lab : same as UTI
general + Bacteriuria general + Bacteriuria
105 (Chlamydia, N. 105 (Chlamydia, N.
Gonorrhoeae, Herpes Gonorrhoeae, Herpes
simplex, Candida a., simplex, Candida a.,
Trichomonas v.) Trichomonas v.)
Empiric antibiotic : Antibiotic profilaksis :
- Trimethoprim- - Trimethoprim-
Sulfomethoxazole Sulfomethoxazole
(avoid pregnant) (avoid pregnant)
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)
 - UTI berulang : reinfeksi 160/800mg 2x1/3 day,
atau persisten or
- Nitrofurantoin 100mg
2x1/5 day, or
- Fosfomycin 3000mg
1x1/5 day, or
- Fluoroquinolone
(Ciprofloxacin 100-
250mg 2x1/3 day)
- Cefpodoxime proxetil
100mg 2x1/3 day
KIE (hygiene + drink more
water)
Planning Antibiotik : Assess symptom 2wk
- Trimethoprim- - No symptom : no urine
Sulfomethoxazole culture
- Sulfonamide - Symptom : urine culture
- Nitrofurantoin + empiric antibiotic
- Fluoroquinolone (jika sesuai suspect pathogen
resisten) Urine culture : treat with
antibiotic 7-14 day (sesuai
pathogen)
Urologic evaluation
Correct reversible risk factor
40/200mg daily, or - TMP-SFX 160/800mg
- Nitrofurantoin 100mg 2x1
daily - Cefpodoxime 200mg
Antibiotic profilaksis 2x1
postcoitus : - Amoxicillin 500mg 3x1
- Trimethoprim- Hospitalized 3 days parenteral
Sulfomethoxazole treatment
(avoid pregnant) - Imipenem-cilastatin 250-
40/200mg 1x1, or 500mg 3x1
- Nitrofurantoin 100mg - Ceftriaxone 1000-
1x1 2000mg 1x1
KIE - Cipro 200-400mg 2x1
- Gentamicin 3-
5mg/kgBB 1x1
KIE
Stop treatment after 6 months Improvement after 3 days :
If pattern returns : longer Yes :
treatment >1thn - 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
 ACUTE CYSTITIS IN CATHETER ASSOCIATED SPINAL CORD INJURY PROSTATITIS
HEALTHY ADULTS WITH INFECTION
POSSIBLE OCCULT RENAL
OR PROSTATIC
INVOLVEMENT
Subject - UTI Symptoms - Risk Factor : Aging, DM, - History of recurrent UTI - Fever, chills,
- Involve occult renal or immunocompromised, - History of catheter usage myalgias
prostatic infection long usage of catheter - Fever, chills, fatigue, - Dysuria,
- DM and pregnancy (>30 days) autonomic instability, urgency,
special attention - Symptom UTI + infection muscular spasm frequency,
- Sulit dalam pengosongan obstructive
bladder voiding
- Pyuria (cloudy + smelly)
symptoms
- Pyuria
Objective - Lab: same as UTI general - Universal bacteriuria with - Lab : bacteriuria - Lab :
+ Bacteriuria (S.aureus in multiple antibiotic - CT abdomen + USG Bacteriuria
hospitalized px) resistant flora renal + IVP Bladder (Gram
- Catheter obstruction over distention, stone in negative
- Stone formation urinary tract, bacilli, E.coli,
- Local genitourinary vesicourethral reflux P.aeruginosa)
infection - Urine culture
- Fistula formation and
++
bladder cancer - DRE
- Lab : Bacteriuria
Prostate
tender and
swollen
Assessment - Correct underlying - Treat infection and - Empiric antibiotic if UTI Severe
anatomic, functional, or symptomatic sign and symptoms hospitalization and
metabolic defect - Correct reversible risk appear parenteral antibiotic
 - Empiric therapy
fluoroquinolone, TMP
- Urine culture
- Treat for 7-10 days + KIE
Planning
factor (Fluoroquinolones) Outpatient
- Removal catheter 10-14 - KIE Fluoroquinolone
day selama tx KIE : treatment 30
- KIE days
- Avoid catheter usage if - Antibiotic prophylaxis
possible (short term) : TMP-SFX,
- Sterile insertion Nitrofurantoin
- Prompt removal
- Strict adherence to a
closed collecting system
 RENAL ABCESS UTI ASYMPTOMATIC BACTERIURIA CYSTITIS
Subject - Fever, chills, abdominal pain - Pyuria - Dysuria, frequency,
- Riwayat pyelonephritis akut yg - Risk factor : DM, Pregnancy, urgency
tidak sembuh dg ab empiris UTI in elderly px, anatomy - Nocturia, pyuria,
malformation, immune hematuria
deficiency - Suprapubic pain
and tenderness
- Older px :
incontinence,
confusion,
behavioral
changes, lethargy,
anorexia, fever,
hypotermia
Objective - Lab : Bacteremia - Sign of obstruction, urolithiasis, - Hyperemic and
- USG + CT contrast abcess renal flank mass, urosepsis hemorrhage of
- CVA Tenderness - CT contrast >> renal infection bladder mucoa
- USG stone and abscess
- Urinalysis + urine culture
bacteriuria
Assessment - Drainage pus - Prophylaxis antibiotic if -
- Urine culture symptom UTI appear (7-14 days)
- Initial tx: Empiric antibiotic (IV : TMP-SFX, Nitrofurantoin
Penicillin, Cefalosporin, - Catheter-associated UTI :
Fluoroquinolone, Aminoglycoside) removal of indwelling catheter
- IV Ab sesuai culture sampai 1-2 followed by 10-14 day course of
hari setelah symptom membaik ab tx
- Switch to oral (2-4 wk) if symptom
improve
Planning Referral Nephrectomy Monitor with urine culture