Practicum 2: Case of Urinary Tract Infection

PRACTICUM 2: CASE OF URINARY TRACT INFECTION (UTI) Description of Theory Urinary tract infection (UTI) is an infection caused by the presence of microorganisms in the urine and has the potential to invade the tissues of the urinary tract. Clinically, this infection can be classified into two, namely complicated UTI and uncomplicated UTI. Uncomplicated urinary tract infection (uncomplicated urinary tract infection)that is, if the urinary tract infection is without complicating factors and there is no disturbance of the structure or function of the urinary tract. Complicated urinary tract infection (complicated urinetract infections) namely if there are certain things such as urinary tract infections and structural or functional abnormalities that change the flow of urine such as obstruction of urine flow, urinary tract stones, kidney cysts, kidney tumors, kidneys, urine residue in the bladder. Based on the location of infection, UTIs are classified into lower UTIs and upper UTIs. Lower urinary tract infections are associated with cystitis (bladder), while upper urinary tract infections are associated with pyelo nephritis (infection involving the kidneys).The majority (75-90%) of uncomplicated UTIs are causedEscherichia coliand the rest are caused mainly byStaphylococcus saprophyticus,Proteus spp., andKlebsiellaspp. Complicated UTIs can be associated with infections by gram-negative bacteria andEnterococcus faecalis.Clinical symptoms Symptoms of lower UTI include dysuria, urgency, frequency, nocturia, and suprapubic discomfort. Meanwhile, upper UTI involves more systemic symptoms such as fever, nausea, vomiting and low back pain. The results of the physical examination of upper UTI indicate the presence of costovertebral tenderness.Laboratory results show bacteriuria (the number of bacteria in the urine is more than 10 bacteria2organisms (colony-forming units, [CFU])/mL), pyuria (total leukocytes more than 10/mm3), positive urine nitrite, positive urine leukocyte esterase, and the presence ofantibody-coated bacteriain upper UTI. The goal of therapy in UTI patients is to eradicate the organism that causes the infection, prevent the systemic consequences of the infection, prevent recurrent infections, and prevent bacterial resistance. Uncomplicated UTIs are generally effective with the antibiotic trimethoprim-sulfamethoxazole for 3 days, 1 dose of fosfomycin, or nitrofurantoin for 5 days. Fluoroquinolones are given to patients suspected of having pyelonephritis or complicated infections. In choosing the right antibiotic, it is necessary to consider the pattern of antibiotic resistance, especially against E. coli. Trimethoprim –sulfamethoxazole has been reported to have reduced activity against E. coli in some areas (more than 20%). Implementation of Practicum CASE 45 year old female patient YA came to the hospital emergency room with complaints of burning sensation when urinating, frequent urination with small amounts of urine and pain in the lower abdomen. From the results of the examination the patient was diagnosed with a UTI. History of illness: I had a UTI a few years ago. History of allergies: Trimethoprim-sulfamethoxazole, Penicillin Vital signs check: BP 100/80 mmHg, Temperature 37oC, RR 20x/minute, HR 95x/minute Urinalysis Results: Color : clear yellowish Specific gravity : 1,028 pH : 6.3 Glucose, ketones, bilirubin: negative Blood and protein : positive Leukocytes : 10-15 cells/LBP Erythrocytes : 5-10 cells/LBP Bacteria : Lots Epithelial cells : 3-5 cells/ lBP Leukocyte esterase & nitrite test : positive Therapy R/ Levofloxacin 250 mg No. VII s. 1 dd 1 tab R/ Phenazopyridine HCl 200 mg No. X s. 3 dd 1 tab