ABSTRACT
Latar belakang. Anak berusia 2 bulan - 2 tahun yang menderita infeksi salurankemih (ISK) dengan gejala demam perlu mendapat perhatian karena memilikirisiko kerusakan ginjal, gejala klinis yang tidak spesifik pada traktus urinarius,serta pengambilan sampel urin yang sulit. Urinalisis merupakan pemeriksaanpenunjang utama pada ISK karena cepat dan tersedia secara luas.Tujuan. Penelitian ini bertujuan menilai sensitivitas, spesifisitas, nilai dugapositif (NDP), nilai duga negatif (NDN), pretest odds, rasio kemungkinan positif(RKP), rasio kemungkinan negatif (RKN), post-test odds, dan post-testprobability dari masing-masing komponen urinalisis, yaitu nitrit, esterase leukosit(EL), leukosituria, bakteriuria beserta gabungannya untuk memprediksi ISK padaanak berusia 2 bulan hingga 2 tahun dengan gejala demam.Metode. Penelitian ini merupakan uji diagnostik yang dilakukan di RSCM, RSUDTangerang, RSUP Fatmawati, dan RSUD Budhi Asih pada anak berusia 2 bulan -2 tahun. Kriteria inklusi meliputi pasien dengan kecurigaan ISK, yaitu demamdengan suhu lebih dari, atau sama dengan 390C, demam lebih dari 2 hari, dantidak ditemukan penyebab lain (infeksi saluran pernapasan akut, otitis media akut,infeksi sistem saraf pusat, dan campak), serta belum mendapat antibiotik dalam 1minggu terakhir. Kriteria eksklusi meliputi pasien immunocompromise dankelainan anatomis pada traktus urinarius. Pengumpulan sampel urin untukpemeriksaan urinalisis dan kultur urin menggunakan urine collector.Hasil. Tujuh puluh lima anak ISK dengan gejala demam memenuhi kriteriapenelitian. Prevalens ISK pada penelitian ini adalah 33%. Hasil positif pada nitrit,EL, leukosituria, bakteria, dan gabungannya memiliki nilai sensitivitas berturutturut24%, 68%, 56%, 52%, dan 54%. Nilai spesifisitas nitrit, EL, leukosituria,bakteria, dan gabungannya berturut-turut 94%, 80%, 86%, 90%, dan 95%. NilaiNDP nitrit, EL, leukosituria, bakteria, dan gabungannya berturut-turut 66%, 63%,66%, 72%, dan 75%. Nilai NDN nitrit, EL, leukosituria, bakteria, dangabungannya berturut-turut 71%, 83%, 79%, 79%, dan 88%. Nilai RKP nitrit, EL,leukosituria, bakteria, dan gabungannya berturut-turut 4; 3,4; 4; 5,2; dan 10,3.Nilai RKN nitrit, EL, leukosituria, bakteria, dan gabungannya berturut-turut 0,8;0,4; 0,5; 0,5; 0,5; dan 0,5.Simpulan. Hasil gabungan komponen urinalisis (nitrit, EL, leukosituria, danbakteriuria) dapat digunakan untuk menyingkirkan ISK karena mempunyaispesifisitas dan NDN tinggi, sehingga tidak diperlukan pemeriksaan kultur urin.
ABSTRACT
Background. Children aged 2 months to 2 years old with febrile urinary tractinfection (UTI) need special attention considering kidney complications,unspecified symptoms, and difficult urine sample collection. Urinalysis was themain supportive examination for UTI because of its immediate result andwidespread availability.Objective. To estimate sensitivity, specificity, positive predictive value (PPV),negative predictive value (NPV), pretest odds, positive likelihood ratio (LR+),negative likelihood ratio (LR-), post-test odds, and post-test probability on eachurinalysis component, which are nitrite, leukocyte esterase (LE), leukocyturia, andbacteriuria, and also combination of all four components in predicting UTI amongchildren aged 2 months to 2 years old with febrile as the main manifestations.Methods. This is a diagnostic study held in Cipto Mangunkusumo Hospital,Tangerang Hospital, Fatmawati Hospital, and Budhi Asih Hospital, involvingchildren aged 2 months to 2 years old. Inclusion criteria are fever with unknownsource (more than or 39⁰C), fever more than 2 days (without acute respiratoryinfection, acute otitis media, central nervous system infection, or measles), and nohistory of antimicrobial consumption in the past week. Exclusion criteria areimmunocompromised state and urinary tract abnormalities. Urine samples forurinalysis and urine culture were collected using urine collector for all subjects.Results. Seventy five children were participating in this study. We found 33%prevalence of febrile UTI in this study. Sensitivity of nitrite, LE, bacteriuria,leucocyturia, and all four components were 24%, 68%, 56%, 52%, and 54%. Thespecificity of nitrite, LE, bacteriuria, leucocyturia, and all four components were94%, 80%, 86%, 90%, and 95%. The PPV of nitrite, LE, bacteriuria, leucocyturia,and all four components were 66%, 63%, 66%, 72%, and 75%. The NPV ofnitrite, LE, bacteriuria, leucocyturia, and all four components were 71%, 83%,79%, 79%, and 88%. The LR+ of nitrite, LE, bacteriuria, leucocyturia, and allfour components were 4; 3,4; 4; 5,2; and 10,3. The LR- of nitrite, LE, bacteriuria,leucocyturia, and all four components were 0,8; 0,4; 0,5; 0,5; and 0,5.Summary. All four components of urinalysis (nitrite, LE, leucocyturia, andbacteriuria) can be used to exclude UTI because of their high specificity and NPV,so urinary culture is not needed. |
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