PP Mikrobiologi
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PP-MIKROBIOLOGI22010113120025 I Wahyu Adhitya Prawirasatra
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Etiologi
• E.coli (80–85%)
• S. saprophyticus (5–10%) honeymoon cystitis
• S. epidermidis, Enterococcus
• Predisposisi kateter urin: Klebsiella, Proteus, Pseudomonas
• Viral (Adenovirus, Cytomegalovirus): Jarang
• Fungi (Candida sp, Histoplasma)
• Parasit (Trichomonas vaginalis)
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MacConkey agar plate of E. coli from urine
MEDIA BLOOD AGAR
S.aureus, S.saprophyticus, S.epidermidis
S. saprophyticusNovobiocine resisten thd. S. saprophyticus
Search images for site: labmed.bwh.harvard.edu urine culture
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Kuman patogen didapat dari kultur
Gejala Klinis
Kondisi pasien
mis. septicaemia, endocarditis,osteomyelitis meningitis,UTI, pneumoniapharyngitis
Bagaimana mengetahui patogen tertentu dapat menyebabkan penyakit tertentu?
Diagnosis dan terapi infeksi tidak tergantung dari kuman tetapi juga
melihat hasil laboratorium yang lain serta gejala klinis pasien
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Alur Pemeriksaan Mikrobiologi
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Urine - General
• Collection method must avoid contamination
• Clean catch, midstream voided
• Catheterized urine
• Suprapubic aspiration
• Cultures performed quantitatively
• Less than 10,000 per ml suggest contamination
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Cara pengumpulan spesimen urine
1. Mid stream urine ( Clean catch urine ) - urine pertama di pagi hari - spesimen dikumpulkan di pertengahan urine
dikeluarkan
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Cara pengambilan urine kateter
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Urine supra pubic puncture
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Cara pengambilan, penyimpanan dan pengiriman bahan
Petunjuk Umum• Pemeriksaan diambil sebelum diberikan
antibiotik
• Bahasn pemeriksaan diambil saat & lokasi yang tepat( untuk dapat kuman)
• Tindakan aseptik
• Jumlah cukup
• Formulir diisi lengkap(riwayat penyakit, pengobatan,diagnosis
• Pelabelan yang jelas
Petunjuk Khusus• Air seni –penampungan pagi hari-
steril-midstream/ kateter-segera kirim.( Urin diambil < 3 hari MRS)
• Darah : diambil sesuai perjalan penyakit
• Dengan media “bactec”
• Ukuran sesuai dengan aturan
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Pengamatan Hasil
Pengamatan
SebelumTerapi Empirik
Spektrum luas
De-escalating
Data epidemiologi
Narrow sp
aman
oost
SesudahTerapi Definitif
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Kultur Darah : Klebsiella pneumonia
Kultur Darah 28/8/2010 Hasil
Kuman: Klebsiella Pneumonia
Sensitif: Amikacin, cefepim. Imipenem, meropenem, sulbactam cefoperazon
Resisten: Ampicilin, ceftazidim, kotrimoksasol, gentamycin, moxifloxacin
Kultur Darah 4/9/2010 Hasil
Kuman: Escherichia Coli, > 100.000
Sensitif: Cefepim. Gentamycin, Imipenem, meropenem, fosfomycin
Resisten: Amikacin, Ampicilin, Ampicilin sulbactam, ceftazidim, kotrimoksasol, moxifloxacin
Kultur Urin : Escherichia ColiKultur Urin : Escherichia Coli
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Pasien dengan diare kronisHasil Kultur feses : Escherichia coli EPEC (+), berarti memang didapatkan infeksi di saluran cerna
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Proses Resistensi bakteria
• Mutation
• Gene exchange
• Selection
• Transmission
proses
biologi
alamiah