SKOR INDIKATOR KLINIS DAN URINALISIS SEBAGAI PREDIKTOR INFEKSI SALURAN KEMIH PADA ANAK

Irwan, dr. Eggi Arguni, M.Sc, Ph.D, Sp.A(K).; dr. Retno Palupi, B.Med.SC, M.Epid, M.Sc, Sp.A(K)

2022 | Tesis | MAGISTER ILMU KEDOKTERAN KLINIS

Background: Urinary tract infection (UTI) is a combination of bacteriuria and pyuria with clinical manifestation and often occurs in children. The prevalence of culture-positive UTI in children varies from 21,4 to 35,5%. Not all hospitals in Indonesia have urine culture examinations. To date, there was no study examining clinical dan urinalysis indicators as predictors of culture-positive UTI. Objective: To determine clinical and urinalysis score model that can predict culture-positive UTI in children. Methods: A case-control study was performed. Samples were UTI children aged 0 to 18 years old who came to Pediatric Department of Dr. Sardjito Hospital from January 2020 to December 2021 and met the inclusion criteria. Samples were taken with consecutive sampling method. The relationship between variables were presented as odds ratio (OR), confidence intervals 95%, score each variable and statistical significance levels p<0,05. The score was made using the regression coefficient of the significant variable in the multivariate analysis followed by the calculation of the ROC curve to determine the quality of score model and the probability of each score. After getting the score model, it was continued with the simplification of the score model for clinical application. Results: The prevalence of positive urine culture UTI in children was 54,7%. The case group consists of 235 culture-positive UTI children and the control group consists of 218 culture-negative UTI children. The ratio of females and males was 1,2 to 1, with the most UTI children aged 1-24 months and >84 months. The most common bacteria in UTI was Escherichia coli. Bivariate and multivariate analysis showed complicated UTI (p=0,004; AOR 3,78; CI95% 1,521-9,404; 1 point), immunodeficiency (p=0,018; AOR 2,41; CI95% 1,164-4,973; 1 point), fever >=380C (p<0,001; AOR 4,61; CI95% 2,075-10,221; 2 point), vomiting (p<0,016; AOR 2,65; CI95% 1,195-5,876; 1point), age specified UTI symptoms (p<0,001; AOR 10,76; CI95% 5,033-22,991; 3 point), urine catheter (p=0,019; AOR 2,64; IK95% 1,173-5,928; 1 point), nitrite (p<0,001; AOR 14,57; CI95% 5,862-36,190; 2 point), leukocyte esterase >=+2 (p<0,001; AOR 9,88; CI95% 4,721-20,686; 3 point) dan bacteriuria >=470/µL (p=0,001; AOR 3,72; CI95% 1,766-7,824; 1 point) were predictive factors of culture-positive UTI in children. Conclusion: Clinical and urinalysis indicator scores consist of complicated UTI, immunocompromised, fever >=380C, vomiting, age specified UTI symptoms, nitrite, leukocyte esterase >=+2, bacteriuria >=470/µL with a cut-off score >=7 can predict children with UTI with sensitivity of 90,6%, specificity of 89,4% and AUC 96% with p value <0,001. Meanwhile, the simple score model consist of fever >=380C, age specified UTI symptoms, nitrite, leukocyte esterase >=+2 with a cut-off score >=4 can predict children with UTI with sensitivity of 93,2%, specificity of 81,2% and AUC 94,5% with p value <0,001.

Background: Urinary tract infection (UTI) is a combination of bacteriuria and pyuria with clinical manifestation and often occurs in children. The prevalence of culture-positive UTI in children varies from 21,4 to 35,5%. Not all hospitals in Indonesia have urine culture examinations. To date, there was no study examining clinical dan urinalysis indicators as predictors of culture-positive UTI. Objective: To determine clinical and urinalysis score model that can predict culture-positive UTI in children. Methods: A case-control study was performed. Samples were UTI children aged 0 to 18 years old who came to Pediatric Department of Dr. Sardjito Hospital from January 2020 to December 2021 and met the inclusion criteria. Samples were taken with consecutive sampling method. The relationship between variables were presented as odds ratio (OR), confidence intervals 95%, score each variable and statistical significance levels p<0,05. The score was made using the regression coefficient of the significant variable in the multivariate analysis followed by the calculation of the ROC curve to determine the quality of score model and the probability of each score. After getting the score model, it was continued with the simplification of the score model for clinical application. Results: The prevalence of positive urine culture UTI in children was 54,7%. The case group consists of 235 culture-positive UTI children and the control group consists of 218 culture-negative UTI children. The ratio of females and males was 1,2 to 1, with the most UTI children aged 1-24 months and >84 months. The most common bacteria in UTI was Escherichia coli. Bivariate and multivariate analysis showed complicated UTI (p=0,004; AOR 3,78; CI95% 1,521-9,404; 1 point), immunodeficiency (p=0,018; AOR 2,41; CI95% 1,164-4,973; 1 point), fever >=380C (p<0,001; AOR 4,61; CI95% 2,075-10,221; 2 point), vomiting (p<0,016; AOR 2,65; CI95% 1,195-5,876; 1point), age specified UTI symptoms (p<0,001; AOR 10,76; CI95% 5,033-22,991; 3 point), urine catheter (p=0,019; AOR 2,64; IK95% 1,173-5,928; 1 point), nitrite (p<0,001; AOR 14,57; CI95% 5,862-36,190; 2 point), leukocyte esterase >=+2 (p<0,001; AOR 9,88; CI95% 4,721-20,686; 3 point) dan bacteriuria >=470/µL (p=0,001; AOR 3,72; CI95% 1,766-7,824; 1 point) were predictive factors of culture-positive UTI in children. Conclusion: Clinical and urinalysis indicator scores consist of complicated UTI, immunocompromised, fever >=380C, vomiting, age specified UTI symptoms, nitrite, leukocyte esterase >=+2, bacteriuria >=470/µL with a cut-off score >=7 can predict children with UTI with sensitivity of 90,6%, specificity of 89,4% and AUC 96% with p value <0,001. Meanwhile, the simple score model consist of fever >=380C, age specified UTI symptoms, nitrite, leukocyte esterase >=+2 with a cut-off score >=4 can predict children with UTI with sensitivity of 93,2%, specificity of 81,2% and AUC 94,5% with p value <0,001.

Kata Kunci : Infeksi saluran kemih, kultur urin positif, anak, indikator klinis dan urinalisis, prediktor, sistem skor, Urinary tract infection, culture-positive, child, urinalysis and clinical indicator, predictors, scoring