HUBUNGAN ANTARA USIA JENIS K E L A M I N T I N G K A T PENDIDIKAN DAN R I W A Y A T D I A B E T E S M E L I T U S

DENGAN K E J A D I A N I N F E K S I S A L U R A N K E M I H PADA PASIEN R A W A T INAP DAN R A W A T

J A L A N DI BAGIAN P E N Y A K I T D A L A M RUMAH S A K I T M U H A M M A D I Y A H

P A L E M B A N G P E R I O D E I J A N U A R I 2015-31

D E S E M B E R 2015

S K R I P S I

Sebagai salah satu syarat memperoleh gelar Saijana Kedokteran (S Ked)

O l e h

R E Z A A G U S T I A N T W O P U T R A M M 702013054

F A K U L T A S K E D O K T E R A N UNIVERSITAS M U H A M M A D I Y A H P A L E M B A N G

2017

HALAMAN PENGESAIUN

HUBUNGAN ANTARA USIA JENIS KELAMIN TINGKAT PENDIDIKAN DAN RIWAYAT DIABETES MELITUS

DENGAN KEJADIAN INFEKSI SALURAN K E M I H PADA PASIEN RAWAT INAP DAN RAWAT

JALAN DI BAGIAN PENYAKIT DALAM RUMAH SAKIT MUHAMMADIYAH

PALEMBANG PERIODE I JANUARI 2015-31

DESEMBER 2015

Dipcrsiapkan dan disusun oleh Reza Agustiaotwo Putra

M M 702013054

Sebagai salah satii syarat memperoleh gelar Sarjana Kedokteran (S Ked)

Pada tanggal 07 Februari 2017

dr M Avus^A^tonK SpPD-KGEH FINASIM MARS Perabimbing Pcrtama

Mcnyctujui

dr Ratika FcbrUni Pembimbing Kedua

PERNYATAAN

D e n g a t i i n i s a y a m e n e r a n g k a n b a h w a

1 K a r y a t u l i s s a y a s k r i p s i i n i a d a i a h a s l i d a n b e l u r n p e m a h d i a j u k a n u n t u k

m e n d a p a t k a n g e l a r a k a d e m i k b a i k d i U n i v e r s i t a s M u h a m m a d i y a h

P a l e m b a n g m a u p u n P e r g u m a n T i n g g i l a i n n y a

2 K a r y a t u l i s i n i m u m i g a g a s a n n i m u s a n d a n p e n e l i t i a n s a y a s e n d i r i t a n p a

b a n t u a n p i h a k l a i n k e c u a l i a r a h a n T i m P e m b i m b i n g

3 D a l a m k a i y - a m l i s i n i t i d a k t e r d a p a t k a i y a a t a u p e n d a p a t y a n g t e l a h d i t u l i s

a t a u d i p u b l i k a s i k a n o r a n g l a i n k e c u a i i s e c a r a t e r t u l i s d e n g a n d i c a n t u m k a n

s e b a g a i a c u a n d a l a m n a s k a h d e n g a n d i s e b u t k a n n a m a p e n g a r a n g d a n

d i c a n t u m k a n d a l a m d a f t a r p u s t a k a

4 P e m y a t a a n i n i s a y a b u a t d e n g a n s e s u n g g u h n y a d a n a p a b i l a d i k e m u d i a n h a r i

t e r d a p a t p e n y i m p a n g a n d a n k e t i d a k b e n a r a n d a l a m p e m y a t a a n i n i m a k a s a y a

b e r s e d i a m e n e r i m a s a n k s i a k a d e m i k a t a u s a n k s i l a i n n y a s e s u a i d e n g a n n o r m a

y a n g b e r l a k u d i P e r g u m a n T i n g g i i n i

P a l e m b a n g 0 7 F e b m a r i 2 0 1 7

Y a n g m e m b i i a t p e m y a t a a n

( R e z a A g u s t i a n t w o P u t r a )

N I M 7 0 2 0 1 3 0 5 4

ii

P E R S E T U J U A N P E N G A L I H A N H A K P U B L I K A S I K A R Y A I L M I A H

UNTUK K E P E N T I N G A N A K A D E M I S

D e n g a n P e n y e r a h a n n a s k a l i a r t i k e l d a n v r t a j ^ v b e r j u d u l H u b u n g a n a n t a r a U s i a J e n i s K e i a m i n T i n g k a t P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h p a d a P a s i e n R a w a t I n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 ^ K e p a d a U n i t P e n e l i t i a n d a n P e n g a b d i a n M a s y a r a k a t U P 2 M ) F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u h a m m a d i y a h P a l e m b a n g ( F K - U M P ) S a y a

N a m a R e z a A g u s t i a n t w o P u t r a N i M 7 0 2 0 1 3 0 5 4 P r o g r a m S t u d i P e n d i d i k a n K e d o k t e r a n U m u m F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u h a m m a d i y a h P a l e m b a n g J e n i s K a r y a i l m i a h S k r i p s i

D e m i p e n g e m b a n g a n i l m u p e n g e t a h u a n s e t u j u m e m b e r i k a n k e p a d a F K - U M P P e n g a l i h a n H a k C i p t a d a n P u b l i k a s i B e b a s R o y a l t i a t a s K a r y a I l m i a h N a s k a l i d a n softcopy d i a t a s D e n g a n h a k t e r s e b u t F K - U M P b e r h a k m e n y i m p a n m e n g a l i h m e d i a f o n n a t k a n d a l a m b e n t u k p a n g k a l a n d a t a (database) m e n d i s t r i b u s i k a n m e n a m p i l k a n m e m p u b l i k a s i k a n d i i n t e r n e t a t a u m e d i a l a i n u n t u k k e p e n t i n g a n a k a d e m i s t a n p a p e r l u m e m i n t a i z i n d a r i S a y a s e l a m a t e t a p m e n c a n t u m k a n n a m a S a y a d a n S a y a m e m b e r i k a n w e w e n a n g k e p a d a p i h a k F K -U M P u n t u k m e n e i i t u k a n s a l a h s a t u P e m b i m b i n g s e b a g a i P e n u l i s U t a m a d a l a m P u b l i k a s i S e g a l a b e n t u k t u n t u t a n h u k u m y a n g t i m b u l a t a s p e l a n g g a r a n H a k C i p t a d a l a m K a r y a I l m i a l i i n i m e n j a d i t a n g g u n g j a w a b S a y a p r i b a d i

D e m i k i a n p e m y a t a a n i n i S a y a b u a t d e n g a n s e b e n a m y a

I T -

T E R A I V E M P E L

J ^ ^ 6 C A E F 3 5 1 6 9 4 3 2 6

D i b u a l d i P a l e m b a n g P a d a t a n g g a l 0 7 F e b r u a r i 2 0 1 7

i g M e i i y e t u j u i

z a A g u s t i a n t w o P u t r a

N I M 7 0 2 0 1 3 0 5 4

iii

HALAMAN PERSEMBAHAN DAN MOTTO

OfaBjrdafi ada sesuatuyan^ menanttmu sedpas Battya^BgsaSaran (yang Bpu

jaCani) yang a^n memStiatmu terpana Singga (au Cupa Setapa pedifinya rasa

saSit - (Jid ltBinABi TltadB)

Dengan izin-Mu ya Allah ku persembahkan karya ini untuk

bull Kedua orangtuaku yang tercinta Riza Efendi SHbdquo MH dan Dra Yusdiami

yang selalu memberikan motivasi nasihat dan semangat untuk meraih cita-

citaku serta doa dan kasih sayang di setiap langkaliku Ma P a i know this

is not enough yet to reply a l l your affection and everything that you already

gave h u t im trying to he the best i n everything for you and absolutely you

a r e my entire worlct

bull Saudara kandungku tersayang Eka Satriawan A Md Im SH MH dan

Threenita Sari Sepgi Putri yang telah banyak membantu menemani serta

menghibur di setiap hari-hariku Im so g r a t e f u l to have you kak g r a You

a r e truly my beloved siblings

bull Pembimbing skripsiku dr M Ayus Astoni Sp PD KGEH FINASIM

MARS dan dr Ratika Febriani yang telah memberikan nasihat saran dan

ilmu yang bermanfaat serta meluangkan waktunya untuk membimbing

skripsi ini bingga selesai

bull Teman-teman terdekatku ( C H A T g r o u p dan Bujang Gadis g r o u p ) yang selalu

dapat memberikan keceriaan semangat dan bantuan di saat menghadapi

kesulitan do believe we can be a success doctor and get our dreams

someday Keep down to e a r t h guys

bull Dan seluruh teman-teman angkatan 2013 (Genome H e x a ) yang telah banyak

memberikan bantuan selama proses perkuliahan di tahap akademik Semoga

kesuksesan dan ridho Allah SWT selalu mengiringi iangkali kita Aamiin ya

rabbal allamin See you on topgjrys

iv

UNIVERSITAS MUHAMMADIYAH P A L E M B A N G F A K U L T A S K E D O K T E R A N

S K R I P S L JANUARI 2017 R E Z A AGUSTIANTWO PUTRA

Hubungan antara Usia Jenis Keiamin Tingkat Pendidikan dan Riwayat Diabetes Melitus dengan Kejadian Infeksi Saiuran Kemih pada Pasien Rawat Inap dan Rawat Jalan di Bagian Penyakit Dalam Rumah Sakit Muhammadiyah Palembang Periode 1 Januari 2015-31 Desember 2015

xii + 37 halaman + 12 tabel + 1 gambar + 8 lampiran

A B S T R A K

I n t e k s i s a i u r a n k e m i h ( I S K ) m e n i p a k a n s u a t u i n f e k s i y a n g m e n g e n a i t r a k t u s u r i n a r i u s d a n h a m p i r 1 0 o r a n g p e m a h t e r k e n a I S K s e l a m a h i d u p n y a M e n u m t t e o r i m e n i n g k a t n y a k e j a d i a n I S K b e r h u b i m g a n d e n g a n p e n i n g k a t a n u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s P e n e l i t i a n i n i b e m i j u a n u n t u k m e n g a n a l i s i s h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i l i p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R i u n a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 J e n i s p e n e l i t i a n i n i a d a i a h o b s e r v a s i o n a i a n a l i t i k d e s a i n cross sectional d e n g a n m e n g g i i n a k a n d a t a s e k u n d e r d a r i r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g S a m p e l p e n e l i t i a n i n i a d a i a h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 d e n g a n b e s a r s a m p e l s e b a n y a k 9 8 s a m p e l S a m p e l p e n e l i t i a n i n i d i a m b i l d e n g a n c a r a consecutive sampling H a s i l u j i s t a t i s t i k d i d a p a t k a n h u b u n g a n i n f e k s i s a i u r a n k e m i h d e n g a n u s i a ( p = 0 0 0 0 ) j e n i s k e i a m i n ( p = 0 0 0 0 ) t i n g k a t p e n d i d i k a n ( p = 0 0 0 0 ) d a n riwayat d i a b e t e s m e l i t u s ( p 0 0 0 0 ) S e h i n g g a d a p a t d i s i m p u l k a n b a h w a t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n rawat j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e i J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

Referensi 29(2002-2015) Kata kunci Infeksi Saiuran Kemih Riwayat Diabetes Melitus

V

U N I V E R S I T Y O F M U H A M M A D I Y A H P A L E M B A N G FA cut T Y or M E D I C I N E

MINI THESIS J A N U A R Y 2 0 1 7 R E Z A A G U S T I A N T W O P U T R A

T h e Relationships between Age Gender Education Level Diabetes M e l i t u s History and The Incidence of U r i n a r y T r a c t Infections i n Hospitalized Patients and Outpatients at I n t e r n a l M e d i c i n e o f M u h a m m a d i y a h Palembang H o s p i t a l d u r i n g I J a n u a r y 2 0 1 5 - 3 1 December 2 0 1 5

x i i + 37pages + 12 tables + I picture + 8 attachments

A B S T R A C T

Urinary trad infection (UTI) is an infection of I he urinary tract and nearly 10 of people experience UTI during their lifeiime According to theory the increasing of urinary tract infections is related with increasing age gender education level and diabetes melitus history This study aim to analyze relationships between age gender education level diabetes melitus history and the incidence of urinary tract infections in hospitalized patients and outpatients at Internal Medicine of Muhammadiyah Palembang Hospilal during P January 2015-31 December 2015 This study lipe was analyiical observaiional with cross sectional design by using secondary data from medical record of Muhammadiyah Palembang Hospital Samples of this study were taken by consecutive sampling technique The results of statistical test were obtained relationship between urinary tract infections with age (p 0000) gender (p 0000) education level (p 0000) and diabetes melitus (p 0000) In conclusion there are significantly relationships between age gender education level diabetes melitus history and the incidence of urinary tract infections in hospitalizedpatients and outpatients at Internal Medicine of Muhammadiyah Palembang Hospital during P January 20J5-3PDecember 2015

References 2 9 ( 2 0 0 2 - 2 0 1 5 ) Keywords U r i n a r y T r a c t I n f e c t i o n s Diabetes M e l i t u s

vi

KATA PENGANTAR

S e g a l a p u j i s y u k u r k e p a d a A l l a l i S W T k a r e n a a t a s b e r k a t d a n r a h m a t - N y a p e n u l i s d a p a t i n e n y e l e s a i k a n s k r i p s i y a n g b e r j u d u l H u b u n g a n A n t a r a U s i a J e n i s K e i a m i n T i n g k a t P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h P a d a P a s i e n R a w a t i n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 S k r i p s i i n i d i s u s u n s e b a g a i s a l a h s a t u s y a r a t u n t u k m e m p e r o l e h g e l a r S a r j a n a K e d o k t e r a n d i F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u l i a m m a d i y a h P a l e m b a n g

P e n u l i s m c n y a d a r i b a l i w a d a l a m p r o s e s i n e n y e l e s a i k a n s k r i p s i i n i b a n y a k k e n d a l a y a n g d i a l a i n i n a n i u n b e r k a t b a n t u a n b i m b i n g a n k e r j a s a m a d a r i b c r b a g a i p i h a k d a n t e r u t a m a b e r k a t A l l a h S W T k e n d a l a t e r s e b u t d a p a t d i a t a s i

P e n u l i s j u g a m e n v a d a r i b a h w a s k r i p s i i n i m a s i h j a u h d a r i s e m p u m a m a k a d e n g a n s e g a l a k e r e n d a h a n l i a t i p e n u l i s m e n g l i a r a p k a n a d a n y a k r i t i k d a n s a r a n y a n g b e r s i f a t m e m b a n g u n d e m i k e s e m p u m a a n s k r i p s i i n i

A k h i r k a t a p e n u l i s b c r l i a r a p A l l a l i S W T b e r k e n a n m e m b a i a s s e g a l a k e b a i k a n s e m u a p i h a k y a n g t e l a h m e m b a n t u S e m o g a s k r i p s i i n i d a p a t b e n n a n f a a t b a g i k i t a s e m u a A a m i i n

P a l e m b a n g 0 7 F e b r u a r i 2 0 1 7

R e z a A g u s t i a n t w o P u t r a

vii

DAFTAR ISI

HALAMAN J D D U L HALAMAN PENCESAHAN i HALAMAN PERNN ATAAN ii HALAMAN PERSEMBAHAN iii A B S T R A K iv A B S T R A C T v K A T A PENGANTAR vi DAFTAR ISI vii DAFTAR T A B E I ix DAFTAR GAMBAR x DAFTAR LAMPIRAN xi

BAB I Pendahuluan 1 1 1 L a t a r B e l a k a n g 1 12 R i i m u s a n M a s a l a h 3 13 T u j u a n P e n e l i t i a n 3 14 M a n l a a t P e n e l i t i a n 4 15 K e a s l i a n P e n e l i t i a n 5

BAB H Tinjauan Pustaka 9 2 1 L a n d a s a n T e o r i 9

2 1 1 I n f e k s i S a i u r a n K e m i h 9 A D e f i n i s i 9 B E p i d e m i o l o g i 9 C K i a s i f i k a s i 1 0 D E t i o l o g i 1 1 E P a t o f i s i o l o g i 11 F F a k t o r R i s i k o 1 2 G M a n i f e s t a s i K l i n i s 1 5 H T a t a l a k s a n a 1 6 I K o m p l i k a s i 1 6

2 2 K e r a n g k a T e o r i 1 7 2 3 H i p o t e s i s 1 8

BAB I I I Metode Penelitian 19 3 1 J e n i s P e n e l i t i a n 1 9 3 2 W a k t u d a n T e m p a t P e n e l i t i a n 1 9 3 3 P o p u l a s i d a n S a m p e l 1 9

3 3 1 P o p u l a s i P e n e l i t i a n 1 9 3 3 2 S a m p e l d a n B e s a r S a m p e l P e n e l i t i a n 1 9 3 3 3 K n t e r i a I n k l u s i d a n E k s k l u s i 2 0 3 3 4 C a r a P e n g a m b i l a n S a m p e l P e n e l i t i a n 2 0

3 4 V a r i a b e l P e n e l i t i a n 2 0 3 4 1 V a r i a b e l Dependent 2 0 3 4 2 V a r i a b e l Independent 2 0

viii

3 5 D e f i n i s i O p e r a s i o n a l 2 1 3 6 C a r a P e n g i i n i p u l a n D a t a 2 2

3 6 1 D a t a S e k u n d e r 2 2 3 7 M e t o d e T e k n i s A n a l i s i s D a t a 2 2

3 7 C a r a P e n g o l a h a n d a n A n a l i s i s D a t a 2 2 3 8 A l u r P e n e l i t i a n 2 4

BAB IV HASIL DAN PEMBAHASAN 25 4 1 H a s i l 2 5 4 2 P e m b a h a s a n 3 3

BAB V KESIMPLILAN DAN SARAN 37 5 1 K e s i m p u l a n 3 7 5 2 S a r a n 3 7

D A F T A R PUSTAKA 38 LAMPIRAN 41 BIODATA 63

ix

DAFTAR T A B E L

Tabel Halaman

T a b e l 1 1 K e a s l i a n P e n e l i t i a n 5 T a b e l 3 1 D e f i n i s i O p e r a s i o n a l 2 1 T a b e l 4 1 D i s t r i b u s i P r o p o r s i K a r a k t e r i s t i k P a s i e n R a w a t i n a p

B e r d a s a r k a n U s i a d a n J e n i s K e i a m i n 2 6 T a b e l 4 2 D i s t r i b u s i P r o p o r s i K a r a k t e r i s t i k P a s i e n R a w a t J a l a n

B e r d a s a r k a n U s i a d a n J e n i s K e i a m i n 2 7 T a b e l 4 3 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n U s i a 2 8 T a b e l 4 4 D i s t r i b u s i P r o p o r s i K e j a d i a n i n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n J e n i s K e l a m m 2 8 T a b e l 4 5 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n T i n g k a t P e n d i d i k a n 2 9 T a b e l 4 6 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n R i w a y a t D i a b e t e s M e l i t u s 2 9 T a b e l 4 7 H a s i l U j i H u b u n g a n a n t a r a U s i a d e n g a n K e j a d i a n

i n f e k s i S a i u r a n K e m i h 3 0 T a b e l 4 8 H a s i i U j i H u b u n g a n a n t a r a J e n i s K e i a m i n d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i b 3 1 T a b e l 4 9 H a s i l U j i H u b u n g a n a n t a r a T i n g k a t P e n d i d i k a n d e n g a n

K e j a d i a n i n t e k s i S a i u r a n K e m i h 3 2 T a b e l 4 1 0 H a s i l U j i H u b u n g a n a n t a r a R i w a y a t D i a b e t e s M e l i t u s

d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h 3 3

X

DAFTAR GAMBAR

Gambar Halaman

G a m b a r 3 1 A l u r P e n e l i t i a n H u b u n g a n U s i a J e n i s K e i a m i n T i n g k a t

P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i h p a d a P a s i e n R a w a t i n a p

d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g I e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1

D e s e m b e r 2 0 1 5 2 4

xi

DAFTAR LAMPIRAN

Lampiran Halaman

L a m p i r a n 1 D a t a R e k a m M e d i s P a s i e n R a w a t I n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 4 3

L a m p i r a n 2 H a s i l A n a l i s i s U n v i a r i a t 4 5

L a m p i r a n 3 H a s i l A n a l i s i s B i v a r i a t 5 1

L a m p i r a n 4 K a r t u B i m b i n g a n P r o p o s a l S k r i p s i 5 8

L a m p i r a n 5 K a r t u B i m b i n g a n S k r i p s i 5 9

L a m p i r a n 6 S u r a t P e n n o h o n a n I z i n P e n e l i t i a n 6 0

L a m p i r a n 7 S u r a t K e t e r a n g a n I z i n P e n g a m b i l a n D a t a d a n P e n e l i t i a n 6 1

L a m p i r a n 8 S u r a t K e t e r a n g a n S e l e s a i P e n e l i t i a n 6 2

xii

BAB I

PENDAHULUAN

11 Latar Belakang

I n f e k s i s a i u r a n k e m i h ( I S K ) m e n i p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m i i k a n d i R u m a h S a k i t a t a u t e m p a t p r a k t i k u m u m s e h a r i - h a r i I S K

a d a i a h s u a t u i n f e k s i y a n g m e n g e n a i t r a k t u s u r i n a r i u s m u l a i d a r i m e a t u s u r e t r a

s a m p a i d e n g a n k e g i n j a l S t r u k t u r y a n g t e n n a s u k d i d a l a m n y a a d a i a h u r e t r a

k a n d u n g k e m i h u r e t e r p e l v i s d a n p a r e n k i m g i n j a l S t r u k t u r y a n g b e r k a i t a n u n t u k

t e r j a d i n y a i n f e k s i d a n r e k u r e n i n f e k s i y a i t u p r o s t a t e p i d i d i m i s d a n fascia

perinephric I s t i l a h I S K m e n u n j u k k a n a d a n y a k e b e r a d a a n m i k r o o r g a n i s m e d i

d a l a m u r i n ( S u d o y o 2 0 0 6 R u b i n 2 0 1 0 ) D e n g a n k a t a l a i n b a h w a d i a g n o s i s I S K

d i t e g a k k a n d e n g a n m e m b u k t i k a n a d a n y a m i k r o o r g a n i s m e d i d a l a m s a i u r a n k e m i h

( R u b i n 2 0 1 0 )

S e b a n y a k 2 5 j u t a k e m a t i a n d i s e l u r u h d u n i a p a d a t a h u n 2 0 1 1 s e p e r t i g a n y a

d i s e b a b k a n o l e h p e n y a k i t i n f e k s i I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n i n f e k s i

d e n g a n k e t e r l i b a t a i i b a k t e r i t e r s e r i n g d i k o m u n i t a s d a n h a m p i r 1 0 o r a n g p e m a h

t e r k e n a I S K s e l a m a h i d u p n y a S e k i t a i - 1 5 0 j u t a p e n d i i d u k d i s e l u r u h d u n i a t i a p

t a l i u n n y a t e r d i a g n o s i s m e n d e r i t a i n f e k s i s a i u r a n k e m i h ( Y u n u s 2 0 1 2 )

I S K d a p a t m e n g e n a i s e m u a k e l o m p o k u m u r b a i k a n a k r e m a j a d e w a s a

m a u p u n u s i a l a n j u t P r e v a l e n s i a n a k u s i a s e k o l a h y a n g m e n d e r i t a I S K s e k i t a r 1 -

3 d a n m e n i n g k a t p a d a r e m a j a y a n g s u d a h m e l a k u k a n h u b i m g a n s e k s u a l

( K o m a r a 2 0 0 9 ) D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r 2 5 - 3 5

s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a S e l a m a

p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n c e n d e r u n g

m e n d e r i t a I S K d i b a n d i n g k a n l a k i - l a k i ( S u d o y o 2 0 0 9 )

R a s i o I S K p a d a w a n i t a d i b a n d i n g p r i a b e r k i s a r 3 0 1 d a n s e k i t a r 5 0 w a n i t a

y a n g t e r k e n a i n f e k s i a k a n b e r k e m b a n g m e n j a d i I S K b e m l a n g I S K m e n i p a k a n

i n f e k s i b a k t e r i y a n g p a l i n g s e r i n g p a d a a n a k - a n a k d e n g a n k e l u h a n d e m a m b a i k

p a d a a n a k p r i a m a u p u n w a n i t a P r e v a l e n s i y a n g p e m a h d i l a p o r k a n b e r k i s a r 4 1

I

2

s a m p a i 7 5 R e k u r e n s i c u k u p s e r i n g d a n t e r j a d i s e k i t a r 1 8 p a d a b a y i l a k i - i a k i

d a n 2 6 p a d a b a y i p e r e m p u a n U n t u k u s i a p r a s e k o l a h I S K l e b i h s e r i n g

m e n g e n a i w a n i t a I n s i d e n I S K p a d a a n a k - a n a k p r a s e k o l a h s e k i t a r 2 ( S y a h r i n i

2 0 1 1 )

D a r i b e r b a g a i p e n e l i t i a n e p i d e m i o l o g i s d i I n d o n e s i a d i d a p a t k a n p r e v a l e n s i

D M s e b e s a r 15 - 2 3 p a d a p e n d u d u k u s i a l e b i J i d a r i 1 5 t a h u n b a h k a n p a d a

s u a t u p e n e l i t i a n e p i d e m i o l o g i s d i M a n a d o d i d a p a t k a n p r e v a l e n s i D M a d a i a h 6 1

P r e v a l e n s i d i a b e t e s m e l i t u s p a d a p e n d u d u k u s i a 2 5 - 6 4 t a h u n d i J a w a d a n B a l i

s e b e s a r 7 5 P e n e l i t i a n y a n g d i l a k u k a n d i J a k a r t a S u r a b a y a M a k a s a r d a n k o t a -

k o t a l a i n d i I n d o n e s i a m e m b u k t i k a n a d a n y a k e n a i k a n p r e v a l e n s i d a r i t a h u n

k e t a h u n ( D E P K E S 2 0 1 4 W H O 2 0 1 0 )

I n f e k s i s a i u r a n k e m i h j u g a m e n i p a k a n m a s a l a h k l i n i s u m u m p a d a p e n d e r i t a

D M o l e h k a r e n a p e n d e r i t a D M m e m p u n y a i k e m u n g k i n a n m e n d e r i t a I S K l e b i h

t i n g g i d i b a n d i n g k a n d e n g a n b u k a n p e n d e r i t a D M d a n j u g a m e n d e r i t a i n f e k s i y a n g

l e b i h b e r a t y a n g a k a n m e n i n g k a t k a n risiko u n t u k m a s u k m m a h s a k i t ( H a r d i n g

d k k 2 0 1 0 ) P e n e l i t i a n y a n g d i l a k u k a n o l e h B o y k o d k k m e n d a p a t k a n w a n i t a D M

ripe 2 d e n g a n b a k t e r i u r i a s i m t o m a t i k s e t e l a h d i l a k u k a n p e m a n t a u a n s e l a m a 1 8

b u l a n m e n g a l a m i p e n i n g k a t a n r i s i k o m e n d a p a t k a n I S K s e b a n y a k 3 4

d i b a n d i n g k a n d e n g a n w a n i t a y a n g t i d a k m e n g a l a m i D M s e b e s a r 1 9 ( B o y k o d k k

2 0 0 2 )

B e r d a s a r k a n u r a i a n - u r a i a n d i a t a s s e r t a b e l u m a d a n y a p e n e l i t i a n y a n g

m e n e m u k a n k e t e r k a i t a n f a k t o r u s i a j e n i s k e l a m m t i n g k a t p e n d i d i k a n d a n r i w a y a t

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h d i K o t a P a l e m b a n g m a k a

p e n e l i t i t e r t a r i k i m t i i k m e l a k u k a n p e n e l i t i a n m e n g e n a i h u b u n g a n a n t a r a u s i a j e n i s

k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

3

12 Rumusan Masalah

1 B a g a i m a n a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s

m e l i t u s

2 A p a k a l i a d a h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

13 Tujuan Penelitian

131 Tujuan Umum

T u j u a n u m u m d a r i p e n e l i t i a n i n i a d a i a h d i k e t e m u k a n n y a h u b u n g a n a n t a i a

u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i m s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

132 Tujuan Khusus

T u j u a n k l i u s u s d a r i p e n e l i t i a n i n i y a i t u

1 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a

2 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n m f e k s i s a i u r a n k e m i b p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n j e n i s k e i a m i n

3 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

4

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n t i n g k a t p e n d i d i k a n

4 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n riwayat d i a b e t e s m e l i t u s

5 T e r a n a l i s i s n y a h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a i m n a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

6 T e r a n a l i s i s n y a h u b u n g a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

7 T e r a n a l i s i s n y a h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

8 T e r a n a l i s i s n y a h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i u i s d e n g a n k e j a d i a n

i n f e k s i s a l i u a i i k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

14 Manfaat Penelitian

141 Manfaat Teoritis

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t m e n a m b a h p e n g e t a h u a n p e n e l i t i

t e n t a n g h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i U i s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

5

142 Manfaat Praktis

A Bagi Peneliti

H a s i l p e n e l i t i a n i n i d i l i a r a p k a n d a p a t d i g u n a k a n s e b a g a i s a l a h s a t u b a h a n

r e f e r e n s i a t a u b a c a a n b a g i p e n e l i t i

B Bagi Institusi

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t d i g u n a k a n p i h a k R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g s e b a g a i s a l a l i s a t u b a h a n a c u a n d a l a m m e n g u p a y a k a n

p e n c e g a h a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

15 Keaslian Penelitian

T a b e l 1 1 K e a s l i a n P e n e l i t i a n

Nama Judul Penelitian Desain Hasil Penelitian

Peneliti Penelitian

Kugan P r e v a l e n s i I n f e k s i Cross D a r i p e n e l i t i a n i i i i

Kandasamy S a i u r a n K e m i l i P a d a seciUmal d i p e r o l e h b a l i w a

W a n i t a Y a n g M e n d e r i t a

D i a b e t e s M e l i t u s T i p e

I I Y a n g D i r a w a t I n a p

p a s i e n w a n i t a d i a b e t e s

m e l i t u s t i p e I y a n g

m e n d e r i t a I S K y a n g

D a n D i r a w a t J a l a n D i d i r a w a t m a p d a n

S u b b a g i a n

E n d o k r i n o l o g i B a g i a n

P e n y a k i t D a l a m D i

d i r a w a t j a l a n d i s u b

b a g i a n E n d o k r i n o l o g i

P e n y a k i t D a l a m

R S U P H A d a m M a l i k R S U P H A d a m

P a d a T a l i u n 2 0 0 9 M a l i k M e d a i i t e r d a p a t

s e b a n y a k 2 5 o r a n g

y a i t u ( 1 2 7 ) D a r i 2 5

o r a n g y a n g m e n d e r i t a

I S K t e r d a p a t 3 o r a n g

y a i t u ( 1 2 0 ) y a n g

d i r a w a t i n a p d a n 2 2

6

o r a n g ( 8 8 0 ) y a n g

d i r a w a t j a l a n

Edel Weisela P e r b e d a a n R i s i k o

Permata I n f e k s i N o s o k o m i a l

Sari dan S a i u r a n K e m i h

Prijono B e r d a s a r k a n

Satyabakti K a i e t e r i s a s i U r i n

U m u r D a n D i a b e t e s

M e l i t u s T a h u n 2 0 1 5

Case H a s i l p e n e l i t i a n y a n g

control d i 1 a k u k a n p a d a 2 0

s a m p e l k a s u s d a n

k o n t r o l m e n u n j u k k a n

b a h w a p a s i e n d e n g a n

u m u r gt 5 5 t a h u n

m e m p u n y a i r i s i k o

5 5 7 k a l i m e n g a l a m i

i n f e k s i n o s o k o m i a l

s a i u r a n k e m i h

d i b a n d i n g k a n p a s i e n

d e n g a n u m u r lt 5 5

t a h u n d e n g a n

p e r i l i t u n g a i i b e s a r

risiko d i p e r o l e h n i l a i

O R s e b e s a r 5 5 7

d e n g a n n i l a i 9 5

(onfidence Interval

l 1 9 lt O R lt 2 8 2 3

P a s i e n d e n g a n s t a t u s

D M m e m p u n y a i risiko

6 k a l i u n t u k

m e n g a l a m i i n f e k s i

n o s o k o m i a l s a i u r a n

k e m i h d i b a n d i n g k a n

d e n g a n p a s i e n y a n g

t i d a k m e n d e r i t a D M

d e n g a n n i l a i O R

7

s e b e s a r 6 0 0 d e n g a n

n i l a i 9 5 Confidence

Interval 1 22 lt O R lt

3 2 2 6

Andry K a r a k t e r i s t i k P a s i e n - D e s k r i p k i f H a s i i p e n e l i t i a n d a r i

Lukandy P a s i e n I n f e k s i S a i u r a n r e t r o s p e k t i f 4 3 o r a n g p e n d e r i t a

K e m i i i d i P o l i u r o l o g i

R S U D D r P i m g a d i

K o t a M e d a n T a h u n

2 0 1 2 - 2 0 1 3

I S K d i d a p a t k a n 5 3 5

p a d a k e l o m p o k u s i a

gt 5 0 t a h u n 5 1 2

b e i j e n i s k e i a m i n l a k i -

l a k i 1 0 0 t i d a k

m e n d e r i t a

v e s i c o u r e t r a l r e f l u x

7 0 Benign Prostatic

Hyperplasia 1 1 6

b a t u s a i u r a n k e m i h

2 7 9 d i a b e t e s t i p e 2

D a r i h a s i l p e n e l i t i a n

i n i d a p a t d i s i m p u l k a n

b a h w a p e n d e r i t a i S K

l e b i h b a n y a k t e r j a d i

p a d a l a k i - l a k i d a n

p e n d e r i t a I S K l e b i h

b a n y a k d i j u m p a i p a d a

k e l o m p o k u m u r gt 5 0

t a h u n s e r t a d i t e m u k a n

I S K d e n g a n B P H

B S K d a n D M T i p e 2

BAB 11

TINJAUAN PUSTAKA

21 Landasan Teori

211Infeksi Saiuran Keniih

A Definisi

I n f e k s i S a i u r a n K e m i h a d a i a h i n v a s i d a n m u l t i p l i k a s i m i k r o o r g a n i s m e a t a u

p a r a s i t d a l a m j a r i n g a n t u b u h k h u s u s n y a s a i u r a n k e m i h y a n g t e r d i r i d a r i g i n j a l

u r e t e r b u l i - b u l i d a n u r e t r a y a n g d i i a n d a i d e n g a n a d a n y a b a k t e r i 1 0 c f i i (colony

forming unit) p e r m l p a d a p e n g a m b i l a n c o n t o h u r i n ( P u m o m o 2 0 1 1 )

I n f e k s i s a i u r a n k e m i h a d a l a l i s u a t u i n f e k s i y a n g m e l i b a t k a n g i n j a l lU e ter

b u l i - b u l i a t a u p u n u r e t r a I n f e k s i s a i u r a n k e m i h ( I S K ) a d a l a l i i s t i l a h u m u m y a n g

m e n u n j u k k a n k e b e r a d a a n m i k r o o r g a n i s m e d a l a m u r i n ( S u d o y o 2 0 0 6 )

B a k t e r i u r i a b e r m a k n a (significant hacteriuria) a d a i a h s u a t u k e a d a a n y a n g

m e n u n j u k k a n p e n u m b u l i a n m i k r o o r g a n i s m e m u m i l e b i h d a r i 1 0 c f t L m l p a d a

b i a k a n u r i n B a k t e r i u r i a b e r m a k n a m u n g k i n t a n p a d i s e r t a i p r e s e n t a s i k l i n i s I S K

d a n d i n a m a k a n b a k t e r i u r i a a s i m t o m a t i k (convert hacteriuria) S e b a l i k n y a

b a k t e r i u r i a b e n n a k n a d i s e r t a i p e r s e n t a s i k l i n i s I S K d i n a m a k a n b a k t e r i u r i a

s i m t o m a t i k P a d a b e b e r a p a k e a d a a n t e r d a p a t p a s i e n d e n g a n p e r s e n t a s i k l i n i s I S K

n a m u n t a n p a b a k t e r i u r i a b e n n a k n a S e l a i n i t u d i k a t a k a n p i u r i a ( l e u k o s i t d a l a m

u r i n ) b e n n a k n a (significant pyuria) b i l a d i t e m u k a n n e u t r o f i l gt 1 0 s e l p e r l a p a n g a n

p a n d a n g ( S u d o y o 2 0 0 6 )

B Epidemiologi

I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m u k a n d i p r a k t i k u m u m w a i a u p u n b e n n a c a m - m a c a m a n t i b i o t i k a s u d a h

t e r s e d i a l u a s d i p a s a r a n D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r

2 5 - 3 5 s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a

S e l a m a p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n

9

10

c e n d e r u n g m e n d e r i t a i S K d i b a n d i n g k a n l a k i - l a k i I S K b e m l a n g p a d a l a k i - l a k i

j a r a n g d i l a p o r k a n k e c u a l i d i s e r t a i f a k t o r p r e d i s p o s i s i ( p e n c e t u s )

P r e v a l e n s i b a k t e r i u r i a a s i m t o m a t i k l e b i h s e r i n g d i t e m u k a n p a d a p e r e m p u a n

P r e v a l e n s i s e l a m a p e r i o d e s e k o l a h (school girls) 1 m e n i n g k a t m e n j a d i 5

s e l a m a p e r i o d e a k t i f s e c a r a s e k s u a l P r e v a l e n s i i n f e k s i a s i m t o m a t i k m e n i n g k a t

m e n c a p a i 3 0 b a i k l a k i - l a k i m a u p u n p e r e m p u a n b i l a d i s e r t a i f a k t o r p r e d i s p o s i s i

( S u d o y o 2 0 0 6 )

C Kiasifikasi

I n f e k s i s a i u r a n k e m i h d a p a t d i b a g i m e n j a d i d u a k a t e g o r i u m u m b e r d a s a r k a n

l o k a s i a n a t o m i y a i t u

1 ) I n f e k s i s a i u r a n k e m i h b a w a h

2 ) I n f e k s i s a i u r a n k e m i h a l a s

P r e s e n t a s i k l i n i s d a r i i n f e k s i s a i u r a n k e m i h b a w a l i t e r g a n t u n g d a r i gender

y a i t u

a ) P e r e m p u a n

a S i s t i t i s

S i s t i t i s a d a i a h p r e s e n t a s i k l i n i s i n f e k s i k a n d u n g k e m i h d i s e r t a i

b a k t e r i u r i a b e n n a k n a

b S i n d r o m U r e t r a A k u t ( S U A )

S i n d r o m a u r e t r a a k u t a d a i a h p r e s e n t a s i k l i n i s s i s t i t i s t a n p a d i t e m u k a n

a d a n y a m i k r o o r g a n i s m e d a l a m L u i n ( s t e r i l ) d a n s e r i n g d i n a m a k a n

s i s t i t i s b a k t e r i a l i s

b ) L a k i - l a k i

P r e s e n t a s i k l i n i s i n f e k s i s a i u r a n k e m i h p a d a l a k i - l a k i m u n g k i n s i s t i t i s

p r o s t a t i t i s e p i d i m i d i s d a n u r e t r i t i s

I n f e k s i s a i u r a n k e m i h a t a s t e r b a g i m e n j a d i 2 y a i t u

1 ) P i e l o n e f r i t i s A k u t ( P N A )

P i e l o n e f r i t i s a k u t a d a l a l i p r o s e s i n f l a m a s i p a r e n k i m g i n j a l y a n g d i s e b a b k a n

o l e h m f e k s i b a k t e r i

11

2 ) P i e l o n e f r i t i s K r o n i s ( P N K )

P i e l o n e f r i t i s k r o n i s m u n g k i n a k i b a t l a n j u t d a r i i n f e k s i b a k t e r i

b e r k e p a n j a n g a n a t a u i n f e k s i s e j a k m a s a k e c i i O b s t r u k s i s a i u r a n k e m i h d a n

r e f l u k s v e s i k o u r e t e r d e n g a n a t a u t a n p a b a k t e r i u r i a k r o n i k s e r i n g d i i k u t i

p e m b e n t u k a n j a r i n g a n i k a t p a r e n k i m g i n j a l y a n g d i t a n d a i d e n g a n

p i e l o n e f r i t i s k r o n i k y a n g s p e s i f i k ( S u d o y o 2 0 0 6 )

D Etiologi

P a d a k e a d a a n n o r m a l u r i n b e r s i f a t s t e r i l U m u m n y a I S K d i s e b a b k a n o l e h

k i i m a n g r a m n e g a t i f E s c h e r i c h i a c o l i m e m p a k a n p e n y e b a b t e r b a n y a k b a i k p a d a

y a n g s i m t o m a t i k m a u p u n y a n g a s i m t o m a t i k y a i t u 7 0 - 9 0 E n t e r o b a k t e r i a s e p e r t i

P r o t e u s m i r a b i l i s ( 3 0 d a r i i n f e k s i s a i u r a n k e m i h p a d a a n a k l a k i - l a k i t e t a p i

k u r a n g d a r i 5 p a d a a n a k p e r e m p u a n ) K l e b s i e l l a p n e u m o n i a d a n P s e u d o m o n a s

a e m g i n o s a d a p a t j u g a s e b a g a i p e n y e b a b O r g a n i s m e g r a m p o s i t i f s e p e r t i

S t r e p t o c o c c u s f a e c a l i s ( e n t e r o k o k u s ) S t a p h y l o c o c c u s e p i d e n n i d i s d a n

S t r e p t o c o c c u s v i r i d a n s j a r a n g d i t e m u k a n P a d a u r o p a t i o b s t m k t i f d a n k e l a i n a n

s t r u k t u r s a i u r a n k e m i h p a d a a n a k l a k i - l a k i s e r i n g d i t e m u k a n P r o t e u s s p e c i e s P a d a

I S K n o s o k o m i a l a t a u I S K k o m p l e k s l e b i h s e r i n g d i t e m u k a n k u m a n P r o t e u s d a n

P s e u d o m o n a s ( L u m b a n b a t u S M 2 0 0 3 )

E Patofisiologi

P a d a i n d i v i d u n o n n a l b i a s a n y a u r i n l a k i - l a k i m a u p u n p e r e m p u a n s e l a l u

d a l a m k e a d a a n s t e r i l k a r e n a d i p e r t a l i a n k a n o l e h j u m l a l i d a n f r e k u e n s i b e r k e m i h

U t e r o d i s t a l m e m p a k a n t e m p a t k o l o n i s a s i m i k r o o r g a n i s m e nonpathogenic

fastidious G r a m - p o s i t i f d a n g r a m n e g a t i f ( S u d o y o 2 0 0 6 )

H a m p i r s e m u a I S K d i s e b a b k a n i n v a s i m i k r o o r g a n i s m e ascending d a r i u r e t r a

k e d a l a m k a n d u n g k e m i b P a d a b e b e r a p a p a s i e n t e r t e n t u i n v a s i m i k r o o r g a n i s m e

d a p a t m e n c a p a i k e g i n j a l P r o s e s i n i d i p e n n u d a h o l e h k o n d i s i r e f l u k s

v e s i k o i i r e t e r a l P r o s e s i n v a s i m i k r o o r g a n i s m e h e m a t o g e n s a n g a t j a r a n g d i t e m u k a n

d i k l i n i k m u n g k i t a k i b a t l a n j u t d a r i b a k t e r e m i a G i n j a l d i d u g a m e n i p a k a n l o k a s i

12

i n f e k s i s e b a g a i a k i b a t l a n j u t d a r i s e p t i k e m i a a t a u e n d o k a r d i t i s a k i b a t S t a f i l o k o k u s

a u r e u s K e l a i n a n g i n j a l y a n g t e r k a i t d e n g a n e n d o k a r d i t i s ( S t a f i l o k k o k u s a u r e u s )

d i k e n a l d e n g a n N e p h r i t i s L o h e i n B e b e r a p a p e n e l i t i a n m e l a p o r k a n p i e l o n e f r i t i s

a k u t ( P N A ) s e b a g a i a k i b a t l a n j u t i n v a s i h e m a t o g e n ( S u d o y o 2 0 0 6 )

F Faktor Risiko

P a t o f i s i o l o g i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h d a p a t d i p e n g a n i h i o l e h

b e b e r a p a f a k t o r A d a p u n b e b e r a p a f a k t o r risiko y a n g m e m p e n g a n i l i i t e r j a d i n y a

i n f e k s i s a i u r a n k e m i h a n t a r a l a i n

1 ) U s i a

I n s i d e n I S K m e n i n g k a t b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i

m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n a d a n y a a b n o r m a l i t a s a n a t o m i y a n g

m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n k e m i h s e p e r t i p e m b e s a r a n p r o s t a t

d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e

P e n y e b a b l a i n t e r m a s u k p e r i n e u m y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s

p e n y a k i t n e u r o m u s k n l a r d a n k a t e t e r i s a s i b u l i - b u l i S e l a i n i t u i n s i d e n I S K

m e n c a p a i 1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o s e 2 0 0 9 F o x m a n e t a l 2 0 1 0

R o n a l d 2 0 1 1 )

M e n u m t t e o r i y a n g d i k e m u k a k a n o l e h S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a d a u s i a

l a n j u t a k a n t e r j a d i p e n i n g k a t a n k e r e n t a n a n t e r h a d a p p e n y a k i t P a d a u s i a d i a t a s 5 0

t a l i u n t e r j a d i p e n u m n a n k e m a m p u a n d a l a m m e m p e r t a h a n k a n s t e n l i t a s b a i k p a d a

k a n d u n g k e m i h m a u p u n u r e t r a H a l t e r s e b u t d i s e b a b k a n o l e h i n v o l u s i t i m u s

I n v o l u s i s e l t i m u s m e n y e b a b k a n j u m l a h se d a n k u a l i t a s r e s p o n s s e l T s e m a k i n

b e r k u r a n g J u m l a h s e l T m e m o r i m e n i n g k a t n a m u n s e m a k i n s u l i t u n t u k

b e r k e m b a n g t e r u t a m a s i t o t o k s i k s e l T ( C D ^ ) d a n s e l T h l ( C D ^ ^ ) k a r e n a t e r j a d i

a p o p t o s i s S i t o t o k s i k s e l T ( C D ^ ^ ) b e i p e r a n d a l a m r e s p o n s i m u n t e r h a d a p a n t i g e n

p a d a s e l y a n g d i i n f e k s i d e n g a n c a r a m e m b u n u l i s e l y a n g t e r i n f e k s i u n t u k

m e n c e g a h p e n y e b a r a n m f e k s i s e d a n g k a n s e l T h l ( C D ^ ^ ) b e r p e r a n m e m b a n t u s e l

B u n t u k m e m p r o d u k s i a n t i b o d i

13

2 ) J e n i s k e l a m m d a n a k t i v i t a s s e k s u a l

I n s i d e n s i I S K y a n g r e n d a h p a d a p r i a d i p e n g a n i h i o l e h 3 f a k t o r y a i t u

1 L e b i h s e d i k i t t e r j a d i k o l o n i s a s i s e k i t a r u r e t r a k a r e n a t i d a k a d a n y a t e m p a t

s e p e r t i v a g i n a p a d a p e r e m p u a n

2 M e m i l i k i u r e t r a y a n g p a n j a n g

3 A d a n y a s u b s t a n s i a n t i b a k t e r i a l p a d a c a i r a n p r o s t a t

U r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a h d e n g a n d e k a t n y a v a g i n a l

v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h l e b i h s e r i n g

p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a f l o r a n o n n a l p a d a d a e r a l i p e r i u r e t r a t e r d i r i

d a r i o r g a n i s m e s e p e r t i l a c t o b a c i l l i i s y a n g m e m b a n t u m e l a w a n k o l o n i s a s i b a k t e r i

p a t o g e n p a d a s a i u r a n k e m i h P e r u b a l i a n l i n g k i m g a n d a r i p e r i u r e t r a l s e p e r t i

p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k b i s a m e n g g a n g g u f l o r a

n o r m a l s e h i n g g a m e m u n g k i n k a n b a k t e r i p a t o g e n b e r k o l o n i s a s i d a n m e n y e b a b k a n

i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

P a d a w a n i t a l e b i h d a r i 5 0 t a h u n a t a u l e b i h m e n o p a u s e m e m p a k a n f a k t o r

l a i n y a n g m e n i n g k a t k a n P V R Post Void Residual) s e l a i n p e n u r u n a n k o i i t r a k t i i i t a s

o t o t d e t r u s o r P e n u m n a n e s t r o g e n y a n g d i s e b a b k a n m e n o p a u s e d a p a t

m e n i n g k a t k a n p H v a g i n a l d a n m e n u m n k a n j u m l a l i l a c t o b a c i l l i A k i b a m y a t e r j a d i

p e n i n g k a t k a n k o l o n i s a s i d a r i b a s i l g r a m n e g a t i f s e h i n g g a m e n i n g k a t k a n r e s i k o

t e r j a d i n y a I S K P a d a p r i a p r o s t a t m e n s e k r e s i k a n c a i r a n y a n g m e n g a n d i m g z i n k

y a n g m e m i l i k i a k t i f i t a s m i k r o b i a l ( K i m 2 0 1 2 )

S e l a i n i t u p i j a t a n u r e t r a s e p e r t i y a n g t e r j a d i s e l a m a h u b u n g a n s e k s u a l

m e n y e b a b k a n m a s u k n y a b a k t e r i k e d a l a m k a n d u n g k e m i h d a n m e m p a k a n h a l

y a n g p e n t i n g d a l a m p a t o g e n e s i s m f e k s i s a l i u a n k e m i h p a d a p e r e m p u a n m u d a

B u a n g a i r k e c i l s e t e l a h h u b u n g a n s e k s u a l t e r b u k t i m e n u m n k a n risiko s i s t i t i s

m u n g k i n k a r e n a t i n d a k a n i n i m e n i n g k a t k a n e r a d i k a s i b a k t e r i y a n g m a s u k s e l a m a

h u b u n g a n s e k s u a l ( K i m 2 0 1 2 )

3 ) T i n g k a t P e n d i d i k a n

P e n g e t a h u a n s e s e o r a n g t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t

p e n d i d i k a n S e s e o r a n g y a n g m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m i u i g k i n a n

p e n g e t a h u a n t e n t a n g k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o n n a s i y a n g d i d a p a t k a n

14

t e n t a n g k e s e h a t a n l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h

S e b a l i k n y a p e n d i d i k a n y a n g k u r a n g d a p a t m e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g

t e r h a d a p n i l a i - n i l a i y a n g b a n i d i k e n a l ( N o t o a d i n o j o 2 0 0 3 )

4 ) R i w a y a t D i a b e t e s M e l i t u s

M e n u r u t S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a s i e n d e n g a n s t a t u s D M s a n g a t

b e r i s i k o u n t u k m e n g a l a m i i n f e k s i s a i u r a n k e m i h A b n o n n a l i i a s s t n i k t u r d a n

k a n d u n g k e m i h n e u r o g e n i k a k i b a t n e u r o p a t i o t o n o m a t a u s t r o k e p a d a p a s i e n D M

m e n y e b a b k a n p e n g o s o n g a n k a n d u n g k e m i h t i d a k n o n n a l D M j u g a d a p a t

m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a h a n a n t u b u h y a n g b e r p o t e n s i m e n i n g k a t

risiko t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a h a n a n t u b u h t e r s e b u t d i a n t a r a n y a

a d a i a h k e g a g a l a n m i g r a s i s e l intracellular killing f a g o s i t o s i s d a n k e m o t a k s i s

p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n m e k a n i s m e p e r t a h a n a n

a l a m i a h i o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p i n f e k s i

5 ) K e h a m i i a n

K e c e n d e r u n g a n i n f e k s i s a i u r a n k e m i h b a g i a n a t a s s e l a m a k e h a m i i a n

d i s e b a b k a n o l e h p e n u m n a n k e k u a t a n u r e t e r p e n u m n a n p e r i s t a l t i k u r e t e r d a n

i n k o m p e t e n s i s e m e n t a r a k a l u p v e s i k o i u - e t e r a l y a n g t e r j a d i s e l a m a h a m i l

6 ) S u m b a t a i i

A d a n y a I i a i a n g a n a l i r a n b e b a s u r i n s e p e r t i t u m o r s t r i k t r a a b a t u a t a u

h i p e r t r o f i p r o s t a t d a p a t m e n y e b a b k a n h i d r o n e f r o s i s d a n risiko i n f e k s i s a i u r a n

k e m i l i y a n g s a n g a t t i n g g i S e l a i n i t u s u p e r i n f e k s i p a d a s u m b a t a n s a i u r a n k e m i h

d a p a t m e n y e b a b k a n k e m s a k a n j a r i n g a n g i n j a l y a n g c e p a t

7 ) D i s f u n g s i n e u r o g e n i k k a n d u n g k e m i h

G a n g g u a n s a r a f y a n g b e k e r j a p a d a k a n d m i g k e m i h s e p e r t i p a d a j e j a s k o r d a

s p i n a l i s t a b e s d o r s a i i s m u l t i p e l s k l e r o s i s d i a b e t e s m e l i t u s a t a u p e n y a k i t l a i n

d a p a t b e r h u b u n g a n d e n g a n i n f e k s i s a i u r a n k e m i h I n f e k s i d a p a t d i a w a l i o l e h

p e n g g u n a a n k a t e l e r u n t u k d r a i n a s e k a n d i u i g k e m i h d a n d i d u k i m g o l e h s t a t i s u r i n

d a l a m k a n d u n g k e m i l i u n t u k j a n g k a w a k t u y a n g l a m a

8 ) R e f l u k s v e s i k o m e t e r a

K e a d a a n i n i d i d e f i n i s i k a n s e b a g a i r e f l u k s u r i n d a r i k a n d u n g k e m i b k e u r e t e r

d a n k a d a n g s a m p a i k e p e l v i s r e n a l H a l i n i t e r j a d i s e l a m a b u a n g a i r k e c i l a t a u

15

d e n g a n p e n i n g k a t a n t e k a n a n p a d a k a n d u n g k e m i h R e f l u k s v e s i k o i i r e t e r a l d a p a t

d i b u k t i k a n d e n g a n a d a n y a g c r a k a n r e t r o g r a d z a t r a d i o o p a k a t a u r a d i o a k t i f m e l a l u i

s i s t o u r e t r o g r a m s e l a m a b u a n g a i r k e c i l R e f l u k s v e s i k o i i r e t e r a l b i a s a n y a

d i s e b a b k a n k a r e n a a d a n y a g a n g g u a n a n a t o m i s p a d a p e r t e m u a n v e s i k o i i r e t e r a l

y a n g d a p a t m e n y e b a b k a n r e f l u k s u r i n d i s e r t a i b a k t e r i d a n k a r e n a i t u t e r j a d i l a h

i n f e k s i s a l r a a n k e m i h

9 ) F a k t o r v i r u l e n s i b a k t e r i

F a k t o r v i r u l e n s i b a k t e r i m e m p e n g a r u b i k e m u n g k i n a n vragt7 t e r t e n m d a l a m

m e n y e b a b k a n i n f e k s i t r a k i u s u r i n a r i u s H a m p i r s e m u a strain F c o l i y a n g

m e n y e b a b k a n p i e l o n e f r i t i s p a d a p a s i e n d e n g a n t r a k i u s u r i n a r i u s n o m i a l s e c a r a

a n a t o m i k m e m p u n y a i p i l u s t e r t e n t u y a n g m e m p e r a n t a r a i p e r l e k a t a n p a d a b a g i a n

d i g a k t o s i d a d a n g l i k o s f i n g o l i p i d y a n g a d a d i u r o e p i t e l Strain y a n g m e n i m b u l k a n

p i e l o n e f r i t i s j u g a b i a s a n y a m e m p a k a n p e n g b a s i l h e m o l i s i n m e m p u n y a i

a e r o b a k t i n d a n r e s i s t e n t e r h a d a p k e r j a b a k t e r i s i d a l d a r i s e m m m a n u s i a

1 0 ) F a k t o r g e n e t i k

F a k t o r g e n e t i k p e n j a m u m e m p e n g a n i l i i k e r e n t a n a n t e r h a d a p i n f e k s i t r a k t u s

u r i n a r i u s J u m l a h d a n t i p e r e s e p t o r p a d a s e l u r o e p i t e l t e m p a t b a k t e r i d a p a t

m e n e m p e l s e l i d a k i i y a s e b a g i a i i d i t e n t u k a r i s e c a r a g e n e t i k ( I s s e l b a c h e r 2 0 0 9 )

G Manifestasi Klinis

G e j a l a k l i n i s d a r i i n f e k s i s a i u r a n k e m i h s e s u a i d e n g a n b a g i a n s a i u r a n k e m i h

y a n g t e r i n f e k s i a d a i a h s e b a g a i b e r i k u t

1 ) I n f e k s i s a i u r a n k e m i h b a g i a n b a w a l i

K e l u h a n p a s i e n b i a s a n y a b e m p a r a s a s a k i t a t a u r a s a p a n a s d i u r e t r a s e w a k t u

k e n c i n g d e n g a n a i r k e m i h s e d i k i t - s e d i k i t s e r t a r a s a t i d a k e n a k d i d a e r a h

s i i p r a p u b i k

2 ) I n f e k s i s a i u r a n k e m i h b a g i a n a t a s

P a d a i n t e k s i s a i u r a n k e m i h b a g i a n a t a s d a p a t d i t e m u k a n g e j a l a s e p e r t i s a k i t

k e p a l a m a l a i s e m u a l m m i t a h d e n i a m m e n g g i g i l r a s a t i d a k e n a k a t a u

n y e r i d i p i n g g a n g ( T e s s y d k k 2 0 0 1 )

16

H Tatalaksana

T u j u a n p e n a t a l a k s a n a a a n i n f e k s i s a i u r a n k e m i h a d a i a h m e n c e g a h d a n

m e n g h i l a n g k a n g e j a l a m e n c e g a h d a n m e n g o b a t i b a k t e n e m i a d a n b a k t e r i u r i a s e r t a

m e n c e g a h d a n m e n g u r a n g i r i s i k o k e r u s a k a n g i n j a l y a n g m u n g k i n t i m b u l d e n g a n

p e m b e r i a n o b a t - o b a t a n y a n g s e n s i t i f m u r a l i d a n a m a n d e n g a n e f e k s a m p i n g y a n g

m i n i m a l

a ) i n f e k s i s a i u r a n k e m i h ( I S K ) b a w a h

P r i n s i p p e n a t a l a k s a n a a n I S K b a w a h m e l i p u t i intake c a i r a n y a n g b a n y a k

a n t i b i o t i k y a n g a d e k u a t d a n b i l a p e r l u t e r a p i s i m t o m a t i k u n t u k a l k a l i s a s i

u r i n

i H a m p i r 8 0 p a s i e n a k a n m e m b e r i k a n r e s p o n s e t e l a h 4 8 j a m d e n g a n

a n t i b i o t i k a t u n g g a l s e p e r t i a m p i s i l i n 3 g r a m a t a u t r i m e t o p r i m 2 0 0 m g

i i B i l a i n f e k s i m e n e t a p d i s e r t a i k e l a i n a n u r i n a l i s i s ( l e u k o s i u i a ) d i p e r i u k a n

t e r a p i k o n v e n s i o n a l s e l a m a 5 - 1 0 h a r i

i i i P e m e r i k s a a n m i k r o s k o p i s u r i n d a n b i a k a n u r i n t i d a k d i p e r i u k a n b i l a

s e m u a g e j a l a h i l a n g d a n t a n p a l e u k o s u r i a

b ) I n f e k s i s a i u r a n k e m i h ( I S K ) a t a s

P a d a u m u m n y a p a s i e n d e n g a n p i e l o n e f r i t i s a k u t m e m e r l u k a n r a w a t i n a p

u n t u k m e m e l i h a r a s t a t u s h i d r a s i d a n t e r a p i a n t i b i o t i k a p a r e n t e r a l p a l i n g

s e d i k i t 4 8 j a m ( S u d o y o 2 0 0 6 )

i Komplikasi

K o m p l i k a s i i n f e k s i s a i u r a n k e m i h t e r g a n t u n g d a r i t i p e y a i t u i n f e k s i s a i u r a n

k e m i h t i p e s e d e r h a n a (uncomplicated) d a n t i p e b e r k o m p l i k a s i (complicated)

1 ) I n f e k s i s a i u r a n k e m i h s e d e r h a n a (uncomplicated)

I n f e k s i s a i u r a n k e m i h a k u t t i p e s e d e r h a n a ( s i s t i t i s ) y a i t u n o n - o b s t r u k s i d a n

b u k a n p e r e m p u a n h a m i l m e m p a k a n p e n y a k i t r i n g a n (self limited disiase)

d a n t i d a k m e n y e b a b k a n a k i b a t l a n j u t j a n g k a l a m a

2 ) I n f e k s i s a i u r a n k e m i h b e r k o m p l i k a s i (complicated)

a ) I n f e k s i s a i u r a n k e m i h s e l a m a k e h a m i i a n

b ) i n f e k s i s a i u r a n k e m i h p a d a d i a b e t e s m e l i t u s ( S u d o y o 2 0 0 6 )

17

22 Kerangka Teori

J

U s i a

J e n i s K e i a m i n

T i n g k a t P e n d i d i k a n

R i w a y a t D i a b e t e s M e l i m s

S u m b a t a n bullT

K e h a m i i a n

D i s f u n g s i n e u r o g e n i k

R e f l u k s v e s i k o i i r e t e r a l

V i r u l e n s i b a k t e r i

F a k t o r g e n e t i k

I n f e k s i b a k t e r i g r a m p o s i t i f a t a u n e g a t i v e p a d a s a i u r a n k e m i h

I n f e k s i S a i u r a n K e m i h

Keterangan

I j = V a r i a b e l y a n g t i d a k d i t e l i t i

= V a r i a b e l y a n g d i t e l i t i

18

Hipotesis

H i p o t e s i s d a l a m p e n e l i t i a n i n i a d a i a h

H O t i d a k t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n

t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

H I t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

BAB 111

M E T O D E PENELITIAN

31 Jenis Penelitian

P a d a p e n e l i t i a n i n i j e n i s p e n e l i t i a n y a n g d i g u n a k a n a d a i a h p e n e l i t i a n

o b s e r v a s i o n a i a n a l i t i k d e s a i n cross scclional d e n g a n m e n g g u n a k a n d a t a s e k u n d e r

d a r i r e k a m m e d i s p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1 D e s e m b e r

2 0 1 5

32 Waktu dan Tempat Penelitian

321 Waktu Penelitian

W a k t u p e n e l i t i a n d i l a k s a n a k a n p a d a t a n g g a l 1 O k t o b e r s a m p a i d e n g a n 3 0

O k t o b e r 2 0 1 6

322 Tempat Penelitian

P e n e l i t i a n i n i d i l a k s a n a k a n d i R u m a l i S a k i t M u h a m m a d i y a h P a e m b a n g ( d i

R u a n g R e k a m M e d i s )

33 Populasi dan Sampel Penelitian

331Populasi Penelitian

P a d a p e n e l i t i a n i n i p o p u l a s i t a r g e t a d a l a l i p a s i e n r a w a t i n a p d a n r a w a t j a l a n

d i R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g s e d a n g k a n p o p u l a s i t e r j a n g k a u n y a

a d a i a h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

332Sampel dan Besar Sampel Penelitian

P a d a p e n e l i t i a n i n i s a m p e l p e n e l i t i a n a d a i a h p a s i e n r a w a t i n a p d a n r a w a t

j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e

1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 y a n g m e m e n u h i k r i t e r i a i n k l u s i p e n e l i t i a n

1 9

20

d e n g a n b e s a r s a m p e l y a n g l a y a k d a l a m p e n e l i t i a n m e n u r u t t e o r i R o s c o e a d a i a h

a n t a r a t i g a p u l u h s a m p a i l i m a r a t i i s o r a n g ( S u g i y o n o 2 0 1 5 )

333 Krttena Inklusi dan Eksklusi

A Kriteria Inklusi

P a d a p e n e l i t i a n i n i k r i t e r i a i n k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t i n a p

d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i

P a l e m b a n g y a n g d i d i a g n o s a m e n g a l a m i i n f e k s i s a i u r a n k e m i h s e r t a m e m i l i k i d a t a

r e k a m m e d i s p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

B Kriteria Eksklusi

P a d a p e n e l i t i a n i n i k r i t e r i a e k s k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t

i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 d e n g a n d a t a r e k a m m e d i s

y a n g t i d a k l e n g k a p

334 Cara Pengambilan Sampel Penelitian

C a r a p e n g a m b i l a n s a m p e l y a n g d i g u n a k a n d a l a m p e n e l i t i a n i n i a d a l a l i

m e n g g u n a k a n t e k n i k consecutive sampling P a d a consecutive sampling s e t i a p

p a s i e n y a n g m e m e n u h i k r i t e r i a p e n e l i t i a n d i m a s u k k a n d a l a m p e n e l i t i a n s a m p a i

k u r u n w a k t u t e r t e n U i s e h i n g g a j u m l a h m i n i m a l y a n g d i p e r i u k a n t e r p e n u h i

( S a s t r o a s m o r o 2 0 1 1 )

34 Variabel Penelitian

341 Variabel Dependent

V a r i a b e l dependent f t e r i k a t ) d a l a m p e n e l i t i a n i n i a d a i a h i n f e k s i s a i u r a n

k e m i h

342 Variabel Independent

V a r i a b e l independent ( b e b a s ) d a l a m p e n e l i t i a n i n i a d a i a h u s i a j e n i s

k e l a i n i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

21

35 Definisi Operasional

Tabel 31 Definisi Operasional

Variabel Alat Cara ueiinisi rldsil L KUr I7 i l l 11 Lz fe 1 V

oKaia LiKur Penelitian Ukur Ukur

Infeksi P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Saiuran d i d i a g n o s a o l e h m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Keniih d o k t e r m e n g a l a m i m e d i s

i n f e k s i s a i u r a n

k e m i h d a n t e r c a n t u m

d i r e k a m m e d i s

U s i a L a m a n y a t a h u n R e k a m O b s e r v a s i 1 lt 5 0 t a h u n O r d i n a l

k e h i d u p a n p a s i e n m e d i s r e k a m 2 gt 5 0 t a l i u n ( k a t e g o r i k )

d a r i l a h i r s a m p a i m e d i s

s e k a r a n g d a n

t e r c a n t u m d i r e k a m

m e d i s

Jenis P r o f i l a n a t o m i a t a u R e k a m O b s e r v a s i 1- L a k i - l a k i N o m i n a l

Keiamin b i o l o g i s p a s i e n y a n g m e d i s r e k a m 2 P e r e m p u a n ( k a t e g o r i k )

d i b e d a k a n m e n j a d i m e d i s

i a k i - l a k i d a n

n e r e m m i a n s e r t a

t e r c a n t u m d i r e k a m

m e d i s

Tingkat P e n d i d i k a n f o n n a l R e k a m O b s e r v a s i 1 P e n d i d i k a n O r d i n a l

Pendidikan t e r a k h i r y a n g m e d i s r e k a m d a s a r ( S D ( k a t e g o r i k )

d i t e m p u h o l e h m e d i s M I S M P

p a s i e n d a n t e r c a n t u m d a n M T s )

d i r e k a m m e d i s 2 P e n d i d i k a n

m e n e n g a l i

d a n t i n g g i

22

( S M A M A

S M K

M A K

d i p l o m a

s a r j a n a

m a g i St e r

s p e s i a l i s

d a n d o k t o r )

Riwayat P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Diabetes d i d i a g n o s i s d e n g a n m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Melitus d i a b e t e s m e l i t u s d a n

t e r c a n t u m d i d a l a m

r e k a m m e d i s

m e d i s

36 Cara Pengumpulan Data

361 Data Sekunder

P e n g u m p u l a n d a t a p a d a p e n e l i t i a n i n i d i p e r o l e h d a r i d a t a s e k u n d e r y a i t u

r e k a m m e d i s p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

37 Metode Teknik Analisis Data

371Cara Pengolahan dan Analisis Data

P e n g o l a h a n d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n m e l a l u i e m p a t t a h a p y a i t u

i Oala Entry

P a d a t a i i a p i n i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n riwayat d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g y a n g t e l a h d i d a p a t d a n

r e k a m m e d i s d i k u m p u l k a n d a n d i m a s u k k a n k e d a l a m p r o g r a m spss

23

2 Editing

P a d a t a h a p i n i d a t a i i s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n y a n g t e l a h d i m a s u k k a n k e d a l a m p r o g r a m s p s s

d i p e r i k s a k e m b a l i a p a k a h s u d a h l e n g k a p d a n t i d a k a d a k e k e l i r u a n

3 ( oding

S e t e l a h m e l a l u i p r o s e s editing d a t a - d a t a t e r s e b u t d i b e r i k o d e t e r t e n t u a n t a r a

l a i n k o d e 1 u n t u k u s i a gt 5 0 t a h u n j e n i s k e i a m i n p e r e m p u a n t i n g k a t

p e n d i d i k a n d a s a r t e r d a p a t r i w a y a t d i a b e t e s m e l i t u s d a n i n f e k s i s a i u r a n

k e m i h s e d a n g k a n k o d e 2 u n t u k u s i a lt 5 0 t a h u n j e n i s k e i a m i n l a k i - l a k i

t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i t i d a k t e r d a p a t r i w a y a t d i a b e t e s

m e l i t u s d a n b u k a n i n f e k s i s a i u r a n k e m i h s e h i n g g a m e m u d a h k a n d a l a m

m e l a k u k a n a n a l i s i s d a t a

4 Tahulaling

P a d a t a h a p i n i d a t a y a n g s a m a d i k e l o m p o k k a n s e c a r a t e l i t i d a n t e r a t m

k e m u d i a n d i l i i t u n g d e n g a n m e n g g u n a k a n p r o g r a m sps s d a n d i j u m l a h k a i i

l a l u d i s a j i k a n d a l a m b e n t u k t a b e l - t a b e l

U n t u k m e n g a n a l i s i s d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n a n a l i s i s d a t a

u n i v a r i a t d a n b i v a r i a t d e n g a n m e n g g u n a k a n p r o g r a m s p s s s e b a g a i b e r i k u t

A A n a l i s i s u n i v a r i a t

A n a l i s i s u n i v a r i a t d i l a k u k a n d e n g a n c a r a m e l a k u k a n a n a l i s i s p a d a s e t i a p

v a r i a b e l h a s i l p e n e l i t i a n d e n g a n t u j u a n u n t u k m e n g e t a h u i d i s t r i b u s i p r o p o r s i p a d a

s e t i a p v a r i a b e l p e n e l i t i a n D a t a d i s a j i k a n d a l a m b e n t u k t a b e l d a n n a r a s i

B A n a l i s i s b i v a r i a t

A n a l i s i s b i v a r i a t d i l a k u k a n d e n g a n m e n g g u n a k a n u j i h i p o t e s i s chi-square

U j i h i p o t e s i s chi-square d a p a t d i g u n a k a n d e n g a n s y a r a t y a i t u lt 2 0 s e l y a n g

m e m p u n y a i n i l a i expected count k u r a n g d a r i l i m a s e h i n g g a j i k a t i d a k m e m e n u h i

s y a r a t u j i chi-square m a k a u j i y a n g d i g u n a k a n a d a i a h u] fisher ( D a h l a n 2 0 1 4 )

B a t a s k e m a k n a a n y a n g d i g u n a k a n a d a i a h a = 0 0 5 J i k a d i d a p a t k a n p value lt 0 0 5

p a d a u j i s t a t i s t i k m a k a t i d a k t e r d a p a t h u b u n g a n y a n g b e n n a k n a a n t a r a d u a

v a r i a b e l y a n g d i t e l i t i d a n H O d i t e r i m a S e d a n g k a n j i k a d i d a p a t k a n p value gt 0 0 5

24

p a d a u j i s t a t i s t i k m a k a t e r d a p a t l i u b u n g a n y a n g b e n n a k n a a n t a r a d u a v a r i a b e l

y a n g d i t e l i t i d a n H O d i t o l a k

38 Alur Penelitian

P e n e n t u a n p o p u l a s i d a n s a m p e l p e n e l i t i a n

K r i t e r i a i n k l u s i K r i t e r i a e k s k l u s i

P e n g a m b i l a n s a m p e l p e n e l i t i a n

P e n g o l a h a n d a n a n a l i s i s d a t a d e n g a n u j i chi-square

H a s i l d a n p e m b a h a s a n

K e s i m p u l a n d a n s a r a n

Gambar 31 Alur Penelitian Hubungan Usia Jenis Keiamin Tingkat Pendidikan dan Riwayat Diabetes Melitus dengan Kejadian Infeksi Saiuran Kemih pada Pasien Rawat Inap di Bagian Penyakit Dalam Rumah Sakit Muhammadiyah Palembang Periode 1 Januari 2015 sampai dengan 31 Desember 2015

BAB IV

HASIL DAN PEMBAHASAN

41 Hasil

P e n e l i t i a n i n i t e l a h d i l a k u k a n d i r u a n g r e k a m m e d i s R u m a h S a k i t

M u h a i m n a d i y a h P a l e m b a n g d a r i t a n g g a l 1 O k t o b e r 2 0 1 5 - 3 1 O k t o b e r 2 0 1 6

P e n e l i t i a n d i m u l a i d e n g a n p e n g a m b i l a n d a t a a w a l b e m p a d a t a r e k a m m e d i s

s e l u r u h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

S e l a n j u t n y a r e k a m m e d i s d i p i l i h s e s u a i d e n g a n k r i t e r i a i n k l u s i d a n e k s k l u s i u n t u k

d i j a d i k a n s a m p e l p e n e l i t i a n s a m p a i m i n i m a l b e s a r s a m p e l y a n g d i b u t u h k a n

t e r p e n u h i s e r t a d i l a k u k a n p e n e l i t i a n s e c a r a o b s e r v a s i o n a i O b s e r v a s i r e k a m m e d i s

d i l a k u k a n u n m k m e n g e t a h u i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t

d i a b e t e s m e l i t u s d a n d i a g n o s a p a s i e n

D a r i c a t a t a n r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g

d i d a p a t k a n s e b a n y a k 4 1 4 1 r e k a m m e d i s p a s i e n r a w a t i n a p d a n 1 4 5 3 r e k a m m e d i s

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 D a r i t o t a l r e k a m m e d i s

p a s i e n r a w a t i n a p d a n r a w a t j a l a n t e r s e b u t p e n e l i t i h a n y a m e n g a m b i l m i n i m a l

b e s a r s a m p e l y a n g d i b u t u h k a n y a i t u s e b a n y a k 9 8 r e k a m m e d i s u n t u k d i j a d i k a n

s a m p e l p e n e l i t i a n y a n g t e r d i r i d a r i 3 0 r e k a m m e d i s p a s i e n y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i h d a n 6 8 r e k a m m e d i s y a n g t i d a k m e n g a l a m i i n f e k s i s a i u r a n k e m i h

411 Hasil Analisis Univariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s u n i v a r i a t

a n t a r a l a i n d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p b e r d a s a r k a n u s i a d a n

j e n i s k e l a m m d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n b e r d a s a r k a n u s i a

d a n j e n i s k e i a m i n d i s t r i b u s i p r o p o r s i s a m p e l b e r d a s a r k a n k e j a d i a n m f e k s i s a i u r a n

k e m i h s e r t a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n u s i a

j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

25

26

A Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan IJsta

dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 41 Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan

Usia dan Jenis Keiamin

Paisen Rawat Inap N Persentase

Usia

1 7 - 2 5 t a h u n 678 1 6 4

2 6 - 3 5 t a h u n 952 2 3 0

3 6 - 4 5 t a l i u n 745 18 0

4 6 - 5 5 t a h u n 695 1 6 8

5 6 - 6 4 t a h u n 571 1 3 8

gt 6 4 t a h u n 500 1 2 1

U s i a r a t a - r a t a ( t a h u n j 43plusmn16543

Jenis Keiamin

P e r e m p u a n 2 6 3 8 6 3 7

L a k i - l a k i 1 5 0 3 3 6 3

Total 4141 100

B e r d a s a r k a n t a b e l 4 1 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R i u n a h S a k i t M u l i a m m a d i y a l i

P a l e m b a n g p e r i o d e J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 2 6 - 3 5 t a h u n y a i t u

s e b a n y a k 9 5 2 o r a n g ( 2 3 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 43plusmn16543 t a l i u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 2 6 3 8 o r a n g ( 6 3 7 )

27

B Distribusi Proporsi Karakteristik Pasien Rawat Jalan Berdasarkan

Usia dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 42 Distribusi Proporsi Karakteristik Pasien Rawat Jalan

Berdasarkan Usia dan Jenis Keiamin

Fasten Rawat Jalan N Persentase

Usia

1 7 - 2 5 t a h u n 9 2 6 3

2 6 - 3 5 t a l n i n 1 3 1 9 0

3 6 - 4 5 t a h u n 2 7 9 1 9 2

46-55 t a l i u n 4 2 1 2 9 0

5 6 - 6 4 t a h u n 3 1 6 2 1 7

gt 6 4 t a h u n 2 1 4 1 4 7

U s i a r a t a - r a t a ( t a h u n ) 50plusmn14120

Jenis Keiamin

P e r e m p u a n 8 9 0 6 1 3

L a k i - l a k i 5 6 3 3 8 7

Total 1453 100

B e r d a s a r k a n t a b e l 4 2 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 4 6 - 5 5 t a h u n y a i t u

s e b a n y a k 4 2 1 o r a n g ( 2 9 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 50plusmn14120 t a h u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 8 9 0 o r a n g ( 6 1 3 )

28

C Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Usia

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i b b e r d a s a r k a n u s i a d a p a t

d i i i h a t p a d a l a b e l d i b a w a h i n i

Tabel 43 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Usia

Usia N Persentase

lt 5 0 t a h u n 1 4 4 6 7

gt 5 0 t a l i u n 1 6 5 3 3

Total 30 100

B e r d a s a r k a n t a b e l 4 3 d i a t a s d a p a t d i k e t a h u i b a h w a u s i a t e r b a n y a k p a d a

s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h gt 5 0 t a h u n y a i t u s e b a n y a k

1 6 o r a n g ( 5 3 3 )

D Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Jenis

Keiamin

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n j e n i s

k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 44 Distribusi Proporsi Kejadian infeksi Saiuran Kemih Berdasarkan

Jenis Keiamin

Jenis Keiamin N Persentase

P e r e m p u a n 1 8 6 0 0

L a k i - l a k i 1 2 4 0 0

Total 30 100

B e r d a s a r k a n t a b e l 4 4 d i a t a s d a p a t d i k e t a h u i b a h w a j e n i s k e i a m i n

t e r b a n y a k p a d a s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h p e r e m p u a n

y a i t u s e b a n y a k 1 8 o r a n g ( 6 0 0 )

29

E Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n t i n g k a t

p e n d i d i k a n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 45 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

Tingkat Pendidikan N Persentase

P e n d i d i k a n d a s a r 20 6 6 7

P e n d i d i k a n m e n e n g a h d a n P e n d i d i k a n m e n e n g a h d a n 10 333

t i n g g i

Total J O 100

B e r d a s a r k a n t a b e l 4 5 d i a t a s d a p a t d i k e t a l i u i b a l i w a t i n g k a t p e n d i d i k a n

t e r b a n y a k p a d a s a m p e i y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h t i n g k a t

p e n d i d i k a n d a s a r y a i t u s e b a n y a k 20 o r a n g ( 6 6 7 )

P Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n riwayat

d i a b e t e s m e l i t u s d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 46 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

Riwayat Diabetes Melitus N Persentase

Y a 17 5 6 7

T i d a k 13 433

Total 30 100

B e r d a s a r k a n t a b e l 4 6 d i a t a s d a p a t d i k e t a h u i b a l i w a s a m p e l y a n g

m e n g a l a m i i n f e k s i s a i u r a n k e m i h t e r b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s

y a i t u s e b a n y a k 1 7 o r a n g ( 5 6 7 )

30

412 Hasil Analisis Bivariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s b i v a r i a t

a n t a r a I a i n h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h j e n i s

k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h t i n g k a t p e n d i d i k a n d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n

i n f e k s i s a l m a n k e m i h

A n a l i s i s y a n g d i g u n a k a n p a d a u j i d u a v a r i a b e l y a n g b e r s k a l a k a t e g o r i k

a d a l a l i d e n g a n u j i Chi-Square d e n g a n n i e i h a t n i l a i Pearson Chi-Square S e m u a

h a s i l d a r i u j i h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h m e n g g i u i a k a n u j i Chi-

Square k a i e n a m e m e n u h i s y a r a t u j i Chi-Square y a i t u lt 2 0 s e l y a n g m e m p u n y a i

n i l a i expected count lt 5

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 47 Hasil Uji Hubungan antara Usia dengan Kejadian Infeksi

Saiuran Kemih

Usia

Infeksi Saiuran Kemih

^a Tidak

n N Mgt

Jumlah P

value 95Cl

lt 50 t a h u n 1 4 1 9 2 5 9 8 0 8 7 3 0 0 0 0 2 7 4 7 - 2 0 4 3 1

gt 5 0 t a h u n 1 6 6 4 0 9 3 6 0 2 5

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 7 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R = 7 4 9 2

( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a u s i a gt

5 0 t a h u n a d a l a l i 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a u s i a lt 5 0 t a h u n

31

B Hubungan antara Jenis Keiamin dengan Kejadian Infeksi Saiuran

Kemih

H a s i l a n a l i s i s b i v a r i a t l i u b u n g a n a n t a r a j e n i s k e l a i n i n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

Tabel 48 Hasil Uji Hubungan antara Jenis Keiamin dengan Kejadian

Infeksi Saiuran Kemih

Infeksi Saiuran Kemih Jenis P

A Tidak Jumlah 95CI Keiamin value

N N

P e r e m p u a n 18 6 4 3 10 357laquoo 2 8 3 2 2 7 -P e r e m p u a n 0 0 0 0

L a k i - l a k i 12 1 7 1 5 8 8 2 9 7 0 2 3 4 5 9

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 8 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a l a l i

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k N 4 a k a a d a l i u b u n g a n y a n g s i g n i f i k a n a n t a r a

j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R ) = 8 7 0 0

f 9 5 C I = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a l a k i - l a k i

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e n i i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

32

Tabel 49 Hasil liji Hubungan antara Tingkat Pendidikan dengan

Kejadian Infeksi Saiuran Kemih

Infeksi Saiuran Kemih P

Y a T i d a k jumlah 95CI value

N

P e n d i d i k a n d a s a r 2 0 5 4 1 1 7 4 5 9 3 7

P e n d i d i k a n

m e n e n g a h d a n 10 1 6 4 5 1 8 3 6 6 1

t i n g g i

Jumlah JO 30 6 68 694 9H

B e r d a s a r k a n t a b e l 4 9 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( 0 R ) =

6 0 0 0 ( 9 5 C I = 2 3 5 1 - 1 5 3 1 0 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r a d a i a h 6 k a l i l e b i h b e s a r

d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i h a t

p a d a t a b e l d i b a w a h i n i

Tingkat

Pendidikan

2 3 5 1 -0 0 0 0

1 5 3 1 0

33

Tabel 4t0 Hasil I j i Hubungan antara Riwayat Diabetes Melitus dengan

Kejadian Infeksi Saiuran Kemih

Riwayat Infeksi Saiuran Kemih P

Diabetes Va Tidak Jumlah value

95CI

Melitus N bullVJ N

Y a

T i d a k

17

1 3

6 8 0

1 7 8

8

6 0

3 2 0

8 2 2

2 5

7 3 0 0 0 0

3 4 9 3 -

2 7 5 3 6

Jumlah 30 306 68 571 98

B e r d a s a r k a n t a b e l 4 1 0 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio

( O R ) = 9 8 0 8 ( 9 5 C I - 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r

d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s m e l i m s

42 Pembahasan

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a l a b e l 4 7 d i d a p a t k a n b a l i w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i b d e n g a n n i l a i s i g n i f i k a n n y a a d a l a l i 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k

Odds Ratio ( O R ) = 7 4 9 2 ( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a u s i a T 5 0 t a h u n a d a i a h 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a

u s i a lt 5 0 t a h u n

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n A n d r y L u k a n d y

( 2 0 1 4 ) m e n g e n a i k a r a k t e r i s t i k p a s i e n - p a s i e n i n f e k s i s a i u r a n k e m i h d i m a n a

p e n d e r i t a I S K d e n g a n k e l o m p o k u m u r gt 5 0 t a h u n s e b a n y a k 2 3 o r a n g s e d a n g k a n

j u m l a h p e n d e r i t a I S K d e n g a n k e l o m p o k u m m lt 5 0 t a l i u n s e b a n y a k 2 0 o r a n g

P e n e l i t i a n i n i j u g a d i p e i k u a t o l e h p e n l i t i a n L e w i s A l e t a l ( 2 0 1 4 ) m e n g e n a i

impact of host age and parity on susceptihility to severe urinary tract injection in

34

a murine mode d e n g a n u j i K r u s k a l - W a l l i s d e n g a n post-test D u n n u n t u k b e b e r a p a

p e r b a n d i n g a n d i m a n a u s i a d a n p a r i t a s s e b a g a i f a k t o r y a n g b e r k o n t r i b u s i d a l a m

k e r e n t a n a n i m t u k t e r j a d i n y a I S K d e n g a n n i l a i p lt 0 0 5

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n g a t a k a n b a h w a i n s i d e n I S K m e n i n g k a t

b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n

a d a n y a a b n o r m a l i t a s a n a t o m i y a n g m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n

k e m i h s e p e r t i p e m b e s a r a n p r o s t a t d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a

p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e ( R o s e 2 0 0 9 ) P e n y e b a b l a i n t e n n a s u k

p e r i n e i u n y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s p e n y a k i t n e u r o m u s k u l a r

d a n k a t e t e r i s a s i b u l i - b u l i ( F o x m a n e t a l 2 0 1 0 ) S e l a i n i t u i n s i d e n I S K m e n c a p a i

1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o n a l d 2 0 1 1 )

B Hubungan antara Jenis Keiamin dengan Kejadian infeksi Saiuran

Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 8 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d e n g a n n i l a i s i g n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O

d i t o l a k Odds Ratio ( O R ) = 8 7 0 0 ( 9 5 C l = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a risiko k e j a d i a n

i n f e k s i s a i u r a n k e m i h p a d a p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n

p a d a l a k i - i a k i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n M a g i i a n o e t a l

( 2 0 1 1 ) m e n g e n a i Gender and Age-Dependent Etiology of Community Acquired

y a n g m e l a k u k a n p e n g a m b i l a n 6 1 2 7 3 s a m p e l k u l t u r u r i n d a l a m p e r i o d e 2 2 b u l a n

d a r i s a m p e l i n i d i d a p a t k a n 1 3 8 2 0 ( 2 2 6 ) d i t e m u k a n p o s i t i f i n f e k s i b a k t e r i

h a m p i r 8 0 b a l i a n y a n g d i i s o l a s i b e r a s a l d a r i p e r e m p u a n P e n e l i t i a n i n i j u g a

d i p e r k u a t o l e h p e n e l i t i a n y a n g d i l a k u k a n o l e h Y u n i t a I ( 2 0 1 0 ) d i m a n a a d a

h u b m i g a n y a n g b e n n a k n a a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h ( P value=O049 R P = 3 2 7 3 ( 9 5 C I = I 0 1 6 - 1 0 5 4 0 )

H a l t e r s e b u t d a p a t t e r j a d i k a r e n a u r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a l i

d e n g a n d e k a t n y a v a g i n a l v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i

s a i u r a n k e m i h l e b i h s e r i n g p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a flora n o r m a l

3 5

p a d a d a e r a h p e r i u r e t r a t e r d i r i d a r i o r g a n i s m e s e p e r t i i a c t o b a c i l l u s y a n g m e m b a n t u

m e l a w a n k o l o n i s a s i b a k t e r i p a t o g e n p a d a s a i u r a n k e m i h P e r u b a h a n l i n g k i m g a n

d a r i p e r i u r e t r a l s e p e r t i p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k

b i s a m e n g g a n g g u f l o r a n o r m a l s e h i n g g a m e n u m g k i n k a n b a k t e r i p a t o g e n

b e r k o l o n i s a s i d a n m e n y e b a b k a n i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Scuare p a d a t a b e l 4 9 d i d a p a t k a n b a h w a

t e r d a p a t l i u b u n g a n y a n g s i g n i f i k a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a

H O d i t o l a k Odds Ratio ( O R ) - 6 0 0 0 ( 9 5 o C l = 2 3 5 1 - 1 5 3 I O ) a r t i n y a n s i k o

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r

a d a i a h 6 k a l i l e b i h b e s a r d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n

m e n e n g a h d a n t i n g g i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h T o r o n d e i B e t

a l ( 2 0 1 5 ) m e n g e n a i Menstrual Hygiene Practices WASH Access and the Risk of

Urogenital Infection in Women from Odisha India d i m a n a p e r e m p u a n y a n g

h a n y a m e n e m p u l i p e n d i d i k a n s e k o l a h d a s a r a t a u l e b i h r e n d a h d i b a n d i n g k a n

d e n g a n t i n g k a t p e n d i d i k a n m e n e n g a h a t a u t i n g g i m e m i l i k i r i s i k o 3 k a l i

k e m u n g k i n a n l e b i h b e s a r m e n g a l a m i i n f e k s i s a i u r a n k e m i h ( A d j O R = 3 l 9 5

C 1 = I 2 - 7 9 p = 0 0 2 )

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a p e n g e t a h u a n s e s e o r a n g

t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t p e n d i d i k a n S e s e o r a n g y a n g

m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m u n g k i n a n p e n g e t a l i u a n t e n t a n g

k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o r m a s i y a n g d i d a p a t k a n t e n t a n g k e s e h a t a n

l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h S e b a l i k n y a

p e n d i d i k a n y a n g k u r a n g d a p a t i n e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g t e r h a d a p

n i l a i - n i l a i y a n g b a r u d i k e n a l ( N o t o a d m o j o 2 0 0 3 )

3 6

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Keniih

B e r d a s a r k a n l i a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 1 0 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a r i w a y a t d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 )

s e h i n g g a H O d i t o l a k Odds Ratio ( O R ) = 9 8 0 8 ( 9 5 C I = 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a

risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h S a r i E W P d a n

S a t y a b a k t i P ( 2 0 1 5 ) m e n g e n a i p e r b e d a a n risiko i n f e k s i n o s o k o m i a l s a i u r a n k e m i h

b e r d a s a r k a n k a t e t e r i s a s i u r i n u m u r d a n d i a b e t e s m e l i m s d i m a n a d a r i 2 0 p a s i e n

i n f e k s i n o s o k o m i a l s a i u r a n k e m i h 1 2 o r a n g ( 6 0 ) d i a n t a r a n y a a d a i a h p a s i e n

d e n g a n s t a t u s D M s e d a n g k a n 8 o r a n g ( 4 0 ) l a i n n y a a d a i a h p a s i e n t a n p a s t a t u s

D M ( P v W w ^ = 0 0 2 4 O R = 6 0 0 9 5 C I = 1 2 2 - 3 2 2 6

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a b a l i w a b e b e r a p a b a g i a n

d a r i i i n u n i t a s p a d a p a s i e n d i a b e t e s m e n g a l a m i p e r u b a h a n F u n g s i

p o l i n i o r f o l e u k o s i t d i t e k a n p a d a k e a d a a n a s i d o s i s I k a t a n l e u k o s i t k e m o t a k s i s d a n

f a g o s i t o s i s j u g a b e m b a l i S i s t e m a n t i o k s i d a n y a n g b e r p e r a n p a d a a k t i f i t a s

b a k t e r i s i d a l j u g a t e r g a n g g u s e h i n g g a m e n y e b a b k a n t e r j a d i n y a I S K p a d a p a s i e n -

p a s i e n d e n g a n p e n y a k i t d i a b e t e s ( J u l k a 2 0 1 4 )

H a l y a n g s a m a j u g a d i i m g k a p k a n o l e b t e o r i S m e l t z e r d a n B a r e ( 2 0 1 0 )

b a l i w a D M d a p a t m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a l i a n a n t u b u h y a n g

b e r p o t e n s i m e n i n g k a t k a n r i s i k o t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a l i a n a n

t u b u h t e r s e b u t d i a n t a r a n y a a d a i a h k e g a g a l a n m i g r a s i s e l iniraceliular killing

f a g o s i t o s i s d a n k e m o t a k s i s p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n

m e k a n i s m e p e r t a l i a n a n a l a m i a h I o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p

i n f e k s i

BAB V

KESIMPULAN DAN SARAN

51 Kesimpulan

1 U s i a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 2 6 - 3 5 t a h u n y a i t u 2 3 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 3 7

2 U s i a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 4 6 - 5 5 t a l i u n y a i t u 2 9 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 1 3

3 U s i a j e n i s k e i a m i n d a n t i n g k a t p e n d i d i k a n s a m p e i y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i l i t e r b a n y a k y a i t u b e r u s i a gt 5 0 t a h u n ( 5 3 3 ) j e n i s k e i a m i n

p e r e m p u a n ( 6 0 0 ) d a n t i n g k a t p e n d i d i k a n d a s a r ( 6 6 7 ) s e r t a p a l i n g

b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s y a i t u 5 6 7

4 T e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 ( p = 0 0 0 0 )

52 Saran

1 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t d i l a k u k a n d e n g a n d e s a i n

p e n e l i t i a n b e r b e d a s e p e r t i cohort a t a u case control

2 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t m e i i c a r i v a r i a b e l independent

y a n g l a i n s e p e r t i v a r i a b e l p e k e r j a a n p e m a s a i i g a n k a t e t e r a t a u l a m a n y a

m e n d e r i t a d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

37

DAFTAR PUSTAKA

B o y k o E J d k k 2 0 0 2 D i a b e t i c A n d T h e R i s k O f A c u t e U r i n a r y T r a c t I n f e c t i o n A m o n g P o s t m e n o p a u s a l W o m e n D i a b e t e s C a r e 2 5 ( 1 0 )

D a h l a n S 2 0 1 4 B u k i i S t a t i s t i k u n t u k K e d o k t e r a n d a n K e s e h a t a n D e s k r i p t i f B i v a r i a t d a n M u l t i v a r i a t d i l e n g k a p i a p l i k a s i d e n g a n m e n g g u n a k a n S P S S E d i s i 6 E p i d e m i o l o g i I n d o n e s i a J a k a r t a I n d o n e s i a

D e p a r t e m e n K e s e h a t a n ( D E P K E S ) R l 2 0 1 4 [ O n l i n e ] K e m e n t e r i a n K e s e h a t a n R e p u b l i k I n d o n e s i a P u s a t D a t a d a n I n f o r m a s i K e m e n t e r a n K e s e h a t a n R l ( http 7depkesgoid diakses tanggal 15 Met 2016)

F o x m a n B e t a i 2 0 1 0 U r i i i a i y T r a c t I n f e c t i o n A m o n g W o m e n A g e d 4 0 T o 6 5 B e h a v i o r a l A n d S e x u a l R i s k F a c t o r s D a l a m T a n a g h o E A M c A n i n c h J W 1 7 t h S m i t h s G e n e r a l U r o l o g y U S A M c G r a w H i l l (http searchproqnestcom diakses tanggal 16 Met 2016)

H a r d i n g G K d k k 2 0 1 0 A n t i m i c r o b i a l T r e a t m e n t I n D i a b e t i c W o m e n W i t l i A s y m t o m a t i c B a c t e r i u r i a N E n g l J M e d 3 4 7 1 5 7 6 - 1 5 8 3 (http nejmorg diakses tanggal 16 Met 2016)

I s s e l b a c h e r d k k 2 0 0 9 I n f e k s i S a i u r a n K e m i h d a n P i e l o n e f r i t i s D a l a m S t a m m W a l t e r E e d H a r r i s o n P r i n s i p - P r i n s i p l l m u P e n y a k i t D a l a m e d V o l u m e 2 J a k a r t a E G C 6 1 6 - 6 2 3

J u l k a S 2 0 1 3 G e n i t o u r i n a r y I n f e c t i o n I n D i a b e t e s I n d i a n J o u m a l o f E n d o c r i n o l o g y a n d M e t a b o l i s m (http searchproquestcom diakses tanggal 16 Mei 2016)

K i m B d k k 2 0 1 2 [ e - b o o k ] T h e R e l a t i o n b e t w e e n P o s t v o i d R e s i d u a l a n d O c c u r r e n c e o f U r i n a r y T r a c t I n f e c t i o n a f t e r S t r o k e i n R e h a b i l i t a t i o n U n i t A n n a l s o f R e h a b i l i t a t i o n M e d i c i n e

K o m a r a A 2 0 0 9 P o l a K e p e k a a n B a k t e r i G r a m N e g a t i f d a r i P a s i e n I n f e k s i S a i u r a n K e m i l i t e r h a d a p A n t i b i o t i k G e n t a m i c i n d a n K o t r i m o k s a z o l y a n g D i k i r i m k e L a b o r a t o r i u m M i k r o b i o l o g i K l i n i k F K U l d a r i T a h u n 2 0 0 1 s a m p a i T a h u n 2 0 0 5 (http dontaruiacid diakses tanggal OH Agustiis 2016)

L e w i s A L e t a l 2 0 1 4 I m p a c t o f H o s t A g e a n d P a r i t y o n S u s c e p t i b i l i t y t o S e v e r e U r i n a r y T r a c t I n f e c t i o n i n a M u r i n e M o d e l P l o s O n e R e s e a r c h A r t i c l e P u b l i c L i b r a r y o f S c i e n c e 9 ( 5 ) (http searchproquestcom diakses pada langgal 30 Desember 2016)

38

HALAMAN PENGESAIUN

HUBUNGAN ANTARA USIA JENIS KELAMIN TINGKAT PENDIDIKAN DAN RIWAYAT DIABETES MELITUS

DENGAN KEJADIAN INFEKSI SALURAN K E M I H PADA PASIEN RAWAT INAP DAN RAWAT

JALAN DI BAGIAN PENYAKIT DALAM RUMAH SAKIT MUHAMMADIYAH

PALEMBANG PERIODE I JANUARI 2015-31

DESEMBER 2015

Dipcrsiapkan dan disusun oleh Reza Agustiaotwo Putra

M M 702013054

Sebagai salah satii syarat memperoleh gelar Sarjana Kedokteran (S Ked)

Pada tanggal 07 Februari 2017

dr M Avus^A^tonK SpPD-KGEH FINASIM MARS Perabimbing Pcrtama

Mcnyctujui

dr Ratika FcbrUni Pembimbing Kedua

PERNYATAAN

D e n g a t i i n i s a y a m e n e r a n g k a n b a h w a

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m e n d a p a t k a n g e l a r a k a d e m i k b a i k d i U n i v e r s i t a s M u h a m m a d i y a h

P a l e m b a n g m a u p u n P e r g u m a n T i n g g i l a i n n y a

2 K a r y a t u l i s i n i m u m i g a g a s a n n i m u s a n d a n p e n e l i t i a n s a y a s e n d i r i t a n p a

b a n t u a n p i h a k l a i n k e c u a l i a r a h a n T i m P e m b i m b i n g

3 D a l a m k a i y - a m l i s i n i t i d a k t e r d a p a t k a i y a a t a u p e n d a p a t y a n g t e l a h d i t u l i s

a t a u d i p u b l i k a s i k a n o r a n g l a i n k e c u a i i s e c a r a t e r t u l i s d e n g a n d i c a n t u m k a n

s e b a g a i a c u a n d a l a m n a s k a h d e n g a n d i s e b u t k a n n a m a p e n g a r a n g d a n

d i c a n t u m k a n d a l a m d a f t a r p u s t a k a

4 P e m y a t a a n i n i s a y a b u a t d e n g a n s e s u n g g u h n y a d a n a p a b i l a d i k e m u d i a n h a r i

t e r d a p a t p e n y i m p a n g a n d a n k e t i d a k b e n a r a n d a l a m p e m y a t a a n i n i m a k a s a y a

b e r s e d i a m e n e r i m a s a n k s i a k a d e m i k a t a u s a n k s i l a i n n y a s e s u a i d e n g a n n o r m a

y a n g b e r l a k u d i P e r g u m a n T i n g g i i n i

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( R e z a A g u s t i a n t w o P u t r a )

N I M 7 0 2 0 1 3 0 5 4

ii

P E R S E T U J U A N P E N G A L I H A N H A K P U B L I K A S I K A R Y A I L M I A H

UNTUK K E P E N T I N G A N A K A D E M I S

D e n g a n P e n y e r a h a n n a s k a l i a r t i k e l d a n v r t a j ^ v b e r j u d u l H u b u n g a n a n t a r a U s i a J e n i s K e i a m i n T i n g k a t P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h p a d a P a s i e n R a w a t I n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 ^ K e p a d a U n i t P e n e l i t i a n d a n P e n g a b d i a n M a s y a r a k a t U P 2 M ) F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u h a m m a d i y a h P a l e m b a n g ( F K - U M P ) S a y a

N a m a R e z a A g u s t i a n t w o P u t r a N i M 7 0 2 0 1 3 0 5 4 P r o g r a m S t u d i P e n d i d i k a n K e d o k t e r a n U m u m F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u h a m m a d i y a h P a l e m b a n g J e n i s K a r y a i l m i a h S k r i p s i

D e m i p e n g e m b a n g a n i l m u p e n g e t a h u a n s e t u j u m e m b e r i k a n k e p a d a F K - U M P P e n g a l i h a n H a k C i p t a d a n P u b l i k a s i B e b a s R o y a l t i a t a s K a r y a I l m i a h N a s k a l i d a n softcopy d i a t a s D e n g a n h a k t e r s e b u t F K - U M P b e r h a k m e n y i m p a n m e n g a l i h m e d i a f o n n a t k a n d a l a m b e n t u k p a n g k a l a n d a t a (database) m e n d i s t r i b u s i k a n m e n a m p i l k a n m e m p u b l i k a s i k a n d i i n t e r n e t a t a u m e d i a l a i n u n t u k k e p e n t i n g a n a k a d e m i s t a n p a p e r l u m e m i n t a i z i n d a r i S a y a s e l a m a t e t a p m e n c a n t u m k a n n a m a S a y a d a n S a y a m e m b e r i k a n w e w e n a n g k e p a d a p i h a k F K -U M P u n t u k m e n e i i t u k a n s a l a h s a t u P e m b i m b i n g s e b a g a i P e n u l i s U t a m a d a l a m P u b l i k a s i S e g a l a b e n t u k t u n t u t a n h u k u m y a n g t i m b u l a t a s p e l a n g g a r a n H a k C i p t a d a l a m K a r y a I l m i a l i i n i m e n j a d i t a n g g u n g j a w a b S a y a p r i b a d i

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i g M e i i y e t u j u i

z a A g u s t i a n t w o P u t r a

N I M 7 0 2 0 1 3 0 5 4

iii

HALAMAN PERSEMBAHAN DAN MOTTO

OfaBjrdafi ada sesuatuyan^ menanttmu sedpas Battya^BgsaSaran (yang Bpu

jaCani) yang a^n memStiatmu terpana Singga (au Cupa Setapa pedifinya rasa

saSit - (Jid ltBinABi TltadB)

Dengan izin-Mu ya Allah ku persembahkan karya ini untuk

bull Kedua orangtuaku yang tercinta Riza Efendi SHbdquo MH dan Dra Yusdiami

yang selalu memberikan motivasi nasihat dan semangat untuk meraih cita-

citaku serta doa dan kasih sayang di setiap langkaliku Ma P a i know this

is not enough yet to reply a l l your affection and everything that you already

gave h u t im trying to he the best i n everything for you and absolutely you

a r e my entire worlct

bull Saudara kandungku tersayang Eka Satriawan A Md Im SH MH dan

Threenita Sari Sepgi Putri yang telah banyak membantu menemani serta

menghibur di setiap hari-hariku Im so g r a t e f u l to have you kak g r a You

a r e truly my beloved siblings

bull Pembimbing skripsiku dr M Ayus Astoni Sp PD KGEH FINASIM

MARS dan dr Ratika Febriani yang telah memberikan nasihat saran dan

ilmu yang bermanfaat serta meluangkan waktunya untuk membimbing

skripsi ini bingga selesai

bull Teman-teman terdekatku ( C H A T g r o u p dan Bujang Gadis g r o u p ) yang selalu

dapat memberikan keceriaan semangat dan bantuan di saat menghadapi

kesulitan do believe we can be a success doctor and get our dreams

someday Keep down to e a r t h guys

bull Dan seluruh teman-teman angkatan 2013 (Genome H e x a ) yang telah banyak

memberikan bantuan selama proses perkuliahan di tahap akademik Semoga

kesuksesan dan ridho Allah SWT selalu mengiringi iangkali kita Aamiin ya

rabbal allamin See you on topgjrys

iv

UNIVERSITAS MUHAMMADIYAH P A L E M B A N G F A K U L T A S K E D O K T E R A N

S K R I P S L JANUARI 2017 R E Z A AGUSTIANTWO PUTRA

Hubungan antara Usia Jenis Keiamin Tingkat Pendidikan dan Riwayat Diabetes Melitus dengan Kejadian Infeksi Saiuran Kemih pada Pasien Rawat Inap dan Rawat Jalan di Bagian Penyakit Dalam Rumah Sakit Muhammadiyah Palembang Periode 1 Januari 2015-31 Desember 2015

xii + 37 halaman + 12 tabel + 1 gambar + 8 lampiran

A B S T R A K

I n t e k s i s a i u r a n k e m i h ( I S K ) m e n i p a k a n s u a t u i n f e k s i y a n g m e n g e n a i t r a k t u s u r i n a r i u s d a n h a m p i r 1 0 o r a n g p e m a h t e r k e n a I S K s e l a m a h i d u p n y a M e n u m t t e o r i m e n i n g k a t n y a k e j a d i a n I S K b e r h u b i m g a n d e n g a n p e n i n g k a t a n u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s P e n e l i t i a n i n i b e m i j u a n u n t u k m e n g a n a l i s i s h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i l i p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R i u n a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 J e n i s p e n e l i t i a n i n i a d a i a h o b s e r v a s i o n a i a n a l i t i k d e s a i n cross sectional d e n g a n m e n g g i i n a k a n d a t a s e k u n d e r d a r i r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g S a m p e l p e n e l i t i a n i n i a d a i a h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 d e n g a n b e s a r s a m p e l s e b a n y a k 9 8 s a m p e l S a m p e l p e n e l i t i a n i n i d i a m b i l d e n g a n c a r a consecutive sampling H a s i l u j i s t a t i s t i k d i d a p a t k a n h u b u n g a n i n f e k s i s a i u r a n k e m i h d e n g a n u s i a ( p = 0 0 0 0 ) j e n i s k e i a m i n ( p = 0 0 0 0 ) t i n g k a t p e n d i d i k a n ( p = 0 0 0 0 ) d a n riwayat d i a b e t e s m e l i t u s ( p 0 0 0 0 ) S e h i n g g a d a p a t d i s i m p u l k a n b a h w a t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n rawat j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e i J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

Referensi 29(2002-2015) Kata kunci Infeksi Saiuran Kemih Riwayat Diabetes Melitus

V

U N I V E R S I T Y O F M U H A M M A D I Y A H P A L E M B A N G FA cut T Y or M E D I C I N E

MINI THESIS J A N U A R Y 2 0 1 7 R E Z A A G U S T I A N T W O P U T R A

T h e Relationships between Age Gender Education Level Diabetes M e l i t u s History and The Incidence of U r i n a r y T r a c t Infections i n Hospitalized Patients and Outpatients at I n t e r n a l M e d i c i n e o f M u h a m m a d i y a h Palembang H o s p i t a l d u r i n g I J a n u a r y 2 0 1 5 - 3 1 December 2 0 1 5

x i i + 37pages + 12 tables + I picture + 8 attachments

A B S T R A C T

Urinary trad infection (UTI) is an infection of I he urinary tract and nearly 10 of people experience UTI during their lifeiime According to theory the increasing of urinary tract infections is related with increasing age gender education level and diabetes melitus history This study aim to analyze relationships between age gender education level diabetes melitus history and the incidence of urinary tract infections in hospitalized patients and outpatients at Internal Medicine of Muhammadiyah Palembang Hospilal during P January 2015-31 December 2015 This study lipe was analyiical observaiional with cross sectional design by using secondary data from medical record of Muhammadiyah Palembang Hospital Samples of this study were taken by consecutive sampling technique The results of statistical test were obtained relationship between urinary tract infections with age (p 0000) gender (p 0000) education level (p 0000) and diabetes melitus (p 0000) In conclusion there are significantly relationships between age gender education level diabetes melitus history and the incidence of urinary tract infections in hospitalizedpatients and outpatients at Internal Medicine of Muhammadiyah Palembang Hospital during P January 20J5-3PDecember 2015

References 2 9 ( 2 0 0 2 - 2 0 1 5 ) Keywords U r i n a r y T r a c t I n f e c t i o n s Diabetes M e l i t u s

vi

KATA PENGANTAR

S e g a l a p u j i s y u k u r k e p a d a A l l a l i S W T k a r e n a a t a s b e r k a t d a n r a h m a t - N y a p e n u l i s d a p a t i n e n y e l e s a i k a n s k r i p s i y a n g b e r j u d u l H u b u n g a n A n t a r a U s i a J e n i s K e i a m i n T i n g k a t P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h P a d a P a s i e n R a w a t i n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 S k r i p s i i n i d i s u s u n s e b a g a i s a l a h s a t u s y a r a t u n t u k m e m p e r o l e h g e l a r S a r j a n a K e d o k t e r a n d i F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u l i a m m a d i y a h P a l e m b a n g

P e n u l i s m c n y a d a r i b a l i w a d a l a m p r o s e s i n e n y e l e s a i k a n s k r i p s i i n i b a n y a k k e n d a l a y a n g d i a l a i n i n a n i u n b e r k a t b a n t u a n b i m b i n g a n k e r j a s a m a d a r i b c r b a g a i p i h a k d a n t e r u t a m a b e r k a t A l l a h S W T k e n d a l a t e r s e b u t d a p a t d i a t a s i

P e n u l i s j u g a m e n v a d a r i b a h w a s k r i p s i i n i m a s i h j a u h d a r i s e m p u m a m a k a d e n g a n s e g a l a k e r e n d a h a n l i a t i p e n u l i s m e n g l i a r a p k a n a d a n y a k r i t i k d a n s a r a n y a n g b e r s i f a t m e m b a n g u n d e m i k e s e m p u m a a n s k r i p s i i n i

A k h i r k a t a p e n u l i s b c r l i a r a p A l l a l i S W T b e r k e n a n m e m b a i a s s e g a l a k e b a i k a n s e m u a p i h a k y a n g t e l a h m e m b a n t u S e m o g a s k r i p s i i n i d a p a t b e n n a n f a a t b a g i k i t a s e m u a A a m i i n

P a l e m b a n g 0 7 F e b r u a r i 2 0 1 7

R e z a A g u s t i a n t w o P u t r a

vii

DAFTAR ISI

HALAMAN J D D U L HALAMAN PENCESAHAN i HALAMAN PERNN ATAAN ii HALAMAN PERSEMBAHAN iii A B S T R A K iv A B S T R A C T v K A T A PENGANTAR vi DAFTAR ISI vii DAFTAR T A B E I ix DAFTAR GAMBAR x DAFTAR LAMPIRAN xi

BAB I Pendahuluan 1 1 1 L a t a r B e l a k a n g 1 12 R i i m u s a n M a s a l a h 3 13 T u j u a n P e n e l i t i a n 3 14 M a n l a a t P e n e l i t i a n 4 15 K e a s l i a n P e n e l i t i a n 5

BAB H Tinjauan Pustaka 9 2 1 L a n d a s a n T e o r i 9

2 1 1 I n f e k s i S a i u r a n K e m i h 9 A D e f i n i s i 9 B E p i d e m i o l o g i 9 C K i a s i f i k a s i 1 0 D E t i o l o g i 1 1 E P a t o f i s i o l o g i 11 F F a k t o r R i s i k o 1 2 G M a n i f e s t a s i K l i n i s 1 5 H T a t a l a k s a n a 1 6 I K o m p l i k a s i 1 6

2 2 K e r a n g k a T e o r i 1 7 2 3 H i p o t e s i s 1 8

BAB I I I Metode Penelitian 19 3 1 J e n i s P e n e l i t i a n 1 9 3 2 W a k t u d a n T e m p a t P e n e l i t i a n 1 9 3 3 P o p u l a s i d a n S a m p e l 1 9

3 3 1 P o p u l a s i P e n e l i t i a n 1 9 3 3 2 S a m p e l d a n B e s a r S a m p e l P e n e l i t i a n 1 9 3 3 3 K n t e r i a I n k l u s i d a n E k s k l u s i 2 0 3 3 4 C a r a P e n g a m b i l a n S a m p e l P e n e l i t i a n 2 0

3 4 V a r i a b e l P e n e l i t i a n 2 0 3 4 1 V a r i a b e l Dependent 2 0 3 4 2 V a r i a b e l Independent 2 0

viii

3 5 D e f i n i s i O p e r a s i o n a l 2 1 3 6 C a r a P e n g i i n i p u l a n D a t a 2 2

3 6 1 D a t a S e k u n d e r 2 2 3 7 M e t o d e T e k n i s A n a l i s i s D a t a 2 2

3 7 C a r a P e n g o l a h a n d a n A n a l i s i s D a t a 2 2 3 8 A l u r P e n e l i t i a n 2 4

BAB IV HASIL DAN PEMBAHASAN 25 4 1 H a s i l 2 5 4 2 P e m b a h a s a n 3 3

BAB V KESIMPLILAN DAN SARAN 37 5 1 K e s i m p u l a n 3 7 5 2 S a r a n 3 7

D A F T A R PUSTAKA 38 LAMPIRAN 41 BIODATA 63

ix

DAFTAR T A B E L

Tabel Halaman

T a b e l 1 1 K e a s l i a n P e n e l i t i a n 5 T a b e l 3 1 D e f i n i s i O p e r a s i o n a l 2 1 T a b e l 4 1 D i s t r i b u s i P r o p o r s i K a r a k t e r i s t i k P a s i e n R a w a t i n a p

B e r d a s a r k a n U s i a d a n J e n i s K e i a m i n 2 6 T a b e l 4 2 D i s t r i b u s i P r o p o r s i K a r a k t e r i s t i k P a s i e n R a w a t J a l a n

B e r d a s a r k a n U s i a d a n J e n i s K e i a m i n 2 7 T a b e l 4 3 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n U s i a 2 8 T a b e l 4 4 D i s t r i b u s i P r o p o r s i K e j a d i a n i n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n J e n i s K e l a m m 2 8 T a b e l 4 5 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n T i n g k a t P e n d i d i k a n 2 9 T a b e l 4 6 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n R i w a y a t D i a b e t e s M e l i t u s 2 9 T a b e l 4 7 H a s i l U j i H u b u n g a n a n t a r a U s i a d e n g a n K e j a d i a n

i n f e k s i S a i u r a n K e m i h 3 0 T a b e l 4 8 H a s i i U j i H u b u n g a n a n t a r a J e n i s K e i a m i n d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i b 3 1 T a b e l 4 9 H a s i l U j i H u b u n g a n a n t a r a T i n g k a t P e n d i d i k a n d e n g a n

K e j a d i a n i n t e k s i S a i u r a n K e m i h 3 2 T a b e l 4 1 0 H a s i l U j i H u b u n g a n a n t a r a R i w a y a t D i a b e t e s M e l i t u s

d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h 3 3

X

DAFTAR GAMBAR

Gambar Halaman

G a m b a r 3 1 A l u r P e n e l i t i a n H u b u n g a n U s i a J e n i s K e i a m i n T i n g k a t

P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i h p a d a P a s i e n R a w a t i n a p

d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g I e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1

D e s e m b e r 2 0 1 5 2 4

xi

DAFTAR LAMPIRAN

Lampiran Halaman

L a m p i r a n 1 D a t a R e k a m M e d i s P a s i e n R a w a t I n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 4 3

L a m p i r a n 2 H a s i l A n a l i s i s U n v i a r i a t 4 5

L a m p i r a n 3 H a s i l A n a l i s i s B i v a r i a t 5 1

L a m p i r a n 4 K a r t u B i m b i n g a n P r o p o s a l S k r i p s i 5 8

L a m p i r a n 5 K a r t u B i m b i n g a n S k r i p s i 5 9

L a m p i r a n 6 S u r a t P e n n o h o n a n I z i n P e n e l i t i a n 6 0

L a m p i r a n 7 S u r a t K e t e r a n g a n I z i n P e n g a m b i l a n D a t a d a n P e n e l i t i a n 6 1

L a m p i r a n 8 S u r a t K e t e r a n g a n S e l e s a i P e n e l i t i a n 6 2

xii

BAB I

PENDAHULUAN

11 Latar Belakang

I n f e k s i s a i u r a n k e m i h ( I S K ) m e n i p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m i i k a n d i R u m a h S a k i t a t a u t e m p a t p r a k t i k u m u m s e h a r i - h a r i I S K

a d a i a h s u a t u i n f e k s i y a n g m e n g e n a i t r a k t u s u r i n a r i u s m u l a i d a r i m e a t u s u r e t r a

s a m p a i d e n g a n k e g i n j a l S t r u k t u r y a n g t e n n a s u k d i d a l a m n y a a d a i a h u r e t r a

k a n d u n g k e m i h u r e t e r p e l v i s d a n p a r e n k i m g i n j a l S t r u k t u r y a n g b e r k a i t a n u n t u k

t e r j a d i n y a i n f e k s i d a n r e k u r e n i n f e k s i y a i t u p r o s t a t e p i d i d i m i s d a n fascia

perinephric I s t i l a h I S K m e n u n j u k k a n a d a n y a k e b e r a d a a n m i k r o o r g a n i s m e d i

d a l a m u r i n ( S u d o y o 2 0 0 6 R u b i n 2 0 1 0 ) D e n g a n k a t a l a i n b a h w a d i a g n o s i s I S K

d i t e g a k k a n d e n g a n m e m b u k t i k a n a d a n y a m i k r o o r g a n i s m e d i d a l a m s a i u r a n k e m i h

( R u b i n 2 0 1 0 )

S e b a n y a k 2 5 j u t a k e m a t i a n d i s e l u r u h d u n i a p a d a t a h u n 2 0 1 1 s e p e r t i g a n y a

d i s e b a b k a n o l e h p e n y a k i t i n f e k s i I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n i n f e k s i

d e n g a n k e t e r l i b a t a i i b a k t e r i t e r s e r i n g d i k o m u n i t a s d a n h a m p i r 1 0 o r a n g p e m a h

t e r k e n a I S K s e l a m a h i d u p n y a S e k i t a i - 1 5 0 j u t a p e n d i i d u k d i s e l u r u h d u n i a t i a p

t a l i u n n y a t e r d i a g n o s i s m e n d e r i t a i n f e k s i s a i u r a n k e m i h ( Y u n u s 2 0 1 2 )

I S K d a p a t m e n g e n a i s e m u a k e l o m p o k u m u r b a i k a n a k r e m a j a d e w a s a

m a u p u n u s i a l a n j u t P r e v a l e n s i a n a k u s i a s e k o l a h y a n g m e n d e r i t a I S K s e k i t a r 1 -

3 d a n m e n i n g k a t p a d a r e m a j a y a n g s u d a h m e l a k u k a n h u b i m g a n s e k s u a l

( K o m a r a 2 0 0 9 ) D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r 2 5 - 3 5

s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a S e l a m a

p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n c e n d e r u n g

m e n d e r i t a I S K d i b a n d i n g k a n l a k i - l a k i ( S u d o y o 2 0 0 9 )

R a s i o I S K p a d a w a n i t a d i b a n d i n g p r i a b e r k i s a r 3 0 1 d a n s e k i t a r 5 0 w a n i t a

y a n g t e r k e n a i n f e k s i a k a n b e r k e m b a n g m e n j a d i I S K b e m l a n g I S K m e n i p a k a n

i n f e k s i b a k t e r i y a n g p a l i n g s e r i n g p a d a a n a k - a n a k d e n g a n k e l u h a n d e m a m b a i k

p a d a a n a k p r i a m a u p u n w a n i t a P r e v a l e n s i y a n g p e m a h d i l a p o r k a n b e r k i s a r 4 1

I

2

s a m p a i 7 5 R e k u r e n s i c u k u p s e r i n g d a n t e r j a d i s e k i t a r 1 8 p a d a b a y i l a k i - i a k i

d a n 2 6 p a d a b a y i p e r e m p u a n U n t u k u s i a p r a s e k o l a h I S K l e b i h s e r i n g

m e n g e n a i w a n i t a I n s i d e n I S K p a d a a n a k - a n a k p r a s e k o l a h s e k i t a r 2 ( S y a h r i n i

2 0 1 1 )

D a r i b e r b a g a i p e n e l i t i a n e p i d e m i o l o g i s d i I n d o n e s i a d i d a p a t k a n p r e v a l e n s i

D M s e b e s a r 15 - 2 3 p a d a p e n d u d u k u s i a l e b i J i d a r i 1 5 t a h u n b a h k a n p a d a

s u a t u p e n e l i t i a n e p i d e m i o l o g i s d i M a n a d o d i d a p a t k a n p r e v a l e n s i D M a d a i a h 6 1

P r e v a l e n s i d i a b e t e s m e l i t u s p a d a p e n d u d u k u s i a 2 5 - 6 4 t a h u n d i J a w a d a n B a l i

s e b e s a r 7 5 P e n e l i t i a n y a n g d i l a k u k a n d i J a k a r t a S u r a b a y a M a k a s a r d a n k o t a -

k o t a l a i n d i I n d o n e s i a m e m b u k t i k a n a d a n y a k e n a i k a n p r e v a l e n s i d a r i t a h u n

k e t a h u n ( D E P K E S 2 0 1 4 W H O 2 0 1 0 )

I n f e k s i s a i u r a n k e m i h j u g a m e n i p a k a n m a s a l a h k l i n i s u m u m p a d a p e n d e r i t a

D M o l e h k a r e n a p e n d e r i t a D M m e m p u n y a i k e m u n g k i n a n m e n d e r i t a I S K l e b i h

t i n g g i d i b a n d i n g k a n d e n g a n b u k a n p e n d e r i t a D M d a n j u g a m e n d e r i t a i n f e k s i y a n g

l e b i h b e r a t y a n g a k a n m e n i n g k a t k a n risiko u n t u k m a s u k m m a h s a k i t ( H a r d i n g

d k k 2 0 1 0 ) P e n e l i t i a n y a n g d i l a k u k a n o l e h B o y k o d k k m e n d a p a t k a n w a n i t a D M

ripe 2 d e n g a n b a k t e r i u r i a s i m t o m a t i k s e t e l a h d i l a k u k a n p e m a n t a u a n s e l a m a 1 8

b u l a n m e n g a l a m i p e n i n g k a t a n r i s i k o m e n d a p a t k a n I S K s e b a n y a k 3 4

d i b a n d i n g k a n d e n g a n w a n i t a y a n g t i d a k m e n g a l a m i D M s e b e s a r 1 9 ( B o y k o d k k

2 0 0 2 )

B e r d a s a r k a n u r a i a n - u r a i a n d i a t a s s e r t a b e l u m a d a n y a p e n e l i t i a n y a n g

m e n e m u k a n k e t e r k a i t a n f a k t o r u s i a j e n i s k e l a m m t i n g k a t p e n d i d i k a n d a n r i w a y a t

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h d i K o t a P a l e m b a n g m a k a

p e n e l i t i t e r t a r i k i m t i i k m e l a k u k a n p e n e l i t i a n m e n g e n a i h u b u n g a n a n t a r a u s i a j e n i s

k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

3

12 Rumusan Masalah

1 B a g a i m a n a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s

m e l i t u s

2 A p a k a l i a d a h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

13 Tujuan Penelitian

131 Tujuan Umum

T u j u a n u m u m d a r i p e n e l i t i a n i n i a d a i a h d i k e t e m u k a n n y a h u b u n g a n a n t a i a

u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i m s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

132 Tujuan Khusus

T u j u a n k l i u s u s d a r i p e n e l i t i a n i n i y a i t u

1 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a

2 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n m f e k s i s a i u r a n k e m i b p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n j e n i s k e i a m i n

3 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

4

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n t i n g k a t p e n d i d i k a n

4 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n riwayat d i a b e t e s m e l i t u s

5 T e r a n a l i s i s n y a h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a i m n a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

6 T e r a n a l i s i s n y a h u b u n g a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

7 T e r a n a l i s i s n y a h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

8 T e r a n a l i s i s n y a h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i u i s d e n g a n k e j a d i a n

i n f e k s i s a l i u a i i k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

14 Manfaat Penelitian

141 Manfaat Teoritis

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t m e n a m b a h p e n g e t a h u a n p e n e l i t i

t e n t a n g h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i U i s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

5

142 Manfaat Praktis

A Bagi Peneliti

H a s i l p e n e l i t i a n i n i d i l i a r a p k a n d a p a t d i g u n a k a n s e b a g a i s a l a h s a t u b a h a n

r e f e r e n s i a t a u b a c a a n b a g i p e n e l i t i

B Bagi Institusi

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t d i g u n a k a n p i h a k R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g s e b a g a i s a l a l i s a t u b a h a n a c u a n d a l a m m e n g u p a y a k a n

p e n c e g a h a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

15 Keaslian Penelitian

T a b e l 1 1 K e a s l i a n P e n e l i t i a n

Nama Judul Penelitian Desain Hasil Penelitian

Peneliti Penelitian

Kugan P r e v a l e n s i I n f e k s i Cross D a r i p e n e l i t i a n i i i i

Kandasamy S a i u r a n K e m i l i P a d a seciUmal d i p e r o l e h b a l i w a

W a n i t a Y a n g M e n d e r i t a

D i a b e t e s M e l i t u s T i p e

I I Y a n g D i r a w a t I n a p

p a s i e n w a n i t a d i a b e t e s

m e l i t u s t i p e I y a n g

m e n d e r i t a I S K y a n g

D a n D i r a w a t J a l a n D i d i r a w a t m a p d a n

S u b b a g i a n

E n d o k r i n o l o g i B a g i a n

P e n y a k i t D a l a m D i

d i r a w a t j a l a n d i s u b

b a g i a n E n d o k r i n o l o g i

P e n y a k i t D a l a m

R S U P H A d a m M a l i k R S U P H A d a m

P a d a T a l i u n 2 0 0 9 M a l i k M e d a i i t e r d a p a t

s e b a n y a k 2 5 o r a n g

y a i t u ( 1 2 7 ) D a r i 2 5

o r a n g y a n g m e n d e r i t a

I S K t e r d a p a t 3 o r a n g

y a i t u ( 1 2 0 ) y a n g

d i r a w a t i n a p d a n 2 2

6

o r a n g ( 8 8 0 ) y a n g

d i r a w a t j a l a n

Edel Weisela P e r b e d a a n R i s i k o

Permata I n f e k s i N o s o k o m i a l

Sari dan S a i u r a n K e m i h

Prijono B e r d a s a r k a n

Satyabakti K a i e t e r i s a s i U r i n

U m u r D a n D i a b e t e s

M e l i t u s T a h u n 2 0 1 5

Case H a s i l p e n e l i t i a n y a n g

control d i 1 a k u k a n p a d a 2 0

s a m p e l k a s u s d a n

k o n t r o l m e n u n j u k k a n

b a h w a p a s i e n d e n g a n

u m u r gt 5 5 t a h u n

m e m p u n y a i r i s i k o

5 5 7 k a l i m e n g a l a m i

i n f e k s i n o s o k o m i a l

s a i u r a n k e m i h

d i b a n d i n g k a n p a s i e n

d e n g a n u m u r lt 5 5

t a h u n d e n g a n

p e r i l i t u n g a i i b e s a r

risiko d i p e r o l e h n i l a i

O R s e b e s a r 5 5 7

d e n g a n n i l a i 9 5

(onfidence Interval

l 1 9 lt O R lt 2 8 2 3

P a s i e n d e n g a n s t a t u s

D M m e m p u n y a i risiko

6 k a l i u n t u k

m e n g a l a m i i n f e k s i

n o s o k o m i a l s a i u r a n

k e m i h d i b a n d i n g k a n

d e n g a n p a s i e n y a n g

t i d a k m e n d e r i t a D M

d e n g a n n i l a i O R

7

s e b e s a r 6 0 0 d e n g a n

n i l a i 9 5 Confidence

Interval 1 22 lt O R lt

3 2 2 6

Andry K a r a k t e r i s t i k P a s i e n - D e s k r i p k i f H a s i i p e n e l i t i a n d a r i

Lukandy P a s i e n I n f e k s i S a i u r a n r e t r o s p e k t i f 4 3 o r a n g p e n d e r i t a

K e m i i i d i P o l i u r o l o g i

R S U D D r P i m g a d i

K o t a M e d a n T a h u n

2 0 1 2 - 2 0 1 3

I S K d i d a p a t k a n 5 3 5

p a d a k e l o m p o k u s i a

gt 5 0 t a h u n 5 1 2

b e i j e n i s k e i a m i n l a k i -

l a k i 1 0 0 t i d a k

m e n d e r i t a

v e s i c o u r e t r a l r e f l u x

7 0 Benign Prostatic

Hyperplasia 1 1 6

b a t u s a i u r a n k e m i h

2 7 9 d i a b e t e s t i p e 2

D a r i h a s i l p e n e l i t i a n

i n i d a p a t d i s i m p u l k a n

b a h w a p e n d e r i t a i S K

l e b i h b a n y a k t e r j a d i

p a d a l a k i - l a k i d a n

p e n d e r i t a I S K l e b i h

b a n y a k d i j u m p a i p a d a

k e l o m p o k u m u r gt 5 0

t a h u n s e r t a d i t e m u k a n

I S K d e n g a n B P H

B S K d a n D M T i p e 2

BAB 11

TINJAUAN PUSTAKA

21 Landasan Teori

211Infeksi Saiuran Keniih

A Definisi

I n f e k s i S a i u r a n K e m i h a d a i a h i n v a s i d a n m u l t i p l i k a s i m i k r o o r g a n i s m e a t a u

p a r a s i t d a l a m j a r i n g a n t u b u h k h u s u s n y a s a i u r a n k e m i h y a n g t e r d i r i d a r i g i n j a l

u r e t e r b u l i - b u l i d a n u r e t r a y a n g d i i a n d a i d e n g a n a d a n y a b a k t e r i 1 0 c f i i (colony

forming unit) p e r m l p a d a p e n g a m b i l a n c o n t o h u r i n ( P u m o m o 2 0 1 1 )

I n f e k s i s a i u r a n k e m i h a d a l a l i s u a t u i n f e k s i y a n g m e l i b a t k a n g i n j a l lU e ter

b u l i - b u l i a t a u p u n u r e t r a I n f e k s i s a i u r a n k e m i h ( I S K ) a d a l a l i i s t i l a h u m u m y a n g

m e n u n j u k k a n k e b e r a d a a n m i k r o o r g a n i s m e d a l a m u r i n ( S u d o y o 2 0 0 6 )

B a k t e r i u r i a b e r m a k n a (significant hacteriuria) a d a i a h s u a t u k e a d a a n y a n g

m e n u n j u k k a n p e n u m b u l i a n m i k r o o r g a n i s m e m u m i l e b i h d a r i 1 0 c f t L m l p a d a

b i a k a n u r i n B a k t e r i u r i a b e r m a k n a m u n g k i n t a n p a d i s e r t a i p r e s e n t a s i k l i n i s I S K

d a n d i n a m a k a n b a k t e r i u r i a a s i m t o m a t i k (convert hacteriuria) S e b a l i k n y a

b a k t e r i u r i a b e n n a k n a d i s e r t a i p e r s e n t a s i k l i n i s I S K d i n a m a k a n b a k t e r i u r i a

s i m t o m a t i k P a d a b e b e r a p a k e a d a a n t e r d a p a t p a s i e n d e n g a n p e r s e n t a s i k l i n i s I S K

n a m u n t a n p a b a k t e r i u r i a b e n n a k n a S e l a i n i t u d i k a t a k a n p i u r i a ( l e u k o s i t d a l a m

u r i n ) b e n n a k n a (significant pyuria) b i l a d i t e m u k a n n e u t r o f i l gt 1 0 s e l p e r l a p a n g a n

p a n d a n g ( S u d o y o 2 0 0 6 )

B Epidemiologi

I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m u k a n d i p r a k t i k u m u m w a i a u p u n b e n n a c a m - m a c a m a n t i b i o t i k a s u d a h

t e r s e d i a l u a s d i p a s a r a n D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r

2 5 - 3 5 s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a

S e l a m a p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n

9

10

c e n d e r u n g m e n d e r i t a i S K d i b a n d i n g k a n l a k i - l a k i I S K b e m l a n g p a d a l a k i - l a k i

j a r a n g d i l a p o r k a n k e c u a l i d i s e r t a i f a k t o r p r e d i s p o s i s i ( p e n c e t u s )

P r e v a l e n s i b a k t e r i u r i a a s i m t o m a t i k l e b i h s e r i n g d i t e m u k a n p a d a p e r e m p u a n

P r e v a l e n s i s e l a m a p e r i o d e s e k o l a h (school girls) 1 m e n i n g k a t m e n j a d i 5

s e l a m a p e r i o d e a k t i f s e c a r a s e k s u a l P r e v a l e n s i i n f e k s i a s i m t o m a t i k m e n i n g k a t

m e n c a p a i 3 0 b a i k l a k i - l a k i m a u p u n p e r e m p u a n b i l a d i s e r t a i f a k t o r p r e d i s p o s i s i

( S u d o y o 2 0 0 6 )

C Kiasifikasi

I n f e k s i s a i u r a n k e m i h d a p a t d i b a g i m e n j a d i d u a k a t e g o r i u m u m b e r d a s a r k a n

l o k a s i a n a t o m i y a i t u

1 ) I n f e k s i s a i u r a n k e m i h b a w a h

2 ) I n f e k s i s a i u r a n k e m i h a l a s

P r e s e n t a s i k l i n i s d a r i i n f e k s i s a i u r a n k e m i h b a w a l i t e r g a n t u n g d a r i gender

y a i t u

a ) P e r e m p u a n

a S i s t i t i s

S i s t i t i s a d a i a h p r e s e n t a s i k l i n i s i n f e k s i k a n d u n g k e m i h d i s e r t a i

b a k t e r i u r i a b e n n a k n a

b S i n d r o m U r e t r a A k u t ( S U A )

S i n d r o m a u r e t r a a k u t a d a i a h p r e s e n t a s i k l i n i s s i s t i t i s t a n p a d i t e m u k a n

a d a n y a m i k r o o r g a n i s m e d a l a m L u i n ( s t e r i l ) d a n s e r i n g d i n a m a k a n

s i s t i t i s b a k t e r i a l i s

b ) L a k i - l a k i

P r e s e n t a s i k l i n i s i n f e k s i s a i u r a n k e m i h p a d a l a k i - l a k i m u n g k i n s i s t i t i s

p r o s t a t i t i s e p i d i m i d i s d a n u r e t r i t i s

I n f e k s i s a i u r a n k e m i h a t a s t e r b a g i m e n j a d i 2 y a i t u

1 ) P i e l o n e f r i t i s A k u t ( P N A )

P i e l o n e f r i t i s a k u t a d a l a l i p r o s e s i n f l a m a s i p a r e n k i m g i n j a l y a n g d i s e b a b k a n

o l e h m f e k s i b a k t e r i

11

2 ) P i e l o n e f r i t i s K r o n i s ( P N K )

P i e l o n e f r i t i s k r o n i s m u n g k i n a k i b a t l a n j u t d a r i i n f e k s i b a k t e r i

b e r k e p a n j a n g a n a t a u i n f e k s i s e j a k m a s a k e c i i O b s t r u k s i s a i u r a n k e m i h d a n

r e f l u k s v e s i k o u r e t e r d e n g a n a t a u t a n p a b a k t e r i u r i a k r o n i k s e r i n g d i i k u t i

p e m b e n t u k a n j a r i n g a n i k a t p a r e n k i m g i n j a l y a n g d i t a n d a i d e n g a n

p i e l o n e f r i t i s k r o n i k y a n g s p e s i f i k ( S u d o y o 2 0 0 6 )

D Etiologi

P a d a k e a d a a n n o r m a l u r i n b e r s i f a t s t e r i l U m u m n y a I S K d i s e b a b k a n o l e h

k i i m a n g r a m n e g a t i f E s c h e r i c h i a c o l i m e m p a k a n p e n y e b a b t e r b a n y a k b a i k p a d a

y a n g s i m t o m a t i k m a u p u n y a n g a s i m t o m a t i k y a i t u 7 0 - 9 0 E n t e r o b a k t e r i a s e p e r t i

P r o t e u s m i r a b i l i s ( 3 0 d a r i i n f e k s i s a i u r a n k e m i h p a d a a n a k l a k i - l a k i t e t a p i

k u r a n g d a r i 5 p a d a a n a k p e r e m p u a n ) K l e b s i e l l a p n e u m o n i a d a n P s e u d o m o n a s

a e m g i n o s a d a p a t j u g a s e b a g a i p e n y e b a b O r g a n i s m e g r a m p o s i t i f s e p e r t i

S t r e p t o c o c c u s f a e c a l i s ( e n t e r o k o k u s ) S t a p h y l o c o c c u s e p i d e n n i d i s d a n

S t r e p t o c o c c u s v i r i d a n s j a r a n g d i t e m u k a n P a d a u r o p a t i o b s t m k t i f d a n k e l a i n a n

s t r u k t u r s a i u r a n k e m i h p a d a a n a k l a k i - l a k i s e r i n g d i t e m u k a n P r o t e u s s p e c i e s P a d a

I S K n o s o k o m i a l a t a u I S K k o m p l e k s l e b i h s e r i n g d i t e m u k a n k u m a n P r o t e u s d a n

P s e u d o m o n a s ( L u m b a n b a t u S M 2 0 0 3 )

E Patofisiologi

P a d a i n d i v i d u n o n n a l b i a s a n y a u r i n l a k i - l a k i m a u p u n p e r e m p u a n s e l a l u

d a l a m k e a d a a n s t e r i l k a r e n a d i p e r t a l i a n k a n o l e h j u m l a l i d a n f r e k u e n s i b e r k e m i h

U t e r o d i s t a l m e m p a k a n t e m p a t k o l o n i s a s i m i k r o o r g a n i s m e nonpathogenic

fastidious G r a m - p o s i t i f d a n g r a m n e g a t i f ( S u d o y o 2 0 0 6 )

H a m p i r s e m u a I S K d i s e b a b k a n i n v a s i m i k r o o r g a n i s m e ascending d a r i u r e t r a

k e d a l a m k a n d u n g k e m i b P a d a b e b e r a p a p a s i e n t e r t e n t u i n v a s i m i k r o o r g a n i s m e

d a p a t m e n c a p a i k e g i n j a l P r o s e s i n i d i p e n n u d a h o l e h k o n d i s i r e f l u k s

v e s i k o i i r e t e r a l P r o s e s i n v a s i m i k r o o r g a n i s m e h e m a t o g e n s a n g a t j a r a n g d i t e m u k a n

d i k l i n i k m u n g k i t a k i b a t l a n j u t d a r i b a k t e r e m i a G i n j a l d i d u g a m e n i p a k a n l o k a s i

12

i n f e k s i s e b a g a i a k i b a t l a n j u t d a r i s e p t i k e m i a a t a u e n d o k a r d i t i s a k i b a t S t a f i l o k o k u s

a u r e u s K e l a i n a n g i n j a l y a n g t e r k a i t d e n g a n e n d o k a r d i t i s ( S t a f i l o k k o k u s a u r e u s )

d i k e n a l d e n g a n N e p h r i t i s L o h e i n B e b e r a p a p e n e l i t i a n m e l a p o r k a n p i e l o n e f r i t i s

a k u t ( P N A ) s e b a g a i a k i b a t l a n j u t i n v a s i h e m a t o g e n ( S u d o y o 2 0 0 6 )

F Faktor Risiko

P a t o f i s i o l o g i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h d a p a t d i p e n g a n i h i o l e h

b e b e r a p a f a k t o r A d a p u n b e b e r a p a f a k t o r risiko y a n g m e m p e n g a n i l i i t e r j a d i n y a

i n f e k s i s a i u r a n k e m i h a n t a r a l a i n

1 ) U s i a

I n s i d e n I S K m e n i n g k a t b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i

m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n a d a n y a a b n o r m a l i t a s a n a t o m i y a n g

m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n k e m i h s e p e r t i p e m b e s a r a n p r o s t a t

d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e

P e n y e b a b l a i n t e r m a s u k p e r i n e u m y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s

p e n y a k i t n e u r o m u s k n l a r d a n k a t e t e r i s a s i b u l i - b u l i S e l a i n i t u i n s i d e n I S K

m e n c a p a i 1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o s e 2 0 0 9 F o x m a n e t a l 2 0 1 0

R o n a l d 2 0 1 1 )

M e n u m t t e o r i y a n g d i k e m u k a k a n o l e h S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a d a u s i a

l a n j u t a k a n t e r j a d i p e n i n g k a t a n k e r e n t a n a n t e r h a d a p p e n y a k i t P a d a u s i a d i a t a s 5 0

t a l i u n t e r j a d i p e n u m n a n k e m a m p u a n d a l a m m e m p e r t a h a n k a n s t e n l i t a s b a i k p a d a

k a n d u n g k e m i h m a u p u n u r e t r a H a l t e r s e b u t d i s e b a b k a n o l e h i n v o l u s i t i m u s

I n v o l u s i s e l t i m u s m e n y e b a b k a n j u m l a h se d a n k u a l i t a s r e s p o n s s e l T s e m a k i n

b e r k u r a n g J u m l a h s e l T m e m o r i m e n i n g k a t n a m u n s e m a k i n s u l i t u n t u k

b e r k e m b a n g t e r u t a m a s i t o t o k s i k s e l T ( C D ^ ) d a n s e l T h l ( C D ^ ^ ) k a r e n a t e r j a d i

a p o p t o s i s S i t o t o k s i k s e l T ( C D ^ ^ ) b e i p e r a n d a l a m r e s p o n s i m u n t e r h a d a p a n t i g e n

p a d a s e l y a n g d i i n f e k s i d e n g a n c a r a m e m b u n u l i s e l y a n g t e r i n f e k s i u n t u k

m e n c e g a h p e n y e b a r a n m f e k s i s e d a n g k a n s e l T h l ( C D ^ ^ ) b e r p e r a n m e m b a n t u s e l

B u n t u k m e m p r o d u k s i a n t i b o d i

13

2 ) J e n i s k e l a m m d a n a k t i v i t a s s e k s u a l

I n s i d e n s i I S K y a n g r e n d a h p a d a p r i a d i p e n g a n i h i o l e h 3 f a k t o r y a i t u

1 L e b i h s e d i k i t t e r j a d i k o l o n i s a s i s e k i t a r u r e t r a k a r e n a t i d a k a d a n y a t e m p a t

s e p e r t i v a g i n a p a d a p e r e m p u a n

2 M e m i l i k i u r e t r a y a n g p a n j a n g

3 A d a n y a s u b s t a n s i a n t i b a k t e r i a l p a d a c a i r a n p r o s t a t

U r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a h d e n g a n d e k a t n y a v a g i n a l

v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h l e b i h s e r i n g

p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a f l o r a n o n n a l p a d a d a e r a l i p e r i u r e t r a t e r d i r i

d a r i o r g a n i s m e s e p e r t i l a c t o b a c i l l i i s y a n g m e m b a n t u m e l a w a n k o l o n i s a s i b a k t e r i

p a t o g e n p a d a s a i u r a n k e m i h P e r u b a l i a n l i n g k i m g a n d a r i p e r i u r e t r a l s e p e r t i

p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k b i s a m e n g g a n g g u f l o r a

n o r m a l s e h i n g g a m e m u n g k i n k a n b a k t e r i p a t o g e n b e r k o l o n i s a s i d a n m e n y e b a b k a n

i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

P a d a w a n i t a l e b i h d a r i 5 0 t a h u n a t a u l e b i h m e n o p a u s e m e m p a k a n f a k t o r

l a i n y a n g m e n i n g k a t k a n P V R Post Void Residual) s e l a i n p e n u r u n a n k o i i t r a k t i i i t a s

o t o t d e t r u s o r P e n u m n a n e s t r o g e n y a n g d i s e b a b k a n m e n o p a u s e d a p a t

m e n i n g k a t k a n p H v a g i n a l d a n m e n u m n k a n j u m l a l i l a c t o b a c i l l i A k i b a m y a t e r j a d i

p e n i n g k a t k a n k o l o n i s a s i d a r i b a s i l g r a m n e g a t i f s e h i n g g a m e n i n g k a t k a n r e s i k o

t e r j a d i n y a I S K P a d a p r i a p r o s t a t m e n s e k r e s i k a n c a i r a n y a n g m e n g a n d i m g z i n k

y a n g m e m i l i k i a k t i f i t a s m i k r o b i a l ( K i m 2 0 1 2 )

S e l a i n i t u p i j a t a n u r e t r a s e p e r t i y a n g t e r j a d i s e l a m a h u b u n g a n s e k s u a l

m e n y e b a b k a n m a s u k n y a b a k t e r i k e d a l a m k a n d u n g k e m i h d a n m e m p a k a n h a l

y a n g p e n t i n g d a l a m p a t o g e n e s i s m f e k s i s a l i u a n k e m i h p a d a p e r e m p u a n m u d a

B u a n g a i r k e c i l s e t e l a h h u b u n g a n s e k s u a l t e r b u k t i m e n u m n k a n risiko s i s t i t i s

m u n g k i n k a r e n a t i n d a k a n i n i m e n i n g k a t k a n e r a d i k a s i b a k t e r i y a n g m a s u k s e l a m a

h u b u n g a n s e k s u a l ( K i m 2 0 1 2 )

3 ) T i n g k a t P e n d i d i k a n

P e n g e t a h u a n s e s e o r a n g t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t

p e n d i d i k a n S e s e o r a n g y a n g m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m i u i g k i n a n

p e n g e t a h u a n t e n t a n g k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o n n a s i y a n g d i d a p a t k a n

14

t e n t a n g k e s e h a t a n l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h

S e b a l i k n y a p e n d i d i k a n y a n g k u r a n g d a p a t m e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g

t e r h a d a p n i l a i - n i l a i y a n g b a n i d i k e n a l ( N o t o a d i n o j o 2 0 0 3 )

4 ) R i w a y a t D i a b e t e s M e l i t u s

M e n u r u t S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a s i e n d e n g a n s t a t u s D M s a n g a t

b e r i s i k o u n t u k m e n g a l a m i i n f e k s i s a i u r a n k e m i h A b n o n n a l i i a s s t n i k t u r d a n

k a n d u n g k e m i h n e u r o g e n i k a k i b a t n e u r o p a t i o t o n o m a t a u s t r o k e p a d a p a s i e n D M

m e n y e b a b k a n p e n g o s o n g a n k a n d u n g k e m i h t i d a k n o n n a l D M j u g a d a p a t

m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a h a n a n t u b u h y a n g b e r p o t e n s i m e n i n g k a t

risiko t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a h a n a n t u b u h t e r s e b u t d i a n t a r a n y a

a d a i a h k e g a g a l a n m i g r a s i s e l intracellular killing f a g o s i t o s i s d a n k e m o t a k s i s

p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n m e k a n i s m e p e r t a h a n a n

a l a m i a h i o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p i n f e k s i

5 ) K e h a m i i a n

K e c e n d e r u n g a n i n f e k s i s a i u r a n k e m i h b a g i a n a t a s s e l a m a k e h a m i i a n

d i s e b a b k a n o l e h p e n u m n a n k e k u a t a n u r e t e r p e n u m n a n p e r i s t a l t i k u r e t e r d a n

i n k o m p e t e n s i s e m e n t a r a k a l u p v e s i k o i u - e t e r a l y a n g t e r j a d i s e l a m a h a m i l

6 ) S u m b a t a i i

A d a n y a I i a i a n g a n a l i r a n b e b a s u r i n s e p e r t i t u m o r s t r i k t r a a b a t u a t a u

h i p e r t r o f i p r o s t a t d a p a t m e n y e b a b k a n h i d r o n e f r o s i s d a n risiko i n f e k s i s a i u r a n

k e m i l i y a n g s a n g a t t i n g g i S e l a i n i t u s u p e r i n f e k s i p a d a s u m b a t a n s a i u r a n k e m i h

d a p a t m e n y e b a b k a n k e m s a k a n j a r i n g a n g i n j a l y a n g c e p a t

7 ) D i s f u n g s i n e u r o g e n i k k a n d u n g k e m i h

G a n g g u a n s a r a f y a n g b e k e r j a p a d a k a n d m i g k e m i h s e p e r t i p a d a j e j a s k o r d a

s p i n a l i s t a b e s d o r s a i i s m u l t i p e l s k l e r o s i s d i a b e t e s m e l i t u s a t a u p e n y a k i t l a i n

d a p a t b e r h u b u n g a n d e n g a n i n f e k s i s a i u r a n k e m i h I n f e k s i d a p a t d i a w a l i o l e h

p e n g g u n a a n k a t e l e r u n t u k d r a i n a s e k a n d i u i g k e m i h d a n d i d u k i m g o l e h s t a t i s u r i n

d a l a m k a n d u n g k e m i l i u n t u k j a n g k a w a k t u y a n g l a m a

8 ) R e f l u k s v e s i k o m e t e r a

K e a d a a n i n i d i d e f i n i s i k a n s e b a g a i r e f l u k s u r i n d a r i k a n d u n g k e m i b k e u r e t e r

d a n k a d a n g s a m p a i k e p e l v i s r e n a l H a l i n i t e r j a d i s e l a m a b u a n g a i r k e c i l a t a u

15

d e n g a n p e n i n g k a t a n t e k a n a n p a d a k a n d u n g k e m i h R e f l u k s v e s i k o i i r e t e r a l d a p a t

d i b u k t i k a n d e n g a n a d a n y a g c r a k a n r e t r o g r a d z a t r a d i o o p a k a t a u r a d i o a k t i f m e l a l u i

s i s t o u r e t r o g r a m s e l a m a b u a n g a i r k e c i l R e f l u k s v e s i k o i i r e t e r a l b i a s a n y a

d i s e b a b k a n k a r e n a a d a n y a g a n g g u a n a n a t o m i s p a d a p e r t e m u a n v e s i k o i i r e t e r a l

y a n g d a p a t m e n y e b a b k a n r e f l u k s u r i n d i s e r t a i b a k t e r i d a n k a r e n a i t u t e r j a d i l a h

i n f e k s i s a l r a a n k e m i h

9 ) F a k t o r v i r u l e n s i b a k t e r i

F a k t o r v i r u l e n s i b a k t e r i m e m p e n g a r u b i k e m u n g k i n a n vragt7 t e r t e n m d a l a m

m e n y e b a b k a n i n f e k s i t r a k i u s u r i n a r i u s H a m p i r s e m u a strain F c o l i y a n g

m e n y e b a b k a n p i e l o n e f r i t i s p a d a p a s i e n d e n g a n t r a k i u s u r i n a r i u s n o m i a l s e c a r a

a n a t o m i k m e m p u n y a i p i l u s t e r t e n t u y a n g m e m p e r a n t a r a i p e r l e k a t a n p a d a b a g i a n

d i g a k t o s i d a d a n g l i k o s f i n g o l i p i d y a n g a d a d i u r o e p i t e l Strain y a n g m e n i m b u l k a n

p i e l o n e f r i t i s j u g a b i a s a n y a m e m p a k a n p e n g b a s i l h e m o l i s i n m e m p u n y a i

a e r o b a k t i n d a n r e s i s t e n t e r h a d a p k e r j a b a k t e r i s i d a l d a r i s e m m m a n u s i a

1 0 ) F a k t o r g e n e t i k

F a k t o r g e n e t i k p e n j a m u m e m p e n g a n i l i i k e r e n t a n a n t e r h a d a p i n f e k s i t r a k t u s

u r i n a r i u s J u m l a h d a n t i p e r e s e p t o r p a d a s e l u r o e p i t e l t e m p a t b a k t e r i d a p a t

m e n e m p e l s e l i d a k i i y a s e b a g i a i i d i t e n t u k a r i s e c a r a g e n e t i k ( I s s e l b a c h e r 2 0 0 9 )

G Manifestasi Klinis

G e j a l a k l i n i s d a r i i n f e k s i s a i u r a n k e m i h s e s u a i d e n g a n b a g i a n s a i u r a n k e m i h

y a n g t e r i n f e k s i a d a i a h s e b a g a i b e r i k u t

1 ) I n f e k s i s a i u r a n k e m i h b a g i a n b a w a l i

K e l u h a n p a s i e n b i a s a n y a b e m p a r a s a s a k i t a t a u r a s a p a n a s d i u r e t r a s e w a k t u

k e n c i n g d e n g a n a i r k e m i h s e d i k i t - s e d i k i t s e r t a r a s a t i d a k e n a k d i d a e r a h

s i i p r a p u b i k

2 ) I n f e k s i s a i u r a n k e m i h b a g i a n a t a s

P a d a i n t e k s i s a i u r a n k e m i h b a g i a n a t a s d a p a t d i t e m u k a n g e j a l a s e p e r t i s a k i t

k e p a l a m a l a i s e m u a l m m i t a h d e n i a m m e n g g i g i l r a s a t i d a k e n a k a t a u

n y e r i d i p i n g g a n g ( T e s s y d k k 2 0 0 1 )

16

H Tatalaksana

T u j u a n p e n a t a l a k s a n a a a n i n f e k s i s a i u r a n k e m i h a d a i a h m e n c e g a h d a n

m e n g h i l a n g k a n g e j a l a m e n c e g a h d a n m e n g o b a t i b a k t e n e m i a d a n b a k t e r i u r i a s e r t a

m e n c e g a h d a n m e n g u r a n g i r i s i k o k e r u s a k a n g i n j a l y a n g m u n g k i n t i m b u l d e n g a n

p e m b e r i a n o b a t - o b a t a n y a n g s e n s i t i f m u r a l i d a n a m a n d e n g a n e f e k s a m p i n g y a n g

m i n i m a l

a ) i n f e k s i s a i u r a n k e m i h ( I S K ) b a w a h

P r i n s i p p e n a t a l a k s a n a a n I S K b a w a h m e l i p u t i intake c a i r a n y a n g b a n y a k

a n t i b i o t i k y a n g a d e k u a t d a n b i l a p e r l u t e r a p i s i m t o m a t i k u n t u k a l k a l i s a s i

u r i n

i H a m p i r 8 0 p a s i e n a k a n m e m b e r i k a n r e s p o n s e t e l a h 4 8 j a m d e n g a n

a n t i b i o t i k a t u n g g a l s e p e r t i a m p i s i l i n 3 g r a m a t a u t r i m e t o p r i m 2 0 0 m g

i i B i l a i n f e k s i m e n e t a p d i s e r t a i k e l a i n a n u r i n a l i s i s ( l e u k o s i u i a ) d i p e r i u k a n

t e r a p i k o n v e n s i o n a l s e l a m a 5 - 1 0 h a r i

i i i P e m e r i k s a a n m i k r o s k o p i s u r i n d a n b i a k a n u r i n t i d a k d i p e r i u k a n b i l a

s e m u a g e j a l a h i l a n g d a n t a n p a l e u k o s u r i a

b ) I n f e k s i s a i u r a n k e m i h ( I S K ) a t a s

P a d a u m u m n y a p a s i e n d e n g a n p i e l o n e f r i t i s a k u t m e m e r l u k a n r a w a t i n a p

u n t u k m e m e l i h a r a s t a t u s h i d r a s i d a n t e r a p i a n t i b i o t i k a p a r e n t e r a l p a l i n g

s e d i k i t 4 8 j a m ( S u d o y o 2 0 0 6 )

i Komplikasi

K o m p l i k a s i i n f e k s i s a i u r a n k e m i h t e r g a n t u n g d a r i t i p e y a i t u i n f e k s i s a i u r a n

k e m i h t i p e s e d e r h a n a (uncomplicated) d a n t i p e b e r k o m p l i k a s i (complicated)

1 ) I n f e k s i s a i u r a n k e m i h s e d e r h a n a (uncomplicated)

I n f e k s i s a i u r a n k e m i h a k u t t i p e s e d e r h a n a ( s i s t i t i s ) y a i t u n o n - o b s t r u k s i d a n

b u k a n p e r e m p u a n h a m i l m e m p a k a n p e n y a k i t r i n g a n (self limited disiase)

d a n t i d a k m e n y e b a b k a n a k i b a t l a n j u t j a n g k a l a m a

2 ) I n f e k s i s a i u r a n k e m i h b e r k o m p l i k a s i (complicated)

a ) I n f e k s i s a i u r a n k e m i h s e l a m a k e h a m i i a n

b ) i n f e k s i s a i u r a n k e m i h p a d a d i a b e t e s m e l i t u s ( S u d o y o 2 0 0 6 )

17

22 Kerangka Teori

J

U s i a

J e n i s K e i a m i n

T i n g k a t P e n d i d i k a n

R i w a y a t D i a b e t e s M e l i m s

S u m b a t a n bullT

K e h a m i i a n

D i s f u n g s i n e u r o g e n i k

R e f l u k s v e s i k o i i r e t e r a l

V i r u l e n s i b a k t e r i

F a k t o r g e n e t i k

I n f e k s i b a k t e r i g r a m p o s i t i f a t a u n e g a t i v e p a d a s a i u r a n k e m i h

I n f e k s i S a i u r a n K e m i h

Keterangan

I j = V a r i a b e l y a n g t i d a k d i t e l i t i

= V a r i a b e l y a n g d i t e l i t i

18

Hipotesis

H i p o t e s i s d a l a m p e n e l i t i a n i n i a d a i a h

H O t i d a k t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n

t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

H I t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

BAB 111

M E T O D E PENELITIAN

31 Jenis Penelitian

P a d a p e n e l i t i a n i n i j e n i s p e n e l i t i a n y a n g d i g u n a k a n a d a i a h p e n e l i t i a n

o b s e r v a s i o n a i a n a l i t i k d e s a i n cross scclional d e n g a n m e n g g u n a k a n d a t a s e k u n d e r

d a r i r e k a m m e d i s p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1 D e s e m b e r

2 0 1 5

32 Waktu dan Tempat Penelitian

321 Waktu Penelitian

W a k t u p e n e l i t i a n d i l a k s a n a k a n p a d a t a n g g a l 1 O k t o b e r s a m p a i d e n g a n 3 0

O k t o b e r 2 0 1 6

322 Tempat Penelitian

P e n e l i t i a n i n i d i l a k s a n a k a n d i R u m a l i S a k i t M u h a m m a d i y a h P a e m b a n g ( d i

R u a n g R e k a m M e d i s )

33 Populasi dan Sampel Penelitian

331Populasi Penelitian

P a d a p e n e l i t i a n i n i p o p u l a s i t a r g e t a d a l a l i p a s i e n r a w a t i n a p d a n r a w a t j a l a n

d i R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g s e d a n g k a n p o p u l a s i t e r j a n g k a u n y a

a d a i a h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

332Sampel dan Besar Sampel Penelitian

P a d a p e n e l i t i a n i n i s a m p e l p e n e l i t i a n a d a i a h p a s i e n r a w a t i n a p d a n r a w a t

j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e

1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 y a n g m e m e n u h i k r i t e r i a i n k l u s i p e n e l i t i a n

1 9

20

d e n g a n b e s a r s a m p e l y a n g l a y a k d a l a m p e n e l i t i a n m e n u r u t t e o r i R o s c o e a d a i a h

a n t a r a t i g a p u l u h s a m p a i l i m a r a t i i s o r a n g ( S u g i y o n o 2 0 1 5 )

333 Krttena Inklusi dan Eksklusi

A Kriteria Inklusi

P a d a p e n e l i t i a n i n i k r i t e r i a i n k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t i n a p

d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i

P a l e m b a n g y a n g d i d i a g n o s a m e n g a l a m i i n f e k s i s a i u r a n k e m i h s e r t a m e m i l i k i d a t a

r e k a m m e d i s p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

B Kriteria Eksklusi

P a d a p e n e l i t i a n i n i k r i t e r i a e k s k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t

i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 d e n g a n d a t a r e k a m m e d i s

y a n g t i d a k l e n g k a p

334 Cara Pengambilan Sampel Penelitian

C a r a p e n g a m b i l a n s a m p e l y a n g d i g u n a k a n d a l a m p e n e l i t i a n i n i a d a l a l i

m e n g g u n a k a n t e k n i k consecutive sampling P a d a consecutive sampling s e t i a p

p a s i e n y a n g m e m e n u h i k r i t e r i a p e n e l i t i a n d i m a s u k k a n d a l a m p e n e l i t i a n s a m p a i

k u r u n w a k t u t e r t e n U i s e h i n g g a j u m l a h m i n i m a l y a n g d i p e r i u k a n t e r p e n u h i

( S a s t r o a s m o r o 2 0 1 1 )

34 Variabel Penelitian

341 Variabel Dependent

V a r i a b e l dependent f t e r i k a t ) d a l a m p e n e l i t i a n i n i a d a i a h i n f e k s i s a i u r a n

k e m i h

342 Variabel Independent

V a r i a b e l independent ( b e b a s ) d a l a m p e n e l i t i a n i n i a d a i a h u s i a j e n i s

k e l a i n i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

21

35 Definisi Operasional

Tabel 31 Definisi Operasional

Variabel Alat Cara ueiinisi rldsil L KUr I7 i l l 11 Lz fe 1 V

oKaia LiKur Penelitian Ukur Ukur

Infeksi P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Saiuran d i d i a g n o s a o l e h m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Keniih d o k t e r m e n g a l a m i m e d i s

i n f e k s i s a i u r a n

k e m i h d a n t e r c a n t u m

d i r e k a m m e d i s

U s i a L a m a n y a t a h u n R e k a m O b s e r v a s i 1 lt 5 0 t a h u n O r d i n a l

k e h i d u p a n p a s i e n m e d i s r e k a m 2 gt 5 0 t a l i u n ( k a t e g o r i k )

d a r i l a h i r s a m p a i m e d i s

s e k a r a n g d a n

t e r c a n t u m d i r e k a m

m e d i s

Jenis P r o f i l a n a t o m i a t a u R e k a m O b s e r v a s i 1- L a k i - l a k i N o m i n a l

Keiamin b i o l o g i s p a s i e n y a n g m e d i s r e k a m 2 P e r e m p u a n ( k a t e g o r i k )

d i b e d a k a n m e n j a d i m e d i s

i a k i - l a k i d a n

n e r e m m i a n s e r t a

t e r c a n t u m d i r e k a m

m e d i s

Tingkat P e n d i d i k a n f o n n a l R e k a m O b s e r v a s i 1 P e n d i d i k a n O r d i n a l

Pendidikan t e r a k h i r y a n g m e d i s r e k a m d a s a r ( S D ( k a t e g o r i k )

d i t e m p u h o l e h m e d i s M I S M P

p a s i e n d a n t e r c a n t u m d a n M T s )

d i r e k a m m e d i s 2 P e n d i d i k a n

m e n e n g a l i

d a n t i n g g i

22

( S M A M A

S M K

M A K

d i p l o m a

s a r j a n a

m a g i St e r

s p e s i a l i s

d a n d o k t o r )

Riwayat P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Diabetes d i d i a g n o s i s d e n g a n m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Melitus d i a b e t e s m e l i t u s d a n

t e r c a n t u m d i d a l a m

r e k a m m e d i s

m e d i s

36 Cara Pengumpulan Data

361 Data Sekunder

P e n g u m p u l a n d a t a p a d a p e n e l i t i a n i n i d i p e r o l e h d a r i d a t a s e k u n d e r y a i t u

r e k a m m e d i s p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

37 Metode Teknik Analisis Data

371Cara Pengolahan dan Analisis Data

P e n g o l a h a n d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n m e l a l u i e m p a t t a h a p y a i t u

i Oala Entry

P a d a t a i i a p i n i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n riwayat d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g y a n g t e l a h d i d a p a t d a n

r e k a m m e d i s d i k u m p u l k a n d a n d i m a s u k k a n k e d a l a m p r o g r a m spss

23

2 Editing

P a d a t a h a p i n i d a t a i i s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n y a n g t e l a h d i m a s u k k a n k e d a l a m p r o g r a m s p s s

d i p e r i k s a k e m b a l i a p a k a h s u d a h l e n g k a p d a n t i d a k a d a k e k e l i r u a n

3 ( oding

S e t e l a h m e l a l u i p r o s e s editing d a t a - d a t a t e r s e b u t d i b e r i k o d e t e r t e n t u a n t a r a

l a i n k o d e 1 u n t u k u s i a gt 5 0 t a h u n j e n i s k e i a m i n p e r e m p u a n t i n g k a t

p e n d i d i k a n d a s a r t e r d a p a t r i w a y a t d i a b e t e s m e l i t u s d a n i n f e k s i s a i u r a n

k e m i h s e d a n g k a n k o d e 2 u n t u k u s i a lt 5 0 t a h u n j e n i s k e i a m i n l a k i - l a k i

t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i t i d a k t e r d a p a t r i w a y a t d i a b e t e s

m e l i t u s d a n b u k a n i n f e k s i s a i u r a n k e m i h s e h i n g g a m e m u d a h k a n d a l a m

m e l a k u k a n a n a l i s i s d a t a

4 Tahulaling

P a d a t a h a p i n i d a t a y a n g s a m a d i k e l o m p o k k a n s e c a r a t e l i t i d a n t e r a t m

k e m u d i a n d i l i i t u n g d e n g a n m e n g g u n a k a n p r o g r a m sps s d a n d i j u m l a h k a i i

l a l u d i s a j i k a n d a l a m b e n t u k t a b e l - t a b e l

U n t u k m e n g a n a l i s i s d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n a n a l i s i s d a t a

u n i v a r i a t d a n b i v a r i a t d e n g a n m e n g g u n a k a n p r o g r a m s p s s s e b a g a i b e r i k u t

A A n a l i s i s u n i v a r i a t

A n a l i s i s u n i v a r i a t d i l a k u k a n d e n g a n c a r a m e l a k u k a n a n a l i s i s p a d a s e t i a p

v a r i a b e l h a s i l p e n e l i t i a n d e n g a n t u j u a n u n t u k m e n g e t a h u i d i s t r i b u s i p r o p o r s i p a d a

s e t i a p v a r i a b e l p e n e l i t i a n D a t a d i s a j i k a n d a l a m b e n t u k t a b e l d a n n a r a s i

B A n a l i s i s b i v a r i a t

A n a l i s i s b i v a r i a t d i l a k u k a n d e n g a n m e n g g u n a k a n u j i h i p o t e s i s chi-square

U j i h i p o t e s i s chi-square d a p a t d i g u n a k a n d e n g a n s y a r a t y a i t u lt 2 0 s e l y a n g

m e m p u n y a i n i l a i expected count k u r a n g d a r i l i m a s e h i n g g a j i k a t i d a k m e m e n u h i

s y a r a t u j i chi-square m a k a u j i y a n g d i g u n a k a n a d a i a h u] fisher ( D a h l a n 2 0 1 4 )

B a t a s k e m a k n a a n y a n g d i g u n a k a n a d a i a h a = 0 0 5 J i k a d i d a p a t k a n p value lt 0 0 5

p a d a u j i s t a t i s t i k m a k a t i d a k t e r d a p a t h u b u n g a n y a n g b e n n a k n a a n t a r a d u a

v a r i a b e l y a n g d i t e l i t i d a n H O d i t e r i m a S e d a n g k a n j i k a d i d a p a t k a n p value gt 0 0 5

24

p a d a u j i s t a t i s t i k m a k a t e r d a p a t l i u b u n g a n y a n g b e n n a k n a a n t a r a d u a v a r i a b e l

y a n g d i t e l i t i d a n H O d i t o l a k

38 Alur Penelitian

P e n e n t u a n p o p u l a s i d a n s a m p e l p e n e l i t i a n

K r i t e r i a i n k l u s i K r i t e r i a e k s k l u s i

P e n g a m b i l a n s a m p e l p e n e l i t i a n

P e n g o l a h a n d a n a n a l i s i s d a t a d e n g a n u j i chi-square

H a s i l d a n p e m b a h a s a n

K e s i m p u l a n d a n s a r a n

Gambar 31 Alur Penelitian Hubungan Usia Jenis Keiamin Tingkat Pendidikan dan Riwayat Diabetes Melitus dengan Kejadian Infeksi Saiuran Kemih pada Pasien Rawat Inap di Bagian Penyakit Dalam Rumah Sakit Muhammadiyah Palembang Periode 1 Januari 2015 sampai dengan 31 Desember 2015

BAB IV

HASIL DAN PEMBAHASAN

41 Hasil

P e n e l i t i a n i n i t e l a h d i l a k u k a n d i r u a n g r e k a m m e d i s R u m a h S a k i t

M u h a i m n a d i y a h P a l e m b a n g d a r i t a n g g a l 1 O k t o b e r 2 0 1 5 - 3 1 O k t o b e r 2 0 1 6

P e n e l i t i a n d i m u l a i d e n g a n p e n g a m b i l a n d a t a a w a l b e m p a d a t a r e k a m m e d i s

s e l u r u h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

S e l a n j u t n y a r e k a m m e d i s d i p i l i h s e s u a i d e n g a n k r i t e r i a i n k l u s i d a n e k s k l u s i u n t u k

d i j a d i k a n s a m p e l p e n e l i t i a n s a m p a i m i n i m a l b e s a r s a m p e l y a n g d i b u t u h k a n

t e r p e n u h i s e r t a d i l a k u k a n p e n e l i t i a n s e c a r a o b s e r v a s i o n a i O b s e r v a s i r e k a m m e d i s

d i l a k u k a n u n m k m e n g e t a h u i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t

d i a b e t e s m e l i t u s d a n d i a g n o s a p a s i e n

D a r i c a t a t a n r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g

d i d a p a t k a n s e b a n y a k 4 1 4 1 r e k a m m e d i s p a s i e n r a w a t i n a p d a n 1 4 5 3 r e k a m m e d i s

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 D a r i t o t a l r e k a m m e d i s

p a s i e n r a w a t i n a p d a n r a w a t j a l a n t e r s e b u t p e n e l i t i h a n y a m e n g a m b i l m i n i m a l

b e s a r s a m p e l y a n g d i b u t u h k a n y a i t u s e b a n y a k 9 8 r e k a m m e d i s u n t u k d i j a d i k a n

s a m p e l p e n e l i t i a n y a n g t e r d i r i d a r i 3 0 r e k a m m e d i s p a s i e n y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i h d a n 6 8 r e k a m m e d i s y a n g t i d a k m e n g a l a m i i n f e k s i s a i u r a n k e m i h

411 Hasil Analisis Univariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s u n i v a r i a t

a n t a r a l a i n d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p b e r d a s a r k a n u s i a d a n

j e n i s k e l a m m d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n b e r d a s a r k a n u s i a

d a n j e n i s k e i a m i n d i s t r i b u s i p r o p o r s i s a m p e l b e r d a s a r k a n k e j a d i a n m f e k s i s a i u r a n

k e m i h s e r t a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n u s i a

j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

25

26

A Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan IJsta

dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 41 Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan

Usia dan Jenis Keiamin

Paisen Rawat Inap N Persentase

Usia

1 7 - 2 5 t a h u n 678 1 6 4

2 6 - 3 5 t a h u n 952 2 3 0

3 6 - 4 5 t a l i u n 745 18 0

4 6 - 5 5 t a h u n 695 1 6 8

5 6 - 6 4 t a h u n 571 1 3 8

gt 6 4 t a h u n 500 1 2 1

U s i a r a t a - r a t a ( t a h u n j 43plusmn16543

Jenis Keiamin

P e r e m p u a n 2 6 3 8 6 3 7

L a k i - l a k i 1 5 0 3 3 6 3

Total 4141 100

B e r d a s a r k a n t a b e l 4 1 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R i u n a h S a k i t M u l i a m m a d i y a l i

P a l e m b a n g p e r i o d e J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 2 6 - 3 5 t a h u n y a i t u

s e b a n y a k 9 5 2 o r a n g ( 2 3 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 43plusmn16543 t a l i u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 2 6 3 8 o r a n g ( 6 3 7 )

27

B Distribusi Proporsi Karakteristik Pasien Rawat Jalan Berdasarkan

Usia dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 42 Distribusi Proporsi Karakteristik Pasien Rawat Jalan

Berdasarkan Usia dan Jenis Keiamin

Fasten Rawat Jalan N Persentase

Usia

1 7 - 2 5 t a h u n 9 2 6 3

2 6 - 3 5 t a l n i n 1 3 1 9 0

3 6 - 4 5 t a h u n 2 7 9 1 9 2

46-55 t a l i u n 4 2 1 2 9 0

5 6 - 6 4 t a h u n 3 1 6 2 1 7

gt 6 4 t a h u n 2 1 4 1 4 7

U s i a r a t a - r a t a ( t a h u n ) 50plusmn14120

Jenis Keiamin

P e r e m p u a n 8 9 0 6 1 3

L a k i - l a k i 5 6 3 3 8 7

Total 1453 100

B e r d a s a r k a n t a b e l 4 2 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 4 6 - 5 5 t a h u n y a i t u

s e b a n y a k 4 2 1 o r a n g ( 2 9 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 50plusmn14120 t a h u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 8 9 0 o r a n g ( 6 1 3 )

28

C Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Usia

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i b b e r d a s a r k a n u s i a d a p a t

d i i i h a t p a d a l a b e l d i b a w a h i n i

Tabel 43 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Usia

Usia N Persentase

lt 5 0 t a h u n 1 4 4 6 7

gt 5 0 t a l i u n 1 6 5 3 3

Total 30 100

B e r d a s a r k a n t a b e l 4 3 d i a t a s d a p a t d i k e t a h u i b a h w a u s i a t e r b a n y a k p a d a

s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h gt 5 0 t a h u n y a i t u s e b a n y a k

1 6 o r a n g ( 5 3 3 )

D Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Jenis

Keiamin

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n j e n i s

k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 44 Distribusi Proporsi Kejadian infeksi Saiuran Kemih Berdasarkan

Jenis Keiamin

Jenis Keiamin N Persentase

P e r e m p u a n 1 8 6 0 0

L a k i - l a k i 1 2 4 0 0

Total 30 100

B e r d a s a r k a n t a b e l 4 4 d i a t a s d a p a t d i k e t a h u i b a h w a j e n i s k e i a m i n

t e r b a n y a k p a d a s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h p e r e m p u a n

y a i t u s e b a n y a k 1 8 o r a n g ( 6 0 0 )

29

E Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n t i n g k a t

p e n d i d i k a n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 45 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

Tingkat Pendidikan N Persentase

P e n d i d i k a n d a s a r 20 6 6 7

P e n d i d i k a n m e n e n g a h d a n P e n d i d i k a n m e n e n g a h d a n 10 333

t i n g g i

Total J O 100

B e r d a s a r k a n t a b e l 4 5 d i a t a s d a p a t d i k e t a l i u i b a l i w a t i n g k a t p e n d i d i k a n

t e r b a n y a k p a d a s a m p e i y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h t i n g k a t

p e n d i d i k a n d a s a r y a i t u s e b a n y a k 20 o r a n g ( 6 6 7 )

P Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n riwayat

d i a b e t e s m e l i t u s d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 46 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

Riwayat Diabetes Melitus N Persentase

Y a 17 5 6 7

T i d a k 13 433

Total 30 100

B e r d a s a r k a n t a b e l 4 6 d i a t a s d a p a t d i k e t a h u i b a l i w a s a m p e l y a n g

m e n g a l a m i i n f e k s i s a i u r a n k e m i h t e r b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s

y a i t u s e b a n y a k 1 7 o r a n g ( 5 6 7 )

30

412 Hasil Analisis Bivariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s b i v a r i a t

a n t a r a I a i n h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h j e n i s

k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h t i n g k a t p e n d i d i k a n d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n

i n f e k s i s a l m a n k e m i h

A n a l i s i s y a n g d i g u n a k a n p a d a u j i d u a v a r i a b e l y a n g b e r s k a l a k a t e g o r i k

a d a l a l i d e n g a n u j i Chi-Square d e n g a n n i e i h a t n i l a i Pearson Chi-Square S e m u a

h a s i l d a r i u j i h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h m e n g g i u i a k a n u j i Chi-

Square k a i e n a m e m e n u h i s y a r a t u j i Chi-Square y a i t u lt 2 0 s e l y a n g m e m p u n y a i

n i l a i expected count lt 5

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 47 Hasil Uji Hubungan antara Usia dengan Kejadian Infeksi

Saiuran Kemih

Usia

Infeksi Saiuran Kemih

^a Tidak

n N Mgt

Jumlah P

value 95Cl

lt 50 t a h u n 1 4 1 9 2 5 9 8 0 8 7 3 0 0 0 0 2 7 4 7 - 2 0 4 3 1

gt 5 0 t a h u n 1 6 6 4 0 9 3 6 0 2 5

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 7 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R = 7 4 9 2

( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a u s i a gt

5 0 t a h u n a d a l a l i 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a u s i a lt 5 0 t a h u n

31

B Hubungan antara Jenis Keiamin dengan Kejadian Infeksi Saiuran

Kemih

H a s i l a n a l i s i s b i v a r i a t l i u b u n g a n a n t a r a j e n i s k e l a i n i n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

Tabel 48 Hasil Uji Hubungan antara Jenis Keiamin dengan Kejadian

Infeksi Saiuran Kemih

Infeksi Saiuran Kemih Jenis P

A Tidak Jumlah 95CI Keiamin value

N N

P e r e m p u a n 18 6 4 3 10 357laquoo 2 8 3 2 2 7 -P e r e m p u a n 0 0 0 0

L a k i - l a k i 12 1 7 1 5 8 8 2 9 7 0 2 3 4 5 9

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 8 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a l a l i

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k N 4 a k a a d a l i u b u n g a n y a n g s i g n i f i k a n a n t a r a

j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R ) = 8 7 0 0

f 9 5 C I = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a l a k i - l a k i

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e n i i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

32

Tabel 49 Hasil liji Hubungan antara Tingkat Pendidikan dengan

Kejadian Infeksi Saiuran Kemih

Infeksi Saiuran Kemih P

Y a T i d a k jumlah 95CI value

N

P e n d i d i k a n d a s a r 2 0 5 4 1 1 7 4 5 9 3 7

P e n d i d i k a n

m e n e n g a h d a n 10 1 6 4 5 1 8 3 6 6 1

t i n g g i

Jumlah JO 30 6 68 694 9H

B e r d a s a r k a n t a b e l 4 9 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( 0 R ) =

6 0 0 0 ( 9 5 C I = 2 3 5 1 - 1 5 3 1 0 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r a d a i a h 6 k a l i l e b i h b e s a r

d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i h a t

p a d a t a b e l d i b a w a h i n i

Tingkat

Pendidikan

2 3 5 1 -0 0 0 0

1 5 3 1 0

33

Tabel 4t0 Hasil I j i Hubungan antara Riwayat Diabetes Melitus dengan

Kejadian Infeksi Saiuran Kemih

Riwayat Infeksi Saiuran Kemih P

Diabetes Va Tidak Jumlah value

95CI

Melitus N bullVJ N

Y a

T i d a k

17

1 3

6 8 0

1 7 8

8

6 0

3 2 0

8 2 2

2 5

7 3 0 0 0 0

3 4 9 3 -

2 7 5 3 6

Jumlah 30 306 68 571 98

B e r d a s a r k a n t a b e l 4 1 0 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio

( O R ) = 9 8 0 8 ( 9 5 C I - 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r

d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s m e l i m s

42 Pembahasan

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a l a b e l 4 7 d i d a p a t k a n b a l i w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i b d e n g a n n i l a i s i g n i f i k a n n y a a d a l a l i 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k

Odds Ratio ( O R ) = 7 4 9 2 ( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a u s i a T 5 0 t a h u n a d a i a h 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a

u s i a lt 5 0 t a h u n

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n A n d r y L u k a n d y

( 2 0 1 4 ) m e n g e n a i k a r a k t e r i s t i k p a s i e n - p a s i e n i n f e k s i s a i u r a n k e m i h d i m a n a

p e n d e r i t a I S K d e n g a n k e l o m p o k u m u r gt 5 0 t a h u n s e b a n y a k 2 3 o r a n g s e d a n g k a n

j u m l a h p e n d e r i t a I S K d e n g a n k e l o m p o k u m m lt 5 0 t a l i u n s e b a n y a k 2 0 o r a n g

P e n e l i t i a n i n i j u g a d i p e i k u a t o l e h p e n l i t i a n L e w i s A l e t a l ( 2 0 1 4 ) m e n g e n a i

impact of host age and parity on susceptihility to severe urinary tract injection in

34

a murine mode d e n g a n u j i K r u s k a l - W a l l i s d e n g a n post-test D u n n u n t u k b e b e r a p a

p e r b a n d i n g a n d i m a n a u s i a d a n p a r i t a s s e b a g a i f a k t o r y a n g b e r k o n t r i b u s i d a l a m

k e r e n t a n a n i m t u k t e r j a d i n y a I S K d e n g a n n i l a i p lt 0 0 5

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n g a t a k a n b a h w a i n s i d e n I S K m e n i n g k a t

b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n

a d a n y a a b n o r m a l i t a s a n a t o m i y a n g m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n

k e m i h s e p e r t i p e m b e s a r a n p r o s t a t d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a

p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e ( R o s e 2 0 0 9 ) P e n y e b a b l a i n t e n n a s u k

p e r i n e i u n y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s p e n y a k i t n e u r o m u s k u l a r

d a n k a t e t e r i s a s i b u l i - b u l i ( F o x m a n e t a l 2 0 1 0 ) S e l a i n i t u i n s i d e n I S K m e n c a p a i

1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o n a l d 2 0 1 1 )

B Hubungan antara Jenis Keiamin dengan Kejadian infeksi Saiuran

Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 8 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d e n g a n n i l a i s i g n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O

d i t o l a k Odds Ratio ( O R ) = 8 7 0 0 ( 9 5 C l = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a risiko k e j a d i a n

i n f e k s i s a i u r a n k e m i h p a d a p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n

p a d a l a k i - i a k i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n M a g i i a n o e t a l

( 2 0 1 1 ) m e n g e n a i Gender and Age-Dependent Etiology of Community Acquired

y a n g m e l a k u k a n p e n g a m b i l a n 6 1 2 7 3 s a m p e l k u l t u r u r i n d a l a m p e r i o d e 2 2 b u l a n

d a r i s a m p e l i n i d i d a p a t k a n 1 3 8 2 0 ( 2 2 6 ) d i t e m u k a n p o s i t i f i n f e k s i b a k t e r i

h a m p i r 8 0 b a l i a n y a n g d i i s o l a s i b e r a s a l d a r i p e r e m p u a n P e n e l i t i a n i n i j u g a

d i p e r k u a t o l e h p e n e l i t i a n y a n g d i l a k u k a n o l e h Y u n i t a I ( 2 0 1 0 ) d i m a n a a d a

h u b m i g a n y a n g b e n n a k n a a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h ( P value=O049 R P = 3 2 7 3 ( 9 5 C I = I 0 1 6 - 1 0 5 4 0 )

H a l t e r s e b u t d a p a t t e r j a d i k a r e n a u r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a l i

d e n g a n d e k a t n y a v a g i n a l v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i

s a i u r a n k e m i h l e b i h s e r i n g p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a flora n o r m a l

3 5

p a d a d a e r a h p e r i u r e t r a t e r d i r i d a r i o r g a n i s m e s e p e r t i i a c t o b a c i l l u s y a n g m e m b a n t u

m e l a w a n k o l o n i s a s i b a k t e r i p a t o g e n p a d a s a i u r a n k e m i h P e r u b a h a n l i n g k i m g a n

d a r i p e r i u r e t r a l s e p e r t i p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k

b i s a m e n g g a n g g u f l o r a n o r m a l s e h i n g g a m e n u m g k i n k a n b a k t e r i p a t o g e n

b e r k o l o n i s a s i d a n m e n y e b a b k a n i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Scuare p a d a t a b e l 4 9 d i d a p a t k a n b a h w a

t e r d a p a t l i u b u n g a n y a n g s i g n i f i k a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a

H O d i t o l a k Odds Ratio ( O R ) - 6 0 0 0 ( 9 5 o C l = 2 3 5 1 - 1 5 3 I O ) a r t i n y a n s i k o

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r

a d a i a h 6 k a l i l e b i h b e s a r d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n

m e n e n g a h d a n t i n g g i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h T o r o n d e i B e t

a l ( 2 0 1 5 ) m e n g e n a i Menstrual Hygiene Practices WASH Access and the Risk of

Urogenital Infection in Women from Odisha India d i m a n a p e r e m p u a n y a n g

h a n y a m e n e m p u l i p e n d i d i k a n s e k o l a h d a s a r a t a u l e b i h r e n d a h d i b a n d i n g k a n

d e n g a n t i n g k a t p e n d i d i k a n m e n e n g a h a t a u t i n g g i m e m i l i k i r i s i k o 3 k a l i

k e m u n g k i n a n l e b i h b e s a r m e n g a l a m i i n f e k s i s a i u r a n k e m i h ( A d j O R = 3 l 9 5

C 1 = I 2 - 7 9 p = 0 0 2 )

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a p e n g e t a h u a n s e s e o r a n g

t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t p e n d i d i k a n S e s e o r a n g y a n g

m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m u n g k i n a n p e n g e t a l i u a n t e n t a n g

k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o r m a s i y a n g d i d a p a t k a n t e n t a n g k e s e h a t a n

l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h S e b a l i k n y a

p e n d i d i k a n y a n g k u r a n g d a p a t i n e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g t e r h a d a p

n i l a i - n i l a i y a n g b a r u d i k e n a l ( N o t o a d m o j o 2 0 0 3 )

3 6

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Keniih

B e r d a s a r k a n l i a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 1 0 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a r i w a y a t d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 )

s e h i n g g a H O d i t o l a k Odds Ratio ( O R ) = 9 8 0 8 ( 9 5 C I = 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a

risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h S a r i E W P d a n

S a t y a b a k t i P ( 2 0 1 5 ) m e n g e n a i p e r b e d a a n risiko i n f e k s i n o s o k o m i a l s a i u r a n k e m i h

b e r d a s a r k a n k a t e t e r i s a s i u r i n u m u r d a n d i a b e t e s m e l i m s d i m a n a d a r i 2 0 p a s i e n

i n f e k s i n o s o k o m i a l s a i u r a n k e m i h 1 2 o r a n g ( 6 0 ) d i a n t a r a n y a a d a i a h p a s i e n

d e n g a n s t a t u s D M s e d a n g k a n 8 o r a n g ( 4 0 ) l a i n n y a a d a i a h p a s i e n t a n p a s t a t u s

D M ( P v W w ^ = 0 0 2 4 O R = 6 0 0 9 5 C I = 1 2 2 - 3 2 2 6

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a b a l i w a b e b e r a p a b a g i a n

d a r i i i n u n i t a s p a d a p a s i e n d i a b e t e s m e n g a l a m i p e r u b a h a n F u n g s i

p o l i n i o r f o l e u k o s i t d i t e k a n p a d a k e a d a a n a s i d o s i s I k a t a n l e u k o s i t k e m o t a k s i s d a n

f a g o s i t o s i s j u g a b e m b a l i S i s t e m a n t i o k s i d a n y a n g b e r p e r a n p a d a a k t i f i t a s

b a k t e r i s i d a l j u g a t e r g a n g g u s e h i n g g a m e n y e b a b k a n t e r j a d i n y a I S K p a d a p a s i e n -

p a s i e n d e n g a n p e n y a k i t d i a b e t e s ( J u l k a 2 0 1 4 )

H a l y a n g s a m a j u g a d i i m g k a p k a n o l e b t e o r i S m e l t z e r d a n B a r e ( 2 0 1 0 )

b a l i w a D M d a p a t m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a l i a n a n t u b u h y a n g

b e r p o t e n s i m e n i n g k a t k a n r i s i k o t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a l i a n a n

t u b u h t e r s e b u t d i a n t a r a n y a a d a i a h k e g a g a l a n m i g r a s i s e l iniraceliular killing

f a g o s i t o s i s d a n k e m o t a k s i s p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n

m e k a n i s m e p e r t a l i a n a n a l a m i a h I o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p

i n f e k s i

BAB V

KESIMPULAN DAN SARAN

51 Kesimpulan

1 U s i a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 2 6 - 3 5 t a h u n y a i t u 2 3 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 3 7

2 U s i a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 4 6 - 5 5 t a l i u n y a i t u 2 9 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 1 3

3 U s i a j e n i s k e i a m i n d a n t i n g k a t p e n d i d i k a n s a m p e i y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i l i t e r b a n y a k y a i t u b e r u s i a gt 5 0 t a h u n ( 5 3 3 ) j e n i s k e i a m i n

p e r e m p u a n ( 6 0 0 ) d a n t i n g k a t p e n d i d i k a n d a s a r ( 6 6 7 ) s e r t a p a l i n g

b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s y a i t u 5 6 7

4 T e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 ( p = 0 0 0 0 )

52 Saran

1 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t d i l a k u k a n d e n g a n d e s a i n

p e n e l i t i a n b e r b e d a s e p e r t i cohort a t a u case control

2 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t m e i i c a r i v a r i a b e l independent

y a n g l a i n s e p e r t i v a r i a b e l p e k e r j a a n p e m a s a i i g a n k a t e t e r a t a u l a m a n y a

m e n d e r i t a d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

37

DAFTAR PUSTAKA

B o y k o E J d k k 2 0 0 2 D i a b e t i c A n d T h e R i s k O f A c u t e U r i n a r y T r a c t I n f e c t i o n A m o n g P o s t m e n o p a u s a l W o m e n D i a b e t e s C a r e 2 5 ( 1 0 )

D a h l a n S 2 0 1 4 B u k i i S t a t i s t i k u n t u k K e d o k t e r a n d a n K e s e h a t a n D e s k r i p t i f B i v a r i a t d a n M u l t i v a r i a t d i l e n g k a p i a p l i k a s i d e n g a n m e n g g u n a k a n S P S S E d i s i 6 E p i d e m i o l o g i I n d o n e s i a J a k a r t a I n d o n e s i a

D e p a r t e m e n K e s e h a t a n ( D E P K E S ) R l 2 0 1 4 [ O n l i n e ] K e m e n t e r i a n K e s e h a t a n R e p u b l i k I n d o n e s i a P u s a t D a t a d a n I n f o r m a s i K e m e n t e r a n K e s e h a t a n R l ( http 7depkesgoid diakses tanggal 15 Met 2016)

F o x m a n B e t a i 2 0 1 0 U r i i i a i y T r a c t I n f e c t i o n A m o n g W o m e n A g e d 4 0 T o 6 5 B e h a v i o r a l A n d S e x u a l R i s k F a c t o r s D a l a m T a n a g h o E A M c A n i n c h J W 1 7 t h S m i t h s G e n e r a l U r o l o g y U S A M c G r a w H i l l (http searchproqnestcom diakses tanggal 16 Met 2016)

H a r d i n g G K d k k 2 0 1 0 A n t i m i c r o b i a l T r e a t m e n t I n D i a b e t i c W o m e n W i t l i A s y m t o m a t i c B a c t e r i u r i a N E n g l J M e d 3 4 7 1 5 7 6 - 1 5 8 3 (http nejmorg diakses tanggal 16 Met 2016)

I s s e l b a c h e r d k k 2 0 0 9 I n f e k s i S a i u r a n K e m i h d a n P i e l o n e f r i t i s D a l a m S t a m m W a l t e r E e d H a r r i s o n P r i n s i p - P r i n s i p l l m u P e n y a k i t D a l a m e d V o l u m e 2 J a k a r t a E G C 6 1 6 - 6 2 3

J u l k a S 2 0 1 3 G e n i t o u r i n a r y I n f e c t i o n I n D i a b e t e s I n d i a n J o u m a l o f E n d o c r i n o l o g y a n d M e t a b o l i s m (http searchproquestcom diakses tanggal 16 Mei 2016)

K i m B d k k 2 0 1 2 [ e - b o o k ] T h e R e l a t i o n b e t w e e n P o s t v o i d R e s i d u a l a n d O c c u r r e n c e o f U r i n a r y T r a c t I n f e c t i o n a f t e r S t r o k e i n R e h a b i l i t a t i o n U n i t A n n a l s o f R e h a b i l i t a t i o n M e d i c i n e

K o m a r a A 2 0 0 9 P o l a K e p e k a a n B a k t e r i G r a m N e g a t i f d a r i P a s i e n I n f e k s i S a i u r a n K e m i l i t e r h a d a p A n t i b i o t i k G e n t a m i c i n d a n K o t r i m o k s a z o l y a n g D i k i r i m k e L a b o r a t o r i u m M i k r o b i o l o g i K l i n i k F K U l d a r i T a h u n 2 0 0 1 s a m p a i T a h u n 2 0 0 5 (http dontaruiacid diakses tanggal OH Agustiis 2016)

L e w i s A L e t a l 2 0 1 4 I m p a c t o f H o s t A g e a n d P a r i t y o n S u s c e p t i b i l i t y t o S e v e r e U r i n a r y T r a c t I n f e c t i o n i n a M u r i n e M o d e l P l o s O n e R e s e a r c h A r t i c l e P u b l i c L i b r a r y o f S c i e n c e 9 ( 5 ) (http searchproquestcom diakses pada langgal 30 Desember 2016)

38

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D e n g a t i i n i s a y a m e n e r a n g k a n b a h w a

1 K a r y a t u l i s s a y a s k r i p s i i n i a d a i a h a s l i d a n b e l u r n p e m a h d i a j u k a n u n t u k

m e n d a p a t k a n g e l a r a k a d e m i k b a i k d i U n i v e r s i t a s M u h a m m a d i y a h

P a l e m b a n g m a u p u n P e r g u m a n T i n g g i l a i n n y a

2 K a r y a t u l i s i n i m u m i g a g a s a n n i m u s a n d a n p e n e l i t i a n s a y a s e n d i r i t a n p a

b a n t u a n p i h a k l a i n k e c u a l i a r a h a n T i m P e m b i m b i n g

3 D a l a m k a i y - a m l i s i n i t i d a k t e r d a p a t k a i y a a t a u p e n d a p a t y a n g t e l a h d i t u l i s

a t a u d i p u b l i k a s i k a n o r a n g l a i n k e c u a i i s e c a r a t e r t u l i s d e n g a n d i c a n t u m k a n

s e b a g a i a c u a n d a l a m n a s k a h d e n g a n d i s e b u t k a n n a m a p e n g a r a n g d a n

d i c a n t u m k a n d a l a m d a f t a r p u s t a k a

4 P e m y a t a a n i n i s a y a b u a t d e n g a n s e s u n g g u h n y a d a n a p a b i l a d i k e m u d i a n h a r i

t e r d a p a t p e n y i m p a n g a n d a n k e t i d a k b e n a r a n d a l a m p e m y a t a a n i n i m a k a s a y a

b e r s e d i a m e n e r i m a s a n k s i a k a d e m i k a t a u s a n k s i l a i n n y a s e s u a i d e n g a n n o r m a

y a n g b e r l a k u d i P e r g u m a n T i n g g i i n i

P a l e m b a n g 0 7 F e b m a r i 2 0 1 7

Y a n g m e m b i i a t p e m y a t a a n

( R e z a A g u s t i a n t w o P u t r a )

N I M 7 0 2 0 1 3 0 5 4

ii

P E R S E T U J U A N P E N G A L I H A N H A K P U B L I K A S I K A R Y A I L M I A H

UNTUK K E P E N T I N G A N A K A D E M I S

D e n g a n P e n y e r a h a n n a s k a l i a r t i k e l d a n v r t a j ^ v b e r j u d u l H u b u n g a n a n t a r a U s i a J e n i s K e i a m i n T i n g k a t P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h p a d a P a s i e n R a w a t I n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 ^ K e p a d a U n i t P e n e l i t i a n d a n P e n g a b d i a n M a s y a r a k a t U P 2 M ) F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u h a m m a d i y a h P a l e m b a n g ( F K - U M P ) S a y a

N a m a R e z a A g u s t i a n t w o P u t r a N i M 7 0 2 0 1 3 0 5 4 P r o g r a m S t u d i P e n d i d i k a n K e d o k t e r a n U m u m F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u h a m m a d i y a h P a l e m b a n g J e n i s K a r y a i l m i a h S k r i p s i

D e m i p e n g e m b a n g a n i l m u p e n g e t a h u a n s e t u j u m e m b e r i k a n k e p a d a F K - U M P P e n g a l i h a n H a k C i p t a d a n P u b l i k a s i B e b a s R o y a l t i a t a s K a r y a I l m i a h N a s k a l i d a n softcopy d i a t a s D e n g a n h a k t e r s e b u t F K - U M P b e r h a k m e n y i m p a n m e n g a l i h m e d i a f o n n a t k a n d a l a m b e n t u k p a n g k a l a n d a t a (database) m e n d i s t r i b u s i k a n m e n a m p i l k a n m e m p u b l i k a s i k a n d i i n t e r n e t a t a u m e d i a l a i n u n t u k k e p e n t i n g a n a k a d e m i s t a n p a p e r l u m e m i n t a i z i n d a r i S a y a s e l a m a t e t a p m e n c a n t u m k a n n a m a S a y a d a n S a y a m e m b e r i k a n w e w e n a n g k e p a d a p i h a k F K -U M P u n t u k m e n e i i t u k a n s a l a h s a t u P e m b i m b i n g s e b a g a i P e n u l i s U t a m a d a l a m P u b l i k a s i S e g a l a b e n t u k t u n t u t a n h u k u m y a n g t i m b u l a t a s p e l a n g g a r a n H a k C i p t a d a l a m K a r y a I l m i a l i i n i m e n j a d i t a n g g u n g j a w a b S a y a p r i b a d i

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N I M 7 0 2 0 1 3 0 5 4

iii

HALAMAN PERSEMBAHAN DAN MOTTO

OfaBjrdafi ada sesuatuyan^ menanttmu sedpas Battya^BgsaSaran (yang Bpu

jaCani) yang a^n memStiatmu terpana Singga (au Cupa Setapa pedifinya rasa

saSit - (Jid ltBinABi TltadB)

Dengan izin-Mu ya Allah ku persembahkan karya ini untuk

bull Kedua orangtuaku yang tercinta Riza Efendi SHbdquo MH dan Dra Yusdiami

yang selalu memberikan motivasi nasihat dan semangat untuk meraih cita-

citaku serta doa dan kasih sayang di setiap langkaliku Ma P a i know this

is not enough yet to reply a l l your affection and everything that you already

gave h u t im trying to he the best i n everything for you and absolutely you

a r e my entire worlct

bull Saudara kandungku tersayang Eka Satriawan A Md Im SH MH dan

Threenita Sari Sepgi Putri yang telah banyak membantu menemani serta

menghibur di setiap hari-hariku Im so g r a t e f u l to have you kak g r a You

a r e truly my beloved siblings

bull Pembimbing skripsiku dr M Ayus Astoni Sp PD KGEH FINASIM

MARS dan dr Ratika Febriani yang telah memberikan nasihat saran dan

ilmu yang bermanfaat serta meluangkan waktunya untuk membimbing

skripsi ini bingga selesai

bull Teman-teman terdekatku ( C H A T g r o u p dan Bujang Gadis g r o u p ) yang selalu

dapat memberikan keceriaan semangat dan bantuan di saat menghadapi

kesulitan do believe we can be a success doctor and get our dreams

someday Keep down to e a r t h guys

bull Dan seluruh teman-teman angkatan 2013 (Genome H e x a ) yang telah banyak

memberikan bantuan selama proses perkuliahan di tahap akademik Semoga

kesuksesan dan ridho Allah SWT selalu mengiringi iangkali kita Aamiin ya

rabbal allamin See you on topgjrys

iv

UNIVERSITAS MUHAMMADIYAH P A L E M B A N G F A K U L T A S K E D O K T E R A N

S K R I P S L JANUARI 2017 R E Z A AGUSTIANTWO PUTRA

Hubungan antara Usia Jenis Keiamin Tingkat Pendidikan dan Riwayat Diabetes Melitus dengan Kejadian Infeksi Saiuran Kemih pada Pasien Rawat Inap dan Rawat Jalan di Bagian Penyakit Dalam Rumah Sakit Muhammadiyah Palembang Periode 1 Januari 2015-31 Desember 2015

xii + 37 halaman + 12 tabel + 1 gambar + 8 lampiran

A B S T R A K

I n t e k s i s a i u r a n k e m i h ( I S K ) m e n i p a k a n s u a t u i n f e k s i y a n g m e n g e n a i t r a k t u s u r i n a r i u s d a n h a m p i r 1 0 o r a n g p e m a h t e r k e n a I S K s e l a m a h i d u p n y a M e n u m t t e o r i m e n i n g k a t n y a k e j a d i a n I S K b e r h u b i m g a n d e n g a n p e n i n g k a t a n u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s P e n e l i t i a n i n i b e m i j u a n u n t u k m e n g a n a l i s i s h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i l i p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R i u n a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 J e n i s p e n e l i t i a n i n i a d a i a h o b s e r v a s i o n a i a n a l i t i k d e s a i n cross sectional d e n g a n m e n g g i i n a k a n d a t a s e k u n d e r d a r i r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g S a m p e l p e n e l i t i a n i n i a d a i a h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 d e n g a n b e s a r s a m p e l s e b a n y a k 9 8 s a m p e l S a m p e l p e n e l i t i a n i n i d i a m b i l d e n g a n c a r a consecutive sampling H a s i l u j i s t a t i s t i k d i d a p a t k a n h u b u n g a n i n f e k s i s a i u r a n k e m i h d e n g a n u s i a ( p = 0 0 0 0 ) j e n i s k e i a m i n ( p = 0 0 0 0 ) t i n g k a t p e n d i d i k a n ( p = 0 0 0 0 ) d a n riwayat d i a b e t e s m e l i t u s ( p 0 0 0 0 ) S e h i n g g a d a p a t d i s i m p u l k a n b a h w a t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n rawat j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e i J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

Referensi 29(2002-2015) Kata kunci Infeksi Saiuran Kemih Riwayat Diabetes Melitus

V

U N I V E R S I T Y O F M U H A M M A D I Y A H P A L E M B A N G FA cut T Y or M E D I C I N E

MINI THESIS J A N U A R Y 2 0 1 7 R E Z A A G U S T I A N T W O P U T R A

T h e Relationships between Age Gender Education Level Diabetes M e l i t u s History and The Incidence of U r i n a r y T r a c t Infections i n Hospitalized Patients and Outpatients at I n t e r n a l M e d i c i n e o f M u h a m m a d i y a h Palembang H o s p i t a l d u r i n g I J a n u a r y 2 0 1 5 - 3 1 December 2 0 1 5

x i i + 37pages + 12 tables + I picture + 8 attachments

A B S T R A C T

Urinary trad infection (UTI) is an infection of I he urinary tract and nearly 10 of people experience UTI during their lifeiime According to theory the increasing of urinary tract infections is related with increasing age gender education level and diabetes melitus history This study aim to analyze relationships between age gender education level diabetes melitus history and the incidence of urinary tract infections in hospitalized patients and outpatients at Internal Medicine of Muhammadiyah Palembang Hospilal during P January 2015-31 December 2015 This study lipe was analyiical observaiional with cross sectional design by using secondary data from medical record of Muhammadiyah Palembang Hospital Samples of this study were taken by consecutive sampling technique The results of statistical test were obtained relationship between urinary tract infections with age (p 0000) gender (p 0000) education level (p 0000) and diabetes melitus (p 0000) In conclusion there are significantly relationships between age gender education level diabetes melitus history and the incidence of urinary tract infections in hospitalizedpatients and outpatients at Internal Medicine of Muhammadiyah Palembang Hospital during P January 20J5-3PDecember 2015

References 2 9 ( 2 0 0 2 - 2 0 1 5 ) Keywords U r i n a r y T r a c t I n f e c t i o n s Diabetes M e l i t u s

vi

KATA PENGANTAR

S e g a l a p u j i s y u k u r k e p a d a A l l a l i S W T k a r e n a a t a s b e r k a t d a n r a h m a t - N y a p e n u l i s d a p a t i n e n y e l e s a i k a n s k r i p s i y a n g b e r j u d u l H u b u n g a n A n t a r a U s i a J e n i s K e i a m i n T i n g k a t P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h P a d a P a s i e n R a w a t i n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 S k r i p s i i n i d i s u s u n s e b a g a i s a l a h s a t u s y a r a t u n t u k m e m p e r o l e h g e l a r S a r j a n a K e d o k t e r a n d i F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u l i a m m a d i y a h P a l e m b a n g

P e n u l i s m c n y a d a r i b a l i w a d a l a m p r o s e s i n e n y e l e s a i k a n s k r i p s i i n i b a n y a k k e n d a l a y a n g d i a l a i n i n a n i u n b e r k a t b a n t u a n b i m b i n g a n k e r j a s a m a d a r i b c r b a g a i p i h a k d a n t e r u t a m a b e r k a t A l l a h S W T k e n d a l a t e r s e b u t d a p a t d i a t a s i

P e n u l i s j u g a m e n v a d a r i b a h w a s k r i p s i i n i m a s i h j a u h d a r i s e m p u m a m a k a d e n g a n s e g a l a k e r e n d a h a n l i a t i p e n u l i s m e n g l i a r a p k a n a d a n y a k r i t i k d a n s a r a n y a n g b e r s i f a t m e m b a n g u n d e m i k e s e m p u m a a n s k r i p s i i n i

A k h i r k a t a p e n u l i s b c r l i a r a p A l l a l i S W T b e r k e n a n m e m b a i a s s e g a l a k e b a i k a n s e m u a p i h a k y a n g t e l a h m e m b a n t u S e m o g a s k r i p s i i n i d a p a t b e n n a n f a a t b a g i k i t a s e m u a A a m i i n

P a l e m b a n g 0 7 F e b r u a r i 2 0 1 7

R e z a A g u s t i a n t w o P u t r a

vii

DAFTAR ISI

HALAMAN J D D U L HALAMAN PENCESAHAN i HALAMAN PERNN ATAAN ii HALAMAN PERSEMBAHAN iii A B S T R A K iv A B S T R A C T v K A T A PENGANTAR vi DAFTAR ISI vii DAFTAR T A B E I ix DAFTAR GAMBAR x DAFTAR LAMPIRAN xi

BAB I Pendahuluan 1 1 1 L a t a r B e l a k a n g 1 12 R i i m u s a n M a s a l a h 3 13 T u j u a n P e n e l i t i a n 3 14 M a n l a a t P e n e l i t i a n 4 15 K e a s l i a n P e n e l i t i a n 5

BAB H Tinjauan Pustaka 9 2 1 L a n d a s a n T e o r i 9

2 1 1 I n f e k s i S a i u r a n K e m i h 9 A D e f i n i s i 9 B E p i d e m i o l o g i 9 C K i a s i f i k a s i 1 0 D E t i o l o g i 1 1 E P a t o f i s i o l o g i 11 F F a k t o r R i s i k o 1 2 G M a n i f e s t a s i K l i n i s 1 5 H T a t a l a k s a n a 1 6 I K o m p l i k a s i 1 6

2 2 K e r a n g k a T e o r i 1 7 2 3 H i p o t e s i s 1 8

BAB I I I Metode Penelitian 19 3 1 J e n i s P e n e l i t i a n 1 9 3 2 W a k t u d a n T e m p a t P e n e l i t i a n 1 9 3 3 P o p u l a s i d a n S a m p e l 1 9

3 3 1 P o p u l a s i P e n e l i t i a n 1 9 3 3 2 S a m p e l d a n B e s a r S a m p e l P e n e l i t i a n 1 9 3 3 3 K n t e r i a I n k l u s i d a n E k s k l u s i 2 0 3 3 4 C a r a P e n g a m b i l a n S a m p e l P e n e l i t i a n 2 0

3 4 V a r i a b e l P e n e l i t i a n 2 0 3 4 1 V a r i a b e l Dependent 2 0 3 4 2 V a r i a b e l Independent 2 0

viii

3 5 D e f i n i s i O p e r a s i o n a l 2 1 3 6 C a r a P e n g i i n i p u l a n D a t a 2 2

3 6 1 D a t a S e k u n d e r 2 2 3 7 M e t o d e T e k n i s A n a l i s i s D a t a 2 2

3 7 C a r a P e n g o l a h a n d a n A n a l i s i s D a t a 2 2 3 8 A l u r P e n e l i t i a n 2 4

BAB IV HASIL DAN PEMBAHASAN 25 4 1 H a s i l 2 5 4 2 P e m b a h a s a n 3 3

BAB V KESIMPLILAN DAN SARAN 37 5 1 K e s i m p u l a n 3 7 5 2 S a r a n 3 7

D A F T A R PUSTAKA 38 LAMPIRAN 41 BIODATA 63

ix

DAFTAR T A B E L

Tabel Halaman

T a b e l 1 1 K e a s l i a n P e n e l i t i a n 5 T a b e l 3 1 D e f i n i s i O p e r a s i o n a l 2 1 T a b e l 4 1 D i s t r i b u s i P r o p o r s i K a r a k t e r i s t i k P a s i e n R a w a t i n a p

B e r d a s a r k a n U s i a d a n J e n i s K e i a m i n 2 6 T a b e l 4 2 D i s t r i b u s i P r o p o r s i K a r a k t e r i s t i k P a s i e n R a w a t J a l a n

B e r d a s a r k a n U s i a d a n J e n i s K e i a m i n 2 7 T a b e l 4 3 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n U s i a 2 8 T a b e l 4 4 D i s t r i b u s i P r o p o r s i K e j a d i a n i n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n J e n i s K e l a m m 2 8 T a b e l 4 5 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n T i n g k a t P e n d i d i k a n 2 9 T a b e l 4 6 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n R i w a y a t D i a b e t e s M e l i t u s 2 9 T a b e l 4 7 H a s i l U j i H u b u n g a n a n t a r a U s i a d e n g a n K e j a d i a n

i n f e k s i S a i u r a n K e m i h 3 0 T a b e l 4 8 H a s i i U j i H u b u n g a n a n t a r a J e n i s K e i a m i n d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i b 3 1 T a b e l 4 9 H a s i l U j i H u b u n g a n a n t a r a T i n g k a t P e n d i d i k a n d e n g a n

K e j a d i a n i n t e k s i S a i u r a n K e m i h 3 2 T a b e l 4 1 0 H a s i l U j i H u b u n g a n a n t a r a R i w a y a t D i a b e t e s M e l i t u s

d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h 3 3

X

DAFTAR GAMBAR

Gambar Halaman

G a m b a r 3 1 A l u r P e n e l i t i a n H u b u n g a n U s i a J e n i s K e i a m i n T i n g k a t

P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i h p a d a P a s i e n R a w a t i n a p

d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g I e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1

D e s e m b e r 2 0 1 5 2 4

xi

DAFTAR LAMPIRAN

Lampiran Halaman

L a m p i r a n 1 D a t a R e k a m M e d i s P a s i e n R a w a t I n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 4 3

L a m p i r a n 2 H a s i l A n a l i s i s U n v i a r i a t 4 5

L a m p i r a n 3 H a s i l A n a l i s i s B i v a r i a t 5 1

L a m p i r a n 4 K a r t u B i m b i n g a n P r o p o s a l S k r i p s i 5 8

L a m p i r a n 5 K a r t u B i m b i n g a n S k r i p s i 5 9

L a m p i r a n 6 S u r a t P e n n o h o n a n I z i n P e n e l i t i a n 6 0

L a m p i r a n 7 S u r a t K e t e r a n g a n I z i n P e n g a m b i l a n D a t a d a n P e n e l i t i a n 6 1

L a m p i r a n 8 S u r a t K e t e r a n g a n S e l e s a i P e n e l i t i a n 6 2

xii

BAB I

PENDAHULUAN

11 Latar Belakang

I n f e k s i s a i u r a n k e m i h ( I S K ) m e n i p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m i i k a n d i R u m a h S a k i t a t a u t e m p a t p r a k t i k u m u m s e h a r i - h a r i I S K

a d a i a h s u a t u i n f e k s i y a n g m e n g e n a i t r a k t u s u r i n a r i u s m u l a i d a r i m e a t u s u r e t r a

s a m p a i d e n g a n k e g i n j a l S t r u k t u r y a n g t e n n a s u k d i d a l a m n y a a d a i a h u r e t r a

k a n d u n g k e m i h u r e t e r p e l v i s d a n p a r e n k i m g i n j a l S t r u k t u r y a n g b e r k a i t a n u n t u k

t e r j a d i n y a i n f e k s i d a n r e k u r e n i n f e k s i y a i t u p r o s t a t e p i d i d i m i s d a n fascia

perinephric I s t i l a h I S K m e n u n j u k k a n a d a n y a k e b e r a d a a n m i k r o o r g a n i s m e d i

d a l a m u r i n ( S u d o y o 2 0 0 6 R u b i n 2 0 1 0 ) D e n g a n k a t a l a i n b a h w a d i a g n o s i s I S K

d i t e g a k k a n d e n g a n m e m b u k t i k a n a d a n y a m i k r o o r g a n i s m e d i d a l a m s a i u r a n k e m i h

( R u b i n 2 0 1 0 )

S e b a n y a k 2 5 j u t a k e m a t i a n d i s e l u r u h d u n i a p a d a t a h u n 2 0 1 1 s e p e r t i g a n y a

d i s e b a b k a n o l e h p e n y a k i t i n f e k s i I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n i n f e k s i

d e n g a n k e t e r l i b a t a i i b a k t e r i t e r s e r i n g d i k o m u n i t a s d a n h a m p i r 1 0 o r a n g p e m a h

t e r k e n a I S K s e l a m a h i d u p n y a S e k i t a i - 1 5 0 j u t a p e n d i i d u k d i s e l u r u h d u n i a t i a p

t a l i u n n y a t e r d i a g n o s i s m e n d e r i t a i n f e k s i s a i u r a n k e m i h ( Y u n u s 2 0 1 2 )

I S K d a p a t m e n g e n a i s e m u a k e l o m p o k u m u r b a i k a n a k r e m a j a d e w a s a

m a u p u n u s i a l a n j u t P r e v a l e n s i a n a k u s i a s e k o l a h y a n g m e n d e r i t a I S K s e k i t a r 1 -

3 d a n m e n i n g k a t p a d a r e m a j a y a n g s u d a h m e l a k u k a n h u b i m g a n s e k s u a l

( K o m a r a 2 0 0 9 ) D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r 2 5 - 3 5

s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a S e l a m a

p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n c e n d e r u n g

m e n d e r i t a I S K d i b a n d i n g k a n l a k i - l a k i ( S u d o y o 2 0 0 9 )

R a s i o I S K p a d a w a n i t a d i b a n d i n g p r i a b e r k i s a r 3 0 1 d a n s e k i t a r 5 0 w a n i t a

y a n g t e r k e n a i n f e k s i a k a n b e r k e m b a n g m e n j a d i I S K b e m l a n g I S K m e n i p a k a n

i n f e k s i b a k t e r i y a n g p a l i n g s e r i n g p a d a a n a k - a n a k d e n g a n k e l u h a n d e m a m b a i k

p a d a a n a k p r i a m a u p u n w a n i t a P r e v a l e n s i y a n g p e m a h d i l a p o r k a n b e r k i s a r 4 1

I

2

s a m p a i 7 5 R e k u r e n s i c u k u p s e r i n g d a n t e r j a d i s e k i t a r 1 8 p a d a b a y i l a k i - i a k i

d a n 2 6 p a d a b a y i p e r e m p u a n U n t u k u s i a p r a s e k o l a h I S K l e b i h s e r i n g

m e n g e n a i w a n i t a I n s i d e n I S K p a d a a n a k - a n a k p r a s e k o l a h s e k i t a r 2 ( S y a h r i n i

2 0 1 1 )

D a r i b e r b a g a i p e n e l i t i a n e p i d e m i o l o g i s d i I n d o n e s i a d i d a p a t k a n p r e v a l e n s i

D M s e b e s a r 15 - 2 3 p a d a p e n d u d u k u s i a l e b i J i d a r i 1 5 t a h u n b a h k a n p a d a

s u a t u p e n e l i t i a n e p i d e m i o l o g i s d i M a n a d o d i d a p a t k a n p r e v a l e n s i D M a d a i a h 6 1

P r e v a l e n s i d i a b e t e s m e l i t u s p a d a p e n d u d u k u s i a 2 5 - 6 4 t a h u n d i J a w a d a n B a l i

s e b e s a r 7 5 P e n e l i t i a n y a n g d i l a k u k a n d i J a k a r t a S u r a b a y a M a k a s a r d a n k o t a -

k o t a l a i n d i I n d o n e s i a m e m b u k t i k a n a d a n y a k e n a i k a n p r e v a l e n s i d a r i t a h u n

k e t a h u n ( D E P K E S 2 0 1 4 W H O 2 0 1 0 )

I n f e k s i s a i u r a n k e m i h j u g a m e n i p a k a n m a s a l a h k l i n i s u m u m p a d a p e n d e r i t a

D M o l e h k a r e n a p e n d e r i t a D M m e m p u n y a i k e m u n g k i n a n m e n d e r i t a I S K l e b i h

t i n g g i d i b a n d i n g k a n d e n g a n b u k a n p e n d e r i t a D M d a n j u g a m e n d e r i t a i n f e k s i y a n g

l e b i h b e r a t y a n g a k a n m e n i n g k a t k a n risiko u n t u k m a s u k m m a h s a k i t ( H a r d i n g

d k k 2 0 1 0 ) P e n e l i t i a n y a n g d i l a k u k a n o l e h B o y k o d k k m e n d a p a t k a n w a n i t a D M

ripe 2 d e n g a n b a k t e r i u r i a s i m t o m a t i k s e t e l a h d i l a k u k a n p e m a n t a u a n s e l a m a 1 8

b u l a n m e n g a l a m i p e n i n g k a t a n r i s i k o m e n d a p a t k a n I S K s e b a n y a k 3 4

d i b a n d i n g k a n d e n g a n w a n i t a y a n g t i d a k m e n g a l a m i D M s e b e s a r 1 9 ( B o y k o d k k

2 0 0 2 )

B e r d a s a r k a n u r a i a n - u r a i a n d i a t a s s e r t a b e l u m a d a n y a p e n e l i t i a n y a n g

m e n e m u k a n k e t e r k a i t a n f a k t o r u s i a j e n i s k e l a m m t i n g k a t p e n d i d i k a n d a n r i w a y a t

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h d i K o t a P a l e m b a n g m a k a

p e n e l i t i t e r t a r i k i m t i i k m e l a k u k a n p e n e l i t i a n m e n g e n a i h u b u n g a n a n t a r a u s i a j e n i s

k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

3

12 Rumusan Masalah

1 B a g a i m a n a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s

m e l i t u s

2 A p a k a l i a d a h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

13 Tujuan Penelitian

131 Tujuan Umum

T u j u a n u m u m d a r i p e n e l i t i a n i n i a d a i a h d i k e t e m u k a n n y a h u b u n g a n a n t a i a

u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i m s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

132 Tujuan Khusus

T u j u a n k l i u s u s d a r i p e n e l i t i a n i n i y a i t u

1 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a

2 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n m f e k s i s a i u r a n k e m i b p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n j e n i s k e i a m i n

3 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

4

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n t i n g k a t p e n d i d i k a n

4 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n riwayat d i a b e t e s m e l i t u s

5 T e r a n a l i s i s n y a h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a i m n a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

6 T e r a n a l i s i s n y a h u b u n g a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

7 T e r a n a l i s i s n y a h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

8 T e r a n a l i s i s n y a h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i u i s d e n g a n k e j a d i a n

i n f e k s i s a l i u a i i k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

14 Manfaat Penelitian

141 Manfaat Teoritis

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t m e n a m b a h p e n g e t a h u a n p e n e l i t i

t e n t a n g h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i U i s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

5

142 Manfaat Praktis

A Bagi Peneliti

H a s i l p e n e l i t i a n i n i d i l i a r a p k a n d a p a t d i g u n a k a n s e b a g a i s a l a h s a t u b a h a n

r e f e r e n s i a t a u b a c a a n b a g i p e n e l i t i

B Bagi Institusi

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t d i g u n a k a n p i h a k R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g s e b a g a i s a l a l i s a t u b a h a n a c u a n d a l a m m e n g u p a y a k a n

p e n c e g a h a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

15 Keaslian Penelitian

T a b e l 1 1 K e a s l i a n P e n e l i t i a n

Nama Judul Penelitian Desain Hasil Penelitian

Peneliti Penelitian

Kugan P r e v a l e n s i I n f e k s i Cross D a r i p e n e l i t i a n i i i i

Kandasamy S a i u r a n K e m i l i P a d a seciUmal d i p e r o l e h b a l i w a

W a n i t a Y a n g M e n d e r i t a

D i a b e t e s M e l i t u s T i p e

I I Y a n g D i r a w a t I n a p

p a s i e n w a n i t a d i a b e t e s

m e l i t u s t i p e I y a n g

m e n d e r i t a I S K y a n g

D a n D i r a w a t J a l a n D i d i r a w a t m a p d a n

S u b b a g i a n

E n d o k r i n o l o g i B a g i a n

P e n y a k i t D a l a m D i

d i r a w a t j a l a n d i s u b

b a g i a n E n d o k r i n o l o g i

P e n y a k i t D a l a m

R S U P H A d a m M a l i k R S U P H A d a m

P a d a T a l i u n 2 0 0 9 M a l i k M e d a i i t e r d a p a t

s e b a n y a k 2 5 o r a n g

y a i t u ( 1 2 7 ) D a r i 2 5

o r a n g y a n g m e n d e r i t a

I S K t e r d a p a t 3 o r a n g

y a i t u ( 1 2 0 ) y a n g

d i r a w a t i n a p d a n 2 2

6

o r a n g ( 8 8 0 ) y a n g

d i r a w a t j a l a n

Edel Weisela P e r b e d a a n R i s i k o

Permata I n f e k s i N o s o k o m i a l

Sari dan S a i u r a n K e m i h

Prijono B e r d a s a r k a n

Satyabakti K a i e t e r i s a s i U r i n

U m u r D a n D i a b e t e s

M e l i t u s T a h u n 2 0 1 5

Case H a s i l p e n e l i t i a n y a n g

control d i 1 a k u k a n p a d a 2 0

s a m p e l k a s u s d a n

k o n t r o l m e n u n j u k k a n

b a h w a p a s i e n d e n g a n

u m u r gt 5 5 t a h u n

m e m p u n y a i r i s i k o

5 5 7 k a l i m e n g a l a m i

i n f e k s i n o s o k o m i a l

s a i u r a n k e m i h

d i b a n d i n g k a n p a s i e n

d e n g a n u m u r lt 5 5

t a h u n d e n g a n

p e r i l i t u n g a i i b e s a r

risiko d i p e r o l e h n i l a i

O R s e b e s a r 5 5 7

d e n g a n n i l a i 9 5

(onfidence Interval

l 1 9 lt O R lt 2 8 2 3

P a s i e n d e n g a n s t a t u s

D M m e m p u n y a i risiko

6 k a l i u n t u k

m e n g a l a m i i n f e k s i

n o s o k o m i a l s a i u r a n

k e m i h d i b a n d i n g k a n

d e n g a n p a s i e n y a n g

t i d a k m e n d e r i t a D M

d e n g a n n i l a i O R

7

s e b e s a r 6 0 0 d e n g a n

n i l a i 9 5 Confidence

Interval 1 22 lt O R lt

3 2 2 6

Andry K a r a k t e r i s t i k P a s i e n - D e s k r i p k i f H a s i i p e n e l i t i a n d a r i

Lukandy P a s i e n I n f e k s i S a i u r a n r e t r o s p e k t i f 4 3 o r a n g p e n d e r i t a

K e m i i i d i P o l i u r o l o g i

R S U D D r P i m g a d i

K o t a M e d a n T a h u n

2 0 1 2 - 2 0 1 3

I S K d i d a p a t k a n 5 3 5

p a d a k e l o m p o k u s i a

gt 5 0 t a h u n 5 1 2

b e i j e n i s k e i a m i n l a k i -

l a k i 1 0 0 t i d a k

m e n d e r i t a

v e s i c o u r e t r a l r e f l u x

7 0 Benign Prostatic

Hyperplasia 1 1 6

b a t u s a i u r a n k e m i h

2 7 9 d i a b e t e s t i p e 2

D a r i h a s i l p e n e l i t i a n

i n i d a p a t d i s i m p u l k a n

b a h w a p e n d e r i t a i S K

l e b i h b a n y a k t e r j a d i

p a d a l a k i - l a k i d a n

p e n d e r i t a I S K l e b i h

b a n y a k d i j u m p a i p a d a

k e l o m p o k u m u r gt 5 0

t a h u n s e r t a d i t e m u k a n

I S K d e n g a n B P H

B S K d a n D M T i p e 2

BAB 11

TINJAUAN PUSTAKA

21 Landasan Teori

211Infeksi Saiuran Keniih

A Definisi

I n f e k s i S a i u r a n K e m i h a d a i a h i n v a s i d a n m u l t i p l i k a s i m i k r o o r g a n i s m e a t a u

p a r a s i t d a l a m j a r i n g a n t u b u h k h u s u s n y a s a i u r a n k e m i h y a n g t e r d i r i d a r i g i n j a l

u r e t e r b u l i - b u l i d a n u r e t r a y a n g d i i a n d a i d e n g a n a d a n y a b a k t e r i 1 0 c f i i (colony

forming unit) p e r m l p a d a p e n g a m b i l a n c o n t o h u r i n ( P u m o m o 2 0 1 1 )

I n f e k s i s a i u r a n k e m i h a d a l a l i s u a t u i n f e k s i y a n g m e l i b a t k a n g i n j a l lU e ter

b u l i - b u l i a t a u p u n u r e t r a I n f e k s i s a i u r a n k e m i h ( I S K ) a d a l a l i i s t i l a h u m u m y a n g

m e n u n j u k k a n k e b e r a d a a n m i k r o o r g a n i s m e d a l a m u r i n ( S u d o y o 2 0 0 6 )

B a k t e r i u r i a b e r m a k n a (significant hacteriuria) a d a i a h s u a t u k e a d a a n y a n g

m e n u n j u k k a n p e n u m b u l i a n m i k r o o r g a n i s m e m u m i l e b i h d a r i 1 0 c f t L m l p a d a

b i a k a n u r i n B a k t e r i u r i a b e r m a k n a m u n g k i n t a n p a d i s e r t a i p r e s e n t a s i k l i n i s I S K

d a n d i n a m a k a n b a k t e r i u r i a a s i m t o m a t i k (convert hacteriuria) S e b a l i k n y a

b a k t e r i u r i a b e n n a k n a d i s e r t a i p e r s e n t a s i k l i n i s I S K d i n a m a k a n b a k t e r i u r i a

s i m t o m a t i k P a d a b e b e r a p a k e a d a a n t e r d a p a t p a s i e n d e n g a n p e r s e n t a s i k l i n i s I S K

n a m u n t a n p a b a k t e r i u r i a b e n n a k n a S e l a i n i t u d i k a t a k a n p i u r i a ( l e u k o s i t d a l a m

u r i n ) b e n n a k n a (significant pyuria) b i l a d i t e m u k a n n e u t r o f i l gt 1 0 s e l p e r l a p a n g a n

p a n d a n g ( S u d o y o 2 0 0 6 )

B Epidemiologi

I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m u k a n d i p r a k t i k u m u m w a i a u p u n b e n n a c a m - m a c a m a n t i b i o t i k a s u d a h

t e r s e d i a l u a s d i p a s a r a n D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r

2 5 - 3 5 s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a

S e l a m a p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n

9

10

c e n d e r u n g m e n d e r i t a i S K d i b a n d i n g k a n l a k i - l a k i I S K b e m l a n g p a d a l a k i - l a k i

j a r a n g d i l a p o r k a n k e c u a l i d i s e r t a i f a k t o r p r e d i s p o s i s i ( p e n c e t u s )

P r e v a l e n s i b a k t e r i u r i a a s i m t o m a t i k l e b i h s e r i n g d i t e m u k a n p a d a p e r e m p u a n

P r e v a l e n s i s e l a m a p e r i o d e s e k o l a h (school girls) 1 m e n i n g k a t m e n j a d i 5

s e l a m a p e r i o d e a k t i f s e c a r a s e k s u a l P r e v a l e n s i i n f e k s i a s i m t o m a t i k m e n i n g k a t

m e n c a p a i 3 0 b a i k l a k i - l a k i m a u p u n p e r e m p u a n b i l a d i s e r t a i f a k t o r p r e d i s p o s i s i

( S u d o y o 2 0 0 6 )

C Kiasifikasi

I n f e k s i s a i u r a n k e m i h d a p a t d i b a g i m e n j a d i d u a k a t e g o r i u m u m b e r d a s a r k a n

l o k a s i a n a t o m i y a i t u

1 ) I n f e k s i s a i u r a n k e m i h b a w a h

2 ) I n f e k s i s a i u r a n k e m i h a l a s

P r e s e n t a s i k l i n i s d a r i i n f e k s i s a i u r a n k e m i h b a w a l i t e r g a n t u n g d a r i gender

y a i t u

a ) P e r e m p u a n

a S i s t i t i s

S i s t i t i s a d a i a h p r e s e n t a s i k l i n i s i n f e k s i k a n d u n g k e m i h d i s e r t a i

b a k t e r i u r i a b e n n a k n a

b S i n d r o m U r e t r a A k u t ( S U A )

S i n d r o m a u r e t r a a k u t a d a i a h p r e s e n t a s i k l i n i s s i s t i t i s t a n p a d i t e m u k a n

a d a n y a m i k r o o r g a n i s m e d a l a m L u i n ( s t e r i l ) d a n s e r i n g d i n a m a k a n

s i s t i t i s b a k t e r i a l i s

b ) L a k i - l a k i

P r e s e n t a s i k l i n i s i n f e k s i s a i u r a n k e m i h p a d a l a k i - l a k i m u n g k i n s i s t i t i s

p r o s t a t i t i s e p i d i m i d i s d a n u r e t r i t i s

I n f e k s i s a i u r a n k e m i h a t a s t e r b a g i m e n j a d i 2 y a i t u

1 ) P i e l o n e f r i t i s A k u t ( P N A )

P i e l o n e f r i t i s a k u t a d a l a l i p r o s e s i n f l a m a s i p a r e n k i m g i n j a l y a n g d i s e b a b k a n

o l e h m f e k s i b a k t e r i

11

2 ) P i e l o n e f r i t i s K r o n i s ( P N K )

P i e l o n e f r i t i s k r o n i s m u n g k i n a k i b a t l a n j u t d a r i i n f e k s i b a k t e r i

b e r k e p a n j a n g a n a t a u i n f e k s i s e j a k m a s a k e c i i O b s t r u k s i s a i u r a n k e m i h d a n

r e f l u k s v e s i k o u r e t e r d e n g a n a t a u t a n p a b a k t e r i u r i a k r o n i k s e r i n g d i i k u t i

p e m b e n t u k a n j a r i n g a n i k a t p a r e n k i m g i n j a l y a n g d i t a n d a i d e n g a n

p i e l o n e f r i t i s k r o n i k y a n g s p e s i f i k ( S u d o y o 2 0 0 6 )

D Etiologi

P a d a k e a d a a n n o r m a l u r i n b e r s i f a t s t e r i l U m u m n y a I S K d i s e b a b k a n o l e h

k i i m a n g r a m n e g a t i f E s c h e r i c h i a c o l i m e m p a k a n p e n y e b a b t e r b a n y a k b a i k p a d a

y a n g s i m t o m a t i k m a u p u n y a n g a s i m t o m a t i k y a i t u 7 0 - 9 0 E n t e r o b a k t e r i a s e p e r t i

P r o t e u s m i r a b i l i s ( 3 0 d a r i i n f e k s i s a i u r a n k e m i h p a d a a n a k l a k i - l a k i t e t a p i

k u r a n g d a r i 5 p a d a a n a k p e r e m p u a n ) K l e b s i e l l a p n e u m o n i a d a n P s e u d o m o n a s

a e m g i n o s a d a p a t j u g a s e b a g a i p e n y e b a b O r g a n i s m e g r a m p o s i t i f s e p e r t i

S t r e p t o c o c c u s f a e c a l i s ( e n t e r o k o k u s ) S t a p h y l o c o c c u s e p i d e n n i d i s d a n

S t r e p t o c o c c u s v i r i d a n s j a r a n g d i t e m u k a n P a d a u r o p a t i o b s t m k t i f d a n k e l a i n a n

s t r u k t u r s a i u r a n k e m i h p a d a a n a k l a k i - l a k i s e r i n g d i t e m u k a n P r o t e u s s p e c i e s P a d a

I S K n o s o k o m i a l a t a u I S K k o m p l e k s l e b i h s e r i n g d i t e m u k a n k u m a n P r o t e u s d a n

P s e u d o m o n a s ( L u m b a n b a t u S M 2 0 0 3 )

E Patofisiologi

P a d a i n d i v i d u n o n n a l b i a s a n y a u r i n l a k i - l a k i m a u p u n p e r e m p u a n s e l a l u

d a l a m k e a d a a n s t e r i l k a r e n a d i p e r t a l i a n k a n o l e h j u m l a l i d a n f r e k u e n s i b e r k e m i h

U t e r o d i s t a l m e m p a k a n t e m p a t k o l o n i s a s i m i k r o o r g a n i s m e nonpathogenic

fastidious G r a m - p o s i t i f d a n g r a m n e g a t i f ( S u d o y o 2 0 0 6 )

H a m p i r s e m u a I S K d i s e b a b k a n i n v a s i m i k r o o r g a n i s m e ascending d a r i u r e t r a

k e d a l a m k a n d u n g k e m i b P a d a b e b e r a p a p a s i e n t e r t e n t u i n v a s i m i k r o o r g a n i s m e

d a p a t m e n c a p a i k e g i n j a l P r o s e s i n i d i p e n n u d a h o l e h k o n d i s i r e f l u k s

v e s i k o i i r e t e r a l P r o s e s i n v a s i m i k r o o r g a n i s m e h e m a t o g e n s a n g a t j a r a n g d i t e m u k a n

d i k l i n i k m u n g k i t a k i b a t l a n j u t d a r i b a k t e r e m i a G i n j a l d i d u g a m e n i p a k a n l o k a s i

12

i n f e k s i s e b a g a i a k i b a t l a n j u t d a r i s e p t i k e m i a a t a u e n d o k a r d i t i s a k i b a t S t a f i l o k o k u s

a u r e u s K e l a i n a n g i n j a l y a n g t e r k a i t d e n g a n e n d o k a r d i t i s ( S t a f i l o k k o k u s a u r e u s )

d i k e n a l d e n g a n N e p h r i t i s L o h e i n B e b e r a p a p e n e l i t i a n m e l a p o r k a n p i e l o n e f r i t i s

a k u t ( P N A ) s e b a g a i a k i b a t l a n j u t i n v a s i h e m a t o g e n ( S u d o y o 2 0 0 6 )

F Faktor Risiko

P a t o f i s i o l o g i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h d a p a t d i p e n g a n i h i o l e h

b e b e r a p a f a k t o r A d a p u n b e b e r a p a f a k t o r risiko y a n g m e m p e n g a n i l i i t e r j a d i n y a

i n f e k s i s a i u r a n k e m i h a n t a r a l a i n

1 ) U s i a

I n s i d e n I S K m e n i n g k a t b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i

m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n a d a n y a a b n o r m a l i t a s a n a t o m i y a n g

m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n k e m i h s e p e r t i p e m b e s a r a n p r o s t a t

d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e

P e n y e b a b l a i n t e r m a s u k p e r i n e u m y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s

p e n y a k i t n e u r o m u s k n l a r d a n k a t e t e r i s a s i b u l i - b u l i S e l a i n i t u i n s i d e n I S K

m e n c a p a i 1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o s e 2 0 0 9 F o x m a n e t a l 2 0 1 0

R o n a l d 2 0 1 1 )

M e n u m t t e o r i y a n g d i k e m u k a k a n o l e h S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a d a u s i a

l a n j u t a k a n t e r j a d i p e n i n g k a t a n k e r e n t a n a n t e r h a d a p p e n y a k i t P a d a u s i a d i a t a s 5 0

t a l i u n t e r j a d i p e n u m n a n k e m a m p u a n d a l a m m e m p e r t a h a n k a n s t e n l i t a s b a i k p a d a

k a n d u n g k e m i h m a u p u n u r e t r a H a l t e r s e b u t d i s e b a b k a n o l e h i n v o l u s i t i m u s

I n v o l u s i s e l t i m u s m e n y e b a b k a n j u m l a h se d a n k u a l i t a s r e s p o n s s e l T s e m a k i n

b e r k u r a n g J u m l a h s e l T m e m o r i m e n i n g k a t n a m u n s e m a k i n s u l i t u n t u k

b e r k e m b a n g t e r u t a m a s i t o t o k s i k s e l T ( C D ^ ) d a n s e l T h l ( C D ^ ^ ) k a r e n a t e r j a d i

a p o p t o s i s S i t o t o k s i k s e l T ( C D ^ ^ ) b e i p e r a n d a l a m r e s p o n s i m u n t e r h a d a p a n t i g e n

p a d a s e l y a n g d i i n f e k s i d e n g a n c a r a m e m b u n u l i s e l y a n g t e r i n f e k s i u n t u k

m e n c e g a h p e n y e b a r a n m f e k s i s e d a n g k a n s e l T h l ( C D ^ ^ ) b e r p e r a n m e m b a n t u s e l

B u n t u k m e m p r o d u k s i a n t i b o d i

13

2 ) J e n i s k e l a m m d a n a k t i v i t a s s e k s u a l

I n s i d e n s i I S K y a n g r e n d a h p a d a p r i a d i p e n g a n i h i o l e h 3 f a k t o r y a i t u

1 L e b i h s e d i k i t t e r j a d i k o l o n i s a s i s e k i t a r u r e t r a k a r e n a t i d a k a d a n y a t e m p a t

s e p e r t i v a g i n a p a d a p e r e m p u a n

2 M e m i l i k i u r e t r a y a n g p a n j a n g

3 A d a n y a s u b s t a n s i a n t i b a k t e r i a l p a d a c a i r a n p r o s t a t

U r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a h d e n g a n d e k a t n y a v a g i n a l

v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h l e b i h s e r i n g

p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a f l o r a n o n n a l p a d a d a e r a l i p e r i u r e t r a t e r d i r i

d a r i o r g a n i s m e s e p e r t i l a c t o b a c i l l i i s y a n g m e m b a n t u m e l a w a n k o l o n i s a s i b a k t e r i

p a t o g e n p a d a s a i u r a n k e m i h P e r u b a l i a n l i n g k i m g a n d a r i p e r i u r e t r a l s e p e r t i

p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k b i s a m e n g g a n g g u f l o r a

n o r m a l s e h i n g g a m e m u n g k i n k a n b a k t e r i p a t o g e n b e r k o l o n i s a s i d a n m e n y e b a b k a n

i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

P a d a w a n i t a l e b i h d a r i 5 0 t a h u n a t a u l e b i h m e n o p a u s e m e m p a k a n f a k t o r

l a i n y a n g m e n i n g k a t k a n P V R Post Void Residual) s e l a i n p e n u r u n a n k o i i t r a k t i i i t a s

o t o t d e t r u s o r P e n u m n a n e s t r o g e n y a n g d i s e b a b k a n m e n o p a u s e d a p a t

m e n i n g k a t k a n p H v a g i n a l d a n m e n u m n k a n j u m l a l i l a c t o b a c i l l i A k i b a m y a t e r j a d i

p e n i n g k a t k a n k o l o n i s a s i d a r i b a s i l g r a m n e g a t i f s e h i n g g a m e n i n g k a t k a n r e s i k o

t e r j a d i n y a I S K P a d a p r i a p r o s t a t m e n s e k r e s i k a n c a i r a n y a n g m e n g a n d i m g z i n k

y a n g m e m i l i k i a k t i f i t a s m i k r o b i a l ( K i m 2 0 1 2 )

S e l a i n i t u p i j a t a n u r e t r a s e p e r t i y a n g t e r j a d i s e l a m a h u b u n g a n s e k s u a l

m e n y e b a b k a n m a s u k n y a b a k t e r i k e d a l a m k a n d u n g k e m i h d a n m e m p a k a n h a l

y a n g p e n t i n g d a l a m p a t o g e n e s i s m f e k s i s a l i u a n k e m i h p a d a p e r e m p u a n m u d a

B u a n g a i r k e c i l s e t e l a h h u b u n g a n s e k s u a l t e r b u k t i m e n u m n k a n risiko s i s t i t i s

m u n g k i n k a r e n a t i n d a k a n i n i m e n i n g k a t k a n e r a d i k a s i b a k t e r i y a n g m a s u k s e l a m a

h u b u n g a n s e k s u a l ( K i m 2 0 1 2 )

3 ) T i n g k a t P e n d i d i k a n

P e n g e t a h u a n s e s e o r a n g t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t

p e n d i d i k a n S e s e o r a n g y a n g m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m i u i g k i n a n

p e n g e t a h u a n t e n t a n g k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o n n a s i y a n g d i d a p a t k a n

14

t e n t a n g k e s e h a t a n l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h

S e b a l i k n y a p e n d i d i k a n y a n g k u r a n g d a p a t m e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g

t e r h a d a p n i l a i - n i l a i y a n g b a n i d i k e n a l ( N o t o a d i n o j o 2 0 0 3 )

4 ) R i w a y a t D i a b e t e s M e l i t u s

M e n u r u t S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a s i e n d e n g a n s t a t u s D M s a n g a t

b e r i s i k o u n t u k m e n g a l a m i i n f e k s i s a i u r a n k e m i h A b n o n n a l i i a s s t n i k t u r d a n

k a n d u n g k e m i h n e u r o g e n i k a k i b a t n e u r o p a t i o t o n o m a t a u s t r o k e p a d a p a s i e n D M

m e n y e b a b k a n p e n g o s o n g a n k a n d u n g k e m i h t i d a k n o n n a l D M j u g a d a p a t

m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a h a n a n t u b u h y a n g b e r p o t e n s i m e n i n g k a t

risiko t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a h a n a n t u b u h t e r s e b u t d i a n t a r a n y a

a d a i a h k e g a g a l a n m i g r a s i s e l intracellular killing f a g o s i t o s i s d a n k e m o t a k s i s

p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n m e k a n i s m e p e r t a h a n a n

a l a m i a h i o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p i n f e k s i

5 ) K e h a m i i a n

K e c e n d e r u n g a n i n f e k s i s a i u r a n k e m i h b a g i a n a t a s s e l a m a k e h a m i i a n

d i s e b a b k a n o l e h p e n u m n a n k e k u a t a n u r e t e r p e n u m n a n p e r i s t a l t i k u r e t e r d a n

i n k o m p e t e n s i s e m e n t a r a k a l u p v e s i k o i u - e t e r a l y a n g t e r j a d i s e l a m a h a m i l

6 ) S u m b a t a i i

A d a n y a I i a i a n g a n a l i r a n b e b a s u r i n s e p e r t i t u m o r s t r i k t r a a b a t u a t a u

h i p e r t r o f i p r o s t a t d a p a t m e n y e b a b k a n h i d r o n e f r o s i s d a n risiko i n f e k s i s a i u r a n

k e m i l i y a n g s a n g a t t i n g g i S e l a i n i t u s u p e r i n f e k s i p a d a s u m b a t a n s a i u r a n k e m i h

d a p a t m e n y e b a b k a n k e m s a k a n j a r i n g a n g i n j a l y a n g c e p a t

7 ) D i s f u n g s i n e u r o g e n i k k a n d u n g k e m i h

G a n g g u a n s a r a f y a n g b e k e r j a p a d a k a n d m i g k e m i h s e p e r t i p a d a j e j a s k o r d a

s p i n a l i s t a b e s d o r s a i i s m u l t i p e l s k l e r o s i s d i a b e t e s m e l i t u s a t a u p e n y a k i t l a i n

d a p a t b e r h u b u n g a n d e n g a n i n f e k s i s a i u r a n k e m i h I n f e k s i d a p a t d i a w a l i o l e h

p e n g g u n a a n k a t e l e r u n t u k d r a i n a s e k a n d i u i g k e m i h d a n d i d u k i m g o l e h s t a t i s u r i n

d a l a m k a n d u n g k e m i l i u n t u k j a n g k a w a k t u y a n g l a m a

8 ) R e f l u k s v e s i k o m e t e r a

K e a d a a n i n i d i d e f i n i s i k a n s e b a g a i r e f l u k s u r i n d a r i k a n d u n g k e m i b k e u r e t e r

d a n k a d a n g s a m p a i k e p e l v i s r e n a l H a l i n i t e r j a d i s e l a m a b u a n g a i r k e c i l a t a u

15

d e n g a n p e n i n g k a t a n t e k a n a n p a d a k a n d u n g k e m i h R e f l u k s v e s i k o i i r e t e r a l d a p a t

d i b u k t i k a n d e n g a n a d a n y a g c r a k a n r e t r o g r a d z a t r a d i o o p a k a t a u r a d i o a k t i f m e l a l u i

s i s t o u r e t r o g r a m s e l a m a b u a n g a i r k e c i l R e f l u k s v e s i k o i i r e t e r a l b i a s a n y a

d i s e b a b k a n k a r e n a a d a n y a g a n g g u a n a n a t o m i s p a d a p e r t e m u a n v e s i k o i i r e t e r a l

y a n g d a p a t m e n y e b a b k a n r e f l u k s u r i n d i s e r t a i b a k t e r i d a n k a r e n a i t u t e r j a d i l a h

i n f e k s i s a l r a a n k e m i h

9 ) F a k t o r v i r u l e n s i b a k t e r i

F a k t o r v i r u l e n s i b a k t e r i m e m p e n g a r u b i k e m u n g k i n a n vragt7 t e r t e n m d a l a m

m e n y e b a b k a n i n f e k s i t r a k i u s u r i n a r i u s H a m p i r s e m u a strain F c o l i y a n g

m e n y e b a b k a n p i e l o n e f r i t i s p a d a p a s i e n d e n g a n t r a k i u s u r i n a r i u s n o m i a l s e c a r a

a n a t o m i k m e m p u n y a i p i l u s t e r t e n t u y a n g m e m p e r a n t a r a i p e r l e k a t a n p a d a b a g i a n

d i g a k t o s i d a d a n g l i k o s f i n g o l i p i d y a n g a d a d i u r o e p i t e l Strain y a n g m e n i m b u l k a n

p i e l o n e f r i t i s j u g a b i a s a n y a m e m p a k a n p e n g b a s i l h e m o l i s i n m e m p u n y a i

a e r o b a k t i n d a n r e s i s t e n t e r h a d a p k e r j a b a k t e r i s i d a l d a r i s e m m m a n u s i a

1 0 ) F a k t o r g e n e t i k

F a k t o r g e n e t i k p e n j a m u m e m p e n g a n i l i i k e r e n t a n a n t e r h a d a p i n f e k s i t r a k t u s

u r i n a r i u s J u m l a h d a n t i p e r e s e p t o r p a d a s e l u r o e p i t e l t e m p a t b a k t e r i d a p a t

m e n e m p e l s e l i d a k i i y a s e b a g i a i i d i t e n t u k a r i s e c a r a g e n e t i k ( I s s e l b a c h e r 2 0 0 9 )

G Manifestasi Klinis

G e j a l a k l i n i s d a r i i n f e k s i s a i u r a n k e m i h s e s u a i d e n g a n b a g i a n s a i u r a n k e m i h

y a n g t e r i n f e k s i a d a i a h s e b a g a i b e r i k u t

1 ) I n f e k s i s a i u r a n k e m i h b a g i a n b a w a l i

K e l u h a n p a s i e n b i a s a n y a b e m p a r a s a s a k i t a t a u r a s a p a n a s d i u r e t r a s e w a k t u

k e n c i n g d e n g a n a i r k e m i h s e d i k i t - s e d i k i t s e r t a r a s a t i d a k e n a k d i d a e r a h

s i i p r a p u b i k

2 ) I n f e k s i s a i u r a n k e m i h b a g i a n a t a s

P a d a i n t e k s i s a i u r a n k e m i h b a g i a n a t a s d a p a t d i t e m u k a n g e j a l a s e p e r t i s a k i t

k e p a l a m a l a i s e m u a l m m i t a h d e n i a m m e n g g i g i l r a s a t i d a k e n a k a t a u

n y e r i d i p i n g g a n g ( T e s s y d k k 2 0 0 1 )

16

H Tatalaksana

T u j u a n p e n a t a l a k s a n a a a n i n f e k s i s a i u r a n k e m i h a d a i a h m e n c e g a h d a n

m e n g h i l a n g k a n g e j a l a m e n c e g a h d a n m e n g o b a t i b a k t e n e m i a d a n b a k t e r i u r i a s e r t a

m e n c e g a h d a n m e n g u r a n g i r i s i k o k e r u s a k a n g i n j a l y a n g m u n g k i n t i m b u l d e n g a n

p e m b e r i a n o b a t - o b a t a n y a n g s e n s i t i f m u r a l i d a n a m a n d e n g a n e f e k s a m p i n g y a n g

m i n i m a l

a ) i n f e k s i s a i u r a n k e m i h ( I S K ) b a w a h

P r i n s i p p e n a t a l a k s a n a a n I S K b a w a h m e l i p u t i intake c a i r a n y a n g b a n y a k

a n t i b i o t i k y a n g a d e k u a t d a n b i l a p e r l u t e r a p i s i m t o m a t i k u n t u k a l k a l i s a s i

u r i n

i H a m p i r 8 0 p a s i e n a k a n m e m b e r i k a n r e s p o n s e t e l a h 4 8 j a m d e n g a n

a n t i b i o t i k a t u n g g a l s e p e r t i a m p i s i l i n 3 g r a m a t a u t r i m e t o p r i m 2 0 0 m g

i i B i l a i n f e k s i m e n e t a p d i s e r t a i k e l a i n a n u r i n a l i s i s ( l e u k o s i u i a ) d i p e r i u k a n

t e r a p i k o n v e n s i o n a l s e l a m a 5 - 1 0 h a r i

i i i P e m e r i k s a a n m i k r o s k o p i s u r i n d a n b i a k a n u r i n t i d a k d i p e r i u k a n b i l a

s e m u a g e j a l a h i l a n g d a n t a n p a l e u k o s u r i a

b ) I n f e k s i s a i u r a n k e m i h ( I S K ) a t a s

P a d a u m u m n y a p a s i e n d e n g a n p i e l o n e f r i t i s a k u t m e m e r l u k a n r a w a t i n a p

u n t u k m e m e l i h a r a s t a t u s h i d r a s i d a n t e r a p i a n t i b i o t i k a p a r e n t e r a l p a l i n g

s e d i k i t 4 8 j a m ( S u d o y o 2 0 0 6 )

i Komplikasi

K o m p l i k a s i i n f e k s i s a i u r a n k e m i h t e r g a n t u n g d a r i t i p e y a i t u i n f e k s i s a i u r a n

k e m i h t i p e s e d e r h a n a (uncomplicated) d a n t i p e b e r k o m p l i k a s i (complicated)

1 ) I n f e k s i s a i u r a n k e m i h s e d e r h a n a (uncomplicated)

I n f e k s i s a i u r a n k e m i h a k u t t i p e s e d e r h a n a ( s i s t i t i s ) y a i t u n o n - o b s t r u k s i d a n

b u k a n p e r e m p u a n h a m i l m e m p a k a n p e n y a k i t r i n g a n (self limited disiase)

d a n t i d a k m e n y e b a b k a n a k i b a t l a n j u t j a n g k a l a m a

2 ) I n f e k s i s a i u r a n k e m i h b e r k o m p l i k a s i (complicated)

a ) I n f e k s i s a i u r a n k e m i h s e l a m a k e h a m i i a n

b ) i n f e k s i s a i u r a n k e m i h p a d a d i a b e t e s m e l i t u s ( S u d o y o 2 0 0 6 )

17

22 Kerangka Teori

J

U s i a

J e n i s K e i a m i n

T i n g k a t P e n d i d i k a n

R i w a y a t D i a b e t e s M e l i m s

S u m b a t a n bullT

K e h a m i i a n

D i s f u n g s i n e u r o g e n i k

R e f l u k s v e s i k o i i r e t e r a l

V i r u l e n s i b a k t e r i

F a k t o r g e n e t i k

I n f e k s i b a k t e r i g r a m p o s i t i f a t a u n e g a t i v e p a d a s a i u r a n k e m i h

I n f e k s i S a i u r a n K e m i h

Keterangan

I j = V a r i a b e l y a n g t i d a k d i t e l i t i

= V a r i a b e l y a n g d i t e l i t i

18

Hipotesis

H i p o t e s i s d a l a m p e n e l i t i a n i n i a d a i a h

H O t i d a k t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n

t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

H I t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

BAB 111

M E T O D E PENELITIAN

31 Jenis Penelitian

P a d a p e n e l i t i a n i n i j e n i s p e n e l i t i a n y a n g d i g u n a k a n a d a i a h p e n e l i t i a n

o b s e r v a s i o n a i a n a l i t i k d e s a i n cross scclional d e n g a n m e n g g u n a k a n d a t a s e k u n d e r

d a r i r e k a m m e d i s p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1 D e s e m b e r

2 0 1 5

32 Waktu dan Tempat Penelitian

321 Waktu Penelitian

W a k t u p e n e l i t i a n d i l a k s a n a k a n p a d a t a n g g a l 1 O k t o b e r s a m p a i d e n g a n 3 0

O k t o b e r 2 0 1 6

322 Tempat Penelitian

P e n e l i t i a n i n i d i l a k s a n a k a n d i R u m a l i S a k i t M u h a m m a d i y a h P a e m b a n g ( d i

R u a n g R e k a m M e d i s )

33 Populasi dan Sampel Penelitian

331Populasi Penelitian

P a d a p e n e l i t i a n i n i p o p u l a s i t a r g e t a d a l a l i p a s i e n r a w a t i n a p d a n r a w a t j a l a n

d i R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g s e d a n g k a n p o p u l a s i t e r j a n g k a u n y a

a d a i a h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

332Sampel dan Besar Sampel Penelitian

P a d a p e n e l i t i a n i n i s a m p e l p e n e l i t i a n a d a i a h p a s i e n r a w a t i n a p d a n r a w a t

j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e

1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 y a n g m e m e n u h i k r i t e r i a i n k l u s i p e n e l i t i a n

1 9

20

d e n g a n b e s a r s a m p e l y a n g l a y a k d a l a m p e n e l i t i a n m e n u r u t t e o r i R o s c o e a d a i a h

a n t a r a t i g a p u l u h s a m p a i l i m a r a t i i s o r a n g ( S u g i y o n o 2 0 1 5 )

333 Krttena Inklusi dan Eksklusi

A Kriteria Inklusi

P a d a p e n e l i t i a n i n i k r i t e r i a i n k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t i n a p

d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i

P a l e m b a n g y a n g d i d i a g n o s a m e n g a l a m i i n f e k s i s a i u r a n k e m i h s e r t a m e m i l i k i d a t a

r e k a m m e d i s p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

B Kriteria Eksklusi

P a d a p e n e l i t i a n i n i k r i t e r i a e k s k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t

i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 d e n g a n d a t a r e k a m m e d i s

y a n g t i d a k l e n g k a p

334 Cara Pengambilan Sampel Penelitian

C a r a p e n g a m b i l a n s a m p e l y a n g d i g u n a k a n d a l a m p e n e l i t i a n i n i a d a l a l i

m e n g g u n a k a n t e k n i k consecutive sampling P a d a consecutive sampling s e t i a p

p a s i e n y a n g m e m e n u h i k r i t e r i a p e n e l i t i a n d i m a s u k k a n d a l a m p e n e l i t i a n s a m p a i

k u r u n w a k t u t e r t e n U i s e h i n g g a j u m l a h m i n i m a l y a n g d i p e r i u k a n t e r p e n u h i

( S a s t r o a s m o r o 2 0 1 1 )

34 Variabel Penelitian

341 Variabel Dependent

V a r i a b e l dependent f t e r i k a t ) d a l a m p e n e l i t i a n i n i a d a i a h i n f e k s i s a i u r a n

k e m i h

342 Variabel Independent

V a r i a b e l independent ( b e b a s ) d a l a m p e n e l i t i a n i n i a d a i a h u s i a j e n i s

k e l a i n i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

21

35 Definisi Operasional

Tabel 31 Definisi Operasional

Variabel Alat Cara ueiinisi rldsil L KUr I7 i l l 11 Lz fe 1 V

oKaia LiKur Penelitian Ukur Ukur

Infeksi P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Saiuran d i d i a g n o s a o l e h m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Keniih d o k t e r m e n g a l a m i m e d i s

i n f e k s i s a i u r a n

k e m i h d a n t e r c a n t u m

d i r e k a m m e d i s

U s i a L a m a n y a t a h u n R e k a m O b s e r v a s i 1 lt 5 0 t a h u n O r d i n a l

k e h i d u p a n p a s i e n m e d i s r e k a m 2 gt 5 0 t a l i u n ( k a t e g o r i k )

d a r i l a h i r s a m p a i m e d i s

s e k a r a n g d a n

t e r c a n t u m d i r e k a m

m e d i s

Jenis P r o f i l a n a t o m i a t a u R e k a m O b s e r v a s i 1- L a k i - l a k i N o m i n a l

Keiamin b i o l o g i s p a s i e n y a n g m e d i s r e k a m 2 P e r e m p u a n ( k a t e g o r i k )

d i b e d a k a n m e n j a d i m e d i s

i a k i - l a k i d a n

n e r e m m i a n s e r t a

t e r c a n t u m d i r e k a m

m e d i s

Tingkat P e n d i d i k a n f o n n a l R e k a m O b s e r v a s i 1 P e n d i d i k a n O r d i n a l

Pendidikan t e r a k h i r y a n g m e d i s r e k a m d a s a r ( S D ( k a t e g o r i k )

d i t e m p u h o l e h m e d i s M I S M P

p a s i e n d a n t e r c a n t u m d a n M T s )

d i r e k a m m e d i s 2 P e n d i d i k a n

m e n e n g a l i

d a n t i n g g i

22

( S M A M A

S M K

M A K

d i p l o m a

s a r j a n a

m a g i St e r

s p e s i a l i s

d a n d o k t o r )

Riwayat P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Diabetes d i d i a g n o s i s d e n g a n m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Melitus d i a b e t e s m e l i t u s d a n

t e r c a n t u m d i d a l a m

r e k a m m e d i s

m e d i s

36 Cara Pengumpulan Data

361 Data Sekunder

P e n g u m p u l a n d a t a p a d a p e n e l i t i a n i n i d i p e r o l e h d a r i d a t a s e k u n d e r y a i t u

r e k a m m e d i s p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

37 Metode Teknik Analisis Data

371Cara Pengolahan dan Analisis Data

P e n g o l a h a n d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n m e l a l u i e m p a t t a h a p y a i t u

i Oala Entry

P a d a t a i i a p i n i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n riwayat d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g y a n g t e l a h d i d a p a t d a n

r e k a m m e d i s d i k u m p u l k a n d a n d i m a s u k k a n k e d a l a m p r o g r a m spss

23

2 Editing

P a d a t a h a p i n i d a t a i i s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n y a n g t e l a h d i m a s u k k a n k e d a l a m p r o g r a m s p s s

d i p e r i k s a k e m b a l i a p a k a h s u d a h l e n g k a p d a n t i d a k a d a k e k e l i r u a n

3 ( oding

S e t e l a h m e l a l u i p r o s e s editing d a t a - d a t a t e r s e b u t d i b e r i k o d e t e r t e n t u a n t a r a

l a i n k o d e 1 u n t u k u s i a gt 5 0 t a h u n j e n i s k e i a m i n p e r e m p u a n t i n g k a t

p e n d i d i k a n d a s a r t e r d a p a t r i w a y a t d i a b e t e s m e l i t u s d a n i n f e k s i s a i u r a n

k e m i h s e d a n g k a n k o d e 2 u n t u k u s i a lt 5 0 t a h u n j e n i s k e i a m i n l a k i - l a k i

t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i t i d a k t e r d a p a t r i w a y a t d i a b e t e s

m e l i t u s d a n b u k a n i n f e k s i s a i u r a n k e m i h s e h i n g g a m e m u d a h k a n d a l a m

m e l a k u k a n a n a l i s i s d a t a

4 Tahulaling

P a d a t a h a p i n i d a t a y a n g s a m a d i k e l o m p o k k a n s e c a r a t e l i t i d a n t e r a t m

k e m u d i a n d i l i i t u n g d e n g a n m e n g g u n a k a n p r o g r a m sps s d a n d i j u m l a h k a i i

l a l u d i s a j i k a n d a l a m b e n t u k t a b e l - t a b e l

U n t u k m e n g a n a l i s i s d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n a n a l i s i s d a t a

u n i v a r i a t d a n b i v a r i a t d e n g a n m e n g g u n a k a n p r o g r a m s p s s s e b a g a i b e r i k u t

A A n a l i s i s u n i v a r i a t

A n a l i s i s u n i v a r i a t d i l a k u k a n d e n g a n c a r a m e l a k u k a n a n a l i s i s p a d a s e t i a p

v a r i a b e l h a s i l p e n e l i t i a n d e n g a n t u j u a n u n t u k m e n g e t a h u i d i s t r i b u s i p r o p o r s i p a d a

s e t i a p v a r i a b e l p e n e l i t i a n D a t a d i s a j i k a n d a l a m b e n t u k t a b e l d a n n a r a s i

B A n a l i s i s b i v a r i a t

A n a l i s i s b i v a r i a t d i l a k u k a n d e n g a n m e n g g u n a k a n u j i h i p o t e s i s chi-square

U j i h i p o t e s i s chi-square d a p a t d i g u n a k a n d e n g a n s y a r a t y a i t u lt 2 0 s e l y a n g

m e m p u n y a i n i l a i expected count k u r a n g d a r i l i m a s e h i n g g a j i k a t i d a k m e m e n u h i

s y a r a t u j i chi-square m a k a u j i y a n g d i g u n a k a n a d a i a h u] fisher ( D a h l a n 2 0 1 4 )

B a t a s k e m a k n a a n y a n g d i g u n a k a n a d a i a h a = 0 0 5 J i k a d i d a p a t k a n p value lt 0 0 5

p a d a u j i s t a t i s t i k m a k a t i d a k t e r d a p a t h u b u n g a n y a n g b e n n a k n a a n t a r a d u a

v a r i a b e l y a n g d i t e l i t i d a n H O d i t e r i m a S e d a n g k a n j i k a d i d a p a t k a n p value gt 0 0 5

24

p a d a u j i s t a t i s t i k m a k a t e r d a p a t l i u b u n g a n y a n g b e n n a k n a a n t a r a d u a v a r i a b e l

y a n g d i t e l i t i d a n H O d i t o l a k

38 Alur Penelitian

P e n e n t u a n p o p u l a s i d a n s a m p e l p e n e l i t i a n

K r i t e r i a i n k l u s i K r i t e r i a e k s k l u s i

P e n g a m b i l a n s a m p e l p e n e l i t i a n

P e n g o l a h a n d a n a n a l i s i s d a t a d e n g a n u j i chi-square

H a s i l d a n p e m b a h a s a n

K e s i m p u l a n d a n s a r a n

Gambar 31 Alur Penelitian Hubungan Usia Jenis Keiamin Tingkat Pendidikan dan Riwayat Diabetes Melitus dengan Kejadian Infeksi Saiuran Kemih pada Pasien Rawat Inap di Bagian Penyakit Dalam Rumah Sakit Muhammadiyah Palembang Periode 1 Januari 2015 sampai dengan 31 Desember 2015

BAB IV

HASIL DAN PEMBAHASAN

41 Hasil

P e n e l i t i a n i n i t e l a h d i l a k u k a n d i r u a n g r e k a m m e d i s R u m a h S a k i t

M u h a i m n a d i y a h P a l e m b a n g d a r i t a n g g a l 1 O k t o b e r 2 0 1 5 - 3 1 O k t o b e r 2 0 1 6

P e n e l i t i a n d i m u l a i d e n g a n p e n g a m b i l a n d a t a a w a l b e m p a d a t a r e k a m m e d i s

s e l u r u h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

S e l a n j u t n y a r e k a m m e d i s d i p i l i h s e s u a i d e n g a n k r i t e r i a i n k l u s i d a n e k s k l u s i u n t u k

d i j a d i k a n s a m p e l p e n e l i t i a n s a m p a i m i n i m a l b e s a r s a m p e l y a n g d i b u t u h k a n

t e r p e n u h i s e r t a d i l a k u k a n p e n e l i t i a n s e c a r a o b s e r v a s i o n a i O b s e r v a s i r e k a m m e d i s

d i l a k u k a n u n m k m e n g e t a h u i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t

d i a b e t e s m e l i t u s d a n d i a g n o s a p a s i e n

D a r i c a t a t a n r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g

d i d a p a t k a n s e b a n y a k 4 1 4 1 r e k a m m e d i s p a s i e n r a w a t i n a p d a n 1 4 5 3 r e k a m m e d i s

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 D a r i t o t a l r e k a m m e d i s

p a s i e n r a w a t i n a p d a n r a w a t j a l a n t e r s e b u t p e n e l i t i h a n y a m e n g a m b i l m i n i m a l

b e s a r s a m p e l y a n g d i b u t u h k a n y a i t u s e b a n y a k 9 8 r e k a m m e d i s u n t u k d i j a d i k a n

s a m p e l p e n e l i t i a n y a n g t e r d i r i d a r i 3 0 r e k a m m e d i s p a s i e n y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i h d a n 6 8 r e k a m m e d i s y a n g t i d a k m e n g a l a m i i n f e k s i s a i u r a n k e m i h

411 Hasil Analisis Univariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s u n i v a r i a t

a n t a r a l a i n d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p b e r d a s a r k a n u s i a d a n

j e n i s k e l a m m d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n b e r d a s a r k a n u s i a

d a n j e n i s k e i a m i n d i s t r i b u s i p r o p o r s i s a m p e l b e r d a s a r k a n k e j a d i a n m f e k s i s a i u r a n

k e m i h s e r t a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n u s i a

j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

25

26

A Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan IJsta

dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 41 Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan

Usia dan Jenis Keiamin

Paisen Rawat Inap N Persentase

Usia

1 7 - 2 5 t a h u n 678 1 6 4

2 6 - 3 5 t a h u n 952 2 3 0

3 6 - 4 5 t a l i u n 745 18 0

4 6 - 5 5 t a h u n 695 1 6 8

5 6 - 6 4 t a h u n 571 1 3 8

gt 6 4 t a h u n 500 1 2 1

U s i a r a t a - r a t a ( t a h u n j 43plusmn16543

Jenis Keiamin

P e r e m p u a n 2 6 3 8 6 3 7

L a k i - l a k i 1 5 0 3 3 6 3

Total 4141 100

B e r d a s a r k a n t a b e l 4 1 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R i u n a h S a k i t M u l i a m m a d i y a l i

P a l e m b a n g p e r i o d e J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 2 6 - 3 5 t a h u n y a i t u

s e b a n y a k 9 5 2 o r a n g ( 2 3 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 43plusmn16543 t a l i u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 2 6 3 8 o r a n g ( 6 3 7 )

27

B Distribusi Proporsi Karakteristik Pasien Rawat Jalan Berdasarkan

Usia dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 42 Distribusi Proporsi Karakteristik Pasien Rawat Jalan

Berdasarkan Usia dan Jenis Keiamin

Fasten Rawat Jalan N Persentase

Usia

1 7 - 2 5 t a h u n 9 2 6 3

2 6 - 3 5 t a l n i n 1 3 1 9 0

3 6 - 4 5 t a h u n 2 7 9 1 9 2

46-55 t a l i u n 4 2 1 2 9 0

5 6 - 6 4 t a h u n 3 1 6 2 1 7

gt 6 4 t a h u n 2 1 4 1 4 7

U s i a r a t a - r a t a ( t a h u n ) 50plusmn14120

Jenis Keiamin

P e r e m p u a n 8 9 0 6 1 3

L a k i - l a k i 5 6 3 3 8 7

Total 1453 100

B e r d a s a r k a n t a b e l 4 2 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 4 6 - 5 5 t a h u n y a i t u

s e b a n y a k 4 2 1 o r a n g ( 2 9 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 50plusmn14120 t a h u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 8 9 0 o r a n g ( 6 1 3 )

28

C Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Usia

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i b b e r d a s a r k a n u s i a d a p a t

d i i i h a t p a d a l a b e l d i b a w a h i n i

Tabel 43 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Usia

Usia N Persentase

lt 5 0 t a h u n 1 4 4 6 7

gt 5 0 t a l i u n 1 6 5 3 3

Total 30 100

B e r d a s a r k a n t a b e l 4 3 d i a t a s d a p a t d i k e t a h u i b a h w a u s i a t e r b a n y a k p a d a

s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h gt 5 0 t a h u n y a i t u s e b a n y a k

1 6 o r a n g ( 5 3 3 )

D Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Jenis

Keiamin

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n j e n i s

k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 44 Distribusi Proporsi Kejadian infeksi Saiuran Kemih Berdasarkan

Jenis Keiamin

Jenis Keiamin N Persentase

P e r e m p u a n 1 8 6 0 0

L a k i - l a k i 1 2 4 0 0

Total 30 100

B e r d a s a r k a n t a b e l 4 4 d i a t a s d a p a t d i k e t a h u i b a h w a j e n i s k e i a m i n

t e r b a n y a k p a d a s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h p e r e m p u a n

y a i t u s e b a n y a k 1 8 o r a n g ( 6 0 0 )

29

E Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n t i n g k a t

p e n d i d i k a n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 45 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

Tingkat Pendidikan N Persentase

P e n d i d i k a n d a s a r 20 6 6 7

P e n d i d i k a n m e n e n g a h d a n P e n d i d i k a n m e n e n g a h d a n 10 333

t i n g g i

Total J O 100

B e r d a s a r k a n t a b e l 4 5 d i a t a s d a p a t d i k e t a l i u i b a l i w a t i n g k a t p e n d i d i k a n

t e r b a n y a k p a d a s a m p e i y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h t i n g k a t

p e n d i d i k a n d a s a r y a i t u s e b a n y a k 20 o r a n g ( 6 6 7 )

P Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n riwayat

d i a b e t e s m e l i t u s d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 46 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

Riwayat Diabetes Melitus N Persentase

Y a 17 5 6 7

T i d a k 13 433

Total 30 100

B e r d a s a r k a n t a b e l 4 6 d i a t a s d a p a t d i k e t a h u i b a l i w a s a m p e l y a n g

m e n g a l a m i i n f e k s i s a i u r a n k e m i h t e r b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s

y a i t u s e b a n y a k 1 7 o r a n g ( 5 6 7 )

30

412 Hasil Analisis Bivariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s b i v a r i a t

a n t a r a I a i n h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h j e n i s

k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h t i n g k a t p e n d i d i k a n d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n

i n f e k s i s a l m a n k e m i h

A n a l i s i s y a n g d i g u n a k a n p a d a u j i d u a v a r i a b e l y a n g b e r s k a l a k a t e g o r i k

a d a l a l i d e n g a n u j i Chi-Square d e n g a n n i e i h a t n i l a i Pearson Chi-Square S e m u a

h a s i l d a r i u j i h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h m e n g g i u i a k a n u j i Chi-

Square k a i e n a m e m e n u h i s y a r a t u j i Chi-Square y a i t u lt 2 0 s e l y a n g m e m p u n y a i

n i l a i expected count lt 5

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 47 Hasil Uji Hubungan antara Usia dengan Kejadian Infeksi

Saiuran Kemih

Usia

Infeksi Saiuran Kemih

^a Tidak

n N Mgt

Jumlah P

value 95Cl

lt 50 t a h u n 1 4 1 9 2 5 9 8 0 8 7 3 0 0 0 0 2 7 4 7 - 2 0 4 3 1

gt 5 0 t a h u n 1 6 6 4 0 9 3 6 0 2 5

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 7 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R = 7 4 9 2

( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a u s i a gt

5 0 t a h u n a d a l a l i 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a u s i a lt 5 0 t a h u n

31

B Hubungan antara Jenis Keiamin dengan Kejadian Infeksi Saiuran

Kemih

H a s i l a n a l i s i s b i v a r i a t l i u b u n g a n a n t a r a j e n i s k e l a i n i n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

Tabel 48 Hasil Uji Hubungan antara Jenis Keiamin dengan Kejadian

Infeksi Saiuran Kemih

Infeksi Saiuran Kemih Jenis P

A Tidak Jumlah 95CI Keiamin value

N N

P e r e m p u a n 18 6 4 3 10 357laquoo 2 8 3 2 2 7 -P e r e m p u a n 0 0 0 0

L a k i - l a k i 12 1 7 1 5 8 8 2 9 7 0 2 3 4 5 9

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 8 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a l a l i

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k N 4 a k a a d a l i u b u n g a n y a n g s i g n i f i k a n a n t a r a

j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R ) = 8 7 0 0

f 9 5 C I = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a l a k i - l a k i

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e n i i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

32

Tabel 49 Hasil liji Hubungan antara Tingkat Pendidikan dengan

Kejadian Infeksi Saiuran Kemih

Infeksi Saiuran Kemih P

Y a T i d a k jumlah 95CI value

N

P e n d i d i k a n d a s a r 2 0 5 4 1 1 7 4 5 9 3 7

P e n d i d i k a n

m e n e n g a h d a n 10 1 6 4 5 1 8 3 6 6 1

t i n g g i

Jumlah JO 30 6 68 694 9H

B e r d a s a r k a n t a b e l 4 9 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( 0 R ) =

6 0 0 0 ( 9 5 C I = 2 3 5 1 - 1 5 3 1 0 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r a d a i a h 6 k a l i l e b i h b e s a r

d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i h a t

p a d a t a b e l d i b a w a h i n i

Tingkat

Pendidikan

2 3 5 1 -0 0 0 0

1 5 3 1 0

33

Tabel 4t0 Hasil I j i Hubungan antara Riwayat Diabetes Melitus dengan

Kejadian Infeksi Saiuran Kemih

Riwayat Infeksi Saiuran Kemih P

Diabetes Va Tidak Jumlah value

95CI

Melitus N bullVJ N

Y a

T i d a k

17

1 3

6 8 0

1 7 8

8

6 0

3 2 0

8 2 2

2 5

7 3 0 0 0 0

3 4 9 3 -

2 7 5 3 6

Jumlah 30 306 68 571 98

B e r d a s a r k a n t a b e l 4 1 0 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio

( O R ) = 9 8 0 8 ( 9 5 C I - 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r

d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s m e l i m s

42 Pembahasan

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a l a b e l 4 7 d i d a p a t k a n b a l i w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i b d e n g a n n i l a i s i g n i f i k a n n y a a d a l a l i 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k

Odds Ratio ( O R ) = 7 4 9 2 ( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a u s i a T 5 0 t a h u n a d a i a h 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a

u s i a lt 5 0 t a h u n

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n A n d r y L u k a n d y

( 2 0 1 4 ) m e n g e n a i k a r a k t e r i s t i k p a s i e n - p a s i e n i n f e k s i s a i u r a n k e m i h d i m a n a

p e n d e r i t a I S K d e n g a n k e l o m p o k u m u r gt 5 0 t a h u n s e b a n y a k 2 3 o r a n g s e d a n g k a n

j u m l a h p e n d e r i t a I S K d e n g a n k e l o m p o k u m m lt 5 0 t a l i u n s e b a n y a k 2 0 o r a n g

P e n e l i t i a n i n i j u g a d i p e i k u a t o l e h p e n l i t i a n L e w i s A l e t a l ( 2 0 1 4 ) m e n g e n a i

impact of host age and parity on susceptihility to severe urinary tract injection in

34

a murine mode d e n g a n u j i K r u s k a l - W a l l i s d e n g a n post-test D u n n u n t u k b e b e r a p a

p e r b a n d i n g a n d i m a n a u s i a d a n p a r i t a s s e b a g a i f a k t o r y a n g b e r k o n t r i b u s i d a l a m

k e r e n t a n a n i m t u k t e r j a d i n y a I S K d e n g a n n i l a i p lt 0 0 5

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n g a t a k a n b a h w a i n s i d e n I S K m e n i n g k a t

b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n

a d a n y a a b n o r m a l i t a s a n a t o m i y a n g m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n

k e m i h s e p e r t i p e m b e s a r a n p r o s t a t d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a

p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e ( R o s e 2 0 0 9 ) P e n y e b a b l a i n t e n n a s u k

p e r i n e i u n y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s p e n y a k i t n e u r o m u s k u l a r

d a n k a t e t e r i s a s i b u l i - b u l i ( F o x m a n e t a l 2 0 1 0 ) S e l a i n i t u i n s i d e n I S K m e n c a p a i

1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o n a l d 2 0 1 1 )

B Hubungan antara Jenis Keiamin dengan Kejadian infeksi Saiuran

Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 8 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d e n g a n n i l a i s i g n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O

d i t o l a k Odds Ratio ( O R ) = 8 7 0 0 ( 9 5 C l = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a risiko k e j a d i a n

i n f e k s i s a i u r a n k e m i h p a d a p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n

p a d a l a k i - i a k i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n M a g i i a n o e t a l

( 2 0 1 1 ) m e n g e n a i Gender and Age-Dependent Etiology of Community Acquired

y a n g m e l a k u k a n p e n g a m b i l a n 6 1 2 7 3 s a m p e l k u l t u r u r i n d a l a m p e r i o d e 2 2 b u l a n

d a r i s a m p e l i n i d i d a p a t k a n 1 3 8 2 0 ( 2 2 6 ) d i t e m u k a n p o s i t i f i n f e k s i b a k t e r i

h a m p i r 8 0 b a l i a n y a n g d i i s o l a s i b e r a s a l d a r i p e r e m p u a n P e n e l i t i a n i n i j u g a

d i p e r k u a t o l e h p e n e l i t i a n y a n g d i l a k u k a n o l e h Y u n i t a I ( 2 0 1 0 ) d i m a n a a d a

h u b m i g a n y a n g b e n n a k n a a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h ( P value=O049 R P = 3 2 7 3 ( 9 5 C I = I 0 1 6 - 1 0 5 4 0 )

H a l t e r s e b u t d a p a t t e r j a d i k a r e n a u r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a l i

d e n g a n d e k a t n y a v a g i n a l v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i

s a i u r a n k e m i h l e b i h s e r i n g p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a flora n o r m a l

3 5

p a d a d a e r a h p e r i u r e t r a t e r d i r i d a r i o r g a n i s m e s e p e r t i i a c t o b a c i l l u s y a n g m e m b a n t u

m e l a w a n k o l o n i s a s i b a k t e r i p a t o g e n p a d a s a i u r a n k e m i h P e r u b a h a n l i n g k i m g a n

d a r i p e r i u r e t r a l s e p e r t i p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k

b i s a m e n g g a n g g u f l o r a n o r m a l s e h i n g g a m e n u m g k i n k a n b a k t e r i p a t o g e n

b e r k o l o n i s a s i d a n m e n y e b a b k a n i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Scuare p a d a t a b e l 4 9 d i d a p a t k a n b a h w a

t e r d a p a t l i u b u n g a n y a n g s i g n i f i k a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a

H O d i t o l a k Odds Ratio ( O R ) - 6 0 0 0 ( 9 5 o C l = 2 3 5 1 - 1 5 3 I O ) a r t i n y a n s i k o

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r

a d a i a h 6 k a l i l e b i h b e s a r d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n

m e n e n g a h d a n t i n g g i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h T o r o n d e i B e t

a l ( 2 0 1 5 ) m e n g e n a i Menstrual Hygiene Practices WASH Access and the Risk of

Urogenital Infection in Women from Odisha India d i m a n a p e r e m p u a n y a n g

h a n y a m e n e m p u l i p e n d i d i k a n s e k o l a h d a s a r a t a u l e b i h r e n d a h d i b a n d i n g k a n

d e n g a n t i n g k a t p e n d i d i k a n m e n e n g a h a t a u t i n g g i m e m i l i k i r i s i k o 3 k a l i

k e m u n g k i n a n l e b i h b e s a r m e n g a l a m i i n f e k s i s a i u r a n k e m i h ( A d j O R = 3 l 9 5

C 1 = I 2 - 7 9 p = 0 0 2 )

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a p e n g e t a h u a n s e s e o r a n g

t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t p e n d i d i k a n S e s e o r a n g y a n g

m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m u n g k i n a n p e n g e t a l i u a n t e n t a n g

k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o r m a s i y a n g d i d a p a t k a n t e n t a n g k e s e h a t a n

l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h S e b a l i k n y a

p e n d i d i k a n y a n g k u r a n g d a p a t i n e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g t e r h a d a p

n i l a i - n i l a i y a n g b a r u d i k e n a l ( N o t o a d m o j o 2 0 0 3 )

3 6

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Keniih

B e r d a s a r k a n l i a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 1 0 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a r i w a y a t d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 )

s e h i n g g a H O d i t o l a k Odds Ratio ( O R ) = 9 8 0 8 ( 9 5 C I = 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a

risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h S a r i E W P d a n

S a t y a b a k t i P ( 2 0 1 5 ) m e n g e n a i p e r b e d a a n risiko i n f e k s i n o s o k o m i a l s a i u r a n k e m i h

b e r d a s a r k a n k a t e t e r i s a s i u r i n u m u r d a n d i a b e t e s m e l i m s d i m a n a d a r i 2 0 p a s i e n

i n f e k s i n o s o k o m i a l s a i u r a n k e m i h 1 2 o r a n g ( 6 0 ) d i a n t a r a n y a a d a i a h p a s i e n

d e n g a n s t a t u s D M s e d a n g k a n 8 o r a n g ( 4 0 ) l a i n n y a a d a i a h p a s i e n t a n p a s t a t u s

D M ( P v W w ^ = 0 0 2 4 O R = 6 0 0 9 5 C I = 1 2 2 - 3 2 2 6

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a b a l i w a b e b e r a p a b a g i a n

d a r i i i n u n i t a s p a d a p a s i e n d i a b e t e s m e n g a l a m i p e r u b a h a n F u n g s i

p o l i n i o r f o l e u k o s i t d i t e k a n p a d a k e a d a a n a s i d o s i s I k a t a n l e u k o s i t k e m o t a k s i s d a n

f a g o s i t o s i s j u g a b e m b a l i S i s t e m a n t i o k s i d a n y a n g b e r p e r a n p a d a a k t i f i t a s

b a k t e r i s i d a l j u g a t e r g a n g g u s e h i n g g a m e n y e b a b k a n t e r j a d i n y a I S K p a d a p a s i e n -

p a s i e n d e n g a n p e n y a k i t d i a b e t e s ( J u l k a 2 0 1 4 )

H a l y a n g s a m a j u g a d i i m g k a p k a n o l e b t e o r i S m e l t z e r d a n B a r e ( 2 0 1 0 )

b a l i w a D M d a p a t m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a l i a n a n t u b u h y a n g

b e r p o t e n s i m e n i n g k a t k a n r i s i k o t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a l i a n a n

t u b u h t e r s e b u t d i a n t a r a n y a a d a i a h k e g a g a l a n m i g r a s i s e l iniraceliular killing

f a g o s i t o s i s d a n k e m o t a k s i s p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n

m e k a n i s m e p e r t a l i a n a n a l a m i a h I o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p

i n f e k s i

BAB V

KESIMPULAN DAN SARAN

51 Kesimpulan

1 U s i a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 2 6 - 3 5 t a h u n y a i t u 2 3 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 3 7

2 U s i a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 4 6 - 5 5 t a l i u n y a i t u 2 9 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 1 3

3 U s i a j e n i s k e i a m i n d a n t i n g k a t p e n d i d i k a n s a m p e i y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i l i t e r b a n y a k y a i t u b e r u s i a gt 5 0 t a h u n ( 5 3 3 ) j e n i s k e i a m i n

p e r e m p u a n ( 6 0 0 ) d a n t i n g k a t p e n d i d i k a n d a s a r ( 6 6 7 ) s e r t a p a l i n g

b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s y a i t u 5 6 7

4 T e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 ( p = 0 0 0 0 )

52 Saran

1 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t d i l a k u k a n d e n g a n d e s a i n

p e n e l i t i a n b e r b e d a s e p e r t i cohort a t a u case control

2 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t m e i i c a r i v a r i a b e l independent

y a n g l a i n s e p e r t i v a r i a b e l p e k e r j a a n p e m a s a i i g a n k a t e t e r a t a u l a m a n y a

m e n d e r i t a d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

37

DAFTAR PUSTAKA

B o y k o E J d k k 2 0 0 2 D i a b e t i c A n d T h e R i s k O f A c u t e U r i n a r y T r a c t I n f e c t i o n A m o n g P o s t m e n o p a u s a l W o m e n D i a b e t e s C a r e 2 5 ( 1 0 )

D a h l a n S 2 0 1 4 B u k i i S t a t i s t i k u n t u k K e d o k t e r a n d a n K e s e h a t a n D e s k r i p t i f B i v a r i a t d a n M u l t i v a r i a t d i l e n g k a p i a p l i k a s i d e n g a n m e n g g u n a k a n S P S S E d i s i 6 E p i d e m i o l o g i I n d o n e s i a J a k a r t a I n d o n e s i a

D e p a r t e m e n K e s e h a t a n ( D E P K E S ) R l 2 0 1 4 [ O n l i n e ] K e m e n t e r i a n K e s e h a t a n R e p u b l i k I n d o n e s i a P u s a t D a t a d a n I n f o r m a s i K e m e n t e r a n K e s e h a t a n R l ( http 7depkesgoid diakses tanggal 15 Met 2016)

F o x m a n B e t a i 2 0 1 0 U r i i i a i y T r a c t I n f e c t i o n A m o n g W o m e n A g e d 4 0 T o 6 5 B e h a v i o r a l A n d S e x u a l R i s k F a c t o r s D a l a m T a n a g h o E A M c A n i n c h J W 1 7 t h S m i t h s G e n e r a l U r o l o g y U S A M c G r a w H i l l (http searchproqnestcom diakses tanggal 16 Met 2016)

H a r d i n g G K d k k 2 0 1 0 A n t i m i c r o b i a l T r e a t m e n t I n D i a b e t i c W o m e n W i t l i A s y m t o m a t i c B a c t e r i u r i a N E n g l J M e d 3 4 7 1 5 7 6 - 1 5 8 3 (http nejmorg diakses tanggal 16 Met 2016)

I s s e l b a c h e r d k k 2 0 0 9 I n f e k s i S a i u r a n K e m i h d a n P i e l o n e f r i t i s D a l a m S t a m m W a l t e r E e d H a r r i s o n P r i n s i p - P r i n s i p l l m u P e n y a k i t D a l a m e d V o l u m e 2 J a k a r t a E G C 6 1 6 - 6 2 3

J u l k a S 2 0 1 3 G e n i t o u r i n a r y I n f e c t i o n I n D i a b e t e s I n d i a n J o u m a l o f E n d o c r i n o l o g y a n d M e t a b o l i s m (http searchproquestcom diakses tanggal 16 Mei 2016)

K i m B d k k 2 0 1 2 [ e - b o o k ] T h e R e l a t i o n b e t w e e n P o s t v o i d R e s i d u a l a n d O c c u r r e n c e o f U r i n a r y T r a c t I n f e c t i o n a f t e r S t r o k e i n R e h a b i l i t a t i o n U n i t A n n a l s o f R e h a b i l i t a t i o n M e d i c i n e

K o m a r a A 2 0 0 9 P o l a K e p e k a a n B a k t e r i G r a m N e g a t i f d a r i P a s i e n I n f e k s i S a i u r a n K e m i l i t e r h a d a p A n t i b i o t i k G e n t a m i c i n d a n K o t r i m o k s a z o l y a n g D i k i r i m k e L a b o r a t o r i u m M i k r o b i o l o g i K l i n i k F K U l d a r i T a h u n 2 0 0 1 s a m p a i T a h u n 2 0 0 5 (http dontaruiacid diakses tanggal OH Agustiis 2016)

L e w i s A L e t a l 2 0 1 4 I m p a c t o f H o s t A g e a n d P a r i t y o n S u s c e p t i b i l i t y t o S e v e r e U r i n a r y T r a c t I n f e c t i o n i n a M u r i n e M o d e l P l o s O n e R e s e a r c h A r t i c l e P u b l i c L i b r a r y o f S c i e n c e 9 ( 5 ) (http searchproquestcom diakses pada langgal 30 Desember 2016)

38

P E R S E T U J U A N P E N G A L I H A N H A K P U B L I K A S I K A R Y A I L M I A H

UNTUK K E P E N T I N G A N A K A D E M I S

D e n g a n P e n y e r a h a n n a s k a l i a r t i k e l d a n v r t a j ^ v b e r j u d u l H u b u n g a n a n t a r a U s i a J e n i s K e i a m i n T i n g k a t P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h p a d a P a s i e n R a w a t I n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 ^ K e p a d a U n i t P e n e l i t i a n d a n P e n g a b d i a n M a s y a r a k a t U P 2 M ) F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u h a m m a d i y a h P a l e m b a n g ( F K - U M P ) S a y a

N a m a R e z a A g u s t i a n t w o P u t r a N i M 7 0 2 0 1 3 0 5 4 P r o g r a m S t u d i P e n d i d i k a n K e d o k t e r a n U m u m F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u h a m m a d i y a h P a l e m b a n g J e n i s K a r y a i l m i a h S k r i p s i

D e m i p e n g e m b a n g a n i l m u p e n g e t a h u a n s e t u j u m e m b e r i k a n k e p a d a F K - U M P P e n g a l i h a n H a k C i p t a d a n P u b l i k a s i B e b a s R o y a l t i a t a s K a r y a I l m i a h N a s k a l i d a n softcopy d i a t a s D e n g a n h a k t e r s e b u t F K - U M P b e r h a k m e n y i m p a n m e n g a l i h m e d i a f o n n a t k a n d a l a m b e n t u k p a n g k a l a n d a t a (database) m e n d i s t r i b u s i k a n m e n a m p i l k a n m e m p u b l i k a s i k a n d i i n t e r n e t a t a u m e d i a l a i n u n t u k k e p e n t i n g a n a k a d e m i s t a n p a p e r l u m e m i n t a i z i n d a r i S a y a s e l a m a t e t a p m e n c a n t u m k a n n a m a S a y a d a n S a y a m e m b e r i k a n w e w e n a n g k e p a d a p i h a k F K -U M P u n t u k m e n e i i t u k a n s a l a h s a t u P e m b i m b i n g s e b a g a i P e n u l i s U t a m a d a l a m P u b l i k a s i S e g a l a b e n t u k t u n t u t a n h u k u m y a n g t i m b u l a t a s p e l a n g g a r a n H a k C i p t a d a l a m K a r y a I l m i a l i i n i m e n j a d i t a n g g u n g j a w a b S a y a p r i b a d i

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i g M e i i y e t u j u i

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N I M 7 0 2 0 1 3 0 5 4

iii

HALAMAN PERSEMBAHAN DAN MOTTO

OfaBjrdafi ada sesuatuyan^ menanttmu sedpas Battya^BgsaSaran (yang Bpu

jaCani) yang a^n memStiatmu terpana Singga (au Cupa Setapa pedifinya rasa

saSit - (Jid ltBinABi TltadB)

Dengan izin-Mu ya Allah ku persembahkan karya ini untuk

bull Kedua orangtuaku yang tercinta Riza Efendi SHbdquo MH dan Dra Yusdiami

yang selalu memberikan motivasi nasihat dan semangat untuk meraih cita-

citaku serta doa dan kasih sayang di setiap langkaliku Ma P a i know this

is not enough yet to reply a l l your affection and everything that you already

gave h u t im trying to he the best i n everything for you and absolutely you

a r e my entire worlct

bull Saudara kandungku tersayang Eka Satriawan A Md Im SH MH dan

Threenita Sari Sepgi Putri yang telah banyak membantu menemani serta

menghibur di setiap hari-hariku Im so g r a t e f u l to have you kak g r a You

a r e truly my beloved siblings

bull Pembimbing skripsiku dr M Ayus Astoni Sp PD KGEH FINASIM

MARS dan dr Ratika Febriani yang telah memberikan nasihat saran dan

ilmu yang bermanfaat serta meluangkan waktunya untuk membimbing

skripsi ini bingga selesai

bull Teman-teman terdekatku ( C H A T g r o u p dan Bujang Gadis g r o u p ) yang selalu

dapat memberikan keceriaan semangat dan bantuan di saat menghadapi

kesulitan do believe we can be a success doctor and get our dreams

someday Keep down to e a r t h guys

bull Dan seluruh teman-teman angkatan 2013 (Genome H e x a ) yang telah banyak

memberikan bantuan selama proses perkuliahan di tahap akademik Semoga

kesuksesan dan ridho Allah SWT selalu mengiringi iangkali kita Aamiin ya

rabbal allamin See you on topgjrys

iv

UNIVERSITAS MUHAMMADIYAH P A L E M B A N G F A K U L T A S K E D O K T E R A N

S K R I P S L JANUARI 2017 R E Z A AGUSTIANTWO PUTRA

Hubungan antara Usia Jenis Keiamin Tingkat Pendidikan dan Riwayat Diabetes Melitus dengan Kejadian Infeksi Saiuran Kemih pada Pasien Rawat Inap dan Rawat Jalan di Bagian Penyakit Dalam Rumah Sakit Muhammadiyah Palembang Periode 1 Januari 2015-31 Desember 2015

xii + 37 halaman + 12 tabel + 1 gambar + 8 lampiran

A B S T R A K

I n t e k s i s a i u r a n k e m i h ( I S K ) m e n i p a k a n s u a t u i n f e k s i y a n g m e n g e n a i t r a k t u s u r i n a r i u s d a n h a m p i r 1 0 o r a n g p e m a h t e r k e n a I S K s e l a m a h i d u p n y a M e n u m t t e o r i m e n i n g k a t n y a k e j a d i a n I S K b e r h u b i m g a n d e n g a n p e n i n g k a t a n u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s P e n e l i t i a n i n i b e m i j u a n u n t u k m e n g a n a l i s i s h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i l i p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R i u n a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 J e n i s p e n e l i t i a n i n i a d a i a h o b s e r v a s i o n a i a n a l i t i k d e s a i n cross sectional d e n g a n m e n g g i i n a k a n d a t a s e k u n d e r d a r i r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g S a m p e l p e n e l i t i a n i n i a d a i a h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 d e n g a n b e s a r s a m p e l s e b a n y a k 9 8 s a m p e l S a m p e l p e n e l i t i a n i n i d i a m b i l d e n g a n c a r a consecutive sampling H a s i l u j i s t a t i s t i k d i d a p a t k a n h u b u n g a n i n f e k s i s a i u r a n k e m i h d e n g a n u s i a ( p = 0 0 0 0 ) j e n i s k e i a m i n ( p = 0 0 0 0 ) t i n g k a t p e n d i d i k a n ( p = 0 0 0 0 ) d a n riwayat d i a b e t e s m e l i t u s ( p 0 0 0 0 ) S e h i n g g a d a p a t d i s i m p u l k a n b a h w a t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n rawat j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e i J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

Referensi 29(2002-2015) Kata kunci Infeksi Saiuran Kemih Riwayat Diabetes Melitus

V

U N I V E R S I T Y O F M U H A M M A D I Y A H P A L E M B A N G FA cut T Y or M E D I C I N E

MINI THESIS J A N U A R Y 2 0 1 7 R E Z A A G U S T I A N T W O P U T R A

T h e Relationships between Age Gender Education Level Diabetes M e l i t u s History and The Incidence of U r i n a r y T r a c t Infections i n Hospitalized Patients and Outpatients at I n t e r n a l M e d i c i n e o f M u h a m m a d i y a h Palembang H o s p i t a l d u r i n g I J a n u a r y 2 0 1 5 - 3 1 December 2 0 1 5

x i i + 37pages + 12 tables + I picture + 8 attachments

A B S T R A C T

Urinary trad infection (UTI) is an infection of I he urinary tract and nearly 10 of people experience UTI during their lifeiime According to theory the increasing of urinary tract infections is related with increasing age gender education level and diabetes melitus history This study aim to analyze relationships between age gender education level diabetes melitus history and the incidence of urinary tract infections in hospitalized patients and outpatients at Internal Medicine of Muhammadiyah Palembang Hospilal during P January 2015-31 December 2015 This study lipe was analyiical observaiional with cross sectional design by using secondary data from medical record of Muhammadiyah Palembang Hospital Samples of this study were taken by consecutive sampling technique The results of statistical test were obtained relationship between urinary tract infections with age (p 0000) gender (p 0000) education level (p 0000) and diabetes melitus (p 0000) In conclusion there are significantly relationships between age gender education level diabetes melitus history and the incidence of urinary tract infections in hospitalizedpatients and outpatients at Internal Medicine of Muhammadiyah Palembang Hospital during P January 20J5-3PDecember 2015

References 2 9 ( 2 0 0 2 - 2 0 1 5 ) Keywords U r i n a r y T r a c t I n f e c t i o n s Diabetes M e l i t u s

vi

KATA PENGANTAR

S e g a l a p u j i s y u k u r k e p a d a A l l a l i S W T k a r e n a a t a s b e r k a t d a n r a h m a t - N y a p e n u l i s d a p a t i n e n y e l e s a i k a n s k r i p s i y a n g b e r j u d u l H u b u n g a n A n t a r a U s i a J e n i s K e i a m i n T i n g k a t P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h P a d a P a s i e n R a w a t i n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 S k r i p s i i n i d i s u s u n s e b a g a i s a l a h s a t u s y a r a t u n t u k m e m p e r o l e h g e l a r S a r j a n a K e d o k t e r a n d i F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u l i a m m a d i y a h P a l e m b a n g

P e n u l i s m c n y a d a r i b a l i w a d a l a m p r o s e s i n e n y e l e s a i k a n s k r i p s i i n i b a n y a k k e n d a l a y a n g d i a l a i n i n a n i u n b e r k a t b a n t u a n b i m b i n g a n k e r j a s a m a d a r i b c r b a g a i p i h a k d a n t e r u t a m a b e r k a t A l l a h S W T k e n d a l a t e r s e b u t d a p a t d i a t a s i

P e n u l i s j u g a m e n v a d a r i b a h w a s k r i p s i i n i m a s i h j a u h d a r i s e m p u m a m a k a d e n g a n s e g a l a k e r e n d a h a n l i a t i p e n u l i s m e n g l i a r a p k a n a d a n y a k r i t i k d a n s a r a n y a n g b e r s i f a t m e m b a n g u n d e m i k e s e m p u m a a n s k r i p s i i n i

A k h i r k a t a p e n u l i s b c r l i a r a p A l l a l i S W T b e r k e n a n m e m b a i a s s e g a l a k e b a i k a n s e m u a p i h a k y a n g t e l a h m e m b a n t u S e m o g a s k r i p s i i n i d a p a t b e n n a n f a a t b a g i k i t a s e m u a A a m i i n

P a l e m b a n g 0 7 F e b r u a r i 2 0 1 7

R e z a A g u s t i a n t w o P u t r a

vii

DAFTAR ISI

HALAMAN J D D U L HALAMAN PENCESAHAN i HALAMAN PERNN ATAAN ii HALAMAN PERSEMBAHAN iii A B S T R A K iv A B S T R A C T v K A T A PENGANTAR vi DAFTAR ISI vii DAFTAR T A B E I ix DAFTAR GAMBAR x DAFTAR LAMPIRAN xi

BAB I Pendahuluan 1 1 1 L a t a r B e l a k a n g 1 12 R i i m u s a n M a s a l a h 3 13 T u j u a n P e n e l i t i a n 3 14 M a n l a a t P e n e l i t i a n 4 15 K e a s l i a n P e n e l i t i a n 5

BAB H Tinjauan Pustaka 9 2 1 L a n d a s a n T e o r i 9

2 1 1 I n f e k s i S a i u r a n K e m i h 9 A D e f i n i s i 9 B E p i d e m i o l o g i 9 C K i a s i f i k a s i 1 0 D E t i o l o g i 1 1 E P a t o f i s i o l o g i 11 F F a k t o r R i s i k o 1 2 G M a n i f e s t a s i K l i n i s 1 5 H T a t a l a k s a n a 1 6 I K o m p l i k a s i 1 6

2 2 K e r a n g k a T e o r i 1 7 2 3 H i p o t e s i s 1 8

BAB I I I Metode Penelitian 19 3 1 J e n i s P e n e l i t i a n 1 9 3 2 W a k t u d a n T e m p a t P e n e l i t i a n 1 9 3 3 P o p u l a s i d a n S a m p e l 1 9

3 3 1 P o p u l a s i P e n e l i t i a n 1 9 3 3 2 S a m p e l d a n B e s a r S a m p e l P e n e l i t i a n 1 9 3 3 3 K n t e r i a I n k l u s i d a n E k s k l u s i 2 0 3 3 4 C a r a P e n g a m b i l a n S a m p e l P e n e l i t i a n 2 0

3 4 V a r i a b e l P e n e l i t i a n 2 0 3 4 1 V a r i a b e l Dependent 2 0 3 4 2 V a r i a b e l Independent 2 0

viii

3 5 D e f i n i s i O p e r a s i o n a l 2 1 3 6 C a r a P e n g i i n i p u l a n D a t a 2 2

3 6 1 D a t a S e k u n d e r 2 2 3 7 M e t o d e T e k n i s A n a l i s i s D a t a 2 2

3 7 C a r a P e n g o l a h a n d a n A n a l i s i s D a t a 2 2 3 8 A l u r P e n e l i t i a n 2 4

BAB IV HASIL DAN PEMBAHASAN 25 4 1 H a s i l 2 5 4 2 P e m b a h a s a n 3 3

BAB V KESIMPLILAN DAN SARAN 37 5 1 K e s i m p u l a n 3 7 5 2 S a r a n 3 7

D A F T A R PUSTAKA 38 LAMPIRAN 41 BIODATA 63

ix

DAFTAR T A B E L

Tabel Halaman

T a b e l 1 1 K e a s l i a n P e n e l i t i a n 5 T a b e l 3 1 D e f i n i s i O p e r a s i o n a l 2 1 T a b e l 4 1 D i s t r i b u s i P r o p o r s i K a r a k t e r i s t i k P a s i e n R a w a t i n a p

B e r d a s a r k a n U s i a d a n J e n i s K e i a m i n 2 6 T a b e l 4 2 D i s t r i b u s i P r o p o r s i K a r a k t e r i s t i k P a s i e n R a w a t J a l a n

B e r d a s a r k a n U s i a d a n J e n i s K e i a m i n 2 7 T a b e l 4 3 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n U s i a 2 8 T a b e l 4 4 D i s t r i b u s i P r o p o r s i K e j a d i a n i n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n J e n i s K e l a m m 2 8 T a b e l 4 5 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n T i n g k a t P e n d i d i k a n 2 9 T a b e l 4 6 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n R i w a y a t D i a b e t e s M e l i t u s 2 9 T a b e l 4 7 H a s i l U j i H u b u n g a n a n t a r a U s i a d e n g a n K e j a d i a n

i n f e k s i S a i u r a n K e m i h 3 0 T a b e l 4 8 H a s i i U j i H u b u n g a n a n t a r a J e n i s K e i a m i n d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i b 3 1 T a b e l 4 9 H a s i l U j i H u b u n g a n a n t a r a T i n g k a t P e n d i d i k a n d e n g a n

K e j a d i a n i n t e k s i S a i u r a n K e m i h 3 2 T a b e l 4 1 0 H a s i l U j i H u b u n g a n a n t a r a R i w a y a t D i a b e t e s M e l i t u s

d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h 3 3

X

DAFTAR GAMBAR

Gambar Halaman

G a m b a r 3 1 A l u r P e n e l i t i a n H u b u n g a n U s i a J e n i s K e i a m i n T i n g k a t

P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i h p a d a P a s i e n R a w a t i n a p

d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g I e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1

D e s e m b e r 2 0 1 5 2 4

xi

DAFTAR LAMPIRAN

Lampiran Halaman

L a m p i r a n 1 D a t a R e k a m M e d i s P a s i e n R a w a t I n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 4 3

L a m p i r a n 2 H a s i l A n a l i s i s U n v i a r i a t 4 5

L a m p i r a n 3 H a s i l A n a l i s i s B i v a r i a t 5 1

L a m p i r a n 4 K a r t u B i m b i n g a n P r o p o s a l S k r i p s i 5 8

L a m p i r a n 5 K a r t u B i m b i n g a n S k r i p s i 5 9

L a m p i r a n 6 S u r a t P e n n o h o n a n I z i n P e n e l i t i a n 6 0

L a m p i r a n 7 S u r a t K e t e r a n g a n I z i n P e n g a m b i l a n D a t a d a n P e n e l i t i a n 6 1

L a m p i r a n 8 S u r a t K e t e r a n g a n S e l e s a i P e n e l i t i a n 6 2

xii

BAB I

PENDAHULUAN

11 Latar Belakang

I n f e k s i s a i u r a n k e m i h ( I S K ) m e n i p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m i i k a n d i R u m a h S a k i t a t a u t e m p a t p r a k t i k u m u m s e h a r i - h a r i I S K

a d a i a h s u a t u i n f e k s i y a n g m e n g e n a i t r a k t u s u r i n a r i u s m u l a i d a r i m e a t u s u r e t r a

s a m p a i d e n g a n k e g i n j a l S t r u k t u r y a n g t e n n a s u k d i d a l a m n y a a d a i a h u r e t r a

k a n d u n g k e m i h u r e t e r p e l v i s d a n p a r e n k i m g i n j a l S t r u k t u r y a n g b e r k a i t a n u n t u k

t e r j a d i n y a i n f e k s i d a n r e k u r e n i n f e k s i y a i t u p r o s t a t e p i d i d i m i s d a n fascia

perinephric I s t i l a h I S K m e n u n j u k k a n a d a n y a k e b e r a d a a n m i k r o o r g a n i s m e d i

d a l a m u r i n ( S u d o y o 2 0 0 6 R u b i n 2 0 1 0 ) D e n g a n k a t a l a i n b a h w a d i a g n o s i s I S K

d i t e g a k k a n d e n g a n m e m b u k t i k a n a d a n y a m i k r o o r g a n i s m e d i d a l a m s a i u r a n k e m i h

( R u b i n 2 0 1 0 )

S e b a n y a k 2 5 j u t a k e m a t i a n d i s e l u r u h d u n i a p a d a t a h u n 2 0 1 1 s e p e r t i g a n y a

d i s e b a b k a n o l e h p e n y a k i t i n f e k s i I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n i n f e k s i

d e n g a n k e t e r l i b a t a i i b a k t e r i t e r s e r i n g d i k o m u n i t a s d a n h a m p i r 1 0 o r a n g p e m a h

t e r k e n a I S K s e l a m a h i d u p n y a S e k i t a i - 1 5 0 j u t a p e n d i i d u k d i s e l u r u h d u n i a t i a p

t a l i u n n y a t e r d i a g n o s i s m e n d e r i t a i n f e k s i s a i u r a n k e m i h ( Y u n u s 2 0 1 2 )

I S K d a p a t m e n g e n a i s e m u a k e l o m p o k u m u r b a i k a n a k r e m a j a d e w a s a

m a u p u n u s i a l a n j u t P r e v a l e n s i a n a k u s i a s e k o l a h y a n g m e n d e r i t a I S K s e k i t a r 1 -

3 d a n m e n i n g k a t p a d a r e m a j a y a n g s u d a h m e l a k u k a n h u b i m g a n s e k s u a l

( K o m a r a 2 0 0 9 ) D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r 2 5 - 3 5

s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a S e l a m a

p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n c e n d e r u n g

m e n d e r i t a I S K d i b a n d i n g k a n l a k i - l a k i ( S u d o y o 2 0 0 9 )

R a s i o I S K p a d a w a n i t a d i b a n d i n g p r i a b e r k i s a r 3 0 1 d a n s e k i t a r 5 0 w a n i t a

y a n g t e r k e n a i n f e k s i a k a n b e r k e m b a n g m e n j a d i I S K b e m l a n g I S K m e n i p a k a n

i n f e k s i b a k t e r i y a n g p a l i n g s e r i n g p a d a a n a k - a n a k d e n g a n k e l u h a n d e m a m b a i k

p a d a a n a k p r i a m a u p u n w a n i t a P r e v a l e n s i y a n g p e m a h d i l a p o r k a n b e r k i s a r 4 1

I

2

s a m p a i 7 5 R e k u r e n s i c u k u p s e r i n g d a n t e r j a d i s e k i t a r 1 8 p a d a b a y i l a k i - i a k i

d a n 2 6 p a d a b a y i p e r e m p u a n U n t u k u s i a p r a s e k o l a h I S K l e b i h s e r i n g

m e n g e n a i w a n i t a I n s i d e n I S K p a d a a n a k - a n a k p r a s e k o l a h s e k i t a r 2 ( S y a h r i n i

2 0 1 1 )

D a r i b e r b a g a i p e n e l i t i a n e p i d e m i o l o g i s d i I n d o n e s i a d i d a p a t k a n p r e v a l e n s i

D M s e b e s a r 15 - 2 3 p a d a p e n d u d u k u s i a l e b i J i d a r i 1 5 t a h u n b a h k a n p a d a

s u a t u p e n e l i t i a n e p i d e m i o l o g i s d i M a n a d o d i d a p a t k a n p r e v a l e n s i D M a d a i a h 6 1

P r e v a l e n s i d i a b e t e s m e l i t u s p a d a p e n d u d u k u s i a 2 5 - 6 4 t a h u n d i J a w a d a n B a l i

s e b e s a r 7 5 P e n e l i t i a n y a n g d i l a k u k a n d i J a k a r t a S u r a b a y a M a k a s a r d a n k o t a -

k o t a l a i n d i I n d o n e s i a m e m b u k t i k a n a d a n y a k e n a i k a n p r e v a l e n s i d a r i t a h u n

k e t a h u n ( D E P K E S 2 0 1 4 W H O 2 0 1 0 )

I n f e k s i s a i u r a n k e m i h j u g a m e n i p a k a n m a s a l a h k l i n i s u m u m p a d a p e n d e r i t a

D M o l e h k a r e n a p e n d e r i t a D M m e m p u n y a i k e m u n g k i n a n m e n d e r i t a I S K l e b i h

t i n g g i d i b a n d i n g k a n d e n g a n b u k a n p e n d e r i t a D M d a n j u g a m e n d e r i t a i n f e k s i y a n g

l e b i h b e r a t y a n g a k a n m e n i n g k a t k a n risiko u n t u k m a s u k m m a h s a k i t ( H a r d i n g

d k k 2 0 1 0 ) P e n e l i t i a n y a n g d i l a k u k a n o l e h B o y k o d k k m e n d a p a t k a n w a n i t a D M

ripe 2 d e n g a n b a k t e r i u r i a s i m t o m a t i k s e t e l a h d i l a k u k a n p e m a n t a u a n s e l a m a 1 8

b u l a n m e n g a l a m i p e n i n g k a t a n r i s i k o m e n d a p a t k a n I S K s e b a n y a k 3 4

d i b a n d i n g k a n d e n g a n w a n i t a y a n g t i d a k m e n g a l a m i D M s e b e s a r 1 9 ( B o y k o d k k

2 0 0 2 )

B e r d a s a r k a n u r a i a n - u r a i a n d i a t a s s e r t a b e l u m a d a n y a p e n e l i t i a n y a n g

m e n e m u k a n k e t e r k a i t a n f a k t o r u s i a j e n i s k e l a m m t i n g k a t p e n d i d i k a n d a n r i w a y a t

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h d i K o t a P a l e m b a n g m a k a

p e n e l i t i t e r t a r i k i m t i i k m e l a k u k a n p e n e l i t i a n m e n g e n a i h u b u n g a n a n t a r a u s i a j e n i s

k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

3

12 Rumusan Masalah

1 B a g a i m a n a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s

m e l i t u s

2 A p a k a l i a d a h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

13 Tujuan Penelitian

131 Tujuan Umum

T u j u a n u m u m d a r i p e n e l i t i a n i n i a d a i a h d i k e t e m u k a n n y a h u b u n g a n a n t a i a

u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i m s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

132 Tujuan Khusus

T u j u a n k l i u s u s d a r i p e n e l i t i a n i n i y a i t u

1 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a

2 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n m f e k s i s a i u r a n k e m i b p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n j e n i s k e i a m i n

3 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

4

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n t i n g k a t p e n d i d i k a n

4 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n riwayat d i a b e t e s m e l i t u s

5 T e r a n a l i s i s n y a h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a i m n a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

6 T e r a n a l i s i s n y a h u b u n g a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

7 T e r a n a l i s i s n y a h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

8 T e r a n a l i s i s n y a h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i u i s d e n g a n k e j a d i a n

i n f e k s i s a l i u a i i k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

14 Manfaat Penelitian

141 Manfaat Teoritis

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t m e n a m b a h p e n g e t a h u a n p e n e l i t i

t e n t a n g h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i U i s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

5

142 Manfaat Praktis

A Bagi Peneliti

H a s i l p e n e l i t i a n i n i d i l i a r a p k a n d a p a t d i g u n a k a n s e b a g a i s a l a h s a t u b a h a n

r e f e r e n s i a t a u b a c a a n b a g i p e n e l i t i

B Bagi Institusi

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t d i g u n a k a n p i h a k R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g s e b a g a i s a l a l i s a t u b a h a n a c u a n d a l a m m e n g u p a y a k a n

p e n c e g a h a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

15 Keaslian Penelitian

T a b e l 1 1 K e a s l i a n P e n e l i t i a n

Nama Judul Penelitian Desain Hasil Penelitian

Peneliti Penelitian

Kugan P r e v a l e n s i I n f e k s i Cross D a r i p e n e l i t i a n i i i i

Kandasamy S a i u r a n K e m i l i P a d a seciUmal d i p e r o l e h b a l i w a

W a n i t a Y a n g M e n d e r i t a

D i a b e t e s M e l i t u s T i p e

I I Y a n g D i r a w a t I n a p

p a s i e n w a n i t a d i a b e t e s

m e l i t u s t i p e I y a n g

m e n d e r i t a I S K y a n g

D a n D i r a w a t J a l a n D i d i r a w a t m a p d a n

S u b b a g i a n

E n d o k r i n o l o g i B a g i a n

P e n y a k i t D a l a m D i

d i r a w a t j a l a n d i s u b

b a g i a n E n d o k r i n o l o g i

P e n y a k i t D a l a m

R S U P H A d a m M a l i k R S U P H A d a m

P a d a T a l i u n 2 0 0 9 M a l i k M e d a i i t e r d a p a t

s e b a n y a k 2 5 o r a n g

y a i t u ( 1 2 7 ) D a r i 2 5

o r a n g y a n g m e n d e r i t a

I S K t e r d a p a t 3 o r a n g

y a i t u ( 1 2 0 ) y a n g

d i r a w a t i n a p d a n 2 2

6

o r a n g ( 8 8 0 ) y a n g

d i r a w a t j a l a n

Edel Weisela P e r b e d a a n R i s i k o

Permata I n f e k s i N o s o k o m i a l

Sari dan S a i u r a n K e m i h

Prijono B e r d a s a r k a n

Satyabakti K a i e t e r i s a s i U r i n

U m u r D a n D i a b e t e s

M e l i t u s T a h u n 2 0 1 5

Case H a s i l p e n e l i t i a n y a n g

control d i 1 a k u k a n p a d a 2 0

s a m p e l k a s u s d a n

k o n t r o l m e n u n j u k k a n

b a h w a p a s i e n d e n g a n

u m u r gt 5 5 t a h u n

m e m p u n y a i r i s i k o

5 5 7 k a l i m e n g a l a m i

i n f e k s i n o s o k o m i a l

s a i u r a n k e m i h

d i b a n d i n g k a n p a s i e n

d e n g a n u m u r lt 5 5

t a h u n d e n g a n

p e r i l i t u n g a i i b e s a r

risiko d i p e r o l e h n i l a i

O R s e b e s a r 5 5 7

d e n g a n n i l a i 9 5

(onfidence Interval

l 1 9 lt O R lt 2 8 2 3

P a s i e n d e n g a n s t a t u s

D M m e m p u n y a i risiko

6 k a l i u n t u k

m e n g a l a m i i n f e k s i

n o s o k o m i a l s a i u r a n

k e m i h d i b a n d i n g k a n

d e n g a n p a s i e n y a n g

t i d a k m e n d e r i t a D M

d e n g a n n i l a i O R

7

s e b e s a r 6 0 0 d e n g a n

n i l a i 9 5 Confidence

Interval 1 22 lt O R lt

3 2 2 6

Andry K a r a k t e r i s t i k P a s i e n - D e s k r i p k i f H a s i i p e n e l i t i a n d a r i

Lukandy P a s i e n I n f e k s i S a i u r a n r e t r o s p e k t i f 4 3 o r a n g p e n d e r i t a

K e m i i i d i P o l i u r o l o g i

R S U D D r P i m g a d i

K o t a M e d a n T a h u n

2 0 1 2 - 2 0 1 3

I S K d i d a p a t k a n 5 3 5

p a d a k e l o m p o k u s i a

gt 5 0 t a h u n 5 1 2

b e i j e n i s k e i a m i n l a k i -

l a k i 1 0 0 t i d a k

m e n d e r i t a

v e s i c o u r e t r a l r e f l u x

7 0 Benign Prostatic

Hyperplasia 1 1 6

b a t u s a i u r a n k e m i h

2 7 9 d i a b e t e s t i p e 2

D a r i h a s i l p e n e l i t i a n

i n i d a p a t d i s i m p u l k a n

b a h w a p e n d e r i t a i S K

l e b i h b a n y a k t e r j a d i

p a d a l a k i - l a k i d a n

p e n d e r i t a I S K l e b i h

b a n y a k d i j u m p a i p a d a

k e l o m p o k u m u r gt 5 0

t a h u n s e r t a d i t e m u k a n

I S K d e n g a n B P H

B S K d a n D M T i p e 2

BAB 11

TINJAUAN PUSTAKA

21 Landasan Teori

211Infeksi Saiuran Keniih

A Definisi

I n f e k s i S a i u r a n K e m i h a d a i a h i n v a s i d a n m u l t i p l i k a s i m i k r o o r g a n i s m e a t a u

p a r a s i t d a l a m j a r i n g a n t u b u h k h u s u s n y a s a i u r a n k e m i h y a n g t e r d i r i d a r i g i n j a l

u r e t e r b u l i - b u l i d a n u r e t r a y a n g d i i a n d a i d e n g a n a d a n y a b a k t e r i 1 0 c f i i (colony

forming unit) p e r m l p a d a p e n g a m b i l a n c o n t o h u r i n ( P u m o m o 2 0 1 1 )

I n f e k s i s a i u r a n k e m i h a d a l a l i s u a t u i n f e k s i y a n g m e l i b a t k a n g i n j a l lU e ter

b u l i - b u l i a t a u p u n u r e t r a I n f e k s i s a i u r a n k e m i h ( I S K ) a d a l a l i i s t i l a h u m u m y a n g

m e n u n j u k k a n k e b e r a d a a n m i k r o o r g a n i s m e d a l a m u r i n ( S u d o y o 2 0 0 6 )

B a k t e r i u r i a b e r m a k n a (significant hacteriuria) a d a i a h s u a t u k e a d a a n y a n g

m e n u n j u k k a n p e n u m b u l i a n m i k r o o r g a n i s m e m u m i l e b i h d a r i 1 0 c f t L m l p a d a

b i a k a n u r i n B a k t e r i u r i a b e r m a k n a m u n g k i n t a n p a d i s e r t a i p r e s e n t a s i k l i n i s I S K

d a n d i n a m a k a n b a k t e r i u r i a a s i m t o m a t i k (convert hacteriuria) S e b a l i k n y a

b a k t e r i u r i a b e n n a k n a d i s e r t a i p e r s e n t a s i k l i n i s I S K d i n a m a k a n b a k t e r i u r i a

s i m t o m a t i k P a d a b e b e r a p a k e a d a a n t e r d a p a t p a s i e n d e n g a n p e r s e n t a s i k l i n i s I S K

n a m u n t a n p a b a k t e r i u r i a b e n n a k n a S e l a i n i t u d i k a t a k a n p i u r i a ( l e u k o s i t d a l a m

u r i n ) b e n n a k n a (significant pyuria) b i l a d i t e m u k a n n e u t r o f i l gt 1 0 s e l p e r l a p a n g a n

p a n d a n g ( S u d o y o 2 0 0 6 )

B Epidemiologi

I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m u k a n d i p r a k t i k u m u m w a i a u p u n b e n n a c a m - m a c a m a n t i b i o t i k a s u d a h

t e r s e d i a l u a s d i p a s a r a n D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r

2 5 - 3 5 s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a

S e l a m a p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n

9

10

c e n d e r u n g m e n d e r i t a i S K d i b a n d i n g k a n l a k i - l a k i I S K b e m l a n g p a d a l a k i - l a k i

j a r a n g d i l a p o r k a n k e c u a l i d i s e r t a i f a k t o r p r e d i s p o s i s i ( p e n c e t u s )

P r e v a l e n s i b a k t e r i u r i a a s i m t o m a t i k l e b i h s e r i n g d i t e m u k a n p a d a p e r e m p u a n

P r e v a l e n s i s e l a m a p e r i o d e s e k o l a h (school girls) 1 m e n i n g k a t m e n j a d i 5

s e l a m a p e r i o d e a k t i f s e c a r a s e k s u a l P r e v a l e n s i i n f e k s i a s i m t o m a t i k m e n i n g k a t

m e n c a p a i 3 0 b a i k l a k i - l a k i m a u p u n p e r e m p u a n b i l a d i s e r t a i f a k t o r p r e d i s p o s i s i

( S u d o y o 2 0 0 6 )

C Kiasifikasi

I n f e k s i s a i u r a n k e m i h d a p a t d i b a g i m e n j a d i d u a k a t e g o r i u m u m b e r d a s a r k a n

l o k a s i a n a t o m i y a i t u

1 ) I n f e k s i s a i u r a n k e m i h b a w a h

2 ) I n f e k s i s a i u r a n k e m i h a l a s

P r e s e n t a s i k l i n i s d a r i i n f e k s i s a i u r a n k e m i h b a w a l i t e r g a n t u n g d a r i gender

y a i t u

a ) P e r e m p u a n

a S i s t i t i s

S i s t i t i s a d a i a h p r e s e n t a s i k l i n i s i n f e k s i k a n d u n g k e m i h d i s e r t a i

b a k t e r i u r i a b e n n a k n a

b S i n d r o m U r e t r a A k u t ( S U A )

S i n d r o m a u r e t r a a k u t a d a i a h p r e s e n t a s i k l i n i s s i s t i t i s t a n p a d i t e m u k a n

a d a n y a m i k r o o r g a n i s m e d a l a m L u i n ( s t e r i l ) d a n s e r i n g d i n a m a k a n

s i s t i t i s b a k t e r i a l i s

b ) L a k i - l a k i

P r e s e n t a s i k l i n i s i n f e k s i s a i u r a n k e m i h p a d a l a k i - l a k i m u n g k i n s i s t i t i s

p r o s t a t i t i s e p i d i m i d i s d a n u r e t r i t i s

I n f e k s i s a i u r a n k e m i h a t a s t e r b a g i m e n j a d i 2 y a i t u

1 ) P i e l o n e f r i t i s A k u t ( P N A )

P i e l o n e f r i t i s a k u t a d a l a l i p r o s e s i n f l a m a s i p a r e n k i m g i n j a l y a n g d i s e b a b k a n

o l e h m f e k s i b a k t e r i

11

2 ) P i e l o n e f r i t i s K r o n i s ( P N K )

P i e l o n e f r i t i s k r o n i s m u n g k i n a k i b a t l a n j u t d a r i i n f e k s i b a k t e r i

b e r k e p a n j a n g a n a t a u i n f e k s i s e j a k m a s a k e c i i O b s t r u k s i s a i u r a n k e m i h d a n

r e f l u k s v e s i k o u r e t e r d e n g a n a t a u t a n p a b a k t e r i u r i a k r o n i k s e r i n g d i i k u t i

p e m b e n t u k a n j a r i n g a n i k a t p a r e n k i m g i n j a l y a n g d i t a n d a i d e n g a n

p i e l o n e f r i t i s k r o n i k y a n g s p e s i f i k ( S u d o y o 2 0 0 6 )

D Etiologi

P a d a k e a d a a n n o r m a l u r i n b e r s i f a t s t e r i l U m u m n y a I S K d i s e b a b k a n o l e h

k i i m a n g r a m n e g a t i f E s c h e r i c h i a c o l i m e m p a k a n p e n y e b a b t e r b a n y a k b a i k p a d a

y a n g s i m t o m a t i k m a u p u n y a n g a s i m t o m a t i k y a i t u 7 0 - 9 0 E n t e r o b a k t e r i a s e p e r t i

P r o t e u s m i r a b i l i s ( 3 0 d a r i i n f e k s i s a i u r a n k e m i h p a d a a n a k l a k i - l a k i t e t a p i

k u r a n g d a r i 5 p a d a a n a k p e r e m p u a n ) K l e b s i e l l a p n e u m o n i a d a n P s e u d o m o n a s

a e m g i n o s a d a p a t j u g a s e b a g a i p e n y e b a b O r g a n i s m e g r a m p o s i t i f s e p e r t i

S t r e p t o c o c c u s f a e c a l i s ( e n t e r o k o k u s ) S t a p h y l o c o c c u s e p i d e n n i d i s d a n

S t r e p t o c o c c u s v i r i d a n s j a r a n g d i t e m u k a n P a d a u r o p a t i o b s t m k t i f d a n k e l a i n a n

s t r u k t u r s a i u r a n k e m i h p a d a a n a k l a k i - l a k i s e r i n g d i t e m u k a n P r o t e u s s p e c i e s P a d a

I S K n o s o k o m i a l a t a u I S K k o m p l e k s l e b i h s e r i n g d i t e m u k a n k u m a n P r o t e u s d a n

P s e u d o m o n a s ( L u m b a n b a t u S M 2 0 0 3 )

E Patofisiologi

P a d a i n d i v i d u n o n n a l b i a s a n y a u r i n l a k i - l a k i m a u p u n p e r e m p u a n s e l a l u

d a l a m k e a d a a n s t e r i l k a r e n a d i p e r t a l i a n k a n o l e h j u m l a l i d a n f r e k u e n s i b e r k e m i h

U t e r o d i s t a l m e m p a k a n t e m p a t k o l o n i s a s i m i k r o o r g a n i s m e nonpathogenic

fastidious G r a m - p o s i t i f d a n g r a m n e g a t i f ( S u d o y o 2 0 0 6 )

H a m p i r s e m u a I S K d i s e b a b k a n i n v a s i m i k r o o r g a n i s m e ascending d a r i u r e t r a

k e d a l a m k a n d u n g k e m i b P a d a b e b e r a p a p a s i e n t e r t e n t u i n v a s i m i k r o o r g a n i s m e

d a p a t m e n c a p a i k e g i n j a l P r o s e s i n i d i p e n n u d a h o l e h k o n d i s i r e f l u k s

v e s i k o i i r e t e r a l P r o s e s i n v a s i m i k r o o r g a n i s m e h e m a t o g e n s a n g a t j a r a n g d i t e m u k a n

d i k l i n i k m u n g k i t a k i b a t l a n j u t d a r i b a k t e r e m i a G i n j a l d i d u g a m e n i p a k a n l o k a s i

12

i n f e k s i s e b a g a i a k i b a t l a n j u t d a r i s e p t i k e m i a a t a u e n d o k a r d i t i s a k i b a t S t a f i l o k o k u s

a u r e u s K e l a i n a n g i n j a l y a n g t e r k a i t d e n g a n e n d o k a r d i t i s ( S t a f i l o k k o k u s a u r e u s )

d i k e n a l d e n g a n N e p h r i t i s L o h e i n B e b e r a p a p e n e l i t i a n m e l a p o r k a n p i e l o n e f r i t i s

a k u t ( P N A ) s e b a g a i a k i b a t l a n j u t i n v a s i h e m a t o g e n ( S u d o y o 2 0 0 6 )

F Faktor Risiko

P a t o f i s i o l o g i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h d a p a t d i p e n g a n i h i o l e h

b e b e r a p a f a k t o r A d a p u n b e b e r a p a f a k t o r risiko y a n g m e m p e n g a n i l i i t e r j a d i n y a

i n f e k s i s a i u r a n k e m i h a n t a r a l a i n

1 ) U s i a

I n s i d e n I S K m e n i n g k a t b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i

m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n a d a n y a a b n o r m a l i t a s a n a t o m i y a n g

m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n k e m i h s e p e r t i p e m b e s a r a n p r o s t a t

d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e

P e n y e b a b l a i n t e r m a s u k p e r i n e u m y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s

p e n y a k i t n e u r o m u s k n l a r d a n k a t e t e r i s a s i b u l i - b u l i S e l a i n i t u i n s i d e n I S K

m e n c a p a i 1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o s e 2 0 0 9 F o x m a n e t a l 2 0 1 0

R o n a l d 2 0 1 1 )

M e n u m t t e o r i y a n g d i k e m u k a k a n o l e h S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a d a u s i a

l a n j u t a k a n t e r j a d i p e n i n g k a t a n k e r e n t a n a n t e r h a d a p p e n y a k i t P a d a u s i a d i a t a s 5 0

t a l i u n t e r j a d i p e n u m n a n k e m a m p u a n d a l a m m e m p e r t a h a n k a n s t e n l i t a s b a i k p a d a

k a n d u n g k e m i h m a u p u n u r e t r a H a l t e r s e b u t d i s e b a b k a n o l e h i n v o l u s i t i m u s

I n v o l u s i s e l t i m u s m e n y e b a b k a n j u m l a h se d a n k u a l i t a s r e s p o n s s e l T s e m a k i n

b e r k u r a n g J u m l a h s e l T m e m o r i m e n i n g k a t n a m u n s e m a k i n s u l i t u n t u k

b e r k e m b a n g t e r u t a m a s i t o t o k s i k s e l T ( C D ^ ) d a n s e l T h l ( C D ^ ^ ) k a r e n a t e r j a d i

a p o p t o s i s S i t o t o k s i k s e l T ( C D ^ ^ ) b e i p e r a n d a l a m r e s p o n s i m u n t e r h a d a p a n t i g e n

p a d a s e l y a n g d i i n f e k s i d e n g a n c a r a m e m b u n u l i s e l y a n g t e r i n f e k s i u n t u k

m e n c e g a h p e n y e b a r a n m f e k s i s e d a n g k a n s e l T h l ( C D ^ ^ ) b e r p e r a n m e m b a n t u s e l

B u n t u k m e m p r o d u k s i a n t i b o d i

13

2 ) J e n i s k e l a m m d a n a k t i v i t a s s e k s u a l

I n s i d e n s i I S K y a n g r e n d a h p a d a p r i a d i p e n g a n i h i o l e h 3 f a k t o r y a i t u

1 L e b i h s e d i k i t t e r j a d i k o l o n i s a s i s e k i t a r u r e t r a k a r e n a t i d a k a d a n y a t e m p a t

s e p e r t i v a g i n a p a d a p e r e m p u a n

2 M e m i l i k i u r e t r a y a n g p a n j a n g

3 A d a n y a s u b s t a n s i a n t i b a k t e r i a l p a d a c a i r a n p r o s t a t

U r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a h d e n g a n d e k a t n y a v a g i n a l

v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h l e b i h s e r i n g

p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a f l o r a n o n n a l p a d a d a e r a l i p e r i u r e t r a t e r d i r i

d a r i o r g a n i s m e s e p e r t i l a c t o b a c i l l i i s y a n g m e m b a n t u m e l a w a n k o l o n i s a s i b a k t e r i

p a t o g e n p a d a s a i u r a n k e m i h P e r u b a l i a n l i n g k i m g a n d a r i p e r i u r e t r a l s e p e r t i

p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k b i s a m e n g g a n g g u f l o r a

n o r m a l s e h i n g g a m e m u n g k i n k a n b a k t e r i p a t o g e n b e r k o l o n i s a s i d a n m e n y e b a b k a n

i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

P a d a w a n i t a l e b i h d a r i 5 0 t a h u n a t a u l e b i h m e n o p a u s e m e m p a k a n f a k t o r

l a i n y a n g m e n i n g k a t k a n P V R Post Void Residual) s e l a i n p e n u r u n a n k o i i t r a k t i i i t a s

o t o t d e t r u s o r P e n u m n a n e s t r o g e n y a n g d i s e b a b k a n m e n o p a u s e d a p a t

m e n i n g k a t k a n p H v a g i n a l d a n m e n u m n k a n j u m l a l i l a c t o b a c i l l i A k i b a m y a t e r j a d i

p e n i n g k a t k a n k o l o n i s a s i d a r i b a s i l g r a m n e g a t i f s e h i n g g a m e n i n g k a t k a n r e s i k o

t e r j a d i n y a I S K P a d a p r i a p r o s t a t m e n s e k r e s i k a n c a i r a n y a n g m e n g a n d i m g z i n k

y a n g m e m i l i k i a k t i f i t a s m i k r o b i a l ( K i m 2 0 1 2 )

S e l a i n i t u p i j a t a n u r e t r a s e p e r t i y a n g t e r j a d i s e l a m a h u b u n g a n s e k s u a l

m e n y e b a b k a n m a s u k n y a b a k t e r i k e d a l a m k a n d u n g k e m i h d a n m e m p a k a n h a l

y a n g p e n t i n g d a l a m p a t o g e n e s i s m f e k s i s a l i u a n k e m i h p a d a p e r e m p u a n m u d a

B u a n g a i r k e c i l s e t e l a h h u b u n g a n s e k s u a l t e r b u k t i m e n u m n k a n risiko s i s t i t i s

m u n g k i n k a r e n a t i n d a k a n i n i m e n i n g k a t k a n e r a d i k a s i b a k t e r i y a n g m a s u k s e l a m a

h u b u n g a n s e k s u a l ( K i m 2 0 1 2 )

3 ) T i n g k a t P e n d i d i k a n

P e n g e t a h u a n s e s e o r a n g t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t

p e n d i d i k a n S e s e o r a n g y a n g m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m i u i g k i n a n

p e n g e t a h u a n t e n t a n g k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o n n a s i y a n g d i d a p a t k a n

14

t e n t a n g k e s e h a t a n l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h

S e b a l i k n y a p e n d i d i k a n y a n g k u r a n g d a p a t m e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g

t e r h a d a p n i l a i - n i l a i y a n g b a n i d i k e n a l ( N o t o a d i n o j o 2 0 0 3 )

4 ) R i w a y a t D i a b e t e s M e l i t u s

M e n u r u t S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a s i e n d e n g a n s t a t u s D M s a n g a t

b e r i s i k o u n t u k m e n g a l a m i i n f e k s i s a i u r a n k e m i h A b n o n n a l i i a s s t n i k t u r d a n

k a n d u n g k e m i h n e u r o g e n i k a k i b a t n e u r o p a t i o t o n o m a t a u s t r o k e p a d a p a s i e n D M

m e n y e b a b k a n p e n g o s o n g a n k a n d u n g k e m i h t i d a k n o n n a l D M j u g a d a p a t

m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a h a n a n t u b u h y a n g b e r p o t e n s i m e n i n g k a t

risiko t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a h a n a n t u b u h t e r s e b u t d i a n t a r a n y a

a d a i a h k e g a g a l a n m i g r a s i s e l intracellular killing f a g o s i t o s i s d a n k e m o t a k s i s

p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n m e k a n i s m e p e r t a h a n a n

a l a m i a h i o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p i n f e k s i

5 ) K e h a m i i a n

K e c e n d e r u n g a n i n f e k s i s a i u r a n k e m i h b a g i a n a t a s s e l a m a k e h a m i i a n

d i s e b a b k a n o l e h p e n u m n a n k e k u a t a n u r e t e r p e n u m n a n p e r i s t a l t i k u r e t e r d a n

i n k o m p e t e n s i s e m e n t a r a k a l u p v e s i k o i u - e t e r a l y a n g t e r j a d i s e l a m a h a m i l

6 ) S u m b a t a i i

A d a n y a I i a i a n g a n a l i r a n b e b a s u r i n s e p e r t i t u m o r s t r i k t r a a b a t u a t a u

h i p e r t r o f i p r o s t a t d a p a t m e n y e b a b k a n h i d r o n e f r o s i s d a n risiko i n f e k s i s a i u r a n

k e m i l i y a n g s a n g a t t i n g g i S e l a i n i t u s u p e r i n f e k s i p a d a s u m b a t a n s a i u r a n k e m i h

d a p a t m e n y e b a b k a n k e m s a k a n j a r i n g a n g i n j a l y a n g c e p a t

7 ) D i s f u n g s i n e u r o g e n i k k a n d u n g k e m i h

G a n g g u a n s a r a f y a n g b e k e r j a p a d a k a n d m i g k e m i h s e p e r t i p a d a j e j a s k o r d a

s p i n a l i s t a b e s d o r s a i i s m u l t i p e l s k l e r o s i s d i a b e t e s m e l i t u s a t a u p e n y a k i t l a i n

d a p a t b e r h u b u n g a n d e n g a n i n f e k s i s a i u r a n k e m i h I n f e k s i d a p a t d i a w a l i o l e h

p e n g g u n a a n k a t e l e r u n t u k d r a i n a s e k a n d i u i g k e m i h d a n d i d u k i m g o l e h s t a t i s u r i n

d a l a m k a n d u n g k e m i l i u n t u k j a n g k a w a k t u y a n g l a m a

8 ) R e f l u k s v e s i k o m e t e r a

K e a d a a n i n i d i d e f i n i s i k a n s e b a g a i r e f l u k s u r i n d a r i k a n d u n g k e m i b k e u r e t e r

d a n k a d a n g s a m p a i k e p e l v i s r e n a l H a l i n i t e r j a d i s e l a m a b u a n g a i r k e c i l a t a u

15

d e n g a n p e n i n g k a t a n t e k a n a n p a d a k a n d u n g k e m i h R e f l u k s v e s i k o i i r e t e r a l d a p a t

d i b u k t i k a n d e n g a n a d a n y a g c r a k a n r e t r o g r a d z a t r a d i o o p a k a t a u r a d i o a k t i f m e l a l u i

s i s t o u r e t r o g r a m s e l a m a b u a n g a i r k e c i l R e f l u k s v e s i k o i i r e t e r a l b i a s a n y a

d i s e b a b k a n k a r e n a a d a n y a g a n g g u a n a n a t o m i s p a d a p e r t e m u a n v e s i k o i i r e t e r a l

y a n g d a p a t m e n y e b a b k a n r e f l u k s u r i n d i s e r t a i b a k t e r i d a n k a r e n a i t u t e r j a d i l a h

i n f e k s i s a l r a a n k e m i h

9 ) F a k t o r v i r u l e n s i b a k t e r i

F a k t o r v i r u l e n s i b a k t e r i m e m p e n g a r u b i k e m u n g k i n a n vragt7 t e r t e n m d a l a m

m e n y e b a b k a n i n f e k s i t r a k i u s u r i n a r i u s H a m p i r s e m u a strain F c o l i y a n g

m e n y e b a b k a n p i e l o n e f r i t i s p a d a p a s i e n d e n g a n t r a k i u s u r i n a r i u s n o m i a l s e c a r a

a n a t o m i k m e m p u n y a i p i l u s t e r t e n t u y a n g m e m p e r a n t a r a i p e r l e k a t a n p a d a b a g i a n

d i g a k t o s i d a d a n g l i k o s f i n g o l i p i d y a n g a d a d i u r o e p i t e l Strain y a n g m e n i m b u l k a n

p i e l o n e f r i t i s j u g a b i a s a n y a m e m p a k a n p e n g b a s i l h e m o l i s i n m e m p u n y a i

a e r o b a k t i n d a n r e s i s t e n t e r h a d a p k e r j a b a k t e r i s i d a l d a r i s e m m m a n u s i a

1 0 ) F a k t o r g e n e t i k

F a k t o r g e n e t i k p e n j a m u m e m p e n g a n i l i i k e r e n t a n a n t e r h a d a p i n f e k s i t r a k t u s

u r i n a r i u s J u m l a h d a n t i p e r e s e p t o r p a d a s e l u r o e p i t e l t e m p a t b a k t e r i d a p a t

m e n e m p e l s e l i d a k i i y a s e b a g i a i i d i t e n t u k a r i s e c a r a g e n e t i k ( I s s e l b a c h e r 2 0 0 9 )

G Manifestasi Klinis

G e j a l a k l i n i s d a r i i n f e k s i s a i u r a n k e m i h s e s u a i d e n g a n b a g i a n s a i u r a n k e m i h

y a n g t e r i n f e k s i a d a i a h s e b a g a i b e r i k u t

1 ) I n f e k s i s a i u r a n k e m i h b a g i a n b a w a l i

K e l u h a n p a s i e n b i a s a n y a b e m p a r a s a s a k i t a t a u r a s a p a n a s d i u r e t r a s e w a k t u

k e n c i n g d e n g a n a i r k e m i h s e d i k i t - s e d i k i t s e r t a r a s a t i d a k e n a k d i d a e r a h

s i i p r a p u b i k

2 ) I n f e k s i s a i u r a n k e m i h b a g i a n a t a s

P a d a i n t e k s i s a i u r a n k e m i h b a g i a n a t a s d a p a t d i t e m u k a n g e j a l a s e p e r t i s a k i t

k e p a l a m a l a i s e m u a l m m i t a h d e n i a m m e n g g i g i l r a s a t i d a k e n a k a t a u

n y e r i d i p i n g g a n g ( T e s s y d k k 2 0 0 1 )

16

H Tatalaksana

T u j u a n p e n a t a l a k s a n a a a n i n f e k s i s a i u r a n k e m i h a d a i a h m e n c e g a h d a n

m e n g h i l a n g k a n g e j a l a m e n c e g a h d a n m e n g o b a t i b a k t e n e m i a d a n b a k t e r i u r i a s e r t a

m e n c e g a h d a n m e n g u r a n g i r i s i k o k e r u s a k a n g i n j a l y a n g m u n g k i n t i m b u l d e n g a n

p e m b e r i a n o b a t - o b a t a n y a n g s e n s i t i f m u r a l i d a n a m a n d e n g a n e f e k s a m p i n g y a n g

m i n i m a l

a ) i n f e k s i s a i u r a n k e m i h ( I S K ) b a w a h

P r i n s i p p e n a t a l a k s a n a a n I S K b a w a h m e l i p u t i intake c a i r a n y a n g b a n y a k

a n t i b i o t i k y a n g a d e k u a t d a n b i l a p e r l u t e r a p i s i m t o m a t i k u n t u k a l k a l i s a s i

u r i n

i H a m p i r 8 0 p a s i e n a k a n m e m b e r i k a n r e s p o n s e t e l a h 4 8 j a m d e n g a n

a n t i b i o t i k a t u n g g a l s e p e r t i a m p i s i l i n 3 g r a m a t a u t r i m e t o p r i m 2 0 0 m g

i i B i l a i n f e k s i m e n e t a p d i s e r t a i k e l a i n a n u r i n a l i s i s ( l e u k o s i u i a ) d i p e r i u k a n

t e r a p i k o n v e n s i o n a l s e l a m a 5 - 1 0 h a r i

i i i P e m e r i k s a a n m i k r o s k o p i s u r i n d a n b i a k a n u r i n t i d a k d i p e r i u k a n b i l a

s e m u a g e j a l a h i l a n g d a n t a n p a l e u k o s u r i a

b ) I n f e k s i s a i u r a n k e m i h ( I S K ) a t a s

P a d a u m u m n y a p a s i e n d e n g a n p i e l o n e f r i t i s a k u t m e m e r l u k a n r a w a t i n a p

u n t u k m e m e l i h a r a s t a t u s h i d r a s i d a n t e r a p i a n t i b i o t i k a p a r e n t e r a l p a l i n g

s e d i k i t 4 8 j a m ( S u d o y o 2 0 0 6 )

i Komplikasi

K o m p l i k a s i i n f e k s i s a i u r a n k e m i h t e r g a n t u n g d a r i t i p e y a i t u i n f e k s i s a i u r a n

k e m i h t i p e s e d e r h a n a (uncomplicated) d a n t i p e b e r k o m p l i k a s i (complicated)

1 ) I n f e k s i s a i u r a n k e m i h s e d e r h a n a (uncomplicated)

I n f e k s i s a i u r a n k e m i h a k u t t i p e s e d e r h a n a ( s i s t i t i s ) y a i t u n o n - o b s t r u k s i d a n

b u k a n p e r e m p u a n h a m i l m e m p a k a n p e n y a k i t r i n g a n (self limited disiase)

d a n t i d a k m e n y e b a b k a n a k i b a t l a n j u t j a n g k a l a m a

2 ) I n f e k s i s a i u r a n k e m i h b e r k o m p l i k a s i (complicated)

a ) I n f e k s i s a i u r a n k e m i h s e l a m a k e h a m i i a n

b ) i n f e k s i s a i u r a n k e m i h p a d a d i a b e t e s m e l i t u s ( S u d o y o 2 0 0 6 )

17

22 Kerangka Teori

J

U s i a

J e n i s K e i a m i n

T i n g k a t P e n d i d i k a n

R i w a y a t D i a b e t e s M e l i m s

S u m b a t a n bullT

K e h a m i i a n

D i s f u n g s i n e u r o g e n i k

R e f l u k s v e s i k o i i r e t e r a l

V i r u l e n s i b a k t e r i

F a k t o r g e n e t i k

I n f e k s i b a k t e r i g r a m p o s i t i f a t a u n e g a t i v e p a d a s a i u r a n k e m i h

I n f e k s i S a i u r a n K e m i h

Keterangan

I j = V a r i a b e l y a n g t i d a k d i t e l i t i

= V a r i a b e l y a n g d i t e l i t i

18

Hipotesis

H i p o t e s i s d a l a m p e n e l i t i a n i n i a d a i a h

H O t i d a k t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n

t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

H I t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

BAB 111

M E T O D E PENELITIAN

31 Jenis Penelitian

P a d a p e n e l i t i a n i n i j e n i s p e n e l i t i a n y a n g d i g u n a k a n a d a i a h p e n e l i t i a n

o b s e r v a s i o n a i a n a l i t i k d e s a i n cross scclional d e n g a n m e n g g u n a k a n d a t a s e k u n d e r

d a r i r e k a m m e d i s p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1 D e s e m b e r

2 0 1 5

32 Waktu dan Tempat Penelitian

321 Waktu Penelitian

W a k t u p e n e l i t i a n d i l a k s a n a k a n p a d a t a n g g a l 1 O k t o b e r s a m p a i d e n g a n 3 0

O k t o b e r 2 0 1 6

322 Tempat Penelitian

P e n e l i t i a n i n i d i l a k s a n a k a n d i R u m a l i S a k i t M u h a m m a d i y a h P a e m b a n g ( d i

R u a n g R e k a m M e d i s )

33 Populasi dan Sampel Penelitian

331Populasi Penelitian

P a d a p e n e l i t i a n i n i p o p u l a s i t a r g e t a d a l a l i p a s i e n r a w a t i n a p d a n r a w a t j a l a n

d i R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g s e d a n g k a n p o p u l a s i t e r j a n g k a u n y a

a d a i a h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

332Sampel dan Besar Sampel Penelitian

P a d a p e n e l i t i a n i n i s a m p e l p e n e l i t i a n a d a i a h p a s i e n r a w a t i n a p d a n r a w a t

j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e

1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 y a n g m e m e n u h i k r i t e r i a i n k l u s i p e n e l i t i a n

1 9

20

d e n g a n b e s a r s a m p e l y a n g l a y a k d a l a m p e n e l i t i a n m e n u r u t t e o r i R o s c o e a d a i a h

a n t a r a t i g a p u l u h s a m p a i l i m a r a t i i s o r a n g ( S u g i y o n o 2 0 1 5 )

333 Krttena Inklusi dan Eksklusi

A Kriteria Inklusi

P a d a p e n e l i t i a n i n i k r i t e r i a i n k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t i n a p

d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i

P a l e m b a n g y a n g d i d i a g n o s a m e n g a l a m i i n f e k s i s a i u r a n k e m i h s e r t a m e m i l i k i d a t a

r e k a m m e d i s p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

B Kriteria Eksklusi

P a d a p e n e l i t i a n i n i k r i t e r i a e k s k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t

i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 d e n g a n d a t a r e k a m m e d i s

y a n g t i d a k l e n g k a p

334 Cara Pengambilan Sampel Penelitian

C a r a p e n g a m b i l a n s a m p e l y a n g d i g u n a k a n d a l a m p e n e l i t i a n i n i a d a l a l i

m e n g g u n a k a n t e k n i k consecutive sampling P a d a consecutive sampling s e t i a p

p a s i e n y a n g m e m e n u h i k r i t e r i a p e n e l i t i a n d i m a s u k k a n d a l a m p e n e l i t i a n s a m p a i

k u r u n w a k t u t e r t e n U i s e h i n g g a j u m l a h m i n i m a l y a n g d i p e r i u k a n t e r p e n u h i

( S a s t r o a s m o r o 2 0 1 1 )

34 Variabel Penelitian

341 Variabel Dependent

V a r i a b e l dependent f t e r i k a t ) d a l a m p e n e l i t i a n i n i a d a i a h i n f e k s i s a i u r a n

k e m i h

342 Variabel Independent

V a r i a b e l independent ( b e b a s ) d a l a m p e n e l i t i a n i n i a d a i a h u s i a j e n i s

k e l a i n i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

21

35 Definisi Operasional

Tabel 31 Definisi Operasional

Variabel Alat Cara ueiinisi rldsil L KUr I7 i l l 11 Lz fe 1 V

oKaia LiKur Penelitian Ukur Ukur

Infeksi P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Saiuran d i d i a g n o s a o l e h m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Keniih d o k t e r m e n g a l a m i m e d i s

i n f e k s i s a i u r a n

k e m i h d a n t e r c a n t u m

d i r e k a m m e d i s

U s i a L a m a n y a t a h u n R e k a m O b s e r v a s i 1 lt 5 0 t a h u n O r d i n a l

k e h i d u p a n p a s i e n m e d i s r e k a m 2 gt 5 0 t a l i u n ( k a t e g o r i k )

d a r i l a h i r s a m p a i m e d i s

s e k a r a n g d a n

t e r c a n t u m d i r e k a m

m e d i s

Jenis P r o f i l a n a t o m i a t a u R e k a m O b s e r v a s i 1- L a k i - l a k i N o m i n a l

Keiamin b i o l o g i s p a s i e n y a n g m e d i s r e k a m 2 P e r e m p u a n ( k a t e g o r i k )

d i b e d a k a n m e n j a d i m e d i s

i a k i - l a k i d a n

n e r e m m i a n s e r t a

t e r c a n t u m d i r e k a m

m e d i s

Tingkat P e n d i d i k a n f o n n a l R e k a m O b s e r v a s i 1 P e n d i d i k a n O r d i n a l

Pendidikan t e r a k h i r y a n g m e d i s r e k a m d a s a r ( S D ( k a t e g o r i k )

d i t e m p u h o l e h m e d i s M I S M P

p a s i e n d a n t e r c a n t u m d a n M T s )

d i r e k a m m e d i s 2 P e n d i d i k a n

m e n e n g a l i

d a n t i n g g i

22

( S M A M A

S M K

M A K

d i p l o m a

s a r j a n a

m a g i St e r

s p e s i a l i s

d a n d o k t o r )

Riwayat P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Diabetes d i d i a g n o s i s d e n g a n m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Melitus d i a b e t e s m e l i t u s d a n

t e r c a n t u m d i d a l a m

r e k a m m e d i s

m e d i s

36 Cara Pengumpulan Data

361 Data Sekunder

P e n g u m p u l a n d a t a p a d a p e n e l i t i a n i n i d i p e r o l e h d a r i d a t a s e k u n d e r y a i t u

r e k a m m e d i s p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

37 Metode Teknik Analisis Data

371Cara Pengolahan dan Analisis Data

P e n g o l a h a n d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n m e l a l u i e m p a t t a h a p y a i t u

i Oala Entry

P a d a t a i i a p i n i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n riwayat d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g y a n g t e l a h d i d a p a t d a n

r e k a m m e d i s d i k u m p u l k a n d a n d i m a s u k k a n k e d a l a m p r o g r a m spss

23

2 Editing

P a d a t a h a p i n i d a t a i i s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n y a n g t e l a h d i m a s u k k a n k e d a l a m p r o g r a m s p s s

d i p e r i k s a k e m b a l i a p a k a h s u d a h l e n g k a p d a n t i d a k a d a k e k e l i r u a n

3 ( oding

S e t e l a h m e l a l u i p r o s e s editing d a t a - d a t a t e r s e b u t d i b e r i k o d e t e r t e n t u a n t a r a

l a i n k o d e 1 u n t u k u s i a gt 5 0 t a h u n j e n i s k e i a m i n p e r e m p u a n t i n g k a t

p e n d i d i k a n d a s a r t e r d a p a t r i w a y a t d i a b e t e s m e l i t u s d a n i n f e k s i s a i u r a n

k e m i h s e d a n g k a n k o d e 2 u n t u k u s i a lt 5 0 t a h u n j e n i s k e i a m i n l a k i - l a k i

t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i t i d a k t e r d a p a t r i w a y a t d i a b e t e s

m e l i t u s d a n b u k a n i n f e k s i s a i u r a n k e m i h s e h i n g g a m e m u d a h k a n d a l a m

m e l a k u k a n a n a l i s i s d a t a

4 Tahulaling

P a d a t a h a p i n i d a t a y a n g s a m a d i k e l o m p o k k a n s e c a r a t e l i t i d a n t e r a t m

k e m u d i a n d i l i i t u n g d e n g a n m e n g g u n a k a n p r o g r a m sps s d a n d i j u m l a h k a i i

l a l u d i s a j i k a n d a l a m b e n t u k t a b e l - t a b e l

U n t u k m e n g a n a l i s i s d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n a n a l i s i s d a t a

u n i v a r i a t d a n b i v a r i a t d e n g a n m e n g g u n a k a n p r o g r a m s p s s s e b a g a i b e r i k u t

A A n a l i s i s u n i v a r i a t

A n a l i s i s u n i v a r i a t d i l a k u k a n d e n g a n c a r a m e l a k u k a n a n a l i s i s p a d a s e t i a p

v a r i a b e l h a s i l p e n e l i t i a n d e n g a n t u j u a n u n t u k m e n g e t a h u i d i s t r i b u s i p r o p o r s i p a d a

s e t i a p v a r i a b e l p e n e l i t i a n D a t a d i s a j i k a n d a l a m b e n t u k t a b e l d a n n a r a s i

B A n a l i s i s b i v a r i a t

A n a l i s i s b i v a r i a t d i l a k u k a n d e n g a n m e n g g u n a k a n u j i h i p o t e s i s chi-square

U j i h i p o t e s i s chi-square d a p a t d i g u n a k a n d e n g a n s y a r a t y a i t u lt 2 0 s e l y a n g

m e m p u n y a i n i l a i expected count k u r a n g d a r i l i m a s e h i n g g a j i k a t i d a k m e m e n u h i

s y a r a t u j i chi-square m a k a u j i y a n g d i g u n a k a n a d a i a h u] fisher ( D a h l a n 2 0 1 4 )

B a t a s k e m a k n a a n y a n g d i g u n a k a n a d a i a h a = 0 0 5 J i k a d i d a p a t k a n p value lt 0 0 5

p a d a u j i s t a t i s t i k m a k a t i d a k t e r d a p a t h u b u n g a n y a n g b e n n a k n a a n t a r a d u a

v a r i a b e l y a n g d i t e l i t i d a n H O d i t e r i m a S e d a n g k a n j i k a d i d a p a t k a n p value gt 0 0 5

24

p a d a u j i s t a t i s t i k m a k a t e r d a p a t l i u b u n g a n y a n g b e n n a k n a a n t a r a d u a v a r i a b e l

y a n g d i t e l i t i d a n H O d i t o l a k

38 Alur Penelitian

P e n e n t u a n p o p u l a s i d a n s a m p e l p e n e l i t i a n

K r i t e r i a i n k l u s i K r i t e r i a e k s k l u s i

P e n g a m b i l a n s a m p e l p e n e l i t i a n

P e n g o l a h a n d a n a n a l i s i s d a t a d e n g a n u j i chi-square

H a s i l d a n p e m b a h a s a n

K e s i m p u l a n d a n s a r a n

Gambar 31 Alur Penelitian Hubungan Usia Jenis Keiamin Tingkat Pendidikan dan Riwayat Diabetes Melitus dengan Kejadian Infeksi Saiuran Kemih pada Pasien Rawat Inap di Bagian Penyakit Dalam Rumah Sakit Muhammadiyah Palembang Periode 1 Januari 2015 sampai dengan 31 Desember 2015

BAB IV

HASIL DAN PEMBAHASAN

41 Hasil

P e n e l i t i a n i n i t e l a h d i l a k u k a n d i r u a n g r e k a m m e d i s R u m a h S a k i t

M u h a i m n a d i y a h P a l e m b a n g d a r i t a n g g a l 1 O k t o b e r 2 0 1 5 - 3 1 O k t o b e r 2 0 1 6

P e n e l i t i a n d i m u l a i d e n g a n p e n g a m b i l a n d a t a a w a l b e m p a d a t a r e k a m m e d i s

s e l u r u h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

S e l a n j u t n y a r e k a m m e d i s d i p i l i h s e s u a i d e n g a n k r i t e r i a i n k l u s i d a n e k s k l u s i u n t u k

d i j a d i k a n s a m p e l p e n e l i t i a n s a m p a i m i n i m a l b e s a r s a m p e l y a n g d i b u t u h k a n

t e r p e n u h i s e r t a d i l a k u k a n p e n e l i t i a n s e c a r a o b s e r v a s i o n a i O b s e r v a s i r e k a m m e d i s

d i l a k u k a n u n m k m e n g e t a h u i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t

d i a b e t e s m e l i t u s d a n d i a g n o s a p a s i e n

D a r i c a t a t a n r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g

d i d a p a t k a n s e b a n y a k 4 1 4 1 r e k a m m e d i s p a s i e n r a w a t i n a p d a n 1 4 5 3 r e k a m m e d i s

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 D a r i t o t a l r e k a m m e d i s

p a s i e n r a w a t i n a p d a n r a w a t j a l a n t e r s e b u t p e n e l i t i h a n y a m e n g a m b i l m i n i m a l

b e s a r s a m p e l y a n g d i b u t u h k a n y a i t u s e b a n y a k 9 8 r e k a m m e d i s u n t u k d i j a d i k a n

s a m p e l p e n e l i t i a n y a n g t e r d i r i d a r i 3 0 r e k a m m e d i s p a s i e n y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i h d a n 6 8 r e k a m m e d i s y a n g t i d a k m e n g a l a m i i n f e k s i s a i u r a n k e m i h

411 Hasil Analisis Univariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s u n i v a r i a t

a n t a r a l a i n d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p b e r d a s a r k a n u s i a d a n

j e n i s k e l a m m d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n b e r d a s a r k a n u s i a

d a n j e n i s k e i a m i n d i s t r i b u s i p r o p o r s i s a m p e l b e r d a s a r k a n k e j a d i a n m f e k s i s a i u r a n

k e m i h s e r t a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n u s i a

j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

25

26

A Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan IJsta

dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 41 Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan

Usia dan Jenis Keiamin

Paisen Rawat Inap N Persentase

Usia

1 7 - 2 5 t a h u n 678 1 6 4

2 6 - 3 5 t a h u n 952 2 3 0

3 6 - 4 5 t a l i u n 745 18 0

4 6 - 5 5 t a h u n 695 1 6 8

5 6 - 6 4 t a h u n 571 1 3 8

gt 6 4 t a h u n 500 1 2 1

U s i a r a t a - r a t a ( t a h u n j 43plusmn16543

Jenis Keiamin

P e r e m p u a n 2 6 3 8 6 3 7

L a k i - l a k i 1 5 0 3 3 6 3

Total 4141 100

B e r d a s a r k a n t a b e l 4 1 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R i u n a h S a k i t M u l i a m m a d i y a l i

P a l e m b a n g p e r i o d e J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 2 6 - 3 5 t a h u n y a i t u

s e b a n y a k 9 5 2 o r a n g ( 2 3 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 43plusmn16543 t a l i u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 2 6 3 8 o r a n g ( 6 3 7 )

27

B Distribusi Proporsi Karakteristik Pasien Rawat Jalan Berdasarkan

Usia dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 42 Distribusi Proporsi Karakteristik Pasien Rawat Jalan

Berdasarkan Usia dan Jenis Keiamin

Fasten Rawat Jalan N Persentase

Usia

1 7 - 2 5 t a h u n 9 2 6 3

2 6 - 3 5 t a l n i n 1 3 1 9 0

3 6 - 4 5 t a h u n 2 7 9 1 9 2

46-55 t a l i u n 4 2 1 2 9 0

5 6 - 6 4 t a h u n 3 1 6 2 1 7

gt 6 4 t a h u n 2 1 4 1 4 7

U s i a r a t a - r a t a ( t a h u n ) 50plusmn14120

Jenis Keiamin

P e r e m p u a n 8 9 0 6 1 3

L a k i - l a k i 5 6 3 3 8 7

Total 1453 100

B e r d a s a r k a n t a b e l 4 2 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 4 6 - 5 5 t a h u n y a i t u

s e b a n y a k 4 2 1 o r a n g ( 2 9 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 50plusmn14120 t a h u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 8 9 0 o r a n g ( 6 1 3 )

28

C Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Usia

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i b b e r d a s a r k a n u s i a d a p a t

d i i i h a t p a d a l a b e l d i b a w a h i n i

Tabel 43 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Usia

Usia N Persentase

lt 5 0 t a h u n 1 4 4 6 7

gt 5 0 t a l i u n 1 6 5 3 3

Total 30 100

B e r d a s a r k a n t a b e l 4 3 d i a t a s d a p a t d i k e t a h u i b a h w a u s i a t e r b a n y a k p a d a

s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h gt 5 0 t a h u n y a i t u s e b a n y a k

1 6 o r a n g ( 5 3 3 )

D Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Jenis

Keiamin

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n j e n i s

k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 44 Distribusi Proporsi Kejadian infeksi Saiuran Kemih Berdasarkan

Jenis Keiamin

Jenis Keiamin N Persentase

P e r e m p u a n 1 8 6 0 0

L a k i - l a k i 1 2 4 0 0

Total 30 100

B e r d a s a r k a n t a b e l 4 4 d i a t a s d a p a t d i k e t a h u i b a h w a j e n i s k e i a m i n

t e r b a n y a k p a d a s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h p e r e m p u a n

y a i t u s e b a n y a k 1 8 o r a n g ( 6 0 0 )

29

E Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n t i n g k a t

p e n d i d i k a n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 45 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

Tingkat Pendidikan N Persentase

P e n d i d i k a n d a s a r 20 6 6 7

P e n d i d i k a n m e n e n g a h d a n P e n d i d i k a n m e n e n g a h d a n 10 333

t i n g g i

Total J O 100

B e r d a s a r k a n t a b e l 4 5 d i a t a s d a p a t d i k e t a l i u i b a l i w a t i n g k a t p e n d i d i k a n

t e r b a n y a k p a d a s a m p e i y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h t i n g k a t

p e n d i d i k a n d a s a r y a i t u s e b a n y a k 20 o r a n g ( 6 6 7 )

P Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n riwayat

d i a b e t e s m e l i t u s d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 46 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

Riwayat Diabetes Melitus N Persentase

Y a 17 5 6 7

T i d a k 13 433

Total 30 100

B e r d a s a r k a n t a b e l 4 6 d i a t a s d a p a t d i k e t a h u i b a l i w a s a m p e l y a n g

m e n g a l a m i i n f e k s i s a i u r a n k e m i h t e r b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s

y a i t u s e b a n y a k 1 7 o r a n g ( 5 6 7 )

30

412 Hasil Analisis Bivariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s b i v a r i a t

a n t a r a I a i n h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h j e n i s

k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h t i n g k a t p e n d i d i k a n d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n

i n f e k s i s a l m a n k e m i h

A n a l i s i s y a n g d i g u n a k a n p a d a u j i d u a v a r i a b e l y a n g b e r s k a l a k a t e g o r i k

a d a l a l i d e n g a n u j i Chi-Square d e n g a n n i e i h a t n i l a i Pearson Chi-Square S e m u a

h a s i l d a r i u j i h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h m e n g g i u i a k a n u j i Chi-

Square k a i e n a m e m e n u h i s y a r a t u j i Chi-Square y a i t u lt 2 0 s e l y a n g m e m p u n y a i

n i l a i expected count lt 5

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 47 Hasil Uji Hubungan antara Usia dengan Kejadian Infeksi

Saiuran Kemih

Usia

Infeksi Saiuran Kemih

^a Tidak

n N Mgt

Jumlah P

value 95Cl

lt 50 t a h u n 1 4 1 9 2 5 9 8 0 8 7 3 0 0 0 0 2 7 4 7 - 2 0 4 3 1

gt 5 0 t a h u n 1 6 6 4 0 9 3 6 0 2 5

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 7 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R = 7 4 9 2

( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a u s i a gt

5 0 t a h u n a d a l a l i 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a u s i a lt 5 0 t a h u n

31

B Hubungan antara Jenis Keiamin dengan Kejadian Infeksi Saiuran

Kemih

H a s i l a n a l i s i s b i v a r i a t l i u b u n g a n a n t a r a j e n i s k e l a i n i n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

Tabel 48 Hasil Uji Hubungan antara Jenis Keiamin dengan Kejadian

Infeksi Saiuran Kemih

Infeksi Saiuran Kemih Jenis P

A Tidak Jumlah 95CI Keiamin value

N N

P e r e m p u a n 18 6 4 3 10 357laquoo 2 8 3 2 2 7 -P e r e m p u a n 0 0 0 0

L a k i - l a k i 12 1 7 1 5 8 8 2 9 7 0 2 3 4 5 9

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 8 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a l a l i

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k N 4 a k a a d a l i u b u n g a n y a n g s i g n i f i k a n a n t a r a

j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R ) = 8 7 0 0

f 9 5 C I = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a l a k i - l a k i

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e n i i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

32

Tabel 49 Hasil liji Hubungan antara Tingkat Pendidikan dengan

Kejadian Infeksi Saiuran Kemih

Infeksi Saiuran Kemih P

Y a T i d a k jumlah 95CI value

N

P e n d i d i k a n d a s a r 2 0 5 4 1 1 7 4 5 9 3 7

P e n d i d i k a n

m e n e n g a h d a n 10 1 6 4 5 1 8 3 6 6 1

t i n g g i

Jumlah JO 30 6 68 694 9H

B e r d a s a r k a n t a b e l 4 9 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( 0 R ) =

6 0 0 0 ( 9 5 C I = 2 3 5 1 - 1 5 3 1 0 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r a d a i a h 6 k a l i l e b i h b e s a r

d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i h a t

p a d a t a b e l d i b a w a h i n i

Tingkat

Pendidikan

2 3 5 1 -0 0 0 0

1 5 3 1 0

33

Tabel 4t0 Hasil I j i Hubungan antara Riwayat Diabetes Melitus dengan

Kejadian Infeksi Saiuran Kemih

Riwayat Infeksi Saiuran Kemih P

Diabetes Va Tidak Jumlah value

95CI

Melitus N bullVJ N

Y a

T i d a k

17

1 3

6 8 0

1 7 8

8

6 0

3 2 0

8 2 2

2 5

7 3 0 0 0 0

3 4 9 3 -

2 7 5 3 6

Jumlah 30 306 68 571 98

B e r d a s a r k a n t a b e l 4 1 0 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio

( O R ) = 9 8 0 8 ( 9 5 C I - 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r

d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s m e l i m s

42 Pembahasan

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a l a b e l 4 7 d i d a p a t k a n b a l i w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i b d e n g a n n i l a i s i g n i f i k a n n y a a d a l a l i 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k

Odds Ratio ( O R ) = 7 4 9 2 ( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a u s i a T 5 0 t a h u n a d a i a h 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a

u s i a lt 5 0 t a h u n

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n A n d r y L u k a n d y

( 2 0 1 4 ) m e n g e n a i k a r a k t e r i s t i k p a s i e n - p a s i e n i n f e k s i s a i u r a n k e m i h d i m a n a

p e n d e r i t a I S K d e n g a n k e l o m p o k u m u r gt 5 0 t a h u n s e b a n y a k 2 3 o r a n g s e d a n g k a n

j u m l a h p e n d e r i t a I S K d e n g a n k e l o m p o k u m m lt 5 0 t a l i u n s e b a n y a k 2 0 o r a n g

P e n e l i t i a n i n i j u g a d i p e i k u a t o l e h p e n l i t i a n L e w i s A l e t a l ( 2 0 1 4 ) m e n g e n a i

impact of host age and parity on susceptihility to severe urinary tract injection in

34

a murine mode d e n g a n u j i K r u s k a l - W a l l i s d e n g a n post-test D u n n u n t u k b e b e r a p a

p e r b a n d i n g a n d i m a n a u s i a d a n p a r i t a s s e b a g a i f a k t o r y a n g b e r k o n t r i b u s i d a l a m

k e r e n t a n a n i m t u k t e r j a d i n y a I S K d e n g a n n i l a i p lt 0 0 5

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n g a t a k a n b a h w a i n s i d e n I S K m e n i n g k a t

b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n

a d a n y a a b n o r m a l i t a s a n a t o m i y a n g m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n

k e m i h s e p e r t i p e m b e s a r a n p r o s t a t d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a

p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e ( R o s e 2 0 0 9 ) P e n y e b a b l a i n t e n n a s u k

p e r i n e i u n y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s p e n y a k i t n e u r o m u s k u l a r

d a n k a t e t e r i s a s i b u l i - b u l i ( F o x m a n e t a l 2 0 1 0 ) S e l a i n i t u i n s i d e n I S K m e n c a p a i

1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o n a l d 2 0 1 1 )

B Hubungan antara Jenis Keiamin dengan Kejadian infeksi Saiuran

Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 8 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d e n g a n n i l a i s i g n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O

d i t o l a k Odds Ratio ( O R ) = 8 7 0 0 ( 9 5 C l = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a risiko k e j a d i a n

i n f e k s i s a i u r a n k e m i h p a d a p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n

p a d a l a k i - i a k i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n M a g i i a n o e t a l

( 2 0 1 1 ) m e n g e n a i Gender and Age-Dependent Etiology of Community Acquired

y a n g m e l a k u k a n p e n g a m b i l a n 6 1 2 7 3 s a m p e l k u l t u r u r i n d a l a m p e r i o d e 2 2 b u l a n

d a r i s a m p e l i n i d i d a p a t k a n 1 3 8 2 0 ( 2 2 6 ) d i t e m u k a n p o s i t i f i n f e k s i b a k t e r i

h a m p i r 8 0 b a l i a n y a n g d i i s o l a s i b e r a s a l d a r i p e r e m p u a n P e n e l i t i a n i n i j u g a

d i p e r k u a t o l e h p e n e l i t i a n y a n g d i l a k u k a n o l e h Y u n i t a I ( 2 0 1 0 ) d i m a n a a d a

h u b m i g a n y a n g b e n n a k n a a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h ( P value=O049 R P = 3 2 7 3 ( 9 5 C I = I 0 1 6 - 1 0 5 4 0 )

H a l t e r s e b u t d a p a t t e r j a d i k a r e n a u r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a l i

d e n g a n d e k a t n y a v a g i n a l v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i

s a i u r a n k e m i h l e b i h s e r i n g p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a flora n o r m a l

3 5

p a d a d a e r a h p e r i u r e t r a t e r d i r i d a r i o r g a n i s m e s e p e r t i i a c t o b a c i l l u s y a n g m e m b a n t u

m e l a w a n k o l o n i s a s i b a k t e r i p a t o g e n p a d a s a i u r a n k e m i h P e r u b a h a n l i n g k i m g a n

d a r i p e r i u r e t r a l s e p e r t i p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k

b i s a m e n g g a n g g u f l o r a n o r m a l s e h i n g g a m e n u m g k i n k a n b a k t e r i p a t o g e n

b e r k o l o n i s a s i d a n m e n y e b a b k a n i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Scuare p a d a t a b e l 4 9 d i d a p a t k a n b a h w a

t e r d a p a t l i u b u n g a n y a n g s i g n i f i k a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a

H O d i t o l a k Odds Ratio ( O R ) - 6 0 0 0 ( 9 5 o C l = 2 3 5 1 - 1 5 3 I O ) a r t i n y a n s i k o

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r

a d a i a h 6 k a l i l e b i h b e s a r d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n

m e n e n g a h d a n t i n g g i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h T o r o n d e i B e t

a l ( 2 0 1 5 ) m e n g e n a i Menstrual Hygiene Practices WASH Access and the Risk of

Urogenital Infection in Women from Odisha India d i m a n a p e r e m p u a n y a n g

h a n y a m e n e m p u l i p e n d i d i k a n s e k o l a h d a s a r a t a u l e b i h r e n d a h d i b a n d i n g k a n

d e n g a n t i n g k a t p e n d i d i k a n m e n e n g a h a t a u t i n g g i m e m i l i k i r i s i k o 3 k a l i

k e m u n g k i n a n l e b i h b e s a r m e n g a l a m i i n f e k s i s a i u r a n k e m i h ( A d j O R = 3 l 9 5

C 1 = I 2 - 7 9 p = 0 0 2 )

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a p e n g e t a h u a n s e s e o r a n g

t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t p e n d i d i k a n S e s e o r a n g y a n g

m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m u n g k i n a n p e n g e t a l i u a n t e n t a n g

k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o r m a s i y a n g d i d a p a t k a n t e n t a n g k e s e h a t a n

l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h S e b a l i k n y a

p e n d i d i k a n y a n g k u r a n g d a p a t i n e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g t e r h a d a p

n i l a i - n i l a i y a n g b a r u d i k e n a l ( N o t o a d m o j o 2 0 0 3 )

3 6

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Keniih

B e r d a s a r k a n l i a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 1 0 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a r i w a y a t d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 )

s e h i n g g a H O d i t o l a k Odds Ratio ( O R ) = 9 8 0 8 ( 9 5 C I = 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a

risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h S a r i E W P d a n

S a t y a b a k t i P ( 2 0 1 5 ) m e n g e n a i p e r b e d a a n risiko i n f e k s i n o s o k o m i a l s a i u r a n k e m i h

b e r d a s a r k a n k a t e t e r i s a s i u r i n u m u r d a n d i a b e t e s m e l i m s d i m a n a d a r i 2 0 p a s i e n

i n f e k s i n o s o k o m i a l s a i u r a n k e m i h 1 2 o r a n g ( 6 0 ) d i a n t a r a n y a a d a i a h p a s i e n

d e n g a n s t a t u s D M s e d a n g k a n 8 o r a n g ( 4 0 ) l a i n n y a a d a i a h p a s i e n t a n p a s t a t u s

D M ( P v W w ^ = 0 0 2 4 O R = 6 0 0 9 5 C I = 1 2 2 - 3 2 2 6

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a b a l i w a b e b e r a p a b a g i a n

d a r i i i n u n i t a s p a d a p a s i e n d i a b e t e s m e n g a l a m i p e r u b a h a n F u n g s i

p o l i n i o r f o l e u k o s i t d i t e k a n p a d a k e a d a a n a s i d o s i s I k a t a n l e u k o s i t k e m o t a k s i s d a n

f a g o s i t o s i s j u g a b e m b a l i S i s t e m a n t i o k s i d a n y a n g b e r p e r a n p a d a a k t i f i t a s

b a k t e r i s i d a l j u g a t e r g a n g g u s e h i n g g a m e n y e b a b k a n t e r j a d i n y a I S K p a d a p a s i e n -

p a s i e n d e n g a n p e n y a k i t d i a b e t e s ( J u l k a 2 0 1 4 )

H a l y a n g s a m a j u g a d i i m g k a p k a n o l e b t e o r i S m e l t z e r d a n B a r e ( 2 0 1 0 )

b a l i w a D M d a p a t m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a l i a n a n t u b u h y a n g

b e r p o t e n s i m e n i n g k a t k a n r i s i k o t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a l i a n a n

t u b u h t e r s e b u t d i a n t a r a n y a a d a i a h k e g a g a l a n m i g r a s i s e l iniraceliular killing

f a g o s i t o s i s d a n k e m o t a k s i s p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n

m e k a n i s m e p e r t a l i a n a n a l a m i a h I o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p

i n f e k s i

BAB V

KESIMPULAN DAN SARAN

51 Kesimpulan

1 U s i a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 2 6 - 3 5 t a h u n y a i t u 2 3 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 3 7

2 U s i a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 4 6 - 5 5 t a l i u n y a i t u 2 9 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 1 3

3 U s i a j e n i s k e i a m i n d a n t i n g k a t p e n d i d i k a n s a m p e i y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i l i t e r b a n y a k y a i t u b e r u s i a gt 5 0 t a h u n ( 5 3 3 ) j e n i s k e i a m i n

p e r e m p u a n ( 6 0 0 ) d a n t i n g k a t p e n d i d i k a n d a s a r ( 6 6 7 ) s e r t a p a l i n g

b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s y a i t u 5 6 7

4 T e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 ( p = 0 0 0 0 )

52 Saran

1 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t d i l a k u k a n d e n g a n d e s a i n

p e n e l i t i a n b e r b e d a s e p e r t i cohort a t a u case control

2 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t m e i i c a r i v a r i a b e l independent

y a n g l a i n s e p e r t i v a r i a b e l p e k e r j a a n p e m a s a i i g a n k a t e t e r a t a u l a m a n y a

m e n d e r i t a d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

37

DAFTAR PUSTAKA

B o y k o E J d k k 2 0 0 2 D i a b e t i c A n d T h e R i s k O f A c u t e U r i n a r y T r a c t I n f e c t i o n A m o n g P o s t m e n o p a u s a l W o m e n D i a b e t e s C a r e 2 5 ( 1 0 )

D a h l a n S 2 0 1 4 B u k i i S t a t i s t i k u n t u k K e d o k t e r a n d a n K e s e h a t a n D e s k r i p t i f B i v a r i a t d a n M u l t i v a r i a t d i l e n g k a p i a p l i k a s i d e n g a n m e n g g u n a k a n S P S S E d i s i 6 E p i d e m i o l o g i I n d o n e s i a J a k a r t a I n d o n e s i a

D e p a r t e m e n K e s e h a t a n ( D E P K E S ) R l 2 0 1 4 [ O n l i n e ] K e m e n t e r i a n K e s e h a t a n R e p u b l i k I n d o n e s i a P u s a t D a t a d a n I n f o r m a s i K e m e n t e r a n K e s e h a t a n R l ( http 7depkesgoid diakses tanggal 15 Met 2016)

F o x m a n B e t a i 2 0 1 0 U r i i i a i y T r a c t I n f e c t i o n A m o n g W o m e n A g e d 4 0 T o 6 5 B e h a v i o r a l A n d S e x u a l R i s k F a c t o r s D a l a m T a n a g h o E A M c A n i n c h J W 1 7 t h S m i t h s G e n e r a l U r o l o g y U S A M c G r a w H i l l (http searchproqnestcom diakses tanggal 16 Met 2016)

H a r d i n g G K d k k 2 0 1 0 A n t i m i c r o b i a l T r e a t m e n t I n D i a b e t i c W o m e n W i t l i A s y m t o m a t i c B a c t e r i u r i a N E n g l J M e d 3 4 7 1 5 7 6 - 1 5 8 3 (http nejmorg diakses tanggal 16 Met 2016)

I s s e l b a c h e r d k k 2 0 0 9 I n f e k s i S a i u r a n K e m i h d a n P i e l o n e f r i t i s D a l a m S t a m m W a l t e r E e d H a r r i s o n P r i n s i p - P r i n s i p l l m u P e n y a k i t D a l a m e d V o l u m e 2 J a k a r t a E G C 6 1 6 - 6 2 3

J u l k a S 2 0 1 3 G e n i t o u r i n a r y I n f e c t i o n I n D i a b e t e s I n d i a n J o u m a l o f E n d o c r i n o l o g y a n d M e t a b o l i s m (http searchproquestcom diakses tanggal 16 Mei 2016)

K i m B d k k 2 0 1 2 [ e - b o o k ] T h e R e l a t i o n b e t w e e n P o s t v o i d R e s i d u a l a n d O c c u r r e n c e o f U r i n a r y T r a c t I n f e c t i o n a f t e r S t r o k e i n R e h a b i l i t a t i o n U n i t A n n a l s o f R e h a b i l i t a t i o n M e d i c i n e

K o m a r a A 2 0 0 9 P o l a K e p e k a a n B a k t e r i G r a m N e g a t i f d a r i P a s i e n I n f e k s i S a i u r a n K e m i l i t e r h a d a p A n t i b i o t i k G e n t a m i c i n d a n K o t r i m o k s a z o l y a n g D i k i r i m k e L a b o r a t o r i u m M i k r o b i o l o g i K l i n i k F K U l d a r i T a h u n 2 0 0 1 s a m p a i T a h u n 2 0 0 5 (http dontaruiacid diakses tanggal OH Agustiis 2016)

L e w i s A L e t a l 2 0 1 4 I m p a c t o f H o s t A g e a n d P a r i t y o n S u s c e p t i b i l i t y t o S e v e r e U r i n a r y T r a c t I n f e c t i o n i n a M u r i n e M o d e l P l o s O n e R e s e a r c h A r t i c l e P u b l i c L i b r a r y o f S c i e n c e 9 ( 5 ) (http searchproquestcom diakses pada langgal 30 Desember 2016)

38

HALAMAN PERSEMBAHAN DAN MOTTO

OfaBjrdafi ada sesuatuyan^ menanttmu sedpas Battya^BgsaSaran (yang Bpu

jaCani) yang a^n memStiatmu terpana Singga (au Cupa Setapa pedifinya rasa

saSit - (Jid ltBinABi TltadB)

Dengan izin-Mu ya Allah ku persembahkan karya ini untuk

bull Kedua orangtuaku yang tercinta Riza Efendi SHbdquo MH dan Dra Yusdiami

yang selalu memberikan motivasi nasihat dan semangat untuk meraih cita-

citaku serta doa dan kasih sayang di setiap langkaliku Ma P a i know this

is not enough yet to reply a l l your affection and everything that you already

gave h u t im trying to he the best i n everything for you and absolutely you

a r e my entire worlct

bull Saudara kandungku tersayang Eka Satriawan A Md Im SH MH dan

Threenita Sari Sepgi Putri yang telah banyak membantu menemani serta

menghibur di setiap hari-hariku Im so g r a t e f u l to have you kak g r a You

a r e truly my beloved siblings

bull Pembimbing skripsiku dr M Ayus Astoni Sp PD KGEH FINASIM

MARS dan dr Ratika Febriani yang telah memberikan nasihat saran dan

ilmu yang bermanfaat serta meluangkan waktunya untuk membimbing

skripsi ini bingga selesai

bull Teman-teman terdekatku ( C H A T g r o u p dan Bujang Gadis g r o u p ) yang selalu

dapat memberikan keceriaan semangat dan bantuan di saat menghadapi

kesulitan do believe we can be a success doctor and get our dreams

someday Keep down to e a r t h guys

bull Dan seluruh teman-teman angkatan 2013 (Genome H e x a ) yang telah banyak

memberikan bantuan selama proses perkuliahan di tahap akademik Semoga

kesuksesan dan ridho Allah SWT selalu mengiringi iangkali kita Aamiin ya

rabbal allamin See you on topgjrys

iv

UNIVERSITAS MUHAMMADIYAH P A L E M B A N G F A K U L T A S K E D O K T E R A N

S K R I P S L JANUARI 2017 R E Z A AGUSTIANTWO PUTRA

Hubungan antara Usia Jenis Keiamin Tingkat Pendidikan dan Riwayat Diabetes Melitus dengan Kejadian Infeksi Saiuran Kemih pada Pasien Rawat Inap dan Rawat Jalan di Bagian Penyakit Dalam Rumah Sakit Muhammadiyah Palembang Periode 1 Januari 2015-31 Desember 2015

xii + 37 halaman + 12 tabel + 1 gambar + 8 lampiran

A B S T R A K

I n t e k s i s a i u r a n k e m i h ( I S K ) m e n i p a k a n s u a t u i n f e k s i y a n g m e n g e n a i t r a k t u s u r i n a r i u s d a n h a m p i r 1 0 o r a n g p e m a h t e r k e n a I S K s e l a m a h i d u p n y a M e n u m t t e o r i m e n i n g k a t n y a k e j a d i a n I S K b e r h u b i m g a n d e n g a n p e n i n g k a t a n u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s P e n e l i t i a n i n i b e m i j u a n u n t u k m e n g a n a l i s i s h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i l i p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R i u n a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 J e n i s p e n e l i t i a n i n i a d a i a h o b s e r v a s i o n a i a n a l i t i k d e s a i n cross sectional d e n g a n m e n g g i i n a k a n d a t a s e k u n d e r d a r i r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g S a m p e l p e n e l i t i a n i n i a d a i a h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 d e n g a n b e s a r s a m p e l s e b a n y a k 9 8 s a m p e l S a m p e l p e n e l i t i a n i n i d i a m b i l d e n g a n c a r a consecutive sampling H a s i l u j i s t a t i s t i k d i d a p a t k a n h u b u n g a n i n f e k s i s a i u r a n k e m i h d e n g a n u s i a ( p = 0 0 0 0 ) j e n i s k e i a m i n ( p = 0 0 0 0 ) t i n g k a t p e n d i d i k a n ( p = 0 0 0 0 ) d a n riwayat d i a b e t e s m e l i t u s ( p 0 0 0 0 ) S e h i n g g a d a p a t d i s i m p u l k a n b a h w a t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n rawat j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e i J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

Referensi 29(2002-2015) Kata kunci Infeksi Saiuran Kemih Riwayat Diabetes Melitus

V

U N I V E R S I T Y O F M U H A M M A D I Y A H P A L E M B A N G FA cut T Y or M E D I C I N E

MINI THESIS J A N U A R Y 2 0 1 7 R E Z A A G U S T I A N T W O P U T R A

T h e Relationships between Age Gender Education Level Diabetes M e l i t u s History and The Incidence of U r i n a r y T r a c t Infections i n Hospitalized Patients and Outpatients at I n t e r n a l M e d i c i n e o f M u h a m m a d i y a h Palembang H o s p i t a l d u r i n g I J a n u a r y 2 0 1 5 - 3 1 December 2 0 1 5

x i i + 37pages + 12 tables + I picture + 8 attachments

A B S T R A C T

Urinary trad infection (UTI) is an infection of I he urinary tract and nearly 10 of people experience UTI during their lifeiime According to theory the increasing of urinary tract infections is related with increasing age gender education level and diabetes melitus history This study aim to analyze relationships between age gender education level diabetes melitus history and the incidence of urinary tract infections in hospitalized patients and outpatients at Internal Medicine of Muhammadiyah Palembang Hospilal during P January 2015-31 December 2015 This study lipe was analyiical observaiional with cross sectional design by using secondary data from medical record of Muhammadiyah Palembang Hospital Samples of this study were taken by consecutive sampling technique The results of statistical test were obtained relationship between urinary tract infections with age (p 0000) gender (p 0000) education level (p 0000) and diabetes melitus (p 0000) In conclusion there are significantly relationships between age gender education level diabetes melitus history and the incidence of urinary tract infections in hospitalizedpatients and outpatients at Internal Medicine of Muhammadiyah Palembang Hospital during P January 20J5-3PDecember 2015

References 2 9 ( 2 0 0 2 - 2 0 1 5 ) Keywords U r i n a r y T r a c t I n f e c t i o n s Diabetes M e l i t u s

vi

KATA PENGANTAR

S e g a l a p u j i s y u k u r k e p a d a A l l a l i S W T k a r e n a a t a s b e r k a t d a n r a h m a t - N y a p e n u l i s d a p a t i n e n y e l e s a i k a n s k r i p s i y a n g b e r j u d u l H u b u n g a n A n t a r a U s i a J e n i s K e i a m i n T i n g k a t P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h P a d a P a s i e n R a w a t i n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 S k r i p s i i n i d i s u s u n s e b a g a i s a l a h s a t u s y a r a t u n t u k m e m p e r o l e h g e l a r S a r j a n a K e d o k t e r a n d i F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u l i a m m a d i y a h P a l e m b a n g

P e n u l i s m c n y a d a r i b a l i w a d a l a m p r o s e s i n e n y e l e s a i k a n s k r i p s i i n i b a n y a k k e n d a l a y a n g d i a l a i n i n a n i u n b e r k a t b a n t u a n b i m b i n g a n k e r j a s a m a d a r i b c r b a g a i p i h a k d a n t e r u t a m a b e r k a t A l l a h S W T k e n d a l a t e r s e b u t d a p a t d i a t a s i

P e n u l i s j u g a m e n v a d a r i b a h w a s k r i p s i i n i m a s i h j a u h d a r i s e m p u m a m a k a d e n g a n s e g a l a k e r e n d a h a n l i a t i p e n u l i s m e n g l i a r a p k a n a d a n y a k r i t i k d a n s a r a n y a n g b e r s i f a t m e m b a n g u n d e m i k e s e m p u m a a n s k r i p s i i n i

A k h i r k a t a p e n u l i s b c r l i a r a p A l l a l i S W T b e r k e n a n m e m b a i a s s e g a l a k e b a i k a n s e m u a p i h a k y a n g t e l a h m e m b a n t u S e m o g a s k r i p s i i n i d a p a t b e n n a n f a a t b a g i k i t a s e m u a A a m i i n

P a l e m b a n g 0 7 F e b r u a r i 2 0 1 7

R e z a A g u s t i a n t w o P u t r a

vii

DAFTAR ISI

HALAMAN J D D U L HALAMAN PENCESAHAN i HALAMAN PERNN ATAAN ii HALAMAN PERSEMBAHAN iii A B S T R A K iv A B S T R A C T v K A T A PENGANTAR vi DAFTAR ISI vii DAFTAR T A B E I ix DAFTAR GAMBAR x DAFTAR LAMPIRAN xi

BAB I Pendahuluan 1 1 1 L a t a r B e l a k a n g 1 12 R i i m u s a n M a s a l a h 3 13 T u j u a n P e n e l i t i a n 3 14 M a n l a a t P e n e l i t i a n 4 15 K e a s l i a n P e n e l i t i a n 5

BAB H Tinjauan Pustaka 9 2 1 L a n d a s a n T e o r i 9

2 1 1 I n f e k s i S a i u r a n K e m i h 9 A D e f i n i s i 9 B E p i d e m i o l o g i 9 C K i a s i f i k a s i 1 0 D E t i o l o g i 1 1 E P a t o f i s i o l o g i 11 F F a k t o r R i s i k o 1 2 G M a n i f e s t a s i K l i n i s 1 5 H T a t a l a k s a n a 1 6 I K o m p l i k a s i 1 6

2 2 K e r a n g k a T e o r i 1 7 2 3 H i p o t e s i s 1 8

BAB I I I Metode Penelitian 19 3 1 J e n i s P e n e l i t i a n 1 9 3 2 W a k t u d a n T e m p a t P e n e l i t i a n 1 9 3 3 P o p u l a s i d a n S a m p e l 1 9

3 3 1 P o p u l a s i P e n e l i t i a n 1 9 3 3 2 S a m p e l d a n B e s a r S a m p e l P e n e l i t i a n 1 9 3 3 3 K n t e r i a I n k l u s i d a n E k s k l u s i 2 0 3 3 4 C a r a P e n g a m b i l a n S a m p e l P e n e l i t i a n 2 0

3 4 V a r i a b e l P e n e l i t i a n 2 0 3 4 1 V a r i a b e l Dependent 2 0 3 4 2 V a r i a b e l Independent 2 0

viii

3 5 D e f i n i s i O p e r a s i o n a l 2 1 3 6 C a r a P e n g i i n i p u l a n D a t a 2 2

3 6 1 D a t a S e k u n d e r 2 2 3 7 M e t o d e T e k n i s A n a l i s i s D a t a 2 2

3 7 C a r a P e n g o l a h a n d a n A n a l i s i s D a t a 2 2 3 8 A l u r P e n e l i t i a n 2 4

BAB IV HASIL DAN PEMBAHASAN 25 4 1 H a s i l 2 5 4 2 P e m b a h a s a n 3 3

BAB V KESIMPLILAN DAN SARAN 37 5 1 K e s i m p u l a n 3 7 5 2 S a r a n 3 7

D A F T A R PUSTAKA 38 LAMPIRAN 41 BIODATA 63

ix

DAFTAR T A B E L

Tabel Halaman

T a b e l 1 1 K e a s l i a n P e n e l i t i a n 5 T a b e l 3 1 D e f i n i s i O p e r a s i o n a l 2 1 T a b e l 4 1 D i s t r i b u s i P r o p o r s i K a r a k t e r i s t i k P a s i e n R a w a t i n a p

B e r d a s a r k a n U s i a d a n J e n i s K e i a m i n 2 6 T a b e l 4 2 D i s t r i b u s i P r o p o r s i K a r a k t e r i s t i k P a s i e n R a w a t J a l a n

B e r d a s a r k a n U s i a d a n J e n i s K e i a m i n 2 7 T a b e l 4 3 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n U s i a 2 8 T a b e l 4 4 D i s t r i b u s i P r o p o r s i K e j a d i a n i n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n J e n i s K e l a m m 2 8 T a b e l 4 5 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n T i n g k a t P e n d i d i k a n 2 9 T a b e l 4 6 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n R i w a y a t D i a b e t e s M e l i t u s 2 9 T a b e l 4 7 H a s i l U j i H u b u n g a n a n t a r a U s i a d e n g a n K e j a d i a n

i n f e k s i S a i u r a n K e m i h 3 0 T a b e l 4 8 H a s i i U j i H u b u n g a n a n t a r a J e n i s K e i a m i n d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i b 3 1 T a b e l 4 9 H a s i l U j i H u b u n g a n a n t a r a T i n g k a t P e n d i d i k a n d e n g a n

K e j a d i a n i n t e k s i S a i u r a n K e m i h 3 2 T a b e l 4 1 0 H a s i l U j i H u b u n g a n a n t a r a R i w a y a t D i a b e t e s M e l i t u s

d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h 3 3

X

DAFTAR GAMBAR

Gambar Halaman

G a m b a r 3 1 A l u r P e n e l i t i a n H u b u n g a n U s i a J e n i s K e i a m i n T i n g k a t

P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i h p a d a P a s i e n R a w a t i n a p

d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g I e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1

D e s e m b e r 2 0 1 5 2 4

xi

DAFTAR LAMPIRAN

Lampiran Halaman

L a m p i r a n 1 D a t a R e k a m M e d i s P a s i e n R a w a t I n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 4 3

L a m p i r a n 2 H a s i l A n a l i s i s U n v i a r i a t 4 5

L a m p i r a n 3 H a s i l A n a l i s i s B i v a r i a t 5 1

L a m p i r a n 4 K a r t u B i m b i n g a n P r o p o s a l S k r i p s i 5 8

L a m p i r a n 5 K a r t u B i m b i n g a n S k r i p s i 5 9

L a m p i r a n 6 S u r a t P e n n o h o n a n I z i n P e n e l i t i a n 6 0

L a m p i r a n 7 S u r a t K e t e r a n g a n I z i n P e n g a m b i l a n D a t a d a n P e n e l i t i a n 6 1

L a m p i r a n 8 S u r a t K e t e r a n g a n S e l e s a i P e n e l i t i a n 6 2

xii

BAB I

PENDAHULUAN

11 Latar Belakang

I n f e k s i s a i u r a n k e m i h ( I S K ) m e n i p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m i i k a n d i R u m a h S a k i t a t a u t e m p a t p r a k t i k u m u m s e h a r i - h a r i I S K

a d a i a h s u a t u i n f e k s i y a n g m e n g e n a i t r a k t u s u r i n a r i u s m u l a i d a r i m e a t u s u r e t r a

s a m p a i d e n g a n k e g i n j a l S t r u k t u r y a n g t e n n a s u k d i d a l a m n y a a d a i a h u r e t r a

k a n d u n g k e m i h u r e t e r p e l v i s d a n p a r e n k i m g i n j a l S t r u k t u r y a n g b e r k a i t a n u n t u k

t e r j a d i n y a i n f e k s i d a n r e k u r e n i n f e k s i y a i t u p r o s t a t e p i d i d i m i s d a n fascia

perinephric I s t i l a h I S K m e n u n j u k k a n a d a n y a k e b e r a d a a n m i k r o o r g a n i s m e d i

d a l a m u r i n ( S u d o y o 2 0 0 6 R u b i n 2 0 1 0 ) D e n g a n k a t a l a i n b a h w a d i a g n o s i s I S K

d i t e g a k k a n d e n g a n m e m b u k t i k a n a d a n y a m i k r o o r g a n i s m e d i d a l a m s a i u r a n k e m i h

( R u b i n 2 0 1 0 )

S e b a n y a k 2 5 j u t a k e m a t i a n d i s e l u r u h d u n i a p a d a t a h u n 2 0 1 1 s e p e r t i g a n y a

d i s e b a b k a n o l e h p e n y a k i t i n f e k s i I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n i n f e k s i

d e n g a n k e t e r l i b a t a i i b a k t e r i t e r s e r i n g d i k o m u n i t a s d a n h a m p i r 1 0 o r a n g p e m a h

t e r k e n a I S K s e l a m a h i d u p n y a S e k i t a i - 1 5 0 j u t a p e n d i i d u k d i s e l u r u h d u n i a t i a p

t a l i u n n y a t e r d i a g n o s i s m e n d e r i t a i n f e k s i s a i u r a n k e m i h ( Y u n u s 2 0 1 2 )

I S K d a p a t m e n g e n a i s e m u a k e l o m p o k u m u r b a i k a n a k r e m a j a d e w a s a

m a u p u n u s i a l a n j u t P r e v a l e n s i a n a k u s i a s e k o l a h y a n g m e n d e r i t a I S K s e k i t a r 1 -

3 d a n m e n i n g k a t p a d a r e m a j a y a n g s u d a h m e l a k u k a n h u b i m g a n s e k s u a l

( K o m a r a 2 0 0 9 ) D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r 2 5 - 3 5

s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a S e l a m a

p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n c e n d e r u n g

m e n d e r i t a I S K d i b a n d i n g k a n l a k i - l a k i ( S u d o y o 2 0 0 9 )

R a s i o I S K p a d a w a n i t a d i b a n d i n g p r i a b e r k i s a r 3 0 1 d a n s e k i t a r 5 0 w a n i t a

y a n g t e r k e n a i n f e k s i a k a n b e r k e m b a n g m e n j a d i I S K b e m l a n g I S K m e n i p a k a n

i n f e k s i b a k t e r i y a n g p a l i n g s e r i n g p a d a a n a k - a n a k d e n g a n k e l u h a n d e m a m b a i k

p a d a a n a k p r i a m a u p u n w a n i t a P r e v a l e n s i y a n g p e m a h d i l a p o r k a n b e r k i s a r 4 1

I

2

s a m p a i 7 5 R e k u r e n s i c u k u p s e r i n g d a n t e r j a d i s e k i t a r 1 8 p a d a b a y i l a k i - i a k i

d a n 2 6 p a d a b a y i p e r e m p u a n U n t u k u s i a p r a s e k o l a h I S K l e b i h s e r i n g

m e n g e n a i w a n i t a I n s i d e n I S K p a d a a n a k - a n a k p r a s e k o l a h s e k i t a r 2 ( S y a h r i n i

2 0 1 1 )

D a r i b e r b a g a i p e n e l i t i a n e p i d e m i o l o g i s d i I n d o n e s i a d i d a p a t k a n p r e v a l e n s i

D M s e b e s a r 15 - 2 3 p a d a p e n d u d u k u s i a l e b i J i d a r i 1 5 t a h u n b a h k a n p a d a

s u a t u p e n e l i t i a n e p i d e m i o l o g i s d i M a n a d o d i d a p a t k a n p r e v a l e n s i D M a d a i a h 6 1

P r e v a l e n s i d i a b e t e s m e l i t u s p a d a p e n d u d u k u s i a 2 5 - 6 4 t a h u n d i J a w a d a n B a l i

s e b e s a r 7 5 P e n e l i t i a n y a n g d i l a k u k a n d i J a k a r t a S u r a b a y a M a k a s a r d a n k o t a -

k o t a l a i n d i I n d o n e s i a m e m b u k t i k a n a d a n y a k e n a i k a n p r e v a l e n s i d a r i t a h u n

k e t a h u n ( D E P K E S 2 0 1 4 W H O 2 0 1 0 )

I n f e k s i s a i u r a n k e m i h j u g a m e n i p a k a n m a s a l a h k l i n i s u m u m p a d a p e n d e r i t a

D M o l e h k a r e n a p e n d e r i t a D M m e m p u n y a i k e m u n g k i n a n m e n d e r i t a I S K l e b i h

t i n g g i d i b a n d i n g k a n d e n g a n b u k a n p e n d e r i t a D M d a n j u g a m e n d e r i t a i n f e k s i y a n g

l e b i h b e r a t y a n g a k a n m e n i n g k a t k a n risiko u n t u k m a s u k m m a h s a k i t ( H a r d i n g

d k k 2 0 1 0 ) P e n e l i t i a n y a n g d i l a k u k a n o l e h B o y k o d k k m e n d a p a t k a n w a n i t a D M

ripe 2 d e n g a n b a k t e r i u r i a s i m t o m a t i k s e t e l a h d i l a k u k a n p e m a n t a u a n s e l a m a 1 8

b u l a n m e n g a l a m i p e n i n g k a t a n r i s i k o m e n d a p a t k a n I S K s e b a n y a k 3 4

d i b a n d i n g k a n d e n g a n w a n i t a y a n g t i d a k m e n g a l a m i D M s e b e s a r 1 9 ( B o y k o d k k

2 0 0 2 )

B e r d a s a r k a n u r a i a n - u r a i a n d i a t a s s e r t a b e l u m a d a n y a p e n e l i t i a n y a n g

m e n e m u k a n k e t e r k a i t a n f a k t o r u s i a j e n i s k e l a m m t i n g k a t p e n d i d i k a n d a n r i w a y a t

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h d i K o t a P a l e m b a n g m a k a

p e n e l i t i t e r t a r i k i m t i i k m e l a k u k a n p e n e l i t i a n m e n g e n a i h u b u n g a n a n t a r a u s i a j e n i s

k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

3

12 Rumusan Masalah

1 B a g a i m a n a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s

m e l i t u s

2 A p a k a l i a d a h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

13 Tujuan Penelitian

131 Tujuan Umum

T u j u a n u m u m d a r i p e n e l i t i a n i n i a d a i a h d i k e t e m u k a n n y a h u b u n g a n a n t a i a

u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i m s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

132 Tujuan Khusus

T u j u a n k l i u s u s d a r i p e n e l i t i a n i n i y a i t u

1 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a

2 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n m f e k s i s a i u r a n k e m i b p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n j e n i s k e i a m i n

3 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

4

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n t i n g k a t p e n d i d i k a n

4 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n riwayat d i a b e t e s m e l i t u s

5 T e r a n a l i s i s n y a h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a i m n a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

6 T e r a n a l i s i s n y a h u b u n g a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

7 T e r a n a l i s i s n y a h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

8 T e r a n a l i s i s n y a h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i u i s d e n g a n k e j a d i a n

i n f e k s i s a l i u a i i k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

14 Manfaat Penelitian

141 Manfaat Teoritis

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t m e n a m b a h p e n g e t a h u a n p e n e l i t i

t e n t a n g h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i U i s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

5

142 Manfaat Praktis

A Bagi Peneliti

H a s i l p e n e l i t i a n i n i d i l i a r a p k a n d a p a t d i g u n a k a n s e b a g a i s a l a h s a t u b a h a n

r e f e r e n s i a t a u b a c a a n b a g i p e n e l i t i

B Bagi Institusi

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t d i g u n a k a n p i h a k R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g s e b a g a i s a l a l i s a t u b a h a n a c u a n d a l a m m e n g u p a y a k a n

p e n c e g a h a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

15 Keaslian Penelitian

T a b e l 1 1 K e a s l i a n P e n e l i t i a n

Nama Judul Penelitian Desain Hasil Penelitian

Peneliti Penelitian

Kugan P r e v a l e n s i I n f e k s i Cross D a r i p e n e l i t i a n i i i i

Kandasamy S a i u r a n K e m i l i P a d a seciUmal d i p e r o l e h b a l i w a

W a n i t a Y a n g M e n d e r i t a

D i a b e t e s M e l i t u s T i p e

I I Y a n g D i r a w a t I n a p

p a s i e n w a n i t a d i a b e t e s

m e l i t u s t i p e I y a n g

m e n d e r i t a I S K y a n g

D a n D i r a w a t J a l a n D i d i r a w a t m a p d a n

S u b b a g i a n

E n d o k r i n o l o g i B a g i a n

P e n y a k i t D a l a m D i

d i r a w a t j a l a n d i s u b

b a g i a n E n d o k r i n o l o g i

P e n y a k i t D a l a m

R S U P H A d a m M a l i k R S U P H A d a m

P a d a T a l i u n 2 0 0 9 M a l i k M e d a i i t e r d a p a t

s e b a n y a k 2 5 o r a n g

y a i t u ( 1 2 7 ) D a r i 2 5

o r a n g y a n g m e n d e r i t a

I S K t e r d a p a t 3 o r a n g

y a i t u ( 1 2 0 ) y a n g

d i r a w a t i n a p d a n 2 2

6

o r a n g ( 8 8 0 ) y a n g

d i r a w a t j a l a n

Edel Weisela P e r b e d a a n R i s i k o

Permata I n f e k s i N o s o k o m i a l

Sari dan S a i u r a n K e m i h

Prijono B e r d a s a r k a n

Satyabakti K a i e t e r i s a s i U r i n

U m u r D a n D i a b e t e s

M e l i t u s T a h u n 2 0 1 5

Case H a s i l p e n e l i t i a n y a n g

control d i 1 a k u k a n p a d a 2 0

s a m p e l k a s u s d a n

k o n t r o l m e n u n j u k k a n

b a h w a p a s i e n d e n g a n

u m u r gt 5 5 t a h u n

m e m p u n y a i r i s i k o

5 5 7 k a l i m e n g a l a m i

i n f e k s i n o s o k o m i a l

s a i u r a n k e m i h

d i b a n d i n g k a n p a s i e n

d e n g a n u m u r lt 5 5

t a h u n d e n g a n

p e r i l i t u n g a i i b e s a r

risiko d i p e r o l e h n i l a i

O R s e b e s a r 5 5 7

d e n g a n n i l a i 9 5

(onfidence Interval

l 1 9 lt O R lt 2 8 2 3

P a s i e n d e n g a n s t a t u s

D M m e m p u n y a i risiko

6 k a l i u n t u k

m e n g a l a m i i n f e k s i

n o s o k o m i a l s a i u r a n

k e m i h d i b a n d i n g k a n

d e n g a n p a s i e n y a n g

t i d a k m e n d e r i t a D M

d e n g a n n i l a i O R

7

s e b e s a r 6 0 0 d e n g a n

n i l a i 9 5 Confidence

Interval 1 22 lt O R lt

3 2 2 6

Andry K a r a k t e r i s t i k P a s i e n - D e s k r i p k i f H a s i i p e n e l i t i a n d a r i

Lukandy P a s i e n I n f e k s i S a i u r a n r e t r o s p e k t i f 4 3 o r a n g p e n d e r i t a

K e m i i i d i P o l i u r o l o g i

R S U D D r P i m g a d i

K o t a M e d a n T a h u n

2 0 1 2 - 2 0 1 3

I S K d i d a p a t k a n 5 3 5

p a d a k e l o m p o k u s i a

gt 5 0 t a h u n 5 1 2

b e i j e n i s k e i a m i n l a k i -

l a k i 1 0 0 t i d a k

m e n d e r i t a

v e s i c o u r e t r a l r e f l u x

7 0 Benign Prostatic

Hyperplasia 1 1 6

b a t u s a i u r a n k e m i h

2 7 9 d i a b e t e s t i p e 2

D a r i h a s i l p e n e l i t i a n

i n i d a p a t d i s i m p u l k a n

b a h w a p e n d e r i t a i S K

l e b i h b a n y a k t e r j a d i

p a d a l a k i - l a k i d a n

p e n d e r i t a I S K l e b i h

b a n y a k d i j u m p a i p a d a

k e l o m p o k u m u r gt 5 0

t a h u n s e r t a d i t e m u k a n

I S K d e n g a n B P H

B S K d a n D M T i p e 2

BAB 11

TINJAUAN PUSTAKA

21 Landasan Teori

211Infeksi Saiuran Keniih

A Definisi

I n f e k s i S a i u r a n K e m i h a d a i a h i n v a s i d a n m u l t i p l i k a s i m i k r o o r g a n i s m e a t a u

p a r a s i t d a l a m j a r i n g a n t u b u h k h u s u s n y a s a i u r a n k e m i h y a n g t e r d i r i d a r i g i n j a l

u r e t e r b u l i - b u l i d a n u r e t r a y a n g d i i a n d a i d e n g a n a d a n y a b a k t e r i 1 0 c f i i (colony

forming unit) p e r m l p a d a p e n g a m b i l a n c o n t o h u r i n ( P u m o m o 2 0 1 1 )

I n f e k s i s a i u r a n k e m i h a d a l a l i s u a t u i n f e k s i y a n g m e l i b a t k a n g i n j a l lU e ter

b u l i - b u l i a t a u p u n u r e t r a I n f e k s i s a i u r a n k e m i h ( I S K ) a d a l a l i i s t i l a h u m u m y a n g

m e n u n j u k k a n k e b e r a d a a n m i k r o o r g a n i s m e d a l a m u r i n ( S u d o y o 2 0 0 6 )

B a k t e r i u r i a b e r m a k n a (significant hacteriuria) a d a i a h s u a t u k e a d a a n y a n g

m e n u n j u k k a n p e n u m b u l i a n m i k r o o r g a n i s m e m u m i l e b i h d a r i 1 0 c f t L m l p a d a

b i a k a n u r i n B a k t e r i u r i a b e r m a k n a m u n g k i n t a n p a d i s e r t a i p r e s e n t a s i k l i n i s I S K

d a n d i n a m a k a n b a k t e r i u r i a a s i m t o m a t i k (convert hacteriuria) S e b a l i k n y a

b a k t e r i u r i a b e n n a k n a d i s e r t a i p e r s e n t a s i k l i n i s I S K d i n a m a k a n b a k t e r i u r i a

s i m t o m a t i k P a d a b e b e r a p a k e a d a a n t e r d a p a t p a s i e n d e n g a n p e r s e n t a s i k l i n i s I S K

n a m u n t a n p a b a k t e r i u r i a b e n n a k n a S e l a i n i t u d i k a t a k a n p i u r i a ( l e u k o s i t d a l a m

u r i n ) b e n n a k n a (significant pyuria) b i l a d i t e m u k a n n e u t r o f i l gt 1 0 s e l p e r l a p a n g a n

p a n d a n g ( S u d o y o 2 0 0 6 )

B Epidemiologi

I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m u k a n d i p r a k t i k u m u m w a i a u p u n b e n n a c a m - m a c a m a n t i b i o t i k a s u d a h

t e r s e d i a l u a s d i p a s a r a n D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r

2 5 - 3 5 s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a

S e l a m a p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n

9

10

c e n d e r u n g m e n d e r i t a i S K d i b a n d i n g k a n l a k i - l a k i I S K b e m l a n g p a d a l a k i - l a k i

j a r a n g d i l a p o r k a n k e c u a l i d i s e r t a i f a k t o r p r e d i s p o s i s i ( p e n c e t u s )

P r e v a l e n s i b a k t e r i u r i a a s i m t o m a t i k l e b i h s e r i n g d i t e m u k a n p a d a p e r e m p u a n

P r e v a l e n s i s e l a m a p e r i o d e s e k o l a h (school girls) 1 m e n i n g k a t m e n j a d i 5

s e l a m a p e r i o d e a k t i f s e c a r a s e k s u a l P r e v a l e n s i i n f e k s i a s i m t o m a t i k m e n i n g k a t

m e n c a p a i 3 0 b a i k l a k i - l a k i m a u p u n p e r e m p u a n b i l a d i s e r t a i f a k t o r p r e d i s p o s i s i

( S u d o y o 2 0 0 6 )

C Kiasifikasi

I n f e k s i s a i u r a n k e m i h d a p a t d i b a g i m e n j a d i d u a k a t e g o r i u m u m b e r d a s a r k a n

l o k a s i a n a t o m i y a i t u

1 ) I n f e k s i s a i u r a n k e m i h b a w a h

2 ) I n f e k s i s a i u r a n k e m i h a l a s

P r e s e n t a s i k l i n i s d a r i i n f e k s i s a i u r a n k e m i h b a w a l i t e r g a n t u n g d a r i gender

y a i t u

a ) P e r e m p u a n

a S i s t i t i s

S i s t i t i s a d a i a h p r e s e n t a s i k l i n i s i n f e k s i k a n d u n g k e m i h d i s e r t a i

b a k t e r i u r i a b e n n a k n a

b S i n d r o m U r e t r a A k u t ( S U A )

S i n d r o m a u r e t r a a k u t a d a i a h p r e s e n t a s i k l i n i s s i s t i t i s t a n p a d i t e m u k a n

a d a n y a m i k r o o r g a n i s m e d a l a m L u i n ( s t e r i l ) d a n s e r i n g d i n a m a k a n

s i s t i t i s b a k t e r i a l i s

b ) L a k i - l a k i

P r e s e n t a s i k l i n i s i n f e k s i s a i u r a n k e m i h p a d a l a k i - l a k i m u n g k i n s i s t i t i s

p r o s t a t i t i s e p i d i m i d i s d a n u r e t r i t i s

I n f e k s i s a i u r a n k e m i h a t a s t e r b a g i m e n j a d i 2 y a i t u

1 ) P i e l o n e f r i t i s A k u t ( P N A )

P i e l o n e f r i t i s a k u t a d a l a l i p r o s e s i n f l a m a s i p a r e n k i m g i n j a l y a n g d i s e b a b k a n

o l e h m f e k s i b a k t e r i

11

2 ) P i e l o n e f r i t i s K r o n i s ( P N K )

P i e l o n e f r i t i s k r o n i s m u n g k i n a k i b a t l a n j u t d a r i i n f e k s i b a k t e r i

b e r k e p a n j a n g a n a t a u i n f e k s i s e j a k m a s a k e c i i O b s t r u k s i s a i u r a n k e m i h d a n

r e f l u k s v e s i k o u r e t e r d e n g a n a t a u t a n p a b a k t e r i u r i a k r o n i k s e r i n g d i i k u t i

p e m b e n t u k a n j a r i n g a n i k a t p a r e n k i m g i n j a l y a n g d i t a n d a i d e n g a n

p i e l o n e f r i t i s k r o n i k y a n g s p e s i f i k ( S u d o y o 2 0 0 6 )

D Etiologi

P a d a k e a d a a n n o r m a l u r i n b e r s i f a t s t e r i l U m u m n y a I S K d i s e b a b k a n o l e h

k i i m a n g r a m n e g a t i f E s c h e r i c h i a c o l i m e m p a k a n p e n y e b a b t e r b a n y a k b a i k p a d a

y a n g s i m t o m a t i k m a u p u n y a n g a s i m t o m a t i k y a i t u 7 0 - 9 0 E n t e r o b a k t e r i a s e p e r t i

P r o t e u s m i r a b i l i s ( 3 0 d a r i i n f e k s i s a i u r a n k e m i h p a d a a n a k l a k i - l a k i t e t a p i

k u r a n g d a r i 5 p a d a a n a k p e r e m p u a n ) K l e b s i e l l a p n e u m o n i a d a n P s e u d o m o n a s

a e m g i n o s a d a p a t j u g a s e b a g a i p e n y e b a b O r g a n i s m e g r a m p o s i t i f s e p e r t i

S t r e p t o c o c c u s f a e c a l i s ( e n t e r o k o k u s ) S t a p h y l o c o c c u s e p i d e n n i d i s d a n

S t r e p t o c o c c u s v i r i d a n s j a r a n g d i t e m u k a n P a d a u r o p a t i o b s t m k t i f d a n k e l a i n a n

s t r u k t u r s a i u r a n k e m i h p a d a a n a k l a k i - l a k i s e r i n g d i t e m u k a n P r o t e u s s p e c i e s P a d a

I S K n o s o k o m i a l a t a u I S K k o m p l e k s l e b i h s e r i n g d i t e m u k a n k u m a n P r o t e u s d a n

P s e u d o m o n a s ( L u m b a n b a t u S M 2 0 0 3 )

E Patofisiologi

P a d a i n d i v i d u n o n n a l b i a s a n y a u r i n l a k i - l a k i m a u p u n p e r e m p u a n s e l a l u

d a l a m k e a d a a n s t e r i l k a r e n a d i p e r t a l i a n k a n o l e h j u m l a l i d a n f r e k u e n s i b e r k e m i h

U t e r o d i s t a l m e m p a k a n t e m p a t k o l o n i s a s i m i k r o o r g a n i s m e nonpathogenic

fastidious G r a m - p o s i t i f d a n g r a m n e g a t i f ( S u d o y o 2 0 0 6 )

H a m p i r s e m u a I S K d i s e b a b k a n i n v a s i m i k r o o r g a n i s m e ascending d a r i u r e t r a

k e d a l a m k a n d u n g k e m i b P a d a b e b e r a p a p a s i e n t e r t e n t u i n v a s i m i k r o o r g a n i s m e

d a p a t m e n c a p a i k e g i n j a l P r o s e s i n i d i p e n n u d a h o l e h k o n d i s i r e f l u k s

v e s i k o i i r e t e r a l P r o s e s i n v a s i m i k r o o r g a n i s m e h e m a t o g e n s a n g a t j a r a n g d i t e m u k a n

d i k l i n i k m u n g k i t a k i b a t l a n j u t d a r i b a k t e r e m i a G i n j a l d i d u g a m e n i p a k a n l o k a s i

12

i n f e k s i s e b a g a i a k i b a t l a n j u t d a r i s e p t i k e m i a a t a u e n d o k a r d i t i s a k i b a t S t a f i l o k o k u s

a u r e u s K e l a i n a n g i n j a l y a n g t e r k a i t d e n g a n e n d o k a r d i t i s ( S t a f i l o k k o k u s a u r e u s )

d i k e n a l d e n g a n N e p h r i t i s L o h e i n B e b e r a p a p e n e l i t i a n m e l a p o r k a n p i e l o n e f r i t i s

a k u t ( P N A ) s e b a g a i a k i b a t l a n j u t i n v a s i h e m a t o g e n ( S u d o y o 2 0 0 6 )

F Faktor Risiko

P a t o f i s i o l o g i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h d a p a t d i p e n g a n i h i o l e h

b e b e r a p a f a k t o r A d a p u n b e b e r a p a f a k t o r risiko y a n g m e m p e n g a n i l i i t e r j a d i n y a

i n f e k s i s a i u r a n k e m i h a n t a r a l a i n

1 ) U s i a

I n s i d e n I S K m e n i n g k a t b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i

m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n a d a n y a a b n o r m a l i t a s a n a t o m i y a n g

m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n k e m i h s e p e r t i p e m b e s a r a n p r o s t a t

d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e

P e n y e b a b l a i n t e r m a s u k p e r i n e u m y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s

p e n y a k i t n e u r o m u s k n l a r d a n k a t e t e r i s a s i b u l i - b u l i S e l a i n i t u i n s i d e n I S K

m e n c a p a i 1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o s e 2 0 0 9 F o x m a n e t a l 2 0 1 0

R o n a l d 2 0 1 1 )

M e n u m t t e o r i y a n g d i k e m u k a k a n o l e h S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a d a u s i a

l a n j u t a k a n t e r j a d i p e n i n g k a t a n k e r e n t a n a n t e r h a d a p p e n y a k i t P a d a u s i a d i a t a s 5 0

t a l i u n t e r j a d i p e n u m n a n k e m a m p u a n d a l a m m e m p e r t a h a n k a n s t e n l i t a s b a i k p a d a

k a n d u n g k e m i h m a u p u n u r e t r a H a l t e r s e b u t d i s e b a b k a n o l e h i n v o l u s i t i m u s

I n v o l u s i s e l t i m u s m e n y e b a b k a n j u m l a h se d a n k u a l i t a s r e s p o n s s e l T s e m a k i n

b e r k u r a n g J u m l a h s e l T m e m o r i m e n i n g k a t n a m u n s e m a k i n s u l i t u n t u k

b e r k e m b a n g t e r u t a m a s i t o t o k s i k s e l T ( C D ^ ) d a n s e l T h l ( C D ^ ^ ) k a r e n a t e r j a d i

a p o p t o s i s S i t o t o k s i k s e l T ( C D ^ ^ ) b e i p e r a n d a l a m r e s p o n s i m u n t e r h a d a p a n t i g e n

p a d a s e l y a n g d i i n f e k s i d e n g a n c a r a m e m b u n u l i s e l y a n g t e r i n f e k s i u n t u k

m e n c e g a h p e n y e b a r a n m f e k s i s e d a n g k a n s e l T h l ( C D ^ ^ ) b e r p e r a n m e m b a n t u s e l

B u n t u k m e m p r o d u k s i a n t i b o d i

13

2 ) J e n i s k e l a m m d a n a k t i v i t a s s e k s u a l

I n s i d e n s i I S K y a n g r e n d a h p a d a p r i a d i p e n g a n i h i o l e h 3 f a k t o r y a i t u

1 L e b i h s e d i k i t t e r j a d i k o l o n i s a s i s e k i t a r u r e t r a k a r e n a t i d a k a d a n y a t e m p a t

s e p e r t i v a g i n a p a d a p e r e m p u a n

2 M e m i l i k i u r e t r a y a n g p a n j a n g

3 A d a n y a s u b s t a n s i a n t i b a k t e r i a l p a d a c a i r a n p r o s t a t

U r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a h d e n g a n d e k a t n y a v a g i n a l

v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h l e b i h s e r i n g

p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a f l o r a n o n n a l p a d a d a e r a l i p e r i u r e t r a t e r d i r i

d a r i o r g a n i s m e s e p e r t i l a c t o b a c i l l i i s y a n g m e m b a n t u m e l a w a n k o l o n i s a s i b a k t e r i

p a t o g e n p a d a s a i u r a n k e m i h P e r u b a l i a n l i n g k i m g a n d a r i p e r i u r e t r a l s e p e r t i

p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k b i s a m e n g g a n g g u f l o r a

n o r m a l s e h i n g g a m e m u n g k i n k a n b a k t e r i p a t o g e n b e r k o l o n i s a s i d a n m e n y e b a b k a n

i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

P a d a w a n i t a l e b i h d a r i 5 0 t a h u n a t a u l e b i h m e n o p a u s e m e m p a k a n f a k t o r

l a i n y a n g m e n i n g k a t k a n P V R Post Void Residual) s e l a i n p e n u r u n a n k o i i t r a k t i i i t a s

o t o t d e t r u s o r P e n u m n a n e s t r o g e n y a n g d i s e b a b k a n m e n o p a u s e d a p a t

m e n i n g k a t k a n p H v a g i n a l d a n m e n u m n k a n j u m l a l i l a c t o b a c i l l i A k i b a m y a t e r j a d i

p e n i n g k a t k a n k o l o n i s a s i d a r i b a s i l g r a m n e g a t i f s e h i n g g a m e n i n g k a t k a n r e s i k o

t e r j a d i n y a I S K P a d a p r i a p r o s t a t m e n s e k r e s i k a n c a i r a n y a n g m e n g a n d i m g z i n k

y a n g m e m i l i k i a k t i f i t a s m i k r o b i a l ( K i m 2 0 1 2 )

S e l a i n i t u p i j a t a n u r e t r a s e p e r t i y a n g t e r j a d i s e l a m a h u b u n g a n s e k s u a l

m e n y e b a b k a n m a s u k n y a b a k t e r i k e d a l a m k a n d u n g k e m i h d a n m e m p a k a n h a l

y a n g p e n t i n g d a l a m p a t o g e n e s i s m f e k s i s a l i u a n k e m i h p a d a p e r e m p u a n m u d a

B u a n g a i r k e c i l s e t e l a h h u b u n g a n s e k s u a l t e r b u k t i m e n u m n k a n risiko s i s t i t i s

m u n g k i n k a r e n a t i n d a k a n i n i m e n i n g k a t k a n e r a d i k a s i b a k t e r i y a n g m a s u k s e l a m a

h u b u n g a n s e k s u a l ( K i m 2 0 1 2 )

3 ) T i n g k a t P e n d i d i k a n

P e n g e t a h u a n s e s e o r a n g t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t

p e n d i d i k a n S e s e o r a n g y a n g m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m i u i g k i n a n

p e n g e t a h u a n t e n t a n g k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o n n a s i y a n g d i d a p a t k a n

14

t e n t a n g k e s e h a t a n l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h

S e b a l i k n y a p e n d i d i k a n y a n g k u r a n g d a p a t m e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g

t e r h a d a p n i l a i - n i l a i y a n g b a n i d i k e n a l ( N o t o a d i n o j o 2 0 0 3 )

4 ) R i w a y a t D i a b e t e s M e l i t u s

M e n u r u t S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a s i e n d e n g a n s t a t u s D M s a n g a t

b e r i s i k o u n t u k m e n g a l a m i i n f e k s i s a i u r a n k e m i h A b n o n n a l i i a s s t n i k t u r d a n

k a n d u n g k e m i h n e u r o g e n i k a k i b a t n e u r o p a t i o t o n o m a t a u s t r o k e p a d a p a s i e n D M

m e n y e b a b k a n p e n g o s o n g a n k a n d u n g k e m i h t i d a k n o n n a l D M j u g a d a p a t

m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a h a n a n t u b u h y a n g b e r p o t e n s i m e n i n g k a t

risiko t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a h a n a n t u b u h t e r s e b u t d i a n t a r a n y a

a d a i a h k e g a g a l a n m i g r a s i s e l intracellular killing f a g o s i t o s i s d a n k e m o t a k s i s

p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n m e k a n i s m e p e r t a h a n a n

a l a m i a h i o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p i n f e k s i

5 ) K e h a m i i a n

K e c e n d e r u n g a n i n f e k s i s a i u r a n k e m i h b a g i a n a t a s s e l a m a k e h a m i i a n

d i s e b a b k a n o l e h p e n u m n a n k e k u a t a n u r e t e r p e n u m n a n p e r i s t a l t i k u r e t e r d a n

i n k o m p e t e n s i s e m e n t a r a k a l u p v e s i k o i u - e t e r a l y a n g t e r j a d i s e l a m a h a m i l

6 ) S u m b a t a i i

A d a n y a I i a i a n g a n a l i r a n b e b a s u r i n s e p e r t i t u m o r s t r i k t r a a b a t u a t a u

h i p e r t r o f i p r o s t a t d a p a t m e n y e b a b k a n h i d r o n e f r o s i s d a n risiko i n f e k s i s a i u r a n

k e m i l i y a n g s a n g a t t i n g g i S e l a i n i t u s u p e r i n f e k s i p a d a s u m b a t a n s a i u r a n k e m i h

d a p a t m e n y e b a b k a n k e m s a k a n j a r i n g a n g i n j a l y a n g c e p a t

7 ) D i s f u n g s i n e u r o g e n i k k a n d u n g k e m i h

G a n g g u a n s a r a f y a n g b e k e r j a p a d a k a n d m i g k e m i h s e p e r t i p a d a j e j a s k o r d a

s p i n a l i s t a b e s d o r s a i i s m u l t i p e l s k l e r o s i s d i a b e t e s m e l i t u s a t a u p e n y a k i t l a i n

d a p a t b e r h u b u n g a n d e n g a n i n f e k s i s a i u r a n k e m i h I n f e k s i d a p a t d i a w a l i o l e h

p e n g g u n a a n k a t e l e r u n t u k d r a i n a s e k a n d i u i g k e m i h d a n d i d u k i m g o l e h s t a t i s u r i n

d a l a m k a n d u n g k e m i l i u n t u k j a n g k a w a k t u y a n g l a m a

8 ) R e f l u k s v e s i k o m e t e r a

K e a d a a n i n i d i d e f i n i s i k a n s e b a g a i r e f l u k s u r i n d a r i k a n d u n g k e m i b k e u r e t e r

d a n k a d a n g s a m p a i k e p e l v i s r e n a l H a l i n i t e r j a d i s e l a m a b u a n g a i r k e c i l a t a u

15

d e n g a n p e n i n g k a t a n t e k a n a n p a d a k a n d u n g k e m i h R e f l u k s v e s i k o i i r e t e r a l d a p a t

d i b u k t i k a n d e n g a n a d a n y a g c r a k a n r e t r o g r a d z a t r a d i o o p a k a t a u r a d i o a k t i f m e l a l u i

s i s t o u r e t r o g r a m s e l a m a b u a n g a i r k e c i l R e f l u k s v e s i k o i i r e t e r a l b i a s a n y a

d i s e b a b k a n k a r e n a a d a n y a g a n g g u a n a n a t o m i s p a d a p e r t e m u a n v e s i k o i i r e t e r a l

y a n g d a p a t m e n y e b a b k a n r e f l u k s u r i n d i s e r t a i b a k t e r i d a n k a r e n a i t u t e r j a d i l a h

i n f e k s i s a l r a a n k e m i h

9 ) F a k t o r v i r u l e n s i b a k t e r i

F a k t o r v i r u l e n s i b a k t e r i m e m p e n g a r u b i k e m u n g k i n a n vragt7 t e r t e n m d a l a m

m e n y e b a b k a n i n f e k s i t r a k i u s u r i n a r i u s H a m p i r s e m u a strain F c o l i y a n g

m e n y e b a b k a n p i e l o n e f r i t i s p a d a p a s i e n d e n g a n t r a k i u s u r i n a r i u s n o m i a l s e c a r a

a n a t o m i k m e m p u n y a i p i l u s t e r t e n t u y a n g m e m p e r a n t a r a i p e r l e k a t a n p a d a b a g i a n

d i g a k t o s i d a d a n g l i k o s f i n g o l i p i d y a n g a d a d i u r o e p i t e l Strain y a n g m e n i m b u l k a n

p i e l o n e f r i t i s j u g a b i a s a n y a m e m p a k a n p e n g b a s i l h e m o l i s i n m e m p u n y a i

a e r o b a k t i n d a n r e s i s t e n t e r h a d a p k e r j a b a k t e r i s i d a l d a r i s e m m m a n u s i a

1 0 ) F a k t o r g e n e t i k

F a k t o r g e n e t i k p e n j a m u m e m p e n g a n i l i i k e r e n t a n a n t e r h a d a p i n f e k s i t r a k t u s

u r i n a r i u s J u m l a h d a n t i p e r e s e p t o r p a d a s e l u r o e p i t e l t e m p a t b a k t e r i d a p a t

m e n e m p e l s e l i d a k i i y a s e b a g i a i i d i t e n t u k a r i s e c a r a g e n e t i k ( I s s e l b a c h e r 2 0 0 9 )

G Manifestasi Klinis

G e j a l a k l i n i s d a r i i n f e k s i s a i u r a n k e m i h s e s u a i d e n g a n b a g i a n s a i u r a n k e m i h

y a n g t e r i n f e k s i a d a i a h s e b a g a i b e r i k u t

1 ) I n f e k s i s a i u r a n k e m i h b a g i a n b a w a l i

K e l u h a n p a s i e n b i a s a n y a b e m p a r a s a s a k i t a t a u r a s a p a n a s d i u r e t r a s e w a k t u

k e n c i n g d e n g a n a i r k e m i h s e d i k i t - s e d i k i t s e r t a r a s a t i d a k e n a k d i d a e r a h

s i i p r a p u b i k

2 ) I n f e k s i s a i u r a n k e m i h b a g i a n a t a s

P a d a i n t e k s i s a i u r a n k e m i h b a g i a n a t a s d a p a t d i t e m u k a n g e j a l a s e p e r t i s a k i t

k e p a l a m a l a i s e m u a l m m i t a h d e n i a m m e n g g i g i l r a s a t i d a k e n a k a t a u

n y e r i d i p i n g g a n g ( T e s s y d k k 2 0 0 1 )

16

H Tatalaksana

T u j u a n p e n a t a l a k s a n a a a n i n f e k s i s a i u r a n k e m i h a d a i a h m e n c e g a h d a n

m e n g h i l a n g k a n g e j a l a m e n c e g a h d a n m e n g o b a t i b a k t e n e m i a d a n b a k t e r i u r i a s e r t a

m e n c e g a h d a n m e n g u r a n g i r i s i k o k e r u s a k a n g i n j a l y a n g m u n g k i n t i m b u l d e n g a n

p e m b e r i a n o b a t - o b a t a n y a n g s e n s i t i f m u r a l i d a n a m a n d e n g a n e f e k s a m p i n g y a n g

m i n i m a l

a ) i n f e k s i s a i u r a n k e m i h ( I S K ) b a w a h

P r i n s i p p e n a t a l a k s a n a a n I S K b a w a h m e l i p u t i intake c a i r a n y a n g b a n y a k

a n t i b i o t i k y a n g a d e k u a t d a n b i l a p e r l u t e r a p i s i m t o m a t i k u n t u k a l k a l i s a s i

u r i n

i H a m p i r 8 0 p a s i e n a k a n m e m b e r i k a n r e s p o n s e t e l a h 4 8 j a m d e n g a n

a n t i b i o t i k a t u n g g a l s e p e r t i a m p i s i l i n 3 g r a m a t a u t r i m e t o p r i m 2 0 0 m g

i i B i l a i n f e k s i m e n e t a p d i s e r t a i k e l a i n a n u r i n a l i s i s ( l e u k o s i u i a ) d i p e r i u k a n

t e r a p i k o n v e n s i o n a l s e l a m a 5 - 1 0 h a r i

i i i P e m e r i k s a a n m i k r o s k o p i s u r i n d a n b i a k a n u r i n t i d a k d i p e r i u k a n b i l a

s e m u a g e j a l a h i l a n g d a n t a n p a l e u k o s u r i a

b ) I n f e k s i s a i u r a n k e m i h ( I S K ) a t a s

P a d a u m u m n y a p a s i e n d e n g a n p i e l o n e f r i t i s a k u t m e m e r l u k a n r a w a t i n a p

u n t u k m e m e l i h a r a s t a t u s h i d r a s i d a n t e r a p i a n t i b i o t i k a p a r e n t e r a l p a l i n g

s e d i k i t 4 8 j a m ( S u d o y o 2 0 0 6 )

i Komplikasi

K o m p l i k a s i i n f e k s i s a i u r a n k e m i h t e r g a n t u n g d a r i t i p e y a i t u i n f e k s i s a i u r a n

k e m i h t i p e s e d e r h a n a (uncomplicated) d a n t i p e b e r k o m p l i k a s i (complicated)

1 ) I n f e k s i s a i u r a n k e m i h s e d e r h a n a (uncomplicated)

I n f e k s i s a i u r a n k e m i h a k u t t i p e s e d e r h a n a ( s i s t i t i s ) y a i t u n o n - o b s t r u k s i d a n

b u k a n p e r e m p u a n h a m i l m e m p a k a n p e n y a k i t r i n g a n (self limited disiase)

d a n t i d a k m e n y e b a b k a n a k i b a t l a n j u t j a n g k a l a m a

2 ) I n f e k s i s a i u r a n k e m i h b e r k o m p l i k a s i (complicated)

a ) I n f e k s i s a i u r a n k e m i h s e l a m a k e h a m i i a n

b ) i n f e k s i s a i u r a n k e m i h p a d a d i a b e t e s m e l i t u s ( S u d o y o 2 0 0 6 )

17

22 Kerangka Teori

J

U s i a

J e n i s K e i a m i n

T i n g k a t P e n d i d i k a n

R i w a y a t D i a b e t e s M e l i m s

S u m b a t a n bullT

K e h a m i i a n

D i s f u n g s i n e u r o g e n i k

R e f l u k s v e s i k o i i r e t e r a l

V i r u l e n s i b a k t e r i

F a k t o r g e n e t i k

I n f e k s i b a k t e r i g r a m p o s i t i f a t a u n e g a t i v e p a d a s a i u r a n k e m i h

I n f e k s i S a i u r a n K e m i h

Keterangan

I j = V a r i a b e l y a n g t i d a k d i t e l i t i

= V a r i a b e l y a n g d i t e l i t i

18

Hipotesis

H i p o t e s i s d a l a m p e n e l i t i a n i n i a d a i a h

H O t i d a k t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n

t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

H I t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

BAB 111

M E T O D E PENELITIAN

31 Jenis Penelitian

P a d a p e n e l i t i a n i n i j e n i s p e n e l i t i a n y a n g d i g u n a k a n a d a i a h p e n e l i t i a n

o b s e r v a s i o n a i a n a l i t i k d e s a i n cross scclional d e n g a n m e n g g u n a k a n d a t a s e k u n d e r

d a r i r e k a m m e d i s p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1 D e s e m b e r

2 0 1 5

32 Waktu dan Tempat Penelitian

321 Waktu Penelitian

W a k t u p e n e l i t i a n d i l a k s a n a k a n p a d a t a n g g a l 1 O k t o b e r s a m p a i d e n g a n 3 0

O k t o b e r 2 0 1 6

322 Tempat Penelitian

P e n e l i t i a n i n i d i l a k s a n a k a n d i R u m a l i S a k i t M u h a m m a d i y a h P a e m b a n g ( d i

R u a n g R e k a m M e d i s )

33 Populasi dan Sampel Penelitian

331Populasi Penelitian

P a d a p e n e l i t i a n i n i p o p u l a s i t a r g e t a d a l a l i p a s i e n r a w a t i n a p d a n r a w a t j a l a n

d i R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g s e d a n g k a n p o p u l a s i t e r j a n g k a u n y a

a d a i a h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

332Sampel dan Besar Sampel Penelitian

P a d a p e n e l i t i a n i n i s a m p e l p e n e l i t i a n a d a i a h p a s i e n r a w a t i n a p d a n r a w a t

j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e

1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 y a n g m e m e n u h i k r i t e r i a i n k l u s i p e n e l i t i a n

1 9

20

d e n g a n b e s a r s a m p e l y a n g l a y a k d a l a m p e n e l i t i a n m e n u r u t t e o r i R o s c o e a d a i a h

a n t a r a t i g a p u l u h s a m p a i l i m a r a t i i s o r a n g ( S u g i y o n o 2 0 1 5 )

333 Krttena Inklusi dan Eksklusi

A Kriteria Inklusi

P a d a p e n e l i t i a n i n i k r i t e r i a i n k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t i n a p

d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i

P a l e m b a n g y a n g d i d i a g n o s a m e n g a l a m i i n f e k s i s a i u r a n k e m i h s e r t a m e m i l i k i d a t a

r e k a m m e d i s p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

B Kriteria Eksklusi

P a d a p e n e l i t i a n i n i k r i t e r i a e k s k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t

i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 d e n g a n d a t a r e k a m m e d i s

y a n g t i d a k l e n g k a p

334 Cara Pengambilan Sampel Penelitian

C a r a p e n g a m b i l a n s a m p e l y a n g d i g u n a k a n d a l a m p e n e l i t i a n i n i a d a l a l i

m e n g g u n a k a n t e k n i k consecutive sampling P a d a consecutive sampling s e t i a p

p a s i e n y a n g m e m e n u h i k r i t e r i a p e n e l i t i a n d i m a s u k k a n d a l a m p e n e l i t i a n s a m p a i

k u r u n w a k t u t e r t e n U i s e h i n g g a j u m l a h m i n i m a l y a n g d i p e r i u k a n t e r p e n u h i

( S a s t r o a s m o r o 2 0 1 1 )

34 Variabel Penelitian

341 Variabel Dependent

V a r i a b e l dependent f t e r i k a t ) d a l a m p e n e l i t i a n i n i a d a i a h i n f e k s i s a i u r a n

k e m i h

342 Variabel Independent

V a r i a b e l independent ( b e b a s ) d a l a m p e n e l i t i a n i n i a d a i a h u s i a j e n i s

k e l a i n i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

21

35 Definisi Operasional

Tabel 31 Definisi Operasional

Variabel Alat Cara ueiinisi rldsil L KUr I7 i l l 11 Lz fe 1 V

oKaia LiKur Penelitian Ukur Ukur

Infeksi P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Saiuran d i d i a g n o s a o l e h m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Keniih d o k t e r m e n g a l a m i m e d i s

i n f e k s i s a i u r a n

k e m i h d a n t e r c a n t u m

d i r e k a m m e d i s

U s i a L a m a n y a t a h u n R e k a m O b s e r v a s i 1 lt 5 0 t a h u n O r d i n a l

k e h i d u p a n p a s i e n m e d i s r e k a m 2 gt 5 0 t a l i u n ( k a t e g o r i k )

d a r i l a h i r s a m p a i m e d i s

s e k a r a n g d a n

t e r c a n t u m d i r e k a m

m e d i s

Jenis P r o f i l a n a t o m i a t a u R e k a m O b s e r v a s i 1- L a k i - l a k i N o m i n a l

Keiamin b i o l o g i s p a s i e n y a n g m e d i s r e k a m 2 P e r e m p u a n ( k a t e g o r i k )

d i b e d a k a n m e n j a d i m e d i s

i a k i - l a k i d a n

n e r e m m i a n s e r t a

t e r c a n t u m d i r e k a m

m e d i s

Tingkat P e n d i d i k a n f o n n a l R e k a m O b s e r v a s i 1 P e n d i d i k a n O r d i n a l

Pendidikan t e r a k h i r y a n g m e d i s r e k a m d a s a r ( S D ( k a t e g o r i k )

d i t e m p u h o l e h m e d i s M I S M P

p a s i e n d a n t e r c a n t u m d a n M T s )

d i r e k a m m e d i s 2 P e n d i d i k a n

m e n e n g a l i

d a n t i n g g i

22

( S M A M A

S M K

M A K

d i p l o m a

s a r j a n a

m a g i St e r

s p e s i a l i s

d a n d o k t o r )

Riwayat P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Diabetes d i d i a g n o s i s d e n g a n m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Melitus d i a b e t e s m e l i t u s d a n

t e r c a n t u m d i d a l a m

r e k a m m e d i s

m e d i s

36 Cara Pengumpulan Data

361 Data Sekunder

P e n g u m p u l a n d a t a p a d a p e n e l i t i a n i n i d i p e r o l e h d a r i d a t a s e k u n d e r y a i t u

r e k a m m e d i s p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

37 Metode Teknik Analisis Data

371Cara Pengolahan dan Analisis Data

P e n g o l a h a n d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n m e l a l u i e m p a t t a h a p y a i t u

i Oala Entry

P a d a t a i i a p i n i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n riwayat d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g y a n g t e l a h d i d a p a t d a n

r e k a m m e d i s d i k u m p u l k a n d a n d i m a s u k k a n k e d a l a m p r o g r a m spss

23

2 Editing

P a d a t a h a p i n i d a t a i i s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n y a n g t e l a h d i m a s u k k a n k e d a l a m p r o g r a m s p s s

d i p e r i k s a k e m b a l i a p a k a h s u d a h l e n g k a p d a n t i d a k a d a k e k e l i r u a n

3 ( oding

S e t e l a h m e l a l u i p r o s e s editing d a t a - d a t a t e r s e b u t d i b e r i k o d e t e r t e n t u a n t a r a

l a i n k o d e 1 u n t u k u s i a gt 5 0 t a h u n j e n i s k e i a m i n p e r e m p u a n t i n g k a t

p e n d i d i k a n d a s a r t e r d a p a t r i w a y a t d i a b e t e s m e l i t u s d a n i n f e k s i s a i u r a n

k e m i h s e d a n g k a n k o d e 2 u n t u k u s i a lt 5 0 t a h u n j e n i s k e i a m i n l a k i - l a k i

t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i t i d a k t e r d a p a t r i w a y a t d i a b e t e s

m e l i t u s d a n b u k a n i n f e k s i s a i u r a n k e m i h s e h i n g g a m e m u d a h k a n d a l a m

m e l a k u k a n a n a l i s i s d a t a

4 Tahulaling

P a d a t a h a p i n i d a t a y a n g s a m a d i k e l o m p o k k a n s e c a r a t e l i t i d a n t e r a t m

k e m u d i a n d i l i i t u n g d e n g a n m e n g g u n a k a n p r o g r a m sps s d a n d i j u m l a h k a i i

l a l u d i s a j i k a n d a l a m b e n t u k t a b e l - t a b e l

U n t u k m e n g a n a l i s i s d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n a n a l i s i s d a t a

u n i v a r i a t d a n b i v a r i a t d e n g a n m e n g g u n a k a n p r o g r a m s p s s s e b a g a i b e r i k u t

A A n a l i s i s u n i v a r i a t

A n a l i s i s u n i v a r i a t d i l a k u k a n d e n g a n c a r a m e l a k u k a n a n a l i s i s p a d a s e t i a p

v a r i a b e l h a s i l p e n e l i t i a n d e n g a n t u j u a n u n t u k m e n g e t a h u i d i s t r i b u s i p r o p o r s i p a d a

s e t i a p v a r i a b e l p e n e l i t i a n D a t a d i s a j i k a n d a l a m b e n t u k t a b e l d a n n a r a s i

B A n a l i s i s b i v a r i a t

A n a l i s i s b i v a r i a t d i l a k u k a n d e n g a n m e n g g u n a k a n u j i h i p o t e s i s chi-square

U j i h i p o t e s i s chi-square d a p a t d i g u n a k a n d e n g a n s y a r a t y a i t u lt 2 0 s e l y a n g

m e m p u n y a i n i l a i expected count k u r a n g d a r i l i m a s e h i n g g a j i k a t i d a k m e m e n u h i

s y a r a t u j i chi-square m a k a u j i y a n g d i g u n a k a n a d a i a h u] fisher ( D a h l a n 2 0 1 4 )

B a t a s k e m a k n a a n y a n g d i g u n a k a n a d a i a h a = 0 0 5 J i k a d i d a p a t k a n p value lt 0 0 5

p a d a u j i s t a t i s t i k m a k a t i d a k t e r d a p a t h u b u n g a n y a n g b e n n a k n a a n t a r a d u a

v a r i a b e l y a n g d i t e l i t i d a n H O d i t e r i m a S e d a n g k a n j i k a d i d a p a t k a n p value gt 0 0 5

24

p a d a u j i s t a t i s t i k m a k a t e r d a p a t l i u b u n g a n y a n g b e n n a k n a a n t a r a d u a v a r i a b e l

y a n g d i t e l i t i d a n H O d i t o l a k

38 Alur Penelitian

P e n e n t u a n p o p u l a s i d a n s a m p e l p e n e l i t i a n

K r i t e r i a i n k l u s i K r i t e r i a e k s k l u s i

P e n g a m b i l a n s a m p e l p e n e l i t i a n

P e n g o l a h a n d a n a n a l i s i s d a t a d e n g a n u j i chi-square

H a s i l d a n p e m b a h a s a n

K e s i m p u l a n d a n s a r a n

Gambar 31 Alur Penelitian Hubungan Usia Jenis Keiamin Tingkat Pendidikan dan Riwayat Diabetes Melitus dengan Kejadian Infeksi Saiuran Kemih pada Pasien Rawat Inap di Bagian Penyakit Dalam Rumah Sakit Muhammadiyah Palembang Periode 1 Januari 2015 sampai dengan 31 Desember 2015

BAB IV

HASIL DAN PEMBAHASAN

41 Hasil

P e n e l i t i a n i n i t e l a h d i l a k u k a n d i r u a n g r e k a m m e d i s R u m a h S a k i t

M u h a i m n a d i y a h P a l e m b a n g d a r i t a n g g a l 1 O k t o b e r 2 0 1 5 - 3 1 O k t o b e r 2 0 1 6

P e n e l i t i a n d i m u l a i d e n g a n p e n g a m b i l a n d a t a a w a l b e m p a d a t a r e k a m m e d i s

s e l u r u h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

S e l a n j u t n y a r e k a m m e d i s d i p i l i h s e s u a i d e n g a n k r i t e r i a i n k l u s i d a n e k s k l u s i u n t u k

d i j a d i k a n s a m p e l p e n e l i t i a n s a m p a i m i n i m a l b e s a r s a m p e l y a n g d i b u t u h k a n

t e r p e n u h i s e r t a d i l a k u k a n p e n e l i t i a n s e c a r a o b s e r v a s i o n a i O b s e r v a s i r e k a m m e d i s

d i l a k u k a n u n m k m e n g e t a h u i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t

d i a b e t e s m e l i t u s d a n d i a g n o s a p a s i e n

D a r i c a t a t a n r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g

d i d a p a t k a n s e b a n y a k 4 1 4 1 r e k a m m e d i s p a s i e n r a w a t i n a p d a n 1 4 5 3 r e k a m m e d i s

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 D a r i t o t a l r e k a m m e d i s

p a s i e n r a w a t i n a p d a n r a w a t j a l a n t e r s e b u t p e n e l i t i h a n y a m e n g a m b i l m i n i m a l

b e s a r s a m p e l y a n g d i b u t u h k a n y a i t u s e b a n y a k 9 8 r e k a m m e d i s u n t u k d i j a d i k a n

s a m p e l p e n e l i t i a n y a n g t e r d i r i d a r i 3 0 r e k a m m e d i s p a s i e n y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i h d a n 6 8 r e k a m m e d i s y a n g t i d a k m e n g a l a m i i n f e k s i s a i u r a n k e m i h

411 Hasil Analisis Univariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s u n i v a r i a t

a n t a r a l a i n d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p b e r d a s a r k a n u s i a d a n

j e n i s k e l a m m d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n b e r d a s a r k a n u s i a

d a n j e n i s k e i a m i n d i s t r i b u s i p r o p o r s i s a m p e l b e r d a s a r k a n k e j a d i a n m f e k s i s a i u r a n

k e m i h s e r t a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n u s i a

j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

25

26

A Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan IJsta

dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 41 Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan

Usia dan Jenis Keiamin

Paisen Rawat Inap N Persentase

Usia

1 7 - 2 5 t a h u n 678 1 6 4

2 6 - 3 5 t a h u n 952 2 3 0

3 6 - 4 5 t a l i u n 745 18 0

4 6 - 5 5 t a h u n 695 1 6 8

5 6 - 6 4 t a h u n 571 1 3 8

gt 6 4 t a h u n 500 1 2 1

U s i a r a t a - r a t a ( t a h u n j 43plusmn16543

Jenis Keiamin

P e r e m p u a n 2 6 3 8 6 3 7

L a k i - l a k i 1 5 0 3 3 6 3

Total 4141 100

B e r d a s a r k a n t a b e l 4 1 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R i u n a h S a k i t M u l i a m m a d i y a l i

P a l e m b a n g p e r i o d e J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 2 6 - 3 5 t a h u n y a i t u

s e b a n y a k 9 5 2 o r a n g ( 2 3 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 43plusmn16543 t a l i u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 2 6 3 8 o r a n g ( 6 3 7 )

27

B Distribusi Proporsi Karakteristik Pasien Rawat Jalan Berdasarkan

Usia dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 42 Distribusi Proporsi Karakteristik Pasien Rawat Jalan

Berdasarkan Usia dan Jenis Keiamin

Fasten Rawat Jalan N Persentase

Usia

1 7 - 2 5 t a h u n 9 2 6 3

2 6 - 3 5 t a l n i n 1 3 1 9 0

3 6 - 4 5 t a h u n 2 7 9 1 9 2

46-55 t a l i u n 4 2 1 2 9 0

5 6 - 6 4 t a h u n 3 1 6 2 1 7

gt 6 4 t a h u n 2 1 4 1 4 7

U s i a r a t a - r a t a ( t a h u n ) 50plusmn14120

Jenis Keiamin

P e r e m p u a n 8 9 0 6 1 3

L a k i - l a k i 5 6 3 3 8 7

Total 1453 100

B e r d a s a r k a n t a b e l 4 2 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 4 6 - 5 5 t a h u n y a i t u

s e b a n y a k 4 2 1 o r a n g ( 2 9 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 50plusmn14120 t a h u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 8 9 0 o r a n g ( 6 1 3 )

28

C Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Usia

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i b b e r d a s a r k a n u s i a d a p a t

d i i i h a t p a d a l a b e l d i b a w a h i n i

Tabel 43 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Usia

Usia N Persentase

lt 5 0 t a h u n 1 4 4 6 7

gt 5 0 t a l i u n 1 6 5 3 3

Total 30 100

B e r d a s a r k a n t a b e l 4 3 d i a t a s d a p a t d i k e t a h u i b a h w a u s i a t e r b a n y a k p a d a

s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h gt 5 0 t a h u n y a i t u s e b a n y a k

1 6 o r a n g ( 5 3 3 )

D Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Jenis

Keiamin

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n j e n i s

k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 44 Distribusi Proporsi Kejadian infeksi Saiuran Kemih Berdasarkan

Jenis Keiamin

Jenis Keiamin N Persentase

P e r e m p u a n 1 8 6 0 0

L a k i - l a k i 1 2 4 0 0

Total 30 100

B e r d a s a r k a n t a b e l 4 4 d i a t a s d a p a t d i k e t a h u i b a h w a j e n i s k e i a m i n

t e r b a n y a k p a d a s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h p e r e m p u a n

y a i t u s e b a n y a k 1 8 o r a n g ( 6 0 0 )

29

E Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n t i n g k a t

p e n d i d i k a n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 45 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

Tingkat Pendidikan N Persentase

P e n d i d i k a n d a s a r 20 6 6 7

P e n d i d i k a n m e n e n g a h d a n P e n d i d i k a n m e n e n g a h d a n 10 333

t i n g g i

Total J O 100

B e r d a s a r k a n t a b e l 4 5 d i a t a s d a p a t d i k e t a l i u i b a l i w a t i n g k a t p e n d i d i k a n

t e r b a n y a k p a d a s a m p e i y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h t i n g k a t

p e n d i d i k a n d a s a r y a i t u s e b a n y a k 20 o r a n g ( 6 6 7 )

P Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n riwayat

d i a b e t e s m e l i t u s d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 46 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

Riwayat Diabetes Melitus N Persentase

Y a 17 5 6 7

T i d a k 13 433

Total 30 100

B e r d a s a r k a n t a b e l 4 6 d i a t a s d a p a t d i k e t a h u i b a l i w a s a m p e l y a n g

m e n g a l a m i i n f e k s i s a i u r a n k e m i h t e r b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s

y a i t u s e b a n y a k 1 7 o r a n g ( 5 6 7 )

30

412 Hasil Analisis Bivariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s b i v a r i a t

a n t a r a I a i n h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h j e n i s

k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h t i n g k a t p e n d i d i k a n d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n

i n f e k s i s a l m a n k e m i h

A n a l i s i s y a n g d i g u n a k a n p a d a u j i d u a v a r i a b e l y a n g b e r s k a l a k a t e g o r i k

a d a l a l i d e n g a n u j i Chi-Square d e n g a n n i e i h a t n i l a i Pearson Chi-Square S e m u a

h a s i l d a r i u j i h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h m e n g g i u i a k a n u j i Chi-

Square k a i e n a m e m e n u h i s y a r a t u j i Chi-Square y a i t u lt 2 0 s e l y a n g m e m p u n y a i

n i l a i expected count lt 5

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 47 Hasil Uji Hubungan antara Usia dengan Kejadian Infeksi

Saiuran Kemih

Usia

Infeksi Saiuran Kemih

^a Tidak

n N Mgt

Jumlah P

value 95Cl

lt 50 t a h u n 1 4 1 9 2 5 9 8 0 8 7 3 0 0 0 0 2 7 4 7 - 2 0 4 3 1

gt 5 0 t a h u n 1 6 6 4 0 9 3 6 0 2 5

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 7 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R = 7 4 9 2

( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a u s i a gt

5 0 t a h u n a d a l a l i 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a u s i a lt 5 0 t a h u n

31

B Hubungan antara Jenis Keiamin dengan Kejadian Infeksi Saiuran

Kemih

H a s i l a n a l i s i s b i v a r i a t l i u b u n g a n a n t a r a j e n i s k e l a i n i n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

Tabel 48 Hasil Uji Hubungan antara Jenis Keiamin dengan Kejadian

Infeksi Saiuran Kemih

Infeksi Saiuran Kemih Jenis P

A Tidak Jumlah 95CI Keiamin value

N N

P e r e m p u a n 18 6 4 3 10 357laquoo 2 8 3 2 2 7 -P e r e m p u a n 0 0 0 0

L a k i - l a k i 12 1 7 1 5 8 8 2 9 7 0 2 3 4 5 9

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 8 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a l a l i

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k N 4 a k a a d a l i u b u n g a n y a n g s i g n i f i k a n a n t a r a

j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R ) = 8 7 0 0

f 9 5 C I = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a l a k i - l a k i

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e n i i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

32

Tabel 49 Hasil liji Hubungan antara Tingkat Pendidikan dengan

Kejadian Infeksi Saiuran Kemih

Infeksi Saiuran Kemih P

Y a T i d a k jumlah 95CI value

N

P e n d i d i k a n d a s a r 2 0 5 4 1 1 7 4 5 9 3 7

P e n d i d i k a n

m e n e n g a h d a n 10 1 6 4 5 1 8 3 6 6 1

t i n g g i

Jumlah JO 30 6 68 694 9H

B e r d a s a r k a n t a b e l 4 9 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( 0 R ) =

6 0 0 0 ( 9 5 C I = 2 3 5 1 - 1 5 3 1 0 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r a d a i a h 6 k a l i l e b i h b e s a r

d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i h a t

p a d a t a b e l d i b a w a h i n i

Tingkat

Pendidikan

2 3 5 1 -0 0 0 0

1 5 3 1 0

33

Tabel 4t0 Hasil I j i Hubungan antara Riwayat Diabetes Melitus dengan

Kejadian Infeksi Saiuran Kemih

Riwayat Infeksi Saiuran Kemih P

Diabetes Va Tidak Jumlah value

95CI

Melitus N bullVJ N

Y a

T i d a k

17

1 3

6 8 0

1 7 8

8

6 0

3 2 0

8 2 2

2 5

7 3 0 0 0 0

3 4 9 3 -

2 7 5 3 6

Jumlah 30 306 68 571 98

B e r d a s a r k a n t a b e l 4 1 0 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio

( O R ) = 9 8 0 8 ( 9 5 C I - 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r

d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s m e l i m s

42 Pembahasan

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a l a b e l 4 7 d i d a p a t k a n b a l i w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i b d e n g a n n i l a i s i g n i f i k a n n y a a d a l a l i 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k

Odds Ratio ( O R ) = 7 4 9 2 ( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a u s i a T 5 0 t a h u n a d a i a h 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a

u s i a lt 5 0 t a h u n

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n A n d r y L u k a n d y

( 2 0 1 4 ) m e n g e n a i k a r a k t e r i s t i k p a s i e n - p a s i e n i n f e k s i s a i u r a n k e m i h d i m a n a

p e n d e r i t a I S K d e n g a n k e l o m p o k u m u r gt 5 0 t a h u n s e b a n y a k 2 3 o r a n g s e d a n g k a n

j u m l a h p e n d e r i t a I S K d e n g a n k e l o m p o k u m m lt 5 0 t a l i u n s e b a n y a k 2 0 o r a n g

P e n e l i t i a n i n i j u g a d i p e i k u a t o l e h p e n l i t i a n L e w i s A l e t a l ( 2 0 1 4 ) m e n g e n a i

impact of host age and parity on susceptihility to severe urinary tract injection in

34

a murine mode d e n g a n u j i K r u s k a l - W a l l i s d e n g a n post-test D u n n u n t u k b e b e r a p a

p e r b a n d i n g a n d i m a n a u s i a d a n p a r i t a s s e b a g a i f a k t o r y a n g b e r k o n t r i b u s i d a l a m

k e r e n t a n a n i m t u k t e r j a d i n y a I S K d e n g a n n i l a i p lt 0 0 5

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n g a t a k a n b a h w a i n s i d e n I S K m e n i n g k a t

b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n

a d a n y a a b n o r m a l i t a s a n a t o m i y a n g m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n

k e m i h s e p e r t i p e m b e s a r a n p r o s t a t d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a

p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e ( R o s e 2 0 0 9 ) P e n y e b a b l a i n t e n n a s u k

p e r i n e i u n y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s p e n y a k i t n e u r o m u s k u l a r

d a n k a t e t e r i s a s i b u l i - b u l i ( F o x m a n e t a l 2 0 1 0 ) S e l a i n i t u i n s i d e n I S K m e n c a p a i

1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o n a l d 2 0 1 1 )

B Hubungan antara Jenis Keiamin dengan Kejadian infeksi Saiuran

Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 8 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d e n g a n n i l a i s i g n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O

d i t o l a k Odds Ratio ( O R ) = 8 7 0 0 ( 9 5 C l = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a risiko k e j a d i a n

i n f e k s i s a i u r a n k e m i h p a d a p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n

p a d a l a k i - i a k i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n M a g i i a n o e t a l

( 2 0 1 1 ) m e n g e n a i Gender and Age-Dependent Etiology of Community Acquired

y a n g m e l a k u k a n p e n g a m b i l a n 6 1 2 7 3 s a m p e l k u l t u r u r i n d a l a m p e r i o d e 2 2 b u l a n

d a r i s a m p e l i n i d i d a p a t k a n 1 3 8 2 0 ( 2 2 6 ) d i t e m u k a n p o s i t i f i n f e k s i b a k t e r i

h a m p i r 8 0 b a l i a n y a n g d i i s o l a s i b e r a s a l d a r i p e r e m p u a n P e n e l i t i a n i n i j u g a

d i p e r k u a t o l e h p e n e l i t i a n y a n g d i l a k u k a n o l e h Y u n i t a I ( 2 0 1 0 ) d i m a n a a d a

h u b m i g a n y a n g b e n n a k n a a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h ( P value=O049 R P = 3 2 7 3 ( 9 5 C I = I 0 1 6 - 1 0 5 4 0 )

H a l t e r s e b u t d a p a t t e r j a d i k a r e n a u r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a l i

d e n g a n d e k a t n y a v a g i n a l v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i

s a i u r a n k e m i h l e b i h s e r i n g p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a flora n o r m a l

3 5

p a d a d a e r a h p e r i u r e t r a t e r d i r i d a r i o r g a n i s m e s e p e r t i i a c t o b a c i l l u s y a n g m e m b a n t u

m e l a w a n k o l o n i s a s i b a k t e r i p a t o g e n p a d a s a i u r a n k e m i h P e r u b a h a n l i n g k i m g a n

d a r i p e r i u r e t r a l s e p e r t i p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k

b i s a m e n g g a n g g u f l o r a n o r m a l s e h i n g g a m e n u m g k i n k a n b a k t e r i p a t o g e n

b e r k o l o n i s a s i d a n m e n y e b a b k a n i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Scuare p a d a t a b e l 4 9 d i d a p a t k a n b a h w a

t e r d a p a t l i u b u n g a n y a n g s i g n i f i k a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a

H O d i t o l a k Odds Ratio ( O R ) - 6 0 0 0 ( 9 5 o C l = 2 3 5 1 - 1 5 3 I O ) a r t i n y a n s i k o

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r

a d a i a h 6 k a l i l e b i h b e s a r d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n

m e n e n g a h d a n t i n g g i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h T o r o n d e i B e t

a l ( 2 0 1 5 ) m e n g e n a i Menstrual Hygiene Practices WASH Access and the Risk of

Urogenital Infection in Women from Odisha India d i m a n a p e r e m p u a n y a n g

h a n y a m e n e m p u l i p e n d i d i k a n s e k o l a h d a s a r a t a u l e b i h r e n d a h d i b a n d i n g k a n

d e n g a n t i n g k a t p e n d i d i k a n m e n e n g a h a t a u t i n g g i m e m i l i k i r i s i k o 3 k a l i

k e m u n g k i n a n l e b i h b e s a r m e n g a l a m i i n f e k s i s a i u r a n k e m i h ( A d j O R = 3 l 9 5

C 1 = I 2 - 7 9 p = 0 0 2 )

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a p e n g e t a h u a n s e s e o r a n g

t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t p e n d i d i k a n S e s e o r a n g y a n g

m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m u n g k i n a n p e n g e t a l i u a n t e n t a n g

k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o r m a s i y a n g d i d a p a t k a n t e n t a n g k e s e h a t a n

l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h S e b a l i k n y a

p e n d i d i k a n y a n g k u r a n g d a p a t i n e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g t e r h a d a p

n i l a i - n i l a i y a n g b a r u d i k e n a l ( N o t o a d m o j o 2 0 0 3 )

3 6

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Keniih

B e r d a s a r k a n l i a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 1 0 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a r i w a y a t d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 )

s e h i n g g a H O d i t o l a k Odds Ratio ( O R ) = 9 8 0 8 ( 9 5 C I = 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a

risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s

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b e r d a s a r k a n k a t e t e r i s a s i u r i n u m u r d a n d i a b e t e s m e l i m s d i m a n a d a r i 2 0 p a s i e n

i n f e k s i n o s o k o m i a l s a i u r a n k e m i h 1 2 o r a n g ( 6 0 ) d i a n t a r a n y a a d a i a h p a s i e n

d e n g a n s t a t u s D M s e d a n g k a n 8 o r a n g ( 4 0 ) l a i n n y a a d a i a h p a s i e n t a n p a s t a t u s

D M ( P v W w ^ = 0 0 2 4 O R = 6 0 0 9 5 C I = 1 2 2 - 3 2 2 6

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a b a l i w a b e b e r a p a b a g i a n

d a r i i i n u n i t a s p a d a p a s i e n d i a b e t e s m e n g a l a m i p e r u b a h a n F u n g s i

p o l i n i o r f o l e u k o s i t d i t e k a n p a d a k e a d a a n a s i d o s i s I k a t a n l e u k o s i t k e m o t a k s i s d a n

f a g o s i t o s i s j u g a b e m b a l i S i s t e m a n t i o k s i d a n y a n g b e r p e r a n p a d a a k t i f i t a s

b a k t e r i s i d a l j u g a t e r g a n g g u s e h i n g g a m e n y e b a b k a n t e r j a d i n y a I S K p a d a p a s i e n -

p a s i e n d e n g a n p e n y a k i t d i a b e t e s ( J u l k a 2 0 1 4 )

H a l y a n g s a m a j u g a d i i m g k a p k a n o l e b t e o r i S m e l t z e r d a n B a r e ( 2 0 1 0 )

b a l i w a D M d a p a t m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a l i a n a n t u b u h y a n g

b e r p o t e n s i m e n i n g k a t k a n r i s i k o t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a l i a n a n

t u b u h t e r s e b u t d i a n t a r a n y a a d a i a h k e g a g a l a n m i g r a s i s e l iniraceliular killing

f a g o s i t o s i s d a n k e m o t a k s i s p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n

m e k a n i s m e p e r t a l i a n a n a l a m i a h I o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p

i n f e k s i

BAB V

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M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 2 6 - 3 5 t a h u n y a i t u 2 3 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 3 7

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M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 4 6 - 5 5 t a l i u n y a i t u 2 9 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 1 3

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s a i u r a n k e m i l i t e r b a n y a k y a i t u b e r u s i a gt 5 0 t a h u n ( 5 3 3 ) j e n i s k e i a m i n

p e r e m p u a n ( 6 0 0 ) d a n t i n g k a t p e n d i d i k a n d a s a r ( 6 6 7 ) s e r t a p a l i n g

b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s y a i t u 5 6 7

4 T e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 ( p = 0 0 0 0 )

52 Saran

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p e n e l i t i a n b e r b e d a s e p e r t i cohort a t a u case control

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y a n g l a i n s e p e r t i v a r i a b e l p e k e r j a a n p e m a s a i i g a n k a t e t e r a t a u l a m a n y a

m e n d e r i t a d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

37

DAFTAR PUSTAKA

B o y k o E J d k k 2 0 0 2 D i a b e t i c A n d T h e R i s k O f A c u t e U r i n a r y T r a c t I n f e c t i o n A m o n g P o s t m e n o p a u s a l W o m e n D i a b e t e s C a r e 2 5 ( 1 0 )

D a h l a n S 2 0 1 4 B u k i i S t a t i s t i k u n t u k K e d o k t e r a n d a n K e s e h a t a n D e s k r i p t i f B i v a r i a t d a n M u l t i v a r i a t d i l e n g k a p i a p l i k a s i d e n g a n m e n g g u n a k a n S P S S E d i s i 6 E p i d e m i o l o g i I n d o n e s i a J a k a r t a I n d o n e s i a

D e p a r t e m e n K e s e h a t a n ( D E P K E S ) R l 2 0 1 4 [ O n l i n e ] K e m e n t e r i a n K e s e h a t a n R e p u b l i k I n d o n e s i a P u s a t D a t a d a n I n f o r m a s i K e m e n t e r a n K e s e h a t a n R l ( http 7depkesgoid diakses tanggal 15 Met 2016)

F o x m a n B e t a i 2 0 1 0 U r i i i a i y T r a c t I n f e c t i o n A m o n g W o m e n A g e d 4 0 T o 6 5 B e h a v i o r a l A n d S e x u a l R i s k F a c t o r s D a l a m T a n a g h o E A M c A n i n c h J W 1 7 t h S m i t h s G e n e r a l U r o l o g y U S A M c G r a w H i l l (http searchproqnestcom diakses tanggal 16 Met 2016)

H a r d i n g G K d k k 2 0 1 0 A n t i m i c r o b i a l T r e a t m e n t I n D i a b e t i c W o m e n W i t l i A s y m t o m a t i c B a c t e r i u r i a N E n g l J M e d 3 4 7 1 5 7 6 - 1 5 8 3 (http nejmorg diakses tanggal 16 Met 2016)

I s s e l b a c h e r d k k 2 0 0 9 I n f e k s i S a i u r a n K e m i h d a n P i e l o n e f r i t i s D a l a m S t a m m W a l t e r E e d H a r r i s o n P r i n s i p - P r i n s i p l l m u P e n y a k i t D a l a m e d V o l u m e 2 J a k a r t a E G C 6 1 6 - 6 2 3

J u l k a S 2 0 1 3 G e n i t o u r i n a r y I n f e c t i o n I n D i a b e t e s I n d i a n J o u m a l o f E n d o c r i n o l o g y a n d M e t a b o l i s m (http searchproquestcom diakses tanggal 16 Mei 2016)

K i m B d k k 2 0 1 2 [ e - b o o k ] T h e R e l a t i o n b e t w e e n P o s t v o i d R e s i d u a l a n d O c c u r r e n c e o f U r i n a r y T r a c t I n f e c t i o n a f t e r S t r o k e i n R e h a b i l i t a t i o n U n i t A n n a l s o f R e h a b i l i t a t i o n M e d i c i n e

K o m a r a A 2 0 0 9 P o l a K e p e k a a n B a k t e r i G r a m N e g a t i f d a r i P a s i e n I n f e k s i S a i u r a n K e m i l i t e r h a d a p A n t i b i o t i k G e n t a m i c i n d a n K o t r i m o k s a z o l y a n g D i k i r i m k e L a b o r a t o r i u m M i k r o b i o l o g i K l i n i k F K U l d a r i T a h u n 2 0 0 1 s a m p a i T a h u n 2 0 0 5 (http dontaruiacid diakses tanggal OH Agustiis 2016)

L e w i s A L e t a l 2 0 1 4 I m p a c t o f H o s t A g e a n d P a r i t y o n S u s c e p t i b i l i t y t o S e v e r e U r i n a r y T r a c t I n f e c t i o n i n a M u r i n e M o d e l P l o s O n e R e s e a r c h A r t i c l e P u b l i c L i b r a r y o f S c i e n c e 9 ( 5 ) (http searchproquestcom diakses pada langgal 30 Desember 2016)

38

UNIVERSITAS MUHAMMADIYAH P A L E M B A N G F A K U L T A S K E D O K T E R A N

S K R I P S L JANUARI 2017 R E Z A AGUSTIANTWO PUTRA

Hubungan antara Usia Jenis Keiamin Tingkat Pendidikan dan Riwayat Diabetes Melitus dengan Kejadian Infeksi Saiuran Kemih pada Pasien Rawat Inap dan Rawat Jalan di Bagian Penyakit Dalam Rumah Sakit Muhammadiyah Palembang Periode 1 Januari 2015-31 Desember 2015

xii + 37 halaman + 12 tabel + 1 gambar + 8 lampiran

A B S T R A K

I n t e k s i s a i u r a n k e m i h ( I S K ) m e n i p a k a n s u a t u i n f e k s i y a n g m e n g e n a i t r a k t u s u r i n a r i u s d a n h a m p i r 1 0 o r a n g p e m a h t e r k e n a I S K s e l a m a h i d u p n y a M e n u m t t e o r i m e n i n g k a t n y a k e j a d i a n I S K b e r h u b i m g a n d e n g a n p e n i n g k a t a n u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s P e n e l i t i a n i n i b e m i j u a n u n t u k m e n g a n a l i s i s h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i l i p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R i u n a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 J e n i s p e n e l i t i a n i n i a d a i a h o b s e r v a s i o n a i a n a l i t i k d e s a i n cross sectional d e n g a n m e n g g i i n a k a n d a t a s e k u n d e r d a r i r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g S a m p e l p e n e l i t i a n i n i a d a i a h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 d e n g a n b e s a r s a m p e l s e b a n y a k 9 8 s a m p e l S a m p e l p e n e l i t i a n i n i d i a m b i l d e n g a n c a r a consecutive sampling H a s i l u j i s t a t i s t i k d i d a p a t k a n h u b u n g a n i n f e k s i s a i u r a n k e m i h d e n g a n u s i a ( p = 0 0 0 0 ) j e n i s k e i a m i n ( p = 0 0 0 0 ) t i n g k a t p e n d i d i k a n ( p = 0 0 0 0 ) d a n riwayat d i a b e t e s m e l i t u s ( p 0 0 0 0 ) S e h i n g g a d a p a t d i s i m p u l k a n b a h w a t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n rawat j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e i J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

Referensi 29(2002-2015) Kata kunci Infeksi Saiuran Kemih Riwayat Diabetes Melitus

V

U N I V E R S I T Y O F M U H A M M A D I Y A H P A L E M B A N G FA cut T Y or M E D I C I N E

MINI THESIS J A N U A R Y 2 0 1 7 R E Z A A G U S T I A N T W O P U T R A

T h e Relationships between Age Gender Education Level Diabetes M e l i t u s History and The Incidence of U r i n a r y T r a c t Infections i n Hospitalized Patients and Outpatients at I n t e r n a l M e d i c i n e o f M u h a m m a d i y a h Palembang H o s p i t a l d u r i n g I J a n u a r y 2 0 1 5 - 3 1 December 2 0 1 5

x i i + 37pages + 12 tables + I picture + 8 attachments

A B S T R A C T

Urinary trad infection (UTI) is an infection of I he urinary tract and nearly 10 of people experience UTI during their lifeiime According to theory the increasing of urinary tract infections is related with increasing age gender education level and diabetes melitus history This study aim to analyze relationships between age gender education level diabetes melitus history and the incidence of urinary tract infections in hospitalized patients and outpatients at Internal Medicine of Muhammadiyah Palembang Hospilal during P January 2015-31 December 2015 This study lipe was analyiical observaiional with cross sectional design by using secondary data from medical record of Muhammadiyah Palembang Hospital Samples of this study were taken by consecutive sampling technique The results of statistical test were obtained relationship between urinary tract infections with age (p 0000) gender (p 0000) education level (p 0000) and diabetes melitus (p 0000) In conclusion there are significantly relationships between age gender education level diabetes melitus history and the incidence of urinary tract infections in hospitalizedpatients and outpatients at Internal Medicine of Muhammadiyah Palembang Hospital during P January 20J5-3PDecember 2015

References 2 9 ( 2 0 0 2 - 2 0 1 5 ) Keywords U r i n a r y T r a c t I n f e c t i o n s Diabetes M e l i t u s

vi

KATA PENGANTAR

S e g a l a p u j i s y u k u r k e p a d a A l l a l i S W T k a r e n a a t a s b e r k a t d a n r a h m a t - N y a p e n u l i s d a p a t i n e n y e l e s a i k a n s k r i p s i y a n g b e r j u d u l H u b u n g a n A n t a r a U s i a J e n i s K e i a m i n T i n g k a t P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h P a d a P a s i e n R a w a t i n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 S k r i p s i i n i d i s u s u n s e b a g a i s a l a h s a t u s y a r a t u n t u k m e m p e r o l e h g e l a r S a r j a n a K e d o k t e r a n d i F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u l i a m m a d i y a h P a l e m b a n g

P e n u l i s m c n y a d a r i b a l i w a d a l a m p r o s e s i n e n y e l e s a i k a n s k r i p s i i n i b a n y a k k e n d a l a y a n g d i a l a i n i n a n i u n b e r k a t b a n t u a n b i m b i n g a n k e r j a s a m a d a r i b c r b a g a i p i h a k d a n t e r u t a m a b e r k a t A l l a h S W T k e n d a l a t e r s e b u t d a p a t d i a t a s i

P e n u l i s j u g a m e n v a d a r i b a h w a s k r i p s i i n i m a s i h j a u h d a r i s e m p u m a m a k a d e n g a n s e g a l a k e r e n d a h a n l i a t i p e n u l i s m e n g l i a r a p k a n a d a n y a k r i t i k d a n s a r a n y a n g b e r s i f a t m e m b a n g u n d e m i k e s e m p u m a a n s k r i p s i i n i

A k h i r k a t a p e n u l i s b c r l i a r a p A l l a l i S W T b e r k e n a n m e m b a i a s s e g a l a k e b a i k a n s e m u a p i h a k y a n g t e l a h m e m b a n t u S e m o g a s k r i p s i i n i d a p a t b e n n a n f a a t b a g i k i t a s e m u a A a m i i n

P a l e m b a n g 0 7 F e b r u a r i 2 0 1 7

R e z a A g u s t i a n t w o P u t r a

vii

DAFTAR ISI

HALAMAN J D D U L HALAMAN PENCESAHAN i HALAMAN PERNN ATAAN ii HALAMAN PERSEMBAHAN iii A B S T R A K iv A B S T R A C T v K A T A PENGANTAR vi DAFTAR ISI vii DAFTAR T A B E I ix DAFTAR GAMBAR x DAFTAR LAMPIRAN xi

BAB I Pendahuluan 1 1 1 L a t a r B e l a k a n g 1 12 R i i m u s a n M a s a l a h 3 13 T u j u a n P e n e l i t i a n 3 14 M a n l a a t P e n e l i t i a n 4 15 K e a s l i a n P e n e l i t i a n 5

BAB H Tinjauan Pustaka 9 2 1 L a n d a s a n T e o r i 9

2 1 1 I n f e k s i S a i u r a n K e m i h 9 A D e f i n i s i 9 B E p i d e m i o l o g i 9 C K i a s i f i k a s i 1 0 D E t i o l o g i 1 1 E P a t o f i s i o l o g i 11 F F a k t o r R i s i k o 1 2 G M a n i f e s t a s i K l i n i s 1 5 H T a t a l a k s a n a 1 6 I K o m p l i k a s i 1 6

2 2 K e r a n g k a T e o r i 1 7 2 3 H i p o t e s i s 1 8

BAB I I I Metode Penelitian 19 3 1 J e n i s P e n e l i t i a n 1 9 3 2 W a k t u d a n T e m p a t P e n e l i t i a n 1 9 3 3 P o p u l a s i d a n S a m p e l 1 9

3 3 1 P o p u l a s i P e n e l i t i a n 1 9 3 3 2 S a m p e l d a n B e s a r S a m p e l P e n e l i t i a n 1 9 3 3 3 K n t e r i a I n k l u s i d a n E k s k l u s i 2 0 3 3 4 C a r a P e n g a m b i l a n S a m p e l P e n e l i t i a n 2 0

3 4 V a r i a b e l P e n e l i t i a n 2 0 3 4 1 V a r i a b e l Dependent 2 0 3 4 2 V a r i a b e l Independent 2 0

viii

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3 7 C a r a P e n g o l a h a n d a n A n a l i s i s D a t a 2 2 3 8 A l u r P e n e l i t i a n 2 4

BAB IV HASIL DAN PEMBAHASAN 25 4 1 H a s i l 2 5 4 2 P e m b a h a s a n 3 3

BAB V KESIMPLILAN DAN SARAN 37 5 1 K e s i m p u l a n 3 7 5 2 S a r a n 3 7

D A F T A R PUSTAKA 38 LAMPIRAN 41 BIODATA 63

ix

DAFTAR T A B E L

Tabel Halaman

T a b e l 1 1 K e a s l i a n P e n e l i t i a n 5 T a b e l 3 1 D e f i n i s i O p e r a s i o n a l 2 1 T a b e l 4 1 D i s t r i b u s i P r o p o r s i K a r a k t e r i s t i k P a s i e n R a w a t i n a p

B e r d a s a r k a n U s i a d a n J e n i s K e i a m i n 2 6 T a b e l 4 2 D i s t r i b u s i P r o p o r s i K a r a k t e r i s t i k P a s i e n R a w a t J a l a n

B e r d a s a r k a n U s i a d a n J e n i s K e i a m i n 2 7 T a b e l 4 3 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n U s i a 2 8 T a b e l 4 4 D i s t r i b u s i P r o p o r s i K e j a d i a n i n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n J e n i s K e l a m m 2 8 T a b e l 4 5 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n T i n g k a t P e n d i d i k a n 2 9 T a b e l 4 6 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n R i w a y a t D i a b e t e s M e l i t u s 2 9 T a b e l 4 7 H a s i l U j i H u b u n g a n a n t a r a U s i a d e n g a n K e j a d i a n

i n f e k s i S a i u r a n K e m i h 3 0 T a b e l 4 8 H a s i i U j i H u b u n g a n a n t a r a J e n i s K e i a m i n d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i b 3 1 T a b e l 4 9 H a s i l U j i H u b u n g a n a n t a r a T i n g k a t P e n d i d i k a n d e n g a n

K e j a d i a n i n t e k s i S a i u r a n K e m i h 3 2 T a b e l 4 1 0 H a s i l U j i H u b u n g a n a n t a r a R i w a y a t D i a b e t e s M e l i t u s

d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h 3 3

X

DAFTAR GAMBAR

Gambar Halaman

G a m b a r 3 1 A l u r P e n e l i t i a n H u b u n g a n U s i a J e n i s K e i a m i n T i n g k a t

P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i h p a d a P a s i e n R a w a t i n a p

d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g I e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1

D e s e m b e r 2 0 1 5 2 4

xi

DAFTAR LAMPIRAN

Lampiran Halaman

L a m p i r a n 1 D a t a R e k a m M e d i s P a s i e n R a w a t I n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 4 3

L a m p i r a n 2 H a s i l A n a l i s i s U n v i a r i a t 4 5

L a m p i r a n 3 H a s i l A n a l i s i s B i v a r i a t 5 1

L a m p i r a n 4 K a r t u B i m b i n g a n P r o p o s a l S k r i p s i 5 8

L a m p i r a n 5 K a r t u B i m b i n g a n S k r i p s i 5 9

L a m p i r a n 6 S u r a t P e n n o h o n a n I z i n P e n e l i t i a n 6 0

L a m p i r a n 7 S u r a t K e t e r a n g a n I z i n P e n g a m b i l a n D a t a d a n P e n e l i t i a n 6 1

L a m p i r a n 8 S u r a t K e t e r a n g a n S e l e s a i P e n e l i t i a n 6 2

xii

BAB I

PENDAHULUAN

11 Latar Belakang

I n f e k s i s a i u r a n k e m i h ( I S K ) m e n i p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m i i k a n d i R u m a h S a k i t a t a u t e m p a t p r a k t i k u m u m s e h a r i - h a r i I S K

a d a i a h s u a t u i n f e k s i y a n g m e n g e n a i t r a k t u s u r i n a r i u s m u l a i d a r i m e a t u s u r e t r a

s a m p a i d e n g a n k e g i n j a l S t r u k t u r y a n g t e n n a s u k d i d a l a m n y a a d a i a h u r e t r a

k a n d u n g k e m i h u r e t e r p e l v i s d a n p a r e n k i m g i n j a l S t r u k t u r y a n g b e r k a i t a n u n t u k

t e r j a d i n y a i n f e k s i d a n r e k u r e n i n f e k s i y a i t u p r o s t a t e p i d i d i m i s d a n fascia

perinephric I s t i l a h I S K m e n u n j u k k a n a d a n y a k e b e r a d a a n m i k r o o r g a n i s m e d i

d a l a m u r i n ( S u d o y o 2 0 0 6 R u b i n 2 0 1 0 ) D e n g a n k a t a l a i n b a h w a d i a g n o s i s I S K

d i t e g a k k a n d e n g a n m e m b u k t i k a n a d a n y a m i k r o o r g a n i s m e d i d a l a m s a i u r a n k e m i h

( R u b i n 2 0 1 0 )

S e b a n y a k 2 5 j u t a k e m a t i a n d i s e l u r u h d u n i a p a d a t a h u n 2 0 1 1 s e p e r t i g a n y a

d i s e b a b k a n o l e h p e n y a k i t i n f e k s i I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n i n f e k s i

d e n g a n k e t e r l i b a t a i i b a k t e r i t e r s e r i n g d i k o m u n i t a s d a n h a m p i r 1 0 o r a n g p e m a h

t e r k e n a I S K s e l a m a h i d u p n y a S e k i t a i - 1 5 0 j u t a p e n d i i d u k d i s e l u r u h d u n i a t i a p

t a l i u n n y a t e r d i a g n o s i s m e n d e r i t a i n f e k s i s a i u r a n k e m i h ( Y u n u s 2 0 1 2 )

I S K d a p a t m e n g e n a i s e m u a k e l o m p o k u m u r b a i k a n a k r e m a j a d e w a s a

m a u p u n u s i a l a n j u t P r e v a l e n s i a n a k u s i a s e k o l a h y a n g m e n d e r i t a I S K s e k i t a r 1 -

3 d a n m e n i n g k a t p a d a r e m a j a y a n g s u d a h m e l a k u k a n h u b i m g a n s e k s u a l

( K o m a r a 2 0 0 9 ) D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r 2 5 - 3 5

s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a S e l a m a

p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n c e n d e r u n g

m e n d e r i t a I S K d i b a n d i n g k a n l a k i - l a k i ( S u d o y o 2 0 0 9 )

R a s i o I S K p a d a w a n i t a d i b a n d i n g p r i a b e r k i s a r 3 0 1 d a n s e k i t a r 5 0 w a n i t a

y a n g t e r k e n a i n f e k s i a k a n b e r k e m b a n g m e n j a d i I S K b e m l a n g I S K m e n i p a k a n

i n f e k s i b a k t e r i y a n g p a l i n g s e r i n g p a d a a n a k - a n a k d e n g a n k e l u h a n d e m a m b a i k

p a d a a n a k p r i a m a u p u n w a n i t a P r e v a l e n s i y a n g p e m a h d i l a p o r k a n b e r k i s a r 4 1

I

2

s a m p a i 7 5 R e k u r e n s i c u k u p s e r i n g d a n t e r j a d i s e k i t a r 1 8 p a d a b a y i l a k i - i a k i

d a n 2 6 p a d a b a y i p e r e m p u a n U n t u k u s i a p r a s e k o l a h I S K l e b i h s e r i n g

m e n g e n a i w a n i t a I n s i d e n I S K p a d a a n a k - a n a k p r a s e k o l a h s e k i t a r 2 ( S y a h r i n i

2 0 1 1 )

D a r i b e r b a g a i p e n e l i t i a n e p i d e m i o l o g i s d i I n d o n e s i a d i d a p a t k a n p r e v a l e n s i

D M s e b e s a r 15 - 2 3 p a d a p e n d u d u k u s i a l e b i J i d a r i 1 5 t a h u n b a h k a n p a d a

s u a t u p e n e l i t i a n e p i d e m i o l o g i s d i M a n a d o d i d a p a t k a n p r e v a l e n s i D M a d a i a h 6 1

P r e v a l e n s i d i a b e t e s m e l i t u s p a d a p e n d u d u k u s i a 2 5 - 6 4 t a h u n d i J a w a d a n B a l i

s e b e s a r 7 5 P e n e l i t i a n y a n g d i l a k u k a n d i J a k a r t a S u r a b a y a M a k a s a r d a n k o t a -

k o t a l a i n d i I n d o n e s i a m e m b u k t i k a n a d a n y a k e n a i k a n p r e v a l e n s i d a r i t a h u n

k e t a h u n ( D E P K E S 2 0 1 4 W H O 2 0 1 0 )

I n f e k s i s a i u r a n k e m i h j u g a m e n i p a k a n m a s a l a h k l i n i s u m u m p a d a p e n d e r i t a

D M o l e h k a r e n a p e n d e r i t a D M m e m p u n y a i k e m u n g k i n a n m e n d e r i t a I S K l e b i h

t i n g g i d i b a n d i n g k a n d e n g a n b u k a n p e n d e r i t a D M d a n j u g a m e n d e r i t a i n f e k s i y a n g

l e b i h b e r a t y a n g a k a n m e n i n g k a t k a n risiko u n t u k m a s u k m m a h s a k i t ( H a r d i n g

d k k 2 0 1 0 ) P e n e l i t i a n y a n g d i l a k u k a n o l e h B o y k o d k k m e n d a p a t k a n w a n i t a D M

ripe 2 d e n g a n b a k t e r i u r i a s i m t o m a t i k s e t e l a h d i l a k u k a n p e m a n t a u a n s e l a m a 1 8

b u l a n m e n g a l a m i p e n i n g k a t a n r i s i k o m e n d a p a t k a n I S K s e b a n y a k 3 4

d i b a n d i n g k a n d e n g a n w a n i t a y a n g t i d a k m e n g a l a m i D M s e b e s a r 1 9 ( B o y k o d k k

2 0 0 2 )

B e r d a s a r k a n u r a i a n - u r a i a n d i a t a s s e r t a b e l u m a d a n y a p e n e l i t i a n y a n g

m e n e m u k a n k e t e r k a i t a n f a k t o r u s i a j e n i s k e l a m m t i n g k a t p e n d i d i k a n d a n r i w a y a t

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h d i K o t a P a l e m b a n g m a k a

p e n e l i t i t e r t a r i k i m t i i k m e l a k u k a n p e n e l i t i a n m e n g e n a i h u b u n g a n a n t a r a u s i a j e n i s

k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

3

12 Rumusan Masalah

1 B a g a i m a n a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s

m e l i t u s

2 A p a k a l i a d a h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

13 Tujuan Penelitian

131 Tujuan Umum

T u j u a n u m u m d a r i p e n e l i t i a n i n i a d a i a h d i k e t e m u k a n n y a h u b u n g a n a n t a i a

u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i m s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

132 Tujuan Khusus

T u j u a n k l i u s u s d a r i p e n e l i t i a n i n i y a i t u

1 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a

2 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n m f e k s i s a i u r a n k e m i b p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n j e n i s k e i a m i n

3 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

4

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n t i n g k a t p e n d i d i k a n

4 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n riwayat d i a b e t e s m e l i t u s

5 T e r a n a l i s i s n y a h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a i m n a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

6 T e r a n a l i s i s n y a h u b u n g a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

7 T e r a n a l i s i s n y a h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

8 T e r a n a l i s i s n y a h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i u i s d e n g a n k e j a d i a n

i n f e k s i s a l i u a i i k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

14 Manfaat Penelitian

141 Manfaat Teoritis

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t m e n a m b a h p e n g e t a h u a n p e n e l i t i

t e n t a n g h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i U i s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

5

142 Manfaat Praktis

A Bagi Peneliti

H a s i l p e n e l i t i a n i n i d i l i a r a p k a n d a p a t d i g u n a k a n s e b a g a i s a l a h s a t u b a h a n

r e f e r e n s i a t a u b a c a a n b a g i p e n e l i t i

B Bagi Institusi

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t d i g u n a k a n p i h a k R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g s e b a g a i s a l a l i s a t u b a h a n a c u a n d a l a m m e n g u p a y a k a n

p e n c e g a h a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

15 Keaslian Penelitian

T a b e l 1 1 K e a s l i a n P e n e l i t i a n

Nama Judul Penelitian Desain Hasil Penelitian

Peneliti Penelitian

Kugan P r e v a l e n s i I n f e k s i Cross D a r i p e n e l i t i a n i i i i

Kandasamy S a i u r a n K e m i l i P a d a seciUmal d i p e r o l e h b a l i w a

W a n i t a Y a n g M e n d e r i t a

D i a b e t e s M e l i t u s T i p e

I I Y a n g D i r a w a t I n a p

p a s i e n w a n i t a d i a b e t e s

m e l i t u s t i p e I y a n g

m e n d e r i t a I S K y a n g

D a n D i r a w a t J a l a n D i d i r a w a t m a p d a n

S u b b a g i a n

E n d o k r i n o l o g i B a g i a n

P e n y a k i t D a l a m D i

d i r a w a t j a l a n d i s u b

b a g i a n E n d o k r i n o l o g i

P e n y a k i t D a l a m

R S U P H A d a m M a l i k R S U P H A d a m

P a d a T a l i u n 2 0 0 9 M a l i k M e d a i i t e r d a p a t

s e b a n y a k 2 5 o r a n g

y a i t u ( 1 2 7 ) D a r i 2 5

o r a n g y a n g m e n d e r i t a

I S K t e r d a p a t 3 o r a n g

y a i t u ( 1 2 0 ) y a n g

d i r a w a t i n a p d a n 2 2

6

o r a n g ( 8 8 0 ) y a n g

d i r a w a t j a l a n

Edel Weisela P e r b e d a a n R i s i k o

Permata I n f e k s i N o s o k o m i a l

Sari dan S a i u r a n K e m i h

Prijono B e r d a s a r k a n

Satyabakti K a i e t e r i s a s i U r i n

U m u r D a n D i a b e t e s

M e l i t u s T a h u n 2 0 1 5

Case H a s i l p e n e l i t i a n y a n g

control d i 1 a k u k a n p a d a 2 0

s a m p e l k a s u s d a n

k o n t r o l m e n u n j u k k a n

b a h w a p a s i e n d e n g a n

u m u r gt 5 5 t a h u n

m e m p u n y a i r i s i k o

5 5 7 k a l i m e n g a l a m i

i n f e k s i n o s o k o m i a l

s a i u r a n k e m i h

d i b a n d i n g k a n p a s i e n

d e n g a n u m u r lt 5 5

t a h u n d e n g a n

p e r i l i t u n g a i i b e s a r

risiko d i p e r o l e h n i l a i

O R s e b e s a r 5 5 7

d e n g a n n i l a i 9 5

(onfidence Interval

l 1 9 lt O R lt 2 8 2 3

P a s i e n d e n g a n s t a t u s

D M m e m p u n y a i risiko

6 k a l i u n t u k

m e n g a l a m i i n f e k s i

n o s o k o m i a l s a i u r a n

k e m i h d i b a n d i n g k a n

d e n g a n p a s i e n y a n g

t i d a k m e n d e r i t a D M

d e n g a n n i l a i O R

7

s e b e s a r 6 0 0 d e n g a n

n i l a i 9 5 Confidence

Interval 1 22 lt O R lt

3 2 2 6

Andry K a r a k t e r i s t i k P a s i e n - D e s k r i p k i f H a s i i p e n e l i t i a n d a r i

Lukandy P a s i e n I n f e k s i S a i u r a n r e t r o s p e k t i f 4 3 o r a n g p e n d e r i t a

K e m i i i d i P o l i u r o l o g i

R S U D D r P i m g a d i

K o t a M e d a n T a h u n

2 0 1 2 - 2 0 1 3

I S K d i d a p a t k a n 5 3 5

p a d a k e l o m p o k u s i a

gt 5 0 t a h u n 5 1 2

b e i j e n i s k e i a m i n l a k i -

l a k i 1 0 0 t i d a k

m e n d e r i t a

v e s i c o u r e t r a l r e f l u x

7 0 Benign Prostatic

Hyperplasia 1 1 6

b a t u s a i u r a n k e m i h

2 7 9 d i a b e t e s t i p e 2

D a r i h a s i l p e n e l i t i a n

i n i d a p a t d i s i m p u l k a n

b a h w a p e n d e r i t a i S K

l e b i h b a n y a k t e r j a d i

p a d a l a k i - l a k i d a n

p e n d e r i t a I S K l e b i h

b a n y a k d i j u m p a i p a d a

k e l o m p o k u m u r gt 5 0

t a h u n s e r t a d i t e m u k a n

I S K d e n g a n B P H

B S K d a n D M T i p e 2

BAB 11

TINJAUAN PUSTAKA

21 Landasan Teori

211Infeksi Saiuran Keniih

A Definisi

I n f e k s i S a i u r a n K e m i h a d a i a h i n v a s i d a n m u l t i p l i k a s i m i k r o o r g a n i s m e a t a u

p a r a s i t d a l a m j a r i n g a n t u b u h k h u s u s n y a s a i u r a n k e m i h y a n g t e r d i r i d a r i g i n j a l

u r e t e r b u l i - b u l i d a n u r e t r a y a n g d i i a n d a i d e n g a n a d a n y a b a k t e r i 1 0 c f i i (colony

forming unit) p e r m l p a d a p e n g a m b i l a n c o n t o h u r i n ( P u m o m o 2 0 1 1 )

I n f e k s i s a i u r a n k e m i h a d a l a l i s u a t u i n f e k s i y a n g m e l i b a t k a n g i n j a l lU e ter

b u l i - b u l i a t a u p u n u r e t r a I n f e k s i s a i u r a n k e m i h ( I S K ) a d a l a l i i s t i l a h u m u m y a n g

m e n u n j u k k a n k e b e r a d a a n m i k r o o r g a n i s m e d a l a m u r i n ( S u d o y o 2 0 0 6 )

B a k t e r i u r i a b e r m a k n a (significant hacteriuria) a d a i a h s u a t u k e a d a a n y a n g

m e n u n j u k k a n p e n u m b u l i a n m i k r o o r g a n i s m e m u m i l e b i h d a r i 1 0 c f t L m l p a d a

b i a k a n u r i n B a k t e r i u r i a b e r m a k n a m u n g k i n t a n p a d i s e r t a i p r e s e n t a s i k l i n i s I S K

d a n d i n a m a k a n b a k t e r i u r i a a s i m t o m a t i k (convert hacteriuria) S e b a l i k n y a

b a k t e r i u r i a b e n n a k n a d i s e r t a i p e r s e n t a s i k l i n i s I S K d i n a m a k a n b a k t e r i u r i a

s i m t o m a t i k P a d a b e b e r a p a k e a d a a n t e r d a p a t p a s i e n d e n g a n p e r s e n t a s i k l i n i s I S K

n a m u n t a n p a b a k t e r i u r i a b e n n a k n a S e l a i n i t u d i k a t a k a n p i u r i a ( l e u k o s i t d a l a m

u r i n ) b e n n a k n a (significant pyuria) b i l a d i t e m u k a n n e u t r o f i l gt 1 0 s e l p e r l a p a n g a n

p a n d a n g ( S u d o y o 2 0 0 6 )

B Epidemiologi

I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m u k a n d i p r a k t i k u m u m w a i a u p u n b e n n a c a m - m a c a m a n t i b i o t i k a s u d a h

t e r s e d i a l u a s d i p a s a r a n D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r

2 5 - 3 5 s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a

S e l a m a p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n

9

10

c e n d e r u n g m e n d e r i t a i S K d i b a n d i n g k a n l a k i - l a k i I S K b e m l a n g p a d a l a k i - l a k i

j a r a n g d i l a p o r k a n k e c u a l i d i s e r t a i f a k t o r p r e d i s p o s i s i ( p e n c e t u s )

P r e v a l e n s i b a k t e r i u r i a a s i m t o m a t i k l e b i h s e r i n g d i t e m u k a n p a d a p e r e m p u a n

P r e v a l e n s i s e l a m a p e r i o d e s e k o l a h (school girls) 1 m e n i n g k a t m e n j a d i 5

s e l a m a p e r i o d e a k t i f s e c a r a s e k s u a l P r e v a l e n s i i n f e k s i a s i m t o m a t i k m e n i n g k a t

m e n c a p a i 3 0 b a i k l a k i - l a k i m a u p u n p e r e m p u a n b i l a d i s e r t a i f a k t o r p r e d i s p o s i s i

( S u d o y o 2 0 0 6 )

C Kiasifikasi

I n f e k s i s a i u r a n k e m i h d a p a t d i b a g i m e n j a d i d u a k a t e g o r i u m u m b e r d a s a r k a n

l o k a s i a n a t o m i y a i t u

1 ) I n f e k s i s a i u r a n k e m i h b a w a h

2 ) I n f e k s i s a i u r a n k e m i h a l a s

P r e s e n t a s i k l i n i s d a r i i n f e k s i s a i u r a n k e m i h b a w a l i t e r g a n t u n g d a r i gender

y a i t u

a ) P e r e m p u a n

a S i s t i t i s

S i s t i t i s a d a i a h p r e s e n t a s i k l i n i s i n f e k s i k a n d u n g k e m i h d i s e r t a i

b a k t e r i u r i a b e n n a k n a

b S i n d r o m U r e t r a A k u t ( S U A )

S i n d r o m a u r e t r a a k u t a d a i a h p r e s e n t a s i k l i n i s s i s t i t i s t a n p a d i t e m u k a n

a d a n y a m i k r o o r g a n i s m e d a l a m L u i n ( s t e r i l ) d a n s e r i n g d i n a m a k a n

s i s t i t i s b a k t e r i a l i s

b ) L a k i - l a k i

P r e s e n t a s i k l i n i s i n f e k s i s a i u r a n k e m i h p a d a l a k i - l a k i m u n g k i n s i s t i t i s

p r o s t a t i t i s e p i d i m i d i s d a n u r e t r i t i s

I n f e k s i s a i u r a n k e m i h a t a s t e r b a g i m e n j a d i 2 y a i t u

1 ) P i e l o n e f r i t i s A k u t ( P N A )

P i e l o n e f r i t i s a k u t a d a l a l i p r o s e s i n f l a m a s i p a r e n k i m g i n j a l y a n g d i s e b a b k a n

o l e h m f e k s i b a k t e r i

11

2 ) P i e l o n e f r i t i s K r o n i s ( P N K )

P i e l o n e f r i t i s k r o n i s m u n g k i n a k i b a t l a n j u t d a r i i n f e k s i b a k t e r i

b e r k e p a n j a n g a n a t a u i n f e k s i s e j a k m a s a k e c i i O b s t r u k s i s a i u r a n k e m i h d a n

r e f l u k s v e s i k o u r e t e r d e n g a n a t a u t a n p a b a k t e r i u r i a k r o n i k s e r i n g d i i k u t i

p e m b e n t u k a n j a r i n g a n i k a t p a r e n k i m g i n j a l y a n g d i t a n d a i d e n g a n

p i e l o n e f r i t i s k r o n i k y a n g s p e s i f i k ( S u d o y o 2 0 0 6 )

D Etiologi

P a d a k e a d a a n n o r m a l u r i n b e r s i f a t s t e r i l U m u m n y a I S K d i s e b a b k a n o l e h

k i i m a n g r a m n e g a t i f E s c h e r i c h i a c o l i m e m p a k a n p e n y e b a b t e r b a n y a k b a i k p a d a

y a n g s i m t o m a t i k m a u p u n y a n g a s i m t o m a t i k y a i t u 7 0 - 9 0 E n t e r o b a k t e r i a s e p e r t i

P r o t e u s m i r a b i l i s ( 3 0 d a r i i n f e k s i s a i u r a n k e m i h p a d a a n a k l a k i - l a k i t e t a p i

k u r a n g d a r i 5 p a d a a n a k p e r e m p u a n ) K l e b s i e l l a p n e u m o n i a d a n P s e u d o m o n a s

a e m g i n o s a d a p a t j u g a s e b a g a i p e n y e b a b O r g a n i s m e g r a m p o s i t i f s e p e r t i

S t r e p t o c o c c u s f a e c a l i s ( e n t e r o k o k u s ) S t a p h y l o c o c c u s e p i d e n n i d i s d a n

S t r e p t o c o c c u s v i r i d a n s j a r a n g d i t e m u k a n P a d a u r o p a t i o b s t m k t i f d a n k e l a i n a n

s t r u k t u r s a i u r a n k e m i h p a d a a n a k l a k i - l a k i s e r i n g d i t e m u k a n P r o t e u s s p e c i e s P a d a

I S K n o s o k o m i a l a t a u I S K k o m p l e k s l e b i h s e r i n g d i t e m u k a n k u m a n P r o t e u s d a n

P s e u d o m o n a s ( L u m b a n b a t u S M 2 0 0 3 )

E Patofisiologi

P a d a i n d i v i d u n o n n a l b i a s a n y a u r i n l a k i - l a k i m a u p u n p e r e m p u a n s e l a l u

d a l a m k e a d a a n s t e r i l k a r e n a d i p e r t a l i a n k a n o l e h j u m l a l i d a n f r e k u e n s i b e r k e m i h

U t e r o d i s t a l m e m p a k a n t e m p a t k o l o n i s a s i m i k r o o r g a n i s m e nonpathogenic

fastidious G r a m - p o s i t i f d a n g r a m n e g a t i f ( S u d o y o 2 0 0 6 )

H a m p i r s e m u a I S K d i s e b a b k a n i n v a s i m i k r o o r g a n i s m e ascending d a r i u r e t r a

k e d a l a m k a n d u n g k e m i b P a d a b e b e r a p a p a s i e n t e r t e n t u i n v a s i m i k r o o r g a n i s m e

d a p a t m e n c a p a i k e g i n j a l P r o s e s i n i d i p e n n u d a h o l e h k o n d i s i r e f l u k s

v e s i k o i i r e t e r a l P r o s e s i n v a s i m i k r o o r g a n i s m e h e m a t o g e n s a n g a t j a r a n g d i t e m u k a n

d i k l i n i k m u n g k i t a k i b a t l a n j u t d a r i b a k t e r e m i a G i n j a l d i d u g a m e n i p a k a n l o k a s i

12

i n f e k s i s e b a g a i a k i b a t l a n j u t d a r i s e p t i k e m i a a t a u e n d o k a r d i t i s a k i b a t S t a f i l o k o k u s

a u r e u s K e l a i n a n g i n j a l y a n g t e r k a i t d e n g a n e n d o k a r d i t i s ( S t a f i l o k k o k u s a u r e u s )

d i k e n a l d e n g a n N e p h r i t i s L o h e i n B e b e r a p a p e n e l i t i a n m e l a p o r k a n p i e l o n e f r i t i s

a k u t ( P N A ) s e b a g a i a k i b a t l a n j u t i n v a s i h e m a t o g e n ( S u d o y o 2 0 0 6 )

F Faktor Risiko

P a t o f i s i o l o g i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h d a p a t d i p e n g a n i h i o l e h

b e b e r a p a f a k t o r A d a p u n b e b e r a p a f a k t o r risiko y a n g m e m p e n g a n i l i i t e r j a d i n y a

i n f e k s i s a i u r a n k e m i h a n t a r a l a i n

1 ) U s i a

I n s i d e n I S K m e n i n g k a t b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i

m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n a d a n y a a b n o r m a l i t a s a n a t o m i y a n g

m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n k e m i h s e p e r t i p e m b e s a r a n p r o s t a t

d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e

P e n y e b a b l a i n t e r m a s u k p e r i n e u m y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s

p e n y a k i t n e u r o m u s k n l a r d a n k a t e t e r i s a s i b u l i - b u l i S e l a i n i t u i n s i d e n I S K

m e n c a p a i 1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o s e 2 0 0 9 F o x m a n e t a l 2 0 1 0

R o n a l d 2 0 1 1 )

M e n u m t t e o r i y a n g d i k e m u k a k a n o l e h S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a d a u s i a

l a n j u t a k a n t e r j a d i p e n i n g k a t a n k e r e n t a n a n t e r h a d a p p e n y a k i t P a d a u s i a d i a t a s 5 0

t a l i u n t e r j a d i p e n u m n a n k e m a m p u a n d a l a m m e m p e r t a h a n k a n s t e n l i t a s b a i k p a d a

k a n d u n g k e m i h m a u p u n u r e t r a H a l t e r s e b u t d i s e b a b k a n o l e h i n v o l u s i t i m u s

I n v o l u s i s e l t i m u s m e n y e b a b k a n j u m l a h se d a n k u a l i t a s r e s p o n s s e l T s e m a k i n

b e r k u r a n g J u m l a h s e l T m e m o r i m e n i n g k a t n a m u n s e m a k i n s u l i t u n t u k

b e r k e m b a n g t e r u t a m a s i t o t o k s i k s e l T ( C D ^ ) d a n s e l T h l ( C D ^ ^ ) k a r e n a t e r j a d i

a p o p t o s i s S i t o t o k s i k s e l T ( C D ^ ^ ) b e i p e r a n d a l a m r e s p o n s i m u n t e r h a d a p a n t i g e n

p a d a s e l y a n g d i i n f e k s i d e n g a n c a r a m e m b u n u l i s e l y a n g t e r i n f e k s i u n t u k

m e n c e g a h p e n y e b a r a n m f e k s i s e d a n g k a n s e l T h l ( C D ^ ^ ) b e r p e r a n m e m b a n t u s e l

B u n t u k m e m p r o d u k s i a n t i b o d i

13

2 ) J e n i s k e l a m m d a n a k t i v i t a s s e k s u a l

I n s i d e n s i I S K y a n g r e n d a h p a d a p r i a d i p e n g a n i h i o l e h 3 f a k t o r y a i t u

1 L e b i h s e d i k i t t e r j a d i k o l o n i s a s i s e k i t a r u r e t r a k a r e n a t i d a k a d a n y a t e m p a t

s e p e r t i v a g i n a p a d a p e r e m p u a n

2 M e m i l i k i u r e t r a y a n g p a n j a n g

3 A d a n y a s u b s t a n s i a n t i b a k t e r i a l p a d a c a i r a n p r o s t a t

U r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a h d e n g a n d e k a t n y a v a g i n a l

v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h l e b i h s e r i n g

p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a f l o r a n o n n a l p a d a d a e r a l i p e r i u r e t r a t e r d i r i

d a r i o r g a n i s m e s e p e r t i l a c t o b a c i l l i i s y a n g m e m b a n t u m e l a w a n k o l o n i s a s i b a k t e r i

p a t o g e n p a d a s a i u r a n k e m i h P e r u b a l i a n l i n g k i m g a n d a r i p e r i u r e t r a l s e p e r t i

p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k b i s a m e n g g a n g g u f l o r a

n o r m a l s e h i n g g a m e m u n g k i n k a n b a k t e r i p a t o g e n b e r k o l o n i s a s i d a n m e n y e b a b k a n

i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

P a d a w a n i t a l e b i h d a r i 5 0 t a h u n a t a u l e b i h m e n o p a u s e m e m p a k a n f a k t o r

l a i n y a n g m e n i n g k a t k a n P V R Post Void Residual) s e l a i n p e n u r u n a n k o i i t r a k t i i i t a s

o t o t d e t r u s o r P e n u m n a n e s t r o g e n y a n g d i s e b a b k a n m e n o p a u s e d a p a t

m e n i n g k a t k a n p H v a g i n a l d a n m e n u m n k a n j u m l a l i l a c t o b a c i l l i A k i b a m y a t e r j a d i

p e n i n g k a t k a n k o l o n i s a s i d a r i b a s i l g r a m n e g a t i f s e h i n g g a m e n i n g k a t k a n r e s i k o

t e r j a d i n y a I S K P a d a p r i a p r o s t a t m e n s e k r e s i k a n c a i r a n y a n g m e n g a n d i m g z i n k

y a n g m e m i l i k i a k t i f i t a s m i k r o b i a l ( K i m 2 0 1 2 )

S e l a i n i t u p i j a t a n u r e t r a s e p e r t i y a n g t e r j a d i s e l a m a h u b u n g a n s e k s u a l

m e n y e b a b k a n m a s u k n y a b a k t e r i k e d a l a m k a n d u n g k e m i h d a n m e m p a k a n h a l

y a n g p e n t i n g d a l a m p a t o g e n e s i s m f e k s i s a l i u a n k e m i h p a d a p e r e m p u a n m u d a

B u a n g a i r k e c i l s e t e l a h h u b u n g a n s e k s u a l t e r b u k t i m e n u m n k a n risiko s i s t i t i s

m u n g k i n k a r e n a t i n d a k a n i n i m e n i n g k a t k a n e r a d i k a s i b a k t e r i y a n g m a s u k s e l a m a

h u b u n g a n s e k s u a l ( K i m 2 0 1 2 )

3 ) T i n g k a t P e n d i d i k a n

P e n g e t a h u a n s e s e o r a n g t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t

p e n d i d i k a n S e s e o r a n g y a n g m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m i u i g k i n a n

p e n g e t a h u a n t e n t a n g k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o n n a s i y a n g d i d a p a t k a n

14

t e n t a n g k e s e h a t a n l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h

S e b a l i k n y a p e n d i d i k a n y a n g k u r a n g d a p a t m e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g

t e r h a d a p n i l a i - n i l a i y a n g b a n i d i k e n a l ( N o t o a d i n o j o 2 0 0 3 )

4 ) R i w a y a t D i a b e t e s M e l i t u s

M e n u r u t S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a s i e n d e n g a n s t a t u s D M s a n g a t

b e r i s i k o u n t u k m e n g a l a m i i n f e k s i s a i u r a n k e m i h A b n o n n a l i i a s s t n i k t u r d a n

k a n d u n g k e m i h n e u r o g e n i k a k i b a t n e u r o p a t i o t o n o m a t a u s t r o k e p a d a p a s i e n D M

m e n y e b a b k a n p e n g o s o n g a n k a n d u n g k e m i h t i d a k n o n n a l D M j u g a d a p a t

m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a h a n a n t u b u h y a n g b e r p o t e n s i m e n i n g k a t

risiko t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a h a n a n t u b u h t e r s e b u t d i a n t a r a n y a

a d a i a h k e g a g a l a n m i g r a s i s e l intracellular killing f a g o s i t o s i s d a n k e m o t a k s i s

p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n m e k a n i s m e p e r t a h a n a n

a l a m i a h i o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p i n f e k s i

5 ) K e h a m i i a n

K e c e n d e r u n g a n i n f e k s i s a i u r a n k e m i h b a g i a n a t a s s e l a m a k e h a m i i a n

d i s e b a b k a n o l e h p e n u m n a n k e k u a t a n u r e t e r p e n u m n a n p e r i s t a l t i k u r e t e r d a n

i n k o m p e t e n s i s e m e n t a r a k a l u p v e s i k o i u - e t e r a l y a n g t e r j a d i s e l a m a h a m i l

6 ) S u m b a t a i i

A d a n y a I i a i a n g a n a l i r a n b e b a s u r i n s e p e r t i t u m o r s t r i k t r a a b a t u a t a u

h i p e r t r o f i p r o s t a t d a p a t m e n y e b a b k a n h i d r o n e f r o s i s d a n risiko i n f e k s i s a i u r a n

k e m i l i y a n g s a n g a t t i n g g i S e l a i n i t u s u p e r i n f e k s i p a d a s u m b a t a n s a i u r a n k e m i h

d a p a t m e n y e b a b k a n k e m s a k a n j a r i n g a n g i n j a l y a n g c e p a t

7 ) D i s f u n g s i n e u r o g e n i k k a n d u n g k e m i h

G a n g g u a n s a r a f y a n g b e k e r j a p a d a k a n d m i g k e m i h s e p e r t i p a d a j e j a s k o r d a

s p i n a l i s t a b e s d o r s a i i s m u l t i p e l s k l e r o s i s d i a b e t e s m e l i t u s a t a u p e n y a k i t l a i n

d a p a t b e r h u b u n g a n d e n g a n i n f e k s i s a i u r a n k e m i h I n f e k s i d a p a t d i a w a l i o l e h

p e n g g u n a a n k a t e l e r u n t u k d r a i n a s e k a n d i u i g k e m i h d a n d i d u k i m g o l e h s t a t i s u r i n

d a l a m k a n d u n g k e m i l i u n t u k j a n g k a w a k t u y a n g l a m a

8 ) R e f l u k s v e s i k o m e t e r a

K e a d a a n i n i d i d e f i n i s i k a n s e b a g a i r e f l u k s u r i n d a r i k a n d u n g k e m i b k e u r e t e r

d a n k a d a n g s a m p a i k e p e l v i s r e n a l H a l i n i t e r j a d i s e l a m a b u a n g a i r k e c i l a t a u

15

d e n g a n p e n i n g k a t a n t e k a n a n p a d a k a n d u n g k e m i h R e f l u k s v e s i k o i i r e t e r a l d a p a t

d i b u k t i k a n d e n g a n a d a n y a g c r a k a n r e t r o g r a d z a t r a d i o o p a k a t a u r a d i o a k t i f m e l a l u i

s i s t o u r e t r o g r a m s e l a m a b u a n g a i r k e c i l R e f l u k s v e s i k o i i r e t e r a l b i a s a n y a

d i s e b a b k a n k a r e n a a d a n y a g a n g g u a n a n a t o m i s p a d a p e r t e m u a n v e s i k o i i r e t e r a l

y a n g d a p a t m e n y e b a b k a n r e f l u k s u r i n d i s e r t a i b a k t e r i d a n k a r e n a i t u t e r j a d i l a h

i n f e k s i s a l r a a n k e m i h

9 ) F a k t o r v i r u l e n s i b a k t e r i

F a k t o r v i r u l e n s i b a k t e r i m e m p e n g a r u b i k e m u n g k i n a n vragt7 t e r t e n m d a l a m

m e n y e b a b k a n i n f e k s i t r a k i u s u r i n a r i u s H a m p i r s e m u a strain F c o l i y a n g

m e n y e b a b k a n p i e l o n e f r i t i s p a d a p a s i e n d e n g a n t r a k i u s u r i n a r i u s n o m i a l s e c a r a

a n a t o m i k m e m p u n y a i p i l u s t e r t e n t u y a n g m e m p e r a n t a r a i p e r l e k a t a n p a d a b a g i a n

d i g a k t o s i d a d a n g l i k o s f i n g o l i p i d y a n g a d a d i u r o e p i t e l Strain y a n g m e n i m b u l k a n

p i e l o n e f r i t i s j u g a b i a s a n y a m e m p a k a n p e n g b a s i l h e m o l i s i n m e m p u n y a i

a e r o b a k t i n d a n r e s i s t e n t e r h a d a p k e r j a b a k t e r i s i d a l d a r i s e m m m a n u s i a

1 0 ) F a k t o r g e n e t i k

F a k t o r g e n e t i k p e n j a m u m e m p e n g a n i l i i k e r e n t a n a n t e r h a d a p i n f e k s i t r a k t u s

u r i n a r i u s J u m l a h d a n t i p e r e s e p t o r p a d a s e l u r o e p i t e l t e m p a t b a k t e r i d a p a t

m e n e m p e l s e l i d a k i i y a s e b a g i a i i d i t e n t u k a r i s e c a r a g e n e t i k ( I s s e l b a c h e r 2 0 0 9 )

G Manifestasi Klinis

G e j a l a k l i n i s d a r i i n f e k s i s a i u r a n k e m i h s e s u a i d e n g a n b a g i a n s a i u r a n k e m i h

y a n g t e r i n f e k s i a d a i a h s e b a g a i b e r i k u t

1 ) I n f e k s i s a i u r a n k e m i h b a g i a n b a w a l i

K e l u h a n p a s i e n b i a s a n y a b e m p a r a s a s a k i t a t a u r a s a p a n a s d i u r e t r a s e w a k t u

k e n c i n g d e n g a n a i r k e m i h s e d i k i t - s e d i k i t s e r t a r a s a t i d a k e n a k d i d a e r a h

s i i p r a p u b i k

2 ) I n f e k s i s a i u r a n k e m i h b a g i a n a t a s

P a d a i n t e k s i s a i u r a n k e m i h b a g i a n a t a s d a p a t d i t e m u k a n g e j a l a s e p e r t i s a k i t

k e p a l a m a l a i s e m u a l m m i t a h d e n i a m m e n g g i g i l r a s a t i d a k e n a k a t a u

n y e r i d i p i n g g a n g ( T e s s y d k k 2 0 0 1 )

16

H Tatalaksana

T u j u a n p e n a t a l a k s a n a a a n i n f e k s i s a i u r a n k e m i h a d a i a h m e n c e g a h d a n

m e n g h i l a n g k a n g e j a l a m e n c e g a h d a n m e n g o b a t i b a k t e n e m i a d a n b a k t e r i u r i a s e r t a

m e n c e g a h d a n m e n g u r a n g i r i s i k o k e r u s a k a n g i n j a l y a n g m u n g k i n t i m b u l d e n g a n

p e m b e r i a n o b a t - o b a t a n y a n g s e n s i t i f m u r a l i d a n a m a n d e n g a n e f e k s a m p i n g y a n g

m i n i m a l

a ) i n f e k s i s a i u r a n k e m i h ( I S K ) b a w a h

P r i n s i p p e n a t a l a k s a n a a n I S K b a w a h m e l i p u t i intake c a i r a n y a n g b a n y a k

a n t i b i o t i k y a n g a d e k u a t d a n b i l a p e r l u t e r a p i s i m t o m a t i k u n t u k a l k a l i s a s i

u r i n

i H a m p i r 8 0 p a s i e n a k a n m e m b e r i k a n r e s p o n s e t e l a h 4 8 j a m d e n g a n

a n t i b i o t i k a t u n g g a l s e p e r t i a m p i s i l i n 3 g r a m a t a u t r i m e t o p r i m 2 0 0 m g

i i B i l a i n f e k s i m e n e t a p d i s e r t a i k e l a i n a n u r i n a l i s i s ( l e u k o s i u i a ) d i p e r i u k a n

t e r a p i k o n v e n s i o n a l s e l a m a 5 - 1 0 h a r i

i i i P e m e r i k s a a n m i k r o s k o p i s u r i n d a n b i a k a n u r i n t i d a k d i p e r i u k a n b i l a

s e m u a g e j a l a h i l a n g d a n t a n p a l e u k o s u r i a

b ) I n f e k s i s a i u r a n k e m i h ( I S K ) a t a s

P a d a u m u m n y a p a s i e n d e n g a n p i e l o n e f r i t i s a k u t m e m e r l u k a n r a w a t i n a p

u n t u k m e m e l i h a r a s t a t u s h i d r a s i d a n t e r a p i a n t i b i o t i k a p a r e n t e r a l p a l i n g

s e d i k i t 4 8 j a m ( S u d o y o 2 0 0 6 )

i Komplikasi

K o m p l i k a s i i n f e k s i s a i u r a n k e m i h t e r g a n t u n g d a r i t i p e y a i t u i n f e k s i s a i u r a n

k e m i h t i p e s e d e r h a n a (uncomplicated) d a n t i p e b e r k o m p l i k a s i (complicated)

1 ) I n f e k s i s a i u r a n k e m i h s e d e r h a n a (uncomplicated)

I n f e k s i s a i u r a n k e m i h a k u t t i p e s e d e r h a n a ( s i s t i t i s ) y a i t u n o n - o b s t r u k s i d a n

b u k a n p e r e m p u a n h a m i l m e m p a k a n p e n y a k i t r i n g a n (self limited disiase)

d a n t i d a k m e n y e b a b k a n a k i b a t l a n j u t j a n g k a l a m a

2 ) I n f e k s i s a i u r a n k e m i h b e r k o m p l i k a s i (complicated)

a ) I n f e k s i s a i u r a n k e m i h s e l a m a k e h a m i i a n

b ) i n f e k s i s a i u r a n k e m i h p a d a d i a b e t e s m e l i t u s ( S u d o y o 2 0 0 6 )

17

22 Kerangka Teori

J

U s i a

J e n i s K e i a m i n

T i n g k a t P e n d i d i k a n

R i w a y a t D i a b e t e s M e l i m s

S u m b a t a n bullT

K e h a m i i a n

D i s f u n g s i n e u r o g e n i k

R e f l u k s v e s i k o i i r e t e r a l

V i r u l e n s i b a k t e r i

F a k t o r g e n e t i k

I n f e k s i b a k t e r i g r a m p o s i t i f a t a u n e g a t i v e p a d a s a i u r a n k e m i h

I n f e k s i S a i u r a n K e m i h

Keterangan

I j = V a r i a b e l y a n g t i d a k d i t e l i t i

= V a r i a b e l y a n g d i t e l i t i

18

Hipotesis

H i p o t e s i s d a l a m p e n e l i t i a n i n i a d a i a h

H O t i d a k t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n

t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

H I t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

BAB 111

M E T O D E PENELITIAN

31 Jenis Penelitian

P a d a p e n e l i t i a n i n i j e n i s p e n e l i t i a n y a n g d i g u n a k a n a d a i a h p e n e l i t i a n

o b s e r v a s i o n a i a n a l i t i k d e s a i n cross scclional d e n g a n m e n g g u n a k a n d a t a s e k u n d e r

d a r i r e k a m m e d i s p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1 D e s e m b e r

2 0 1 5

32 Waktu dan Tempat Penelitian

321 Waktu Penelitian

W a k t u p e n e l i t i a n d i l a k s a n a k a n p a d a t a n g g a l 1 O k t o b e r s a m p a i d e n g a n 3 0

O k t o b e r 2 0 1 6

322 Tempat Penelitian

P e n e l i t i a n i n i d i l a k s a n a k a n d i R u m a l i S a k i t M u h a m m a d i y a h P a e m b a n g ( d i

R u a n g R e k a m M e d i s )

33 Populasi dan Sampel Penelitian

331Populasi Penelitian

P a d a p e n e l i t i a n i n i p o p u l a s i t a r g e t a d a l a l i p a s i e n r a w a t i n a p d a n r a w a t j a l a n

d i R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g s e d a n g k a n p o p u l a s i t e r j a n g k a u n y a

a d a i a h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

332Sampel dan Besar Sampel Penelitian

P a d a p e n e l i t i a n i n i s a m p e l p e n e l i t i a n a d a i a h p a s i e n r a w a t i n a p d a n r a w a t

j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e

1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 y a n g m e m e n u h i k r i t e r i a i n k l u s i p e n e l i t i a n

1 9

20

d e n g a n b e s a r s a m p e l y a n g l a y a k d a l a m p e n e l i t i a n m e n u r u t t e o r i R o s c o e a d a i a h

a n t a r a t i g a p u l u h s a m p a i l i m a r a t i i s o r a n g ( S u g i y o n o 2 0 1 5 )

333 Krttena Inklusi dan Eksklusi

A Kriteria Inklusi

P a d a p e n e l i t i a n i n i k r i t e r i a i n k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t i n a p

d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i

P a l e m b a n g y a n g d i d i a g n o s a m e n g a l a m i i n f e k s i s a i u r a n k e m i h s e r t a m e m i l i k i d a t a

r e k a m m e d i s p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

B Kriteria Eksklusi

P a d a p e n e l i t i a n i n i k r i t e r i a e k s k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t

i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 d e n g a n d a t a r e k a m m e d i s

y a n g t i d a k l e n g k a p

334 Cara Pengambilan Sampel Penelitian

C a r a p e n g a m b i l a n s a m p e l y a n g d i g u n a k a n d a l a m p e n e l i t i a n i n i a d a l a l i

m e n g g u n a k a n t e k n i k consecutive sampling P a d a consecutive sampling s e t i a p

p a s i e n y a n g m e m e n u h i k r i t e r i a p e n e l i t i a n d i m a s u k k a n d a l a m p e n e l i t i a n s a m p a i

k u r u n w a k t u t e r t e n U i s e h i n g g a j u m l a h m i n i m a l y a n g d i p e r i u k a n t e r p e n u h i

( S a s t r o a s m o r o 2 0 1 1 )

34 Variabel Penelitian

341 Variabel Dependent

V a r i a b e l dependent f t e r i k a t ) d a l a m p e n e l i t i a n i n i a d a i a h i n f e k s i s a i u r a n

k e m i h

342 Variabel Independent

V a r i a b e l independent ( b e b a s ) d a l a m p e n e l i t i a n i n i a d a i a h u s i a j e n i s

k e l a i n i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

21

35 Definisi Operasional

Tabel 31 Definisi Operasional

Variabel Alat Cara ueiinisi rldsil L KUr I7 i l l 11 Lz fe 1 V

oKaia LiKur Penelitian Ukur Ukur

Infeksi P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Saiuran d i d i a g n o s a o l e h m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Keniih d o k t e r m e n g a l a m i m e d i s

i n f e k s i s a i u r a n

k e m i h d a n t e r c a n t u m

d i r e k a m m e d i s

U s i a L a m a n y a t a h u n R e k a m O b s e r v a s i 1 lt 5 0 t a h u n O r d i n a l

k e h i d u p a n p a s i e n m e d i s r e k a m 2 gt 5 0 t a l i u n ( k a t e g o r i k )

d a r i l a h i r s a m p a i m e d i s

s e k a r a n g d a n

t e r c a n t u m d i r e k a m

m e d i s

Jenis P r o f i l a n a t o m i a t a u R e k a m O b s e r v a s i 1- L a k i - l a k i N o m i n a l

Keiamin b i o l o g i s p a s i e n y a n g m e d i s r e k a m 2 P e r e m p u a n ( k a t e g o r i k )

d i b e d a k a n m e n j a d i m e d i s

i a k i - l a k i d a n

n e r e m m i a n s e r t a

t e r c a n t u m d i r e k a m

m e d i s

Tingkat P e n d i d i k a n f o n n a l R e k a m O b s e r v a s i 1 P e n d i d i k a n O r d i n a l

Pendidikan t e r a k h i r y a n g m e d i s r e k a m d a s a r ( S D ( k a t e g o r i k )

d i t e m p u h o l e h m e d i s M I S M P

p a s i e n d a n t e r c a n t u m d a n M T s )

d i r e k a m m e d i s 2 P e n d i d i k a n

m e n e n g a l i

d a n t i n g g i

22

( S M A M A

S M K

M A K

d i p l o m a

s a r j a n a

m a g i St e r

s p e s i a l i s

d a n d o k t o r )

Riwayat P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Diabetes d i d i a g n o s i s d e n g a n m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Melitus d i a b e t e s m e l i t u s d a n

t e r c a n t u m d i d a l a m

r e k a m m e d i s

m e d i s

36 Cara Pengumpulan Data

361 Data Sekunder

P e n g u m p u l a n d a t a p a d a p e n e l i t i a n i n i d i p e r o l e h d a r i d a t a s e k u n d e r y a i t u

r e k a m m e d i s p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

37 Metode Teknik Analisis Data

371Cara Pengolahan dan Analisis Data

P e n g o l a h a n d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n m e l a l u i e m p a t t a h a p y a i t u

i Oala Entry

P a d a t a i i a p i n i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n riwayat d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g y a n g t e l a h d i d a p a t d a n

r e k a m m e d i s d i k u m p u l k a n d a n d i m a s u k k a n k e d a l a m p r o g r a m spss

23

2 Editing

P a d a t a h a p i n i d a t a i i s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n y a n g t e l a h d i m a s u k k a n k e d a l a m p r o g r a m s p s s

d i p e r i k s a k e m b a l i a p a k a h s u d a h l e n g k a p d a n t i d a k a d a k e k e l i r u a n

3 ( oding

S e t e l a h m e l a l u i p r o s e s editing d a t a - d a t a t e r s e b u t d i b e r i k o d e t e r t e n t u a n t a r a

l a i n k o d e 1 u n t u k u s i a gt 5 0 t a h u n j e n i s k e i a m i n p e r e m p u a n t i n g k a t

p e n d i d i k a n d a s a r t e r d a p a t r i w a y a t d i a b e t e s m e l i t u s d a n i n f e k s i s a i u r a n

k e m i h s e d a n g k a n k o d e 2 u n t u k u s i a lt 5 0 t a h u n j e n i s k e i a m i n l a k i - l a k i

t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i t i d a k t e r d a p a t r i w a y a t d i a b e t e s

m e l i t u s d a n b u k a n i n f e k s i s a i u r a n k e m i h s e h i n g g a m e m u d a h k a n d a l a m

m e l a k u k a n a n a l i s i s d a t a

4 Tahulaling

P a d a t a h a p i n i d a t a y a n g s a m a d i k e l o m p o k k a n s e c a r a t e l i t i d a n t e r a t m

k e m u d i a n d i l i i t u n g d e n g a n m e n g g u n a k a n p r o g r a m sps s d a n d i j u m l a h k a i i

l a l u d i s a j i k a n d a l a m b e n t u k t a b e l - t a b e l

U n t u k m e n g a n a l i s i s d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n a n a l i s i s d a t a

u n i v a r i a t d a n b i v a r i a t d e n g a n m e n g g u n a k a n p r o g r a m s p s s s e b a g a i b e r i k u t

A A n a l i s i s u n i v a r i a t

A n a l i s i s u n i v a r i a t d i l a k u k a n d e n g a n c a r a m e l a k u k a n a n a l i s i s p a d a s e t i a p

v a r i a b e l h a s i l p e n e l i t i a n d e n g a n t u j u a n u n t u k m e n g e t a h u i d i s t r i b u s i p r o p o r s i p a d a

s e t i a p v a r i a b e l p e n e l i t i a n D a t a d i s a j i k a n d a l a m b e n t u k t a b e l d a n n a r a s i

B A n a l i s i s b i v a r i a t

A n a l i s i s b i v a r i a t d i l a k u k a n d e n g a n m e n g g u n a k a n u j i h i p o t e s i s chi-square

U j i h i p o t e s i s chi-square d a p a t d i g u n a k a n d e n g a n s y a r a t y a i t u lt 2 0 s e l y a n g

m e m p u n y a i n i l a i expected count k u r a n g d a r i l i m a s e h i n g g a j i k a t i d a k m e m e n u h i

s y a r a t u j i chi-square m a k a u j i y a n g d i g u n a k a n a d a i a h u] fisher ( D a h l a n 2 0 1 4 )

B a t a s k e m a k n a a n y a n g d i g u n a k a n a d a i a h a = 0 0 5 J i k a d i d a p a t k a n p value lt 0 0 5

p a d a u j i s t a t i s t i k m a k a t i d a k t e r d a p a t h u b u n g a n y a n g b e n n a k n a a n t a r a d u a

v a r i a b e l y a n g d i t e l i t i d a n H O d i t e r i m a S e d a n g k a n j i k a d i d a p a t k a n p value gt 0 0 5

24

p a d a u j i s t a t i s t i k m a k a t e r d a p a t l i u b u n g a n y a n g b e n n a k n a a n t a r a d u a v a r i a b e l

y a n g d i t e l i t i d a n H O d i t o l a k

38 Alur Penelitian

P e n e n t u a n p o p u l a s i d a n s a m p e l p e n e l i t i a n

K r i t e r i a i n k l u s i K r i t e r i a e k s k l u s i

P e n g a m b i l a n s a m p e l p e n e l i t i a n

P e n g o l a h a n d a n a n a l i s i s d a t a d e n g a n u j i chi-square

H a s i l d a n p e m b a h a s a n

K e s i m p u l a n d a n s a r a n

Gambar 31 Alur Penelitian Hubungan Usia Jenis Keiamin Tingkat Pendidikan dan Riwayat Diabetes Melitus dengan Kejadian Infeksi Saiuran Kemih pada Pasien Rawat Inap di Bagian Penyakit Dalam Rumah Sakit Muhammadiyah Palembang Periode 1 Januari 2015 sampai dengan 31 Desember 2015

BAB IV

HASIL DAN PEMBAHASAN

41 Hasil

P e n e l i t i a n i n i t e l a h d i l a k u k a n d i r u a n g r e k a m m e d i s R u m a h S a k i t

M u h a i m n a d i y a h P a l e m b a n g d a r i t a n g g a l 1 O k t o b e r 2 0 1 5 - 3 1 O k t o b e r 2 0 1 6

P e n e l i t i a n d i m u l a i d e n g a n p e n g a m b i l a n d a t a a w a l b e m p a d a t a r e k a m m e d i s

s e l u r u h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

S e l a n j u t n y a r e k a m m e d i s d i p i l i h s e s u a i d e n g a n k r i t e r i a i n k l u s i d a n e k s k l u s i u n t u k

d i j a d i k a n s a m p e l p e n e l i t i a n s a m p a i m i n i m a l b e s a r s a m p e l y a n g d i b u t u h k a n

t e r p e n u h i s e r t a d i l a k u k a n p e n e l i t i a n s e c a r a o b s e r v a s i o n a i O b s e r v a s i r e k a m m e d i s

d i l a k u k a n u n m k m e n g e t a h u i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t

d i a b e t e s m e l i t u s d a n d i a g n o s a p a s i e n

D a r i c a t a t a n r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g

d i d a p a t k a n s e b a n y a k 4 1 4 1 r e k a m m e d i s p a s i e n r a w a t i n a p d a n 1 4 5 3 r e k a m m e d i s

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 D a r i t o t a l r e k a m m e d i s

p a s i e n r a w a t i n a p d a n r a w a t j a l a n t e r s e b u t p e n e l i t i h a n y a m e n g a m b i l m i n i m a l

b e s a r s a m p e l y a n g d i b u t u h k a n y a i t u s e b a n y a k 9 8 r e k a m m e d i s u n t u k d i j a d i k a n

s a m p e l p e n e l i t i a n y a n g t e r d i r i d a r i 3 0 r e k a m m e d i s p a s i e n y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i h d a n 6 8 r e k a m m e d i s y a n g t i d a k m e n g a l a m i i n f e k s i s a i u r a n k e m i h

411 Hasil Analisis Univariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s u n i v a r i a t

a n t a r a l a i n d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p b e r d a s a r k a n u s i a d a n

j e n i s k e l a m m d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n b e r d a s a r k a n u s i a

d a n j e n i s k e i a m i n d i s t r i b u s i p r o p o r s i s a m p e l b e r d a s a r k a n k e j a d i a n m f e k s i s a i u r a n

k e m i h s e r t a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n u s i a

j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

25

26

A Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan IJsta

dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 41 Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan

Usia dan Jenis Keiamin

Paisen Rawat Inap N Persentase

Usia

1 7 - 2 5 t a h u n 678 1 6 4

2 6 - 3 5 t a h u n 952 2 3 0

3 6 - 4 5 t a l i u n 745 18 0

4 6 - 5 5 t a h u n 695 1 6 8

5 6 - 6 4 t a h u n 571 1 3 8

gt 6 4 t a h u n 500 1 2 1

U s i a r a t a - r a t a ( t a h u n j 43plusmn16543

Jenis Keiamin

P e r e m p u a n 2 6 3 8 6 3 7

L a k i - l a k i 1 5 0 3 3 6 3

Total 4141 100

B e r d a s a r k a n t a b e l 4 1 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R i u n a h S a k i t M u l i a m m a d i y a l i

P a l e m b a n g p e r i o d e J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 2 6 - 3 5 t a h u n y a i t u

s e b a n y a k 9 5 2 o r a n g ( 2 3 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 43plusmn16543 t a l i u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 2 6 3 8 o r a n g ( 6 3 7 )

27

B Distribusi Proporsi Karakteristik Pasien Rawat Jalan Berdasarkan

Usia dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 42 Distribusi Proporsi Karakteristik Pasien Rawat Jalan

Berdasarkan Usia dan Jenis Keiamin

Fasten Rawat Jalan N Persentase

Usia

1 7 - 2 5 t a h u n 9 2 6 3

2 6 - 3 5 t a l n i n 1 3 1 9 0

3 6 - 4 5 t a h u n 2 7 9 1 9 2

46-55 t a l i u n 4 2 1 2 9 0

5 6 - 6 4 t a h u n 3 1 6 2 1 7

gt 6 4 t a h u n 2 1 4 1 4 7

U s i a r a t a - r a t a ( t a h u n ) 50plusmn14120

Jenis Keiamin

P e r e m p u a n 8 9 0 6 1 3

L a k i - l a k i 5 6 3 3 8 7

Total 1453 100

B e r d a s a r k a n t a b e l 4 2 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 4 6 - 5 5 t a h u n y a i t u

s e b a n y a k 4 2 1 o r a n g ( 2 9 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 50plusmn14120 t a h u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 8 9 0 o r a n g ( 6 1 3 )

28

C Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Usia

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i b b e r d a s a r k a n u s i a d a p a t

d i i i h a t p a d a l a b e l d i b a w a h i n i

Tabel 43 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Usia

Usia N Persentase

lt 5 0 t a h u n 1 4 4 6 7

gt 5 0 t a l i u n 1 6 5 3 3

Total 30 100

B e r d a s a r k a n t a b e l 4 3 d i a t a s d a p a t d i k e t a h u i b a h w a u s i a t e r b a n y a k p a d a

s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h gt 5 0 t a h u n y a i t u s e b a n y a k

1 6 o r a n g ( 5 3 3 )

D Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Jenis

Keiamin

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n j e n i s

k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 44 Distribusi Proporsi Kejadian infeksi Saiuran Kemih Berdasarkan

Jenis Keiamin

Jenis Keiamin N Persentase

P e r e m p u a n 1 8 6 0 0

L a k i - l a k i 1 2 4 0 0

Total 30 100

B e r d a s a r k a n t a b e l 4 4 d i a t a s d a p a t d i k e t a h u i b a h w a j e n i s k e i a m i n

t e r b a n y a k p a d a s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h p e r e m p u a n

y a i t u s e b a n y a k 1 8 o r a n g ( 6 0 0 )

29

E Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n t i n g k a t

p e n d i d i k a n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 45 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

Tingkat Pendidikan N Persentase

P e n d i d i k a n d a s a r 20 6 6 7

P e n d i d i k a n m e n e n g a h d a n P e n d i d i k a n m e n e n g a h d a n 10 333

t i n g g i

Total J O 100

B e r d a s a r k a n t a b e l 4 5 d i a t a s d a p a t d i k e t a l i u i b a l i w a t i n g k a t p e n d i d i k a n

t e r b a n y a k p a d a s a m p e i y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h t i n g k a t

p e n d i d i k a n d a s a r y a i t u s e b a n y a k 20 o r a n g ( 6 6 7 )

P Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n riwayat

d i a b e t e s m e l i t u s d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 46 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

Riwayat Diabetes Melitus N Persentase

Y a 17 5 6 7

T i d a k 13 433

Total 30 100

B e r d a s a r k a n t a b e l 4 6 d i a t a s d a p a t d i k e t a h u i b a l i w a s a m p e l y a n g

m e n g a l a m i i n f e k s i s a i u r a n k e m i h t e r b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s

y a i t u s e b a n y a k 1 7 o r a n g ( 5 6 7 )

30

412 Hasil Analisis Bivariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s b i v a r i a t

a n t a r a I a i n h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h j e n i s

k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h t i n g k a t p e n d i d i k a n d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n

i n f e k s i s a l m a n k e m i h

A n a l i s i s y a n g d i g u n a k a n p a d a u j i d u a v a r i a b e l y a n g b e r s k a l a k a t e g o r i k

a d a l a l i d e n g a n u j i Chi-Square d e n g a n n i e i h a t n i l a i Pearson Chi-Square S e m u a

h a s i l d a r i u j i h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h m e n g g i u i a k a n u j i Chi-

Square k a i e n a m e m e n u h i s y a r a t u j i Chi-Square y a i t u lt 2 0 s e l y a n g m e m p u n y a i

n i l a i expected count lt 5

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 47 Hasil Uji Hubungan antara Usia dengan Kejadian Infeksi

Saiuran Kemih

Usia

Infeksi Saiuran Kemih

^a Tidak

n N Mgt

Jumlah P

value 95Cl

lt 50 t a h u n 1 4 1 9 2 5 9 8 0 8 7 3 0 0 0 0 2 7 4 7 - 2 0 4 3 1

gt 5 0 t a h u n 1 6 6 4 0 9 3 6 0 2 5

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 7 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R = 7 4 9 2

( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a u s i a gt

5 0 t a h u n a d a l a l i 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a u s i a lt 5 0 t a h u n

31

B Hubungan antara Jenis Keiamin dengan Kejadian Infeksi Saiuran

Kemih

H a s i l a n a l i s i s b i v a r i a t l i u b u n g a n a n t a r a j e n i s k e l a i n i n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

Tabel 48 Hasil Uji Hubungan antara Jenis Keiamin dengan Kejadian

Infeksi Saiuran Kemih

Infeksi Saiuran Kemih Jenis P

A Tidak Jumlah 95CI Keiamin value

N N

P e r e m p u a n 18 6 4 3 10 357laquoo 2 8 3 2 2 7 -P e r e m p u a n 0 0 0 0

L a k i - l a k i 12 1 7 1 5 8 8 2 9 7 0 2 3 4 5 9

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 8 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a l a l i

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k N 4 a k a a d a l i u b u n g a n y a n g s i g n i f i k a n a n t a r a

j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R ) = 8 7 0 0

f 9 5 C I = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a l a k i - l a k i

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e n i i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

32

Tabel 49 Hasil liji Hubungan antara Tingkat Pendidikan dengan

Kejadian Infeksi Saiuran Kemih

Infeksi Saiuran Kemih P

Y a T i d a k jumlah 95CI value

N

P e n d i d i k a n d a s a r 2 0 5 4 1 1 7 4 5 9 3 7

P e n d i d i k a n

m e n e n g a h d a n 10 1 6 4 5 1 8 3 6 6 1

t i n g g i

Jumlah JO 30 6 68 694 9H

B e r d a s a r k a n t a b e l 4 9 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( 0 R ) =

6 0 0 0 ( 9 5 C I = 2 3 5 1 - 1 5 3 1 0 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r a d a i a h 6 k a l i l e b i h b e s a r

d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i h a t

p a d a t a b e l d i b a w a h i n i

Tingkat

Pendidikan

2 3 5 1 -0 0 0 0

1 5 3 1 0

33

Tabel 4t0 Hasil I j i Hubungan antara Riwayat Diabetes Melitus dengan

Kejadian Infeksi Saiuran Kemih

Riwayat Infeksi Saiuran Kemih P

Diabetes Va Tidak Jumlah value

95CI

Melitus N bullVJ N

Y a

T i d a k

17

1 3

6 8 0

1 7 8

8

6 0

3 2 0

8 2 2

2 5

7 3 0 0 0 0

3 4 9 3 -

2 7 5 3 6

Jumlah 30 306 68 571 98

B e r d a s a r k a n t a b e l 4 1 0 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio

( O R ) = 9 8 0 8 ( 9 5 C I - 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r

d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s m e l i m s

42 Pembahasan

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a l a b e l 4 7 d i d a p a t k a n b a l i w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i b d e n g a n n i l a i s i g n i f i k a n n y a a d a l a l i 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k

Odds Ratio ( O R ) = 7 4 9 2 ( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a u s i a T 5 0 t a h u n a d a i a h 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a

u s i a lt 5 0 t a h u n

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n A n d r y L u k a n d y

( 2 0 1 4 ) m e n g e n a i k a r a k t e r i s t i k p a s i e n - p a s i e n i n f e k s i s a i u r a n k e m i h d i m a n a

p e n d e r i t a I S K d e n g a n k e l o m p o k u m u r gt 5 0 t a h u n s e b a n y a k 2 3 o r a n g s e d a n g k a n

j u m l a h p e n d e r i t a I S K d e n g a n k e l o m p o k u m m lt 5 0 t a l i u n s e b a n y a k 2 0 o r a n g

P e n e l i t i a n i n i j u g a d i p e i k u a t o l e h p e n l i t i a n L e w i s A l e t a l ( 2 0 1 4 ) m e n g e n a i

impact of host age and parity on susceptihility to severe urinary tract injection in

34

a murine mode d e n g a n u j i K r u s k a l - W a l l i s d e n g a n post-test D u n n u n t u k b e b e r a p a

p e r b a n d i n g a n d i m a n a u s i a d a n p a r i t a s s e b a g a i f a k t o r y a n g b e r k o n t r i b u s i d a l a m

k e r e n t a n a n i m t u k t e r j a d i n y a I S K d e n g a n n i l a i p lt 0 0 5

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n g a t a k a n b a h w a i n s i d e n I S K m e n i n g k a t

b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n

a d a n y a a b n o r m a l i t a s a n a t o m i y a n g m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n

k e m i h s e p e r t i p e m b e s a r a n p r o s t a t d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a

p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e ( R o s e 2 0 0 9 ) P e n y e b a b l a i n t e n n a s u k

p e r i n e i u n y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s p e n y a k i t n e u r o m u s k u l a r

d a n k a t e t e r i s a s i b u l i - b u l i ( F o x m a n e t a l 2 0 1 0 ) S e l a i n i t u i n s i d e n I S K m e n c a p a i

1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o n a l d 2 0 1 1 )

B Hubungan antara Jenis Keiamin dengan Kejadian infeksi Saiuran

Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 8 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d e n g a n n i l a i s i g n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O

d i t o l a k Odds Ratio ( O R ) = 8 7 0 0 ( 9 5 C l = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a risiko k e j a d i a n

i n f e k s i s a i u r a n k e m i h p a d a p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n

p a d a l a k i - i a k i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n M a g i i a n o e t a l

( 2 0 1 1 ) m e n g e n a i Gender and Age-Dependent Etiology of Community Acquired

y a n g m e l a k u k a n p e n g a m b i l a n 6 1 2 7 3 s a m p e l k u l t u r u r i n d a l a m p e r i o d e 2 2 b u l a n

d a r i s a m p e l i n i d i d a p a t k a n 1 3 8 2 0 ( 2 2 6 ) d i t e m u k a n p o s i t i f i n f e k s i b a k t e r i

h a m p i r 8 0 b a l i a n y a n g d i i s o l a s i b e r a s a l d a r i p e r e m p u a n P e n e l i t i a n i n i j u g a

d i p e r k u a t o l e h p e n e l i t i a n y a n g d i l a k u k a n o l e h Y u n i t a I ( 2 0 1 0 ) d i m a n a a d a

h u b m i g a n y a n g b e n n a k n a a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h ( P value=O049 R P = 3 2 7 3 ( 9 5 C I = I 0 1 6 - 1 0 5 4 0 )

H a l t e r s e b u t d a p a t t e r j a d i k a r e n a u r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a l i

d e n g a n d e k a t n y a v a g i n a l v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i

s a i u r a n k e m i h l e b i h s e r i n g p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a flora n o r m a l

3 5

p a d a d a e r a h p e r i u r e t r a t e r d i r i d a r i o r g a n i s m e s e p e r t i i a c t o b a c i l l u s y a n g m e m b a n t u

m e l a w a n k o l o n i s a s i b a k t e r i p a t o g e n p a d a s a i u r a n k e m i h P e r u b a h a n l i n g k i m g a n

d a r i p e r i u r e t r a l s e p e r t i p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k

b i s a m e n g g a n g g u f l o r a n o r m a l s e h i n g g a m e n u m g k i n k a n b a k t e r i p a t o g e n

b e r k o l o n i s a s i d a n m e n y e b a b k a n i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Scuare p a d a t a b e l 4 9 d i d a p a t k a n b a h w a

t e r d a p a t l i u b u n g a n y a n g s i g n i f i k a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a

H O d i t o l a k Odds Ratio ( O R ) - 6 0 0 0 ( 9 5 o C l = 2 3 5 1 - 1 5 3 I O ) a r t i n y a n s i k o

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r

a d a i a h 6 k a l i l e b i h b e s a r d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n

m e n e n g a h d a n t i n g g i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h T o r o n d e i B e t

a l ( 2 0 1 5 ) m e n g e n a i Menstrual Hygiene Practices WASH Access and the Risk of

Urogenital Infection in Women from Odisha India d i m a n a p e r e m p u a n y a n g

h a n y a m e n e m p u l i p e n d i d i k a n s e k o l a h d a s a r a t a u l e b i h r e n d a h d i b a n d i n g k a n

d e n g a n t i n g k a t p e n d i d i k a n m e n e n g a h a t a u t i n g g i m e m i l i k i r i s i k o 3 k a l i

k e m u n g k i n a n l e b i h b e s a r m e n g a l a m i i n f e k s i s a i u r a n k e m i h ( A d j O R = 3 l 9 5

C 1 = I 2 - 7 9 p = 0 0 2 )

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a p e n g e t a h u a n s e s e o r a n g

t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t p e n d i d i k a n S e s e o r a n g y a n g

m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m u n g k i n a n p e n g e t a l i u a n t e n t a n g

k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o r m a s i y a n g d i d a p a t k a n t e n t a n g k e s e h a t a n

l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h S e b a l i k n y a

p e n d i d i k a n y a n g k u r a n g d a p a t i n e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g t e r h a d a p

n i l a i - n i l a i y a n g b a r u d i k e n a l ( N o t o a d m o j o 2 0 0 3 )

3 6

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Keniih

B e r d a s a r k a n l i a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 1 0 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a r i w a y a t d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 )

s e h i n g g a H O d i t o l a k Odds Ratio ( O R ) = 9 8 0 8 ( 9 5 C I = 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a

risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h S a r i E W P d a n

S a t y a b a k t i P ( 2 0 1 5 ) m e n g e n a i p e r b e d a a n risiko i n f e k s i n o s o k o m i a l s a i u r a n k e m i h

b e r d a s a r k a n k a t e t e r i s a s i u r i n u m u r d a n d i a b e t e s m e l i m s d i m a n a d a r i 2 0 p a s i e n

i n f e k s i n o s o k o m i a l s a i u r a n k e m i h 1 2 o r a n g ( 6 0 ) d i a n t a r a n y a a d a i a h p a s i e n

d e n g a n s t a t u s D M s e d a n g k a n 8 o r a n g ( 4 0 ) l a i n n y a a d a i a h p a s i e n t a n p a s t a t u s

D M ( P v W w ^ = 0 0 2 4 O R = 6 0 0 9 5 C I = 1 2 2 - 3 2 2 6

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a b a l i w a b e b e r a p a b a g i a n

d a r i i i n u n i t a s p a d a p a s i e n d i a b e t e s m e n g a l a m i p e r u b a h a n F u n g s i

p o l i n i o r f o l e u k o s i t d i t e k a n p a d a k e a d a a n a s i d o s i s I k a t a n l e u k o s i t k e m o t a k s i s d a n

f a g o s i t o s i s j u g a b e m b a l i S i s t e m a n t i o k s i d a n y a n g b e r p e r a n p a d a a k t i f i t a s

b a k t e r i s i d a l j u g a t e r g a n g g u s e h i n g g a m e n y e b a b k a n t e r j a d i n y a I S K p a d a p a s i e n -

p a s i e n d e n g a n p e n y a k i t d i a b e t e s ( J u l k a 2 0 1 4 )

H a l y a n g s a m a j u g a d i i m g k a p k a n o l e b t e o r i S m e l t z e r d a n B a r e ( 2 0 1 0 )

b a l i w a D M d a p a t m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a l i a n a n t u b u h y a n g

b e r p o t e n s i m e n i n g k a t k a n r i s i k o t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a l i a n a n

t u b u h t e r s e b u t d i a n t a r a n y a a d a i a h k e g a g a l a n m i g r a s i s e l iniraceliular killing

f a g o s i t o s i s d a n k e m o t a k s i s p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n

m e k a n i s m e p e r t a l i a n a n a l a m i a h I o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p

i n f e k s i

BAB V

KESIMPULAN DAN SARAN

51 Kesimpulan

1 U s i a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 2 6 - 3 5 t a h u n y a i t u 2 3 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 3 7

2 U s i a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 4 6 - 5 5 t a l i u n y a i t u 2 9 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 1 3

3 U s i a j e n i s k e i a m i n d a n t i n g k a t p e n d i d i k a n s a m p e i y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i l i t e r b a n y a k y a i t u b e r u s i a gt 5 0 t a h u n ( 5 3 3 ) j e n i s k e i a m i n

p e r e m p u a n ( 6 0 0 ) d a n t i n g k a t p e n d i d i k a n d a s a r ( 6 6 7 ) s e r t a p a l i n g

b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s y a i t u 5 6 7

4 T e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 ( p = 0 0 0 0 )

52 Saran

1 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t d i l a k u k a n d e n g a n d e s a i n

p e n e l i t i a n b e r b e d a s e p e r t i cohort a t a u case control

2 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t m e i i c a r i v a r i a b e l independent

y a n g l a i n s e p e r t i v a r i a b e l p e k e r j a a n p e m a s a i i g a n k a t e t e r a t a u l a m a n y a

m e n d e r i t a d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

37

DAFTAR PUSTAKA

B o y k o E J d k k 2 0 0 2 D i a b e t i c A n d T h e R i s k O f A c u t e U r i n a r y T r a c t I n f e c t i o n A m o n g P o s t m e n o p a u s a l W o m e n D i a b e t e s C a r e 2 5 ( 1 0 )

D a h l a n S 2 0 1 4 B u k i i S t a t i s t i k u n t u k K e d o k t e r a n d a n K e s e h a t a n D e s k r i p t i f B i v a r i a t d a n M u l t i v a r i a t d i l e n g k a p i a p l i k a s i d e n g a n m e n g g u n a k a n S P S S E d i s i 6 E p i d e m i o l o g i I n d o n e s i a J a k a r t a I n d o n e s i a

D e p a r t e m e n K e s e h a t a n ( D E P K E S ) R l 2 0 1 4 [ O n l i n e ] K e m e n t e r i a n K e s e h a t a n R e p u b l i k I n d o n e s i a P u s a t D a t a d a n I n f o r m a s i K e m e n t e r a n K e s e h a t a n R l ( http 7depkesgoid diakses tanggal 15 Met 2016)

F o x m a n B e t a i 2 0 1 0 U r i i i a i y T r a c t I n f e c t i o n A m o n g W o m e n A g e d 4 0 T o 6 5 B e h a v i o r a l A n d S e x u a l R i s k F a c t o r s D a l a m T a n a g h o E A M c A n i n c h J W 1 7 t h S m i t h s G e n e r a l U r o l o g y U S A M c G r a w H i l l (http searchproqnestcom diakses tanggal 16 Met 2016)

H a r d i n g G K d k k 2 0 1 0 A n t i m i c r o b i a l T r e a t m e n t I n D i a b e t i c W o m e n W i t l i A s y m t o m a t i c B a c t e r i u r i a N E n g l J M e d 3 4 7 1 5 7 6 - 1 5 8 3 (http nejmorg diakses tanggal 16 Met 2016)

I s s e l b a c h e r d k k 2 0 0 9 I n f e k s i S a i u r a n K e m i h d a n P i e l o n e f r i t i s D a l a m S t a m m W a l t e r E e d H a r r i s o n P r i n s i p - P r i n s i p l l m u P e n y a k i t D a l a m e d V o l u m e 2 J a k a r t a E G C 6 1 6 - 6 2 3

J u l k a S 2 0 1 3 G e n i t o u r i n a r y I n f e c t i o n I n D i a b e t e s I n d i a n J o u m a l o f E n d o c r i n o l o g y a n d M e t a b o l i s m (http searchproquestcom diakses tanggal 16 Mei 2016)

K i m B d k k 2 0 1 2 [ e - b o o k ] T h e R e l a t i o n b e t w e e n P o s t v o i d R e s i d u a l a n d O c c u r r e n c e o f U r i n a r y T r a c t I n f e c t i o n a f t e r S t r o k e i n R e h a b i l i t a t i o n U n i t A n n a l s o f R e h a b i l i t a t i o n M e d i c i n e

K o m a r a A 2 0 0 9 P o l a K e p e k a a n B a k t e r i G r a m N e g a t i f d a r i P a s i e n I n f e k s i S a i u r a n K e m i l i t e r h a d a p A n t i b i o t i k G e n t a m i c i n d a n K o t r i m o k s a z o l y a n g D i k i r i m k e L a b o r a t o r i u m M i k r o b i o l o g i K l i n i k F K U l d a r i T a h u n 2 0 0 1 s a m p a i T a h u n 2 0 0 5 (http dontaruiacid diakses tanggal OH Agustiis 2016)

L e w i s A L e t a l 2 0 1 4 I m p a c t o f H o s t A g e a n d P a r i t y o n S u s c e p t i b i l i t y t o S e v e r e U r i n a r y T r a c t I n f e c t i o n i n a M u r i n e M o d e l P l o s O n e R e s e a r c h A r t i c l e P u b l i c L i b r a r y o f S c i e n c e 9 ( 5 ) (http searchproquestcom diakses pada langgal 30 Desember 2016)

38

U N I V E R S I T Y O F M U H A M M A D I Y A H P A L E M B A N G FA cut T Y or M E D I C I N E

MINI THESIS J A N U A R Y 2 0 1 7 R E Z A A G U S T I A N T W O P U T R A

T h e Relationships between Age Gender Education Level Diabetes M e l i t u s History and The Incidence of U r i n a r y T r a c t Infections i n Hospitalized Patients and Outpatients at I n t e r n a l M e d i c i n e o f M u h a m m a d i y a h Palembang H o s p i t a l d u r i n g I J a n u a r y 2 0 1 5 - 3 1 December 2 0 1 5

x i i + 37pages + 12 tables + I picture + 8 attachments

A B S T R A C T

Urinary trad infection (UTI) is an infection of I he urinary tract and nearly 10 of people experience UTI during their lifeiime According to theory the increasing of urinary tract infections is related with increasing age gender education level and diabetes melitus history This study aim to analyze relationships between age gender education level diabetes melitus history and the incidence of urinary tract infections in hospitalized patients and outpatients at Internal Medicine of Muhammadiyah Palembang Hospilal during P January 2015-31 December 2015 This study lipe was analyiical observaiional with cross sectional design by using secondary data from medical record of Muhammadiyah Palembang Hospital Samples of this study were taken by consecutive sampling technique The results of statistical test were obtained relationship between urinary tract infections with age (p 0000) gender (p 0000) education level (p 0000) and diabetes melitus (p 0000) In conclusion there are significantly relationships between age gender education level diabetes melitus history and the incidence of urinary tract infections in hospitalizedpatients and outpatients at Internal Medicine of Muhammadiyah Palembang Hospital during P January 20J5-3PDecember 2015

References 2 9 ( 2 0 0 2 - 2 0 1 5 ) Keywords U r i n a r y T r a c t I n f e c t i o n s Diabetes M e l i t u s

vi

KATA PENGANTAR

S e g a l a p u j i s y u k u r k e p a d a A l l a l i S W T k a r e n a a t a s b e r k a t d a n r a h m a t - N y a p e n u l i s d a p a t i n e n y e l e s a i k a n s k r i p s i y a n g b e r j u d u l H u b u n g a n A n t a r a U s i a J e n i s K e i a m i n T i n g k a t P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h P a d a P a s i e n R a w a t i n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 S k r i p s i i n i d i s u s u n s e b a g a i s a l a h s a t u s y a r a t u n t u k m e m p e r o l e h g e l a r S a r j a n a K e d o k t e r a n d i F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u l i a m m a d i y a h P a l e m b a n g

P e n u l i s m c n y a d a r i b a l i w a d a l a m p r o s e s i n e n y e l e s a i k a n s k r i p s i i n i b a n y a k k e n d a l a y a n g d i a l a i n i n a n i u n b e r k a t b a n t u a n b i m b i n g a n k e r j a s a m a d a r i b c r b a g a i p i h a k d a n t e r u t a m a b e r k a t A l l a h S W T k e n d a l a t e r s e b u t d a p a t d i a t a s i

P e n u l i s j u g a m e n v a d a r i b a h w a s k r i p s i i n i m a s i h j a u h d a r i s e m p u m a m a k a d e n g a n s e g a l a k e r e n d a h a n l i a t i p e n u l i s m e n g l i a r a p k a n a d a n y a k r i t i k d a n s a r a n y a n g b e r s i f a t m e m b a n g u n d e m i k e s e m p u m a a n s k r i p s i i n i

A k h i r k a t a p e n u l i s b c r l i a r a p A l l a l i S W T b e r k e n a n m e m b a i a s s e g a l a k e b a i k a n s e m u a p i h a k y a n g t e l a h m e m b a n t u S e m o g a s k r i p s i i n i d a p a t b e n n a n f a a t b a g i k i t a s e m u a A a m i i n

P a l e m b a n g 0 7 F e b r u a r i 2 0 1 7

R e z a A g u s t i a n t w o P u t r a

vii

DAFTAR ISI

HALAMAN J D D U L HALAMAN PENCESAHAN i HALAMAN PERNN ATAAN ii HALAMAN PERSEMBAHAN iii A B S T R A K iv A B S T R A C T v K A T A PENGANTAR vi DAFTAR ISI vii DAFTAR T A B E I ix DAFTAR GAMBAR x DAFTAR LAMPIRAN xi

BAB I Pendahuluan 1 1 1 L a t a r B e l a k a n g 1 12 R i i m u s a n M a s a l a h 3 13 T u j u a n P e n e l i t i a n 3 14 M a n l a a t P e n e l i t i a n 4 15 K e a s l i a n P e n e l i t i a n 5

BAB H Tinjauan Pustaka 9 2 1 L a n d a s a n T e o r i 9

2 1 1 I n f e k s i S a i u r a n K e m i h 9 A D e f i n i s i 9 B E p i d e m i o l o g i 9 C K i a s i f i k a s i 1 0 D E t i o l o g i 1 1 E P a t o f i s i o l o g i 11 F F a k t o r R i s i k o 1 2 G M a n i f e s t a s i K l i n i s 1 5 H T a t a l a k s a n a 1 6 I K o m p l i k a s i 1 6

2 2 K e r a n g k a T e o r i 1 7 2 3 H i p o t e s i s 1 8

BAB I I I Metode Penelitian 19 3 1 J e n i s P e n e l i t i a n 1 9 3 2 W a k t u d a n T e m p a t P e n e l i t i a n 1 9 3 3 P o p u l a s i d a n S a m p e l 1 9

3 3 1 P o p u l a s i P e n e l i t i a n 1 9 3 3 2 S a m p e l d a n B e s a r S a m p e l P e n e l i t i a n 1 9 3 3 3 K n t e r i a I n k l u s i d a n E k s k l u s i 2 0 3 3 4 C a r a P e n g a m b i l a n S a m p e l P e n e l i t i a n 2 0

3 4 V a r i a b e l P e n e l i t i a n 2 0 3 4 1 V a r i a b e l Dependent 2 0 3 4 2 V a r i a b e l Independent 2 0

viii

3 5 D e f i n i s i O p e r a s i o n a l 2 1 3 6 C a r a P e n g i i n i p u l a n D a t a 2 2

3 6 1 D a t a S e k u n d e r 2 2 3 7 M e t o d e T e k n i s A n a l i s i s D a t a 2 2

3 7 C a r a P e n g o l a h a n d a n A n a l i s i s D a t a 2 2 3 8 A l u r P e n e l i t i a n 2 4

BAB IV HASIL DAN PEMBAHASAN 25 4 1 H a s i l 2 5 4 2 P e m b a h a s a n 3 3

BAB V KESIMPLILAN DAN SARAN 37 5 1 K e s i m p u l a n 3 7 5 2 S a r a n 3 7

D A F T A R PUSTAKA 38 LAMPIRAN 41 BIODATA 63

ix

DAFTAR T A B E L

Tabel Halaman

T a b e l 1 1 K e a s l i a n P e n e l i t i a n 5 T a b e l 3 1 D e f i n i s i O p e r a s i o n a l 2 1 T a b e l 4 1 D i s t r i b u s i P r o p o r s i K a r a k t e r i s t i k P a s i e n R a w a t i n a p

B e r d a s a r k a n U s i a d a n J e n i s K e i a m i n 2 6 T a b e l 4 2 D i s t r i b u s i P r o p o r s i K a r a k t e r i s t i k P a s i e n R a w a t J a l a n

B e r d a s a r k a n U s i a d a n J e n i s K e i a m i n 2 7 T a b e l 4 3 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n U s i a 2 8 T a b e l 4 4 D i s t r i b u s i P r o p o r s i K e j a d i a n i n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n J e n i s K e l a m m 2 8 T a b e l 4 5 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n T i n g k a t P e n d i d i k a n 2 9 T a b e l 4 6 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n R i w a y a t D i a b e t e s M e l i t u s 2 9 T a b e l 4 7 H a s i l U j i H u b u n g a n a n t a r a U s i a d e n g a n K e j a d i a n

i n f e k s i S a i u r a n K e m i h 3 0 T a b e l 4 8 H a s i i U j i H u b u n g a n a n t a r a J e n i s K e i a m i n d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i b 3 1 T a b e l 4 9 H a s i l U j i H u b u n g a n a n t a r a T i n g k a t P e n d i d i k a n d e n g a n

K e j a d i a n i n t e k s i S a i u r a n K e m i h 3 2 T a b e l 4 1 0 H a s i l U j i H u b u n g a n a n t a r a R i w a y a t D i a b e t e s M e l i t u s

d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h 3 3

X

DAFTAR GAMBAR

Gambar Halaman

G a m b a r 3 1 A l u r P e n e l i t i a n H u b u n g a n U s i a J e n i s K e i a m i n T i n g k a t

P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i h p a d a P a s i e n R a w a t i n a p

d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g I e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1

D e s e m b e r 2 0 1 5 2 4

xi

DAFTAR LAMPIRAN

Lampiran Halaman

L a m p i r a n 1 D a t a R e k a m M e d i s P a s i e n R a w a t I n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 4 3

L a m p i r a n 2 H a s i l A n a l i s i s U n v i a r i a t 4 5

L a m p i r a n 3 H a s i l A n a l i s i s B i v a r i a t 5 1

L a m p i r a n 4 K a r t u B i m b i n g a n P r o p o s a l S k r i p s i 5 8

L a m p i r a n 5 K a r t u B i m b i n g a n S k r i p s i 5 9

L a m p i r a n 6 S u r a t P e n n o h o n a n I z i n P e n e l i t i a n 6 0

L a m p i r a n 7 S u r a t K e t e r a n g a n I z i n P e n g a m b i l a n D a t a d a n P e n e l i t i a n 6 1

L a m p i r a n 8 S u r a t K e t e r a n g a n S e l e s a i P e n e l i t i a n 6 2

xii

BAB I

PENDAHULUAN

11 Latar Belakang

I n f e k s i s a i u r a n k e m i h ( I S K ) m e n i p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m i i k a n d i R u m a h S a k i t a t a u t e m p a t p r a k t i k u m u m s e h a r i - h a r i I S K

a d a i a h s u a t u i n f e k s i y a n g m e n g e n a i t r a k t u s u r i n a r i u s m u l a i d a r i m e a t u s u r e t r a

s a m p a i d e n g a n k e g i n j a l S t r u k t u r y a n g t e n n a s u k d i d a l a m n y a a d a i a h u r e t r a

k a n d u n g k e m i h u r e t e r p e l v i s d a n p a r e n k i m g i n j a l S t r u k t u r y a n g b e r k a i t a n u n t u k

t e r j a d i n y a i n f e k s i d a n r e k u r e n i n f e k s i y a i t u p r o s t a t e p i d i d i m i s d a n fascia

perinephric I s t i l a h I S K m e n u n j u k k a n a d a n y a k e b e r a d a a n m i k r o o r g a n i s m e d i

d a l a m u r i n ( S u d o y o 2 0 0 6 R u b i n 2 0 1 0 ) D e n g a n k a t a l a i n b a h w a d i a g n o s i s I S K

d i t e g a k k a n d e n g a n m e m b u k t i k a n a d a n y a m i k r o o r g a n i s m e d i d a l a m s a i u r a n k e m i h

( R u b i n 2 0 1 0 )

S e b a n y a k 2 5 j u t a k e m a t i a n d i s e l u r u h d u n i a p a d a t a h u n 2 0 1 1 s e p e r t i g a n y a

d i s e b a b k a n o l e h p e n y a k i t i n f e k s i I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n i n f e k s i

d e n g a n k e t e r l i b a t a i i b a k t e r i t e r s e r i n g d i k o m u n i t a s d a n h a m p i r 1 0 o r a n g p e m a h

t e r k e n a I S K s e l a m a h i d u p n y a S e k i t a i - 1 5 0 j u t a p e n d i i d u k d i s e l u r u h d u n i a t i a p

t a l i u n n y a t e r d i a g n o s i s m e n d e r i t a i n f e k s i s a i u r a n k e m i h ( Y u n u s 2 0 1 2 )

I S K d a p a t m e n g e n a i s e m u a k e l o m p o k u m u r b a i k a n a k r e m a j a d e w a s a

m a u p u n u s i a l a n j u t P r e v a l e n s i a n a k u s i a s e k o l a h y a n g m e n d e r i t a I S K s e k i t a r 1 -

3 d a n m e n i n g k a t p a d a r e m a j a y a n g s u d a h m e l a k u k a n h u b i m g a n s e k s u a l

( K o m a r a 2 0 0 9 ) D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r 2 5 - 3 5

s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a S e l a m a

p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n c e n d e r u n g

m e n d e r i t a I S K d i b a n d i n g k a n l a k i - l a k i ( S u d o y o 2 0 0 9 )

R a s i o I S K p a d a w a n i t a d i b a n d i n g p r i a b e r k i s a r 3 0 1 d a n s e k i t a r 5 0 w a n i t a

y a n g t e r k e n a i n f e k s i a k a n b e r k e m b a n g m e n j a d i I S K b e m l a n g I S K m e n i p a k a n

i n f e k s i b a k t e r i y a n g p a l i n g s e r i n g p a d a a n a k - a n a k d e n g a n k e l u h a n d e m a m b a i k

p a d a a n a k p r i a m a u p u n w a n i t a P r e v a l e n s i y a n g p e m a h d i l a p o r k a n b e r k i s a r 4 1

I

2

s a m p a i 7 5 R e k u r e n s i c u k u p s e r i n g d a n t e r j a d i s e k i t a r 1 8 p a d a b a y i l a k i - i a k i

d a n 2 6 p a d a b a y i p e r e m p u a n U n t u k u s i a p r a s e k o l a h I S K l e b i h s e r i n g

m e n g e n a i w a n i t a I n s i d e n I S K p a d a a n a k - a n a k p r a s e k o l a h s e k i t a r 2 ( S y a h r i n i

2 0 1 1 )

D a r i b e r b a g a i p e n e l i t i a n e p i d e m i o l o g i s d i I n d o n e s i a d i d a p a t k a n p r e v a l e n s i

D M s e b e s a r 15 - 2 3 p a d a p e n d u d u k u s i a l e b i J i d a r i 1 5 t a h u n b a h k a n p a d a

s u a t u p e n e l i t i a n e p i d e m i o l o g i s d i M a n a d o d i d a p a t k a n p r e v a l e n s i D M a d a i a h 6 1

P r e v a l e n s i d i a b e t e s m e l i t u s p a d a p e n d u d u k u s i a 2 5 - 6 4 t a h u n d i J a w a d a n B a l i

s e b e s a r 7 5 P e n e l i t i a n y a n g d i l a k u k a n d i J a k a r t a S u r a b a y a M a k a s a r d a n k o t a -

k o t a l a i n d i I n d o n e s i a m e m b u k t i k a n a d a n y a k e n a i k a n p r e v a l e n s i d a r i t a h u n

k e t a h u n ( D E P K E S 2 0 1 4 W H O 2 0 1 0 )

I n f e k s i s a i u r a n k e m i h j u g a m e n i p a k a n m a s a l a h k l i n i s u m u m p a d a p e n d e r i t a

D M o l e h k a r e n a p e n d e r i t a D M m e m p u n y a i k e m u n g k i n a n m e n d e r i t a I S K l e b i h

t i n g g i d i b a n d i n g k a n d e n g a n b u k a n p e n d e r i t a D M d a n j u g a m e n d e r i t a i n f e k s i y a n g

l e b i h b e r a t y a n g a k a n m e n i n g k a t k a n risiko u n t u k m a s u k m m a h s a k i t ( H a r d i n g

d k k 2 0 1 0 ) P e n e l i t i a n y a n g d i l a k u k a n o l e h B o y k o d k k m e n d a p a t k a n w a n i t a D M

ripe 2 d e n g a n b a k t e r i u r i a s i m t o m a t i k s e t e l a h d i l a k u k a n p e m a n t a u a n s e l a m a 1 8

b u l a n m e n g a l a m i p e n i n g k a t a n r i s i k o m e n d a p a t k a n I S K s e b a n y a k 3 4

d i b a n d i n g k a n d e n g a n w a n i t a y a n g t i d a k m e n g a l a m i D M s e b e s a r 1 9 ( B o y k o d k k

2 0 0 2 )

B e r d a s a r k a n u r a i a n - u r a i a n d i a t a s s e r t a b e l u m a d a n y a p e n e l i t i a n y a n g

m e n e m u k a n k e t e r k a i t a n f a k t o r u s i a j e n i s k e l a m m t i n g k a t p e n d i d i k a n d a n r i w a y a t

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h d i K o t a P a l e m b a n g m a k a

p e n e l i t i t e r t a r i k i m t i i k m e l a k u k a n p e n e l i t i a n m e n g e n a i h u b u n g a n a n t a r a u s i a j e n i s

k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

3

12 Rumusan Masalah

1 B a g a i m a n a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s

m e l i t u s

2 A p a k a l i a d a h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

13 Tujuan Penelitian

131 Tujuan Umum

T u j u a n u m u m d a r i p e n e l i t i a n i n i a d a i a h d i k e t e m u k a n n y a h u b u n g a n a n t a i a

u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i m s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

132 Tujuan Khusus

T u j u a n k l i u s u s d a r i p e n e l i t i a n i n i y a i t u

1 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a

2 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n m f e k s i s a i u r a n k e m i b p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n j e n i s k e i a m i n

3 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

4

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n t i n g k a t p e n d i d i k a n

4 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n riwayat d i a b e t e s m e l i t u s

5 T e r a n a l i s i s n y a h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a i m n a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

6 T e r a n a l i s i s n y a h u b u n g a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

7 T e r a n a l i s i s n y a h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

8 T e r a n a l i s i s n y a h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i u i s d e n g a n k e j a d i a n

i n f e k s i s a l i u a i i k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

14 Manfaat Penelitian

141 Manfaat Teoritis

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t m e n a m b a h p e n g e t a h u a n p e n e l i t i

t e n t a n g h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i U i s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

5

142 Manfaat Praktis

A Bagi Peneliti

H a s i l p e n e l i t i a n i n i d i l i a r a p k a n d a p a t d i g u n a k a n s e b a g a i s a l a h s a t u b a h a n

r e f e r e n s i a t a u b a c a a n b a g i p e n e l i t i

B Bagi Institusi

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t d i g u n a k a n p i h a k R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g s e b a g a i s a l a l i s a t u b a h a n a c u a n d a l a m m e n g u p a y a k a n

p e n c e g a h a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

15 Keaslian Penelitian

T a b e l 1 1 K e a s l i a n P e n e l i t i a n

Nama Judul Penelitian Desain Hasil Penelitian

Peneliti Penelitian

Kugan P r e v a l e n s i I n f e k s i Cross D a r i p e n e l i t i a n i i i i

Kandasamy S a i u r a n K e m i l i P a d a seciUmal d i p e r o l e h b a l i w a

W a n i t a Y a n g M e n d e r i t a

D i a b e t e s M e l i t u s T i p e

I I Y a n g D i r a w a t I n a p

p a s i e n w a n i t a d i a b e t e s

m e l i t u s t i p e I y a n g

m e n d e r i t a I S K y a n g

D a n D i r a w a t J a l a n D i d i r a w a t m a p d a n

S u b b a g i a n

E n d o k r i n o l o g i B a g i a n

P e n y a k i t D a l a m D i

d i r a w a t j a l a n d i s u b

b a g i a n E n d o k r i n o l o g i

P e n y a k i t D a l a m

R S U P H A d a m M a l i k R S U P H A d a m

P a d a T a l i u n 2 0 0 9 M a l i k M e d a i i t e r d a p a t

s e b a n y a k 2 5 o r a n g

y a i t u ( 1 2 7 ) D a r i 2 5

o r a n g y a n g m e n d e r i t a

I S K t e r d a p a t 3 o r a n g

y a i t u ( 1 2 0 ) y a n g

d i r a w a t i n a p d a n 2 2

6

o r a n g ( 8 8 0 ) y a n g

d i r a w a t j a l a n

Edel Weisela P e r b e d a a n R i s i k o

Permata I n f e k s i N o s o k o m i a l

Sari dan S a i u r a n K e m i h

Prijono B e r d a s a r k a n

Satyabakti K a i e t e r i s a s i U r i n

U m u r D a n D i a b e t e s

M e l i t u s T a h u n 2 0 1 5

Case H a s i l p e n e l i t i a n y a n g

control d i 1 a k u k a n p a d a 2 0

s a m p e l k a s u s d a n

k o n t r o l m e n u n j u k k a n

b a h w a p a s i e n d e n g a n

u m u r gt 5 5 t a h u n

m e m p u n y a i r i s i k o

5 5 7 k a l i m e n g a l a m i

i n f e k s i n o s o k o m i a l

s a i u r a n k e m i h

d i b a n d i n g k a n p a s i e n

d e n g a n u m u r lt 5 5

t a h u n d e n g a n

p e r i l i t u n g a i i b e s a r

risiko d i p e r o l e h n i l a i

O R s e b e s a r 5 5 7

d e n g a n n i l a i 9 5

(onfidence Interval

l 1 9 lt O R lt 2 8 2 3

P a s i e n d e n g a n s t a t u s

D M m e m p u n y a i risiko

6 k a l i u n t u k

m e n g a l a m i i n f e k s i

n o s o k o m i a l s a i u r a n

k e m i h d i b a n d i n g k a n

d e n g a n p a s i e n y a n g

t i d a k m e n d e r i t a D M

d e n g a n n i l a i O R

7

s e b e s a r 6 0 0 d e n g a n

n i l a i 9 5 Confidence

Interval 1 22 lt O R lt

3 2 2 6

Andry K a r a k t e r i s t i k P a s i e n - D e s k r i p k i f H a s i i p e n e l i t i a n d a r i

Lukandy P a s i e n I n f e k s i S a i u r a n r e t r o s p e k t i f 4 3 o r a n g p e n d e r i t a

K e m i i i d i P o l i u r o l o g i

R S U D D r P i m g a d i

K o t a M e d a n T a h u n

2 0 1 2 - 2 0 1 3

I S K d i d a p a t k a n 5 3 5

p a d a k e l o m p o k u s i a

gt 5 0 t a h u n 5 1 2

b e i j e n i s k e i a m i n l a k i -

l a k i 1 0 0 t i d a k

m e n d e r i t a

v e s i c o u r e t r a l r e f l u x

7 0 Benign Prostatic

Hyperplasia 1 1 6

b a t u s a i u r a n k e m i h

2 7 9 d i a b e t e s t i p e 2

D a r i h a s i l p e n e l i t i a n

i n i d a p a t d i s i m p u l k a n

b a h w a p e n d e r i t a i S K

l e b i h b a n y a k t e r j a d i

p a d a l a k i - l a k i d a n

p e n d e r i t a I S K l e b i h

b a n y a k d i j u m p a i p a d a

k e l o m p o k u m u r gt 5 0

t a h u n s e r t a d i t e m u k a n

I S K d e n g a n B P H

B S K d a n D M T i p e 2

BAB 11

TINJAUAN PUSTAKA

21 Landasan Teori

211Infeksi Saiuran Keniih

A Definisi

I n f e k s i S a i u r a n K e m i h a d a i a h i n v a s i d a n m u l t i p l i k a s i m i k r o o r g a n i s m e a t a u

p a r a s i t d a l a m j a r i n g a n t u b u h k h u s u s n y a s a i u r a n k e m i h y a n g t e r d i r i d a r i g i n j a l

u r e t e r b u l i - b u l i d a n u r e t r a y a n g d i i a n d a i d e n g a n a d a n y a b a k t e r i 1 0 c f i i (colony

forming unit) p e r m l p a d a p e n g a m b i l a n c o n t o h u r i n ( P u m o m o 2 0 1 1 )

I n f e k s i s a i u r a n k e m i h a d a l a l i s u a t u i n f e k s i y a n g m e l i b a t k a n g i n j a l lU e ter

b u l i - b u l i a t a u p u n u r e t r a I n f e k s i s a i u r a n k e m i h ( I S K ) a d a l a l i i s t i l a h u m u m y a n g

m e n u n j u k k a n k e b e r a d a a n m i k r o o r g a n i s m e d a l a m u r i n ( S u d o y o 2 0 0 6 )

B a k t e r i u r i a b e r m a k n a (significant hacteriuria) a d a i a h s u a t u k e a d a a n y a n g

m e n u n j u k k a n p e n u m b u l i a n m i k r o o r g a n i s m e m u m i l e b i h d a r i 1 0 c f t L m l p a d a

b i a k a n u r i n B a k t e r i u r i a b e r m a k n a m u n g k i n t a n p a d i s e r t a i p r e s e n t a s i k l i n i s I S K

d a n d i n a m a k a n b a k t e r i u r i a a s i m t o m a t i k (convert hacteriuria) S e b a l i k n y a

b a k t e r i u r i a b e n n a k n a d i s e r t a i p e r s e n t a s i k l i n i s I S K d i n a m a k a n b a k t e r i u r i a

s i m t o m a t i k P a d a b e b e r a p a k e a d a a n t e r d a p a t p a s i e n d e n g a n p e r s e n t a s i k l i n i s I S K

n a m u n t a n p a b a k t e r i u r i a b e n n a k n a S e l a i n i t u d i k a t a k a n p i u r i a ( l e u k o s i t d a l a m

u r i n ) b e n n a k n a (significant pyuria) b i l a d i t e m u k a n n e u t r o f i l gt 1 0 s e l p e r l a p a n g a n

p a n d a n g ( S u d o y o 2 0 0 6 )

B Epidemiologi

I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m u k a n d i p r a k t i k u m u m w a i a u p u n b e n n a c a m - m a c a m a n t i b i o t i k a s u d a h

t e r s e d i a l u a s d i p a s a r a n D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r

2 5 - 3 5 s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a

S e l a m a p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n

9

10

c e n d e r u n g m e n d e r i t a i S K d i b a n d i n g k a n l a k i - l a k i I S K b e m l a n g p a d a l a k i - l a k i

j a r a n g d i l a p o r k a n k e c u a l i d i s e r t a i f a k t o r p r e d i s p o s i s i ( p e n c e t u s )

P r e v a l e n s i b a k t e r i u r i a a s i m t o m a t i k l e b i h s e r i n g d i t e m u k a n p a d a p e r e m p u a n

P r e v a l e n s i s e l a m a p e r i o d e s e k o l a h (school girls) 1 m e n i n g k a t m e n j a d i 5

s e l a m a p e r i o d e a k t i f s e c a r a s e k s u a l P r e v a l e n s i i n f e k s i a s i m t o m a t i k m e n i n g k a t

m e n c a p a i 3 0 b a i k l a k i - l a k i m a u p u n p e r e m p u a n b i l a d i s e r t a i f a k t o r p r e d i s p o s i s i

( S u d o y o 2 0 0 6 )

C Kiasifikasi

I n f e k s i s a i u r a n k e m i h d a p a t d i b a g i m e n j a d i d u a k a t e g o r i u m u m b e r d a s a r k a n

l o k a s i a n a t o m i y a i t u

1 ) I n f e k s i s a i u r a n k e m i h b a w a h

2 ) I n f e k s i s a i u r a n k e m i h a l a s

P r e s e n t a s i k l i n i s d a r i i n f e k s i s a i u r a n k e m i h b a w a l i t e r g a n t u n g d a r i gender

y a i t u

a ) P e r e m p u a n

a S i s t i t i s

S i s t i t i s a d a i a h p r e s e n t a s i k l i n i s i n f e k s i k a n d u n g k e m i h d i s e r t a i

b a k t e r i u r i a b e n n a k n a

b S i n d r o m U r e t r a A k u t ( S U A )

S i n d r o m a u r e t r a a k u t a d a i a h p r e s e n t a s i k l i n i s s i s t i t i s t a n p a d i t e m u k a n

a d a n y a m i k r o o r g a n i s m e d a l a m L u i n ( s t e r i l ) d a n s e r i n g d i n a m a k a n

s i s t i t i s b a k t e r i a l i s

b ) L a k i - l a k i

P r e s e n t a s i k l i n i s i n f e k s i s a i u r a n k e m i h p a d a l a k i - l a k i m u n g k i n s i s t i t i s

p r o s t a t i t i s e p i d i m i d i s d a n u r e t r i t i s

I n f e k s i s a i u r a n k e m i h a t a s t e r b a g i m e n j a d i 2 y a i t u

1 ) P i e l o n e f r i t i s A k u t ( P N A )

P i e l o n e f r i t i s a k u t a d a l a l i p r o s e s i n f l a m a s i p a r e n k i m g i n j a l y a n g d i s e b a b k a n

o l e h m f e k s i b a k t e r i

11

2 ) P i e l o n e f r i t i s K r o n i s ( P N K )

P i e l o n e f r i t i s k r o n i s m u n g k i n a k i b a t l a n j u t d a r i i n f e k s i b a k t e r i

b e r k e p a n j a n g a n a t a u i n f e k s i s e j a k m a s a k e c i i O b s t r u k s i s a i u r a n k e m i h d a n

r e f l u k s v e s i k o u r e t e r d e n g a n a t a u t a n p a b a k t e r i u r i a k r o n i k s e r i n g d i i k u t i

p e m b e n t u k a n j a r i n g a n i k a t p a r e n k i m g i n j a l y a n g d i t a n d a i d e n g a n

p i e l o n e f r i t i s k r o n i k y a n g s p e s i f i k ( S u d o y o 2 0 0 6 )

D Etiologi

P a d a k e a d a a n n o r m a l u r i n b e r s i f a t s t e r i l U m u m n y a I S K d i s e b a b k a n o l e h

k i i m a n g r a m n e g a t i f E s c h e r i c h i a c o l i m e m p a k a n p e n y e b a b t e r b a n y a k b a i k p a d a

y a n g s i m t o m a t i k m a u p u n y a n g a s i m t o m a t i k y a i t u 7 0 - 9 0 E n t e r o b a k t e r i a s e p e r t i

P r o t e u s m i r a b i l i s ( 3 0 d a r i i n f e k s i s a i u r a n k e m i h p a d a a n a k l a k i - l a k i t e t a p i

k u r a n g d a r i 5 p a d a a n a k p e r e m p u a n ) K l e b s i e l l a p n e u m o n i a d a n P s e u d o m o n a s

a e m g i n o s a d a p a t j u g a s e b a g a i p e n y e b a b O r g a n i s m e g r a m p o s i t i f s e p e r t i

S t r e p t o c o c c u s f a e c a l i s ( e n t e r o k o k u s ) S t a p h y l o c o c c u s e p i d e n n i d i s d a n

S t r e p t o c o c c u s v i r i d a n s j a r a n g d i t e m u k a n P a d a u r o p a t i o b s t m k t i f d a n k e l a i n a n

s t r u k t u r s a i u r a n k e m i h p a d a a n a k l a k i - l a k i s e r i n g d i t e m u k a n P r o t e u s s p e c i e s P a d a

I S K n o s o k o m i a l a t a u I S K k o m p l e k s l e b i h s e r i n g d i t e m u k a n k u m a n P r o t e u s d a n

P s e u d o m o n a s ( L u m b a n b a t u S M 2 0 0 3 )

E Patofisiologi

P a d a i n d i v i d u n o n n a l b i a s a n y a u r i n l a k i - l a k i m a u p u n p e r e m p u a n s e l a l u

d a l a m k e a d a a n s t e r i l k a r e n a d i p e r t a l i a n k a n o l e h j u m l a l i d a n f r e k u e n s i b e r k e m i h

U t e r o d i s t a l m e m p a k a n t e m p a t k o l o n i s a s i m i k r o o r g a n i s m e nonpathogenic

fastidious G r a m - p o s i t i f d a n g r a m n e g a t i f ( S u d o y o 2 0 0 6 )

H a m p i r s e m u a I S K d i s e b a b k a n i n v a s i m i k r o o r g a n i s m e ascending d a r i u r e t r a

k e d a l a m k a n d u n g k e m i b P a d a b e b e r a p a p a s i e n t e r t e n t u i n v a s i m i k r o o r g a n i s m e

d a p a t m e n c a p a i k e g i n j a l P r o s e s i n i d i p e n n u d a h o l e h k o n d i s i r e f l u k s

v e s i k o i i r e t e r a l P r o s e s i n v a s i m i k r o o r g a n i s m e h e m a t o g e n s a n g a t j a r a n g d i t e m u k a n

d i k l i n i k m u n g k i t a k i b a t l a n j u t d a r i b a k t e r e m i a G i n j a l d i d u g a m e n i p a k a n l o k a s i

12

i n f e k s i s e b a g a i a k i b a t l a n j u t d a r i s e p t i k e m i a a t a u e n d o k a r d i t i s a k i b a t S t a f i l o k o k u s

a u r e u s K e l a i n a n g i n j a l y a n g t e r k a i t d e n g a n e n d o k a r d i t i s ( S t a f i l o k k o k u s a u r e u s )

d i k e n a l d e n g a n N e p h r i t i s L o h e i n B e b e r a p a p e n e l i t i a n m e l a p o r k a n p i e l o n e f r i t i s

a k u t ( P N A ) s e b a g a i a k i b a t l a n j u t i n v a s i h e m a t o g e n ( S u d o y o 2 0 0 6 )

F Faktor Risiko

P a t o f i s i o l o g i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h d a p a t d i p e n g a n i h i o l e h

b e b e r a p a f a k t o r A d a p u n b e b e r a p a f a k t o r risiko y a n g m e m p e n g a n i l i i t e r j a d i n y a

i n f e k s i s a i u r a n k e m i h a n t a r a l a i n

1 ) U s i a

I n s i d e n I S K m e n i n g k a t b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i

m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n a d a n y a a b n o r m a l i t a s a n a t o m i y a n g

m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n k e m i h s e p e r t i p e m b e s a r a n p r o s t a t

d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e

P e n y e b a b l a i n t e r m a s u k p e r i n e u m y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s

p e n y a k i t n e u r o m u s k n l a r d a n k a t e t e r i s a s i b u l i - b u l i S e l a i n i t u i n s i d e n I S K

m e n c a p a i 1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o s e 2 0 0 9 F o x m a n e t a l 2 0 1 0

R o n a l d 2 0 1 1 )

M e n u m t t e o r i y a n g d i k e m u k a k a n o l e h S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a d a u s i a

l a n j u t a k a n t e r j a d i p e n i n g k a t a n k e r e n t a n a n t e r h a d a p p e n y a k i t P a d a u s i a d i a t a s 5 0

t a l i u n t e r j a d i p e n u m n a n k e m a m p u a n d a l a m m e m p e r t a h a n k a n s t e n l i t a s b a i k p a d a

k a n d u n g k e m i h m a u p u n u r e t r a H a l t e r s e b u t d i s e b a b k a n o l e h i n v o l u s i t i m u s

I n v o l u s i s e l t i m u s m e n y e b a b k a n j u m l a h se d a n k u a l i t a s r e s p o n s s e l T s e m a k i n

b e r k u r a n g J u m l a h s e l T m e m o r i m e n i n g k a t n a m u n s e m a k i n s u l i t u n t u k

b e r k e m b a n g t e r u t a m a s i t o t o k s i k s e l T ( C D ^ ) d a n s e l T h l ( C D ^ ^ ) k a r e n a t e r j a d i

a p o p t o s i s S i t o t o k s i k s e l T ( C D ^ ^ ) b e i p e r a n d a l a m r e s p o n s i m u n t e r h a d a p a n t i g e n

p a d a s e l y a n g d i i n f e k s i d e n g a n c a r a m e m b u n u l i s e l y a n g t e r i n f e k s i u n t u k

m e n c e g a h p e n y e b a r a n m f e k s i s e d a n g k a n s e l T h l ( C D ^ ^ ) b e r p e r a n m e m b a n t u s e l

B u n t u k m e m p r o d u k s i a n t i b o d i

13

2 ) J e n i s k e l a m m d a n a k t i v i t a s s e k s u a l

I n s i d e n s i I S K y a n g r e n d a h p a d a p r i a d i p e n g a n i h i o l e h 3 f a k t o r y a i t u

1 L e b i h s e d i k i t t e r j a d i k o l o n i s a s i s e k i t a r u r e t r a k a r e n a t i d a k a d a n y a t e m p a t

s e p e r t i v a g i n a p a d a p e r e m p u a n

2 M e m i l i k i u r e t r a y a n g p a n j a n g

3 A d a n y a s u b s t a n s i a n t i b a k t e r i a l p a d a c a i r a n p r o s t a t

U r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a h d e n g a n d e k a t n y a v a g i n a l

v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h l e b i h s e r i n g

p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a f l o r a n o n n a l p a d a d a e r a l i p e r i u r e t r a t e r d i r i

d a r i o r g a n i s m e s e p e r t i l a c t o b a c i l l i i s y a n g m e m b a n t u m e l a w a n k o l o n i s a s i b a k t e r i

p a t o g e n p a d a s a i u r a n k e m i h P e r u b a l i a n l i n g k i m g a n d a r i p e r i u r e t r a l s e p e r t i

p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k b i s a m e n g g a n g g u f l o r a

n o r m a l s e h i n g g a m e m u n g k i n k a n b a k t e r i p a t o g e n b e r k o l o n i s a s i d a n m e n y e b a b k a n

i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

P a d a w a n i t a l e b i h d a r i 5 0 t a h u n a t a u l e b i h m e n o p a u s e m e m p a k a n f a k t o r

l a i n y a n g m e n i n g k a t k a n P V R Post Void Residual) s e l a i n p e n u r u n a n k o i i t r a k t i i i t a s

o t o t d e t r u s o r P e n u m n a n e s t r o g e n y a n g d i s e b a b k a n m e n o p a u s e d a p a t

m e n i n g k a t k a n p H v a g i n a l d a n m e n u m n k a n j u m l a l i l a c t o b a c i l l i A k i b a m y a t e r j a d i

p e n i n g k a t k a n k o l o n i s a s i d a r i b a s i l g r a m n e g a t i f s e h i n g g a m e n i n g k a t k a n r e s i k o

t e r j a d i n y a I S K P a d a p r i a p r o s t a t m e n s e k r e s i k a n c a i r a n y a n g m e n g a n d i m g z i n k

y a n g m e m i l i k i a k t i f i t a s m i k r o b i a l ( K i m 2 0 1 2 )

S e l a i n i t u p i j a t a n u r e t r a s e p e r t i y a n g t e r j a d i s e l a m a h u b u n g a n s e k s u a l

m e n y e b a b k a n m a s u k n y a b a k t e r i k e d a l a m k a n d u n g k e m i h d a n m e m p a k a n h a l

y a n g p e n t i n g d a l a m p a t o g e n e s i s m f e k s i s a l i u a n k e m i h p a d a p e r e m p u a n m u d a

B u a n g a i r k e c i l s e t e l a h h u b u n g a n s e k s u a l t e r b u k t i m e n u m n k a n risiko s i s t i t i s

m u n g k i n k a r e n a t i n d a k a n i n i m e n i n g k a t k a n e r a d i k a s i b a k t e r i y a n g m a s u k s e l a m a

h u b u n g a n s e k s u a l ( K i m 2 0 1 2 )

3 ) T i n g k a t P e n d i d i k a n

P e n g e t a h u a n s e s e o r a n g t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t

p e n d i d i k a n S e s e o r a n g y a n g m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m i u i g k i n a n

p e n g e t a h u a n t e n t a n g k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o n n a s i y a n g d i d a p a t k a n

14

t e n t a n g k e s e h a t a n l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h

S e b a l i k n y a p e n d i d i k a n y a n g k u r a n g d a p a t m e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g

t e r h a d a p n i l a i - n i l a i y a n g b a n i d i k e n a l ( N o t o a d i n o j o 2 0 0 3 )

4 ) R i w a y a t D i a b e t e s M e l i t u s

M e n u r u t S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a s i e n d e n g a n s t a t u s D M s a n g a t

b e r i s i k o u n t u k m e n g a l a m i i n f e k s i s a i u r a n k e m i h A b n o n n a l i i a s s t n i k t u r d a n

k a n d u n g k e m i h n e u r o g e n i k a k i b a t n e u r o p a t i o t o n o m a t a u s t r o k e p a d a p a s i e n D M

m e n y e b a b k a n p e n g o s o n g a n k a n d u n g k e m i h t i d a k n o n n a l D M j u g a d a p a t

m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a h a n a n t u b u h y a n g b e r p o t e n s i m e n i n g k a t

risiko t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a h a n a n t u b u h t e r s e b u t d i a n t a r a n y a

a d a i a h k e g a g a l a n m i g r a s i s e l intracellular killing f a g o s i t o s i s d a n k e m o t a k s i s

p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n m e k a n i s m e p e r t a h a n a n

a l a m i a h i o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p i n f e k s i

5 ) K e h a m i i a n

K e c e n d e r u n g a n i n f e k s i s a i u r a n k e m i h b a g i a n a t a s s e l a m a k e h a m i i a n

d i s e b a b k a n o l e h p e n u m n a n k e k u a t a n u r e t e r p e n u m n a n p e r i s t a l t i k u r e t e r d a n

i n k o m p e t e n s i s e m e n t a r a k a l u p v e s i k o i u - e t e r a l y a n g t e r j a d i s e l a m a h a m i l

6 ) S u m b a t a i i

A d a n y a I i a i a n g a n a l i r a n b e b a s u r i n s e p e r t i t u m o r s t r i k t r a a b a t u a t a u

h i p e r t r o f i p r o s t a t d a p a t m e n y e b a b k a n h i d r o n e f r o s i s d a n risiko i n f e k s i s a i u r a n

k e m i l i y a n g s a n g a t t i n g g i S e l a i n i t u s u p e r i n f e k s i p a d a s u m b a t a n s a i u r a n k e m i h

d a p a t m e n y e b a b k a n k e m s a k a n j a r i n g a n g i n j a l y a n g c e p a t

7 ) D i s f u n g s i n e u r o g e n i k k a n d u n g k e m i h

G a n g g u a n s a r a f y a n g b e k e r j a p a d a k a n d m i g k e m i h s e p e r t i p a d a j e j a s k o r d a

s p i n a l i s t a b e s d o r s a i i s m u l t i p e l s k l e r o s i s d i a b e t e s m e l i t u s a t a u p e n y a k i t l a i n

d a p a t b e r h u b u n g a n d e n g a n i n f e k s i s a i u r a n k e m i h I n f e k s i d a p a t d i a w a l i o l e h

p e n g g u n a a n k a t e l e r u n t u k d r a i n a s e k a n d i u i g k e m i h d a n d i d u k i m g o l e h s t a t i s u r i n

d a l a m k a n d u n g k e m i l i u n t u k j a n g k a w a k t u y a n g l a m a

8 ) R e f l u k s v e s i k o m e t e r a

K e a d a a n i n i d i d e f i n i s i k a n s e b a g a i r e f l u k s u r i n d a r i k a n d u n g k e m i b k e u r e t e r

d a n k a d a n g s a m p a i k e p e l v i s r e n a l H a l i n i t e r j a d i s e l a m a b u a n g a i r k e c i l a t a u

15

d e n g a n p e n i n g k a t a n t e k a n a n p a d a k a n d u n g k e m i h R e f l u k s v e s i k o i i r e t e r a l d a p a t

d i b u k t i k a n d e n g a n a d a n y a g c r a k a n r e t r o g r a d z a t r a d i o o p a k a t a u r a d i o a k t i f m e l a l u i

s i s t o u r e t r o g r a m s e l a m a b u a n g a i r k e c i l R e f l u k s v e s i k o i i r e t e r a l b i a s a n y a

d i s e b a b k a n k a r e n a a d a n y a g a n g g u a n a n a t o m i s p a d a p e r t e m u a n v e s i k o i i r e t e r a l

y a n g d a p a t m e n y e b a b k a n r e f l u k s u r i n d i s e r t a i b a k t e r i d a n k a r e n a i t u t e r j a d i l a h

i n f e k s i s a l r a a n k e m i h

9 ) F a k t o r v i r u l e n s i b a k t e r i

F a k t o r v i r u l e n s i b a k t e r i m e m p e n g a r u b i k e m u n g k i n a n vragt7 t e r t e n m d a l a m

m e n y e b a b k a n i n f e k s i t r a k i u s u r i n a r i u s H a m p i r s e m u a strain F c o l i y a n g

m e n y e b a b k a n p i e l o n e f r i t i s p a d a p a s i e n d e n g a n t r a k i u s u r i n a r i u s n o m i a l s e c a r a

a n a t o m i k m e m p u n y a i p i l u s t e r t e n t u y a n g m e m p e r a n t a r a i p e r l e k a t a n p a d a b a g i a n

d i g a k t o s i d a d a n g l i k o s f i n g o l i p i d y a n g a d a d i u r o e p i t e l Strain y a n g m e n i m b u l k a n

p i e l o n e f r i t i s j u g a b i a s a n y a m e m p a k a n p e n g b a s i l h e m o l i s i n m e m p u n y a i

a e r o b a k t i n d a n r e s i s t e n t e r h a d a p k e r j a b a k t e r i s i d a l d a r i s e m m m a n u s i a

1 0 ) F a k t o r g e n e t i k

F a k t o r g e n e t i k p e n j a m u m e m p e n g a n i l i i k e r e n t a n a n t e r h a d a p i n f e k s i t r a k t u s

u r i n a r i u s J u m l a h d a n t i p e r e s e p t o r p a d a s e l u r o e p i t e l t e m p a t b a k t e r i d a p a t

m e n e m p e l s e l i d a k i i y a s e b a g i a i i d i t e n t u k a r i s e c a r a g e n e t i k ( I s s e l b a c h e r 2 0 0 9 )

G Manifestasi Klinis

G e j a l a k l i n i s d a r i i n f e k s i s a i u r a n k e m i h s e s u a i d e n g a n b a g i a n s a i u r a n k e m i h

y a n g t e r i n f e k s i a d a i a h s e b a g a i b e r i k u t

1 ) I n f e k s i s a i u r a n k e m i h b a g i a n b a w a l i

K e l u h a n p a s i e n b i a s a n y a b e m p a r a s a s a k i t a t a u r a s a p a n a s d i u r e t r a s e w a k t u

k e n c i n g d e n g a n a i r k e m i h s e d i k i t - s e d i k i t s e r t a r a s a t i d a k e n a k d i d a e r a h

s i i p r a p u b i k

2 ) I n f e k s i s a i u r a n k e m i h b a g i a n a t a s

P a d a i n t e k s i s a i u r a n k e m i h b a g i a n a t a s d a p a t d i t e m u k a n g e j a l a s e p e r t i s a k i t

k e p a l a m a l a i s e m u a l m m i t a h d e n i a m m e n g g i g i l r a s a t i d a k e n a k a t a u

n y e r i d i p i n g g a n g ( T e s s y d k k 2 0 0 1 )

16

H Tatalaksana

T u j u a n p e n a t a l a k s a n a a a n i n f e k s i s a i u r a n k e m i h a d a i a h m e n c e g a h d a n

m e n g h i l a n g k a n g e j a l a m e n c e g a h d a n m e n g o b a t i b a k t e n e m i a d a n b a k t e r i u r i a s e r t a

m e n c e g a h d a n m e n g u r a n g i r i s i k o k e r u s a k a n g i n j a l y a n g m u n g k i n t i m b u l d e n g a n

p e m b e r i a n o b a t - o b a t a n y a n g s e n s i t i f m u r a l i d a n a m a n d e n g a n e f e k s a m p i n g y a n g

m i n i m a l

a ) i n f e k s i s a i u r a n k e m i h ( I S K ) b a w a h

P r i n s i p p e n a t a l a k s a n a a n I S K b a w a h m e l i p u t i intake c a i r a n y a n g b a n y a k

a n t i b i o t i k y a n g a d e k u a t d a n b i l a p e r l u t e r a p i s i m t o m a t i k u n t u k a l k a l i s a s i

u r i n

i H a m p i r 8 0 p a s i e n a k a n m e m b e r i k a n r e s p o n s e t e l a h 4 8 j a m d e n g a n

a n t i b i o t i k a t u n g g a l s e p e r t i a m p i s i l i n 3 g r a m a t a u t r i m e t o p r i m 2 0 0 m g

i i B i l a i n f e k s i m e n e t a p d i s e r t a i k e l a i n a n u r i n a l i s i s ( l e u k o s i u i a ) d i p e r i u k a n

t e r a p i k o n v e n s i o n a l s e l a m a 5 - 1 0 h a r i

i i i P e m e r i k s a a n m i k r o s k o p i s u r i n d a n b i a k a n u r i n t i d a k d i p e r i u k a n b i l a

s e m u a g e j a l a h i l a n g d a n t a n p a l e u k o s u r i a

b ) I n f e k s i s a i u r a n k e m i h ( I S K ) a t a s

P a d a u m u m n y a p a s i e n d e n g a n p i e l o n e f r i t i s a k u t m e m e r l u k a n r a w a t i n a p

u n t u k m e m e l i h a r a s t a t u s h i d r a s i d a n t e r a p i a n t i b i o t i k a p a r e n t e r a l p a l i n g

s e d i k i t 4 8 j a m ( S u d o y o 2 0 0 6 )

i Komplikasi

K o m p l i k a s i i n f e k s i s a i u r a n k e m i h t e r g a n t u n g d a r i t i p e y a i t u i n f e k s i s a i u r a n

k e m i h t i p e s e d e r h a n a (uncomplicated) d a n t i p e b e r k o m p l i k a s i (complicated)

1 ) I n f e k s i s a i u r a n k e m i h s e d e r h a n a (uncomplicated)

I n f e k s i s a i u r a n k e m i h a k u t t i p e s e d e r h a n a ( s i s t i t i s ) y a i t u n o n - o b s t r u k s i d a n

b u k a n p e r e m p u a n h a m i l m e m p a k a n p e n y a k i t r i n g a n (self limited disiase)

d a n t i d a k m e n y e b a b k a n a k i b a t l a n j u t j a n g k a l a m a

2 ) I n f e k s i s a i u r a n k e m i h b e r k o m p l i k a s i (complicated)

a ) I n f e k s i s a i u r a n k e m i h s e l a m a k e h a m i i a n

b ) i n f e k s i s a i u r a n k e m i h p a d a d i a b e t e s m e l i t u s ( S u d o y o 2 0 0 6 )

17

22 Kerangka Teori

J

U s i a

J e n i s K e i a m i n

T i n g k a t P e n d i d i k a n

R i w a y a t D i a b e t e s M e l i m s

S u m b a t a n bullT

K e h a m i i a n

D i s f u n g s i n e u r o g e n i k

R e f l u k s v e s i k o i i r e t e r a l

V i r u l e n s i b a k t e r i

F a k t o r g e n e t i k

I n f e k s i b a k t e r i g r a m p o s i t i f a t a u n e g a t i v e p a d a s a i u r a n k e m i h

I n f e k s i S a i u r a n K e m i h

Keterangan

I j = V a r i a b e l y a n g t i d a k d i t e l i t i

= V a r i a b e l y a n g d i t e l i t i

18

Hipotesis

H i p o t e s i s d a l a m p e n e l i t i a n i n i a d a i a h

H O t i d a k t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n

t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

H I t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

BAB 111

M E T O D E PENELITIAN

31 Jenis Penelitian

P a d a p e n e l i t i a n i n i j e n i s p e n e l i t i a n y a n g d i g u n a k a n a d a i a h p e n e l i t i a n

o b s e r v a s i o n a i a n a l i t i k d e s a i n cross scclional d e n g a n m e n g g u n a k a n d a t a s e k u n d e r

d a r i r e k a m m e d i s p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1 D e s e m b e r

2 0 1 5

32 Waktu dan Tempat Penelitian

321 Waktu Penelitian

W a k t u p e n e l i t i a n d i l a k s a n a k a n p a d a t a n g g a l 1 O k t o b e r s a m p a i d e n g a n 3 0

O k t o b e r 2 0 1 6

322 Tempat Penelitian

P e n e l i t i a n i n i d i l a k s a n a k a n d i R u m a l i S a k i t M u h a m m a d i y a h P a e m b a n g ( d i

R u a n g R e k a m M e d i s )

33 Populasi dan Sampel Penelitian

331Populasi Penelitian

P a d a p e n e l i t i a n i n i p o p u l a s i t a r g e t a d a l a l i p a s i e n r a w a t i n a p d a n r a w a t j a l a n

d i R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g s e d a n g k a n p o p u l a s i t e r j a n g k a u n y a

a d a i a h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

332Sampel dan Besar Sampel Penelitian

P a d a p e n e l i t i a n i n i s a m p e l p e n e l i t i a n a d a i a h p a s i e n r a w a t i n a p d a n r a w a t

j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e

1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 y a n g m e m e n u h i k r i t e r i a i n k l u s i p e n e l i t i a n

1 9

20

d e n g a n b e s a r s a m p e l y a n g l a y a k d a l a m p e n e l i t i a n m e n u r u t t e o r i R o s c o e a d a i a h

a n t a r a t i g a p u l u h s a m p a i l i m a r a t i i s o r a n g ( S u g i y o n o 2 0 1 5 )

333 Krttena Inklusi dan Eksklusi

A Kriteria Inklusi

P a d a p e n e l i t i a n i n i k r i t e r i a i n k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t i n a p

d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i

P a l e m b a n g y a n g d i d i a g n o s a m e n g a l a m i i n f e k s i s a i u r a n k e m i h s e r t a m e m i l i k i d a t a

r e k a m m e d i s p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

B Kriteria Eksklusi

P a d a p e n e l i t i a n i n i k r i t e r i a e k s k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t

i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 d e n g a n d a t a r e k a m m e d i s

y a n g t i d a k l e n g k a p

334 Cara Pengambilan Sampel Penelitian

C a r a p e n g a m b i l a n s a m p e l y a n g d i g u n a k a n d a l a m p e n e l i t i a n i n i a d a l a l i

m e n g g u n a k a n t e k n i k consecutive sampling P a d a consecutive sampling s e t i a p

p a s i e n y a n g m e m e n u h i k r i t e r i a p e n e l i t i a n d i m a s u k k a n d a l a m p e n e l i t i a n s a m p a i

k u r u n w a k t u t e r t e n U i s e h i n g g a j u m l a h m i n i m a l y a n g d i p e r i u k a n t e r p e n u h i

( S a s t r o a s m o r o 2 0 1 1 )

34 Variabel Penelitian

341 Variabel Dependent

V a r i a b e l dependent f t e r i k a t ) d a l a m p e n e l i t i a n i n i a d a i a h i n f e k s i s a i u r a n

k e m i h

342 Variabel Independent

V a r i a b e l independent ( b e b a s ) d a l a m p e n e l i t i a n i n i a d a i a h u s i a j e n i s

k e l a i n i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

21

35 Definisi Operasional

Tabel 31 Definisi Operasional

Variabel Alat Cara ueiinisi rldsil L KUr I7 i l l 11 Lz fe 1 V

oKaia LiKur Penelitian Ukur Ukur

Infeksi P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Saiuran d i d i a g n o s a o l e h m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Keniih d o k t e r m e n g a l a m i m e d i s

i n f e k s i s a i u r a n

k e m i h d a n t e r c a n t u m

d i r e k a m m e d i s

U s i a L a m a n y a t a h u n R e k a m O b s e r v a s i 1 lt 5 0 t a h u n O r d i n a l

k e h i d u p a n p a s i e n m e d i s r e k a m 2 gt 5 0 t a l i u n ( k a t e g o r i k )

d a r i l a h i r s a m p a i m e d i s

s e k a r a n g d a n

t e r c a n t u m d i r e k a m

m e d i s

Jenis P r o f i l a n a t o m i a t a u R e k a m O b s e r v a s i 1- L a k i - l a k i N o m i n a l

Keiamin b i o l o g i s p a s i e n y a n g m e d i s r e k a m 2 P e r e m p u a n ( k a t e g o r i k )

d i b e d a k a n m e n j a d i m e d i s

i a k i - l a k i d a n

n e r e m m i a n s e r t a

t e r c a n t u m d i r e k a m

m e d i s

Tingkat P e n d i d i k a n f o n n a l R e k a m O b s e r v a s i 1 P e n d i d i k a n O r d i n a l

Pendidikan t e r a k h i r y a n g m e d i s r e k a m d a s a r ( S D ( k a t e g o r i k )

d i t e m p u h o l e h m e d i s M I S M P

p a s i e n d a n t e r c a n t u m d a n M T s )

d i r e k a m m e d i s 2 P e n d i d i k a n

m e n e n g a l i

d a n t i n g g i

22

( S M A M A

S M K

M A K

d i p l o m a

s a r j a n a

m a g i St e r

s p e s i a l i s

d a n d o k t o r )

Riwayat P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Diabetes d i d i a g n o s i s d e n g a n m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Melitus d i a b e t e s m e l i t u s d a n

t e r c a n t u m d i d a l a m

r e k a m m e d i s

m e d i s

36 Cara Pengumpulan Data

361 Data Sekunder

P e n g u m p u l a n d a t a p a d a p e n e l i t i a n i n i d i p e r o l e h d a r i d a t a s e k u n d e r y a i t u

r e k a m m e d i s p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

37 Metode Teknik Analisis Data

371Cara Pengolahan dan Analisis Data

P e n g o l a h a n d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n m e l a l u i e m p a t t a h a p y a i t u

i Oala Entry

P a d a t a i i a p i n i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n riwayat d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g y a n g t e l a h d i d a p a t d a n

r e k a m m e d i s d i k u m p u l k a n d a n d i m a s u k k a n k e d a l a m p r o g r a m spss

23

2 Editing

P a d a t a h a p i n i d a t a i i s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n y a n g t e l a h d i m a s u k k a n k e d a l a m p r o g r a m s p s s

d i p e r i k s a k e m b a l i a p a k a h s u d a h l e n g k a p d a n t i d a k a d a k e k e l i r u a n

3 ( oding

S e t e l a h m e l a l u i p r o s e s editing d a t a - d a t a t e r s e b u t d i b e r i k o d e t e r t e n t u a n t a r a

l a i n k o d e 1 u n t u k u s i a gt 5 0 t a h u n j e n i s k e i a m i n p e r e m p u a n t i n g k a t

p e n d i d i k a n d a s a r t e r d a p a t r i w a y a t d i a b e t e s m e l i t u s d a n i n f e k s i s a i u r a n

k e m i h s e d a n g k a n k o d e 2 u n t u k u s i a lt 5 0 t a h u n j e n i s k e i a m i n l a k i - l a k i

t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i t i d a k t e r d a p a t r i w a y a t d i a b e t e s

m e l i t u s d a n b u k a n i n f e k s i s a i u r a n k e m i h s e h i n g g a m e m u d a h k a n d a l a m

m e l a k u k a n a n a l i s i s d a t a

4 Tahulaling

P a d a t a h a p i n i d a t a y a n g s a m a d i k e l o m p o k k a n s e c a r a t e l i t i d a n t e r a t m

k e m u d i a n d i l i i t u n g d e n g a n m e n g g u n a k a n p r o g r a m sps s d a n d i j u m l a h k a i i

l a l u d i s a j i k a n d a l a m b e n t u k t a b e l - t a b e l

U n t u k m e n g a n a l i s i s d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n a n a l i s i s d a t a

u n i v a r i a t d a n b i v a r i a t d e n g a n m e n g g u n a k a n p r o g r a m s p s s s e b a g a i b e r i k u t

A A n a l i s i s u n i v a r i a t

A n a l i s i s u n i v a r i a t d i l a k u k a n d e n g a n c a r a m e l a k u k a n a n a l i s i s p a d a s e t i a p

v a r i a b e l h a s i l p e n e l i t i a n d e n g a n t u j u a n u n t u k m e n g e t a h u i d i s t r i b u s i p r o p o r s i p a d a

s e t i a p v a r i a b e l p e n e l i t i a n D a t a d i s a j i k a n d a l a m b e n t u k t a b e l d a n n a r a s i

B A n a l i s i s b i v a r i a t

A n a l i s i s b i v a r i a t d i l a k u k a n d e n g a n m e n g g u n a k a n u j i h i p o t e s i s chi-square

U j i h i p o t e s i s chi-square d a p a t d i g u n a k a n d e n g a n s y a r a t y a i t u lt 2 0 s e l y a n g

m e m p u n y a i n i l a i expected count k u r a n g d a r i l i m a s e h i n g g a j i k a t i d a k m e m e n u h i

s y a r a t u j i chi-square m a k a u j i y a n g d i g u n a k a n a d a i a h u] fisher ( D a h l a n 2 0 1 4 )

B a t a s k e m a k n a a n y a n g d i g u n a k a n a d a i a h a = 0 0 5 J i k a d i d a p a t k a n p value lt 0 0 5

p a d a u j i s t a t i s t i k m a k a t i d a k t e r d a p a t h u b u n g a n y a n g b e n n a k n a a n t a r a d u a

v a r i a b e l y a n g d i t e l i t i d a n H O d i t e r i m a S e d a n g k a n j i k a d i d a p a t k a n p value gt 0 0 5

24

p a d a u j i s t a t i s t i k m a k a t e r d a p a t l i u b u n g a n y a n g b e n n a k n a a n t a r a d u a v a r i a b e l

y a n g d i t e l i t i d a n H O d i t o l a k

38 Alur Penelitian

P e n e n t u a n p o p u l a s i d a n s a m p e l p e n e l i t i a n

K r i t e r i a i n k l u s i K r i t e r i a e k s k l u s i

P e n g a m b i l a n s a m p e l p e n e l i t i a n

P e n g o l a h a n d a n a n a l i s i s d a t a d e n g a n u j i chi-square

H a s i l d a n p e m b a h a s a n

K e s i m p u l a n d a n s a r a n

Gambar 31 Alur Penelitian Hubungan Usia Jenis Keiamin Tingkat Pendidikan dan Riwayat Diabetes Melitus dengan Kejadian Infeksi Saiuran Kemih pada Pasien Rawat Inap di Bagian Penyakit Dalam Rumah Sakit Muhammadiyah Palembang Periode 1 Januari 2015 sampai dengan 31 Desember 2015

BAB IV

HASIL DAN PEMBAHASAN

41 Hasil

P e n e l i t i a n i n i t e l a h d i l a k u k a n d i r u a n g r e k a m m e d i s R u m a h S a k i t

M u h a i m n a d i y a h P a l e m b a n g d a r i t a n g g a l 1 O k t o b e r 2 0 1 5 - 3 1 O k t o b e r 2 0 1 6

P e n e l i t i a n d i m u l a i d e n g a n p e n g a m b i l a n d a t a a w a l b e m p a d a t a r e k a m m e d i s

s e l u r u h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

S e l a n j u t n y a r e k a m m e d i s d i p i l i h s e s u a i d e n g a n k r i t e r i a i n k l u s i d a n e k s k l u s i u n t u k

d i j a d i k a n s a m p e l p e n e l i t i a n s a m p a i m i n i m a l b e s a r s a m p e l y a n g d i b u t u h k a n

t e r p e n u h i s e r t a d i l a k u k a n p e n e l i t i a n s e c a r a o b s e r v a s i o n a i O b s e r v a s i r e k a m m e d i s

d i l a k u k a n u n m k m e n g e t a h u i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t

d i a b e t e s m e l i t u s d a n d i a g n o s a p a s i e n

D a r i c a t a t a n r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g

d i d a p a t k a n s e b a n y a k 4 1 4 1 r e k a m m e d i s p a s i e n r a w a t i n a p d a n 1 4 5 3 r e k a m m e d i s

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 D a r i t o t a l r e k a m m e d i s

p a s i e n r a w a t i n a p d a n r a w a t j a l a n t e r s e b u t p e n e l i t i h a n y a m e n g a m b i l m i n i m a l

b e s a r s a m p e l y a n g d i b u t u h k a n y a i t u s e b a n y a k 9 8 r e k a m m e d i s u n t u k d i j a d i k a n

s a m p e l p e n e l i t i a n y a n g t e r d i r i d a r i 3 0 r e k a m m e d i s p a s i e n y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i h d a n 6 8 r e k a m m e d i s y a n g t i d a k m e n g a l a m i i n f e k s i s a i u r a n k e m i h

411 Hasil Analisis Univariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s u n i v a r i a t

a n t a r a l a i n d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p b e r d a s a r k a n u s i a d a n

j e n i s k e l a m m d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n b e r d a s a r k a n u s i a

d a n j e n i s k e i a m i n d i s t r i b u s i p r o p o r s i s a m p e l b e r d a s a r k a n k e j a d i a n m f e k s i s a i u r a n

k e m i h s e r t a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n u s i a

j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

25

26

A Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan IJsta

dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 41 Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan

Usia dan Jenis Keiamin

Paisen Rawat Inap N Persentase

Usia

1 7 - 2 5 t a h u n 678 1 6 4

2 6 - 3 5 t a h u n 952 2 3 0

3 6 - 4 5 t a l i u n 745 18 0

4 6 - 5 5 t a h u n 695 1 6 8

5 6 - 6 4 t a h u n 571 1 3 8

gt 6 4 t a h u n 500 1 2 1

U s i a r a t a - r a t a ( t a h u n j 43plusmn16543

Jenis Keiamin

P e r e m p u a n 2 6 3 8 6 3 7

L a k i - l a k i 1 5 0 3 3 6 3

Total 4141 100

B e r d a s a r k a n t a b e l 4 1 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R i u n a h S a k i t M u l i a m m a d i y a l i

P a l e m b a n g p e r i o d e J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 2 6 - 3 5 t a h u n y a i t u

s e b a n y a k 9 5 2 o r a n g ( 2 3 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 43plusmn16543 t a l i u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 2 6 3 8 o r a n g ( 6 3 7 )

27

B Distribusi Proporsi Karakteristik Pasien Rawat Jalan Berdasarkan

Usia dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 42 Distribusi Proporsi Karakteristik Pasien Rawat Jalan

Berdasarkan Usia dan Jenis Keiamin

Fasten Rawat Jalan N Persentase

Usia

1 7 - 2 5 t a h u n 9 2 6 3

2 6 - 3 5 t a l n i n 1 3 1 9 0

3 6 - 4 5 t a h u n 2 7 9 1 9 2

46-55 t a l i u n 4 2 1 2 9 0

5 6 - 6 4 t a h u n 3 1 6 2 1 7

gt 6 4 t a h u n 2 1 4 1 4 7

U s i a r a t a - r a t a ( t a h u n ) 50plusmn14120

Jenis Keiamin

P e r e m p u a n 8 9 0 6 1 3

L a k i - l a k i 5 6 3 3 8 7

Total 1453 100

B e r d a s a r k a n t a b e l 4 2 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 4 6 - 5 5 t a h u n y a i t u

s e b a n y a k 4 2 1 o r a n g ( 2 9 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 50plusmn14120 t a h u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 8 9 0 o r a n g ( 6 1 3 )

28

C Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Usia

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i b b e r d a s a r k a n u s i a d a p a t

d i i i h a t p a d a l a b e l d i b a w a h i n i

Tabel 43 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Usia

Usia N Persentase

lt 5 0 t a h u n 1 4 4 6 7

gt 5 0 t a l i u n 1 6 5 3 3

Total 30 100

B e r d a s a r k a n t a b e l 4 3 d i a t a s d a p a t d i k e t a h u i b a h w a u s i a t e r b a n y a k p a d a

s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h gt 5 0 t a h u n y a i t u s e b a n y a k

1 6 o r a n g ( 5 3 3 )

D Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Jenis

Keiamin

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n j e n i s

k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 44 Distribusi Proporsi Kejadian infeksi Saiuran Kemih Berdasarkan

Jenis Keiamin

Jenis Keiamin N Persentase

P e r e m p u a n 1 8 6 0 0

L a k i - l a k i 1 2 4 0 0

Total 30 100

B e r d a s a r k a n t a b e l 4 4 d i a t a s d a p a t d i k e t a h u i b a h w a j e n i s k e i a m i n

t e r b a n y a k p a d a s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h p e r e m p u a n

y a i t u s e b a n y a k 1 8 o r a n g ( 6 0 0 )

29

E Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n t i n g k a t

p e n d i d i k a n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 45 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

Tingkat Pendidikan N Persentase

P e n d i d i k a n d a s a r 20 6 6 7

P e n d i d i k a n m e n e n g a h d a n P e n d i d i k a n m e n e n g a h d a n 10 333

t i n g g i

Total J O 100

B e r d a s a r k a n t a b e l 4 5 d i a t a s d a p a t d i k e t a l i u i b a l i w a t i n g k a t p e n d i d i k a n

t e r b a n y a k p a d a s a m p e i y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h t i n g k a t

p e n d i d i k a n d a s a r y a i t u s e b a n y a k 20 o r a n g ( 6 6 7 )

P Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n riwayat

d i a b e t e s m e l i t u s d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 46 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

Riwayat Diabetes Melitus N Persentase

Y a 17 5 6 7

T i d a k 13 433

Total 30 100

B e r d a s a r k a n t a b e l 4 6 d i a t a s d a p a t d i k e t a h u i b a l i w a s a m p e l y a n g

m e n g a l a m i i n f e k s i s a i u r a n k e m i h t e r b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s

y a i t u s e b a n y a k 1 7 o r a n g ( 5 6 7 )

30

412 Hasil Analisis Bivariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s b i v a r i a t

a n t a r a I a i n h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h j e n i s

k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h t i n g k a t p e n d i d i k a n d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n

i n f e k s i s a l m a n k e m i h

A n a l i s i s y a n g d i g u n a k a n p a d a u j i d u a v a r i a b e l y a n g b e r s k a l a k a t e g o r i k

a d a l a l i d e n g a n u j i Chi-Square d e n g a n n i e i h a t n i l a i Pearson Chi-Square S e m u a

h a s i l d a r i u j i h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h m e n g g i u i a k a n u j i Chi-

Square k a i e n a m e m e n u h i s y a r a t u j i Chi-Square y a i t u lt 2 0 s e l y a n g m e m p u n y a i

n i l a i expected count lt 5

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 47 Hasil Uji Hubungan antara Usia dengan Kejadian Infeksi

Saiuran Kemih

Usia

Infeksi Saiuran Kemih

^a Tidak

n N Mgt

Jumlah P

value 95Cl

lt 50 t a h u n 1 4 1 9 2 5 9 8 0 8 7 3 0 0 0 0 2 7 4 7 - 2 0 4 3 1

gt 5 0 t a h u n 1 6 6 4 0 9 3 6 0 2 5

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 7 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R = 7 4 9 2

( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a u s i a gt

5 0 t a h u n a d a l a l i 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a u s i a lt 5 0 t a h u n

31

B Hubungan antara Jenis Keiamin dengan Kejadian Infeksi Saiuran

Kemih

H a s i l a n a l i s i s b i v a r i a t l i u b u n g a n a n t a r a j e n i s k e l a i n i n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

Tabel 48 Hasil Uji Hubungan antara Jenis Keiamin dengan Kejadian

Infeksi Saiuran Kemih

Infeksi Saiuran Kemih Jenis P

A Tidak Jumlah 95CI Keiamin value

N N

P e r e m p u a n 18 6 4 3 10 357laquoo 2 8 3 2 2 7 -P e r e m p u a n 0 0 0 0

L a k i - l a k i 12 1 7 1 5 8 8 2 9 7 0 2 3 4 5 9

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 8 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a l a l i

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k N 4 a k a a d a l i u b u n g a n y a n g s i g n i f i k a n a n t a r a

j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R ) = 8 7 0 0

f 9 5 C I = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a l a k i - l a k i

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e n i i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

32

Tabel 49 Hasil liji Hubungan antara Tingkat Pendidikan dengan

Kejadian Infeksi Saiuran Kemih

Infeksi Saiuran Kemih P

Y a T i d a k jumlah 95CI value

N

P e n d i d i k a n d a s a r 2 0 5 4 1 1 7 4 5 9 3 7

P e n d i d i k a n

m e n e n g a h d a n 10 1 6 4 5 1 8 3 6 6 1

t i n g g i

Jumlah JO 30 6 68 694 9H

B e r d a s a r k a n t a b e l 4 9 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( 0 R ) =

6 0 0 0 ( 9 5 C I = 2 3 5 1 - 1 5 3 1 0 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r a d a i a h 6 k a l i l e b i h b e s a r

d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i h a t

p a d a t a b e l d i b a w a h i n i

Tingkat

Pendidikan

2 3 5 1 -0 0 0 0

1 5 3 1 0

33

Tabel 4t0 Hasil I j i Hubungan antara Riwayat Diabetes Melitus dengan

Kejadian Infeksi Saiuran Kemih

Riwayat Infeksi Saiuran Kemih P

Diabetes Va Tidak Jumlah value

95CI

Melitus N bullVJ N

Y a

T i d a k

17

1 3

6 8 0

1 7 8

8

6 0

3 2 0

8 2 2

2 5

7 3 0 0 0 0

3 4 9 3 -

2 7 5 3 6

Jumlah 30 306 68 571 98

B e r d a s a r k a n t a b e l 4 1 0 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio

( O R ) = 9 8 0 8 ( 9 5 C I - 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r

d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s m e l i m s

42 Pembahasan

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a l a b e l 4 7 d i d a p a t k a n b a l i w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i b d e n g a n n i l a i s i g n i f i k a n n y a a d a l a l i 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k

Odds Ratio ( O R ) = 7 4 9 2 ( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a u s i a T 5 0 t a h u n a d a i a h 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a

u s i a lt 5 0 t a h u n

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n A n d r y L u k a n d y

( 2 0 1 4 ) m e n g e n a i k a r a k t e r i s t i k p a s i e n - p a s i e n i n f e k s i s a i u r a n k e m i h d i m a n a

p e n d e r i t a I S K d e n g a n k e l o m p o k u m u r gt 5 0 t a h u n s e b a n y a k 2 3 o r a n g s e d a n g k a n

j u m l a h p e n d e r i t a I S K d e n g a n k e l o m p o k u m m lt 5 0 t a l i u n s e b a n y a k 2 0 o r a n g

P e n e l i t i a n i n i j u g a d i p e i k u a t o l e h p e n l i t i a n L e w i s A l e t a l ( 2 0 1 4 ) m e n g e n a i

impact of host age and parity on susceptihility to severe urinary tract injection in

34

a murine mode d e n g a n u j i K r u s k a l - W a l l i s d e n g a n post-test D u n n u n t u k b e b e r a p a

p e r b a n d i n g a n d i m a n a u s i a d a n p a r i t a s s e b a g a i f a k t o r y a n g b e r k o n t r i b u s i d a l a m

k e r e n t a n a n i m t u k t e r j a d i n y a I S K d e n g a n n i l a i p lt 0 0 5

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n g a t a k a n b a h w a i n s i d e n I S K m e n i n g k a t

b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n

a d a n y a a b n o r m a l i t a s a n a t o m i y a n g m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n

k e m i h s e p e r t i p e m b e s a r a n p r o s t a t d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a

p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e ( R o s e 2 0 0 9 ) P e n y e b a b l a i n t e n n a s u k

p e r i n e i u n y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s p e n y a k i t n e u r o m u s k u l a r

d a n k a t e t e r i s a s i b u l i - b u l i ( F o x m a n e t a l 2 0 1 0 ) S e l a i n i t u i n s i d e n I S K m e n c a p a i

1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o n a l d 2 0 1 1 )

B Hubungan antara Jenis Keiamin dengan Kejadian infeksi Saiuran

Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 8 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d e n g a n n i l a i s i g n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O

d i t o l a k Odds Ratio ( O R ) = 8 7 0 0 ( 9 5 C l = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a risiko k e j a d i a n

i n f e k s i s a i u r a n k e m i h p a d a p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n

p a d a l a k i - i a k i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n M a g i i a n o e t a l

( 2 0 1 1 ) m e n g e n a i Gender and Age-Dependent Etiology of Community Acquired

y a n g m e l a k u k a n p e n g a m b i l a n 6 1 2 7 3 s a m p e l k u l t u r u r i n d a l a m p e r i o d e 2 2 b u l a n

d a r i s a m p e l i n i d i d a p a t k a n 1 3 8 2 0 ( 2 2 6 ) d i t e m u k a n p o s i t i f i n f e k s i b a k t e r i

h a m p i r 8 0 b a l i a n y a n g d i i s o l a s i b e r a s a l d a r i p e r e m p u a n P e n e l i t i a n i n i j u g a

d i p e r k u a t o l e h p e n e l i t i a n y a n g d i l a k u k a n o l e h Y u n i t a I ( 2 0 1 0 ) d i m a n a a d a

h u b m i g a n y a n g b e n n a k n a a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h ( P value=O049 R P = 3 2 7 3 ( 9 5 C I = I 0 1 6 - 1 0 5 4 0 )

H a l t e r s e b u t d a p a t t e r j a d i k a r e n a u r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a l i

d e n g a n d e k a t n y a v a g i n a l v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i

s a i u r a n k e m i h l e b i h s e r i n g p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a flora n o r m a l

3 5

p a d a d a e r a h p e r i u r e t r a t e r d i r i d a r i o r g a n i s m e s e p e r t i i a c t o b a c i l l u s y a n g m e m b a n t u

m e l a w a n k o l o n i s a s i b a k t e r i p a t o g e n p a d a s a i u r a n k e m i h P e r u b a h a n l i n g k i m g a n

d a r i p e r i u r e t r a l s e p e r t i p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k

b i s a m e n g g a n g g u f l o r a n o r m a l s e h i n g g a m e n u m g k i n k a n b a k t e r i p a t o g e n

b e r k o l o n i s a s i d a n m e n y e b a b k a n i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Scuare p a d a t a b e l 4 9 d i d a p a t k a n b a h w a

t e r d a p a t l i u b u n g a n y a n g s i g n i f i k a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a

H O d i t o l a k Odds Ratio ( O R ) - 6 0 0 0 ( 9 5 o C l = 2 3 5 1 - 1 5 3 I O ) a r t i n y a n s i k o

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r

a d a i a h 6 k a l i l e b i h b e s a r d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n

m e n e n g a h d a n t i n g g i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h T o r o n d e i B e t

a l ( 2 0 1 5 ) m e n g e n a i Menstrual Hygiene Practices WASH Access and the Risk of

Urogenital Infection in Women from Odisha India d i m a n a p e r e m p u a n y a n g

h a n y a m e n e m p u l i p e n d i d i k a n s e k o l a h d a s a r a t a u l e b i h r e n d a h d i b a n d i n g k a n

d e n g a n t i n g k a t p e n d i d i k a n m e n e n g a h a t a u t i n g g i m e m i l i k i r i s i k o 3 k a l i

k e m u n g k i n a n l e b i h b e s a r m e n g a l a m i i n f e k s i s a i u r a n k e m i h ( A d j O R = 3 l 9 5

C 1 = I 2 - 7 9 p = 0 0 2 )

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a p e n g e t a h u a n s e s e o r a n g

t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t p e n d i d i k a n S e s e o r a n g y a n g

m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m u n g k i n a n p e n g e t a l i u a n t e n t a n g

k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o r m a s i y a n g d i d a p a t k a n t e n t a n g k e s e h a t a n

l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h S e b a l i k n y a

p e n d i d i k a n y a n g k u r a n g d a p a t i n e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g t e r h a d a p

n i l a i - n i l a i y a n g b a r u d i k e n a l ( N o t o a d m o j o 2 0 0 3 )

3 6

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Keniih

B e r d a s a r k a n l i a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 1 0 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a r i w a y a t d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 )

s e h i n g g a H O d i t o l a k Odds Ratio ( O R ) = 9 8 0 8 ( 9 5 C I = 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a

risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h S a r i E W P d a n

S a t y a b a k t i P ( 2 0 1 5 ) m e n g e n a i p e r b e d a a n risiko i n f e k s i n o s o k o m i a l s a i u r a n k e m i h

b e r d a s a r k a n k a t e t e r i s a s i u r i n u m u r d a n d i a b e t e s m e l i m s d i m a n a d a r i 2 0 p a s i e n

i n f e k s i n o s o k o m i a l s a i u r a n k e m i h 1 2 o r a n g ( 6 0 ) d i a n t a r a n y a a d a i a h p a s i e n

d e n g a n s t a t u s D M s e d a n g k a n 8 o r a n g ( 4 0 ) l a i n n y a a d a i a h p a s i e n t a n p a s t a t u s

D M ( P v W w ^ = 0 0 2 4 O R = 6 0 0 9 5 C I = 1 2 2 - 3 2 2 6

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a b a l i w a b e b e r a p a b a g i a n

d a r i i i n u n i t a s p a d a p a s i e n d i a b e t e s m e n g a l a m i p e r u b a h a n F u n g s i

p o l i n i o r f o l e u k o s i t d i t e k a n p a d a k e a d a a n a s i d o s i s I k a t a n l e u k o s i t k e m o t a k s i s d a n

f a g o s i t o s i s j u g a b e m b a l i S i s t e m a n t i o k s i d a n y a n g b e r p e r a n p a d a a k t i f i t a s

b a k t e r i s i d a l j u g a t e r g a n g g u s e h i n g g a m e n y e b a b k a n t e r j a d i n y a I S K p a d a p a s i e n -

p a s i e n d e n g a n p e n y a k i t d i a b e t e s ( J u l k a 2 0 1 4 )

H a l y a n g s a m a j u g a d i i m g k a p k a n o l e b t e o r i S m e l t z e r d a n B a r e ( 2 0 1 0 )

b a l i w a D M d a p a t m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a l i a n a n t u b u h y a n g

b e r p o t e n s i m e n i n g k a t k a n r i s i k o t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a l i a n a n

t u b u h t e r s e b u t d i a n t a r a n y a a d a i a h k e g a g a l a n m i g r a s i s e l iniraceliular killing

f a g o s i t o s i s d a n k e m o t a k s i s p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n

m e k a n i s m e p e r t a l i a n a n a l a m i a h I o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p

i n f e k s i

BAB V

KESIMPULAN DAN SARAN

51 Kesimpulan

1 U s i a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 2 6 - 3 5 t a h u n y a i t u 2 3 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 3 7

2 U s i a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 4 6 - 5 5 t a l i u n y a i t u 2 9 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 1 3

3 U s i a j e n i s k e i a m i n d a n t i n g k a t p e n d i d i k a n s a m p e i y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i l i t e r b a n y a k y a i t u b e r u s i a gt 5 0 t a h u n ( 5 3 3 ) j e n i s k e i a m i n

p e r e m p u a n ( 6 0 0 ) d a n t i n g k a t p e n d i d i k a n d a s a r ( 6 6 7 ) s e r t a p a l i n g

b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s y a i t u 5 6 7

4 T e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 ( p = 0 0 0 0 )

52 Saran

1 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t d i l a k u k a n d e n g a n d e s a i n

p e n e l i t i a n b e r b e d a s e p e r t i cohort a t a u case control

2 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t m e i i c a r i v a r i a b e l independent

y a n g l a i n s e p e r t i v a r i a b e l p e k e r j a a n p e m a s a i i g a n k a t e t e r a t a u l a m a n y a

m e n d e r i t a d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

37

DAFTAR PUSTAKA

B o y k o E J d k k 2 0 0 2 D i a b e t i c A n d T h e R i s k O f A c u t e U r i n a r y T r a c t I n f e c t i o n A m o n g P o s t m e n o p a u s a l W o m e n D i a b e t e s C a r e 2 5 ( 1 0 )

D a h l a n S 2 0 1 4 B u k i i S t a t i s t i k u n t u k K e d o k t e r a n d a n K e s e h a t a n D e s k r i p t i f B i v a r i a t d a n M u l t i v a r i a t d i l e n g k a p i a p l i k a s i d e n g a n m e n g g u n a k a n S P S S E d i s i 6 E p i d e m i o l o g i I n d o n e s i a J a k a r t a I n d o n e s i a

D e p a r t e m e n K e s e h a t a n ( D E P K E S ) R l 2 0 1 4 [ O n l i n e ] K e m e n t e r i a n K e s e h a t a n R e p u b l i k I n d o n e s i a P u s a t D a t a d a n I n f o r m a s i K e m e n t e r a n K e s e h a t a n R l ( http 7depkesgoid diakses tanggal 15 Met 2016)

F o x m a n B e t a i 2 0 1 0 U r i i i a i y T r a c t I n f e c t i o n A m o n g W o m e n A g e d 4 0 T o 6 5 B e h a v i o r a l A n d S e x u a l R i s k F a c t o r s D a l a m T a n a g h o E A M c A n i n c h J W 1 7 t h S m i t h s G e n e r a l U r o l o g y U S A M c G r a w H i l l (http searchproqnestcom diakses tanggal 16 Met 2016)

H a r d i n g G K d k k 2 0 1 0 A n t i m i c r o b i a l T r e a t m e n t I n D i a b e t i c W o m e n W i t l i A s y m t o m a t i c B a c t e r i u r i a N E n g l J M e d 3 4 7 1 5 7 6 - 1 5 8 3 (http nejmorg diakses tanggal 16 Met 2016)

I s s e l b a c h e r d k k 2 0 0 9 I n f e k s i S a i u r a n K e m i h d a n P i e l o n e f r i t i s D a l a m S t a m m W a l t e r E e d H a r r i s o n P r i n s i p - P r i n s i p l l m u P e n y a k i t D a l a m e d V o l u m e 2 J a k a r t a E G C 6 1 6 - 6 2 3

J u l k a S 2 0 1 3 G e n i t o u r i n a r y I n f e c t i o n I n D i a b e t e s I n d i a n J o u m a l o f E n d o c r i n o l o g y a n d M e t a b o l i s m (http searchproquestcom diakses tanggal 16 Mei 2016)

K i m B d k k 2 0 1 2 [ e - b o o k ] T h e R e l a t i o n b e t w e e n P o s t v o i d R e s i d u a l a n d O c c u r r e n c e o f U r i n a r y T r a c t I n f e c t i o n a f t e r S t r o k e i n R e h a b i l i t a t i o n U n i t A n n a l s o f R e h a b i l i t a t i o n M e d i c i n e

K o m a r a A 2 0 0 9 P o l a K e p e k a a n B a k t e r i G r a m N e g a t i f d a r i P a s i e n I n f e k s i S a i u r a n K e m i l i t e r h a d a p A n t i b i o t i k G e n t a m i c i n d a n K o t r i m o k s a z o l y a n g D i k i r i m k e L a b o r a t o r i u m M i k r o b i o l o g i K l i n i k F K U l d a r i T a h u n 2 0 0 1 s a m p a i T a h u n 2 0 0 5 (http dontaruiacid diakses tanggal OH Agustiis 2016)

L e w i s A L e t a l 2 0 1 4 I m p a c t o f H o s t A g e a n d P a r i t y o n S u s c e p t i b i l i t y t o S e v e r e U r i n a r y T r a c t I n f e c t i o n i n a M u r i n e M o d e l P l o s O n e R e s e a r c h A r t i c l e P u b l i c L i b r a r y o f S c i e n c e 9 ( 5 ) (http searchproquestcom diakses pada langgal 30 Desember 2016)

38

KATA PENGANTAR

S e g a l a p u j i s y u k u r k e p a d a A l l a l i S W T k a r e n a a t a s b e r k a t d a n r a h m a t - N y a p e n u l i s d a p a t i n e n y e l e s a i k a n s k r i p s i y a n g b e r j u d u l H u b u n g a n A n t a r a U s i a J e n i s K e i a m i n T i n g k a t P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h P a d a P a s i e n R a w a t i n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 S k r i p s i i n i d i s u s u n s e b a g a i s a l a h s a t u s y a r a t u n t u k m e m p e r o l e h g e l a r S a r j a n a K e d o k t e r a n d i F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u l i a m m a d i y a h P a l e m b a n g

P e n u l i s m c n y a d a r i b a l i w a d a l a m p r o s e s i n e n y e l e s a i k a n s k r i p s i i n i b a n y a k k e n d a l a y a n g d i a l a i n i n a n i u n b e r k a t b a n t u a n b i m b i n g a n k e r j a s a m a d a r i b c r b a g a i p i h a k d a n t e r u t a m a b e r k a t A l l a h S W T k e n d a l a t e r s e b u t d a p a t d i a t a s i

P e n u l i s j u g a m e n v a d a r i b a h w a s k r i p s i i n i m a s i h j a u h d a r i s e m p u m a m a k a d e n g a n s e g a l a k e r e n d a h a n l i a t i p e n u l i s m e n g l i a r a p k a n a d a n y a k r i t i k d a n s a r a n y a n g b e r s i f a t m e m b a n g u n d e m i k e s e m p u m a a n s k r i p s i i n i

A k h i r k a t a p e n u l i s b c r l i a r a p A l l a l i S W T b e r k e n a n m e m b a i a s s e g a l a k e b a i k a n s e m u a p i h a k y a n g t e l a h m e m b a n t u S e m o g a s k r i p s i i n i d a p a t b e n n a n f a a t b a g i k i t a s e m u a A a m i i n

P a l e m b a n g 0 7 F e b r u a r i 2 0 1 7

R e z a A g u s t i a n t w o P u t r a

vii

DAFTAR ISI

HALAMAN J D D U L HALAMAN PENCESAHAN i HALAMAN PERNN ATAAN ii HALAMAN PERSEMBAHAN iii A B S T R A K iv A B S T R A C T v K A T A PENGANTAR vi DAFTAR ISI vii DAFTAR T A B E I ix DAFTAR GAMBAR x DAFTAR LAMPIRAN xi

BAB I Pendahuluan 1 1 1 L a t a r B e l a k a n g 1 12 R i i m u s a n M a s a l a h 3 13 T u j u a n P e n e l i t i a n 3 14 M a n l a a t P e n e l i t i a n 4 15 K e a s l i a n P e n e l i t i a n 5

BAB H Tinjauan Pustaka 9 2 1 L a n d a s a n T e o r i 9

2 1 1 I n f e k s i S a i u r a n K e m i h 9 A D e f i n i s i 9 B E p i d e m i o l o g i 9 C K i a s i f i k a s i 1 0 D E t i o l o g i 1 1 E P a t o f i s i o l o g i 11 F F a k t o r R i s i k o 1 2 G M a n i f e s t a s i K l i n i s 1 5 H T a t a l a k s a n a 1 6 I K o m p l i k a s i 1 6

2 2 K e r a n g k a T e o r i 1 7 2 3 H i p o t e s i s 1 8

BAB I I I Metode Penelitian 19 3 1 J e n i s P e n e l i t i a n 1 9 3 2 W a k t u d a n T e m p a t P e n e l i t i a n 1 9 3 3 P o p u l a s i d a n S a m p e l 1 9

3 3 1 P o p u l a s i P e n e l i t i a n 1 9 3 3 2 S a m p e l d a n B e s a r S a m p e l P e n e l i t i a n 1 9 3 3 3 K n t e r i a I n k l u s i d a n E k s k l u s i 2 0 3 3 4 C a r a P e n g a m b i l a n S a m p e l P e n e l i t i a n 2 0

3 4 V a r i a b e l P e n e l i t i a n 2 0 3 4 1 V a r i a b e l Dependent 2 0 3 4 2 V a r i a b e l Independent 2 0

viii

3 5 D e f i n i s i O p e r a s i o n a l 2 1 3 6 C a r a P e n g i i n i p u l a n D a t a 2 2

3 6 1 D a t a S e k u n d e r 2 2 3 7 M e t o d e T e k n i s A n a l i s i s D a t a 2 2

3 7 C a r a P e n g o l a h a n d a n A n a l i s i s D a t a 2 2 3 8 A l u r P e n e l i t i a n 2 4

BAB IV HASIL DAN PEMBAHASAN 25 4 1 H a s i l 2 5 4 2 P e m b a h a s a n 3 3

BAB V KESIMPLILAN DAN SARAN 37 5 1 K e s i m p u l a n 3 7 5 2 S a r a n 3 7

D A F T A R PUSTAKA 38 LAMPIRAN 41 BIODATA 63

ix

DAFTAR T A B E L

Tabel Halaman

T a b e l 1 1 K e a s l i a n P e n e l i t i a n 5 T a b e l 3 1 D e f i n i s i O p e r a s i o n a l 2 1 T a b e l 4 1 D i s t r i b u s i P r o p o r s i K a r a k t e r i s t i k P a s i e n R a w a t i n a p

B e r d a s a r k a n U s i a d a n J e n i s K e i a m i n 2 6 T a b e l 4 2 D i s t r i b u s i P r o p o r s i K a r a k t e r i s t i k P a s i e n R a w a t J a l a n

B e r d a s a r k a n U s i a d a n J e n i s K e i a m i n 2 7 T a b e l 4 3 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n U s i a 2 8 T a b e l 4 4 D i s t r i b u s i P r o p o r s i K e j a d i a n i n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n J e n i s K e l a m m 2 8 T a b e l 4 5 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n T i n g k a t P e n d i d i k a n 2 9 T a b e l 4 6 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n R i w a y a t D i a b e t e s M e l i t u s 2 9 T a b e l 4 7 H a s i l U j i H u b u n g a n a n t a r a U s i a d e n g a n K e j a d i a n

i n f e k s i S a i u r a n K e m i h 3 0 T a b e l 4 8 H a s i i U j i H u b u n g a n a n t a r a J e n i s K e i a m i n d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i b 3 1 T a b e l 4 9 H a s i l U j i H u b u n g a n a n t a r a T i n g k a t P e n d i d i k a n d e n g a n

K e j a d i a n i n t e k s i S a i u r a n K e m i h 3 2 T a b e l 4 1 0 H a s i l U j i H u b u n g a n a n t a r a R i w a y a t D i a b e t e s M e l i t u s

d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h 3 3

X

DAFTAR GAMBAR

Gambar Halaman

G a m b a r 3 1 A l u r P e n e l i t i a n H u b u n g a n U s i a J e n i s K e i a m i n T i n g k a t

P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i h p a d a P a s i e n R a w a t i n a p

d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g I e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1

D e s e m b e r 2 0 1 5 2 4

xi

DAFTAR LAMPIRAN

Lampiran Halaman

L a m p i r a n 1 D a t a R e k a m M e d i s P a s i e n R a w a t I n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 4 3

L a m p i r a n 2 H a s i l A n a l i s i s U n v i a r i a t 4 5

L a m p i r a n 3 H a s i l A n a l i s i s B i v a r i a t 5 1

L a m p i r a n 4 K a r t u B i m b i n g a n P r o p o s a l S k r i p s i 5 8

L a m p i r a n 5 K a r t u B i m b i n g a n S k r i p s i 5 9

L a m p i r a n 6 S u r a t P e n n o h o n a n I z i n P e n e l i t i a n 6 0

L a m p i r a n 7 S u r a t K e t e r a n g a n I z i n P e n g a m b i l a n D a t a d a n P e n e l i t i a n 6 1

L a m p i r a n 8 S u r a t K e t e r a n g a n S e l e s a i P e n e l i t i a n 6 2

xii

BAB I

PENDAHULUAN

11 Latar Belakang

I n f e k s i s a i u r a n k e m i h ( I S K ) m e n i p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m i i k a n d i R u m a h S a k i t a t a u t e m p a t p r a k t i k u m u m s e h a r i - h a r i I S K

a d a i a h s u a t u i n f e k s i y a n g m e n g e n a i t r a k t u s u r i n a r i u s m u l a i d a r i m e a t u s u r e t r a

s a m p a i d e n g a n k e g i n j a l S t r u k t u r y a n g t e n n a s u k d i d a l a m n y a a d a i a h u r e t r a

k a n d u n g k e m i h u r e t e r p e l v i s d a n p a r e n k i m g i n j a l S t r u k t u r y a n g b e r k a i t a n u n t u k

t e r j a d i n y a i n f e k s i d a n r e k u r e n i n f e k s i y a i t u p r o s t a t e p i d i d i m i s d a n fascia

perinephric I s t i l a h I S K m e n u n j u k k a n a d a n y a k e b e r a d a a n m i k r o o r g a n i s m e d i

d a l a m u r i n ( S u d o y o 2 0 0 6 R u b i n 2 0 1 0 ) D e n g a n k a t a l a i n b a h w a d i a g n o s i s I S K

d i t e g a k k a n d e n g a n m e m b u k t i k a n a d a n y a m i k r o o r g a n i s m e d i d a l a m s a i u r a n k e m i h

( R u b i n 2 0 1 0 )

S e b a n y a k 2 5 j u t a k e m a t i a n d i s e l u r u h d u n i a p a d a t a h u n 2 0 1 1 s e p e r t i g a n y a

d i s e b a b k a n o l e h p e n y a k i t i n f e k s i I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n i n f e k s i

d e n g a n k e t e r l i b a t a i i b a k t e r i t e r s e r i n g d i k o m u n i t a s d a n h a m p i r 1 0 o r a n g p e m a h

t e r k e n a I S K s e l a m a h i d u p n y a S e k i t a i - 1 5 0 j u t a p e n d i i d u k d i s e l u r u h d u n i a t i a p

t a l i u n n y a t e r d i a g n o s i s m e n d e r i t a i n f e k s i s a i u r a n k e m i h ( Y u n u s 2 0 1 2 )

I S K d a p a t m e n g e n a i s e m u a k e l o m p o k u m u r b a i k a n a k r e m a j a d e w a s a

m a u p u n u s i a l a n j u t P r e v a l e n s i a n a k u s i a s e k o l a h y a n g m e n d e r i t a I S K s e k i t a r 1 -

3 d a n m e n i n g k a t p a d a r e m a j a y a n g s u d a h m e l a k u k a n h u b i m g a n s e k s u a l

( K o m a r a 2 0 0 9 ) D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r 2 5 - 3 5

s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a S e l a m a

p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n c e n d e r u n g

m e n d e r i t a I S K d i b a n d i n g k a n l a k i - l a k i ( S u d o y o 2 0 0 9 )

R a s i o I S K p a d a w a n i t a d i b a n d i n g p r i a b e r k i s a r 3 0 1 d a n s e k i t a r 5 0 w a n i t a

y a n g t e r k e n a i n f e k s i a k a n b e r k e m b a n g m e n j a d i I S K b e m l a n g I S K m e n i p a k a n

i n f e k s i b a k t e r i y a n g p a l i n g s e r i n g p a d a a n a k - a n a k d e n g a n k e l u h a n d e m a m b a i k

p a d a a n a k p r i a m a u p u n w a n i t a P r e v a l e n s i y a n g p e m a h d i l a p o r k a n b e r k i s a r 4 1

I

2

s a m p a i 7 5 R e k u r e n s i c u k u p s e r i n g d a n t e r j a d i s e k i t a r 1 8 p a d a b a y i l a k i - i a k i

d a n 2 6 p a d a b a y i p e r e m p u a n U n t u k u s i a p r a s e k o l a h I S K l e b i h s e r i n g

m e n g e n a i w a n i t a I n s i d e n I S K p a d a a n a k - a n a k p r a s e k o l a h s e k i t a r 2 ( S y a h r i n i

2 0 1 1 )

D a r i b e r b a g a i p e n e l i t i a n e p i d e m i o l o g i s d i I n d o n e s i a d i d a p a t k a n p r e v a l e n s i

D M s e b e s a r 15 - 2 3 p a d a p e n d u d u k u s i a l e b i J i d a r i 1 5 t a h u n b a h k a n p a d a

s u a t u p e n e l i t i a n e p i d e m i o l o g i s d i M a n a d o d i d a p a t k a n p r e v a l e n s i D M a d a i a h 6 1

P r e v a l e n s i d i a b e t e s m e l i t u s p a d a p e n d u d u k u s i a 2 5 - 6 4 t a h u n d i J a w a d a n B a l i

s e b e s a r 7 5 P e n e l i t i a n y a n g d i l a k u k a n d i J a k a r t a S u r a b a y a M a k a s a r d a n k o t a -

k o t a l a i n d i I n d o n e s i a m e m b u k t i k a n a d a n y a k e n a i k a n p r e v a l e n s i d a r i t a h u n

k e t a h u n ( D E P K E S 2 0 1 4 W H O 2 0 1 0 )

I n f e k s i s a i u r a n k e m i h j u g a m e n i p a k a n m a s a l a h k l i n i s u m u m p a d a p e n d e r i t a

D M o l e h k a r e n a p e n d e r i t a D M m e m p u n y a i k e m u n g k i n a n m e n d e r i t a I S K l e b i h

t i n g g i d i b a n d i n g k a n d e n g a n b u k a n p e n d e r i t a D M d a n j u g a m e n d e r i t a i n f e k s i y a n g

l e b i h b e r a t y a n g a k a n m e n i n g k a t k a n risiko u n t u k m a s u k m m a h s a k i t ( H a r d i n g

d k k 2 0 1 0 ) P e n e l i t i a n y a n g d i l a k u k a n o l e h B o y k o d k k m e n d a p a t k a n w a n i t a D M

ripe 2 d e n g a n b a k t e r i u r i a s i m t o m a t i k s e t e l a h d i l a k u k a n p e m a n t a u a n s e l a m a 1 8

b u l a n m e n g a l a m i p e n i n g k a t a n r i s i k o m e n d a p a t k a n I S K s e b a n y a k 3 4

d i b a n d i n g k a n d e n g a n w a n i t a y a n g t i d a k m e n g a l a m i D M s e b e s a r 1 9 ( B o y k o d k k

2 0 0 2 )

B e r d a s a r k a n u r a i a n - u r a i a n d i a t a s s e r t a b e l u m a d a n y a p e n e l i t i a n y a n g

m e n e m u k a n k e t e r k a i t a n f a k t o r u s i a j e n i s k e l a m m t i n g k a t p e n d i d i k a n d a n r i w a y a t

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h d i K o t a P a l e m b a n g m a k a

p e n e l i t i t e r t a r i k i m t i i k m e l a k u k a n p e n e l i t i a n m e n g e n a i h u b u n g a n a n t a r a u s i a j e n i s

k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

3

12 Rumusan Masalah

1 B a g a i m a n a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s

m e l i t u s

2 A p a k a l i a d a h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

13 Tujuan Penelitian

131 Tujuan Umum

T u j u a n u m u m d a r i p e n e l i t i a n i n i a d a i a h d i k e t e m u k a n n y a h u b u n g a n a n t a i a

u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i m s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

132 Tujuan Khusus

T u j u a n k l i u s u s d a r i p e n e l i t i a n i n i y a i t u

1 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a

2 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n m f e k s i s a i u r a n k e m i b p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n j e n i s k e i a m i n

3 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

4

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n t i n g k a t p e n d i d i k a n

4 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n riwayat d i a b e t e s m e l i t u s

5 T e r a n a l i s i s n y a h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a i m n a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

6 T e r a n a l i s i s n y a h u b u n g a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

7 T e r a n a l i s i s n y a h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

8 T e r a n a l i s i s n y a h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i u i s d e n g a n k e j a d i a n

i n f e k s i s a l i u a i i k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

14 Manfaat Penelitian

141 Manfaat Teoritis

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t m e n a m b a h p e n g e t a h u a n p e n e l i t i

t e n t a n g h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i U i s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

5

142 Manfaat Praktis

A Bagi Peneliti

H a s i l p e n e l i t i a n i n i d i l i a r a p k a n d a p a t d i g u n a k a n s e b a g a i s a l a h s a t u b a h a n

r e f e r e n s i a t a u b a c a a n b a g i p e n e l i t i

B Bagi Institusi

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t d i g u n a k a n p i h a k R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g s e b a g a i s a l a l i s a t u b a h a n a c u a n d a l a m m e n g u p a y a k a n

p e n c e g a h a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

15 Keaslian Penelitian

T a b e l 1 1 K e a s l i a n P e n e l i t i a n

Nama Judul Penelitian Desain Hasil Penelitian

Peneliti Penelitian

Kugan P r e v a l e n s i I n f e k s i Cross D a r i p e n e l i t i a n i i i i

Kandasamy S a i u r a n K e m i l i P a d a seciUmal d i p e r o l e h b a l i w a

W a n i t a Y a n g M e n d e r i t a

D i a b e t e s M e l i t u s T i p e

I I Y a n g D i r a w a t I n a p

p a s i e n w a n i t a d i a b e t e s

m e l i t u s t i p e I y a n g

m e n d e r i t a I S K y a n g

D a n D i r a w a t J a l a n D i d i r a w a t m a p d a n

S u b b a g i a n

E n d o k r i n o l o g i B a g i a n

P e n y a k i t D a l a m D i

d i r a w a t j a l a n d i s u b

b a g i a n E n d o k r i n o l o g i

P e n y a k i t D a l a m

R S U P H A d a m M a l i k R S U P H A d a m

P a d a T a l i u n 2 0 0 9 M a l i k M e d a i i t e r d a p a t

s e b a n y a k 2 5 o r a n g

y a i t u ( 1 2 7 ) D a r i 2 5

o r a n g y a n g m e n d e r i t a

I S K t e r d a p a t 3 o r a n g

y a i t u ( 1 2 0 ) y a n g

d i r a w a t i n a p d a n 2 2

6

o r a n g ( 8 8 0 ) y a n g

d i r a w a t j a l a n

Edel Weisela P e r b e d a a n R i s i k o

Permata I n f e k s i N o s o k o m i a l

Sari dan S a i u r a n K e m i h

Prijono B e r d a s a r k a n

Satyabakti K a i e t e r i s a s i U r i n

U m u r D a n D i a b e t e s

M e l i t u s T a h u n 2 0 1 5

Case H a s i l p e n e l i t i a n y a n g

control d i 1 a k u k a n p a d a 2 0

s a m p e l k a s u s d a n

k o n t r o l m e n u n j u k k a n

b a h w a p a s i e n d e n g a n

u m u r gt 5 5 t a h u n

m e m p u n y a i r i s i k o

5 5 7 k a l i m e n g a l a m i

i n f e k s i n o s o k o m i a l

s a i u r a n k e m i h

d i b a n d i n g k a n p a s i e n

d e n g a n u m u r lt 5 5

t a h u n d e n g a n

p e r i l i t u n g a i i b e s a r

risiko d i p e r o l e h n i l a i

O R s e b e s a r 5 5 7

d e n g a n n i l a i 9 5

(onfidence Interval

l 1 9 lt O R lt 2 8 2 3

P a s i e n d e n g a n s t a t u s

D M m e m p u n y a i risiko

6 k a l i u n t u k

m e n g a l a m i i n f e k s i

n o s o k o m i a l s a i u r a n

k e m i h d i b a n d i n g k a n

d e n g a n p a s i e n y a n g

t i d a k m e n d e r i t a D M

d e n g a n n i l a i O R

7

s e b e s a r 6 0 0 d e n g a n

n i l a i 9 5 Confidence

Interval 1 22 lt O R lt

3 2 2 6

Andry K a r a k t e r i s t i k P a s i e n - D e s k r i p k i f H a s i i p e n e l i t i a n d a r i

Lukandy P a s i e n I n f e k s i S a i u r a n r e t r o s p e k t i f 4 3 o r a n g p e n d e r i t a

K e m i i i d i P o l i u r o l o g i

R S U D D r P i m g a d i

K o t a M e d a n T a h u n

2 0 1 2 - 2 0 1 3

I S K d i d a p a t k a n 5 3 5

p a d a k e l o m p o k u s i a

gt 5 0 t a h u n 5 1 2

b e i j e n i s k e i a m i n l a k i -

l a k i 1 0 0 t i d a k

m e n d e r i t a

v e s i c o u r e t r a l r e f l u x

7 0 Benign Prostatic

Hyperplasia 1 1 6

b a t u s a i u r a n k e m i h

2 7 9 d i a b e t e s t i p e 2

D a r i h a s i l p e n e l i t i a n

i n i d a p a t d i s i m p u l k a n

b a h w a p e n d e r i t a i S K

l e b i h b a n y a k t e r j a d i

p a d a l a k i - l a k i d a n

p e n d e r i t a I S K l e b i h

b a n y a k d i j u m p a i p a d a

k e l o m p o k u m u r gt 5 0

t a h u n s e r t a d i t e m u k a n

I S K d e n g a n B P H

B S K d a n D M T i p e 2

BAB 11

TINJAUAN PUSTAKA

21 Landasan Teori

211Infeksi Saiuran Keniih

A Definisi

I n f e k s i S a i u r a n K e m i h a d a i a h i n v a s i d a n m u l t i p l i k a s i m i k r o o r g a n i s m e a t a u

p a r a s i t d a l a m j a r i n g a n t u b u h k h u s u s n y a s a i u r a n k e m i h y a n g t e r d i r i d a r i g i n j a l

u r e t e r b u l i - b u l i d a n u r e t r a y a n g d i i a n d a i d e n g a n a d a n y a b a k t e r i 1 0 c f i i (colony

forming unit) p e r m l p a d a p e n g a m b i l a n c o n t o h u r i n ( P u m o m o 2 0 1 1 )

I n f e k s i s a i u r a n k e m i h a d a l a l i s u a t u i n f e k s i y a n g m e l i b a t k a n g i n j a l lU e ter

b u l i - b u l i a t a u p u n u r e t r a I n f e k s i s a i u r a n k e m i h ( I S K ) a d a l a l i i s t i l a h u m u m y a n g

m e n u n j u k k a n k e b e r a d a a n m i k r o o r g a n i s m e d a l a m u r i n ( S u d o y o 2 0 0 6 )

B a k t e r i u r i a b e r m a k n a (significant hacteriuria) a d a i a h s u a t u k e a d a a n y a n g

m e n u n j u k k a n p e n u m b u l i a n m i k r o o r g a n i s m e m u m i l e b i h d a r i 1 0 c f t L m l p a d a

b i a k a n u r i n B a k t e r i u r i a b e r m a k n a m u n g k i n t a n p a d i s e r t a i p r e s e n t a s i k l i n i s I S K

d a n d i n a m a k a n b a k t e r i u r i a a s i m t o m a t i k (convert hacteriuria) S e b a l i k n y a

b a k t e r i u r i a b e n n a k n a d i s e r t a i p e r s e n t a s i k l i n i s I S K d i n a m a k a n b a k t e r i u r i a

s i m t o m a t i k P a d a b e b e r a p a k e a d a a n t e r d a p a t p a s i e n d e n g a n p e r s e n t a s i k l i n i s I S K

n a m u n t a n p a b a k t e r i u r i a b e n n a k n a S e l a i n i t u d i k a t a k a n p i u r i a ( l e u k o s i t d a l a m

u r i n ) b e n n a k n a (significant pyuria) b i l a d i t e m u k a n n e u t r o f i l gt 1 0 s e l p e r l a p a n g a n

p a n d a n g ( S u d o y o 2 0 0 6 )

B Epidemiologi

I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m u k a n d i p r a k t i k u m u m w a i a u p u n b e n n a c a m - m a c a m a n t i b i o t i k a s u d a h

t e r s e d i a l u a s d i p a s a r a n D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r

2 5 - 3 5 s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a

S e l a m a p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n

9

10

c e n d e r u n g m e n d e r i t a i S K d i b a n d i n g k a n l a k i - l a k i I S K b e m l a n g p a d a l a k i - l a k i

j a r a n g d i l a p o r k a n k e c u a l i d i s e r t a i f a k t o r p r e d i s p o s i s i ( p e n c e t u s )

P r e v a l e n s i b a k t e r i u r i a a s i m t o m a t i k l e b i h s e r i n g d i t e m u k a n p a d a p e r e m p u a n

P r e v a l e n s i s e l a m a p e r i o d e s e k o l a h (school girls) 1 m e n i n g k a t m e n j a d i 5

s e l a m a p e r i o d e a k t i f s e c a r a s e k s u a l P r e v a l e n s i i n f e k s i a s i m t o m a t i k m e n i n g k a t

m e n c a p a i 3 0 b a i k l a k i - l a k i m a u p u n p e r e m p u a n b i l a d i s e r t a i f a k t o r p r e d i s p o s i s i

( S u d o y o 2 0 0 6 )

C Kiasifikasi

I n f e k s i s a i u r a n k e m i h d a p a t d i b a g i m e n j a d i d u a k a t e g o r i u m u m b e r d a s a r k a n

l o k a s i a n a t o m i y a i t u

1 ) I n f e k s i s a i u r a n k e m i h b a w a h

2 ) I n f e k s i s a i u r a n k e m i h a l a s

P r e s e n t a s i k l i n i s d a r i i n f e k s i s a i u r a n k e m i h b a w a l i t e r g a n t u n g d a r i gender

y a i t u

a ) P e r e m p u a n

a S i s t i t i s

S i s t i t i s a d a i a h p r e s e n t a s i k l i n i s i n f e k s i k a n d u n g k e m i h d i s e r t a i

b a k t e r i u r i a b e n n a k n a

b S i n d r o m U r e t r a A k u t ( S U A )

S i n d r o m a u r e t r a a k u t a d a i a h p r e s e n t a s i k l i n i s s i s t i t i s t a n p a d i t e m u k a n

a d a n y a m i k r o o r g a n i s m e d a l a m L u i n ( s t e r i l ) d a n s e r i n g d i n a m a k a n

s i s t i t i s b a k t e r i a l i s

b ) L a k i - l a k i

P r e s e n t a s i k l i n i s i n f e k s i s a i u r a n k e m i h p a d a l a k i - l a k i m u n g k i n s i s t i t i s

p r o s t a t i t i s e p i d i m i d i s d a n u r e t r i t i s

I n f e k s i s a i u r a n k e m i h a t a s t e r b a g i m e n j a d i 2 y a i t u

1 ) P i e l o n e f r i t i s A k u t ( P N A )

P i e l o n e f r i t i s a k u t a d a l a l i p r o s e s i n f l a m a s i p a r e n k i m g i n j a l y a n g d i s e b a b k a n

o l e h m f e k s i b a k t e r i

11

2 ) P i e l o n e f r i t i s K r o n i s ( P N K )

P i e l o n e f r i t i s k r o n i s m u n g k i n a k i b a t l a n j u t d a r i i n f e k s i b a k t e r i

b e r k e p a n j a n g a n a t a u i n f e k s i s e j a k m a s a k e c i i O b s t r u k s i s a i u r a n k e m i h d a n

r e f l u k s v e s i k o u r e t e r d e n g a n a t a u t a n p a b a k t e r i u r i a k r o n i k s e r i n g d i i k u t i

p e m b e n t u k a n j a r i n g a n i k a t p a r e n k i m g i n j a l y a n g d i t a n d a i d e n g a n

p i e l o n e f r i t i s k r o n i k y a n g s p e s i f i k ( S u d o y o 2 0 0 6 )

D Etiologi

P a d a k e a d a a n n o r m a l u r i n b e r s i f a t s t e r i l U m u m n y a I S K d i s e b a b k a n o l e h

k i i m a n g r a m n e g a t i f E s c h e r i c h i a c o l i m e m p a k a n p e n y e b a b t e r b a n y a k b a i k p a d a

y a n g s i m t o m a t i k m a u p u n y a n g a s i m t o m a t i k y a i t u 7 0 - 9 0 E n t e r o b a k t e r i a s e p e r t i

P r o t e u s m i r a b i l i s ( 3 0 d a r i i n f e k s i s a i u r a n k e m i h p a d a a n a k l a k i - l a k i t e t a p i

k u r a n g d a r i 5 p a d a a n a k p e r e m p u a n ) K l e b s i e l l a p n e u m o n i a d a n P s e u d o m o n a s

a e m g i n o s a d a p a t j u g a s e b a g a i p e n y e b a b O r g a n i s m e g r a m p o s i t i f s e p e r t i

S t r e p t o c o c c u s f a e c a l i s ( e n t e r o k o k u s ) S t a p h y l o c o c c u s e p i d e n n i d i s d a n

S t r e p t o c o c c u s v i r i d a n s j a r a n g d i t e m u k a n P a d a u r o p a t i o b s t m k t i f d a n k e l a i n a n

s t r u k t u r s a i u r a n k e m i h p a d a a n a k l a k i - l a k i s e r i n g d i t e m u k a n P r o t e u s s p e c i e s P a d a

I S K n o s o k o m i a l a t a u I S K k o m p l e k s l e b i h s e r i n g d i t e m u k a n k u m a n P r o t e u s d a n

P s e u d o m o n a s ( L u m b a n b a t u S M 2 0 0 3 )

E Patofisiologi

P a d a i n d i v i d u n o n n a l b i a s a n y a u r i n l a k i - l a k i m a u p u n p e r e m p u a n s e l a l u

d a l a m k e a d a a n s t e r i l k a r e n a d i p e r t a l i a n k a n o l e h j u m l a l i d a n f r e k u e n s i b e r k e m i h

U t e r o d i s t a l m e m p a k a n t e m p a t k o l o n i s a s i m i k r o o r g a n i s m e nonpathogenic

fastidious G r a m - p o s i t i f d a n g r a m n e g a t i f ( S u d o y o 2 0 0 6 )

H a m p i r s e m u a I S K d i s e b a b k a n i n v a s i m i k r o o r g a n i s m e ascending d a r i u r e t r a

k e d a l a m k a n d u n g k e m i b P a d a b e b e r a p a p a s i e n t e r t e n t u i n v a s i m i k r o o r g a n i s m e

d a p a t m e n c a p a i k e g i n j a l P r o s e s i n i d i p e n n u d a h o l e h k o n d i s i r e f l u k s

v e s i k o i i r e t e r a l P r o s e s i n v a s i m i k r o o r g a n i s m e h e m a t o g e n s a n g a t j a r a n g d i t e m u k a n

d i k l i n i k m u n g k i t a k i b a t l a n j u t d a r i b a k t e r e m i a G i n j a l d i d u g a m e n i p a k a n l o k a s i

12

i n f e k s i s e b a g a i a k i b a t l a n j u t d a r i s e p t i k e m i a a t a u e n d o k a r d i t i s a k i b a t S t a f i l o k o k u s

a u r e u s K e l a i n a n g i n j a l y a n g t e r k a i t d e n g a n e n d o k a r d i t i s ( S t a f i l o k k o k u s a u r e u s )

d i k e n a l d e n g a n N e p h r i t i s L o h e i n B e b e r a p a p e n e l i t i a n m e l a p o r k a n p i e l o n e f r i t i s

a k u t ( P N A ) s e b a g a i a k i b a t l a n j u t i n v a s i h e m a t o g e n ( S u d o y o 2 0 0 6 )

F Faktor Risiko

P a t o f i s i o l o g i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h d a p a t d i p e n g a n i h i o l e h

b e b e r a p a f a k t o r A d a p u n b e b e r a p a f a k t o r risiko y a n g m e m p e n g a n i l i i t e r j a d i n y a

i n f e k s i s a i u r a n k e m i h a n t a r a l a i n

1 ) U s i a

I n s i d e n I S K m e n i n g k a t b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i

m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n a d a n y a a b n o r m a l i t a s a n a t o m i y a n g

m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n k e m i h s e p e r t i p e m b e s a r a n p r o s t a t

d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e

P e n y e b a b l a i n t e r m a s u k p e r i n e u m y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s

p e n y a k i t n e u r o m u s k n l a r d a n k a t e t e r i s a s i b u l i - b u l i S e l a i n i t u i n s i d e n I S K

m e n c a p a i 1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o s e 2 0 0 9 F o x m a n e t a l 2 0 1 0

R o n a l d 2 0 1 1 )

M e n u m t t e o r i y a n g d i k e m u k a k a n o l e h S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a d a u s i a

l a n j u t a k a n t e r j a d i p e n i n g k a t a n k e r e n t a n a n t e r h a d a p p e n y a k i t P a d a u s i a d i a t a s 5 0

t a l i u n t e r j a d i p e n u m n a n k e m a m p u a n d a l a m m e m p e r t a h a n k a n s t e n l i t a s b a i k p a d a

k a n d u n g k e m i h m a u p u n u r e t r a H a l t e r s e b u t d i s e b a b k a n o l e h i n v o l u s i t i m u s

I n v o l u s i s e l t i m u s m e n y e b a b k a n j u m l a h se d a n k u a l i t a s r e s p o n s s e l T s e m a k i n

b e r k u r a n g J u m l a h s e l T m e m o r i m e n i n g k a t n a m u n s e m a k i n s u l i t u n t u k

b e r k e m b a n g t e r u t a m a s i t o t o k s i k s e l T ( C D ^ ) d a n s e l T h l ( C D ^ ^ ) k a r e n a t e r j a d i

a p o p t o s i s S i t o t o k s i k s e l T ( C D ^ ^ ) b e i p e r a n d a l a m r e s p o n s i m u n t e r h a d a p a n t i g e n

p a d a s e l y a n g d i i n f e k s i d e n g a n c a r a m e m b u n u l i s e l y a n g t e r i n f e k s i u n t u k

m e n c e g a h p e n y e b a r a n m f e k s i s e d a n g k a n s e l T h l ( C D ^ ^ ) b e r p e r a n m e m b a n t u s e l

B u n t u k m e m p r o d u k s i a n t i b o d i

13

2 ) J e n i s k e l a m m d a n a k t i v i t a s s e k s u a l

I n s i d e n s i I S K y a n g r e n d a h p a d a p r i a d i p e n g a n i h i o l e h 3 f a k t o r y a i t u

1 L e b i h s e d i k i t t e r j a d i k o l o n i s a s i s e k i t a r u r e t r a k a r e n a t i d a k a d a n y a t e m p a t

s e p e r t i v a g i n a p a d a p e r e m p u a n

2 M e m i l i k i u r e t r a y a n g p a n j a n g

3 A d a n y a s u b s t a n s i a n t i b a k t e r i a l p a d a c a i r a n p r o s t a t

U r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a h d e n g a n d e k a t n y a v a g i n a l

v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h l e b i h s e r i n g

p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a f l o r a n o n n a l p a d a d a e r a l i p e r i u r e t r a t e r d i r i

d a r i o r g a n i s m e s e p e r t i l a c t o b a c i l l i i s y a n g m e m b a n t u m e l a w a n k o l o n i s a s i b a k t e r i

p a t o g e n p a d a s a i u r a n k e m i h P e r u b a l i a n l i n g k i m g a n d a r i p e r i u r e t r a l s e p e r t i

p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k b i s a m e n g g a n g g u f l o r a

n o r m a l s e h i n g g a m e m u n g k i n k a n b a k t e r i p a t o g e n b e r k o l o n i s a s i d a n m e n y e b a b k a n

i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

P a d a w a n i t a l e b i h d a r i 5 0 t a h u n a t a u l e b i h m e n o p a u s e m e m p a k a n f a k t o r

l a i n y a n g m e n i n g k a t k a n P V R Post Void Residual) s e l a i n p e n u r u n a n k o i i t r a k t i i i t a s

o t o t d e t r u s o r P e n u m n a n e s t r o g e n y a n g d i s e b a b k a n m e n o p a u s e d a p a t

m e n i n g k a t k a n p H v a g i n a l d a n m e n u m n k a n j u m l a l i l a c t o b a c i l l i A k i b a m y a t e r j a d i

p e n i n g k a t k a n k o l o n i s a s i d a r i b a s i l g r a m n e g a t i f s e h i n g g a m e n i n g k a t k a n r e s i k o

t e r j a d i n y a I S K P a d a p r i a p r o s t a t m e n s e k r e s i k a n c a i r a n y a n g m e n g a n d i m g z i n k

y a n g m e m i l i k i a k t i f i t a s m i k r o b i a l ( K i m 2 0 1 2 )

S e l a i n i t u p i j a t a n u r e t r a s e p e r t i y a n g t e r j a d i s e l a m a h u b u n g a n s e k s u a l

m e n y e b a b k a n m a s u k n y a b a k t e r i k e d a l a m k a n d u n g k e m i h d a n m e m p a k a n h a l

y a n g p e n t i n g d a l a m p a t o g e n e s i s m f e k s i s a l i u a n k e m i h p a d a p e r e m p u a n m u d a

B u a n g a i r k e c i l s e t e l a h h u b u n g a n s e k s u a l t e r b u k t i m e n u m n k a n risiko s i s t i t i s

m u n g k i n k a r e n a t i n d a k a n i n i m e n i n g k a t k a n e r a d i k a s i b a k t e r i y a n g m a s u k s e l a m a

h u b u n g a n s e k s u a l ( K i m 2 0 1 2 )

3 ) T i n g k a t P e n d i d i k a n

P e n g e t a h u a n s e s e o r a n g t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t

p e n d i d i k a n S e s e o r a n g y a n g m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m i u i g k i n a n

p e n g e t a h u a n t e n t a n g k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o n n a s i y a n g d i d a p a t k a n

14

t e n t a n g k e s e h a t a n l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h

S e b a l i k n y a p e n d i d i k a n y a n g k u r a n g d a p a t m e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g

t e r h a d a p n i l a i - n i l a i y a n g b a n i d i k e n a l ( N o t o a d i n o j o 2 0 0 3 )

4 ) R i w a y a t D i a b e t e s M e l i t u s

M e n u r u t S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a s i e n d e n g a n s t a t u s D M s a n g a t

b e r i s i k o u n t u k m e n g a l a m i i n f e k s i s a i u r a n k e m i h A b n o n n a l i i a s s t n i k t u r d a n

k a n d u n g k e m i h n e u r o g e n i k a k i b a t n e u r o p a t i o t o n o m a t a u s t r o k e p a d a p a s i e n D M

m e n y e b a b k a n p e n g o s o n g a n k a n d u n g k e m i h t i d a k n o n n a l D M j u g a d a p a t

m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a h a n a n t u b u h y a n g b e r p o t e n s i m e n i n g k a t

risiko t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a h a n a n t u b u h t e r s e b u t d i a n t a r a n y a

a d a i a h k e g a g a l a n m i g r a s i s e l intracellular killing f a g o s i t o s i s d a n k e m o t a k s i s

p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n m e k a n i s m e p e r t a h a n a n

a l a m i a h i o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p i n f e k s i

5 ) K e h a m i i a n

K e c e n d e r u n g a n i n f e k s i s a i u r a n k e m i h b a g i a n a t a s s e l a m a k e h a m i i a n

d i s e b a b k a n o l e h p e n u m n a n k e k u a t a n u r e t e r p e n u m n a n p e r i s t a l t i k u r e t e r d a n

i n k o m p e t e n s i s e m e n t a r a k a l u p v e s i k o i u - e t e r a l y a n g t e r j a d i s e l a m a h a m i l

6 ) S u m b a t a i i

A d a n y a I i a i a n g a n a l i r a n b e b a s u r i n s e p e r t i t u m o r s t r i k t r a a b a t u a t a u

h i p e r t r o f i p r o s t a t d a p a t m e n y e b a b k a n h i d r o n e f r o s i s d a n risiko i n f e k s i s a i u r a n

k e m i l i y a n g s a n g a t t i n g g i S e l a i n i t u s u p e r i n f e k s i p a d a s u m b a t a n s a i u r a n k e m i h

d a p a t m e n y e b a b k a n k e m s a k a n j a r i n g a n g i n j a l y a n g c e p a t

7 ) D i s f u n g s i n e u r o g e n i k k a n d u n g k e m i h

G a n g g u a n s a r a f y a n g b e k e r j a p a d a k a n d m i g k e m i h s e p e r t i p a d a j e j a s k o r d a

s p i n a l i s t a b e s d o r s a i i s m u l t i p e l s k l e r o s i s d i a b e t e s m e l i t u s a t a u p e n y a k i t l a i n

d a p a t b e r h u b u n g a n d e n g a n i n f e k s i s a i u r a n k e m i h I n f e k s i d a p a t d i a w a l i o l e h

p e n g g u n a a n k a t e l e r u n t u k d r a i n a s e k a n d i u i g k e m i h d a n d i d u k i m g o l e h s t a t i s u r i n

d a l a m k a n d u n g k e m i l i u n t u k j a n g k a w a k t u y a n g l a m a

8 ) R e f l u k s v e s i k o m e t e r a

K e a d a a n i n i d i d e f i n i s i k a n s e b a g a i r e f l u k s u r i n d a r i k a n d u n g k e m i b k e u r e t e r

d a n k a d a n g s a m p a i k e p e l v i s r e n a l H a l i n i t e r j a d i s e l a m a b u a n g a i r k e c i l a t a u

15

d e n g a n p e n i n g k a t a n t e k a n a n p a d a k a n d u n g k e m i h R e f l u k s v e s i k o i i r e t e r a l d a p a t

d i b u k t i k a n d e n g a n a d a n y a g c r a k a n r e t r o g r a d z a t r a d i o o p a k a t a u r a d i o a k t i f m e l a l u i

s i s t o u r e t r o g r a m s e l a m a b u a n g a i r k e c i l R e f l u k s v e s i k o i i r e t e r a l b i a s a n y a

d i s e b a b k a n k a r e n a a d a n y a g a n g g u a n a n a t o m i s p a d a p e r t e m u a n v e s i k o i i r e t e r a l

y a n g d a p a t m e n y e b a b k a n r e f l u k s u r i n d i s e r t a i b a k t e r i d a n k a r e n a i t u t e r j a d i l a h

i n f e k s i s a l r a a n k e m i h

9 ) F a k t o r v i r u l e n s i b a k t e r i

F a k t o r v i r u l e n s i b a k t e r i m e m p e n g a r u b i k e m u n g k i n a n vragt7 t e r t e n m d a l a m

m e n y e b a b k a n i n f e k s i t r a k i u s u r i n a r i u s H a m p i r s e m u a strain F c o l i y a n g

m e n y e b a b k a n p i e l o n e f r i t i s p a d a p a s i e n d e n g a n t r a k i u s u r i n a r i u s n o m i a l s e c a r a

a n a t o m i k m e m p u n y a i p i l u s t e r t e n t u y a n g m e m p e r a n t a r a i p e r l e k a t a n p a d a b a g i a n

d i g a k t o s i d a d a n g l i k o s f i n g o l i p i d y a n g a d a d i u r o e p i t e l Strain y a n g m e n i m b u l k a n

p i e l o n e f r i t i s j u g a b i a s a n y a m e m p a k a n p e n g b a s i l h e m o l i s i n m e m p u n y a i

a e r o b a k t i n d a n r e s i s t e n t e r h a d a p k e r j a b a k t e r i s i d a l d a r i s e m m m a n u s i a

1 0 ) F a k t o r g e n e t i k

F a k t o r g e n e t i k p e n j a m u m e m p e n g a n i l i i k e r e n t a n a n t e r h a d a p i n f e k s i t r a k t u s

u r i n a r i u s J u m l a h d a n t i p e r e s e p t o r p a d a s e l u r o e p i t e l t e m p a t b a k t e r i d a p a t

m e n e m p e l s e l i d a k i i y a s e b a g i a i i d i t e n t u k a r i s e c a r a g e n e t i k ( I s s e l b a c h e r 2 0 0 9 )

G Manifestasi Klinis

G e j a l a k l i n i s d a r i i n f e k s i s a i u r a n k e m i h s e s u a i d e n g a n b a g i a n s a i u r a n k e m i h

y a n g t e r i n f e k s i a d a i a h s e b a g a i b e r i k u t

1 ) I n f e k s i s a i u r a n k e m i h b a g i a n b a w a l i

K e l u h a n p a s i e n b i a s a n y a b e m p a r a s a s a k i t a t a u r a s a p a n a s d i u r e t r a s e w a k t u

k e n c i n g d e n g a n a i r k e m i h s e d i k i t - s e d i k i t s e r t a r a s a t i d a k e n a k d i d a e r a h

s i i p r a p u b i k

2 ) I n f e k s i s a i u r a n k e m i h b a g i a n a t a s

P a d a i n t e k s i s a i u r a n k e m i h b a g i a n a t a s d a p a t d i t e m u k a n g e j a l a s e p e r t i s a k i t

k e p a l a m a l a i s e m u a l m m i t a h d e n i a m m e n g g i g i l r a s a t i d a k e n a k a t a u

n y e r i d i p i n g g a n g ( T e s s y d k k 2 0 0 1 )

16

H Tatalaksana

T u j u a n p e n a t a l a k s a n a a a n i n f e k s i s a i u r a n k e m i h a d a i a h m e n c e g a h d a n

m e n g h i l a n g k a n g e j a l a m e n c e g a h d a n m e n g o b a t i b a k t e n e m i a d a n b a k t e r i u r i a s e r t a

m e n c e g a h d a n m e n g u r a n g i r i s i k o k e r u s a k a n g i n j a l y a n g m u n g k i n t i m b u l d e n g a n

p e m b e r i a n o b a t - o b a t a n y a n g s e n s i t i f m u r a l i d a n a m a n d e n g a n e f e k s a m p i n g y a n g

m i n i m a l

a ) i n f e k s i s a i u r a n k e m i h ( I S K ) b a w a h

P r i n s i p p e n a t a l a k s a n a a n I S K b a w a h m e l i p u t i intake c a i r a n y a n g b a n y a k

a n t i b i o t i k y a n g a d e k u a t d a n b i l a p e r l u t e r a p i s i m t o m a t i k u n t u k a l k a l i s a s i

u r i n

i H a m p i r 8 0 p a s i e n a k a n m e m b e r i k a n r e s p o n s e t e l a h 4 8 j a m d e n g a n

a n t i b i o t i k a t u n g g a l s e p e r t i a m p i s i l i n 3 g r a m a t a u t r i m e t o p r i m 2 0 0 m g

i i B i l a i n f e k s i m e n e t a p d i s e r t a i k e l a i n a n u r i n a l i s i s ( l e u k o s i u i a ) d i p e r i u k a n

t e r a p i k o n v e n s i o n a l s e l a m a 5 - 1 0 h a r i

i i i P e m e r i k s a a n m i k r o s k o p i s u r i n d a n b i a k a n u r i n t i d a k d i p e r i u k a n b i l a

s e m u a g e j a l a h i l a n g d a n t a n p a l e u k o s u r i a

b ) I n f e k s i s a i u r a n k e m i h ( I S K ) a t a s

P a d a u m u m n y a p a s i e n d e n g a n p i e l o n e f r i t i s a k u t m e m e r l u k a n r a w a t i n a p

u n t u k m e m e l i h a r a s t a t u s h i d r a s i d a n t e r a p i a n t i b i o t i k a p a r e n t e r a l p a l i n g

s e d i k i t 4 8 j a m ( S u d o y o 2 0 0 6 )

i Komplikasi

K o m p l i k a s i i n f e k s i s a i u r a n k e m i h t e r g a n t u n g d a r i t i p e y a i t u i n f e k s i s a i u r a n

k e m i h t i p e s e d e r h a n a (uncomplicated) d a n t i p e b e r k o m p l i k a s i (complicated)

1 ) I n f e k s i s a i u r a n k e m i h s e d e r h a n a (uncomplicated)

I n f e k s i s a i u r a n k e m i h a k u t t i p e s e d e r h a n a ( s i s t i t i s ) y a i t u n o n - o b s t r u k s i d a n

b u k a n p e r e m p u a n h a m i l m e m p a k a n p e n y a k i t r i n g a n (self limited disiase)

d a n t i d a k m e n y e b a b k a n a k i b a t l a n j u t j a n g k a l a m a

2 ) I n f e k s i s a i u r a n k e m i h b e r k o m p l i k a s i (complicated)

a ) I n f e k s i s a i u r a n k e m i h s e l a m a k e h a m i i a n

b ) i n f e k s i s a i u r a n k e m i h p a d a d i a b e t e s m e l i t u s ( S u d o y o 2 0 0 6 )

17

22 Kerangka Teori

J

U s i a

J e n i s K e i a m i n

T i n g k a t P e n d i d i k a n

R i w a y a t D i a b e t e s M e l i m s

S u m b a t a n bullT

K e h a m i i a n

D i s f u n g s i n e u r o g e n i k

R e f l u k s v e s i k o i i r e t e r a l

V i r u l e n s i b a k t e r i

F a k t o r g e n e t i k

I n f e k s i b a k t e r i g r a m p o s i t i f a t a u n e g a t i v e p a d a s a i u r a n k e m i h

I n f e k s i S a i u r a n K e m i h

Keterangan

I j = V a r i a b e l y a n g t i d a k d i t e l i t i

= V a r i a b e l y a n g d i t e l i t i

18

Hipotesis

H i p o t e s i s d a l a m p e n e l i t i a n i n i a d a i a h

H O t i d a k t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n

t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

H I t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

BAB 111

M E T O D E PENELITIAN

31 Jenis Penelitian

P a d a p e n e l i t i a n i n i j e n i s p e n e l i t i a n y a n g d i g u n a k a n a d a i a h p e n e l i t i a n

o b s e r v a s i o n a i a n a l i t i k d e s a i n cross scclional d e n g a n m e n g g u n a k a n d a t a s e k u n d e r

d a r i r e k a m m e d i s p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1 D e s e m b e r

2 0 1 5

32 Waktu dan Tempat Penelitian

321 Waktu Penelitian

W a k t u p e n e l i t i a n d i l a k s a n a k a n p a d a t a n g g a l 1 O k t o b e r s a m p a i d e n g a n 3 0

O k t o b e r 2 0 1 6

322 Tempat Penelitian

P e n e l i t i a n i n i d i l a k s a n a k a n d i R u m a l i S a k i t M u h a m m a d i y a h P a e m b a n g ( d i

R u a n g R e k a m M e d i s )

33 Populasi dan Sampel Penelitian

331Populasi Penelitian

P a d a p e n e l i t i a n i n i p o p u l a s i t a r g e t a d a l a l i p a s i e n r a w a t i n a p d a n r a w a t j a l a n

d i R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g s e d a n g k a n p o p u l a s i t e r j a n g k a u n y a

a d a i a h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

332Sampel dan Besar Sampel Penelitian

P a d a p e n e l i t i a n i n i s a m p e l p e n e l i t i a n a d a i a h p a s i e n r a w a t i n a p d a n r a w a t

j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e

1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 y a n g m e m e n u h i k r i t e r i a i n k l u s i p e n e l i t i a n

1 9

20

d e n g a n b e s a r s a m p e l y a n g l a y a k d a l a m p e n e l i t i a n m e n u r u t t e o r i R o s c o e a d a i a h

a n t a r a t i g a p u l u h s a m p a i l i m a r a t i i s o r a n g ( S u g i y o n o 2 0 1 5 )

333 Krttena Inklusi dan Eksklusi

A Kriteria Inklusi

P a d a p e n e l i t i a n i n i k r i t e r i a i n k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t i n a p

d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i

P a l e m b a n g y a n g d i d i a g n o s a m e n g a l a m i i n f e k s i s a i u r a n k e m i h s e r t a m e m i l i k i d a t a

r e k a m m e d i s p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

B Kriteria Eksklusi

P a d a p e n e l i t i a n i n i k r i t e r i a e k s k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t

i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 d e n g a n d a t a r e k a m m e d i s

y a n g t i d a k l e n g k a p

334 Cara Pengambilan Sampel Penelitian

C a r a p e n g a m b i l a n s a m p e l y a n g d i g u n a k a n d a l a m p e n e l i t i a n i n i a d a l a l i

m e n g g u n a k a n t e k n i k consecutive sampling P a d a consecutive sampling s e t i a p

p a s i e n y a n g m e m e n u h i k r i t e r i a p e n e l i t i a n d i m a s u k k a n d a l a m p e n e l i t i a n s a m p a i

k u r u n w a k t u t e r t e n U i s e h i n g g a j u m l a h m i n i m a l y a n g d i p e r i u k a n t e r p e n u h i

( S a s t r o a s m o r o 2 0 1 1 )

34 Variabel Penelitian

341 Variabel Dependent

V a r i a b e l dependent f t e r i k a t ) d a l a m p e n e l i t i a n i n i a d a i a h i n f e k s i s a i u r a n

k e m i h

342 Variabel Independent

V a r i a b e l independent ( b e b a s ) d a l a m p e n e l i t i a n i n i a d a i a h u s i a j e n i s

k e l a i n i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

21

35 Definisi Operasional

Tabel 31 Definisi Operasional

Variabel Alat Cara ueiinisi rldsil L KUr I7 i l l 11 Lz fe 1 V

oKaia LiKur Penelitian Ukur Ukur

Infeksi P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Saiuran d i d i a g n o s a o l e h m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Keniih d o k t e r m e n g a l a m i m e d i s

i n f e k s i s a i u r a n

k e m i h d a n t e r c a n t u m

d i r e k a m m e d i s

U s i a L a m a n y a t a h u n R e k a m O b s e r v a s i 1 lt 5 0 t a h u n O r d i n a l

k e h i d u p a n p a s i e n m e d i s r e k a m 2 gt 5 0 t a l i u n ( k a t e g o r i k )

d a r i l a h i r s a m p a i m e d i s

s e k a r a n g d a n

t e r c a n t u m d i r e k a m

m e d i s

Jenis P r o f i l a n a t o m i a t a u R e k a m O b s e r v a s i 1- L a k i - l a k i N o m i n a l

Keiamin b i o l o g i s p a s i e n y a n g m e d i s r e k a m 2 P e r e m p u a n ( k a t e g o r i k )

d i b e d a k a n m e n j a d i m e d i s

i a k i - l a k i d a n

n e r e m m i a n s e r t a

t e r c a n t u m d i r e k a m

m e d i s

Tingkat P e n d i d i k a n f o n n a l R e k a m O b s e r v a s i 1 P e n d i d i k a n O r d i n a l

Pendidikan t e r a k h i r y a n g m e d i s r e k a m d a s a r ( S D ( k a t e g o r i k )

d i t e m p u h o l e h m e d i s M I S M P

p a s i e n d a n t e r c a n t u m d a n M T s )

d i r e k a m m e d i s 2 P e n d i d i k a n

m e n e n g a l i

d a n t i n g g i

22

( S M A M A

S M K

M A K

d i p l o m a

s a r j a n a

m a g i St e r

s p e s i a l i s

d a n d o k t o r )

Riwayat P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Diabetes d i d i a g n o s i s d e n g a n m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Melitus d i a b e t e s m e l i t u s d a n

t e r c a n t u m d i d a l a m

r e k a m m e d i s

m e d i s

36 Cara Pengumpulan Data

361 Data Sekunder

P e n g u m p u l a n d a t a p a d a p e n e l i t i a n i n i d i p e r o l e h d a r i d a t a s e k u n d e r y a i t u

r e k a m m e d i s p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

37 Metode Teknik Analisis Data

371Cara Pengolahan dan Analisis Data

P e n g o l a h a n d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n m e l a l u i e m p a t t a h a p y a i t u

i Oala Entry

P a d a t a i i a p i n i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n riwayat d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g y a n g t e l a h d i d a p a t d a n

r e k a m m e d i s d i k u m p u l k a n d a n d i m a s u k k a n k e d a l a m p r o g r a m spss

23

2 Editing

P a d a t a h a p i n i d a t a i i s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n y a n g t e l a h d i m a s u k k a n k e d a l a m p r o g r a m s p s s

d i p e r i k s a k e m b a l i a p a k a h s u d a h l e n g k a p d a n t i d a k a d a k e k e l i r u a n

3 ( oding

S e t e l a h m e l a l u i p r o s e s editing d a t a - d a t a t e r s e b u t d i b e r i k o d e t e r t e n t u a n t a r a

l a i n k o d e 1 u n t u k u s i a gt 5 0 t a h u n j e n i s k e i a m i n p e r e m p u a n t i n g k a t

p e n d i d i k a n d a s a r t e r d a p a t r i w a y a t d i a b e t e s m e l i t u s d a n i n f e k s i s a i u r a n

k e m i h s e d a n g k a n k o d e 2 u n t u k u s i a lt 5 0 t a h u n j e n i s k e i a m i n l a k i - l a k i

t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i t i d a k t e r d a p a t r i w a y a t d i a b e t e s

m e l i t u s d a n b u k a n i n f e k s i s a i u r a n k e m i h s e h i n g g a m e m u d a h k a n d a l a m

m e l a k u k a n a n a l i s i s d a t a

4 Tahulaling

P a d a t a h a p i n i d a t a y a n g s a m a d i k e l o m p o k k a n s e c a r a t e l i t i d a n t e r a t m

k e m u d i a n d i l i i t u n g d e n g a n m e n g g u n a k a n p r o g r a m sps s d a n d i j u m l a h k a i i

l a l u d i s a j i k a n d a l a m b e n t u k t a b e l - t a b e l

U n t u k m e n g a n a l i s i s d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n a n a l i s i s d a t a

u n i v a r i a t d a n b i v a r i a t d e n g a n m e n g g u n a k a n p r o g r a m s p s s s e b a g a i b e r i k u t

A A n a l i s i s u n i v a r i a t

A n a l i s i s u n i v a r i a t d i l a k u k a n d e n g a n c a r a m e l a k u k a n a n a l i s i s p a d a s e t i a p

v a r i a b e l h a s i l p e n e l i t i a n d e n g a n t u j u a n u n t u k m e n g e t a h u i d i s t r i b u s i p r o p o r s i p a d a

s e t i a p v a r i a b e l p e n e l i t i a n D a t a d i s a j i k a n d a l a m b e n t u k t a b e l d a n n a r a s i

B A n a l i s i s b i v a r i a t

A n a l i s i s b i v a r i a t d i l a k u k a n d e n g a n m e n g g u n a k a n u j i h i p o t e s i s chi-square

U j i h i p o t e s i s chi-square d a p a t d i g u n a k a n d e n g a n s y a r a t y a i t u lt 2 0 s e l y a n g

m e m p u n y a i n i l a i expected count k u r a n g d a r i l i m a s e h i n g g a j i k a t i d a k m e m e n u h i

s y a r a t u j i chi-square m a k a u j i y a n g d i g u n a k a n a d a i a h u] fisher ( D a h l a n 2 0 1 4 )

B a t a s k e m a k n a a n y a n g d i g u n a k a n a d a i a h a = 0 0 5 J i k a d i d a p a t k a n p value lt 0 0 5

p a d a u j i s t a t i s t i k m a k a t i d a k t e r d a p a t h u b u n g a n y a n g b e n n a k n a a n t a r a d u a

v a r i a b e l y a n g d i t e l i t i d a n H O d i t e r i m a S e d a n g k a n j i k a d i d a p a t k a n p value gt 0 0 5

24

p a d a u j i s t a t i s t i k m a k a t e r d a p a t l i u b u n g a n y a n g b e n n a k n a a n t a r a d u a v a r i a b e l

y a n g d i t e l i t i d a n H O d i t o l a k

38 Alur Penelitian

P e n e n t u a n p o p u l a s i d a n s a m p e l p e n e l i t i a n

K r i t e r i a i n k l u s i K r i t e r i a e k s k l u s i

P e n g a m b i l a n s a m p e l p e n e l i t i a n

P e n g o l a h a n d a n a n a l i s i s d a t a d e n g a n u j i chi-square

H a s i l d a n p e m b a h a s a n

K e s i m p u l a n d a n s a r a n

Gambar 31 Alur Penelitian Hubungan Usia Jenis Keiamin Tingkat Pendidikan dan Riwayat Diabetes Melitus dengan Kejadian Infeksi Saiuran Kemih pada Pasien Rawat Inap di Bagian Penyakit Dalam Rumah Sakit Muhammadiyah Palembang Periode 1 Januari 2015 sampai dengan 31 Desember 2015

BAB IV

HASIL DAN PEMBAHASAN

41 Hasil

P e n e l i t i a n i n i t e l a h d i l a k u k a n d i r u a n g r e k a m m e d i s R u m a h S a k i t

M u h a i m n a d i y a h P a l e m b a n g d a r i t a n g g a l 1 O k t o b e r 2 0 1 5 - 3 1 O k t o b e r 2 0 1 6

P e n e l i t i a n d i m u l a i d e n g a n p e n g a m b i l a n d a t a a w a l b e m p a d a t a r e k a m m e d i s

s e l u r u h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

S e l a n j u t n y a r e k a m m e d i s d i p i l i h s e s u a i d e n g a n k r i t e r i a i n k l u s i d a n e k s k l u s i u n t u k

d i j a d i k a n s a m p e l p e n e l i t i a n s a m p a i m i n i m a l b e s a r s a m p e l y a n g d i b u t u h k a n

t e r p e n u h i s e r t a d i l a k u k a n p e n e l i t i a n s e c a r a o b s e r v a s i o n a i O b s e r v a s i r e k a m m e d i s

d i l a k u k a n u n m k m e n g e t a h u i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t

d i a b e t e s m e l i t u s d a n d i a g n o s a p a s i e n

D a r i c a t a t a n r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g

d i d a p a t k a n s e b a n y a k 4 1 4 1 r e k a m m e d i s p a s i e n r a w a t i n a p d a n 1 4 5 3 r e k a m m e d i s

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 D a r i t o t a l r e k a m m e d i s

p a s i e n r a w a t i n a p d a n r a w a t j a l a n t e r s e b u t p e n e l i t i h a n y a m e n g a m b i l m i n i m a l

b e s a r s a m p e l y a n g d i b u t u h k a n y a i t u s e b a n y a k 9 8 r e k a m m e d i s u n t u k d i j a d i k a n

s a m p e l p e n e l i t i a n y a n g t e r d i r i d a r i 3 0 r e k a m m e d i s p a s i e n y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i h d a n 6 8 r e k a m m e d i s y a n g t i d a k m e n g a l a m i i n f e k s i s a i u r a n k e m i h

411 Hasil Analisis Univariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s u n i v a r i a t

a n t a r a l a i n d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p b e r d a s a r k a n u s i a d a n

j e n i s k e l a m m d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n b e r d a s a r k a n u s i a

d a n j e n i s k e i a m i n d i s t r i b u s i p r o p o r s i s a m p e l b e r d a s a r k a n k e j a d i a n m f e k s i s a i u r a n

k e m i h s e r t a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n u s i a

j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

25

26

A Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan IJsta

dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 41 Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan

Usia dan Jenis Keiamin

Paisen Rawat Inap N Persentase

Usia

1 7 - 2 5 t a h u n 678 1 6 4

2 6 - 3 5 t a h u n 952 2 3 0

3 6 - 4 5 t a l i u n 745 18 0

4 6 - 5 5 t a h u n 695 1 6 8

5 6 - 6 4 t a h u n 571 1 3 8

gt 6 4 t a h u n 500 1 2 1

U s i a r a t a - r a t a ( t a h u n j 43plusmn16543

Jenis Keiamin

P e r e m p u a n 2 6 3 8 6 3 7

L a k i - l a k i 1 5 0 3 3 6 3

Total 4141 100

B e r d a s a r k a n t a b e l 4 1 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R i u n a h S a k i t M u l i a m m a d i y a l i

P a l e m b a n g p e r i o d e J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 2 6 - 3 5 t a h u n y a i t u

s e b a n y a k 9 5 2 o r a n g ( 2 3 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 43plusmn16543 t a l i u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 2 6 3 8 o r a n g ( 6 3 7 )

27

B Distribusi Proporsi Karakteristik Pasien Rawat Jalan Berdasarkan

Usia dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 42 Distribusi Proporsi Karakteristik Pasien Rawat Jalan

Berdasarkan Usia dan Jenis Keiamin

Fasten Rawat Jalan N Persentase

Usia

1 7 - 2 5 t a h u n 9 2 6 3

2 6 - 3 5 t a l n i n 1 3 1 9 0

3 6 - 4 5 t a h u n 2 7 9 1 9 2

46-55 t a l i u n 4 2 1 2 9 0

5 6 - 6 4 t a h u n 3 1 6 2 1 7

gt 6 4 t a h u n 2 1 4 1 4 7

U s i a r a t a - r a t a ( t a h u n ) 50plusmn14120

Jenis Keiamin

P e r e m p u a n 8 9 0 6 1 3

L a k i - l a k i 5 6 3 3 8 7

Total 1453 100

B e r d a s a r k a n t a b e l 4 2 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 4 6 - 5 5 t a h u n y a i t u

s e b a n y a k 4 2 1 o r a n g ( 2 9 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 50plusmn14120 t a h u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 8 9 0 o r a n g ( 6 1 3 )

28

C Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Usia

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i b b e r d a s a r k a n u s i a d a p a t

d i i i h a t p a d a l a b e l d i b a w a h i n i

Tabel 43 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Usia

Usia N Persentase

lt 5 0 t a h u n 1 4 4 6 7

gt 5 0 t a l i u n 1 6 5 3 3

Total 30 100

B e r d a s a r k a n t a b e l 4 3 d i a t a s d a p a t d i k e t a h u i b a h w a u s i a t e r b a n y a k p a d a

s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h gt 5 0 t a h u n y a i t u s e b a n y a k

1 6 o r a n g ( 5 3 3 )

D Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Jenis

Keiamin

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n j e n i s

k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 44 Distribusi Proporsi Kejadian infeksi Saiuran Kemih Berdasarkan

Jenis Keiamin

Jenis Keiamin N Persentase

P e r e m p u a n 1 8 6 0 0

L a k i - l a k i 1 2 4 0 0

Total 30 100

B e r d a s a r k a n t a b e l 4 4 d i a t a s d a p a t d i k e t a h u i b a h w a j e n i s k e i a m i n

t e r b a n y a k p a d a s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h p e r e m p u a n

y a i t u s e b a n y a k 1 8 o r a n g ( 6 0 0 )

29

E Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n t i n g k a t

p e n d i d i k a n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 45 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

Tingkat Pendidikan N Persentase

P e n d i d i k a n d a s a r 20 6 6 7

P e n d i d i k a n m e n e n g a h d a n P e n d i d i k a n m e n e n g a h d a n 10 333

t i n g g i

Total J O 100

B e r d a s a r k a n t a b e l 4 5 d i a t a s d a p a t d i k e t a l i u i b a l i w a t i n g k a t p e n d i d i k a n

t e r b a n y a k p a d a s a m p e i y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h t i n g k a t

p e n d i d i k a n d a s a r y a i t u s e b a n y a k 20 o r a n g ( 6 6 7 )

P Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n riwayat

d i a b e t e s m e l i t u s d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 46 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

Riwayat Diabetes Melitus N Persentase

Y a 17 5 6 7

T i d a k 13 433

Total 30 100

B e r d a s a r k a n t a b e l 4 6 d i a t a s d a p a t d i k e t a h u i b a l i w a s a m p e l y a n g

m e n g a l a m i i n f e k s i s a i u r a n k e m i h t e r b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s

y a i t u s e b a n y a k 1 7 o r a n g ( 5 6 7 )

30

412 Hasil Analisis Bivariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s b i v a r i a t

a n t a r a I a i n h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h j e n i s

k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h t i n g k a t p e n d i d i k a n d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n

i n f e k s i s a l m a n k e m i h

A n a l i s i s y a n g d i g u n a k a n p a d a u j i d u a v a r i a b e l y a n g b e r s k a l a k a t e g o r i k

a d a l a l i d e n g a n u j i Chi-Square d e n g a n n i e i h a t n i l a i Pearson Chi-Square S e m u a

h a s i l d a r i u j i h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h m e n g g i u i a k a n u j i Chi-

Square k a i e n a m e m e n u h i s y a r a t u j i Chi-Square y a i t u lt 2 0 s e l y a n g m e m p u n y a i

n i l a i expected count lt 5

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 47 Hasil Uji Hubungan antara Usia dengan Kejadian Infeksi

Saiuran Kemih

Usia

Infeksi Saiuran Kemih

^a Tidak

n N Mgt

Jumlah P

value 95Cl

lt 50 t a h u n 1 4 1 9 2 5 9 8 0 8 7 3 0 0 0 0 2 7 4 7 - 2 0 4 3 1

gt 5 0 t a h u n 1 6 6 4 0 9 3 6 0 2 5

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 7 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R = 7 4 9 2

( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a u s i a gt

5 0 t a h u n a d a l a l i 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a u s i a lt 5 0 t a h u n

31

B Hubungan antara Jenis Keiamin dengan Kejadian Infeksi Saiuran

Kemih

H a s i l a n a l i s i s b i v a r i a t l i u b u n g a n a n t a r a j e n i s k e l a i n i n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

Tabel 48 Hasil Uji Hubungan antara Jenis Keiamin dengan Kejadian

Infeksi Saiuran Kemih

Infeksi Saiuran Kemih Jenis P

A Tidak Jumlah 95CI Keiamin value

N N

P e r e m p u a n 18 6 4 3 10 357laquoo 2 8 3 2 2 7 -P e r e m p u a n 0 0 0 0

L a k i - l a k i 12 1 7 1 5 8 8 2 9 7 0 2 3 4 5 9

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 8 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a l a l i

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k N 4 a k a a d a l i u b u n g a n y a n g s i g n i f i k a n a n t a r a

j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R ) = 8 7 0 0

f 9 5 C I = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a l a k i - l a k i

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e n i i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

32

Tabel 49 Hasil liji Hubungan antara Tingkat Pendidikan dengan

Kejadian Infeksi Saiuran Kemih

Infeksi Saiuran Kemih P

Y a T i d a k jumlah 95CI value

N

P e n d i d i k a n d a s a r 2 0 5 4 1 1 7 4 5 9 3 7

P e n d i d i k a n

m e n e n g a h d a n 10 1 6 4 5 1 8 3 6 6 1

t i n g g i

Jumlah JO 30 6 68 694 9H

B e r d a s a r k a n t a b e l 4 9 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( 0 R ) =

6 0 0 0 ( 9 5 C I = 2 3 5 1 - 1 5 3 1 0 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r a d a i a h 6 k a l i l e b i h b e s a r

d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i h a t

p a d a t a b e l d i b a w a h i n i

Tingkat

Pendidikan

2 3 5 1 -0 0 0 0

1 5 3 1 0

33

Tabel 4t0 Hasil I j i Hubungan antara Riwayat Diabetes Melitus dengan

Kejadian Infeksi Saiuran Kemih

Riwayat Infeksi Saiuran Kemih P

Diabetes Va Tidak Jumlah value

95CI

Melitus N bullVJ N

Y a

T i d a k

17

1 3

6 8 0

1 7 8

8

6 0

3 2 0

8 2 2

2 5

7 3 0 0 0 0

3 4 9 3 -

2 7 5 3 6

Jumlah 30 306 68 571 98

B e r d a s a r k a n t a b e l 4 1 0 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio

( O R ) = 9 8 0 8 ( 9 5 C I - 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r

d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s m e l i m s

42 Pembahasan

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a l a b e l 4 7 d i d a p a t k a n b a l i w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i b d e n g a n n i l a i s i g n i f i k a n n y a a d a l a l i 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k

Odds Ratio ( O R ) = 7 4 9 2 ( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a u s i a T 5 0 t a h u n a d a i a h 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a

u s i a lt 5 0 t a h u n

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n A n d r y L u k a n d y

( 2 0 1 4 ) m e n g e n a i k a r a k t e r i s t i k p a s i e n - p a s i e n i n f e k s i s a i u r a n k e m i h d i m a n a

p e n d e r i t a I S K d e n g a n k e l o m p o k u m u r gt 5 0 t a h u n s e b a n y a k 2 3 o r a n g s e d a n g k a n

j u m l a h p e n d e r i t a I S K d e n g a n k e l o m p o k u m m lt 5 0 t a l i u n s e b a n y a k 2 0 o r a n g

P e n e l i t i a n i n i j u g a d i p e i k u a t o l e h p e n l i t i a n L e w i s A l e t a l ( 2 0 1 4 ) m e n g e n a i

impact of host age and parity on susceptihility to severe urinary tract injection in

34

a murine mode d e n g a n u j i K r u s k a l - W a l l i s d e n g a n post-test D u n n u n t u k b e b e r a p a

p e r b a n d i n g a n d i m a n a u s i a d a n p a r i t a s s e b a g a i f a k t o r y a n g b e r k o n t r i b u s i d a l a m

k e r e n t a n a n i m t u k t e r j a d i n y a I S K d e n g a n n i l a i p lt 0 0 5

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n g a t a k a n b a h w a i n s i d e n I S K m e n i n g k a t

b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n

a d a n y a a b n o r m a l i t a s a n a t o m i y a n g m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n

k e m i h s e p e r t i p e m b e s a r a n p r o s t a t d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a

p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e ( R o s e 2 0 0 9 ) P e n y e b a b l a i n t e n n a s u k

p e r i n e i u n y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s p e n y a k i t n e u r o m u s k u l a r

d a n k a t e t e r i s a s i b u l i - b u l i ( F o x m a n e t a l 2 0 1 0 ) S e l a i n i t u i n s i d e n I S K m e n c a p a i

1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o n a l d 2 0 1 1 )

B Hubungan antara Jenis Keiamin dengan Kejadian infeksi Saiuran

Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 8 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d e n g a n n i l a i s i g n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O

d i t o l a k Odds Ratio ( O R ) = 8 7 0 0 ( 9 5 C l = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a risiko k e j a d i a n

i n f e k s i s a i u r a n k e m i h p a d a p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n

p a d a l a k i - i a k i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n M a g i i a n o e t a l

( 2 0 1 1 ) m e n g e n a i Gender and Age-Dependent Etiology of Community Acquired

y a n g m e l a k u k a n p e n g a m b i l a n 6 1 2 7 3 s a m p e l k u l t u r u r i n d a l a m p e r i o d e 2 2 b u l a n

d a r i s a m p e l i n i d i d a p a t k a n 1 3 8 2 0 ( 2 2 6 ) d i t e m u k a n p o s i t i f i n f e k s i b a k t e r i

h a m p i r 8 0 b a l i a n y a n g d i i s o l a s i b e r a s a l d a r i p e r e m p u a n P e n e l i t i a n i n i j u g a

d i p e r k u a t o l e h p e n e l i t i a n y a n g d i l a k u k a n o l e h Y u n i t a I ( 2 0 1 0 ) d i m a n a a d a

h u b m i g a n y a n g b e n n a k n a a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h ( P value=O049 R P = 3 2 7 3 ( 9 5 C I = I 0 1 6 - 1 0 5 4 0 )

H a l t e r s e b u t d a p a t t e r j a d i k a r e n a u r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a l i

d e n g a n d e k a t n y a v a g i n a l v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i

s a i u r a n k e m i h l e b i h s e r i n g p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a flora n o r m a l

3 5

p a d a d a e r a h p e r i u r e t r a t e r d i r i d a r i o r g a n i s m e s e p e r t i i a c t o b a c i l l u s y a n g m e m b a n t u

m e l a w a n k o l o n i s a s i b a k t e r i p a t o g e n p a d a s a i u r a n k e m i h P e r u b a h a n l i n g k i m g a n

d a r i p e r i u r e t r a l s e p e r t i p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k

b i s a m e n g g a n g g u f l o r a n o r m a l s e h i n g g a m e n u m g k i n k a n b a k t e r i p a t o g e n

b e r k o l o n i s a s i d a n m e n y e b a b k a n i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Scuare p a d a t a b e l 4 9 d i d a p a t k a n b a h w a

t e r d a p a t l i u b u n g a n y a n g s i g n i f i k a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a

H O d i t o l a k Odds Ratio ( O R ) - 6 0 0 0 ( 9 5 o C l = 2 3 5 1 - 1 5 3 I O ) a r t i n y a n s i k o

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r

a d a i a h 6 k a l i l e b i h b e s a r d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n

m e n e n g a h d a n t i n g g i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h T o r o n d e i B e t

a l ( 2 0 1 5 ) m e n g e n a i Menstrual Hygiene Practices WASH Access and the Risk of

Urogenital Infection in Women from Odisha India d i m a n a p e r e m p u a n y a n g

h a n y a m e n e m p u l i p e n d i d i k a n s e k o l a h d a s a r a t a u l e b i h r e n d a h d i b a n d i n g k a n

d e n g a n t i n g k a t p e n d i d i k a n m e n e n g a h a t a u t i n g g i m e m i l i k i r i s i k o 3 k a l i

k e m u n g k i n a n l e b i h b e s a r m e n g a l a m i i n f e k s i s a i u r a n k e m i h ( A d j O R = 3 l 9 5

C 1 = I 2 - 7 9 p = 0 0 2 )

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a p e n g e t a h u a n s e s e o r a n g

t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t p e n d i d i k a n S e s e o r a n g y a n g

m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m u n g k i n a n p e n g e t a l i u a n t e n t a n g

k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o r m a s i y a n g d i d a p a t k a n t e n t a n g k e s e h a t a n

l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h S e b a l i k n y a

p e n d i d i k a n y a n g k u r a n g d a p a t i n e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g t e r h a d a p

n i l a i - n i l a i y a n g b a r u d i k e n a l ( N o t o a d m o j o 2 0 0 3 )

3 6

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Keniih

B e r d a s a r k a n l i a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 1 0 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a r i w a y a t d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 )

s e h i n g g a H O d i t o l a k Odds Ratio ( O R ) = 9 8 0 8 ( 9 5 C I = 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a

risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h S a r i E W P d a n

S a t y a b a k t i P ( 2 0 1 5 ) m e n g e n a i p e r b e d a a n risiko i n f e k s i n o s o k o m i a l s a i u r a n k e m i h

b e r d a s a r k a n k a t e t e r i s a s i u r i n u m u r d a n d i a b e t e s m e l i m s d i m a n a d a r i 2 0 p a s i e n

i n f e k s i n o s o k o m i a l s a i u r a n k e m i h 1 2 o r a n g ( 6 0 ) d i a n t a r a n y a a d a i a h p a s i e n

d e n g a n s t a t u s D M s e d a n g k a n 8 o r a n g ( 4 0 ) l a i n n y a a d a i a h p a s i e n t a n p a s t a t u s

D M ( P v W w ^ = 0 0 2 4 O R = 6 0 0 9 5 C I = 1 2 2 - 3 2 2 6

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a b a l i w a b e b e r a p a b a g i a n

d a r i i i n u n i t a s p a d a p a s i e n d i a b e t e s m e n g a l a m i p e r u b a h a n F u n g s i

p o l i n i o r f o l e u k o s i t d i t e k a n p a d a k e a d a a n a s i d o s i s I k a t a n l e u k o s i t k e m o t a k s i s d a n

f a g o s i t o s i s j u g a b e m b a l i S i s t e m a n t i o k s i d a n y a n g b e r p e r a n p a d a a k t i f i t a s

b a k t e r i s i d a l j u g a t e r g a n g g u s e h i n g g a m e n y e b a b k a n t e r j a d i n y a I S K p a d a p a s i e n -

p a s i e n d e n g a n p e n y a k i t d i a b e t e s ( J u l k a 2 0 1 4 )

H a l y a n g s a m a j u g a d i i m g k a p k a n o l e b t e o r i S m e l t z e r d a n B a r e ( 2 0 1 0 )

b a l i w a D M d a p a t m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a l i a n a n t u b u h y a n g

b e r p o t e n s i m e n i n g k a t k a n r i s i k o t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a l i a n a n

t u b u h t e r s e b u t d i a n t a r a n y a a d a i a h k e g a g a l a n m i g r a s i s e l iniraceliular killing

f a g o s i t o s i s d a n k e m o t a k s i s p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n

m e k a n i s m e p e r t a l i a n a n a l a m i a h I o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p

i n f e k s i

BAB V

KESIMPULAN DAN SARAN

51 Kesimpulan

1 U s i a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 2 6 - 3 5 t a h u n y a i t u 2 3 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 3 7

2 U s i a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 4 6 - 5 5 t a l i u n y a i t u 2 9 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 1 3

3 U s i a j e n i s k e i a m i n d a n t i n g k a t p e n d i d i k a n s a m p e i y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i l i t e r b a n y a k y a i t u b e r u s i a gt 5 0 t a h u n ( 5 3 3 ) j e n i s k e i a m i n

p e r e m p u a n ( 6 0 0 ) d a n t i n g k a t p e n d i d i k a n d a s a r ( 6 6 7 ) s e r t a p a l i n g

b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s y a i t u 5 6 7

4 T e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 ( p = 0 0 0 0 )

52 Saran

1 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t d i l a k u k a n d e n g a n d e s a i n

p e n e l i t i a n b e r b e d a s e p e r t i cohort a t a u case control

2 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t m e i i c a r i v a r i a b e l independent

y a n g l a i n s e p e r t i v a r i a b e l p e k e r j a a n p e m a s a i i g a n k a t e t e r a t a u l a m a n y a

m e n d e r i t a d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

37

DAFTAR PUSTAKA

B o y k o E J d k k 2 0 0 2 D i a b e t i c A n d T h e R i s k O f A c u t e U r i n a r y T r a c t I n f e c t i o n A m o n g P o s t m e n o p a u s a l W o m e n D i a b e t e s C a r e 2 5 ( 1 0 )

D a h l a n S 2 0 1 4 B u k i i S t a t i s t i k u n t u k K e d o k t e r a n d a n K e s e h a t a n D e s k r i p t i f B i v a r i a t d a n M u l t i v a r i a t d i l e n g k a p i a p l i k a s i d e n g a n m e n g g u n a k a n S P S S E d i s i 6 E p i d e m i o l o g i I n d o n e s i a J a k a r t a I n d o n e s i a

D e p a r t e m e n K e s e h a t a n ( D E P K E S ) R l 2 0 1 4 [ O n l i n e ] K e m e n t e r i a n K e s e h a t a n R e p u b l i k I n d o n e s i a P u s a t D a t a d a n I n f o r m a s i K e m e n t e r a n K e s e h a t a n R l ( http 7depkesgoid diakses tanggal 15 Met 2016)

F o x m a n B e t a i 2 0 1 0 U r i i i a i y T r a c t I n f e c t i o n A m o n g W o m e n A g e d 4 0 T o 6 5 B e h a v i o r a l A n d S e x u a l R i s k F a c t o r s D a l a m T a n a g h o E A M c A n i n c h J W 1 7 t h S m i t h s G e n e r a l U r o l o g y U S A M c G r a w H i l l (http searchproqnestcom diakses tanggal 16 Met 2016)

H a r d i n g G K d k k 2 0 1 0 A n t i m i c r o b i a l T r e a t m e n t I n D i a b e t i c W o m e n W i t l i A s y m t o m a t i c B a c t e r i u r i a N E n g l J M e d 3 4 7 1 5 7 6 - 1 5 8 3 (http nejmorg diakses tanggal 16 Met 2016)

I s s e l b a c h e r d k k 2 0 0 9 I n f e k s i S a i u r a n K e m i h d a n P i e l o n e f r i t i s D a l a m S t a m m W a l t e r E e d H a r r i s o n P r i n s i p - P r i n s i p l l m u P e n y a k i t D a l a m e d V o l u m e 2 J a k a r t a E G C 6 1 6 - 6 2 3

J u l k a S 2 0 1 3 G e n i t o u r i n a r y I n f e c t i o n I n D i a b e t e s I n d i a n J o u m a l o f E n d o c r i n o l o g y a n d M e t a b o l i s m (http searchproquestcom diakses tanggal 16 Mei 2016)

K i m B d k k 2 0 1 2 [ e - b o o k ] T h e R e l a t i o n b e t w e e n P o s t v o i d R e s i d u a l a n d O c c u r r e n c e o f U r i n a r y T r a c t I n f e c t i o n a f t e r S t r o k e i n R e h a b i l i t a t i o n U n i t A n n a l s o f R e h a b i l i t a t i o n M e d i c i n e

K o m a r a A 2 0 0 9 P o l a K e p e k a a n B a k t e r i G r a m N e g a t i f d a r i P a s i e n I n f e k s i S a i u r a n K e m i l i t e r h a d a p A n t i b i o t i k G e n t a m i c i n d a n K o t r i m o k s a z o l y a n g D i k i r i m k e L a b o r a t o r i u m M i k r o b i o l o g i K l i n i k F K U l d a r i T a h u n 2 0 0 1 s a m p a i T a h u n 2 0 0 5 (http dontaruiacid diakses tanggal OH Agustiis 2016)

L e w i s A L e t a l 2 0 1 4 I m p a c t o f H o s t A g e a n d P a r i t y o n S u s c e p t i b i l i t y t o S e v e r e U r i n a r y T r a c t I n f e c t i o n i n a M u r i n e M o d e l P l o s O n e R e s e a r c h A r t i c l e P u b l i c L i b r a r y o f S c i e n c e 9 ( 5 ) (http searchproquestcom diakses pada langgal 30 Desember 2016)

38

DAFTAR ISI

HALAMAN J D D U L HALAMAN PENCESAHAN i HALAMAN PERNN ATAAN ii HALAMAN PERSEMBAHAN iii A B S T R A K iv A B S T R A C T v K A T A PENGANTAR vi DAFTAR ISI vii DAFTAR T A B E I ix DAFTAR GAMBAR x DAFTAR LAMPIRAN xi

BAB I Pendahuluan 1 1 1 L a t a r B e l a k a n g 1 12 R i i m u s a n M a s a l a h 3 13 T u j u a n P e n e l i t i a n 3 14 M a n l a a t P e n e l i t i a n 4 15 K e a s l i a n P e n e l i t i a n 5

BAB H Tinjauan Pustaka 9 2 1 L a n d a s a n T e o r i 9

2 1 1 I n f e k s i S a i u r a n K e m i h 9 A D e f i n i s i 9 B E p i d e m i o l o g i 9 C K i a s i f i k a s i 1 0 D E t i o l o g i 1 1 E P a t o f i s i o l o g i 11 F F a k t o r R i s i k o 1 2 G M a n i f e s t a s i K l i n i s 1 5 H T a t a l a k s a n a 1 6 I K o m p l i k a s i 1 6

2 2 K e r a n g k a T e o r i 1 7 2 3 H i p o t e s i s 1 8

BAB I I I Metode Penelitian 19 3 1 J e n i s P e n e l i t i a n 1 9 3 2 W a k t u d a n T e m p a t P e n e l i t i a n 1 9 3 3 P o p u l a s i d a n S a m p e l 1 9

3 3 1 P o p u l a s i P e n e l i t i a n 1 9 3 3 2 S a m p e l d a n B e s a r S a m p e l P e n e l i t i a n 1 9 3 3 3 K n t e r i a I n k l u s i d a n E k s k l u s i 2 0 3 3 4 C a r a P e n g a m b i l a n S a m p e l P e n e l i t i a n 2 0

3 4 V a r i a b e l P e n e l i t i a n 2 0 3 4 1 V a r i a b e l Dependent 2 0 3 4 2 V a r i a b e l Independent 2 0

viii

3 5 D e f i n i s i O p e r a s i o n a l 2 1 3 6 C a r a P e n g i i n i p u l a n D a t a 2 2

3 6 1 D a t a S e k u n d e r 2 2 3 7 M e t o d e T e k n i s A n a l i s i s D a t a 2 2

3 7 C a r a P e n g o l a h a n d a n A n a l i s i s D a t a 2 2 3 8 A l u r P e n e l i t i a n 2 4

BAB IV HASIL DAN PEMBAHASAN 25 4 1 H a s i l 2 5 4 2 P e m b a h a s a n 3 3

BAB V KESIMPLILAN DAN SARAN 37 5 1 K e s i m p u l a n 3 7 5 2 S a r a n 3 7

D A F T A R PUSTAKA 38 LAMPIRAN 41 BIODATA 63

ix

DAFTAR T A B E L

Tabel Halaman

T a b e l 1 1 K e a s l i a n P e n e l i t i a n 5 T a b e l 3 1 D e f i n i s i O p e r a s i o n a l 2 1 T a b e l 4 1 D i s t r i b u s i P r o p o r s i K a r a k t e r i s t i k P a s i e n R a w a t i n a p

B e r d a s a r k a n U s i a d a n J e n i s K e i a m i n 2 6 T a b e l 4 2 D i s t r i b u s i P r o p o r s i K a r a k t e r i s t i k P a s i e n R a w a t J a l a n

B e r d a s a r k a n U s i a d a n J e n i s K e i a m i n 2 7 T a b e l 4 3 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n U s i a 2 8 T a b e l 4 4 D i s t r i b u s i P r o p o r s i K e j a d i a n i n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n J e n i s K e l a m m 2 8 T a b e l 4 5 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n T i n g k a t P e n d i d i k a n 2 9 T a b e l 4 6 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n R i w a y a t D i a b e t e s M e l i t u s 2 9 T a b e l 4 7 H a s i l U j i H u b u n g a n a n t a r a U s i a d e n g a n K e j a d i a n

i n f e k s i S a i u r a n K e m i h 3 0 T a b e l 4 8 H a s i i U j i H u b u n g a n a n t a r a J e n i s K e i a m i n d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i b 3 1 T a b e l 4 9 H a s i l U j i H u b u n g a n a n t a r a T i n g k a t P e n d i d i k a n d e n g a n

K e j a d i a n i n t e k s i S a i u r a n K e m i h 3 2 T a b e l 4 1 0 H a s i l U j i H u b u n g a n a n t a r a R i w a y a t D i a b e t e s M e l i t u s

d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h 3 3

X

DAFTAR GAMBAR

Gambar Halaman

G a m b a r 3 1 A l u r P e n e l i t i a n H u b u n g a n U s i a J e n i s K e i a m i n T i n g k a t

P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i h p a d a P a s i e n R a w a t i n a p

d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g I e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1

D e s e m b e r 2 0 1 5 2 4

xi

DAFTAR LAMPIRAN

Lampiran Halaman

L a m p i r a n 1 D a t a R e k a m M e d i s P a s i e n R a w a t I n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 4 3

L a m p i r a n 2 H a s i l A n a l i s i s U n v i a r i a t 4 5

L a m p i r a n 3 H a s i l A n a l i s i s B i v a r i a t 5 1

L a m p i r a n 4 K a r t u B i m b i n g a n P r o p o s a l S k r i p s i 5 8

L a m p i r a n 5 K a r t u B i m b i n g a n S k r i p s i 5 9

L a m p i r a n 6 S u r a t P e n n o h o n a n I z i n P e n e l i t i a n 6 0

L a m p i r a n 7 S u r a t K e t e r a n g a n I z i n P e n g a m b i l a n D a t a d a n P e n e l i t i a n 6 1

L a m p i r a n 8 S u r a t K e t e r a n g a n S e l e s a i P e n e l i t i a n 6 2

xii

BAB I

PENDAHULUAN

11 Latar Belakang

I n f e k s i s a i u r a n k e m i h ( I S K ) m e n i p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m i i k a n d i R u m a h S a k i t a t a u t e m p a t p r a k t i k u m u m s e h a r i - h a r i I S K

a d a i a h s u a t u i n f e k s i y a n g m e n g e n a i t r a k t u s u r i n a r i u s m u l a i d a r i m e a t u s u r e t r a

s a m p a i d e n g a n k e g i n j a l S t r u k t u r y a n g t e n n a s u k d i d a l a m n y a a d a i a h u r e t r a

k a n d u n g k e m i h u r e t e r p e l v i s d a n p a r e n k i m g i n j a l S t r u k t u r y a n g b e r k a i t a n u n t u k

t e r j a d i n y a i n f e k s i d a n r e k u r e n i n f e k s i y a i t u p r o s t a t e p i d i d i m i s d a n fascia

perinephric I s t i l a h I S K m e n u n j u k k a n a d a n y a k e b e r a d a a n m i k r o o r g a n i s m e d i

d a l a m u r i n ( S u d o y o 2 0 0 6 R u b i n 2 0 1 0 ) D e n g a n k a t a l a i n b a h w a d i a g n o s i s I S K

d i t e g a k k a n d e n g a n m e m b u k t i k a n a d a n y a m i k r o o r g a n i s m e d i d a l a m s a i u r a n k e m i h

( R u b i n 2 0 1 0 )

S e b a n y a k 2 5 j u t a k e m a t i a n d i s e l u r u h d u n i a p a d a t a h u n 2 0 1 1 s e p e r t i g a n y a

d i s e b a b k a n o l e h p e n y a k i t i n f e k s i I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n i n f e k s i

d e n g a n k e t e r l i b a t a i i b a k t e r i t e r s e r i n g d i k o m u n i t a s d a n h a m p i r 1 0 o r a n g p e m a h

t e r k e n a I S K s e l a m a h i d u p n y a S e k i t a i - 1 5 0 j u t a p e n d i i d u k d i s e l u r u h d u n i a t i a p

t a l i u n n y a t e r d i a g n o s i s m e n d e r i t a i n f e k s i s a i u r a n k e m i h ( Y u n u s 2 0 1 2 )

I S K d a p a t m e n g e n a i s e m u a k e l o m p o k u m u r b a i k a n a k r e m a j a d e w a s a

m a u p u n u s i a l a n j u t P r e v a l e n s i a n a k u s i a s e k o l a h y a n g m e n d e r i t a I S K s e k i t a r 1 -

3 d a n m e n i n g k a t p a d a r e m a j a y a n g s u d a h m e l a k u k a n h u b i m g a n s e k s u a l

( K o m a r a 2 0 0 9 ) D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r 2 5 - 3 5

s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a S e l a m a

p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n c e n d e r u n g

m e n d e r i t a I S K d i b a n d i n g k a n l a k i - l a k i ( S u d o y o 2 0 0 9 )

R a s i o I S K p a d a w a n i t a d i b a n d i n g p r i a b e r k i s a r 3 0 1 d a n s e k i t a r 5 0 w a n i t a

y a n g t e r k e n a i n f e k s i a k a n b e r k e m b a n g m e n j a d i I S K b e m l a n g I S K m e n i p a k a n

i n f e k s i b a k t e r i y a n g p a l i n g s e r i n g p a d a a n a k - a n a k d e n g a n k e l u h a n d e m a m b a i k

p a d a a n a k p r i a m a u p u n w a n i t a P r e v a l e n s i y a n g p e m a h d i l a p o r k a n b e r k i s a r 4 1

I

2

s a m p a i 7 5 R e k u r e n s i c u k u p s e r i n g d a n t e r j a d i s e k i t a r 1 8 p a d a b a y i l a k i - i a k i

d a n 2 6 p a d a b a y i p e r e m p u a n U n t u k u s i a p r a s e k o l a h I S K l e b i h s e r i n g

m e n g e n a i w a n i t a I n s i d e n I S K p a d a a n a k - a n a k p r a s e k o l a h s e k i t a r 2 ( S y a h r i n i

2 0 1 1 )

D a r i b e r b a g a i p e n e l i t i a n e p i d e m i o l o g i s d i I n d o n e s i a d i d a p a t k a n p r e v a l e n s i

D M s e b e s a r 15 - 2 3 p a d a p e n d u d u k u s i a l e b i J i d a r i 1 5 t a h u n b a h k a n p a d a

s u a t u p e n e l i t i a n e p i d e m i o l o g i s d i M a n a d o d i d a p a t k a n p r e v a l e n s i D M a d a i a h 6 1

P r e v a l e n s i d i a b e t e s m e l i t u s p a d a p e n d u d u k u s i a 2 5 - 6 4 t a h u n d i J a w a d a n B a l i

s e b e s a r 7 5 P e n e l i t i a n y a n g d i l a k u k a n d i J a k a r t a S u r a b a y a M a k a s a r d a n k o t a -

k o t a l a i n d i I n d o n e s i a m e m b u k t i k a n a d a n y a k e n a i k a n p r e v a l e n s i d a r i t a h u n

k e t a h u n ( D E P K E S 2 0 1 4 W H O 2 0 1 0 )

I n f e k s i s a i u r a n k e m i h j u g a m e n i p a k a n m a s a l a h k l i n i s u m u m p a d a p e n d e r i t a

D M o l e h k a r e n a p e n d e r i t a D M m e m p u n y a i k e m u n g k i n a n m e n d e r i t a I S K l e b i h

t i n g g i d i b a n d i n g k a n d e n g a n b u k a n p e n d e r i t a D M d a n j u g a m e n d e r i t a i n f e k s i y a n g

l e b i h b e r a t y a n g a k a n m e n i n g k a t k a n risiko u n t u k m a s u k m m a h s a k i t ( H a r d i n g

d k k 2 0 1 0 ) P e n e l i t i a n y a n g d i l a k u k a n o l e h B o y k o d k k m e n d a p a t k a n w a n i t a D M

ripe 2 d e n g a n b a k t e r i u r i a s i m t o m a t i k s e t e l a h d i l a k u k a n p e m a n t a u a n s e l a m a 1 8

b u l a n m e n g a l a m i p e n i n g k a t a n r i s i k o m e n d a p a t k a n I S K s e b a n y a k 3 4

d i b a n d i n g k a n d e n g a n w a n i t a y a n g t i d a k m e n g a l a m i D M s e b e s a r 1 9 ( B o y k o d k k

2 0 0 2 )

B e r d a s a r k a n u r a i a n - u r a i a n d i a t a s s e r t a b e l u m a d a n y a p e n e l i t i a n y a n g

m e n e m u k a n k e t e r k a i t a n f a k t o r u s i a j e n i s k e l a m m t i n g k a t p e n d i d i k a n d a n r i w a y a t

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h d i K o t a P a l e m b a n g m a k a

p e n e l i t i t e r t a r i k i m t i i k m e l a k u k a n p e n e l i t i a n m e n g e n a i h u b u n g a n a n t a r a u s i a j e n i s

k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

3

12 Rumusan Masalah

1 B a g a i m a n a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s

m e l i t u s

2 A p a k a l i a d a h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

13 Tujuan Penelitian

131 Tujuan Umum

T u j u a n u m u m d a r i p e n e l i t i a n i n i a d a i a h d i k e t e m u k a n n y a h u b u n g a n a n t a i a

u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i m s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

132 Tujuan Khusus

T u j u a n k l i u s u s d a r i p e n e l i t i a n i n i y a i t u

1 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a

2 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n m f e k s i s a i u r a n k e m i b p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n j e n i s k e i a m i n

3 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

4

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n t i n g k a t p e n d i d i k a n

4 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n riwayat d i a b e t e s m e l i t u s

5 T e r a n a l i s i s n y a h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a i m n a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

6 T e r a n a l i s i s n y a h u b u n g a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

7 T e r a n a l i s i s n y a h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

8 T e r a n a l i s i s n y a h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i u i s d e n g a n k e j a d i a n

i n f e k s i s a l i u a i i k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

14 Manfaat Penelitian

141 Manfaat Teoritis

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t m e n a m b a h p e n g e t a h u a n p e n e l i t i

t e n t a n g h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i U i s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

5

142 Manfaat Praktis

A Bagi Peneliti

H a s i l p e n e l i t i a n i n i d i l i a r a p k a n d a p a t d i g u n a k a n s e b a g a i s a l a h s a t u b a h a n

r e f e r e n s i a t a u b a c a a n b a g i p e n e l i t i

B Bagi Institusi

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t d i g u n a k a n p i h a k R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g s e b a g a i s a l a l i s a t u b a h a n a c u a n d a l a m m e n g u p a y a k a n

p e n c e g a h a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

15 Keaslian Penelitian

T a b e l 1 1 K e a s l i a n P e n e l i t i a n

Nama Judul Penelitian Desain Hasil Penelitian

Peneliti Penelitian

Kugan P r e v a l e n s i I n f e k s i Cross D a r i p e n e l i t i a n i i i i

Kandasamy S a i u r a n K e m i l i P a d a seciUmal d i p e r o l e h b a l i w a

W a n i t a Y a n g M e n d e r i t a

D i a b e t e s M e l i t u s T i p e

I I Y a n g D i r a w a t I n a p

p a s i e n w a n i t a d i a b e t e s

m e l i t u s t i p e I y a n g

m e n d e r i t a I S K y a n g

D a n D i r a w a t J a l a n D i d i r a w a t m a p d a n

S u b b a g i a n

E n d o k r i n o l o g i B a g i a n

P e n y a k i t D a l a m D i

d i r a w a t j a l a n d i s u b

b a g i a n E n d o k r i n o l o g i

P e n y a k i t D a l a m

R S U P H A d a m M a l i k R S U P H A d a m

P a d a T a l i u n 2 0 0 9 M a l i k M e d a i i t e r d a p a t

s e b a n y a k 2 5 o r a n g

y a i t u ( 1 2 7 ) D a r i 2 5

o r a n g y a n g m e n d e r i t a

I S K t e r d a p a t 3 o r a n g

y a i t u ( 1 2 0 ) y a n g

d i r a w a t i n a p d a n 2 2

6

o r a n g ( 8 8 0 ) y a n g

d i r a w a t j a l a n

Edel Weisela P e r b e d a a n R i s i k o

Permata I n f e k s i N o s o k o m i a l

Sari dan S a i u r a n K e m i h

Prijono B e r d a s a r k a n

Satyabakti K a i e t e r i s a s i U r i n

U m u r D a n D i a b e t e s

M e l i t u s T a h u n 2 0 1 5

Case H a s i l p e n e l i t i a n y a n g

control d i 1 a k u k a n p a d a 2 0

s a m p e l k a s u s d a n

k o n t r o l m e n u n j u k k a n

b a h w a p a s i e n d e n g a n

u m u r gt 5 5 t a h u n

m e m p u n y a i r i s i k o

5 5 7 k a l i m e n g a l a m i

i n f e k s i n o s o k o m i a l

s a i u r a n k e m i h

d i b a n d i n g k a n p a s i e n

d e n g a n u m u r lt 5 5

t a h u n d e n g a n

p e r i l i t u n g a i i b e s a r

risiko d i p e r o l e h n i l a i

O R s e b e s a r 5 5 7

d e n g a n n i l a i 9 5

(onfidence Interval

l 1 9 lt O R lt 2 8 2 3

P a s i e n d e n g a n s t a t u s

D M m e m p u n y a i risiko

6 k a l i u n t u k

m e n g a l a m i i n f e k s i

n o s o k o m i a l s a i u r a n

k e m i h d i b a n d i n g k a n

d e n g a n p a s i e n y a n g

t i d a k m e n d e r i t a D M

d e n g a n n i l a i O R

7

s e b e s a r 6 0 0 d e n g a n

n i l a i 9 5 Confidence

Interval 1 22 lt O R lt

3 2 2 6

Andry K a r a k t e r i s t i k P a s i e n - D e s k r i p k i f H a s i i p e n e l i t i a n d a r i

Lukandy P a s i e n I n f e k s i S a i u r a n r e t r o s p e k t i f 4 3 o r a n g p e n d e r i t a

K e m i i i d i P o l i u r o l o g i

R S U D D r P i m g a d i

K o t a M e d a n T a h u n

2 0 1 2 - 2 0 1 3

I S K d i d a p a t k a n 5 3 5

p a d a k e l o m p o k u s i a

gt 5 0 t a h u n 5 1 2

b e i j e n i s k e i a m i n l a k i -

l a k i 1 0 0 t i d a k

m e n d e r i t a

v e s i c o u r e t r a l r e f l u x

7 0 Benign Prostatic

Hyperplasia 1 1 6

b a t u s a i u r a n k e m i h

2 7 9 d i a b e t e s t i p e 2

D a r i h a s i l p e n e l i t i a n

i n i d a p a t d i s i m p u l k a n

b a h w a p e n d e r i t a i S K

l e b i h b a n y a k t e r j a d i

p a d a l a k i - l a k i d a n

p e n d e r i t a I S K l e b i h

b a n y a k d i j u m p a i p a d a

k e l o m p o k u m u r gt 5 0

t a h u n s e r t a d i t e m u k a n

I S K d e n g a n B P H

B S K d a n D M T i p e 2

BAB 11

TINJAUAN PUSTAKA

21 Landasan Teori

211Infeksi Saiuran Keniih

A Definisi

I n f e k s i S a i u r a n K e m i h a d a i a h i n v a s i d a n m u l t i p l i k a s i m i k r o o r g a n i s m e a t a u

p a r a s i t d a l a m j a r i n g a n t u b u h k h u s u s n y a s a i u r a n k e m i h y a n g t e r d i r i d a r i g i n j a l

u r e t e r b u l i - b u l i d a n u r e t r a y a n g d i i a n d a i d e n g a n a d a n y a b a k t e r i 1 0 c f i i (colony

forming unit) p e r m l p a d a p e n g a m b i l a n c o n t o h u r i n ( P u m o m o 2 0 1 1 )

I n f e k s i s a i u r a n k e m i h a d a l a l i s u a t u i n f e k s i y a n g m e l i b a t k a n g i n j a l lU e ter

b u l i - b u l i a t a u p u n u r e t r a I n f e k s i s a i u r a n k e m i h ( I S K ) a d a l a l i i s t i l a h u m u m y a n g

m e n u n j u k k a n k e b e r a d a a n m i k r o o r g a n i s m e d a l a m u r i n ( S u d o y o 2 0 0 6 )

B a k t e r i u r i a b e r m a k n a (significant hacteriuria) a d a i a h s u a t u k e a d a a n y a n g

m e n u n j u k k a n p e n u m b u l i a n m i k r o o r g a n i s m e m u m i l e b i h d a r i 1 0 c f t L m l p a d a

b i a k a n u r i n B a k t e r i u r i a b e r m a k n a m u n g k i n t a n p a d i s e r t a i p r e s e n t a s i k l i n i s I S K

d a n d i n a m a k a n b a k t e r i u r i a a s i m t o m a t i k (convert hacteriuria) S e b a l i k n y a

b a k t e r i u r i a b e n n a k n a d i s e r t a i p e r s e n t a s i k l i n i s I S K d i n a m a k a n b a k t e r i u r i a

s i m t o m a t i k P a d a b e b e r a p a k e a d a a n t e r d a p a t p a s i e n d e n g a n p e r s e n t a s i k l i n i s I S K

n a m u n t a n p a b a k t e r i u r i a b e n n a k n a S e l a i n i t u d i k a t a k a n p i u r i a ( l e u k o s i t d a l a m

u r i n ) b e n n a k n a (significant pyuria) b i l a d i t e m u k a n n e u t r o f i l gt 1 0 s e l p e r l a p a n g a n

p a n d a n g ( S u d o y o 2 0 0 6 )

B Epidemiologi

I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m u k a n d i p r a k t i k u m u m w a i a u p u n b e n n a c a m - m a c a m a n t i b i o t i k a s u d a h

t e r s e d i a l u a s d i p a s a r a n D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r

2 5 - 3 5 s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a

S e l a m a p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n

9

10

c e n d e r u n g m e n d e r i t a i S K d i b a n d i n g k a n l a k i - l a k i I S K b e m l a n g p a d a l a k i - l a k i

j a r a n g d i l a p o r k a n k e c u a l i d i s e r t a i f a k t o r p r e d i s p o s i s i ( p e n c e t u s )

P r e v a l e n s i b a k t e r i u r i a a s i m t o m a t i k l e b i h s e r i n g d i t e m u k a n p a d a p e r e m p u a n

P r e v a l e n s i s e l a m a p e r i o d e s e k o l a h (school girls) 1 m e n i n g k a t m e n j a d i 5

s e l a m a p e r i o d e a k t i f s e c a r a s e k s u a l P r e v a l e n s i i n f e k s i a s i m t o m a t i k m e n i n g k a t

m e n c a p a i 3 0 b a i k l a k i - l a k i m a u p u n p e r e m p u a n b i l a d i s e r t a i f a k t o r p r e d i s p o s i s i

( S u d o y o 2 0 0 6 )

C Kiasifikasi

I n f e k s i s a i u r a n k e m i h d a p a t d i b a g i m e n j a d i d u a k a t e g o r i u m u m b e r d a s a r k a n

l o k a s i a n a t o m i y a i t u

1 ) I n f e k s i s a i u r a n k e m i h b a w a h

2 ) I n f e k s i s a i u r a n k e m i h a l a s

P r e s e n t a s i k l i n i s d a r i i n f e k s i s a i u r a n k e m i h b a w a l i t e r g a n t u n g d a r i gender

y a i t u

a ) P e r e m p u a n

a S i s t i t i s

S i s t i t i s a d a i a h p r e s e n t a s i k l i n i s i n f e k s i k a n d u n g k e m i h d i s e r t a i

b a k t e r i u r i a b e n n a k n a

b S i n d r o m U r e t r a A k u t ( S U A )

S i n d r o m a u r e t r a a k u t a d a i a h p r e s e n t a s i k l i n i s s i s t i t i s t a n p a d i t e m u k a n

a d a n y a m i k r o o r g a n i s m e d a l a m L u i n ( s t e r i l ) d a n s e r i n g d i n a m a k a n

s i s t i t i s b a k t e r i a l i s

b ) L a k i - l a k i

P r e s e n t a s i k l i n i s i n f e k s i s a i u r a n k e m i h p a d a l a k i - l a k i m u n g k i n s i s t i t i s

p r o s t a t i t i s e p i d i m i d i s d a n u r e t r i t i s

I n f e k s i s a i u r a n k e m i h a t a s t e r b a g i m e n j a d i 2 y a i t u

1 ) P i e l o n e f r i t i s A k u t ( P N A )

P i e l o n e f r i t i s a k u t a d a l a l i p r o s e s i n f l a m a s i p a r e n k i m g i n j a l y a n g d i s e b a b k a n

o l e h m f e k s i b a k t e r i

11

2 ) P i e l o n e f r i t i s K r o n i s ( P N K )

P i e l o n e f r i t i s k r o n i s m u n g k i n a k i b a t l a n j u t d a r i i n f e k s i b a k t e r i

b e r k e p a n j a n g a n a t a u i n f e k s i s e j a k m a s a k e c i i O b s t r u k s i s a i u r a n k e m i h d a n

r e f l u k s v e s i k o u r e t e r d e n g a n a t a u t a n p a b a k t e r i u r i a k r o n i k s e r i n g d i i k u t i

p e m b e n t u k a n j a r i n g a n i k a t p a r e n k i m g i n j a l y a n g d i t a n d a i d e n g a n

p i e l o n e f r i t i s k r o n i k y a n g s p e s i f i k ( S u d o y o 2 0 0 6 )

D Etiologi

P a d a k e a d a a n n o r m a l u r i n b e r s i f a t s t e r i l U m u m n y a I S K d i s e b a b k a n o l e h

k i i m a n g r a m n e g a t i f E s c h e r i c h i a c o l i m e m p a k a n p e n y e b a b t e r b a n y a k b a i k p a d a

y a n g s i m t o m a t i k m a u p u n y a n g a s i m t o m a t i k y a i t u 7 0 - 9 0 E n t e r o b a k t e r i a s e p e r t i

P r o t e u s m i r a b i l i s ( 3 0 d a r i i n f e k s i s a i u r a n k e m i h p a d a a n a k l a k i - l a k i t e t a p i

k u r a n g d a r i 5 p a d a a n a k p e r e m p u a n ) K l e b s i e l l a p n e u m o n i a d a n P s e u d o m o n a s

a e m g i n o s a d a p a t j u g a s e b a g a i p e n y e b a b O r g a n i s m e g r a m p o s i t i f s e p e r t i

S t r e p t o c o c c u s f a e c a l i s ( e n t e r o k o k u s ) S t a p h y l o c o c c u s e p i d e n n i d i s d a n

S t r e p t o c o c c u s v i r i d a n s j a r a n g d i t e m u k a n P a d a u r o p a t i o b s t m k t i f d a n k e l a i n a n

s t r u k t u r s a i u r a n k e m i h p a d a a n a k l a k i - l a k i s e r i n g d i t e m u k a n P r o t e u s s p e c i e s P a d a

I S K n o s o k o m i a l a t a u I S K k o m p l e k s l e b i h s e r i n g d i t e m u k a n k u m a n P r o t e u s d a n

P s e u d o m o n a s ( L u m b a n b a t u S M 2 0 0 3 )

E Patofisiologi

P a d a i n d i v i d u n o n n a l b i a s a n y a u r i n l a k i - l a k i m a u p u n p e r e m p u a n s e l a l u

d a l a m k e a d a a n s t e r i l k a r e n a d i p e r t a l i a n k a n o l e h j u m l a l i d a n f r e k u e n s i b e r k e m i h

U t e r o d i s t a l m e m p a k a n t e m p a t k o l o n i s a s i m i k r o o r g a n i s m e nonpathogenic

fastidious G r a m - p o s i t i f d a n g r a m n e g a t i f ( S u d o y o 2 0 0 6 )

H a m p i r s e m u a I S K d i s e b a b k a n i n v a s i m i k r o o r g a n i s m e ascending d a r i u r e t r a

k e d a l a m k a n d u n g k e m i b P a d a b e b e r a p a p a s i e n t e r t e n t u i n v a s i m i k r o o r g a n i s m e

d a p a t m e n c a p a i k e g i n j a l P r o s e s i n i d i p e n n u d a h o l e h k o n d i s i r e f l u k s

v e s i k o i i r e t e r a l P r o s e s i n v a s i m i k r o o r g a n i s m e h e m a t o g e n s a n g a t j a r a n g d i t e m u k a n

d i k l i n i k m u n g k i t a k i b a t l a n j u t d a r i b a k t e r e m i a G i n j a l d i d u g a m e n i p a k a n l o k a s i

12

i n f e k s i s e b a g a i a k i b a t l a n j u t d a r i s e p t i k e m i a a t a u e n d o k a r d i t i s a k i b a t S t a f i l o k o k u s

a u r e u s K e l a i n a n g i n j a l y a n g t e r k a i t d e n g a n e n d o k a r d i t i s ( S t a f i l o k k o k u s a u r e u s )

d i k e n a l d e n g a n N e p h r i t i s L o h e i n B e b e r a p a p e n e l i t i a n m e l a p o r k a n p i e l o n e f r i t i s

a k u t ( P N A ) s e b a g a i a k i b a t l a n j u t i n v a s i h e m a t o g e n ( S u d o y o 2 0 0 6 )

F Faktor Risiko

P a t o f i s i o l o g i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h d a p a t d i p e n g a n i h i o l e h

b e b e r a p a f a k t o r A d a p u n b e b e r a p a f a k t o r risiko y a n g m e m p e n g a n i l i i t e r j a d i n y a

i n f e k s i s a i u r a n k e m i h a n t a r a l a i n

1 ) U s i a

I n s i d e n I S K m e n i n g k a t b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i

m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n a d a n y a a b n o r m a l i t a s a n a t o m i y a n g

m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n k e m i h s e p e r t i p e m b e s a r a n p r o s t a t

d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e

P e n y e b a b l a i n t e r m a s u k p e r i n e u m y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s

p e n y a k i t n e u r o m u s k n l a r d a n k a t e t e r i s a s i b u l i - b u l i S e l a i n i t u i n s i d e n I S K

m e n c a p a i 1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o s e 2 0 0 9 F o x m a n e t a l 2 0 1 0

R o n a l d 2 0 1 1 )

M e n u m t t e o r i y a n g d i k e m u k a k a n o l e h S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a d a u s i a

l a n j u t a k a n t e r j a d i p e n i n g k a t a n k e r e n t a n a n t e r h a d a p p e n y a k i t P a d a u s i a d i a t a s 5 0

t a l i u n t e r j a d i p e n u m n a n k e m a m p u a n d a l a m m e m p e r t a h a n k a n s t e n l i t a s b a i k p a d a

k a n d u n g k e m i h m a u p u n u r e t r a H a l t e r s e b u t d i s e b a b k a n o l e h i n v o l u s i t i m u s

I n v o l u s i s e l t i m u s m e n y e b a b k a n j u m l a h se d a n k u a l i t a s r e s p o n s s e l T s e m a k i n

b e r k u r a n g J u m l a h s e l T m e m o r i m e n i n g k a t n a m u n s e m a k i n s u l i t u n t u k

b e r k e m b a n g t e r u t a m a s i t o t o k s i k s e l T ( C D ^ ) d a n s e l T h l ( C D ^ ^ ) k a r e n a t e r j a d i

a p o p t o s i s S i t o t o k s i k s e l T ( C D ^ ^ ) b e i p e r a n d a l a m r e s p o n s i m u n t e r h a d a p a n t i g e n

p a d a s e l y a n g d i i n f e k s i d e n g a n c a r a m e m b u n u l i s e l y a n g t e r i n f e k s i u n t u k

m e n c e g a h p e n y e b a r a n m f e k s i s e d a n g k a n s e l T h l ( C D ^ ^ ) b e r p e r a n m e m b a n t u s e l

B u n t u k m e m p r o d u k s i a n t i b o d i

13

2 ) J e n i s k e l a m m d a n a k t i v i t a s s e k s u a l

I n s i d e n s i I S K y a n g r e n d a h p a d a p r i a d i p e n g a n i h i o l e h 3 f a k t o r y a i t u

1 L e b i h s e d i k i t t e r j a d i k o l o n i s a s i s e k i t a r u r e t r a k a r e n a t i d a k a d a n y a t e m p a t

s e p e r t i v a g i n a p a d a p e r e m p u a n

2 M e m i l i k i u r e t r a y a n g p a n j a n g

3 A d a n y a s u b s t a n s i a n t i b a k t e r i a l p a d a c a i r a n p r o s t a t

U r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a h d e n g a n d e k a t n y a v a g i n a l

v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h l e b i h s e r i n g

p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a f l o r a n o n n a l p a d a d a e r a l i p e r i u r e t r a t e r d i r i

d a r i o r g a n i s m e s e p e r t i l a c t o b a c i l l i i s y a n g m e m b a n t u m e l a w a n k o l o n i s a s i b a k t e r i

p a t o g e n p a d a s a i u r a n k e m i h P e r u b a l i a n l i n g k i m g a n d a r i p e r i u r e t r a l s e p e r t i

p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k b i s a m e n g g a n g g u f l o r a

n o r m a l s e h i n g g a m e m u n g k i n k a n b a k t e r i p a t o g e n b e r k o l o n i s a s i d a n m e n y e b a b k a n

i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

P a d a w a n i t a l e b i h d a r i 5 0 t a h u n a t a u l e b i h m e n o p a u s e m e m p a k a n f a k t o r

l a i n y a n g m e n i n g k a t k a n P V R Post Void Residual) s e l a i n p e n u r u n a n k o i i t r a k t i i i t a s

o t o t d e t r u s o r P e n u m n a n e s t r o g e n y a n g d i s e b a b k a n m e n o p a u s e d a p a t

m e n i n g k a t k a n p H v a g i n a l d a n m e n u m n k a n j u m l a l i l a c t o b a c i l l i A k i b a m y a t e r j a d i

p e n i n g k a t k a n k o l o n i s a s i d a r i b a s i l g r a m n e g a t i f s e h i n g g a m e n i n g k a t k a n r e s i k o

t e r j a d i n y a I S K P a d a p r i a p r o s t a t m e n s e k r e s i k a n c a i r a n y a n g m e n g a n d i m g z i n k

y a n g m e m i l i k i a k t i f i t a s m i k r o b i a l ( K i m 2 0 1 2 )

S e l a i n i t u p i j a t a n u r e t r a s e p e r t i y a n g t e r j a d i s e l a m a h u b u n g a n s e k s u a l

m e n y e b a b k a n m a s u k n y a b a k t e r i k e d a l a m k a n d u n g k e m i h d a n m e m p a k a n h a l

y a n g p e n t i n g d a l a m p a t o g e n e s i s m f e k s i s a l i u a n k e m i h p a d a p e r e m p u a n m u d a

B u a n g a i r k e c i l s e t e l a h h u b u n g a n s e k s u a l t e r b u k t i m e n u m n k a n risiko s i s t i t i s

m u n g k i n k a r e n a t i n d a k a n i n i m e n i n g k a t k a n e r a d i k a s i b a k t e r i y a n g m a s u k s e l a m a

h u b u n g a n s e k s u a l ( K i m 2 0 1 2 )

3 ) T i n g k a t P e n d i d i k a n

P e n g e t a h u a n s e s e o r a n g t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t

p e n d i d i k a n S e s e o r a n g y a n g m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m i u i g k i n a n

p e n g e t a h u a n t e n t a n g k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o n n a s i y a n g d i d a p a t k a n

14

t e n t a n g k e s e h a t a n l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h

S e b a l i k n y a p e n d i d i k a n y a n g k u r a n g d a p a t m e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g

t e r h a d a p n i l a i - n i l a i y a n g b a n i d i k e n a l ( N o t o a d i n o j o 2 0 0 3 )

4 ) R i w a y a t D i a b e t e s M e l i t u s

M e n u r u t S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a s i e n d e n g a n s t a t u s D M s a n g a t

b e r i s i k o u n t u k m e n g a l a m i i n f e k s i s a i u r a n k e m i h A b n o n n a l i i a s s t n i k t u r d a n

k a n d u n g k e m i h n e u r o g e n i k a k i b a t n e u r o p a t i o t o n o m a t a u s t r o k e p a d a p a s i e n D M

m e n y e b a b k a n p e n g o s o n g a n k a n d u n g k e m i h t i d a k n o n n a l D M j u g a d a p a t

m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a h a n a n t u b u h y a n g b e r p o t e n s i m e n i n g k a t

risiko t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a h a n a n t u b u h t e r s e b u t d i a n t a r a n y a

a d a i a h k e g a g a l a n m i g r a s i s e l intracellular killing f a g o s i t o s i s d a n k e m o t a k s i s

p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n m e k a n i s m e p e r t a h a n a n

a l a m i a h i o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p i n f e k s i

5 ) K e h a m i i a n

K e c e n d e r u n g a n i n f e k s i s a i u r a n k e m i h b a g i a n a t a s s e l a m a k e h a m i i a n

d i s e b a b k a n o l e h p e n u m n a n k e k u a t a n u r e t e r p e n u m n a n p e r i s t a l t i k u r e t e r d a n

i n k o m p e t e n s i s e m e n t a r a k a l u p v e s i k o i u - e t e r a l y a n g t e r j a d i s e l a m a h a m i l

6 ) S u m b a t a i i

A d a n y a I i a i a n g a n a l i r a n b e b a s u r i n s e p e r t i t u m o r s t r i k t r a a b a t u a t a u

h i p e r t r o f i p r o s t a t d a p a t m e n y e b a b k a n h i d r o n e f r o s i s d a n risiko i n f e k s i s a i u r a n

k e m i l i y a n g s a n g a t t i n g g i S e l a i n i t u s u p e r i n f e k s i p a d a s u m b a t a n s a i u r a n k e m i h

d a p a t m e n y e b a b k a n k e m s a k a n j a r i n g a n g i n j a l y a n g c e p a t

7 ) D i s f u n g s i n e u r o g e n i k k a n d u n g k e m i h

G a n g g u a n s a r a f y a n g b e k e r j a p a d a k a n d m i g k e m i h s e p e r t i p a d a j e j a s k o r d a

s p i n a l i s t a b e s d o r s a i i s m u l t i p e l s k l e r o s i s d i a b e t e s m e l i t u s a t a u p e n y a k i t l a i n

d a p a t b e r h u b u n g a n d e n g a n i n f e k s i s a i u r a n k e m i h I n f e k s i d a p a t d i a w a l i o l e h

p e n g g u n a a n k a t e l e r u n t u k d r a i n a s e k a n d i u i g k e m i h d a n d i d u k i m g o l e h s t a t i s u r i n

d a l a m k a n d u n g k e m i l i u n t u k j a n g k a w a k t u y a n g l a m a

8 ) R e f l u k s v e s i k o m e t e r a

K e a d a a n i n i d i d e f i n i s i k a n s e b a g a i r e f l u k s u r i n d a r i k a n d u n g k e m i b k e u r e t e r

d a n k a d a n g s a m p a i k e p e l v i s r e n a l H a l i n i t e r j a d i s e l a m a b u a n g a i r k e c i l a t a u

15

d e n g a n p e n i n g k a t a n t e k a n a n p a d a k a n d u n g k e m i h R e f l u k s v e s i k o i i r e t e r a l d a p a t

d i b u k t i k a n d e n g a n a d a n y a g c r a k a n r e t r o g r a d z a t r a d i o o p a k a t a u r a d i o a k t i f m e l a l u i

s i s t o u r e t r o g r a m s e l a m a b u a n g a i r k e c i l R e f l u k s v e s i k o i i r e t e r a l b i a s a n y a

d i s e b a b k a n k a r e n a a d a n y a g a n g g u a n a n a t o m i s p a d a p e r t e m u a n v e s i k o i i r e t e r a l

y a n g d a p a t m e n y e b a b k a n r e f l u k s u r i n d i s e r t a i b a k t e r i d a n k a r e n a i t u t e r j a d i l a h

i n f e k s i s a l r a a n k e m i h

9 ) F a k t o r v i r u l e n s i b a k t e r i

F a k t o r v i r u l e n s i b a k t e r i m e m p e n g a r u b i k e m u n g k i n a n vragt7 t e r t e n m d a l a m

m e n y e b a b k a n i n f e k s i t r a k i u s u r i n a r i u s H a m p i r s e m u a strain F c o l i y a n g

m e n y e b a b k a n p i e l o n e f r i t i s p a d a p a s i e n d e n g a n t r a k i u s u r i n a r i u s n o m i a l s e c a r a

a n a t o m i k m e m p u n y a i p i l u s t e r t e n t u y a n g m e m p e r a n t a r a i p e r l e k a t a n p a d a b a g i a n

d i g a k t o s i d a d a n g l i k o s f i n g o l i p i d y a n g a d a d i u r o e p i t e l Strain y a n g m e n i m b u l k a n

p i e l o n e f r i t i s j u g a b i a s a n y a m e m p a k a n p e n g b a s i l h e m o l i s i n m e m p u n y a i

a e r o b a k t i n d a n r e s i s t e n t e r h a d a p k e r j a b a k t e r i s i d a l d a r i s e m m m a n u s i a

1 0 ) F a k t o r g e n e t i k

F a k t o r g e n e t i k p e n j a m u m e m p e n g a n i l i i k e r e n t a n a n t e r h a d a p i n f e k s i t r a k t u s

u r i n a r i u s J u m l a h d a n t i p e r e s e p t o r p a d a s e l u r o e p i t e l t e m p a t b a k t e r i d a p a t

m e n e m p e l s e l i d a k i i y a s e b a g i a i i d i t e n t u k a r i s e c a r a g e n e t i k ( I s s e l b a c h e r 2 0 0 9 )

G Manifestasi Klinis

G e j a l a k l i n i s d a r i i n f e k s i s a i u r a n k e m i h s e s u a i d e n g a n b a g i a n s a i u r a n k e m i h

y a n g t e r i n f e k s i a d a i a h s e b a g a i b e r i k u t

1 ) I n f e k s i s a i u r a n k e m i h b a g i a n b a w a l i

K e l u h a n p a s i e n b i a s a n y a b e m p a r a s a s a k i t a t a u r a s a p a n a s d i u r e t r a s e w a k t u

k e n c i n g d e n g a n a i r k e m i h s e d i k i t - s e d i k i t s e r t a r a s a t i d a k e n a k d i d a e r a h

s i i p r a p u b i k

2 ) I n f e k s i s a i u r a n k e m i h b a g i a n a t a s

P a d a i n t e k s i s a i u r a n k e m i h b a g i a n a t a s d a p a t d i t e m u k a n g e j a l a s e p e r t i s a k i t

k e p a l a m a l a i s e m u a l m m i t a h d e n i a m m e n g g i g i l r a s a t i d a k e n a k a t a u

n y e r i d i p i n g g a n g ( T e s s y d k k 2 0 0 1 )

16

H Tatalaksana

T u j u a n p e n a t a l a k s a n a a a n i n f e k s i s a i u r a n k e m i h a d a i a h m e n c e g a h d a n

m e n g h i l a n g k a n g e j a l a m e n c e g a h d a n m e n g o b a t i b a k t e n e m i a d a n b a k t e r i u r i a s e r t a

m e n c e g a h d a n m e n g u r a n g i r i s i k o k e r u s a k a n g i n j a l y a n g m u n g k i n t i m b u l d e n g a n

p e m b e r i a n o b a t - o b a t a n y a n g s e n s i t i f m u r a l i d a n a m a n d e n g a n e f e k s a m p i n g y a n g

m i n i m a l

a ) i n f e k s i s a i u r a n k e m i h ( I S K ) b a w a h

P r i n s i p p e n a t a l a k s a n a a n I S K b a w a h m e l i p u t i intake c a i r a n y a n g b a n y a k

a n t i b i o t i k y a n g a d e k u a t d a n b i l a p e r l u t e r a p i s i m t o m a t i k u n t u k a l k a l i s a s i

u r i n

i H a m p i r 8 0 p a s i e n a k a n m e m b e r i k a n r e s p o n s e t e l a h 4 8 j a m d e n g a n

a n t i b i o t i k a t u n g g a l s e p e r t i a m p i s i l i n 3 g r a m a t a u t r i m e t o p r i m 2 0 0 m g

i i B i l a i n f e k s i m e n e t a p d i s e r t a i k e l a i n a n u r i n a l i s i s ( l e u k o s i u i a ) d i p e r i u k a n

t e r a p i k o n v e n s i o n a l s e l a m a 5 - 1 0 h a r i

i i i P e m e r i k s a a n m i k r o s k o p i s u r i n d a n b i a k a n u r i n t i d a k d i p e r i u k a n b i l a

s e m u a g e j a l a h i l a n g d a n t a n p a l e u k o s u r i a

b ) I n f e k s i s a i u r a n k e m i h ( I S K ) a t a s

P a d a u m u m n y a p a s i e n d e n g a n p i e l o n e f r i t i s a k u t m e m e r l u k a n r a w a t i n a p

u n t u k m e m e l i h a r a s t a t u s h i d r a s i d a n t e r a p i a n t i b i o t i k a p a r e n t e r a l p a l i n g

s e d i k i t 4 8 j a m ( S u d o y o 2 0 0 6 )

i Komplikasi

K o m p l i k a s i i n f e k s i s a i u r a n k e m i h t e r g a n t u n g d a r i t i p e y a i t u i n f e k s i s a i u r a n

k e m i h t i p e s e d e r h a n a (uncomplicated) d a n t i p e b e r k o m p l i k a s i (complicated)

1 ) I n f e k s i s a i u r a n k e m i h s e d e r h a n a (uncomplicated)

I n f e k s i s a i u r a n k e m i h a k u t t i p e s e d e r h a n a ( s i s t i t i s ) y a i t u n o n - o b s t r u k s i d a n

b u k a n p e r e m p u a n h a m i l m e m p a k a n p e n y a k i t r i n g a n (self limited disiase)

d a n t i d a k m e n y e b a b k a n a k i b a t l a n j u t j a n g k a l a m a

2 ) I n f e k s i s a i u r a n k e m i h b e r k o m p l i k a s i (complicated)

a ) I n f e k s i s a i u r a n k e m i h s e l a m a k e h a m i i a n

b ) i n f e k s i s a i u r a n k e m i h p a d a d i a b e t e s m e l i t u s ( S u d o y o 2 0 0 6 )

17

22 Kerangka Teori

J

U s i a

J e n i s K e i a m i n

T i n g k a t P e n d i d i k a n

R i w a y a t D i a b e t e s M e l i m s

S u m b a t a n bullT

K e h a m i i a n

D i s f u n g s i n e u r o g e n i k

R e f l u k s v e s i k o i i r e t e r a l

V i r u l e n s i b a k t e r i

F a k t o r g e n e t i k

I n f e k s i b a k t e r i g r a m p o s i t i f a t a u n e g a t i v e p a d a s a i u r a n k e m i h

I n f e k s i S a i u r a n K e m i h

Keterangan

I j = V a r i a b e l y a n g t i d a k d i t e l i t i

= V a r i a b e l y a n g d i t e l i t i

18

Hipotesis

H i p o t e s i s d a l a m p e n e l i t i a n i n i a d a i a h

H O t i d a k t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n

t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

H I t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

BAB 111

M E T O D E PENELITIAN

31 Jenis Penelitian

P a d a p e n e l i t i a n i n i j e n i s p e n e l i t i a n y a n g d i g u n a k a n a d a i a h p e n e l i t i a n

o b s e r v a s i o n a i a n a l i t i k d e s a i n cross scclional d e n g a n m e n g g u n a k a n d a t a s e k u n d e r

d a r i r e k a m m e d i s p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1 D e s e m b e r

2 0 1 5

32 Waktu dan Tempat Penelitian

321 Waktu Penelitian

W a k t u p e n e l i t i a n d i l a k s a n a k a n p a d a t a n g g a l 1 O k t o b e r s a m p a i d e n g a n 3 0

O k t o b e r 2 0 1 6

322 Tempat Penelitian

P e n e l i t i a n i n i d i l a k s a n a k a n d i R u m a l i S a k i t M u h a m m a d i y a h P a e m b a n g ( d i

R u a n g R e k a m M e d i s )

33 Populasi dan Sampel Penelitian

331Populasi Penelitian

P a d a p e n e l i t i a n i n i p o p u l a s i t a r g e t a d a l a l i p a s i e n r a w a t i n a p d a n r a w a t j a l a n

d i R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g s e d a n g k a n p o p u l a s i t e r j a n g k a u n y a

a d a i a h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

332Sampel dan Besar Sampel Penelitian

P a d a p e n e l i t i a n i n i s a m p e l p e n e l i t i a n a d a i a h p a s i e n r a w a t i n a p d a n r a w a t

j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e

1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 y a n g m e m e n u h i k r i t e r i a i n k l u s i p e n e l i t i a n

1 9

20

d e n g a n b e s a r s a m p e l y a n g l a y a k d a l a m p e n e l i t i a n m e n u r u t t e o r i R o s c o e a d a i a h

a n t a r a t i g a p u l u h s a m p a i l i m a r a t i i s o r a n g ( S u g i y o n o 2 0 1 5 )

333 Krttena Inklusi dan Eksklusi

A Kriteria Inklusi

P a d a p e n e l i t i a n i n i k r i t e r i a i n k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t i n a p

d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i

P a l e m b a n g y a n g d i d i a g n o s a m e n g a l a m i i n f e k s i s a i u r a n k e m i h s e r t a m e m i l i k i d a t a

r e k a m m e d i s p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

B Kriteria Eksklusi

P a d a p e n e l i t i a n i n i k r i t e r i a e k s k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t

i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 d e n g a n d a t a r e k a m m e d i s

y a n g t i d a k l e n g k a p

334 Cara Pengambilan Sampel Penelitian

C a r a p e n g a m b i l a n s a m p e l y a n g d i g u n a k a n d a l a m p e n e l i t i a n i n i a d a l a l i

m e n g g u n a k a n t e k n i k consecutive sampling P a d a consecutive sampling s e t i a p

p a s i e n y a n g m e m e n u h i k r i t e r i a p e n e l i t i a n d i m a s u k k a n d a l a m p e n e l i t i a n s a m p a i

k u r u n w a k t u t e r t e n U i s e h i n g g a j u m l a h m i n i m a l y a n g d i p e r i u k a n t e r p e n u h i

( S a s t r o a s m o r o 2 0 1 1 )

34 Variabel Penelitian

341 Variabel Dependent

V a r i a b e l dependent f t e r i k a t ) d a l a m p e n e l i t i a n i n i a d a i a h i n f e k s i s a i u r a n

k e m i h

342 Variabel Independent

V a r i a b e l independent ( b e b a s ) d a l a m p e n e l i t i a n i n i a d a i a h u s i a j e n i s

k e l a i n i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

21

35 Definisi Operasional

Tabel 31 Definisi Operasional

Variabel Alat Cara ueiinisi rldsil L KUr I7 i l l 11 Lz fe 1 V

oKaia LiKur Penelitian Ukur Ukur

Infeksi P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Saiuran d i d i a g n o s a o l e h m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Keniih d o k t e r m e n g a l a m i m e d i s

i n f e k s i s a i u r a n

k e m i h d a n t e r c a n t u m

d i r e k a m m e d i s

U s i a L a m a n y a t a h u n R e k a m O b s e r v a s i 1 lt 5 0 t a h u n O r d i n a l

k e h i d u p a n p a s i e n m e d i s r e k a m 2 gt 5 0 t a l i u n ( k a t e g o r i k )

d a r i l a h i r s a m p a i m e d i s

s e k a r a n g d a n

t e r c a n t u m d i r e k a m

m e d i s

Jenis P r o f i l a n a t o m i a t a u R e k a m O b s e r v a s i 1- L a k i - l a k i N o m i n a l

Keiamin b i o l o g i s p a s i e n y a n g m e d i s r e k a m 2 P e r e m p u a n ( k a t e g o r i k )

d i b e d a k a n m e n j a d i m e d i s

i a k i - l a k i d a n

n e r e m m i a n s e r t a

t e r c a n t u m d i r e k a m

m e d i s

Tingkat P e n d i d i k a n f o n n a l R e k a m O b s e r v a s i 1 P e n d i d i k a n O r d i n a l

Pendidikan t e r a k h i r y a n g m e d i s r e k a m d a s a r ( S D ( k a t e g o r i k )

d i t e m p u h o l e h m e d i s M I S M P

p a s i e n d a n t e r c a n t u m d a n M T s )

d i r e k a m m e d i s 2 P e n d i d i k a n

m e n e n g a l i

d a n t i n g g i

22

( S M A M A

S M K

M A K

d i p l o m a

s a r j a n a

m a g i St e r

s p e s i a l i s

d a n d o k t o r )

Riwayat P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Diabetes d i d i a g n o s i s d e n g a n m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Melitus d i a b e t e s m e l i t u s d a n

t e r c a n t u m d i d a l a m

r e k a m m e d i s

m e d i s

36 Cara Pengumpulan Data

361 Data Sekunder

P e n g u m p u l a n d a t a p a d a p e n e l i t i a n i n i d i p e r o l e h d a r i d a t a s e k u n d e r y a i t u

r e k a m m e d i s p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

37 Metode Teknik Analisis Data

371Cara Pengolahan dan Analisis Data

P e n g o l a h a n d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n m e l a l u i e m p a t t a h a p y a i t u

i Oala Entry

P a d a t a i i a p i n i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n riwayat d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g y a n g t e l a h d i d a p a t d a n

r e k a m m e d i s d i k u m p u l k a n d a n d i m a s u k k a n k e d a l a m p r o g r a m spss

23

2 Editing

P a d a t a h a p i n i d a t a i i s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n y a n g t e l a h d i m a s u k k a n k e d a l a m p r o g r a m s p s s

d i p e r i k s a k e m b a l i a p a k a h s u d a h l e n g k a p d a n t i d a k a d a k e k e l i r u a n

3 ( oding

S e t e l a h m e l a l u i p r o s e s editing d a t a - d a t a t e r s e b u t d i b e r i k o d e t e r t e n t u a n t a r a

l a i n k o d e 1 u n t u k u s i a gt 5 0 t a h u n j e n i s k e i a m i n p e r e m p u a n t i n g k a t

p e n d i d i k a n d a s a r t e r d a p a t r i w a y a t d i a b e t e s m e l i t u s d a n i n f e k s i s a i u r a n

k e m i h s e d a n g k a n k o d e 2 u n t u k u s i a lt 5 0 t a h u n j e n i s k e i a m i n l a k i - l a k i

t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i t i d a k t e r d a p a t r i w a y a t d i a b e t e s

m e l i t u s d a n b u k a n i n f e k s i s a i u r a n k e m i h s e h i n g g a m e m u d a h k a n d a l a m

m e l a k u k a n a n a l i s i s d a t a

4 Tahulaling

P a d a t a h a p i n i d a t a y a n g s a m a d i k e l o m p o k k a n s e c a r a t e l i t i d a n t e r a t m

k e m u d i a n d i l i i t u n g d e n g a n m e n g g u n a k a n p r o g r a m sps s d a n d i j u m l a h k a i i

l a l u d i s a j i k a n d a l a m b e n t u k t a b e l - t a b e l

U n t u k m e n g a n a l i s i s d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n a n a l i s i s d a t a

u n i v a r i a t d a n b i v a r i a t d e n g a n m e n g g u n a k a n p r o g r a m s p s s s e b a g a i b e r i k u t

A A n a l i s i s u n i v a r i a t

A n a l i s i s u n i v a r i a t d i l a k u k a n d e n g a n c a r a m e l a k u k a n a n a l i s i s p a d a s e t i a p

v a r i a b e l h a s i l p e n e l i t i a n d e n g a n t u j u a n u n t u k m e n g e t a h u i d i s t r i b u s i p r o p o r s i p a d a

s e t i a p v a r i a b e l p e n e l i t i a n D a t a d i s a j i k a n d a l a m b e n t u k t a b e l d a n n a r a s i

B A n a l i s i s b i v a r i a t

A n a l i s i s b i v a r i a t d i l a k u k a n d e n g a n m e n g g u n a k a n u j i h i p o t e s i s chi-square

U j i h i p o t e s i s chi-square d a p a t d i g u n a k a n d e n g a n s y a r a t y a i t u lt 2 0 s e l y a n g

m e m p u n y a i n i l a i expected count k u r a n g d a r i l i m a s e h i n g g a j i k a t i d a k m e m e n u h i

s y a r a t u j i chi-square m a k a u j i y a n g d i g u n a k a n a d a i a h u] fisher ( D a h l a n 2 0 1 4 )

B a t a s k e m a k n a a n y a n g d i g u n a k a n a d a i a h a = 0 0 5 J i k a d i d a p a t k a n p value lt 0 0 5

p a d a u j i s t a t i s t i k m a k a t i d a k t e r d a p a t h u b u n g a n y a n g b e n n a k n a a n t a r a d u a

v a r i a b e l y a n g d i t e l i t i d a n H O d i t e r i m a S e d a n g k a n j i k a d i d a p a t k a n p value gt 0 0 5

24

p a d a u j i s t a t i s t i k m a k a t e r d a p a t l i u b u n g a n y a n g b e n n a k n a a n t a r a d u a v a r i a b e l

y a n g d i t e l i t i d a n H O d i t o l a k

38 Alur Penelitian

P e n e n t u a n p o p u l a s i d a n s a m p e l p e n e l i t i a n

K r i t e r i a i n k l u s i K r i t e r i a e k s k l u s i

P e n g a m b i l a n s a m p e l p e n e l i t i a n

P e n g o l a h a n d a n a n a l i s i s d a t a d e n g a n u j i chi-square

H a s i l d a n p e m b a h a s a n

K e s i m p u l a n d a n s a r a n

Gambar 31 Alur Penelitian Hubungan Usia Jenis Keiamin Tingkat Pendidikan dan Riwayat Diabetes Melitus dengan Kejadian Infeksi Saiuran Kemih pada Pasien Rawat Inap di Bagian Penyakit Dalam Rumah Sakit Muhammadiyah Palembang Periode 1 Januari 2015 sampai dengan 31 Desember 2015

BAB IV

HASIL DAN PEMBAHASAN

41 Hasil

P e n e l i t i a n i n i t e l a h d i l a k u k a n d i r u a n g r e k a m m e d i s R u m a h S a k i t

M u h a i m n a d i y a h P a l e m b a n g d a r i t a n g g a l 1 O k t o b e r 2 0 1 5 - 3 1 O k t o b e r 2 0 1 6

P e n e l i t i a n d i m u l a i d e n g a n p e n g a m b i l a n d a t a a w a l b e m p a d a t a r e k a m m e d i s

s e l u r u h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

S e l a n j u t n y a r e k a m m e d i s d i p i l i h s e s u a i d e n g a n k r i t e r i a i n k l u s i d a n e k s k l u s i u n t u k

d i j a d i k a n s a m p e l p e n e l i t i a n s a m p a i m i n i m a l b e s a r s a m p e l y a n g d i b u t u h k a n

t e r p e n u h i s e r t a d i l a k u k a n p e n e l i t i a n s e c a r a o b s e r v a s i o n a i O b s e r v a s i r e k a m m e d i s

d i l a k u k a n u n m k m e n g e t a h u i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t

d i a b e t e s m e l i t u s d a n d i a g n o s a p a s i e n

D a r i c a t a t a n r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g

d i d a p a t k a n s e b a n y a k 4 1 4 1 r e k a m m e d i s p a s i e n r a w a t i n a p d a n 1 4 5 3 r e k a m m e d i s

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 D a r i t o t a l r e k a m m e d i s

p a s i e n r a w a t i n a p d a n r a w a t j a l a n t e r s e b u t p e n e l i t i h a n y a m e n g a m b i l m i n i m a l

b e s a r s a m p e l y a n g d i b u t u h k a n y a i t u s e b a n y a k 9 8 r e k a m m e d i s u n t u k d i j a d i k a n

s a m p e l p e n e l i t i a n y a n g t e r d i r i d a r i 3 0 r e k a m m e d i s p a s i e n y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i h d a n 6 8 r e k a m m e d i s y a n g t i d a k m e n g a l a m i i n f e k s i s a i u r a n k e m i h

411 Hasil Analisis Univariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s u n i v a r i a t

a n t a r a l a i n d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p b e r d a s a r k a n u s i a d a n

j e n i s k e l a m m d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n b e r d a s a r k a n u s i a

d a n j e n i s k e i a m i n d i s t r i b u s i p r o p o r s i s a m p e l b e r d a s a r k a n k e j a d i a n m f e k s i s a i u r a n

k e m i h s e r t a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n u s i a

j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

25

26

A Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan IJsta

dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 41 Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan

Usia dan Jenis Keiamin

Paisen Rawat Inap N Persentase

Usia

1 7 - 2 5 t a h u n 678 1 6 4

2 6 - 3 5 t a h u n 952 2 3 0

3 6 - 4 5 t a l i u n 745 18 0

4 6 - 5 5 t a h u n 695 1 6 8

5 6 - 6 4 t a h u n 571 1 3 8

gt 6 4 t a h u n 500 1 2 1

U s i a r a t a - r a t a ( t a h u n j 43plusmn16543

Jenis Keiamin

P e r e m p u a n 2 6 3 8 6 3 7

L a k i - l a k i 1 5 0 3 3 6 3

Total 4141 100

B e r d a s a r k a n t a b e l 4 1 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R i u n a h S a k i t M u l i a m m a d i y a l i

P a l e m b a n g p e r i o d e J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 2 6 - 3 5 t a h u n y a i t u

s e b a n y a k 9 5 2 o r a n g ( 2 3 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 43plusmn16543 t a l i u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 2 6 3 8 o r a n g ( 6 3 7 )

27

B Distribusi Proporsi Karakteristik Pasien Rawat Jalan Berdasarkan

Usia dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 42 Distribusi Proporsi Karakteristik Pasien Rawat Jalan

Berdasarkan Usia dan Jenis Keiamin

Fasten Rawat Jalan N Persentase

Usia

1 7 - 2 5 t a h u n 9 2 6 3

2 6 - 3 5 t a l n i n 1 3 1 9 0

3 6 - 4 5 t a h u n 2 7 9 1 9 2

46-55 t a l i u n 4 2 1 2 9 0

5 6 - 6 4 t a h u n 3 1 6 2 1 7

gt 6 4 t a h u n 2 1 4 1 4 7

U s i a r a t a - r a t a ( t a h u n ) 50plusmn14120

Jenis Keiamin

P e r e m p u a n 8 9 0 6 1 3

L a k i - l a k i 5 6 3 3 8 7

Total 1453 100

B e r d a s a r k a n t a b e l 4 2 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 4 6 - 5 5 t a h u n y a i t u

s e b a n y a k 4 2 1 o r a n g ( 2 9 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 50plusmn14120 t a h u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 8 9 0 o r a n g ( 6 1 3 )

28

C Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Usia

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i b b e r d a s a r k a n u s i a d a p a t

d i i i h a t p a d a l a b e l d i b a w a h i n i

Tabel 43 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Usia

Usia N Persentase

lt 5 0 t a h u n 1 4 4 6 7

gt 5 0 t a l i u n 1 6 5 3 3

Total 30 100

B e r d a s a r k a n t a b e l 4 3 d i a t a s d a p a t d i k e t a h u i b a h w a u s i a t e r b a n y a k p a d a

s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h gt 5 0 t a h u n y a i t u s e b a n y a k

1 6 o r a n g ( 5 3 3 )

D Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Jenis

Keiamin

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n j e n i s

k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 44 Distribusi Proporsi Kejadian infeksi Saiuran Kemih Berdasarkan

Jenis Keiamin

Jenis Keiamin N Persentase

P e r e m p u a n 1 8 6 0 0

L a k i - l a k i 1 2 4 0 0

Total 30 100

B e r d a s a r k a n t a b e l 4 4 d i a t a s d a p a t d i k e t a h u i b a h w a j e n i s k e i a m i n

t e r b a n y a k p a d a s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h p e r e m p u a n

y a i t u s e b a n y a k 1 8 o r a n g ( 6 0 0 )

29

E Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n t i n g k a t

p e n d i d i k a n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 45 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

Tingkat Pendidikan N Persentase

P e n d i d i k a n d a s a r 20 6 6 7

P e n d i d i k a n m e n e n g a h d a n P e n d i d i k a n m e n e n g a h d a n 10 333

t i n g g i

Total J O 100

B e r d a s a r k a n t a b e l 4 5 d i a t a s d a p a t d i k e t a l i u i b a l i w a t i n g k a t p e n d i d i k a n

t e r b a n y a k p a d a s a m p e i y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h t i n g k a t

p e n d i d i k a n d a s a r y a i t u s e b a n y a k 20 o r a n g ( 6 6 7 )

P Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n riwayat

d i a b e t e s m e l i t u s d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 46 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

Riwayat Diabetes Melitus N Persentase

Y a 17 5 6 7

T i d a k 13 433

Total 30 100

B e r d a s a r k a n t a b e l 4 6 d i a t a s d a p a t d i k e t a h u i b a l i w a s a m p e l y a n g

m e n g a l a m i i n f e k s i s a i u r a n k e m i h t e r b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s

y a i t u s e b a n y a k 1 7 o r a n g ( 5 6 7 )

30

412 Hasil Analisis Bivariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s b i v a r i a t

a n t a r a I a i n h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h j e n i s

k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h t i n g k a t p e n d i d i k a n d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n

i n f e k s i s a l m a n k e m i h

A n a l i s i s y a n g d i g u n a k a n p a d a u j i d u a v a r i a b e l y a n g b e r s k a l a k a t e g o r i k

a d a l a l i d e n g a n u j i Chi-Square d e n g a n n i e i h a t n i l a i Pearson Chi-Square S e m u a

h a s i l d a r i u j i h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h m e n g g i u i a k a n u j i Chi-

Square k a i e n a m e m e n u h i s y a r a t u j i Chi-Square y a i t u lt 2 0 s e l y a n g m e m p u n y a i

n i l a i expected count lt 5

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 47 Hasil Uji Hubungan antara Usia dengan Kejadian Infeksi

Saiuran Kemih

Usia

Infeksi Saiuran Kemih

^a Tidak

n N Mgt

Jumlah P

value 95Cl

lt 50 t a h u n 1 4 1 9 2 5 9 8 0 8 7 3 0 0 0 0 2 7 4 7 - 2 0 4 3 1

gt 5 0 t a h u n 1 6 6 4 0 9 3 6 0 2 5

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 7 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R = 7 4 9 2

( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a u s i a gt

5 0 t a h u n a d a l a l i 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a u s i a lt 5 0 t a h u n

31

B Hubungan antara Jenis Keiamin dengan Kejadian Infeksi Saiuran

Kemih

H a s i l a n a l i s i s b i v a r i a t l i u b u n g a n a n t a r a j e n i s k e l a i n i n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

Tabel 48 Hasil Uji Hubungan antara Jenis Keiamin dengan Kejadian

Infeksi Saiuran Kemih

Infeksi Saiuran Kemih Jenis P

A Tidak Jumlah 95CI Keiamin value

N N

P e r e m p u a n 18 6 4 3 10 357laquoo 2 8 3 2 2 7 -P e r e m p u a n 0 0 0 0

L a k i - l a k i 12 1 7 1 5 8 8 2 9 7 0 2 3 4 5 9

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 8 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a l a l i

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k N 4 a k a a d a l i u b u n g a n y a n g s i g n i f i k a n a n t a r a

j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R ) = 8 7 0 0

f 9 5 C I = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a l a k i - l a k i

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e n i i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

32

Tabel 49 Hasil liji Hubungan antara Tingkat Pendidikan dengan

Kejadian Infeksi Saiuran Kemih

Infeksi Saiuran Kemih P

Y a T i d a k jumlah 95CI value

N

P e n d i d i k a n d a s a r 2 0 5 4 1 1 7 4 5 9 3 7

P e n d i d i k a n

m e n e n g a h d a n 10 1 6 4 5 1 8 3 6 6 1

t i n g g i

Jumlah JO 30 6 68 694 9H

B e r d a s a r k a n t a b e l 4 9 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( 0 R ) =

6 0 0 0 ( 9 5 C I = 2 3 5 1 - 1 5 3 1 0 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r a d a i a h 6 k a l i l e b i h b e s a r

d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i h a t

p a d a t a b e l d i b a w a h i n i

Tingkat

Pendidikan

2 3 5 1 -0 0 0 0

1 5 3 1 0

33

Tabel 4t0 Hasil I j i Hubungan antara Riwayat Diabetes Melitus dengan

Kejadian Infeksi Saiuran Kemih

Riwayat Infeksi Saiuran Kemih P

Diabetes Va Tidak Jumlah value

95CI

Melitus N bullVJ N

Y a

T i d a k

17

1 3

6 8 0

1 7 8

8

6 0

3 2 0

8 2 2

2 5

7 3 0 0 0 0

3 4 9 3 -

2 7 5 3 6

Jumlah 30 306 68 571 98

B e r d a s a r k a n t a b e l 4 1 0 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio

( O R ) = 9 8 0 8 ( 9 5 C I - 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r

d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s m e l i m s

42 Pembahasan

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a l a b e l 4 7 d i d a p a t k a n b a l i w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i b d e n g a n n i l a i s i g n i f i k a n n y a a d a l a l i 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k

Odds Ratio ( O R ) = 7 4 9 2 ( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a u s i a T 5 0 t a h u n a d a i a h 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a

u s i a lt 5 0 t a h u n

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n A n d r y L u k a n d y

( 2 0 1 4 ) m e n g e n a i k a r a k t e r i s t i k p a s i e n - p a s i e n i n f e k s i s a i u r a n k e m i h d i m a n a

p e n d e r i t a I S K d e n g a n k e l o m p o k u m u r gt 5 0 t a h u n s e b a n y a k 2 3 o r a n g s e d a n g k a n

j u m l a h p e n d e r i t a I S K d e n g a n k e l o m p o k u m m lt 5 0 t a l i u n s e b a n y a k 2 0 o r a n g

P e n e l i t i a n i n i j u g a d i p e i k u a t o l e h p e n l i t i a n L e w i s A l e t a l ( 2 0 1 4 ) m e n g e n a i

impact of host age and parity on susceptihility to severe urinary tract injection in

34

a murine mode d e n g a n u j i K r u s k a l - W a l l i s d e n g a n post-test D u n n u n t u k b e b e r a p a

p e r b a n d i n g a n d i m a n a u s i a d a n p a r i t a s s e b a g a i f a k t o r y a n g b e r k o n t r i b u s i d a l a m

k e r e n t a n a n i m t u k t e r j a d i n y a I S K d e n g a n n i l a i p lt 0 0 5

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n g a t a k a n b a h w a i n s i d e n I S K m e n i n g k a t

b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n

a d a n y a a b n o r m a l i t a s a n a t o m i y a n g m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n

k e m i h s e p e r t i p e m b e s a r a n p r o s t a t d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a

p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e ( R o s e 2 0 0 9 ) P e n y e b a b l a i n t e n n a s u k

p e r i n e i u n y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s p e n y a k i t n e u r o m u s k u l a r

d a n k a t e t e r i s a s i b u l i - b u l i ( F o x m a n e t a l 2 0 1 0 ) S e l a i n i t u i n s i d e n I S K m e n c a p a i

1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o n a l d 2 0 1 1 )

B Hubungan antara Jenis Keiamin dengan Kejadian infeksi Saiuran

Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 8 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d e n g a n n i l a i s i g n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O

d i t o l a k Odds Ratio ( O R ) = 8 7 0 0 ( 9 5 C l = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a risiko k e j a d i a n

i n f e k s i s a i u r a n k e m i h p a d a p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n

p a d a l a k i - i a k i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n M a g i i a n o e t a l

( 2 0 1 1 ) m e n g e n a i Gender and Age-Dependent Etiology of Community Acquired

y a n g m e l a k u k a n p e n g a m b i l a n 6 1 2 7 3 s a m p e l k u l t u r u r i n d a l a m p e r i o d e 2 2 b u l a n

d a r i s a m p e l i n i d i d a p a t k a n 1 3 8 2 0 ( 2 2 6 ) d i t e m u k a n p o s i t i f i n f e k s i b a k t e r i

h a m p i r 8 0 b a l i a n y a n g d i i s o l a s i b e r a s a l d a r i p e r e m p u a n P e n e l i t i a n i n i j u g a

d i p e r k u a t o l e h p e n e l i t i a n y a n g d i l a k u k a n o l e h Y u n i t a I ( 2 0 1 0 ) d i m a n a a d a

h u b m i g a n y a n g b e n n a k n a a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h ( P value=O049 R P = 3 2 7 3 ( 9 5 C I = I 0 1 6 - 1 0 5 4 0 )

H a l t e r s e b u t d a p a t t e r j a d i k a r e n a u r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a l i

d e n g a n d e k a t n y a v a g i n a l v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i

s a i u r a n k e m i h l e b i h s e r i n g p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a flora n o r m a l

3 5

p a d a d a e r a h p e r i u r e t r a t e r d i r i d a r i o r g a n i s m e s e p e r t i i a c t o b a c i l l u s y a n g m e m b a n t u

m e l a w a n k o l o n i s a s i b a k t e r i p a t o g e n p a d a s a i u r a n k e m i h P e r u b a h a n l i n g k i m g a n

d a r i p e r i u r e t r a l s e p e r t i p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k

b i s a m e n g g a n g g u f l o r a n o r m a l s e h i n g g a m e n u m g k i n k a n b a k t e r i p a t o g e n

b e r k o l o n i s a s i d a n m e n y e b a b k a n i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Scuare p a d a t a b e l 4 9 d i d a p a t k a n b a h w a

t e r d a p a t l i u b u n g a n y a n g s i g n i f i k a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a

H O d i t o l a k Odds Ratio ( O R ) - 6 0 0 0 ( 9 5 o C l = 2 3 5 1 - 1 5 3 I O ) a r t i n y a n s i k o

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r

a d a i a h 6 k a l i l e b i h b e s a r d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n

m e n e n g a h d a n t i n g g i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h T o r o n d e i B e t

a l ( 2 0 1 5 ) m e n g e n a i Menstrual Hygiene Practices WASH Access and the Risk of

Urogenital Infection in Women from Odisha India d i m a n a p e r e m p u a n y a n g

h a n y a m e n e m p u l i p e n d i d i k a n s e k o l a h d a s a r a t a u l e b i h r e n d a h d i b a n d i n g k a n

d e n g a n t i n g k a t p e n d i d i k a n m e n e n g a h a t a u t i n g g i m e m i l i k i r i s i k o 3 k a l i

k e m u n g k i n a n l e b i h b e s a r m e n g a l a m i i n f e k s i s a i u r a n k e m i h ( A d j O R = 3 l 9 5

C 1 = I 2 - 7 9 p = 0 0 2 )

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a p e n g e t a h u a n s e s e o r a n g

t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t p e n d i d i k a n S e s e o r a n g y a n g

m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m u n g k i n a n p e n g e t a l i u a n t e n t a n g

k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o r m a s i y a n g d i d a p a t k a n t e n t a n g k e s e h a t a n

l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h S e b a l i k n y a

p e n d i d i k a n y a n g k u r a n g d a p a t i n e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g t e r h a d a p

n i l a i - n i l a i y a n g b a r u d i k e n a l ( N o t o a d m o j o 2 0 0 3 )

3 6

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Keniih

B e r d a s a r k a n l i a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 1 0 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a r i w a y a t d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 )

s e h i n g g a H O d i t o l a k Odds Ratio ( O R ) = 9 8 0 8 ( 9 5 C I = 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a

risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h S a r i E W P d a n

S a t y a b a k t i P ( 2 0 1 5 ) m e n g e n a i p e r b e d a a n risiko i n f e k s i n o s o k o m i a l s a i u r a n k e m i h

b e r d a s a r k a n k a t e t e r i s a s i u r i n u m u r d a n d i a b e t e s m e l i m s d i m a n a d a r i 2 0 p a s i e n

i n f e k s i n o s o k o m i a l s a i u r a n k e m i h 1 2 o r a n g ( 6 0 ) d i a n t a r a n y a a d a i a h p a s i e n

d e n g a n s t a t u s D M s e d a n g k a n 8 o r a n g ( 4 0 ) l a i n n y a a d a i a h p a s i e n t a n p a s t a t u s

D M ( P v W w ^ = 0 0 2 4 O R = 6 0 0 9 5 C I = 1 2 2 - 3 2 2 6

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a b a l i w a b e b e r a p a b a g i a n

d a r i i i n u n i t a s p a d a p a s i e n d i a b e t e s m e n g a l a m i p e r u b a h a n F u n g s i

p o l i n i o r f o l e u k o s i t d i t e k a n p a d a k e a d a a n a s i d o s i s I k a t a n l e u k o s i t k e m o t a k s i s d a n

f a g o s i t o s i s j u g a b e m b a l i S i s t e m a n t i o k s i d a n y a n g b e r p e r a n p a d a a k t i f i t a s

b a k t e r i s i d a l j u g a t e r g a n g g u s e h i n g g a m e n y e b a b k a n t e r j a d i n y a I S K p a d a p a s i e n -

p a s i e n d e n g a n p e n y a k i t d i a b e t e s ( J u l k a 2 0 1 4 )

H a l y a n g s a m a j u g a d i i m g k a p k a n o l e b t e o r i S m e l t z e r d a n B a r e ( 2 0 1 0 )

b a l i w a D M d a p a t m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a l i a n a n t u b u h y a n g

b e r p o t e n s i m e n i n g k a t k a n r i s i k o t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a l i a n a n

t u b u h t e r s e b u t d i a n t a r a n y a a d a i a h k e g a g a l a n m i g r a s i s e l iniraceliular killing

f a g o s i t o s i s d a n k e m o t a k s i s p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n

m e k a n i s m e p e r t a l i a n a n a l a m i a h I o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p

i n f e k s i

BAB V

KESIMPULAN DAN SARAN

51 Kesimpulan

1 U s i a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 2 6 - 3 5 t a h u n y a i t u 2 3 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 3 7

2 U s i a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 4 6 - 5 5 t a l i u n y a i t u 2 9 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 1 3

3 U s i a j e n i s k e i a m i n d a n t i n g k a t p e n d i d i k a n s a m p e i y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i l i t e r b a n y a k y a i t u b e r u s i a gt 5 0 t a h u n ( 5 3 3 ) j e n i s k e i a m i n

p e r e m p u a n ( 6 0 0 ) d a n t i n g k a t p e n d i d i k a n d a s a r ( 6 6 7 ) s e r t a p a l i n g

b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s y a i t u 5 6 7

4 T e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 ( p = 0 0 0 0 )

52 Saran

1 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t d i l a k u k a n d e n g a n d e s a i n

p e n e l i t i a n b e r b e d a s e p e r t i cohort a t a u case control

2 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t m e i i c a r i v a r i a b e l independent

y a n g l a i n s e p e r t i v a r i a b e l p e k e r j a a n p e m a s a i i g a n k a t e t e r a t a u l a m a n y a

m e n d e r i t a d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

37

DAFTAR PUSTAKA

B o y k o E J d k k 2 0 0 2 D i a b e t i c A n d T h e R i s k O f A c u t e U r i n a r y T r a c t I n f e c t i o n A m o n g P o s t m e n o p a u s a l W o m e n D i a b e t e s C a r e 2 5 ( 1 0 )

D a h l a n S 2 0 1 4 B u k i i S t a t i s t i k u n t u k K e d o k t e r a n d a n K e s e h a t a n D e s k r i p t i f B i v a r i a t d a n M u l t i v a r i a t d i l e n g k a p i a p l i k a s i d e n g a n m e n g g u n a k a n S P S S E d i s i 6 E p i d e m i o l o g i I n d o n e s i a J a k a r t a I n d o n e s i a

D e p a r t e m e n K e s e h a t a n ( D E P K E S ) R l 2 0 1 4 [ O n l i n e ] K e m e n t e r i a n K e s e h a t a n R e p u b l i k I n d o n e s i a P u s a t D a t a d a n I n f o r m a s i K e m e n t e r a n K e s e h a t a n R l ( http 7depkesgoid diakses tanggal 15 Met 2016)

F o x m a n B e t a i 2 0 1 0 U r i i i a i y T r a c t I n f e c t i o n A m o n g W o m e n A g e d 4 0 T o 6 5 B e h a v i o r a l A n d S e x u a l R i s k F a c t o r s D a l a m T a n a g h o E A M c A n i n c h J W 1 7 t h S m i t h s G e n e r a l U r o l o g y U S A M c G r a w H i l l (http searchproqnestcom diakses tanggal 16 Met 2016)

H a r d i n g G K d k k 2 0 1 0 A n t i m i c r o b i a l T r e a t m e n t I n D i a b e t i c W o m e n W i t l i A s y m t o m a t i c B a c t e r i u r i a N E n g l J M e d 3 4 7 1 5 7 6 - 1 5 8 3 (http nejmorg diakses tanggal 16 Met 2016)

I s s e l b a c h e r d k k 2 0 0 9 I n f e k s i S a i u r a n K e m i h d a n P i e l o n e f r i t i s D a l a m S t a m m W a l t e r E e d H a r r i s o n P r i n s i p - P r i n s i p l l m u P e n y a k i t D a l a m e d V o l u m e 2 J a k a r t a E G C 6 1 6 - 6 2 3

J u l k a S 2 0 1 3 G e n i t o u r i n a r y I n f e c t i o n I n D i a b e t e s I n d i a n J o u m a l o f E n d o c r i n o l o g y a n d M e t a b o l i s m (http searchproquestcom diakses tanggal 16 Mei 2016)

K i m B d k k 2 0 1 2 [ e - b o o k ] T h e R e l a t i o n b e t w e e n P o s t v o i d R e s i d u a l a n d O c c u r r e n c e o f U r i n a r y T r a c t I n f e c t i o n a f t e r S t r o k e i n R e h a b i l i t a t i o n U n i t A n n a l s o f R e h a b i l i t a t i o n M e d i c i n e

K o m a r a A 2 0 0 9 P o l a K e p e k a a n B a k t e r i G r a m N e g a t i f d a r i P a s i e n I n f e k s i S a i u r a n K e m i l i t e r h a d a p A n t i b i o t i k G e n t a m i c i n d a n K o t r i m o k s a z o l y a n g D i k i r i m k e L a b o r a t o r i u m M i k r o b i o l o g i K l i n i k F K U l d a r i T a h u n 2 0 0 1 s a m p a i T a h u n 2 0 0 5 (http dontaruiacid diakses tanggal OH Agustiis 2016)

L e w i s A L e t a l 2 0 1 4 I m p a c t o f H o s t A g e a n d P a r i t y o n S u s c e p t i b i l i t y t o S e v e r e U r i n a r y T r a c t I n f e c t i o n i n a M u r i n e M o d e l P l o s O n e R e s e a r c h A r t i c l e P u b l i c L i b r a r y o f S c i e n c e 9 ( 5 ) (http searchproquestcom diakses pada langgal 30 Desember 2016)

38

3 5 D e f i n i s i O p e r a s i o n a l 2 1 3 6 C a r a P e n g i i n i p u l a n D a t a 2 2

3 6 1 D a t a S e k u n d e r 2 2 3 7 M e t o d e T e k n i s A n a l i s i s D a t a 2 2

3 7 C a r a P e n g o l a h a n d a n A n a l i s i s D a t a 2 2 3 8 A l u r P e n e l i t i a n 2 4

BAB IV HASIL DAN PEMBAHASAN 25 4 1 H a s i l 2 5 4 2 P e m b a h a s a n 3 3

BAB V KESIMPLILAN DAN SARAN 37 5 1 K e s i m p u l a n 3 7 5 2 S a r a n 3 7

D A F T A R PUSTAKA 38 LAMPIRAN 41 BIODATA 63

ix

DAFTAR T A B E L

Tabel Halaman

T a b e l 1 1 K e a s l i a n P e n e l i t i a n 5 T a b e l 3 1 D e f i n i s i O p e r a s i o n a l 2 1 T a b e l 4 1 D i s t r i b u s i P r o p o r s i K a r a k t e r i s t i k P a s i e n R a w a t i n a p

B e r d a s a r k a n U s i a d a n J e n i s K e i a m i n 2 6 T a b e l 4 2 D i s t r i b u s i P r o p o r s i K a r a k t e r i s t i k P a s i e n R a w a t J a l a n

B e r d a s a r k a n U s i a d a n J e n i s K e i a m i n 2 7 T a b e l 4 3 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n U s i a 2 8 T a b e l 4 4 D i s t r i b u s i P r o p o r s i K e j a d i a n i n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n J e n i s K e l a m m 2 8 T a b e l 4 5 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n T i n g k a t P e n d i d i k a n 2 9 T a b e l 4 6 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n R i w a y a t D i a b e t e s M e l i t u s 2 9 T a b e l 4 7 H a s i l U j i H u b u n g a n a n t a r a U s i a d e n g a n K e j a d i a n

i n f e k s i S a i u r a n K e m i h 3 0 T a b e l 4 8 H a s i i U j i H u b u n g a n a n t a r a J e n i s K e i a m i n d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i b 3 1 T a b e l 4 9 H a s i l U j i H u b u n g a n a n t a r a T i n g k a t P e n d i d i k a n d e n g a n

K e j a d i a n i n t e k s i S a i u r a n K e m i h 3 2 T a b e l 4 1 0 H a s i l U j i H u b u n g a n a n t a r a R i w a y a t D i a b e t e s M e l i t u s

d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h 3 3

X

DAFTAR GAMBAR

Gambar Halaman

G a m b a r 3 1 A l u r P e n e l i t i a n H u b u n g a n U s i a J e n i s K e i a m i n T i n g k a t

P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i h p a d a P a s i e n R a w a t i n a p

d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g I e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1

D e s e m b e r 2 0 1 5 2 4

xi

DAFTAR LAMPIRAN

Lampiran Halaman

L a m p i r a n 1 D a t a R e k a m M e d i s P a s i e n R a w a t I n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 4 3

L a m p i r a n 2 H a s i l A n a l i s i s U n v i a r i a t 4 5

L a m p i r a n 3 H a s i l A n a l i s i s B i v a r i a t 5 1

L a m p i r a n 4 K a r t u B i m b i n g a n P r o p o s a l S k r i p s i 5 8

L a m p i r a n 5 K a r t u B i m b i n g a n S k r i p s i 5 9

L a m p i r a n 6 S u r a t P e n n o h o n a n I z i n P e n e l i t i a n 6 0

L a m p i r a n 7 S u r a t K e t e r a n g a n I z i n P e n g a m b i l a n D a t a d a n P e n e l i t i a n 6 1

L a m p i r a n 8 S u r a t K e t e r a n g a n S e l e s a i P e n e l i t i a n 6 2

xii

BAB I

PENDAHULUAN

11 Latar Belakang

I n f e k s i s a i u r a n k e m i h ( I S K ) m e n i p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m i i k a n d i R u m a h S a k i t a t a u t e m p a t p r a k t i k u m u m s e h a r i - h a r i I S K

a d a i a h s u a t u i n f e k s i y a n g m e n g e n a i t r a k t u s u r i n a r i u s m u l a i d a r i m e a t u s u r e t r a

s a m p a i d e n g a n k e g i n j a l S t r u k t u r y a n g t e n n a s u k d i d a l a m n y a a d a i a h u r e t r a

k a n d u n g k e m i h u r e t e r p e l v i s d a n p a r e n k i m g i n j a l S t r u k t u r y a n g b e r k a i t a n u n t u k

t e r j a d i n y a i n f e k s i d a n r e k u r e n i n f e k s i y a i t u p r o s t a t e p i d i d i m i s d a n fascia

perinephric I s t i l a h I S K m e n u n j u k k a n a d a n y a k e b e r a d a a n m i k r o o r g a n i s m e d i

d a l a m u r i n ( S u d o y o 2 0 0 6 R u b i n 2 0 1 0 ) D e n g a n k a t a l a i n b a h w a d i a g n o s i s I S K

d i t e g a k k a n d e n g a n m e m b u k t i k a n a d a n y a m i k r o o r g a n i s m e d i d a l a m s a i u r a n k e m i h

( R u b i n 2 0 1 0 )

S e b a n y a k 2 5 j u t a k e m a t i a n d i s e l u r u h d u n i a p a d a t a h u n 2 0 1 1 s e p e r t i g a n y a

d i s e b a b k a n o l e h p e n y a k i t i n f e k s i I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n i n f e k s i

d e n g a n k e t e r l i b a t a i i b a k t e r i t e r s e r i n g d i k o m u n i t a s d a n h a m p i r 1 0 o r a n g p e m a h

t e r k e n a I S K s e l a m a h i d u p n y a S e k i t a i - 1 5 0 j u t a p e n d i i d u k d i s e l u r u h d u n i a t i a p

t a l i u n n y a t e r d i a g n o s i s m e n d e r i t a i n f e k s i s a i u r a n k e m i h ( Y u n u s 2 0 1 2 )

I S K d a p a t m e n g e n a i s e m u a k e l o m p o k u m u r b a i k a n a k r e m a j a d e w a s a

m a u p u n u s i a l a n j u t P r e v a l e n s i a n a k u s i a s e k o l a h y a n g m e n d e r i t a I S K s e k i t a r 1 -

3 d a n m e n i n g k a t p a d a r e m a j a y a n g s u d a h m e l a k u k a n h u b i m g a n s e k s u a l

( K o m a r a 2 0 0 9 ) D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r 2 5 - 3 5

s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a S e l a m a

p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n c e n d e r u n g

m e n d e r i t a I S K d i b a n d i n g k a n l a k i - l a k i ( S u d o y o 2 0 0 9 )

R a s i o I S K p a d a w a n i t a d i b a n d i n g p r i a b e r k i s a r 3 0 1 d a n s e k i t a r 5 0 w a n i t a

y a n g t e r k e n a i n f e k s i a k a n b e r k e m b a n g m e n j a d i I S K b e m l a n g I S K m e n i p a k a n

i n f e k s i b a k t e r i y a n g p a l i n g s e r i n g p a d a a n a k - a n a k d e n g a n k e l u h a n d e m a m b a i k

p a d a a n a k p r i a m a u p u n w a n i t a P r e v a l e n s i y a n g p e m a h d i l a p o r k a n b e r k i s a r 4 1

I

2

s a m p a i 7 5 R e k u r e n s i c u k u p s e r i n g d a n t e r j a d i s e k i t a r 1 8 p a d a b a y i l a k i - i a k i

d a n 2 6 p a d a b a y i p e r e m p u a n U n t u k u s i a p r a s e k o l a h I S K l e b i h s e r i n g

m e n g e n a i w a n i t a I n s i d e n I S K p a d a a n a k - a n a k p r a s e k o l a h s e k i t a r 2 ( S y a h r i n i

2 0 1 1 )

D a r i b e r b a g a i p e n e l i t i a n e p i d e m i o l o g i s d i I n d o n e s i a d i d a p a t k a n p r e v a l e n s i

D M s e b e s a r 15 - 2 3 p a d a p e n d u d u k u s i a l e b i J i d a r i 1 5 t a h u n b a h k a n p a d a

s u a t u p e n e l i t i a n e p i d e m i o l o g i s d i M a n a d o d i d a p a t k a n p r e v a l e n s i D M a d a i a h 6 1

P r e v a l e n s i d i a b e t e s m e l i t u s p a d a p e n d u d u k u s i a 2 5 - 6 4 t a h u n d i J a w a d a n B a l i

s e b e s a r 7 5 P e n e l i t i a n y a n g d i l a k u k a n d i J a k a r t a S u r a b a y a M a k a s a r d a n k o t a -

k o t a l a i n d i I n d o n e s i a m e m b u k t i k a n a d a n y a k e n a i k a n p r e v a l e n s i d a r i t a h u n

k e t a h u n ( D E P K E S 2 0 1 4 W H O 2 0 1 0 )

I n f e k s i s a i u r a n k e m i h j u g a m e n i p a k a n m a s a l a h k l i n i s u m u m p a d a p e n d e r i t a

D M o l e h k a r e n a p e n d e r i t a D M m e m p u n y a i k e m u n g k i n a n m e n d e r i t a I S K l e b i h

t i n g g i d i b a n d i n g k a n d e n g a n b u k a n p e n d e r i t a D M d a n j u g a m e n d e r i t a i n f e k s i y a n g

l e b i h b e r a t y a n g a k a n m e n i n g k a t k a n risiko u n t u k m a s u k m m a h s a k i t ( H a r d i n g

d k k 2 0 1 0 ) P e n e l i t i a n y a n g d i l a k u k a n o l e h B o y k o d k k m e n d a p a t k a n w a n i t a D M

ripe 2 d e n g a n b a k t e r i u r i a s i m t o m a t i k s e t e l a h d i l a k u k a n p e m a n t a u a n s e l a m a 1 8

b u l a n m e n g a l a m i p e n i n g k a t a n r i s i k o m e n d a p a t k a n I S K s e b a n y a k 3 4

d i b a n d i n g k a n d e n g a n w a n i t a y a n g t i d a k m e n g a l a m i D M s e b e s a r 1 9 ( B o y k o d k k

2 0 0 2 )

B e r d a s a r k a n u r a i a n - u r a i a n d i a t a s s e r t a b e l u m a d a n y a p e n e l i t i a n y a n g

m e n e m u k a n k e t e r k a i t a n f a k t o r u s i a j e n i s k e l a m m t i n g k a t p e n d i d i k a n d a n r i w a y a t

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h d i K o t a P a l e m b a n g m a k a

p e n e l i t i t e r t a r i k i m t i i k m e l a k u k a n p e n e l i t i a n m e n g e n a i h u b u n g a n a n t a r a u s i a j e n i s

k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

3

12 Rumusan Masalah

1 B a g a i m a n a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s

m e l i t u s

2 A p a k a l i a d a h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

13 Tujuan Penelitian

131 Tujuan Umum

T u j u a n u m u m d a r i p e n e l i t i a n i n i a d a i a h d i k e t e m u k a n n y a h u b u n g a n a n t a i a

u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i m s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

132 Tujuan Khusus

T u j u a n k l i u s u s d a r i p e n e l i t i a n i n i y a i t u

1 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a

2 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n m f e k s i s a i u r a n k e m i b p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n j e n i s k e i a m i n

3 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

4

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n t i n g k a t p e n d i d i k a n

4 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n riwayat d i a b e t e s m e l i t u s

5 T e r a n a l i s i s n y a h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a i m n a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

6 T e r a n a l i s i s n y a h u b u n g a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

7 T e r a n a l i s i s n y a h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

8 T e r a n a l i s i s n y a h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i u i s d e n g a n k e j a d i a n

i n f e k s i s a l i u a i i k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

14 Manfaat Penelitian

141 Manfaat Teoritis

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t m e n a m b a h p e n g e t a h u a n p e n e l i t i

t e n t a n g h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i U i s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

5

142 Manfaat Praktis

A Bagi Peneliti

H a s i l p e n e l i t i a n i n i d i l i a r a p k a n d a p a t d i g u n a k a n s e b a g a i s a l a h s a t u b a h a n

r e f e r e n s i a t a u b a c a a n b a g i p e n e l i t i

B Bagi Institusi

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t d i g u n a k a n p i h a k R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g s e b a g a i s a l a l i s a t u b a h a n a c u a n d a l a m m e n g u p a y a k a n

p e n c e g a h a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

15 Keaslian Penelitian

T a b e l 1 1 K e a s l i a n P e n e l i t i a n

Nama Judul Penelitian Desain Hasil Penelitian

Peneliti Penelitian

Kugan P r e v a l e n s i I n f e k s i Cross D a r i p e n e l i t i a n i i i i

Kandasamy S a i u r a n K e m i l i P a d a seciUmal d i p e r o l e h b a l i w a

W a n i t a Y a n g M e n d e r i t a

D i a b e t e s M e l i t u s T i p e

I I Y a n g D i r a w a t I n a p

p a s i e n w a n i t a d i a b e t e s

m e l i t u s t i p e I y a n g

m e n d e r i t a I S K y a n g

D a n D i r a w a t J a l a n D i d i r a w a t m a p d a n

S u b b a g i a n

E n d o k r i n o l o g i B a g i a n

P e n y a k i t D a l a m D i

d i r a w a t j a l a n d i s u b

b a g i a n E n d o k r i n o l o g i

P e n y a k i t D a l a m

R S U P H A d a m M a l i k R S U P H A d a m

P a d a T a l i u n 2 0 0 9 M a l i k M e d a i i t e r d a p a t

s e b a n y a k 2 5 o r a n g

y a i t u ( 1 2 7 ) D a r i 2 5

o r a n g y a n g m e n d e r i t a

I S K t e r d a p a t 3 o r a n g

y a i t u ( 1 2 0 ) y a n g

d i r a w a t i n a p d a n 2 2

6

o r a n g ( 8 8 0 ) y a n g

d i r a w a t j a l a n

Edel Weisela P e r b e d a a n R i s i k o

Permata I n f e k s i N o s o k o m i a l

Sari dan S a i u r a n K e m i h

Prijono B e r d a s a r k a n

Satyabakti K a i e t e r i s a s i U r i n

U m u r D a n D i a b e t e s

M e l i t u s T a h u n 2 0 1 5

Case H a s i l p e n e l i t i a n y a n g

control d i 1 a k u k a n p a d a 2 0

s a m p e l k a s u s d a n

k o n t r o l m e n u n j u k k a n

b a h w a p a s i e n d e n g a n

u m u r gt 5 5 t a h u n

m e m p u n y a i r i s i k o

5 5 7 k a l i m e n g a l a m i

i n f e k s i n o s o k o m i a l

s a i u r a n k e m i h

d i b a n d i n g k a n p a s i e n

d e n g a n u m u r lt 5 5

t a h u n d e n g a n

p e r i l i t u n g a i i b e s a r

risiko d i p e r o l e h n i l a i

O R s e b e s a r 5 5 7

d e n g a n n i l a i 9 5

(onfidence Interval

l 1 9 lt O R lt 2 8 2 3

P a s i e n d e n g a n s t a t u s

D M m e m p u n y a i risiko

6 k a l i u n t u k

m e n g a l a m i i n f e k s i

n o s o k o m i a l s a i u r a n

k e m i h d i b a n d i n g k a n

d e n g a n p a s i e n y a n g

t i d a k m e n d e r i t a D M

d e n g a n n i l a i O R

7

s e b e s a r 6 0 0 d e n g a n

n i l a i 9 5 Confidence

Interval 1 22 lt O R lt

3 2 2 6

Andry K a r a k t e r i s t i k P a s i e n - D e s k r i p k i f H a s i i p e n e l i t i a n d a r i

Lukandy P a s i e n I n f e k s i S a i u r a n r e t r o s p e k t i f 4 3 o r a n g p e n d e r i t a

K e m i i i d i P o l i u r o l o g i

R S U D D r P i m g a d i

K o t a M e d a n T a h u n

2 0 1 2 - 2 0 1 3

I S K d i d a p a t k a n 5 3 5

p a d a k e l o m p o k u s i a

gt 5 0 t a h u n 5 1 2

b e i j e n i s k e i a m i n l a k i -

l a k i 1 0 0 t i d a k

m e n d e r i t a

v e s i c o u r e t r a l r e f l u x

7 0 Benign Prostatic

Hyperplasia 1 1 6

b a t u s a i u r a n k e m i h

2 7 9 d i a b e t e s t i p e 2

D a r i h a s i l p e n e l i t i a n

i n i d a p a t d i s i m p u l k a n

b a h w a p e n d e r i t a i S K

l e b i h b a n y a k t e r j a d i

p a d a l a k i - l a k i d a n

p e n d e r i t a I S K l e b i h

b a n y a k d i j u m p a i p a d a

k e l o m p o k u m u r gt 5 0

t a h u n s e r t a d i t e m u k a n

I S K d e n g a n B P H

B S K d a n D M T i p e 2

BAB 11

TINJAUAN PUSTAKA

21 Landasan Teori

211Infeksi Saiuran Keniih

A Definisi

I n f e k s i S a i u r a n K e m i h a d a i a h i n v a s i d a n m u l t i p l i k a s i m i k r o o r g a n i s m e a t a u

p a r a s i t d a l a m j a r i n g a n t u b u h k h u s u s n y a s a i u r a n k e m i h y a n g t e r d i r i d a r i g i n j a l

u r e t e r b u l i - b u l i d a n u r e t r a y a n g d i i a n d a i d e n g a n a d a n y a b a k t e r i 1 0 c f i i (colony

forming unit) p e r m l p a d a p e n g a m b i l a n c o n t o h u r i n ( P u m o m o 2 0 1 1 )

I n f e k s i s a i u r a n k e m i h a d a l a l i s u a t u i n f e k s i y a n g m e l i b a t k a n g i n j a l lU e ter

b u l i - b u l i a t a u p u n u r e t r a I n f e k s i s a i u r a n k e m i h ( I S K ) a d a l a l i i s t i l a h u m u m y a n g

m e n u n j u k k a n k e b e r a d a a n m i k r o o r g a n i s m e d a l a m u r i n ( S u d o y o 2 0 0 6 )

B a k t e r i u r i a b e r m a k n a (significant hacteriuria) a d a i a h s u a t u k e a d a a n y a n g

m e n u n j u k k a n p e n u m b u l i a n m i k r o o r g a n i s m e m u m i l e b i h d a r i 1 0 c f t L m l p a d a

b i a k a n u r i n B a k t e r i u r i a b e r m a k n a m u n g k i n t a n p a d i s e r t a i p r e s e n t a s i k l i n i s I S K

d a n d i n a m a k a n b a k t e r i u r i a a s i m t o m a t i k (convert hacteriuria) S e b a l i k n y a

b a k t e r i u r i a b e n n a k n a d i s e r t a i p e r s e n t a s i k l i n i s I S K d i n a m a k a n b a k t e r i u r i a

s i m t o m a t i k P a d a b e b e r a p a k e a d a a n t e r d a p a t p a s i e n d e n g a n p e r s e n t a s i k l i n i s I S K

n a m u n t a n p a b a k t e r i u r i a b e n n a k n a S e l a i n i t u d i k a t a k a n p i u r i a ( l e u k o s i t d a l a m

u r i n ) b e n n a k n a (significant pyuria) b i l a d i t e m u k a n n e u t r o f i l gt 1 0 s e l p e r l a p a n g a n

p a n d a n g ( S u d o y o 2 0 0 6 )

B Epidemiologi

I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m u k a n d i p r a k t i k u m u m w a i a u p u n b e n n a c a m - m a c a m a n t i b i o t i k a s u d a h

t e r s e d i a l u a s d i p a s a r a n D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r

2 5 - 3 5 s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a

S e l a m a p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n

9

10

c e n d e r u n g m e n d e r i t a i S K d i b a n d i n g k a n l a k i - l a k i I S K b e m l a n g p a d a l a k i - l a k i

j a r a n g d i l a p o r k a n k e c u a l i d i s e r t a i f a k t o r p r e d i s p o s i s i ( p e n c e t u s )

P r e v a l e n s i b a k t e r i u r i a a s i m t o m a t i k l e b i h s e r i n g d i t e m u k a n p a d a p e r e m p u a n

P r e v a l e n s i s e l a m a p e r i o d e s e k o l a h (school girls) 1 m e n i n g k a t m e n j a d i 5

s e l a m a p e r i o d e a k t i f s e c a r a s e k s u a l P r e v a l e n s i i n f e k s i a s i m t o m a t i k m e n i n g k a t

m e n c a p a i 3 0 b a i k l a k i - l a k i m a u p u n p e r e m p u a n b i l a d i s e r t a i f a k t o r p r e d i s p o s i s i

( S u d o y o 2 0 0 6 )

C Kiasifikasi

I n f e k s i s a i u r a n k e m i h d a p a t d i b a g i m e n j a d i d u a k a t e g o r i u m u m b e r d a s a r k a n

l o k a s i a n a t o m i y a i t u

1 ) I n f e k s i s a i u r a n k e m i h b a w a h

2 ) I n f e k s i s a i u r a n k e m i h a l a s

P r e s e n t a s i k l i n i s d a r i i n f e k s i s a i u r a n k e m i h b a w a l i t e r g a n t u n g d a r i gender

y a i t u

a ) P e r e m p u a n

a S i s t i t i s

S i s t i t i s a d a i a h p r e s e n t a s i k l i n i s i n f e k s i k a n d u n g k e m i h d i s e r t a i

b a k t e r i u r i a b e n n a k n a

b S i n d r o m U r e t r a A k u t ( S U A )

S i n d r o m a u r e t r a a k u t a d a i a h p r e s e n t a s i k l i n i s s i s t i t i s t a n p a d i t e m u k a n

a d a n y a m i k r o o r g a n i s m e d a l a m L u i n ( s t e r i l ) d a n s e r i n g d i n a m a k a n

s i s t i t i s b a k t e r i a l i s

b ) L a k i - l a k i

P r e s e n t a s i k l i n i s i n f e k s i s a i u r a n k e m i h p a d a l a k i - l a k i m u n g k i n s i s t i t i s

p r o s t a t i t i s e p i d i m i d i s d a n u r e t r i t i s

I n f e k s i s a i u r a n k e m i h a t a s t e r b a g i m e n j a d i 2 y a i t u

1 ) P i e l o n e f r i t i s A k u t ( P N A )

P i e l o n e f r i t i s a k u t a d a l a l i p r o s e s i n f l a m a s i p a r e n k i m g i n j a l y a n g d i s e b a b k a n

o l e h m f e k s i b a k t e r i

11

2 ) P i e l o n e f r i t i s K r o n i s ( P N K )

P i e l o n e f r i t i s k r o n i s m u n g k i n a k i b a t l a n j u t d a r i i n f e k s i b a k t e r i

b e r k e p a n j a n g a n a t a u i n f e k s i s e j a k m a s a k e c i i O b s t r u k s i s a i u r a n k e m i h d a n

r e f l u k s v e s i k o u r e t e r d e n g a n a t a u t a n p a b a k t e r i u r i a k r o n i k s e r i n g d i i k u t i

p e m b e n t u k a n j a r i n g a n i k a t p a r e n k i m g i n j a l y a n g d i t a n d a i d e n g a n

p i e l o n e f r i t i s k r o n i k y a n g s p e s i f i k ( S u d o y o 2 0 0 6 )

D Etiologi

P a d a k e a d a a n n o r m a l u r i n b e r s i f a t s t e r i l U m u m n y a I S K d i s e b a b k a n o l e h

k i i m a n g r a m n e g a t i f E s c h e r i c h i a c o l i m e m p a k a n p e n y e b a b t e r b a n y a k b a i k p a d a

y a n g s i m t o m a t i k m a u p u n y a n g a s i m t o m a t i k y a i t u 7 0 - 9 0 E n t e r o b a k t e r i a s e p e r t i

P r o t e u s m i r a b i l i s ( 3 0 d a r i i n f e k s i s a i u r a n k e m i h p a d a a n a k l a k i - l a k i t e t a p i

k u r a n g d a r i 5 p a d a a n a k p e r e m p u a n ) K l e b s i e l l a p n e u m o n i a d a n P s e u d o m o n a s

a e m g i n o s a d a p a t j u g a s e b a g a i p e n y e b a b O r g a n i s m e g r a m p o s i t i f s e p e r t i

S t r e p t o c o c c u s f a e c a l i s ( e n t e r o k o k u s ) S t a p h y l o c o c c u s e p i d e n n i d i s d a n

S t r e p t o c o c c u s v i r i d a n s j a r a n g d i t e m u k a n P a d a u r o p a t i o b s t m k t i f d a n k e l a i n a n

s t r u k t u r s a i u r a n k e m i h p a d a a n a k l a k i - l a k i s e r i n g d i t e m u k a n P r o t e u s s p e c i e s P a d a

I S K n o s o k o m i a l a t a u I S K k o m p l e k s l e b i h s e r i n g d i t e m u k a n k u m a n P r o t e u s d a n

P s e u d o m o n a s ( L u m b a n b a t u S M 2 0 0 3 )

E Patofisiologi

P a d a i n d i v i d u n o n n a l b i a s a n y a u r i n l a k i - l a k i m a u p u n p e r e m p u a n s e l a l u

d a l a m k e a d a a n s t e r i l k a r e n a d i p e r t a l i a n k a n o l e h j u m l a l i d a n f r e k u e n s i b e r k e m i h

U t e r o d i s t a l m e m p a k a n t e m p a t k o l o n i s a s i m i k r o o r g a n i s m e nonpathogenic

fastidious G r a m - p o s i t i f d a n g r a m n e g a t i f ( S u d o y o 2 0 0 6 )

H a m p i r s e m u a I S K d i s e b a b k a n i n v a s i m i k r o o r g a n i s m e ascending d a r i u r e t r a

k e d a l a m k a n d u n g k e m i b P a d a b e b e r a p a p a s i e n t e r t e n t u i n v a s i m i k r o o r g a n i s m e

d a p a t m e n c a p a i k e g i n j a l P r o s e s i n i d i p e n n u d a h o l e h k o n d i s i r e f l u k s

v e s i k o i i r e t e r a l P r o s e s i n v a s i m i k r o o r g a n i s m e h e m a t o g e n s a n g a t j a r a n g d i t e m u k a n

d i k l i n i k m u n g k i t a k i b a t l a n j u t d a r i b a k t e r e m i a G i n j a l d i d u g a m e n i p a k a n l o k a s i

12

i n f e k s i s e b a g a i a k i b a t l a n j u t d a r i s e p t i k e m i a a t a u e n d o k a r d i t i s a k i b a t S t a f i l o k o k u s

a u r e u s K e l a i n a n g i n j a l y a n g t e r k a i t d e n g a n e n d o k a r d i t i s ( S t a f i l o k k o k u s a u r e u s )

d i k e n a l d e n g a n N e p h r i t i s L o h e i n B e b e r a p a p e n e l i t i a n m e l a p o r k a n p i e l o n e f r i t i s

a k u t ( P N A ) s e b a g a i a k i b a t l a n j u t i n v a s i h e m a t o g e n ( S u d o y o 2 0 0 6 )

F Faktor Risiko

P a t o f i s i o l o g i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h d a p a t d i p e n g a n i h i o l e h

b e b e r a p a f a k t o r A d a p u n b e b e r a p a f a k t o r risiko y a n g m e m p e n g a n i l i i t e r j a d i n y a

i n f e k s i s a i u r a n k e m i h a n t a r a l a i n

1 ) U s i a

I n s i d e n I S K m e n i n g k a t b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i

m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n a d a n y a a b n o r m a l i t a s a n a t o m i y a n g

m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n k e m i h s e p e r t i p e m b e s a r a n p r o s t a t

d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e

P e n y e b a b l a i n t e r m a s u k p e r i n e u m y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s

p e n y a k i t n e u r o m u s k n l a r d a n k a t e t e r i s a s i b u l i - b u l i S e l a i n i t u i n s i d e n I S K

m e n c a p a i 1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o s e 2 0 0 9 F o x m a n e t a l 2 0 1 0

R o n a l d 2 0 1 1 )

M e n u m t t e o r i y a n g d i k e m u k a k a n o l e h S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a d a u s i a

l a n j u t a k a n t e r j a d i p e n i n g k a t a n k e r e n t a n a n t e r h a d a p p e n y a k i t P a d a u s i a d i a t a s 5 0

t a l i u n t e r j a d i p e n u m n a n k e m a m p u a n d a l a m m e m p e r t a h a n k a n s t e n l i t a s b a i k p a d a

k a n d u n g k e m i h m a u p u n u r e t r a H a l t e r s e b u t d i s e b a b k a n o l e h i n v o l u s i t i m u s

I n v o l u s i s e l t i m u s m e n y e b a b k a n j u m l a h se d a n k u a l i t a s r e s p o n s s e l T s e m a k i n

b e r k u r a n g J u m l a h s e l T m e m o r i m e n i n g k a t n a m u n s e m a k i n s u l i t u n t u k

b e r k e m b a n g t e r u t a m a s i t o t o k s i k s e l T ( C D ^ ) d a n s e l T h l ( C D ^ ^ ) k a r e n a t e r j a d i

a p o p t o s i s S i t o t o k s i k s e l T ( C D ^ ^ ) b e i p e r a n d a l a m r e s p o n s i m u n t e r h a d a p a n t i g e n

p a d a s e l y a n g d i i n f e k s i d e n g a n c a r a m e m b u n u l i s e l y a n g t e r i n f e k s i u n t u k

m e n c e g a h p e n y e b a r a n m f e k s i s e d a n g k a n s e l T h l ( C D ^ ^ ) b e r p e r a n m e m b a n t u s e l

B u n t u k m e m p r o d u k s i a n t i b o d i

13

2 ) J e n i s k e l a m m d a n a k t i v i t a s s e k s u a l

I n s i d e n s i I S K y a n g r e n d a h p a d a p r i a d i p e n g a n i h i o l e h 3 f a k t o r y a i t u

1 L e b i h s e d i k i t t e r j a d i k o l o n i s a s i s e k i t a r u r e t r a k a r e n a t i d a k a d a n y a t e m p a t

s e p e r t i v a g i n a p a d a p e r e m p u a n

2 M e m i l i k i u r e t r a y a n g p a n j a n g

3 A d a n y a s u b s t a n s i a n t i b a k t e r i a l p a d a c a i r a n p r o s t a t

U r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a h d e n g a n d e k a t n y a v a g i n a l

v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h l e b i h s e r i n g

p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a f l o r a n o n n a l p a d a d a e r a l i p e r i u r e t r a t e r d i r i

d a r i o r g a n i s m e s e p e r t i l a c t o b a c i l l i i s y a n g m e m b a n t u m e l a w a n k o l o n i s a s i b a k t e r i

p a t o g e n p a d a s a i u r a n k e m i h P e r u b a l i a n l i n g k i m g a n d a r i p e r i u r e t r a l s e p e r t i

p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k b i s a m e n g g a n g g u f l o r a

n o r m a l s e h i n g g a m e m u n g k i n k a n b a k t e r i p a t o g e n b e r k o l o n i s a s i d a n m e n y e b a b k a n

i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

P a d a w a n i t a l e b i h d a r i 5 0 t a h u n a t a u l e b i h m e n o p a u s e m e m p a k a n f a k t o r

l a i n y a n g m e n i n g k a t k a n P V R Post Void Residual) s e l a i n p e n u r u n a n k o i i t r a k t i i i t a s

o t o t d e t r u s o r P e n u m n a n e s t r o g e n y a n g d i s e b a b k a n m e n o p a u s e d a p a t

m e n i n g k a t k a n p H v a g i n a l d a n m e n u m n k a n j u m l a l i l a c t o b a c i l l i A k i b a m y a t e r j a d i

p e n i n g k a t k a n k o l o n i s a s i d a r i b a s i l g r a m n e g a t i f s e h i n g g a m e n i n g k a t k a n r e s i k o

t e r j a d i n y a I S K P a d a p r i a p r o s t a t m e n s e k r e s i k a n c a i r a n y a n g m e n g a n d i m g z i n k

y a n g m e m i l i k i a k t i f i t a s m i k r o b i a l ( K i m 2 0 1 2 )

S e l a i n i t u p i j a t a n u r e t r a s e p e r t i y a n g t e r j a d i s e l a m a h u b u n g a n s e k s u a l

m e n y e b a b k a n m a s u k n y a b a k t e r i k e d a l a m k a n d u n g k e m i h d a n m e m p a k a n h a l

y a n g p e n t i n g d a l a m p a t o g e n e s i s m f e k s i s a l i u a n k e m i h p a d a p e r e m p u a n m u d a

B u a n g a i r k e c i l s e t e l a h h u b u n g a n s e k s u a l t e r b u k t i m e n u m n k a n risiko s i s t i t i s

m u n g k i n k a r e n a t i n d a k a n i n i m e n i n g k a t k a n e r a d i k a s i b a k t e r i y a n g m a s u k s e l a m a

h u b u n g a n s e k s u a l ( K i m 2 0 1 2 )

3 ) T i n g k a t P e n d i d i k a n

P e n g e t a h u a n s e s e o r a n g t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t

p e n d i d i k a n S e s e o r a n g y a n g m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m i u i g k i n a n

p e n g e t a h u a n t e n t a n g k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o n n a s i y a n g d i d a p a t k a n

14

t e n t a n g k e s e h a t a n l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h

S e b a l i k n y a p e n d i d i k a n y a n g k u r a n g d a p a t m e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g

t e r h a d a p n i l a i - n i l a i y a n g b a n i d i k e n a l ( N o t o a d i n o j o 2 0 0 3 )

4 ) R i w a y a t D i a b e t e s M e l i t u s

M e n u r u t S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a s i e n d e n g a n s t a t u s D M s a n g a t

b e r i s i k o u n t u k m e n g a l a m i i n f e k s i s a i u r a n k e m i h A b n o n n a l i i a s s t n i k t u r d a n

k a n d u n g k e m i h n e u r o g e n i k a k i b a t n e u r o p a t i o t o n o m a t a u s t r o k e p a d a p a s i e n D M

m e n y e b a b k a n p e n g o s o n g a n k a n d u n g k e m i h t i d a k n o n n a l D M j u g a d a p a t

m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a h a n a n t u b u h y a n g b e r p o t e n s i m e n i n g k a t

risiko t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a h a n a n t u b u h t e r s e b u t d i a n t a r a n y a

a d a i a h k e g a g a l a n m i g r a s i s e l intracellular killing f a g o s i t o s i s d a n k e m o t a k s i s

p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n m e k a n i s m e p e r t a h a n a n

a l a m i a h i o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p i n f e k s i

5 ) K e h a m i i a n

K e c e n d e r u n g a n i n f e k s i s a i u r a n k e m i h b a g i a n a t a s s e l a m a k e h a m i i a n

d i s e b a b k a n o l e h p e n u m n a n k e k u a t a n u r e t e r p e n u m n a n p e r i s t a l t i k u r e t e r d a n

i n k o m p e t e n s i s e m e n t a r a k a l u p v e s i k o i u - e t e r a l y a n g t e r j a d i s e l a m a h a m i l

6 ) S u m b a t a i i

A d a n y a I i a i a n g a n a l i r a n b e b a s u r i n s e p e r t i t u m o r s t r i k t r a a b a t u a t a u

h i p e r t r o f i p r o s t a t d a p a t m e n y e b a b k a n h i d r o n e f r o s i s d a n risiko i n f e k s i s a i u r a n

k e m i l i y a n g s a n g a t t i n g g i S e l a i n i t u s u p e r i n f e k s i p a d a s u m b a t a n s a i u r a n k e m i h

d a p a t m e n y e b a b k a n k e m s a k a n j a r i n g a n g i n j a l y a n g c e p a t

7 ) D i s f u n g s i n e u r o g e n i k k a n d u n g k e m i h

G a n g g u a n s a r a f y a n g b e k e r j a p a d a k a n d m i g k e m i h s e p e r t i p a d a j e j a s k o r d a

s p i n a l i s t a b e s d o r s a i i s m u l t i p e l s k l e r o s i s d i a b e t e s m e l i t u s a t a u p e n y a k i t l a i n

d a p a t b e r h u b u n g a n d e n g a n i n f e k s i s a i u r a n k e m i h I n f e k s i d a p a t d i a w a l i o l e h

p e n g g u n a a n k a t e l e r u n t u k d r a i n a s e k a n d i u i g k e m i h d a n d i d u k i m g o l e h s t a t i s u r i n

d a l a m k a n d u n g k e m i l i u n t u k j a n g k a w a k t u y a n g l a m a

8 ) R e f l u k s v e s i k o m e t e r a

K e a d a a n i n i d i d e f i n i s i k a n s e b a g a i r e f l u k s u r i n d a r i k a n d u n g k e m i b k e u r e t e r

d a n k a d a n g s a m p a i k e p e l v i s r e n a l H a l i n i t e r j a d i s e l a m a b u a n g a i r k e c i l a t a u

15

d e n g a n p e n i n g k a t a n t e k a n a n p a d a k a n d u n g k e m i h R e f l u k s v e s i k o i i r e t e r a l d a p a t

d i b u k t i k a n d e n g a n a d a n y a g c r a k a n r e t r o g r a d z a t r a d i o o p a k a t a u r a d i o a k t i f m e l a l u i

s i s t o u r e t r o g r a m s e l a m a b u a n g a i r k e c i l R e f l u k s v e s i k o i i r e t e r a l b i a s a n y a

d i s e b a b k a n k a r e n a a d a n y a g a n g g u a n a n a t o m i s p a d a p e r t e m u a n v e s i k o i i r e t e r a l

y a n g d a p a t m e n y e b a b k a n r e f l u k s u r i n d i s e r t a i b a k t e r i d a n k a r e n a i t u t e r j a d i l a h

i n f e k s i s a l r a a n k e m i h

9 ) F a k t o r v i r u l e n s i b a k t e r i

F a k t o r v i r u l e n s i b a k t e r i m e m p e n g a r u b i k e m u n g k i n a n vragt7 t e r t e n m d a l a m

m e n y e b a b k a n i n f e k s i t r a k i u s u r i n a r i u s H a m p i r s e m u a strain F c o l i y a n g

m e n y e b a b k a n p i e l o n e f r i t i s p a d a p a s i e n d e n g a n t r a k i u s u r i n a r i u s n o m i a l s e c a r a

a n a t o m i k m e m p u n y a i p i l u s t e r t e n t u y a n g m e m p e r a n t a r a i p e r l e k a t a n p a d a b a g i a n

d i g a k t o s i d a d a n g l i k o s f i n g o l i p i d y a n g a d a d i u r o e p i t e l Strain y a n g m e n i m b u l k a n

p i e l o n e f r i t i s j u g a b i a s a n y a m e m p a k a n p e n g b a s i l h e m o l i s i n m e m p u n y a i

a e r o b a k t i n d a n r e s i s t e n t e r h a d a p k e r j a b a k t e r i s i d a l d a r i s e m m m a n u s i a

1 0 ) F a k t o r g e n e t i k

F a k t o r g e n e t i k p e n j a m u m e m p e n g a n i l i i k e r e n t a n a n t e r h a d a p i n f e k s i t r a k t u s

u r i n a r i u s J u m l a h d a n t i p e r e s e p t o r p a d a s e l u r o e p i t e l t e m p a t b a k t e r i d a p a t

m e n e m p e l s e l i d a k i i y a s e b a g i a i i d i t e n t u k a r i s e c a r a g e n e t i k ( I s s e l b a c h e r 2 0 0 9 )

G Manifestasi Klinis

G e j a l a k l i n i s d a r i i n f e k s i s a i u r a n k e m i h s e s u a i d e n g a n b a g i a n s a i u r a n k e m i h

y a n g t e r i n f e k s i a d a i a h s e b a g a i b e r i k u t

1 ) I n f e k s i s a i u r a n k e m i h b a g i a n b a w a l i

K e l u h a n p a s i e n b i a s a n y a b e m p a r a s a s a k i t a t a u r a s a p a n a s d i u r e t r a s e w a k t u

k e n c i n g d e n g a n a i r k e m i h s e d i k i t - s e d i k i t s e r t a r a s a t i d a k e n a k d i d a e r a h

s i i p r a p u b i k

2 ) I n f e k s i s a i u r a n k e m i h b a g i a n a t a s

P a d a i n t e k s i s a i u r a n k e m i h b a g i a n a t a s d a p a t d i t e m u k a n g e j a l a s e p e r t i s a k i t

k e p a l a m a l a i s e m u a l m m i t a h d e n i a m m e n g g i g i l r a s a t i d a k e n a k a t a u

n y e r i d i p i n g g a n g ( T e s s y d k k 2 0 0 1 )

16

H Tatalaksana

T u j u a n p e n a t a l a k s a n a a a n i n f e k s i s a i u r a n k e m i h a d a i a h m e n c e g a h d a n

m e n g h i l a n g k a n g e j a l a m e n c e g a h d a n m e n g o b a t i b a k t e n e m i a d a n b a k t e r i u r i a s e r t a

m e n c e g a h d a n m e n g u r a n g i r i s i k o k e r u s a k a n g i n j a l y a n g m u n g k i n t i m b u l d e n g a n

p e m b e r i a n o b a t - o b a t a n y a n g s e n s i t i f m u r a l i d a n a m a n d e n g a n e f e k s a m p i n g y a n g

m i n i m a l

a ) i n f e k s i s a i u r a n k e m i h ( I S K ) b a w a h

P r i n s i p p e n a t a l a k s a n a a n I S K b a w a h m e l i p u t i intake c a i r a n y a n g b a n y a k

a n t i b i o t i k y a n g a d e k u a t d a n b i l a p e r l u t e r a p i s i m t o m a t i k u n t u k a l k a l i s a s i

u r i n

i H a m p i r 8 0 p a s i e n a k a n m e m b e r i k a n r e s p o n s e t e l a h 4 8 j a m d e n g a n

a n t i b i o t i k a t u n g g a l s e p e r t i a m p i s i l i n 3 g r a m a t a u t r i m e t o p r i m 2 0 0 m g

i i B i l a i n f e k s i m e n e t a p d i s e r t a i k e l a i n a n u r i n a l i s i s ( l e u k o s i u i a ) d i p e r i u k a n

t e r a p i k o n v e n s i o n a l s e l a m a 5 - 1 0 h a r i

i i i P e m e r i k s a a n m i k r o s k o p i s u r i n d a n b i a k a n u r i n t i d a k d i p e r i u k a n b i l a

s e m u a g e j a l a h i l a n g d a n t a n p a l e u k o s u r i a

b ) I n f e k s i s a i u r a n k e m i h ( I S K ) a t a s

P a d a u m u m n y a p a s i e n d e n g a n p i e l o n e f r i t i s a k u t m e m e r l u k a n r a w a t i n a p

u n t u k m e m e l i h a r a s t a t u s h i d r a s i d a n t e r a p i a n t i b i o t i k a p a r e n t e r a l p a l i n g

s e d i k i t 4 8 j a m ( S u d o y o 2 0 0 6 )

i Komplikasi

K o m p l i k a s i i n f e k s i s a i u r a n k e m i h t e r g a n t u n g d a r i t i p e y a i t u i n f e k s i s a i u r a n

k e m i h t i p e s e d e r h a n a (uncomplicated) d a n t i p e b e r k o m p l i k a s i (complicated)

1 ) I n f e k s i s a i u r a n k e m i h s e d e r h a n a (uncomplicated)

I n f e k s i s a i u r a n k e m i h a k u t t i p e s e d e r h a n a ( s i s t i t i s ) y a i t u n o n - o b s t r u k s i d a n

b u k a n p e r e m p u a n h a m i l m e m p a k a n p e n y a k i t r i n g a n (self limited disiase)

d a n t i d a k m e n y e b a b k a n a k i b a t l a n j u t j a n g k a l a m a

2 ) I n f e k s i s a i u r a n k e m i h b e r k o m p l i k a s i (complicated)

a ) I n f e k s i s a i u r a n k e m i h s e l a m a k e h a m i i a n

b ) i n f e k s i s a i u r a n k e m i h p a d a d i a b e t e s m e l i t u s ( S u d o y o 2 0 0 6 )

17

22 Kerangka Teori

J

U s i a

J e n i s K e i a m i n

T i n g k a t P e n d i d i k a n

R i w a y a t D i a b e t e s M e l i m s

S u m b a t a n bullT

K e h a m i i a n

D i s f u n g s i n e u r o g e n i k

R e f l u k s v e s i k o i i r e t e r a l

V i r u l e n s i b a k t e r i

F a k t o r g e n e t i k

I n f e k s i b a k t e r i g r a m p o s i t i f a t a u n e g a t i v e p a d a s a i u r a n k e m i h

I n f e k s i S a i u r a n K e m i h

Keterangan

I j = V a r i a b e l y a n g t i d a k d i t e l i t i

= V a r i a b e l y a n g d i t e l i t i

18

Hipotesis

H i p o t e s i s d a l a m p e n e l i t i a n i n i a d a i a h

H O t i d a k t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n

t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

H I t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

BAB 111

M E T O D E PENELITIAN

31 Jenis Penelitian

P a d a p e n e l i t i a n i n i j e n i s p e n e l i t i a n y a n g d i g u n a k a n a d a i a h p e n e l i t i a n

o b s e r v a s i o n a i a n a l i t i k d e s a i n cross scclional d e n g a n m e n g g u n a k a n d a t a s e k u n d e r

d a r i r e k a m m e d i s p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1 D e s e m b e r

2 0 1 5

32 Waktu dan Tempat Penelitian

321 Waktu Penelitian

W a k t u p e n e l i t i a n d i l a k s a n a k a n p a d a t a n g g a l 1 O k t o b e r s a m p a i d e n g a n 3 0

O k t o b e r 2 0 1 6

322 Tempat Penelitian

P e n e l i t i a n i n i d i l a k s a n a k a n d i R u m a l i S a k i t M u h a m m a d i y a h P a e m b a n g ( d i

R u a n g R e k a m M e d i s )

33 Populasi dan Sampel Penelitian

331Populasi Penelitian

P a d a p e n e l i t i a n i n i p o p u l a s i t a r g e t a d a l a l i p a s i e n r a w a t i n a p d a n r a w a t j a l a n

d i R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g s e d a n g k a n p o p u l a s i t e r j a n g k a u n y a

a d a i a h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

332Sampel dan Besar Sampel Penelitian

P a d a p e n e l i t i a n i n i s a m p e l p e n e l i t i a n a d a i a h p a s i e n r a w a t i n a p d a n r a w a t

j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e

1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 y a n g m e m e n u h i k r i t e r i a i n k l u s i p e n e l i t i a n

1 9

20

d e n g a n b e s a r s a m p e l y a n g l a y a k d a l a m p e n e l i t i a n m e n u r u t t e o r i R o s c o e a d a i a h

a n t a r a t i g a p u l u h s a m p a i l i m a r a t i i s o r a n g ( S u g i y o n o 2 0 1 5 )

333 Krttena Inklusi dan Eksklusi

A Kriteria Inklusi

P a d a p e n e l i t i a n i n i k r i t e r i a i n k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t i n a p

d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i

P a l e m b a n g y a n g d i d i a g n o s a m e n g a l a m i i n f e k s i s a i u r a n k e m i h s e r t a m e m i l i k i d a t a

r e k a m m e d i s p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

B Kriteria Eksklusi

P a d a p e n e l i t i a n i n i k r i t e r i a e k s k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t

i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 d e n g a n d a t a r e k a m m e d i s

y a n g t i d a k l e n g k a p

334 Cara Pengambilan Sampel Penelitian

C a r a p e n g a m b i l a n s a m p e l y a n g d i g u n a k a n d a l a m p e n e l i t i a n i n i a d a l a l i

m e n g g u n a k a n t e k n i k consecutive sampling P a d a consecutive sampling s e t i a p

p a s i e n y a n g m e m e n u h i k r i t e r i a p e n e l i t i a n d i m a s u k k a n d a l a m p e n e l i t i a n s a m p a i

k u r u n w a k t u t e r t e n U i s e h i n g g a j u m l a h m i n i m a l y a n g d i p e r i u k a n t e r p e n u h i

( S a s t r o a s m o r o 2 0 1 1 )

34 Variabel Penelitian

341 Variabel Dependent

V a r i a b e l dependent f t e r i k a t ) d a l a m p e n e l i t i a n i n i a d a i a h i n f e k s i s a i u r a n

k e m i h

342 Variabel Independent

V a r i a b e l independent ( b e b a s ) d a l a m p e n e l i t i a n i n i a d a i a h u s i a j e n i s

k e l a i n i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

21

35 Definisi Operasional

Tabel 31 Definisi Operasional

Variabel Alat Cara ueiinisi rldsil L KUr I7 i l l 11 Lz fe 1 V

oKaia LiKur Penelitian Ukur Ukur

Infeksi P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Saiuran d i d i a g n o s a o l e h m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Keniih d o k t e r m e n g a l a m i m e d i s

i n f e k s i s a i u r a n

k e m i h d a n t e r c a n t u m

d i r e k a m m e d i s

U s i a L a m a n y a t a h u n R e k a m O b s e r v a s i 1 lt 5 0 t a h u n O r d i n a l

k e h i d u p a n p a s i e n m e d i s r e k a m 2 gt 5 0 t a l i u n ( k a t e g o r i k )

d a r i l a h i r s a m p a i m e d i s

s e k a r a n g d a n

t e r c a n t u m d i r e k a m

m e d i s

Jenis P r o f i l a n a t o m i a t a u R e k a m O b s e r v a s i 1- L a k i - l a k i N o m i n a l

Keiamin b i o l o g i s p a s i e n y a n g m e d i s r e k a m 2 P e r e m p u a n ( k a t e g o r i k )

d i b e d a k a n m e n j a d i m e d i s

i a k i - l a k i d a n

n e r e m m i a n s e r t a

t e r c a n t u m d i r e k a m

m e d i s

Tingkat P e n d i d i k a n f o n n a l R e k a m O b s e r v a s i 1 P e n d i d i k a n O r d i n a l

Pendidikan t e r a k h i r y a n g m e d i s r e k a m d a s a r ( S D ( k a t e g o r i k )

d i t e m p u h o l e h m e d i s M I S M P

p a s i e n d a n t e r c a n t u m d a n M T s )

d i r e k a m m e d i s 2 P e n d i d i k a n

m e n e n g a l i

d a n t i n g g i

22

( S M A M A

S M K

M A K

d i p l o m a

s a r j a n a

m a g i St e r

s p e s i a l i s

d a n d o k t o r )

Riwayat P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Diabetes d i d i a g n o s i s d e n g a n m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Melitus d i a b e t e s m e l i t u s d a n

t e r c a n t u m d i d a l a m

r e k a m m e d i s

m e d i s

36 Cara Pengumpulan Data

361 Data Sekunder

P e n g u m p u l a n d a t a p a d a p e n e l i t i a n i n i d i p e r o l e h d a r i d a t a s e k u n d e r y a i t u

r e k a m m e d i s p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

37 Metode Teknik Analisis Data

371Cara Pengolahan dan Analisis Data

P e n g o l a h a n d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n m e l a l u i e m p a t t a h a p y a i t u

i Oala Entry

P a d a t a i i a p i n i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n riwayat d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g y a n g t e l a h d i d a p a t d a n

r e k a m m e d i s d i k u m p u l k a n d a n d i m a s u k k a n k e d a l a m p r o g r a m spss

23

2 Editing

P a d a t a h a p i n i d a t a i i s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n y a n g t e l a h d i m a s u k k a n k e d a l a m p r o g r a m s p s s

d i p e r i k s a k e m b a l i a p a k a h s u d a h l e n g k a p d a n t i d a k a d a k e k e l i r u a n

3 ( oding

S e t e l a h m e l a l u i p r o s e s editing d a t a - d a t a t e r s e b u t d i b e r i k o d e t e r t e n t u a n t a r a

l a i n k o d e 1 u n t u k u s i a gt 5 0 t a h u n j e n i s k e i a m i n p e r e m p u a n t i n g k a t

p e n d i d i k a n d a s a r t e r d a p a t r i w a y a t d i a b e t e s m e l i t u s d a n i n f e k s i s a i u r a n

k e m i h s e d a n g k a n k o d e 2 u n t u k u s i a lt 5 0 t a h u n j e n i s k e i a m i n l a k i - l a k i

t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i t i d a k t e r d a p a t r i w a y a t d i a b e t e s

m e l i t u s d a n b u k a n i n f e k s i s a i u r a n k e m i h s e h i n g g a m e m u d a h k a n d a l a m

m e l a k u k a n a n a l i s i s d a t a

4 Tahulaling

P a d a t a h a p i n i d a t a y a n g s a m a d i k e l o m p o k k a n s e c a r a t e l i t i d a n t e r a t m

k e m u d i a n d i l i i t u n g d e n g a n m e n g g u n a k a n p r o g r a m sps s d a n d i j u m l a h k a i i

l a l u d i s a j i k a n d a l a m b e n t u k t a b e l - t a b e l

U n t u k m e n g a n a l i s i s d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n a n a l i s i s d a t a

u n i v a r i a t d a n b i v a r i a t d e n g a n m e n g g u n a k a n p r o g r a m s p s s s e b a g a i b e r i k u t

A A n a l i s i s u n i v a r i a t

A n a l i s i s u n i v a r i a t d i l a k u k a n d e n g a n c a r a m e l a k u k a n a n a l i s i s p a d a s e t i a p

v a r i a b e l h a s i l p e n e l i t i a n d e n g a n t u j u a n u n t u k m e n g e t a h u i d i s t r i b u s i p r o p o r s i p a d a

s e t i a p v a r i a b e l p e n e l i t i a n D a t a d i s a j i k a n d a l a m b e n t u k t a b e l d a n n a r a s i

B A n a l i s i s b i v a r i a t

A n a l i s i s b i v a r i a t d i l a k u k a n d e n g a n m e n g g u n a k a n u j i h i p o t e s i s chi-square

U j i h i p o t e s i s chi-square d a p a t d i g u n a k a n d e n g a n s y a r a t y a i t u lt 2 0 s e l y a n g

m e m p u n y a i n i l a i expected count k u r a n g d a r i l i m a s e h i n g g a j i k a t i d a k m e m e n u h i

s y a r a t u j i chi-square m a k a u j i y a n g d i g u n a k a n a d a i a h u] fisher ( D a h l a n 2 0 1 4 )

B a t a s k e m a k n a a n y a n g d i g u n a k a n a d a i a h a = 0 0 5 J i k a d i d a p a t k a n p value lt 0 0 5

p a d a u j i s t a t i s t i k m a k a t i d a k t e r d a p a t h u b u n g a n y a n g b e n n a k n a a n t a r a d u a

v a r i a b e l y a n g d i t e l i t i d a n H O d i t e r i m a S e d a n g k a n j i k a d i d a p a t k a n p value gt 0 0 5

24

p a d a u j i s t a t i s t i k m a k a t e r d a p a t l i u b u n g a n y a n g b e n n a k n a a n t a r a d u a v a r i a b e l

y a n g d i t e l i t i d a n H O d i t o l a k

38 Alur Penelitian

P e n e n t u a n p o p u l a s i d a n s a m p e l p e n e l i t i a n

K r i t e r i a i n k l u s i K r i t e r i a e k s k l u s i

P e n g a m b i l a n s a m p e l p e n e l i t i a n

P e n g o l a h a n d a n a n a l i s i s d a t a d e n g a n u j i chi-square

H a s i l d a n p e m b a h a s a n

K e s i m p u l a n d a n s a r a n

Gambar 31 Alur Penelitian Hubungan Usia Jenis Keiamin Tingkat Pendidikan dan Riwayat Diabetes Melitus dengan Kejadian Infeksi Saiuran Kemih pada Pasien Rawat Inap di Bagian Penyakit Dalam Rumah Sakit Muhammadiyah Palembang Periode 1 Januari 2015 sampai dengan 31 Desember 2015

BAB IV

HASIL DAN PEMBAHASAN

41 Hasil

P e n e l i t i a n i n i t e l a h d i l a k u k a n d i r u a n g r e k a m m e d i s R u m a h S a k i t

M u h a i m n a d i y a h P a l e m b a n g d a r i t a n g g a l 1 O k t o b e r 2 0 1 5 - 3 1 O k t o b e r 2 0 1 6

P e n e l i t i a n d i m u l a i d e n g a n p e n g a m b i l a n d a t a a w a l b e m p a d a t a r e k a m m e d i s

s e l u r u h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

S e l a n j u t n y a r e k a m m e d i s d i p i l i h s e s u a i d e n g a n k r i t e r i a i n k l u s i d a n e k s k l u s i u n t u k

d i j a d i k a n s a m p e l p e n e l i t i a n s a m p a i m i n i m a l b e s a r s a m p e l y a n g d i b u t u h k a n

t e r p e n u h i s e r t a d i l a k u k a n p e n e l i t i a n s e c a r a o b s e r v a s i o n a i O b s e r v a s i r e k a m m e d i s

d i l a k u k a n u n m k m e n g e t a h u i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t

d i a b e t e s m e l i t u s d a n d i a g n o s a p a s i e n

D a r i c a t a t a n r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g

d i d a p a t k a n s e b a n y a k 4 1 4 1 r e k a m m e d i s p a s i e n r a w a t i n a p d a n 1 4 5 3 r e k a m m e d i s

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 D a r i t o t a l r e k a m m e d i s

p a s i e n r a w a t i n a p d a n r a w a t j a l a n t e r s e b u t p e n e l i t i h a n y a m e n g a m b i l m i n i m a l

b e s a r s a m p e l y a n g d i b u t u h k a n y a i t u s e b a n y a k 9 8 r e k a m m e d i s u n t u k d i j a d i k a n

s a m p e l p e n e l i t i a n y a n g t e r d i r i d a r i 3 0 r e k a m m e d i s p a s i e n y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i h d a n 6 8 r e k a m m e d i s y a n g t i d a k m e n g a l a m i i n f e k s i s a i u r a n k e m i h

411 Hasil Analisis Univariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s u n i v a r i a t

a n t a r a l a i n d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p b e r d a s a r k a n u s i a d a n

j e n i s k e l a m m d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n b e r d a s a r k a n u s i a

d a n j e n i s k e i a m i n d i s t r i b u s i p r o p o r s i s a m p e l b e r d a s a r k a n k e j a d i a n m f e k s i s a i u r a n

k e m i h s e r t a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n u s i a

j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

25

26

A Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan IJsta

dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 41 Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan

Usia dan Jenis Keiamin

Paisen Rawat Inap N Persentase

Usia

1 7 - 2 5 t a h u n 678 1 6 4

2 6 - 3 5 t a h u n 952 2 3 0

3 6 - 4 5 t a l i u n 745 18 0

4 6 - 5 5 t a h u n 695 1 6 8

5 6 - 6 4 t a h u n 571 1 3 8

gt 6 4 t a h u n 500 1 2 1

U s i a r a t a - r a t a ( t a h u n j 43plusmn16543

Jenis Keiamin

P e r e m p u a n 2 6 3 8 6 3 7

L a k i - l a k i 1 5 0 3 3 6 3

Total 4141 100

B e r d a s a r k a n t a b e l 4 1 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R i u n a h S a k i t M u l i a m m a d i y a l i

P a l e m b a n g p e r i o d e J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 2 6 - 3 5 t a h u n y a i t u

s e b a n y a k 9 5 2 o r a n g ( 2 3 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 43plusmn16543 t a l i u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 2 6 3 8 o r a n g ( 6 3 7 )

27

B Distribusi Proporsi Karakteristik Pasien Rawat Jalan Berdasarkan

Usia dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 42 Distribusi Proporsi Karakteristik Pasien Rawat Jalan

Berdasarkan Usia dan Jenis Keiamin

Fasten Rawat Jalan N Persentase

Usia

1 7 - 2 5 t a h u n 9 2 6 3

2 6 - 3 5 t a l n i n 1 3 1 9 0

3 6 - 4 5 t a h u n 2 7 9 1 9 2

46-55 t a l i u n 4 2 1 2 9 0

5 6 - 6 4 t a h u n 3 1 6 2 1 7

gt 6 4 t a h u n 2 1 4 1 4 7

U s i a r a t a - r a t a ( t a h u n ) 50plusmn14120

Jenis Keiamin

P e r e m p u a n 8 9 0 6 1 3

L a k i - l a k i 5 6 3 3 8 7

Total 1453 100

B e r d a s a r k a n t a b e l 4 2 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 4 6 - 5 5 t a h u n y a i t u

s e b a n y a k 4 2 1 o r a n g ( 2 9 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 50plusmn14120 t a h u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 8 9 0 o r a n g ( 6 1 3 )

28

C Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Usia

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i b b e r d a s a r k a n u s i a d a p a t

d i i i h a t p a d a l a b e l d i b a w a h i n i

Tabel 43 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Usia

Usia N Persentase

lt 5 0 t a h u n 1 4 4 6 7

gt 5 0 t a l i u n 1 6 5 3 3

Total 30 100

B e r d a s a r k a n t a b e l 4 3 d i a t a s d a p a t d i k e t a h u i b a h w a u s i a t e r b a n y a k p a d a

s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h gt 5 0 t a h u n y a i t u s e b a n y a k

1 6 o r a n g ( 5 3 3 )

D Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Jenis

Keiamin

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n j e n i s

k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 44 Distribusi Proporsi Kejadian infeksi Saiuran Kemih Berdasarkan

Jenis Keiamin

Jenis Keiamin N Persentase

P e r e m p u a n 1 8 6 0 0

L a k i - l a k i 1 2 4 0 0

Total 30 100

B e r d a s a r k a n t a b e l 4 4 d i a t a s d a p a t d i k e t a h u i b a h w a j e n i s k e i a m i n

t e r b a n y a k p a d a s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h p e r e m p u a n

y a i t u s e b a n y a k 1 8 o r a n g ( 6 0 0 )

29

E Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n t i n g k a t

p e n d i d i k a n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 45 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

Tingkat Pendidikan N Persentase

P e n d i d i k a n d a s a r 20 6 6 7

P e n d i d i k a n m e n e n g a h d a n P e n d i d i k a n m e n e n g a h d a n 10 333

t i n g g i

Total J O 100

B e r d a s a r k a n t a b e l 4 5 d i a t a s d a p a t d i k e t a l i u i b a l i w a t i n g k a t p e n d i d i k a n

t e r b a n y a k p a d a s a m p e i y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h t i n g k a t

p e n d i d i k a n d a s a r y a i t u s e b a n y a k 20 o r a n g ( 6 6 7 )

P Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n riwayat

d i a b e t e s m e l i t u s d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 46 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

Riwayat Diabetes Melitus N Persentase

Y a 17 5 6 7

T i d a k 13 433

Total 30 100

B e r d a s a r k a n t a b e l 4 6 d i a t a s d a p a t d i k e t a h u i b a l i w a s a m p e l y a n g

m e n g a l a m i i n f e k s i s a i u r a n k e m i h t e r b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s

y a i t u s e b a n y a k 1 7 o r a n g ( 5 6 7 )

30

412 Hasil Analisis Bivariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s b i v a r i a t

a n t a r a I a i n h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h j e n i s

k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h t i n g k a t p e n d i d i k a n d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n

i n f e k s i s a l m a n k e m i h

A n a l i s i s y a n g d i g u n a k a n p a d a u j i d u a v a r i a b e l y a n g b e r s k a l a k a t e g o r i k

a d a l a l i d e n g a n u j i Chi-Square d e n g a n n i e i h a t n i l a i Pearson Chi-Square S e m u a

h a s i l d a r i u j i h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h m e n g g i u i a k a n u j i Chi-

Square k a i e n a m e m e n u h i s y a r a t u j i Chi-Square y a i t u lt 2 0 s e l y a n g m e m p u n y a i

n i l a i expected count lt 5

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 47 Hasil Uji Hubungan antara Usia dengan Kejadian Infeksi

Saiuran Kemih

Usia

Infeksi Saiuran Kemih

^a Tidak

n N Mgt

Jumlah P

value 95Cl

lt 50 t a h u n 1 4 1 9 2 5 9 8 0 8 7 3 0 0 0 0 2 7 4 7 - 2 0 4 3 1

gt 5 0 t a h u n 1 6 6 4 0 9 3 6 0 2 5

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 7 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R = 7 4 9 2

( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a u s i a gt

5 0 t a h u n a d a l a l i 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a u s i a lt 5 0 t a h u n

31

B Hubungan antara Jenis Keiamin dengan Kejadian Infeksi Saiuran

Kemih

H a s i l a n a l i s i s b i v a r i a t l i u b u n g a n a n t a r a j e n i s k e l a i n i n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

Tabel 48 Hasil Uji Hubungan antara Jenis Keiamin dengan Kejadian

Infeksi Saiuran Kemih

Infeksi Saiuran Kemih Jenis P

A Tidak Jumlah 95CI Keiamin value

N N

P e r e m p u a n 18 6 4 3 10 357laquoo 2 8 3 2 2 7 -P e r e m p u a n 0 0 0 0

L a k i - l a k i 12 1 7 1 5 8 8 2 9 7 0 2 3 4 5 9

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 8 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a l a l i

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k N 4 a k a a d a l i u b u n g a n y a n g s i g n i f i k a n a n t a r a

j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R ) = 8 7 0 0

f 9 5 C I = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a l a k i - l a k i

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e n i i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

32

Tabel 49 Hasil liji Hubungan antara Tingkat Pendidikan dengan

Kejadian Infeksi Saiuran Kemih

Infeksi Saiuran Kemih P

Y a T i d a k jumlah 95CI value

N

P e n d i d i k a n d a s a r 2 0 5 4 1 1 7 4 5 9 3 7

P e n d i d i k a n

m e n e n g a h d a n 10 1 6 4 5 1 8 3 6 6 1

t i n g g i

Jumlah JO 30 6 68 694 9H

B e r d a s a r k a n t a b e l 4 9 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( 0 R ) =

6 0 0 0 ( 9 5 C I = 2 3 5 1 - 1 5 3 1 0 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r a d a i a h 6 k a l i l e b i h b e s a r

d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i h a t

p a d a t a b e l d i b a w a h i n i

Tingkat

Pendidikan

2 3 5 1 -0 0 0 0

1 5 3 1 0

33

Tabel 4t0 Hasil I j i Hubungan antara Riwayat Diabetes Melitus dengan

Kejadian Infeksi Saiuran Kemih

Riwayat Infeksi Saiuran Kemih P

Diabetes Va Tidak Jumlah value

95CI

Melitus N bullVJ N

Y a

T i d a k

17

1 3

6 8 0

1 7 8

8

6 0

3 2 0

8 2 2

2 5

7 3 0 0 0 0

3 4 9 3 -

2 7 5 3 6

Jumlah 30 306 68 571 98

B e r d a s a r k a n t a b e l 4 1 0 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio

( O R ) = 9 8 0 8 ( 9 5 C I - 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r

d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s m e l i m s

42 Pembahasan

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a l a b e l 4 7 d i d a p a t k a n b a l i w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i b d e n g a n n i l a i s i g n i f i k a n n y a a d a l a l i 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k

Odds Ratio ( O R ) = 7 4 9 2 ( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a u s i a T 5 0 t a h u n a d a i a h 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a

u s i a lt 5 0 t a h u n

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n A n d r y L u k a n d y

( 2 0 1 4 ) m e n g e n a i k a r a k t e r i s t i k p a s i e n - p a s i e n i n f e k s i s a i u r a n k e m i h d i m a n a

p e n d e r i t a I S K d e n g a n k e l o m p o k u m u r gt 5 0 t a h u n s e b a n y a k 2 3 o r a n g s e d a n g k a n

j u m l a h p e n d e r i t a I S K d e n g a n k e l o m p o k u m m lt 5 0 t a l i u n s e b a n y a k 2 0 o r a n g

P e n e l i t i a n i n i j u g a d i p e i k u a t o l e h p e n l i t i a n L e w i s A l e t a l ( 2 0 1 4 ) m e n g e n a i

impact of host age and parity on susceptihility to severe urinary tract injection in

34

a murine mode d e n g a n u j i K r u s k a l - W a l l i s d e n g a n post-test D u n n u n t u k b e b e r a p a

p e r b a n d i n g a n d i m a n a u s i a d a n p a r i t a s s e b a g a i f a k t o r y a n g b e r k o n t r i b u s i d a l a m

k e r e n t a n a n i m t u k t e r j a d i n y a I S K d e n g a n n i l a i p lt 0 0 5

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n g a t a k a n b a h w a i n s i d e n I S K m e n i n g k a t

b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n

a d a n y a a b n o r m a l i t a s a n a t o m i y a n g m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n

k e m i h s e p e r t i p e m b e s a r a n p r o s t a t d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a

p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e ( R o s e 2 0 0 9 ) P e n y e b a b l a i n t e n n a s u k

p e r i n e i u n y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s p e n y a k i t n e u r o m u s k u l a r

d a n k a t e t e r i s a s i b u l i - b u l i ( F o x m a n e t a l 2 0 1 0 ) S e l a i n i t u i n s i d e n I S K m e n c a p a i

1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o n a l d 2 0 1 1 )

B Hubungan antara Jenis Keiamin dengan Kejadian infeksi Saiuran

Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 8 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d e n g a n n i l a i s i g n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O

d i t o l a k Odds Ratio ( O R ) = 8 7 0 0 ( 9 5 C l = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a risiko k e j a d i a n

i n f e k s i s a i u r a n k e m i h p a d a p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n

p a d a l a k i - i a k i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n M a g i i a n o e t a l

( 2 0 1 1 ) m e n g e n a i Gender and Age-Dependent Etiology of Community Acquired

y a n g m e l a k u k a n p e n g a m b i l a n 6 1 2 7 3 s a m p e l k u l t u r u r i n d a l a m p e r i o d e 2 2 b u l a n

d a r i s a m p e l i n i d i d a p a t k a n 1 3 8 2 0 ( 2 2 6 ) d i t e m u k a n p o s i t i f i n f e k s i b a k t e r i

h a m p i r 8 0 b a l i a n y a n g d i i s o l a s i b e r a s a l d a r i p e r e m p u a n P e n e l i t i a n i n i j u g a

d i p e r k u a t o l e h p e n e l i t i a n y a n g d i l a k u k a n o l e h Y u n i t a I ( 2 0 1 0 ) d i m a n a a d a

h u b m i g a n y a n g b e n n a k n a a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h ( P value=O049 R P = 3 2 7 3 ( 9 5 C I = I 0 1 6 - 1 0 5 4 0 )

H a l t e r s e b u t d a p a t t e r j a d i k a r e n a u r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a l i

d e n g a n d e k a t n y a v a g i n a l v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i

s a i u r a n k e m i h l e b i h s e r i n g p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a flora n o r m a l

3 5

p a d a d a e r a h p e r i u r e t r a t e r d i r i d a r i o r g a n i s m e s e p e r t i i a c t o b a c i l l u s y a n g m e m b a n t u

m e l a w a n k o l o n i s a s i b a k t e r i p a t o g e n p a d a s a i u r a n k e m i h P e r u b a h a n l i n g k i m g a n

d a r i p e r i u r e t r a l s e p e r t i p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k

b i s a m e n g g a n g g u f l o r a n o r m a l s e h i n g g a m e n u m g k i n k a n b a k t e r i p a t o g e n

b e r k o l o n i s a s i d a n m e n y e b a b k a n i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Scuare p a d a t a b e l 4 9 d i d a p a t k a n b a h w a

t e r d a p a t l i u b u n g a n y a n g s i g n i f i k a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a

H O d i t o l a k Odds Ratio ( O R ) - 6 0 0 0 ( 9 5 o C l = 2 3 5 1 - 1 5 3 I O ) a r t i n y a n s i k o

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r

a d a i a h 6 k a l i l e b i h b e s a r d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n

m e n e n g a h d a n t i n g g i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h T o r o n d e i B e t

a l ( 2 0 1 5 ) m e n g e n a i Menstrual Hygiene Practices WASH Access and the Risk of

Urogenital Infection in Women from Odisha India d i m a n a p e r e m p u a n y a n g

h a n y a m e n e m p u l i p e n d i d i k a n s e k o l a h d a s a r a t a u l e b i h r e n d a h d i b a n d i n g k a n

d e n g a n t i n g k a t p e n d i d i k a n m e n e n g a h a t a u t i n g g i m e m i l i k i r i s i k o 3 k a l i

k e m u n g k i n a n l e b i h b e s a r m e n g a l a m i i n f e k s i s a i u r a n k e m i h ( A d j O R = 3 l 9 5

C 1 = I 2 - 7 9 p = 0 0 2 )

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a p e n g e t a h u a n s e s e o r a n g

t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t p e n d i d i k a n S e s e o r a n g y a n g

m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m u n g k i n a n p e n g e t a l i u a n t e n t a n g

k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o r m a s i y a n g d i d a p a t k a n t e n t a n g k e s e h a t a n

l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h S e b a l i k n y a

p e n d i d i k a n y a n g k u r a n g d a p a t i n e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g t e r h a d a p

n i l a i - n i l a i y a n g b a r u d i k e n a l ( N o t o a d m o j o 2 0 0 3 )

3 6

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Keniih

B e r d a s a r k a n l i a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 1 0 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a r i w a y a t d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 )

s e h i n g g a H O d i t o l a k Odds Ratio ( O R ) = 9 8 0 8 ( 9 5 C I = 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a

risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h S a r i E W P d a n

S a t y a b a k t i P ( 2 0 1 5 ) m e n g e n a i p e r b e d a a n risiko i n f e k s i n o s o k o m i a l s a i u r a n k e m i h

b e r d a s a r k a n k a t e t e r i s a s i u r i n u m u r d a n d i a b e t e s m e l i m s d i m a n a d a r i 2 0 p a s i e n

i n f e k s i n o s o k o m i a l s a i u r a n k e m i h 1 2 o r a n g ( 6 0 ) d i a n t a r a n y a a d a i a h p a s i e n

d e n g a n s t a t u s D M s e d a n g k a n 8 o r a n g ( 4 0 ) l a i n n y a a d a i a h p a s i e n t a n p a s t a t u s

D M ( P v W w ^ = 0 0 2 4 O R = 6 0 0 9 5 C I = 1 2 2 - 3 2 2 6

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a b a l i w a b e b e r a p a b a g i a n

d a r i i i n u n i t a s p a d a p a s i e n d i a b e t e s m e n g a l a m i p e r u b a h a n F u n g s i

p o l i n i o r f o l e u k o s i t d i t e k a n p a d a k e a d a a n a s i d o s i s I k a t a n l e u k o s i t k e m o t a k s i s d a n

f a g o s i t o s i s j u g a b e m b a l i S i s t e m a n t i o k s i d a n y a n g b e r p e r a n p a d a a k t i f i t a s

b a k t e r i s i d a l j u g a t e r g a n g g u s e h i n g g a m e n y e b a b k a n t e r j a d i n y a I S K p a d a p a s i e n -

p a s i e n d e n g a n p e n y a k i t d i a b e t e s ( J u l k a 2 0 1 4 )

H a l y a n g s a m a j u g a d i i m g k a p k a n o l e b t e o r i S m e l t z e r d a n B a r e ( 2 0 1 0 )

b a l i w a D M d a p a t m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a l i a n a n t u b u h y a n g

b e r p o t e n s i m e n i n g k a t k a n r i s i k o t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a l i a n a n

t u b u h t e r s e b u t d i a n t a r a n y a a d a i a h k e g a g a l a n m i g r a s i s e l iniraceliular killing

f a g o s i t o s i s d a n k e m o t a k s i s p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n

m e k a n i s m e p e r t a l i a n a n a l a m i a h I o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p

i n f e k s i

BAB V

KESIMPULAN DAN SARAN

51 Kesimpulan

1 U s i a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 2 6 - 3 5 t a h u n y a i t u 2 3 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 3 7

2 U s i a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 4 6 - 5 5 t a l i u n y a i t u 2 9 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 1 3

3 U s i a j e n i s k e i a m i n d a n t i n g k a t p e n d i d i k a n s a m p e i y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i l i t e r b a n y a k y a i t u b e r u s i a gt 5 0 t a h u n ( 5 3 3 ) j e n i s k e i a m i n

p e r e m p u a n ( 6 0 0 ) d a n t i n g k a t p e n d i d i k a n d a s a r ( 6 6 7 ) s e r t a p a l i n g

b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s y a i t u 5 6 7

4 T e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 ( p = 0 0 0 0 )

52 Saran

1 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t d i l a k u k a n d e n g a n d e s a i n

p e n e l i t i a n b e r b e d a s e p e r t i cohort a t a u case control

2 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t m e i i c a r i v a r i a b e l independent

y a n g l a i n s e p e r t i v a r i a b e l p e k e r j a a n p e m a s a i i g a n k a t e t e r a t a u l a m a n y a

m e n d e r i t a d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

37

DAFTAR PUSTAKA

B o y k o E J d k k 2 0 0 2 D i a b e t i c A n d T h e R i s k O f A c u t e U r i n a r y T r a c t I n f e c t i o n A m o n g P o s t m e n o p a u s a l W o m e n D i a b e t e s C a r e 2 5 ( 1 0 )

D a h l a n S 2 0 1 4 B u k i i S t a t i s t i k u n t u k K e d o k t e r a n d a n K e s e h a t a n D e s k r i p t i f B i v a r i a t d a n M u l t i v a r i a t d i l e n g k a p i a p l i k a s i d e n g a n m e n g g u n a k a n S P S S E d i s i 6 E p i d e m i o l o g i I n d o n e s i a J a k a r t a I n d o n e s i a

D e p a r t e m e n K e s e h a t a n ( D E P K E S ) R l 2 0 1 4 [ O n l i n e ] K e m e n t e r i a n K e s e h a t a n R e p u b l i k I n d o n e s i a P u s a t D a t a d a n I n f o r m a s i K e m e n t e r a n K e s e h a t a n R l ( http 7depkesgoid diakses tanggal 15 Met 2016)

F o x m a n B e t a i 2 0 1 0 U r i i i a i y T r a c t I n f e c t i o n A m o n g W o m e n A g e d 4 0 T o 6 5 B e h a v i o r a l A n d S e x u a l R i s k F a c t o r s D a l a m T a n a g h o E A M c A n i n c h J W 1 7 t h S m i t h s G e n e r a l U r o l o g y U S A M c G r a w H i l l (http searchproqnestcom diakses tanggal 16 Met 2016)

H a r d i n g G K d k k 2 0 1 0 A n t i m i c r o b i a l T r e a t m e n t I n D i a b e t i c W o m e n W i t l i A s y m t o m a t i c B a c t e r i u r i a N E n g l J M e d 3 4 7 1 5 7 6 - 1 5 8 3 (http nejmorg diakses tanggal 16 Met 2016)

I s s e l b a c h e r d k k 2 0 0 9 I n f e k s i S a i u r a n K e m i h d a n P i e l o n e f r i t i s D a l a m S t a m m W a l t e r E e d H a r r i s o n P r i n s i p - P r i n s i p l l m u P e n y a k i t D a l a m e d V o l u m e 2 J a k a r t a E G C 6 1 6 - 6 2 3

J u l k a S 2 0 1 3 G e n i t o u r i n a r y I n f e c t i o n I n D i a b e t e s I n d i a n J o u m a l o f E n d o c r i n o l o g y a n d M e t a b o l i s m (http searchproquestcom diakses tanggal 16 Mei 2016)

K i m B d k k 2 0 1 2 [ e - b o o k ] T h e R e l a t i o n b e t w e e n P o s t v o i d R e s i d u a l a n d O c c u r r e n c e o f U r i n a r y T r a c t I n f e c t i o n a f t e r S t r o k e i n R e h a b i l i t a t i o n U n i t A n n a l s o f R e h a b i l i t a t i o n M e d i c i n e

K o m a r a A 2 0 0 9 P o l a K e p e k a a n B a k t e r i G r a m N e g a t i f d a r i P a s i e n I n f e k s i S a i u r a n K e m i l i t e r h a d a p A n t i b i o t i k G e n t a m i c i n d a n K o t r i m o k s a z o l y a n g D i k i r i m k e L a b o r a t o r i u m M i k r o b i o l o g i K l i n i k F K U l d a r i T a h u n 2 0 0 1 s a m p a i T a h u n 2 0 0 5 (http dontaruiacid diakses tanggal OH Agustiis 2016)

L e w i s A L e t a l 2 0 1 4 I m p a c t o f H o s t A g e a n d P a r i t y o n S u s c e p t i b i l i t y t o S e v e r e U r i n a r y T r a c t I n f e c t i o n i n a M u r i n e M o d e l P l o s O n e R e s e a r c h A r t i c l e P u b l i c L i b r a r y o f S c i e n c e 9 ( 5 ) (http searchproquestcom diakses pada langgal 30 Desember 2016)

38

DAFTAR T A B E L

Tabel Halaman

T a b e l 1 1 K e a s l i a n P e n e l i t i a n 5 T a b e l 3 1 D e f i n i s i O p e r a s i o n a l 2 1 T a b e l 4 1 D i s t r i b u s i P r o p o r s i K a r a k t e r i s t i k P a s i e n R a w a t i n a p

B e r d a s a r k a n U s i a d a n J e n i s K e i a m i n 2 6 T a b e l 4 2 D i s t r i b u s i P r o p o r s i K a r a k t e r i s t i k P a s i e n R a w a t J a l a n

B e r d a s a r k a n U s i a d a n J e n i s K e i a m i n 2 7 T a b e l 4 3 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n U s i a 2 8 T a b e l 4 4 D i s t r i b u s i P r o p o r s i K e j a d i a n i n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n J e n i s K e l a m m 2 8 T a b e l 4 5 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n T i n g k a t P e n d i d i k a n 2 9 T a b e l 4 6 D i s t r i b u s i P r o p o r s i K e j a d i a n I n f e k s i S a i u r a n K e m i h

B e r d a s a r k a n R i w a y a t D i a b e t e s M e l i t u s 2 9 T a b e l 4 7 H a s i l U j i H u b u n g a n a n t a r a U s i a d e n g a n K e j a d i a n

i n f e k s i S a i u r a n K e m i h 3 0 T a b e l 4 8 H a s i i U j i H u b u n g a n a n t a r a J e n i s K e i a m i n d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i b 3 1 T a b e l 4 9 H a s i l U j i H u b u n g a n a n t a r a T i n g k a t P e n d i d i k a n d e n g a n

K e j a d i a n i n t e k s i S a i u r a n K e m i h 3 2 T a b e l 4 1 0 H a s i l U j i H u b u n g a n a n t a r a R i w a y a t D i a b e t e s M e l i t u s

d e n g a n K e j a d i a n I n f e k s i S a i u r a n K e m i h 3 3

X

DAFTAR GAMBAR

Gambar Halaman

G a m b a r 3 1 A l u r P e n e l i t i a n H u b u n g a n U s i a J e n i s K e i a m i n T i n g k a t

P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i h p a d a P a s i e n R a w a t i n a p

d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g I e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1

D e s e m b e r 2 0 1 5 2 4

xi

DAFTAR LAMPIRAN

Lampiran Halaman

L a m p i r a n 1 D a t a R e k a m M e d i s P a s i e n R a w a t I n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 4 3

L a m p i r a n 2 H a s i l A n a l i s i s U n v i a r i a t 4 5

L a m p i r a n 3 H a s i l A n a l i s i s B i v a r i a t 5 1

L a m p i r a n 4 K a r t u B i m b i n g a n P r o p o s a l S k r i p s i 5 8

L a m p i r a n 5 K a r t u B i m b i n g a n S k r i p s i 5 9

L a m p i r a n 6 S u r a t P e n n o h o n a n I z i n P e n e l i t i a n 6 0

L a m p i r a n 7 S u r a t K e t e r a n g a n I z i n P e n g a m b i l a n D a t a d a n P e n e l i t i a n 6 1

L a m p i r a n 8 S u r a t K e t e r a n g a n S e l e s a i P e n e l i t i a n 6 2

xii

BAB I

PENDAHULUAN

11 Latar Belakang

I n f e k s i s a i u r a n k e m i h ( I S K ) m e n i p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m i i k a n d i R u m a h S a k i t a t a u t e m p a t p r a k t i k u m u m s e h a r i - h a r i I S K

a d a i a h s u a t u i n f e k s i y a n g m e n g e n a i t r a k t u s u r i n a r i u s m u l a i d a r i m e a t u s u r e t r a

s a m p a i d e n g a n k e g i n j a l S t r u k t u r y a n g t e n n a s u k d i d a l a m n y a a d a i a h u r e t r a

k a n d u n g k e m i h u r e t e r p e l v i s d a n p a r e n k i m g i n j a l S t r u k t u r y a n g b e r k a i t a n u n t u k

t e r j a d i n y a i n f e k s i d a n r e k u r e n i n f e k s i y a i t u p r o s t a t e p i d i d i m i s d a n fascia

perinephric I s t i l a h I S K m e n u n j u k k a n a d a n y a k e b e r a d a a n m i k r o o r g a n i s m e d i

d a l a m u r i n ( S u d o y o 2 0 0 6 R u b i n 2 0 1 0 ) D e n g a n k a t a l a i n b a h w a d i a g n o s i s I S K

d i t e g a k k a n d e n g a n m e m b u k t i k a n a d a n y a m i k r o o r g a n i s m e d i d a l a m s a i u r a n k e m i h

( R u b i n 2 0 1 0 )

S e b a n y a k 2 5 j u t a k e m a t i a n d i s e l u r u h d u n i a p a d a t a h u n 2 0 1 1 s e p e r t i g a n y a

d i s e b a b k a n o l e h p e n y a k i t i n f e k s i I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n i n f e k s i

d e n g a n k e t e r l i b a t a i i b a k t e r i t e r s e r i n g d i k o m u n i t a s d a n h a m p i r 1 0 o r a n g p e m a h

t e r k e n a I S K s e l a m a h i d u p n y a S e k i t a i - 1 5 0 j u t a p e n d i i d u k d i s e l u r u h d u n i a t i a p

t a l i u n n y a t e r d i a g n o s i s m e n d e r i t a i n f e k s i s a i u r a n k e m i h ( Y u n u s 2 0 1 2 )

I S K d a p a t m e n g e n a i s e m u a k e l o m p o k u m u r b a i k a n a k r e m a j a d e w a s a

m a u p u n u s i a l a n j u t P r e v a l e n s i a n a k u s i a s e k o l a h y a n g m e n d e r i t a I S K s e k i t a r 1 -

3 d a n m e n i n g k a t p a d a r e m a j a y a n g s u d a h m e l a k u k a n h u b i m g a n s e k s u a l

( K o m a r a 2 0 0 9 ) D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r 2 5 - 3 5

s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a S e l a m a

p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n c e n d e r u n g

m e n d e r i t a I S K d i b a n d i n g k a n l a k i - l a k i ( S u d o y o 2 0 0 9 )

R a s i o I S K p a d a w a n i t a d i b a n d i n g p r i a b e r k i s a r 3 0 1 d a n s e k i t a r 5 0 w a n i t a

y a n g t e r k e n a i n f e k s i a k a n b e r k e m b a n g m e n j a d i I S K b e m l a n g I S K m e n i p a k a n

i n f e k s i b a k t e r i y a n g p a l i n g s e r i n g p a d a a n a k - a n a k d e n g a n k e l u h a n d e m a m b a i k

p a d a a n a k p r i a m a u p u n w a n i t a P r e v a l e n s i y a n g p e m a h d i l a p o r k a n b e r k i s a r 4 1

I

2

s a m p a i 7 5 R e k u r e n s i c u k u p s e r i n g d a n t e r j a d i s e k i t a r 1 8 p a d a b a y i l a k i - i a k i

d a n 2 6 p a d a b a y i p e r e m p u a n U n t u k u s i a p r a s e k o l a h I S K l e b i h s e r i n g

m e n g e n a i w a n i t a I n s i d e n I S K p a d a a n a k - a n a k p r a s e k o l a h s e k i t a r 2 ( S y a h r i n i

2 0 1 1 )

D a r i b e r b a g a i p e n e l i t i a n e p i d e m i o l o g i s d i I n d o n e s i a d i d a p a t k a n p r e v a l e n s i

D M s e b e s a r 15 - 2 3 p a d a p e n d u d u k u s i a l e b i J i d a r i 1 5 t a h u n b a h k a n p a d a

s u a t u p e n e l i t i a n e p i d e m i o l o g i s d i M a n a d o d i d a p a t k a n p r e v a l e n s i D M a d a i a h 6 1

P r e v a l e n s i d i a b e t e s m e l i t u s p a d a p e n d u d u k u s i a 2 5 - 6 4 t a h u n d i J a w a d a n B a l i

s e b e s a r 7 5 P e n e l i t i a n y a n g d i l a k u k a n d i J a k a r t a S u r a b a y a M a k a s a r d a n k o t a -

k o t a l a i n d i I n d o n e s i a m e m b u k t i k a n a d a n y a k e n a i k a n p r e v a l e n s i d a r i t a h u n

k e t a h u n ( D E P K E S 2 0 1 4 W H O 2 0 1 0 )

I n f e k s i s a i u r a n k e m i h j u g a m e n i p a k a n m a s a l a h k l i n i s u m u m p a d a p e n d e r i t a

D M o l e h k a r e n a p e n d e r i t a D M m e m p u n y a i k e m u n g k i n a n m e n d e r i t a I S K l e b i h

t i n g g i d i b a n d i n g k a n d e n g a n b u k a n p e n d e r i t a D M d a n j u g a m e n d e r i t a i n f e k s i y a n g

l e b i h b e r a t y a n g a k a n m e n i n g k a t k a n risiko u n t u k m a s u k m m a h s a k i t ( H a r d i n g

d k k 2 0 1 0 ) P e n e l i t i a n y a n g d i l a k u k a n o l e h B o y k o d k k m e n d a p a t k a n w a n i t a D M

ripe 2 d e n g a n b a k t e r i u r i a s i m t o m a t i k s e t e l a h d i l a k u k a n p e m a n t a u a n s e l a m a 1 8

b u l a n m e n g a l a m i p e n i n g k a t a n r i s i k o m e n d a p a t k a n I S K s e b a n y a k 3 4

d i b a n d i n g k a n d e n g a n w a n i t a y a n g t i d a k m e n g a l a m i D M s e b e s a r 1 9 ( B o y k o d k k

2 0 0 2 )

B e r d a s a r k a n u r a i a n - u r a i a n d i a t a s s e r t a b e l u m a d a n y a p e n e l i t i a n y a n g

m e n e m u k a n k e t e r k a i t a n f a k t o r u s i a j e n i s k e l a m m t i n g k a t p e n d i d i k a n d a n r i w a y a t

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h d i K o t a P a l e m b a n g m a k a

p e n e l i t i t e r t a r i k i m t i i k m e l a k u k a n p e n e l i t i a n m e n g e n a i h u b u n g a n a n t a r a u s i a j e n i s

k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

3

12 Rumusan Masalah

1 B a g a i m a n a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s

m e l i t u s

2 A p a k a l i a d a h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

13 Tujuan Penelitian

131 Tujuan Umum

T u j u a n u m u m d a r i p e n e l i t i a n i n i a d a i a h d i k e t e m u k a n n y a h u b u n g a n a n t a i a

u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i m s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

132 Tujuan Khusus

T u j u a n k l i u s u s d a r i p e n e l i t i a n i n i y a i t u

1 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a

2 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n m f e k s i s a i u r a n k e m i b p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n j e n i s k e i a m i n

3 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

4

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n t i n g k a t p e n d i d i k a n

4 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n riwayat d i a b e t e s m e l i t u s

5 T e r a n a l i s i s n y a h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a i m n a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

6 T e r a n a l i s i s n y a h u b u n g a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

7 T e r a n a l i s i s n y a h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

8 T e r a n a l i s i s n y a h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i u i s d e n g a n k e j a d i a n

i n f e k s i s a l i u a i i k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

14 Manfaat Penelitian

141 Manfaat Teoritis

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t m e n a m b a h p e n g e t a h u a n p e n e l i t i

t e n t a n g h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i U i s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

5

142 Manfaat Praktis

A Bagi Peneliti

H a s i l p e n e l i t i a n i n i d i l i a r a p k a n d a p a t d i g u n a k a n s e b a g a i s a l a h s a t u b a h a n

r e f e r e n s i a t a u b a c a a n b a g i p e n e l i t i

B Bagi Institusi

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t d i g u n a k a n p i h a k R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g s e b a g a i s a l a l i s a t u b a h a n a c u a n d a l a m m e n g u p a y a k a n

p e n c e g a h a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

15 Keaslian Penelitian

T a b e l 1 1 K e a s l i a n P e n e l i t i a n

Nama Judul Penelitian Desain Hasil Penelitian

Peneliti Penelitian

Kugan P r e v a l e n s i I n f e k s i Cross D a r i p e n e l i t i a n i i i i

Kandasamy S a i u r a n K e m i l i P a d a seciUmal d i p e r o l e h b a l i w a

W a n i t a Y a n g M e n d e r i t a

D i a b e t e s M e l i t u s T i p e

I I Y a n g D i r a w a t I n a p

p a s i e n w a n i t a d i a b e t e s

m e l i t u s t i p e I y a n g

m e n d e r i t a I S K y a n g

D a n D i r a w a t J a l a n D i d i r a w a t m a p d a n

S u b b a g i a n

E n d o k r i n o l o g i B a g i a n

P e n y a k i t D a l a m D i

d i r a w a t j a l a n d i s u b

b a g i a n E n d o k r i n o l o g i

P e n y a k i t D a l a m

R S U P H A d a m M a l i k R S U P H A d a m

P a d a T a l i u n 2 0 0 9 M a l i k M e d a i i t e r d a p a t

s e b a n y a k 2 5 o r a n g

y a i t u ( 1 2 7 ) D a r i 2 5

o r a n g y a n g m e n d e r i t a

I S K t e r d a p a t 3 o r a n g

y a i t u ( 1 2 0 ) y a n g

d i r a w a t i n a p d a n 2 2

6

o r a n g ( 8 8 0 ) y a n g

d i r a w a t j a l a n

Edel Weisela P e r b e d a a n R i s i k o

Permata I n f e k s i N o s o k o m i a l

Sari dan S a i u r a n K e m i h

Prijono B e r d a s a r k a n

Satyabakti K a i e t e r i s a s i U r i n

U m u r D a n D i a b e t e s

M e l i t u s T a h u n 2 0 1 5

Case H a s i l p e n e l i t i a n y a n g

control d i 1 a k u k a n p a d a 2 0

s a m p e l k a s u s d a n

k o n t r o l m e n u n j u k k a n

b a h w a p a s i e n d e n g a n

u m u r gt 5 5 t a h u n

m e m p u n y a i r i s i k o

5 5 7 k a l i m e n g a l a m i

i n f e k s i n o s o k o m i a l

s a i u r a n k e m i h

d i b a n d i n g k a n p a s i e n

d e n g a n u m u r lt 5 5

t a h u n d e n g a n

p e r i l i t u n g a i i b e s a r

risiko d i p e r o l e h n i l a i

O R s e b e s a r 5 5 7

d e n g a n n i l a i 9 5

(onfidence Interval

l 1 9 lt O R lt 2 8 2 3

P a s i e n d e n g a n s t a t u s

D M m e m p u n y a i risiko

6 k a l i u n t u k

m e n g a l a m i i n f e k s i

n o s o k o m i a l s a i u r a n

k e m i h d i b a n d i n g k a n

d e n g a n p a s i e n y a n g

t i d a k m e n d e r i t a D M

d e n g a n n i l a i O R

7

s e b e s a r 6 0 0 d e n g a n

n i l a i 9 5 Confidence

Interval 1 22 lt O R lt

3 2 2 6

Andry K a r a k t e r i s t i k P a s i e n - D e s k r i p k i f H a s i i p e n e l i t i a n d a r i

Lukandy P a s i e n I n f e k s i S a i u r a n r e t r o s p e k t i f 4 3 o r a n g p e n d e r i t a

K e m i i i d i P o l i u r o l o g i

R S U D D r P i m g a d i

K o t a M e d a n T a h u n

2 0 1 2 - 2 0 1 3

I S K d i d a p a t k a n 5 3 5

p a d a k e l o m p o k u s i a

gt 5 0 t a h u n 5 1 2

b e i j e n i s k e i a m i n l a k i -

l a k i 1 0 0 t i d a k

m e n d e r i t a

v e s i c o u r e t r a l r e f l u x

7 0 Benign Prostatic

Hyperplasia 1 1 6

b a t u s a i u r a n k e m i h

2 7 9 d i a b e t e s t i p e 2

D a r i h a s i l p e n e l i t i a n

i n i d a p a t d i s i m p u l k a n

b a h w a p e n d e r i t a i S K

l e b i h b a n y a k t e r j a d i

p a d a l a k i - l a k i d a n

p e n d e r i t a I S K l e b i h

b a n y a k d i j u m p a i p a d a

k e l o m p o k u m u r gt 5 0

t a h u n s e r t a d i t e m u k a n

I S K d e n g a n B P H

B S K d a n D M T i p e 2

BAB 11

TINJAUAN PUSTAKA

21 Landasan Teori

211Infeksi Saiuran Keniih

A Definisi

I n f e k s i S a i u r a n K e m i h a d a i a h i n v a s i d a n m u l t i p l i k a s i m i k r o o r g a n i s m e a t a u

p a r a s i t d a l a m j a r i n g a n t u b u h k h u s u s n y a s a i u r a n k e m i h y a n g t e r d i r i d a r i g i n j a l

u r e t e r b u l i - b u l i d a n u r e t r a y a n g d i i a n d a i d e n g a n a d a n y a b a k t e r i 1 0 c f i i (colony

forming unit) p e r m l p a d a p e n g a m b i l a n c o n t o h u r i n ( P u m o m o 2 0 1 1 )

I n f e k s i s a i u r a n k e m i h a d a l a l i s u a t u i n f e k s i y a n g m e l i b a t k a n g i n j a l lU e ter

b u l i - b u l i a t a u p u n u r e t r a I n f e k s i s a i u r a n k e m i h ( I S K ) a d a l a l i i s t i l a h u m u m y a n g

m e n u n j u k k a n k e b e r a d a a n m i k r o o r g a n i s m e d a l a m u r i n ( S u d o y o 2 0 0 6 )

B a k t e r i u r i a b e r m a k n a (significant hacteriuria) a d a i a h s u a t u k e a d a a n y a n g

m e n u n j u k k a n p e n u m b u l i a n m i k r o o r g a n i s m e m u m i l e b i h d a r i 1 0 c f t L m l p a d a

b i a k a n u r i n B a k t e r i u r i a b e r m a k n a m u n g k i n t a n p a d i s e r t a i p r e s e n t a s i k l i n i s I S K

d a n d i n a m a k a n b a k t e r i u r i a a s i m t o m a t i k (convert hacteriuria) S e b a l i k n y a

b a k t e r i u r i a b e n n a k n a d i s e r t a i p e r s e n t a s i k l i n i s I S K d i n a m a k a n b a k t e r i u r i a

s i m t o m a t i k P a d a b e b e r a p a k e a d a a n t e r d a p a t p a s i e n d e n g a n p e r s e n t a s i k l i n i s I S K

n a m u n t a n p a b a k t e r i u r i a b e n n a k n a S e l a i n i t u d i k a t a k a n p i u r i a ( l e u k o s i t d a l a m

u r i n ) b e n n a k n a (significant pyuria) b i l a d i t e m u k a n n e u t r o f i l gt 1 0 s e l p e r l a p a n g a n

p a n d a n g ( S u d o y o 2 0 0 6 )

B Epidemiologi

I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m u k a n d i p r a k t i k u m u m w a i a u p u n b e n n a c a m - m a c a m a n t i b i o t i k a s u d a h

t e r s e d i a l u a s d i p a s a r a n D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r

2 5 - 3 5 s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a

S e l a m a p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n

9

10

c e n d e r u n g m e n d e r i t a i S K d i b a n d i n g k a n l a k i - l a k i I S K b e m l a n g p a d a l a k i - l a k i

j a r a n g d i l a p o r k a n k e c u a l i d i s e r t a i f a k t o r p r e d i s p o s i s i ( p e n c e t u s )

P r e v a l e n s i b a k t e r i u r i a a s i m t o m a t i k l e b i h s e r i n g d i t e m u k a n p a d a p e r e m p u a n

P r e v a l e n s i s e l a m a p e r i o d e s e k o l a h (school girls) 1 m e n i n g k a t m e n j a d i 5

s e l a m a p e r i o d e a k t i f s e c a r a s e k s u a l P r e v a l e n s i i n f e k s i a s i m t o m a t i k m e n i n g k a t

m e n c a p a i 3 0 b a i k l a k i - l a k i m a u p u n p e r e m p u a n b i l a d i s e r t a i f a k t o r p r e d i s p o s i s i

( S u d o y o 2 0 0 6 )

C Kiasifikasi

I n f e k s i s a i u r a n k e m i h d a p a t d i b a g i m e n j a d i d u a k a t e g o r i u m u m b e r d a s a r k a n

l o k a s i a n a t o m i y a i t u

1 ) I n f e k s i s a i u r a n k e m i h b a w a h

2 ) I n f e k s i s a i u r a n k e m i h a l a s

P r e s e n t a s i k l i n i s d a r i i n f e k s i s a i u r a n k e m i h b a w a l i t e r g a n t u n g d a r i gender

y a i t u

a ) P e r e m p u a n

a S i s t i t i s

S i s t i t i s a d a i a h p r e s e n t a s i k l i n i s i n f e k s i k a n d u n g k e m i h d i s e r t a i

b a k t e r i u r i a b e n n a k n a

b S i n d r o m U r e t r a A k u t ( S U A )

S i n d r o m a u r e t r a a k u t a d a i a h p r e s e n t a s i k l i n i s s i s t i t i s t a n p a d i t e m u k a n

a d a n y a m i k r o o r g a n i s m e d a l a m L u i n ( s t e r i l ) d a n s e r i n g d i n a m a k a n

s i s t i t i s b a k t e r i a l i s

b ) L a k i - l a k i

P r e s e n t a s i k l i n i s i n f e k s i s a i u r a n k e m i h p a d a l a k i - l a k i m u n g k i n s i s t i t i s

p r o s t a t i t i s e p i d i m i d i s d a n u r e t r i t i s

I n f e k s i s a i u r a n k e m i h a t a s t e r b a g i m e n j a d i 2 y a i t u

1 ) P i e l o n e f r i t i s A k u t ( P N A )

P i e l o n e f r i t i s a k u t a d a l a l i p r o s e s i n f l a m a s i p a r e n k i m g i n j a l y a n g d i s e b a b k a n

o l e h m f e k s i b a k t e r i

11

2 ) P i e l o n e f r i t i s K r o n i s ( P N K )

P i e l o n e f r i t i s k r o n i s m u n g k i n a k i b a t l a n j u t d a r i i n f e k s i b a k t e r i

b e r k e p a n j a n g a n a t a u i n f e k s i s e j a k m a s a k e c i i O b s t r u k s i s a i u r a n k e m i h d a n

r e f l u k s v e s i k o u r e t e r d e n g a n a t a u t a n p a b a k t e r i u r i a k r o n i k s e r i n g d i i k u t i

p e m b e n t u k a n j a r i n g a n i k a t p a r e n k i m g i n j a l y a n g d i t a n d a i d e n g a n

p i e l o n e f r i t i s k r o n i k y a n g s p e s i f i k ( S u d o y o 2 0 0 6 )

D Etiologi

P a d a k e a d a a n n o r m a l u r i n b e r s i f a t s t e r i l U m u m n y a I S K d i s e b a b k a n o l e h

k i i m a n g r a m n e g a t i f E s c h e r i c h i a c o l i m e m p a k a n p e n y e b a b t e r b a n y a k b a i k p a d a

y a n g s i m t o m a t i k m a u p u n y a n g a s i m t o m a t i k y a i t u 7 0 - 9 0 E n t e r o b a k t e r i a s e p e r t i

P r o t e u s m i r a b i l i s ( 3 0 d a r i i n f e k s i s a i u r a n k e m i h p a d a a n a k l a k i - l a k i t e t a p i

k u r a n g d a r i 5 p a d a a n a k p e r e m p u a n ) K l e b s i e l l a p n e u m o n i a d a n P s e u d o m o n a s

a e m g i n o s a d a p a t j u g a s e b a g a i p e n y e b a b O r g a n i s m e g r a m p o s i t i f s e p e r t i

S t r e p t o c o c c u s f a e c a l i s ( e n t e r o k o k u s ) S t a p h y l o c o c c u s e p i d e n n i d i s d a n

S t r e p t o c o c c u s v i r i d a n s j a r a n g d i t e m u k a n P a d a u r o p a t i o b s t m k t i f d a n k e l a i n a n

s t r u k t u r s a i u r a n k e m i h p a d a a n a k l a k i - l a k i s e r i n g d i t e m u k a n P r o t e u s s p e c i e s P a d a

I S K n o s o k o m i a l a t a u I S K k o m p l e k s l e b i h s e r i n g d i t e m u k a n k u m a n P r o t e u s d a n

P s e u d o m o n a s ( L u m b a n b a t u S M 2 0 0 3 )

E Patofisiologi

P a d a i n d i v i d u n o n n a l b i a s a n y a u r i n l a k i - l a k i m a u p u n p e r e m p u a n s e l a l u

d a l a m k e a d a a n s t e r i l k a r e n a d i p e r t a l i a n k a n o l e h j u m l a l i d a n f r e k u e n s i b e r k e m i h

U t e r o d i s t a l m e m p a k a n t e m p a t k o l o n i s a s i m i k r o o r g a n i s m e nonpathogenic

fastidious G r a m - p o s i t i f d a n g r a m n e g a t i f ( S u d o y o 2 0 0 6 )

H a m p i r s e m u a I S K d i s e b a b k a n i n v a s i m i k r o o r g a n i s m e ascending d a r i u r e t r a

k e d a l a m k a n d u n g k e m i b P a d a b e b e r a p a p a s i e n t e r t e n t u i n v a s i m i k r o o r g a n i s m e

d a p a t m e n c a p a i k e g i n j a l P r o s e s i n i d i p e n n u d a h o l e h k o n d i s i r e f l u k s

v e s i k o i i r e t e r a l P r o s e s i n v a s i m i k r o o r g a n i s m e h e m a t o g e n s a n g a t j a r a n g d i t e m u k a n

d i k l i n i k m u n g k i t a k i b a t l a n j u t d a r i b a k t e r e m i a G i n j a l d i d u g a m e n i p a k a n l o k a s i

12

i n f e k s i s e b a g a i a k i b a t l a n j u t d a r i s e p t i k e m i a a t a u e n d o k a r d i t i s a k i b a t S t a f i l o k o k u s

a u r e u s K e l a i n a n g i n j a l y a n g t e r k a i t d e n g a n e n d o k a r d i t i s ( S t a f i l o k k o k u s a u r e u s )

d i k e n a l d e n g a n N e p h r i t i s L o h e i n B e b e r a p a p e n e l i t i a n m e l a p o r k a n p i e l o n e f r i t i s

a k u t ( P N A ) s e b a g a i a k i b a t l a n j u t i n v a s i h e m a t o g e n ( S u d o y o 2 0 0 6 )

F Faktor Risiko

P a t o f i s i o l o g i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h d a p a t d i p e n g a n i h i o l e h

b e b e r a p a f a k t o r A d a p u n b e b e r a p a f a k t o r risiko y a n g m e m p e n g a n i l i i t e r j a d i n y a

i n f e k s i s a i u r a n k e m i h a n t a r a l a i n

1 ) U s i a

I n s i d e n I S K m e n i n g k a t b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i

m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n a d a n y a a b n o r m a l i t a s a n a t o m i y a n g

m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n k e m i h s e p e r t i p e m b e s a r a n p r o s t a t

d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e

P e n y e b a b l a i n t e r m a s u k p e r i n e u m y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s

p e n y a k i t n e u r o m u s k n l a r d a n k a t e t e r i s a s i b u l i - b u l i S e l a i n i t u i n s i d e n I S K

m e n c a p a i 1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o s e 2 0 0 9 F o x m a n e t a l 2 0 1 0

R o n a l d 2 0 1 1 )

M e n u m t t e o r i y a n g d i k e m u k a k a n o l e h S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a d a u s i a

l a n j u t a k a n t e r j a d i p e n i n g k a t a n k e r e n t a n a n t e r h a d a p p e n y a k i t P a d a u s i a d i a t a s 5 0

t a l i u n t e r j a d i p e n u m n a n k e m a m p u a n d a l a m m e m p e r t a h a n k a n s t e n l i t a s b a i k p a d a

k a n d u n g k e m i h m a u p u n u r e t r a H a l t e r s e b u t d i s e b a b k a n o l e h i n v o l u s i t i m u s

I n v o l u s i s e l t i m u s m e n y e b a b k a n j u m l a h se d a n k u a l i t a s r e s p o n s s e l T s e m a k i n

b e r k u r a n g J u m l a h s e l T m e m o r i m e n i n g k a t n a m u n s e m a k i n s u l i t u n t u k

b e r k e m b a n g t e r u t a m a s i t o t o k s i k s e l T ( C D ^ ) d a n s e l T h l ( C D ^ ^ ) k a r e n a t e r j a d i

a p o p t o s i s S i t o t o k s i k s e l T ( C D ^ ^ ) b e i p e r a n d a l a m r e s p o n s i m u n t e r h a d a p a n t i g e n

p a d a s e l y a n g d i i n f e k s i d e n g a n c a r a m e m b u n u l i s e l y a n g t e r i n f e k s i u n t u k

m e n c e g a h p e n y e b a r a n m f e k s i s e d a n g k a n s e l T h l ( C D ^ ^ ) b e r p e r a n m e m b a n t u s e l

B u n t u k m e m p r o d u k s i a n t i b o d i

13

2 ) J e n i s k e l a m m d a n a k t i v i t a s s e k s u a l

I n s i d e n s i I S K y a n g r e n d a h p a d a p r i a d i p e n g a n i h i o l e h 3 f a k t o r y a i t u

1 L e b i h s e d i k i t t e r j a d i k o l o n i s a s i s e k i t a r u r e t r a k a r e n a t i d a k a d a n y a t e m p a t

s e p e r t i v a g i n a p a d a p e r e m p u a n

2 M e m i l i k i u r e t r a y a n g p a n j a n g

3 A d a n y a s u b s t a n s i a n t i b a k t e r i a l p a d a c a i r a n p r o s t a t

U r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a h d e n g a n d e k a t n y a v a g i n a l

v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h l e b i h s e r i n g

p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a f l o r a n o n n a l p a d a d a e r a l i p e r i u r e t r a t e r d i r i

d a r i o r g a n i s m e s e p e r t i l a c t o b a c i l l i i s y a n g m e m b a n t u m e l a w a n k o l o n i s a s i b a k t e r i

p a t o g e n p a d a s a i u r a n k e m i h P e r u b a l i a n l i n g k i m g a n d a r i p e r i u r e t r a l s e p e r t i

p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k b i s a m e n g g a n g g u f l o r a

n o r m a l s e h i n g g a m e m u n g k i n k a n b a k t e r i p a t o g e n b e r k o l o n i s a s i d a n m e n y e b a b k a n

i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

P a d a w a n i t a l e b i h d a r i 5 0 t a h u n a t a u l e b i h m e n o p a u s e m e m p a k a n f a k t o r

l a i n y a n g m e n i n g k a t k a n P V R Post Void Residual) s e l a i n p e n u r u n a n k o i i t r a k t i i i t a s

o t o t d e t r u s o r P e n u m n a n e s t r o g e n y a n g d i s e b a b k a n m e n o p a u s e d a p a t

m e n i n g k a t k a n p H v a g i n a l d a n m e n u m n k a n j u m l a l i l a c t o b a c i l l i A k i b a m y a t e r j a d i

p e n i n g k a t k a n k o l o n i s a s i d a r i b a s i l g r a m n e g a t i f s e h i n g g a m e n i n g k a t k a n r e s i k o

t e r j a d i n y a I S K P a d a p r i a p r o s t a t m e n s e k r e s i k a n c a i r a n y a n g m e n g a n d i m g z i n k

y a n g m e m i l i k i a k t i f i t a s m i k r o b i a l ( K i m 2 0 1 2 )

S e l a i n i t u p i j a t a n u r e t r a s e p e r t i y a n g t e r j a d i s e l a m a h u b u n g a n s e k s u a l

m e n y e b a b k a n m a s u k n y a b a k t e r i k e d a l a m k a n d u n g k e m i h d a n m e m p a k a n h a l

y a n g p e n t i n g d a l a m p a t o g e n e s i s m f e k s i s a l i u a n k e m i h p a d a p e r e m p u a n m u d a

B u a n g a i r k e c i l s e t e l a h h u b u n g a n s e k s u a l t e r b u k t i m e n u m n k a n risiko s i s t i t i s

m u n g k i n k a r e n a t i n d a k a n i n i m e n i n g k a t k a n e r a d i k a s i b a k t e r i y a n g m a s u k s e l a m a

h u b u n g a n s e k s u a l ( K i m 2 0 1 2 )

3 ) T i n g k a t P e n d i d i k a n

P e n g e t a h u a n s e s e o r a n g t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t

p e n d i d i k a n S e s e o r a n g y a n g m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m i u i g k i n a n

p e n g e t a h u a n t e n t a n g k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o n n a s i y a n g d i d a p a t k a n

14

t e n t a n g k e s e h a t a n l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h

S e b a l i k n y a p e n d i d i k a n y a n g k u r a n g d a p a t m e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g

t e r h a d a p n i l a i - n i l a i y a n g b a n i d i k e n a l ( N o t o a d i n o j o 2 0 0 3 )

4 ) R i w a y a t D i a b e t e s M e l i t u s

M e n u r u t S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a s i e n d e n g a n s t a t u s D M s a n g a t

b e r i s i k o u n t u k m e n g a l a m i i n f e k s i s a i u r a n k e m i h A b n o n n a l i i a s s t n i k t u r d a n

k a n d u n g k e m i h n e u r o g e n i k a k i b a t n e u r o p a t i o t o n o m a t a u s t r o k e p a d a p a s i e n D M

m e n y e b a b k a n p e n g o s o n g a n k a n d u n g k e m i h t i d a k n o n n a l D M j u g a d a p a t

m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a h a n a n t u b u h y a n g b e r p o t e n s i m e n i n g k a t

risiko t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a h a n a n t u b u h t e r s e b u t d i a n t a r a n y a

a d a i a h k e g a g a l a n m i g r a s i s e l intracellular killing f a g o s i t o s i s d a n k e m o t a k s i s

p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n m e k a n i s m e p e r t a h a n a n

a l a m i a h i o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p i n f e k s i

5 ) K e h a m i i a n

K e c e n d e r u n g a n i n f e k s i s a i u r a n k e m i h b a g i a n a t a s s e l a m a k e h a m i i a n

d i s e b a b k a n o l e h p e n u m n a n k e k u a t a n u r e t e r p e n u m n a n p e r i s t a l t i k u r e t e r d a n

i n k o m p e t e n s i s e m e n t a r a k a l u p v e s i k o i u - e t e r a l y a n g t e r j a d i s e l a m a h a m i l

6 ) S u m b a t a i i

A d a n y a I i a i a n g a n a l i r a n b e b a s u r i n s e p e r t i t u m o r s t r i k t r a a b a t u a t a u

h i p e r t r o f i p r o s t a t d a p a t m e n y e b a b k a n h i d r o n e f r o s i s d a n risiko i n f e k s i s a i u r a n

k e m i l i y a n g s a n g a t t i n g g i S e l a i n i t u s u p e r i n f e k s i p a d a s u m b a t a n s a i u r a n k e m i h

d a p a t m e n y e b a b k a n k e m s a k a n j a r i n g a n g i n j a l y a n g c e p a t

7 ) D i s f u n g s i n e u r o g e n i k k a n d u n g k e m i h

G a n g g u a n s a r a f y a n g b e k e r j a p a d a k a n d m i g k e m i h s e p e r t i p a d a j e j a s k o r d a

s p i n a l i s t a b e s d o r s a i i s m u l t i p e l s k l e r o s i s d i a b e t e s m e l i t u s a t a u p e n y a k i t l a i n

d a p a t b e r h u b u n g a n d e n g a n i n f e k s i s a i u r a n k e m i h I n f e k s i d a p a t d i a w a l i o l e h

p e n g g u n a a n k a t e l e r u n t u k d r a i n a s e k a n d i u i g k e m i h d a n d i d u k i m g o l e h s t a t i s u r i n

d a l a m k a n d u n g k e m i l i u n t u k j a n g k a w a k t u y a n g l a m a

8 ) R e f l u k s v e s i k o m e t e r a

K e a d a a n i n i d i d e f i n i s i k a n s e b a g a i r e f l u k s u r i n d a r i k a n d u n g k e m i b k e u r e t e r

d a n k a d a n g s a m p a i k e p e l v i s r e n a l H a l i n i t e r j a d i s e l a m a b u a n g a i r k e c i l a t a u

15

d e n g a n p e n i n g k a t a n t e k a n a n p a d a k a n d u n g k e m i h R e f l u k s v e s i k o i i r e t e r a l d a p a t

d i b u k t i k a n d e n g a n a d a n y a g c r a k a n r e t r o g r a d z a t r a d i o o p a k a t a u r a d i o a k t i f m e l a l u i

s i s t o u r e t r o g r a m s e l a m a b u a n g a i r k e c i l R e f l u k s v e s i k o i i r e t e r a l b i a s a n y a

d i s e b a b k a n k a r e n a a d a n y a g a n g g u a n a n a t o m i s p a d a p e r t e m u a n v e s i k o i i r e t e r a l

y a n g d a p a t m e n y e b a b k a n r e f l u k s u r i n d i s e r t a i b a k t e r i d a n k a r e n a i t u t e r j a d i l a h

i n f e k s i s a l r a a n k e m i h

9 ) F a k t o r v i r u l e n s i b a k t e r i

F a k t o r v i r u l e n s i b a k t e r i m e m p e n g a r u b i k e m u n g k i n a n vragt7 t e r t e n m d a l a m

m e n y e b a b k a n i n f e k s i t r a k i u s u r i n a r i u s H a m p i r s e m u a strain F c o l i y a n g

m e n y e b a b k a n p i e l o n e f r i t i s p a d a p a s i e n d e n g a n t r a k i u s u r i n a r i u s n o m i a l s e c a r a

a n a t o m i k m e m p u n y a i p i l u s t e r t e n t u y a n g m e m p e r a n t a r a i p e r l e k a t a n p a d a b a g i a n

d i g a k t o s i d a d a n g l i k o s f i n g o l i p i d y a n g a d a d i u r o e p i t e l Strain y a n g m e n i m b u l k a n

p i e l o n e f r i t i s j u g a b i a s a n y a m e m p a k a n p e n g b a s i l h e m o l i s i n m e m p u n y a i

a e r o b a k t i n d a n r e s i s t e n t e r h a d a p k e r j a b a k t e r i s i d a l d a r i s e m m m a n u s i a

1 0 ) F a k t o r g e n e t i k

F a k t o r g e n e t i k p e n j a m u m e m p e n g a n i l i i k e r e n t a n a n t e r h a d a p i n f e k s i t r a k t u s

u r i n a r i u s J u m l a h d a n t i p e r e s e p t o r p a d a s e l u r o e p i t e l t e m p a t b a k t e r i d a p a t

m e n e m p e l s e l i d a k i i y a s e b a g i a i i d i t e n t u k a r i s e c a r a g e n e t i k ( I s s e l b a c h e r 2 0 0 9 )

G Manifestasi Klinis

G e j a l a k l i n i s d a r i i n f e k s i s a i u r a n k e m i h s e s u a i d e n g a n b a g i a n s a i u r a n k e m i h

y a n g t e r i n f e k s i a d a i a h s e b a g a i b e r i k u t

1 ) I n f e k s i s a i u r a n k e m i h b a g i a n b a w a l i

K e l u h a n p a s i e n b i a s a n y a b e m p a r a s a s a k i t a t a u r a s a p a n a s d i u r e t r a s e w a k t u

k e n c i n g d e n g a n a i r k e m i h s e d i k i t - s e d i k i t s e r t a r a s a t i d a k e n a k d i d a e r a h

s i i p r a p u b i k

2 ) I n f e k s i s a i u r a n k e m i h b a g i a n a t a s

P a d a i n t e k s i s a i u r a n k e m i h b a g i a n a t a s d a p a t d i t e m u k a n g e j a l a s e p e r t i s a k i t

k e p a l a m a l a i s e m u a l m m i t a h d e n i a m m e n g g i g i l r a s a t i d a k e n a k a t a u

n y e r i d i p i n g g a n g ( T e s s y d k k 2 0 0 1 )

16

H Tatalaksana

T u j u a n p e n a t a l a k s a n a a a n i n f e k s i s a i u r a n k e m i h a d a i a h m e n c e g a h d a n

m e n g h i l a n g k a n g e j a l a m e n c e g a h d a n m e n g o b a t i b a k t e n e m i a d a n b a k t e r i u r i a s e r t a

m e n c e g a h d a n m e n g u r a n g i r i s i k o k e r u s a k a n g i n j a l y a n g m u n g k i n t i m b u l d e n g a n

p e m b e r i a n o b a t - o b a t a n y a n g s e n s i t i f m u r a l i d a n a m a n d e n g a n e f e k s a m p i n g y a n g

m i n i m a l

a ) i n f e k s i s a i u r a n k e m i h ( I S K ) b a w a h

P r i n s i p p e n a t a l a k s a n a a n I S K b a w a h m e l i p u t i intake c a i r a n y a n g b a n y a k

a n t i b i o t i k y a n g a d e k u a t d a n b i l a p e r l u t e r a p i s i m t o m a t i k u n t u k a l k a l i s a s i

u r i n

i H a m p i r 8 0 p a s i e n a k a n m e m b e r i k a n r e s p o n s e t e l a h 4 8 j a m d e n g a n

a n t i b i o t i k a t u n g g a l s e p e r t i a m p i s i l i n 3 g r a m a t a u t r i m e t o p r i m 2 0 0 m g

i i B i l a i n f e k s i m e n e t a p d i s e r t a i k e l a i n a n u r i n a l i s i s ( l e u k o s i u i a ) d i p e r i u k a n

t e r a p i k o n v e n s i o n a l s e l a m a 5 - 1 0 h a r i

i i i P e m e r i k s a a n m i k r o s k o p i s u r i n d a n b i a k a n u r i n t i d a k d i p e r i u k a n b i l a

s e m u a g e j a l a h i l a n g d a n t a n p a l e u k o s u r i a

b ) I n f e k s i s a i u r a n k e m i h ( I S K ) a t a s

P a d a u m u m n y a p a s i e n d e n g a n p i e l o n e f r i t i s a k u t m e m e r l u k a n r a w a t i n a p

u n t u k m e m e l i h a r a s t a t u s h i d r a s i d a n t e r a p i a n t i b i o t i k a p a r e n t e r a l p a l i n g

s e d i k i t 4 8 j a m ( S u d o y o 2 0 0 6 )

i Komplikasi

K o m p l i k a s i i n f e k s i s a i u r a n k e m i h t e r g a n t u n g d a r i t i p e y a i t u i n f e k s i s a i u r a n

k e m i h t i p e s e d e r h a n a (uncomplicated) d a n t i p e b e r k o m p l i k a s i (complicated)

1 ) I n f e k s i s a i u r a n k e m i h s e d e r h a n a (uncomplicated)

I n f e k s i s a i u r a n k e m i h a k u t t i p e s e d e r h a n a ( s i s t i t i s ) y a i t u n o n - o b s t r u k s i d a n

b u k a n p e r e m p u a n h a m i l m e m p a k a n p e n y a k i t r i n g a n (self limited disiase)

d a n t i d a k m e n y e b a b k a n a k i b a t l a n j u t j a n g k a l a m a

2 ) I n f e k s i s a i u r a n k e m i h b e r k o m p l i k a s i (complicated)

a ) I n f e k s i s a i u r a n k e m i h s e l a m a k e h a m i i a n

b ) i n f e k s i s a i u r a n k e m i h p a d a d i a b e t e s m e l i t u s ( S u d o y o 2 0 0 6 )

17

22 Kerangka Teori

J

U s i a

J e n i s K e i a m i n

T i n g k a t P e n d i d i k a n

R i w a y a t D i a b e t e s M e l i m s

S u m b a t a n bullT

K e h a m i i a n

D i s f u n g s i n e u r o g e n i k

R e f l u k s v e s i k o i i r e t e r a l

V i r u l e n s i b a k t e r i

F a k t o r g e n e t i k

I n f e k s i b a k t e r i g r a m p o s i t i f a t a u n e g a t i v e p a d a s a i u r a n k e m i h

I n f e k s i S a i u r a n K e m i h

Keterangan

I j = V a r i a b e l y a n g t i d a k d i t e l i t i

= V a r i a b e l y a n g d i t e l i t i

18

Hipotesis

H i p o t e s i s d a l a m p e n e l i t i a n i n i a d a i a h

H O t i d a k t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n

t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

H I t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

BAB 111

M E T O D E PENELITIAN

31 Jenis Penelitian

P a d a p e n e l i t i a n i n i j e n i s p e n e l i t i a n y a n g d i g u n a k a n a d a i a h p e n e l i t i a n

o b s e r v a s i o n a i a n a l i t i k d e s a i n cross scclional d e n g a n m e n g g u n a k a n d a t a s e k u n d e r

d a r i r e k a m m e d i s p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1 D e s e m b e r

2 0 1 5

32 Waktu dan Tempat Penelitian

321 Waktu Penelitian

W a k t u p e n e l i t i a n d i l a k s a n a k a n p a d a t a n g g a l 1 O k t o b e r s a m p a i d e n g a n 3 0

O k t o b e r 2 0 1 6

322 Tempat Penelitian

P e n e l i t i a n i n i d i l a k s a n a k a n d i R u m a l i S a k i t M u h a m m a d i y a h P a e m b a n g ( d i

R u a n g R e k a m M e d i s )

33 Populasi dan Sampel Penelitian

331Populasi Penelitian

P a d a p e n e l i t i a n i n i p o p u l a s i t a r g e t a d a l a l i p a s i e n r a w a t i n a p d a n r a w a t j a l a n

d i R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g s e d a n g k a n p o p u l a s i t e r j a n g k a u n y a

a d a i a h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

332Sampel dan Besar Sampel Penelitian

P a d a p e n e l i t i a n i n i s a m p e l p e n e l i t i a n a d a i a h p a s i e n r a w a t i n a p d a n r a w a t

j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e

1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 y a n g m e m e n u h i k r i t e r i a i n k l u s i p e n e l i t i a n

1 9

20

d e n g a n b e s a r s a m p e l y a n g l a y a k d a l a m p e n e l i t i a n m e n u r u t t e o r i R o s c o e a d a i a h

a n t a r a t i g a p u l u h s a m p a i l i m a r a t i i s o r a n g ( S u g i y o n o 2 0 1 5 )

333 Krttena Inklusi dan Eksklusi

A Kriteria Inklusi

P a d a p e n e l i t i a n i n i k r i t e r i a i n k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t i n a p

d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i

P a l e m b a n g y a n g d i d i a g n o s a m e n g a l a m i i n f e k s i s a i u r a n k e m i h s e r t a m e m i l i k i d a t a

r e k a m m e d i s p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

B Kriteria Eksklusi

P a d a p e n e l i t i a n i n i k r i t e r i a e k s k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t

i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 d e n g a n d a t a r e k a m m e d i s

y a n g t i d a k l e n g k a p

334 Cara Pengambilan Sampel Penelitian

C a r a p e n g a m b i l a n s a m p e l y a n g d i g u n a k a n d a l a m p e n e l i t i a n i n i a d a l a l i

m e n g g u n a k a n t e k n i k consecutive sampling P a d a consecutive sampling s e t i a p

p a s i e n y a n g m e m e n u h i k r i t e r i a p e n e l i t i a n d i m a s u k k a n d a l a m p e n e l i t i a n s a m p a i

k u r u n w a k t u t e r t e n U i s e h i n g g a j u m l a h m i n i m a l y a n g d i p e r i u k a n t e r p e n u h i

( S a s t r o a s m o r o 2 0 1 1 )

34 Variabel Penelitian

341 Variabel Dependent

V a r i a b e l dependent f t e r i k a t ) d a l a m p e n e l i t i a n i n i a d a i a h i n f e k s i s a i u r a n

k e m i h

342 Variabel Independent

V a r i a b e l independent ( b e b a s ) d a l a m p e n e l i t i a n i n i a d a i a h u s i a j e n i s

k e l a i n i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

21

35 Definisi Operasional

Tabel 31 Definisi Operasional

Variabel Alat Cara ueiinisi rldsil L KUr I7 i l l 11 Lz fe 1 V

oKaia LiKur Penelitian Ukur Ukur

Infeksi P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Saiuran d i d i a g n o s a o l e h m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Keniih d o k t e r m e n g a l a m i m e d i s

i n f e k s i s a i u r a n

k e m i h d a n t e r c a n t u m

d i r e k a m m e d i s

U s i a L a m a n y a t a h u n R e k a m O b s e r v a s i 1 lt 5 0 t a h u n O r d i n a l

k e h i d u p a n p a s i e n m e d i s r e k a m 2 gt 5 0 t a l i u n ( k a t e g o r i k )

d a r i l a h i r s a m p a i m e d i s

s e k a r a n g d a n

t e r c a n t u m d i r e k a m

m e d i s

Jenis P r o f i l a n a t o m i a t a u R e k a m O b s e r v a s i 1- L a k i - l a k i N o m i n a l

Keiamin b i o l o g i s p a s i e n y a n g m e d i s r e k a m 2 P e r e m p u a n ( k a t e g o r i k )

d i b e d a k a n m e n j a d i m e d i s

i a k i - l a k i d a n

n e r e m m i a n s e r t a

t e r c a n t u m d i r e k a m

m e d i s

Tingkat P e n d i d i k a n f o n n a l R e k a m O b s e r v a s i 1 P e n d i d i k a n O r d i n a l

Pendidikan t e r a k h i r y a n g m e d i s r e k a m d a s a r ( S D ( k a t e g o r i k )

d i t e m p u h o l e h m e d i s M I S M P

p a s i e n d a n t e r c a n t u m d a n M T s )

d i r e k a m m e d i s 2 P e n d i d i k a n

m e n e n g a l i

d a n t i n g g i

22

( S M A M A

S M K

M A K

d i p l o m a

s a r j a n a

m a g i St e r

s p e s i a l i s

d a n d o k t o r )

Riwayat P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Diabetes d i d i a g n o s i s d e n g a n m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Melitus d i a b e t e s m e l i t u s d a n

t e r c a n t u m d i d a l a m

r e k a m m e d i s

m e d i s

36 Cara Pengumpulan Data

361 Data Sekunder

P e n g u m p u l a n d a t a p a d a p e n e l i t i a n i n i d i p e r o l e h d a r i d a t a s e k u n d e r y a i t u

r e k a m m e d i s p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

37 Metode Teknik Analisis Data

371Cara Pengolahan dan Analisis Data

P e n g o l a h a n d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n m e l a l u i e m p a t t a h a p y a i t u

i Oala Entry

P a d a t a i i a p i n i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n riwayat d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g y a n g t e l a h d i d a p a t d a n

r e k a m m e d i s d i k u m p u l k a n d a n d i m a s u k k a n k e d a l a m p r o g r a m spss

23

2 Editing

P a d a t a h a p i n i d a t a i i s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n y a n g t e l a h d i m a s u k k a n k e d a l a m p r o g r a m s p s s

d i p e r i k s a k e m b a l i a p a k a h s u d a h l e n g k a p d a n t i d a k a d a k e k e l i r u a n

3 ( oding

S e t e l a h m e l a l u i p r o s e s editing d a t a - d a t a t e r s e b u t d i b e r i k o d e t e r t e n t u a n t a r a

l a i n k o d e 1 u n t u k u s i a gt 5 0 t a h u n j e n i s k e i a m i n p e r e m p u a n t i n g k a t

p e n d i d i k a n d a s a r t e r d a p a t r i w a y a t d i a b e t e s m e l i t u s d a n i n f e k s i s a i u r a n

k e m i h s e d a n g k a n k o d e 2 u n t u k u s i a lt 5 0 t a h u n j e n i s k e i a m i n l a k i - l a k i

t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i t i d a k t e r d a p a t r i w a y a t d i a b e t e s

m e l i t u s d a n b u k a n i n f e k s i s a i u r a n k e m i h s e h i n g g a m e m u d a h k a n d a l a m

m e l a k u k a n a n a l i s i s d a t a

4 Tahulaling

P a d a t a h a p i n i d a t a y a n g s a m a d i k e l o m p o k k a n s e c a r a t e l i t i d a n t e r a t m

k e m u d i a n d i l i i t u n g d e n g a n m e n g g u n a k a n p r o g r a m sps s d a n d i j u m l a h k a i i

l a l u d i s a j i k a n d a l a m b e n t u k t a b e l - t a b e l

U n t u k m e n g a n a l i s i s d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n a n a l i s i s d a t a

u n i v a r i a t d a n b i v a r i a t d e n g a n m e n g g u n a k a n p r o g r a m s p s s s e b a g a i b e r i k u t

A A n a l i s i s u n i v a r i a t

A n a l i s i s u n i v a r i a t d i l a k u k a n d e n g a n c a r a m e l a k u k a n a n a l i s i s p a d a s e t i a p

v a r i a b e l h a s i l p e n e l i t i a n d e n g a n t u j u a n u n t u k m e n g e t a h u i d i s t r i b u s i p r o p o r s i p a d a

s e t i a p v a r i a b e l p e n e l i t i a n D a t a d i s a j i k a n d a l a m b e n t u k t a b e l d a n n a r a s i

B A n a l i s i s b i v a r i a t

A n a l i s i s b i v a r i a t d i l a k u k a n d e n g a n m e n g g u n a k a n u j i h i p o t e s i s chi-square

U j i h i p o t e s i s chi-square d a p a t d i g u n a k a n d e n g a n s y a r a t y a i t u lt 2 0 s e l y a n g

m e m p u n y a i n i l a i expected count k u r a n g d a r i l i m a s e h i n g g a j i k a t i d a k m e m e n u h i

s y a r a t u j i chi-square m a k a u j i y a n g d i g u n a k a n a d a i a h u] fisher ( D a h l a n 2 0 1 4 )

B a t a s k e m a k n a a n y a n g d i g u n a k a n a d a i a h a = 0 0 5 J i k a d i d a p a t k a n p value lt 0 0 5

p a d a u j i s t a t i s t i k m a k a t i d a k t e r d a p a t h u b u n g a n y a n g b e n n a k n a a n t a r a d u a

v a r i a b e l y a n g d i t e l i t i d a n H O d i t e r i m a S e d a n g k a n j i k a d i d a p a t k a n p value gt 0 0 5

24

p a d a u j i s t a t i s t i k m a k a t e r d a p a t l i u b u n g a n y a n g b e n n a k n a a n t a r a d u a v a r i a b e l

y a n g d i t e l i t i d a n H O d i t o l a k

38 Alur Penelitian

P e n e n t u a n p o p u l a s i d a n s a m p e l p e n e l i t i a n

K r i t e r i a i n k l u s i K r i t e r i a e k s k l u s i

P e n g a m b i l a n s a m p e l p e n e l i t i a n

P e n g o l a h a n d a n a n a l i s i s d a t a d e n g a n u j i chi-square

H a s i l d a n p e m b a h a s a n

K e s i m p u l a n d a n s a r a n

Gambar 31 Alur Penelitian Hubungan Usia Jenis Keiamin Tingkat Pendidikan dan Riwayat Diabetes Melitus dengan Kejadian Infeksi Saiuran Kemih pada Pasien Rawat Inap di Bagian Penyakit Dalam Rumah Sakit Muhammadiyah Palembang Periode 1 Januari 2015 sampai dengan 31 Desember 2015

BAB IV

HASIL DAN PEMBAHASAN

41 Hasil

P e n e l i t i a n i n i t e l a h d i l a k u k a n d i r u a n g r e k a m m e d i s R u m a h S a k i t

M u h a i m n a d i y a h P a l e m b a n g d a r i t a n g g a l 1 O k t o b e r 2 0 1 5 - 3 1 O k t o b e r 2 0 1 6

P e n e l i t i a n d i m u l a i d e n g a n p e n g a m b i l a n d a t a a w a l b e m p a d a t a r e k a m m e d i s

s e l u r u h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

S e l a n j u t n y a r e k a m m e d i s d i p i l i h s e s u a i d e n g a n k r i t e r i a i n k l u s i d a n e k s k l u s i u n t u k

d i j a d i k a n s a m p e l p e n e l i t i a n s a m p a i m i n i m a l b e s a r s a m p e l y a n g d i b u t u h k a n

t e r p e n u h i s e r t a d i l a k u k a n p e n e l i t i a n s e c a r a o b s e r v a s i o n a i O b s e r v a s i r e k a m m e d i s

d i l a k u k a n u n m k m e n g e t a h u i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t

d i a b e t e s m e l i t u s d a n d i a g n o s a p a s i e n

D a r i c a t a t a n r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g

d i d a p a t k a n s e b a n y a k 4 1 4 1 r e k a m m e d i s p a s i e n r a w a t i n a p d a n 1 4 5 3 r e k a m m e d i s

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 D a r i t o t a l r e k a m m e d i s

p a s i e n r a w a t i n a p d a n r a w a t j a l a n t e r s e b u t p e n e l i t i h a n y a m e n g a m b i l m i n i m a l

b e s a r s a m p e l y a n g d i b u t u h k a n y a i t u s e b a n y a k 9 8 r e k a m m e d i s u n t u k d i j a d i k a n

s a m p e l p e n e l i t i a n y a n g t e r d i r i d a r i 3 0 r e k a m m e d i s p a s i e n y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i h d a n 6 8 r e k a m m e d i s y a n g t i d a k m e n g a l a m i i n f e k s i s a i u r a n k e m i h

411 Hasil Analisis Univariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s u n i v a r i a t

a n t a r a l a i n d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p b e r d a s a r k a n u s i a d a n

j e n i s k e l a m m d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n b e r d a s a r k a n u s i a

d a n j e n i s k e i a m i n d i s t r i b u s i p r o p o r s i s a m p e l b e r d a s a r k a n k e j a d i a n m f e k s i s a i u r a n

k e m i h s e r t a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n u s i a

j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

25

26

A Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan IJsta

dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 41 Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan

Usia dan Jenis Keiamin

Paisen Rawat Inap N Persentase

Usia

1 7 - 2 5 t a h u n 678 1 6 4

2 6 - 3 5 t a h u n 952 2 3 0

3 6 - 4 5 t a l i u n 745 18 0

4 6 - 5 5 t a h u n 695 1 6 8

5 6 - 6 4 t a h u n 571 1 3 8

gt 6 4 t a h u n 500 1 2 1

U s i a r a t a - r a t a ( t a h u n j 43plusmn16543

Jenis Keiamin

P e r e m p u a n 2 6 3 8 6 3 7

L a k i - l a k i 1 5 0 3 3 6 3

Total 4141 100

B e r d a s a r k a n t a b e l 4 1 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R i u n a h S a k i t M u l i a m m a d i y a l i

P a l e m b a n g p e r i o d e J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 2 6 - 3 5 t a h u n y a i t u

s e b a n y a k 9 5 2 o r a n g ( 2 3 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 43plusmn16543 t a l i u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 2 6 3 8 o r a n g ( 6 3 7 )

27

B Distribusi Proporsi Karakteristik Pasien Rawat Jalan Berdasarkan

Usia dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 42 Distribusi Proporsi Karakteristik Pasien Rawat Jalan

Berdasarkan Usia dan Jenis Keiamin

Fasten Rawat Jalan N Persentase

Usia

1 7 - 2 5 t a h u n 9 2 6 3

2 6 - 3 5 t a l n i n 1 3 1 9 0

3 6 - 4 5 t a h u n 2 7 9 1 9 2

46-55 t a l i u n 4 2 1 2 9 0

5 6 - 6 4 t a h u n 3 1 6 2 1 7

gt 6 4 t a h u n 2 1 4 1 4 7

U s i a r a t a - r a t a ( t a h u n ) 50plusmn14120

Jenis Keiamin

P e r e m p u a n 8 9 0 6 1 3

L a k i - l a k i 5 6 3 3 8 7

Total 1453 100

B e r d a s a r k a n t a b e l 4 2 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 4 6 - 5 5 t a h u n y a i t u

s e b a n y a k 4 2 1 o r a n g ( 2 9 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 50plusmn14120 t a h u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 8 9 0 o r a n g ( 6 1 3 )

28

C Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Usia

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i b b e r d a s a r k a n u s i a d a p a t

d i i i h a t p a d a l a b e l d i b a w a h i n i

Tabel 43 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Usia

Usia N Persentase

lt 5 0 t a h u n 1 4 4 6 7

gt 5 0 t a l i u n 1 6 5 3 3

Total 30 100

B e r d a s a r k a n t a b e l 4 3 d i a t a s d a p a t d i k e t a h u i b a h w a u s i a t e r b a n y a k p a d a

s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h gt 5 0 t a h u n y a i t u s e b a n y a k

1 6 o r a n g ( 5 3 3 )

D Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Jenis

Keiamin

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n j e n i s

k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 44 Distribusi Proporsi Kejadian infeksi Saiuran Kemih Berdasarkan

Jenis Keiamin

Jenis Keiamin N Persentase

P e r e m p u a n 1 8 6 0 0

L a k i - l a k i 1 2 4 0 0

Total 30 100

B e r d a s a r k a n t a b e l 4 4 d i a t a s d a p a t d i k e t a h u i b a h w a j e n i s k e i a m i n

t e r b a n y a k p a d a s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h p e r e m p u a n

y a i t u s e b a n y a k 1 8 o r a n g ( 6 0 0 )

29

E Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n t i n g k a t

p e n d i d i k a n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 45 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

Tingkat Pendidikan N Persentase

P e n d i d i k a n d a s a r 20 6 6 7

P e n d i d i k a n m e n e n g a h d a n P e n d i d i k a n m e n e n g a h d a n 10 333

t i n g g i

Total J O 100

B e r d a s a r k a n t a b e l 4 5 d i a t a s d a p a t d i k e t a l i u i b a l i w a t i n g k a t p e n d i d i k a n

t e r b a n y a k p a d a s a m p e i y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h t i n g k a t

p e n d i d i k a n d a s a r y a i t u s e b a n y a k 20 o r a n g ( 6 6 7 )

P Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n riwayat

d i a b e t e s m e l i t u s d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 46 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

Riwayat Diabetes Melitus N Persentase

Y a 17 5 6 7

T i d a k 13 433

Total 30 100

B e r d a s a r k a n t a b e l 4 6 d i a t a s d a p a t d i k e t a h u i b a l i w a s a m p e l y a n g

m e n g a l a m i i n f e k s i s a i u r a n k e m i h t e r b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s

y a i t u s e b a n y a k 1 7 o r a n g ( 5 6 7 )

30

412 Hasil Analisis Bivariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s b i v a r i a t

a n t a r a I a i n h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h j e n i s

k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h t i n g k a t p e n d i d i k a n d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n

i n f e k s i s a l m a n k e m i h

A n a l i s i s y a n g d i g u n a k a n p a d a u j i d u a v a r i a b e l y a n g b e r s k a l a k a t e g o r i k

a d a l a l i d e n g a n u j i Chi-Square d e n g a n n i e i h a t n i l a i Pearson Chi-Square S e m u a

h a s i l d a r i u j i h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h m e n g g i u i a k a n u j i Chi-

Square k a i e n a m e m e n u h i s y a r a t u j i Chi-Square y a i t u lt 2 0 s e l y a n g m e m p u n y a i

n i l a i expected count lt 5

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 47 Hasil Uji Hubungan antara Usia dengan Kejadian Infeksi

Saiuran Kemih

Usia

Infeksi Saiuran Kemih

^a Tidak

n N Mgt

Jumlah P

value 95Cl

lt 50 t a h u n 1 4 1 9 2 5 9 8 0 8 7 3 0 0 0 0 2 7 4 7 - 2 0 4 3 1

gt 5 0 t a h u n 1 6 6 4 0 9 3 6 0 2 5

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 7 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R = 7 4 9 2

( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a u s i a gt

5 0 t a h u n a d a l a l i 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a u s i a lt 5 0 t a h u n

31

B Hubungan antara Jenis Keiamin dengan Kejadian Infeksi Saiuran

Kemih

H a s i l a n a l i s i s b i v a r i a t l i u b u n g a n a n t a r a j e n i s k e l a i n i n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

Tabel 48 Hasil Uji Hubungan antara Jenis Keiamin dengan Kejadian

Infeksi Saiuran Kemih

Infeksi Saiuran Kemih Jenis P

A Tidak Jumlah 95CI Keiamin value

N N

P e r e m p u a n 18 6 4 3 10 357laquoo 2 8 3 2 2 7 -P e r e m p u a n 0 0 0 0

L a k i - l a k i 12 1 7 1 5 8 8 2 9 7 0 2 3 4 5 9

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 8 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a l a l i

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k N 4 a k a a d a l i u b u n g a n y a n g s i g n i f i k a n a n t a r a

j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R ) = 8 7 0 0

f 9 5 C I = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a l a k i - l a k i

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e n i i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

32

Tabel 49 Hasil liji Hubungan antara Tingkat Pendidikan dengan

Kejadian Infeksi Saiuran Kemih

Infeksi Saiuran Kemih P

Y a T i d a k jumlah 95CI value

N

P e n d i d i k a n d a s a r 2 0 5 4 1 1 7 4 5 9 3 7

P e n d i d i k a n

m e n e n g a h d a n 10 1 6 4 5 1 8 3 6 6 1

t i n g g i

Jumlah JO 30 6 68 694 9H

B e r d a s a r k a n t a b e l 4 9 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( 0 R ) =

6 0 0 0 ( 9 5 C I = 2 3 5 1 - 1 5 3 1 0 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r a d a i a h 6 k a l i l e b i h b e s a r

d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i h a t

p a d a t a b e l d i b a w a h i n i

Tingkat

Pendidikan

2 3 5 1 -0 0 0 0

1 5 3 1 0

33

Tabel 4t0 Hasil I j i Hubungan antara Riwayat Diabetes Melitus dengan

Kejadian Infeksi Saiuran Kemih

Riwayat Infeksi Saiuran Kemih P

Diabetes Va Tidak Jumlah value

95CI

Melitus N bullVJ N

Y a

T i d a k

17

1 3

6 8 0

1 7 8

8

6 0

3 2 0

8 2 2

2 5

7 3 0 0 0 0

3 4 9 3 -

2 7 5 3 6

Jumlah 30 306 68 571 98

B e r d a s a r k a n t a b e l 4 1 0 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio

( O R ) = 9 8 0 8 ( 9 5 C I - 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r

d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s m e l i m s

42 Pembahasan

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a l a b e l 4 7 d i d a p a t k a n b a l i w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i b d e n g a n n i l a i s i g n i f i k a n n y a a d a l a l i 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k

Odds Ratio ( O R ) = 7 4 9 2 ( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a u s i a T 5 0 t a h u n a d a i a h 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a

u s i a lt 5 0 t a h u n

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n A n d r y L u k a n d y

( 2 0 1 4 ) m e n g e n a i k a r a k t e r i s t i k p a s i e n - p a s i e n i n f e k s i s a i u r a n k e m i h d i m a n a

p e n d e r i t a I S K d e n g a n k e l o m p o k u m u r gt 5 0 t a h u n s e b a n y a k 2 3 o r a n g s e d a n g k a n

j u m l a h p e n d e r i t a I S K d e n g a n k e l o m p o k u m m lt 5 0 t a l i u n s e b a n y a k 2 0 o r a n g

P e n e l i t i a n i n i j u g a d i p e i k u a t o l e h p e n l i t i a n L e w i s A l e t a l ( 2 0 1 4 ) m e n g e n a i

impact of host age and parity on susceptihility to severe urinary tract injection in

34

a murine mode d e n g a n u j i K r u s k a l - W a l l i s d e n g a n post-test D u n n u n t u k b e b e r a p a

p e r b a n d i n g a n d i m a n a u s i a d a n p a r i t a s s e b a g a i f a k t o r y a n g b e r k o n t r i b u s i d a l a m

k e r e n t a n a n i m t u k t e r j a d i n y a I S K d e n g a n n i l a i p lt 0 0 5

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n g a t a k a n b a h w a i n s i d e n I S K m e n i n g k a t

b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n

a d a n y a a b n o r m a l i t a s a n a t o m i y a n g m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n

k e m i h s e p e r t i p e m b e s a r a n p r o s t a t d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a

p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e ( R o s e 2 0 0 9 ) P e n y e b a b l a i n t e n n a s u k

p e r i n e i u n y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s p e n y a k i t n e u r o m u s k u l a r

d a n k a t e t e r i s a s i b u l i - b u l i ( F o x m a n e t a l 2 0 1 0 ) S e l a i n i t u i n s i d e n I S K m e n c a p a i

1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o n a l d 2 0 1 1 )

B Hubungan antara Jenis Keiamin dengan Kejadian infeksi Saiuran

Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 8 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d e n g a n n i l a i s i g n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O

d i t o l a k Odds Ratio ( O R ) = 8 7 0 0 ( 9 5 C l = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a risiko k e j a d i a n

i n f e k s i s a i u r a n k e m i h p a d a p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n

p a d a l a k i - i a k i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n M a g i i a n o e t a l

( 2 0 1 1 ) m e n g e n a i Gender and Age-Dependent Etiology of Community Acquired

y a n g m e l a k u k a n p e n g a m b i l a n 6 1 2 7 3 s a m p e l k u l t u r u r i n d a l a m p e r i o d e 2 2 b u l a n

d a r i s a m p e l i n i d i d a p a t k a n 1 3 8 2 0 ( 2 2 6 ) d i t e m u k a n p o s i t i f i n f e k s i b a k t e r i

h a m p i r 8 0 b a l i a n y a n g d i i s o l a s i b e r a s a l d a r i p e r e m p u a n P e n e l i t i a n i n i j u g a

d i p e r k u a t o l e h p e n e l i t i a n y a n g d i l a k u k a n o l e h Y u n i t a I ( 2 0 1 0 ) d i m a n a a d a

h u b m i g a n y a n g b e n n a k n a a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h ( P value=O049 R P = 3 2 7 3 ( 9 5 C I = I 0 1 6 - 1 0 5 4 0 )

H a l t e r s e b u t d a p a t t e r j a d i k a r e n a u r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a l i

d e n g a n d e k a t n y a v a g i n a l v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i

s a i u r a n k e m i h l e b i h s e r i n g p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a flora n o r m a l

3 5

p a d a d a e r a h p e r i u r e t r a t e r d i r i d a r i o r g a n i s m e s e p e r t i i a c t o b a c i l l u s y a n g m e m b a n t u

m e l a w a n k o l o n i s a s i b a k t e r i p a t o g e n p a d a s a i u r a n k e m i h P e r u b a h a n l i n g k i m g a n

d a r i p e r i u r e t r a l s e p e r t i p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k

b i s a m e n g g a n g g u f l o r a n o r m a l s e h i n g g a m e n u m g k i n k a n b a k t e r i p a t o g e n

b e r k o l o n i s a s i d a n m e n y e b a b k a n i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Scuare p a d a t a b e l 4 9 d i d a p a t k a n b a h w a

t e r d a p a t l i u b u n g a n y a n g s i g n i f i k a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a

H O d i t o l a k Odds Ratio ( O R ) - 6 0 0 0 ( 9 5 o C l = 2 3 5 1 - 1 5 3 I O ) a r t i n y a n s i k o

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r

a d a i a h 6 k a l i l e b i h b e s a r d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n

m e n e n g a h d a n t i n g g i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h T o r o n d e i B e t

a l ( 2 0 1 5 ) m e n g e n a i Menstrual Hygiene Practices WASH Access and the Risk of

Urogenital Infection in Women from Odisha India d i m a n a p e r e m p u a n y a n g

h a n y a m e n e m p u l i p e n d i d i k a n s e k o l a h d a s a r a t a u l e b i h r e n d a h d i b a n d i n g k a n

d e n g a n t i n g k a t p e n d i d i k a n m e n e n g a h a t a u t i n g g i m e m i l i k i r i s i k o 3 k a l i

k e m u n g k i n a n l e b i h b e s a r m e n g a l a m i i n f e k s i s a i u r a n k e m i h ( A d j O R = 3 l 9 5

C 1 = I 2 - 7 9 p = 0 0 2 )

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a p e n g e t a h u a n s e s e o r a n g

t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t p e n d i d i k a n S e s e o r a n g y a n g

m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m u n g k i n a n p e n g e t a l i u a n t e n t a n g

k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o r m a s i y a n g d i d a p a t k a n t e n t a n g k e s e h a t a n

l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h S e b a l i k n y a

p e n d i d i k a n y a n g k u r a n g d a p a t i n e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g t e r h a d a p

n i l a i - n i l a i y a n g b a r u d i k e n a l ( N o t o a d m o j o 2 0 0 3 )

3 6

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Keniih

B e r d a s a r k a n l i a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 1 0 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a r i w a y a t d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 )

s e h i n g g a H O d i t o l a k Odds Ratio ( O R ) = 9 8 0 8 ( 9 5 C I = 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a

risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h S a r i E W P d a n

S a t y a b a k t i P ( 2 0 1 5 ) m e n g e n a i p e r b e d a a n risiko i n f e k s i n o s o k o m i a l s a i u r a n k e m i h

b e r d a s a r k a n k a t e t e r i s a s i u r i n u m u r d a n d i a b e t e s m e l i m s d i m a n a d a r i 2 0 p a s i e n

i n f e k s i n o s o k o m i a l s a i u r a n k e m i h 1 2 o r a n g ( 6 0 ) d i a n t a r a n y a a d a i a h p a s i e n

d e n g a n s t a t u s D M s e d a n g k a n 8 o r a n g ( 4 0 ) l a i n n y a a d a i a h p a s i e n t a n p a s t a t u s

D M ( P v W w ^ = 0 0 2 4 O R = 6 0 0 9 5 C I = 1 2 2 - 3 2 2 6

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a b a l i w a b e b e r a p a b a g i a n

d a r i i i n u n i t a s p a d a p a s i e n d i a b e t e s m e n g a l a m i p e r u b a h a n F u n g s i

p o l i n i o r f o l e u k o s i t d i t e k a n p a d a k e a d a a n a s i d o s i s I k a t a n l e u k o s i t k e m o t a k s i s d a n

f a g o s i t o s i s j u g a b e m b a l i S i s t e m a n t i o k s i d a n y a n g b e r p e r a n p a d a a k t i f i t a s

b a k t e r i s i d a l j u g a t e r g a n g g u s e h i n g g a m e n y e b a b k a n t e r j a d i n y a I S K p a d a p a s i e n -

p a s i e n d e n g a n p e n y a k i t d i a b e t e s ( J u l k a 2 0 1 4 )

H a l y a n g s a m a j u g a d i i m g k a p k a n o l e b t e o r i S m e l t z e r d a n B a r e ( 2 0 1 0 )

b a l i w a D M d a p a t m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a l i a n a n t u b u h y a n g

b e r p o t e n s i m e n i n g k a t k a n r i s i k o t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a l i a n a n

t u b u h t e r s e b u t d i a n t a r a n y a a d a i a h k e g a g a l a n m i g r a s i s e l iniraceliular killing

f a g o s i t o s i s d a n k e m o t a k s i s p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n

m e k a n i s m e p e r t a l i a n a n a l a m i a h I o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p

i n f e k s i

BAB V

KESIMPULAN DAN SARAN

51 Kesimpulan

1 U s i a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 2 6 - 3 5 t a h u n y a i t u 2 3 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 3 7

2 U s i a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 4 6 - 5 5 t a l i u n y a i t u 2 9 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 1 3

3 U s i a j e n i s k e i a m i n d a n t i n g k a t p e n d i d i k a n s a m p e i y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i l i t e r b a n y a k y a i t u b e r u s i a gt 5 0 t a h u n ( 5 3 3 ) j e n i s k e i a m i n

p e r e m p u a n ( 6 0 0 ) d a n t i n g k a t p e n d i d i k a n d a s a r ( 6 6 7 ) s e r t a p a l i n g

b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s y a i t u 5 6 7

4 T e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 ( p = 0 0 0 0 )

52 Saran

1 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t d i l a k u k a n d e n g a n d e s a i n

p e n e l i t i a n b e r b e d a s e p e r t i cohort a t a u case control

2 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t m e i i c a r i v a r i a b e l independent

y a n g l a i n s e p e r t i v a r i a b e l p e k e r j a a n p e m a s a i i g a n k a t e t e r a t a u l a m a n y a

m e n d e r i t a d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

37

DAFTAR PUSTAKA

B o y k o E J d k k 2 0 0 2 D i a b e t i c A n d T h e R i s k O f A c u t e U r i n a r y T r a c t I n f e c t i o n A m o n g P o s t m e n o p a u s a l W o m e n D i a b e t e s C a r e 2 5 ( 1 0 )

D a h l a n S 2 0 1 4 B u k i i S t a t i s t i k u n t u k K e d o k t e r a n d a n K e s e h a t a n D e s k r i p t i f B i v a r i a t d a n M u l t i v a r i a t d i l e n g k a p i a p l i k a s i d e n g a n m e n g g u n a k a n S P S S E d i s i 6 E p i d e m i o l o g i I n d o n e s i a J a k a r t a I n d o n e s i a

D e p a r t e m e n K e s e h a t a n ( D E P K E S ) R l 2 0 1 4 [ O n l i n e ] K e m e n t e r i a n K e s e h a t a n R e p u b l i k I n d o n e s i a P u s a t D a t a d a n I n f o r m a s i K e m e n t e r a n K e s e h a t a n R l ( http 7depkesgoid diakses tanggal 15 Met 2016)

F o x m a n B e t a i 2 0 1 0 U r i i i a i y T r a c t I n f e c t i o n A m o n g W o m e n A g e d 4 0 T o 6 5 B e h a v i o r a l A n d S e x u a l R i s k F a c t o r s D a l a m T a n a g h o E A M c A n i n c h J W 1 7 t h S m i t h s G e n e r a l U r o l o g y U S A M c G r a w H i l l (http searchproqnestcom diakses tanggal 16 Met 2016)

H a r d i n g G K d k k 2 0 1 0 A n t i m i c r o b i a l T r e a t m e n t I n D i a b e t i c W o m e n W i t l i A s y m t o m a t i c B a c t e r i u r i a N E n g l J M e d 3 4 7 1 5 7 6 - 1 5 8 3 (http nejmorg diakses tanggal 16 Met 2016)

I s s e l b a c h e r d k k 2 0 0 9 I n f e k s i S a i u r a n K e m i h d a n P i e l o n e f r i t i s D a l a m S t a m m W a l t e r E e d H a r r i s o n P r i n s i p - P r i n s i p l l m u P e n y a k i t D a l a m e d V o l u m e 2 J a k a r t a E G C 6 1 6 - 6 2 3

J u l k a S 2 0 1 3 G e n i t o u r i n a r y I n f e c t i o n I n D i a b e t e s I n d i a n J o u m a l o f E n d o c r i n o l o g y a n d M e t a b o l i s m (http searchproquestcom diakses tanggal 16 Mei 2016)

K i m B d k k 2 0 1 2 [ e - b o o k ] T h e R e l a t i o n b e t w e e n P o s t v o i d R e s i d u a l a n d O c c u r r e n c e o f U r i n a r y T r a c t I n f e c t i o n a f t e r S t r o k e i n R e h a b i l i t a t i o n U n i t A n n a l s o f R e h a b i l i t a t i o n M e d i c i n e

K o m a r a A 2 0 0 9 P o l a K e p e k a a n B a k t e r i G r a m N e g a t i f d a r i P a s i e n I n f e k s i S a i u r a n K e m i l i t e r h a d a p A n t i b i o t i k G e n t a m i c i n d a n K o t r i m o k s a z o l y a n g D i k i r i m k e L a b o r a t o r i u m M i k r o b i o l o g i K l i n i k F K U l d a r i T a h u n 2 0 0 1 s a m p a i T a h u n 2 0 0 5 (http dontaruiacid diakses tanggal OH Agustiis 2016)

L e w i s A L e t a l 2 0 1 4 I m p a c t o f H o s t A g e a n d P a r i t y o n S u s c e p t i b i l i t y t o S e v e r e U r i n a r y T r a c t I n f e c t i o n i n a M u r i n e M o d e l P l o s O n e R e s e a r c h A r t i c l e P u b l i c L i b r a r y o f S c i e n c e 9 ( 5 ) (http searchproquestcom diakses pada langgal 30 Desember 2016)

38

DAFTAR GAMBAR

Gambar Halaman

G a m b a r 3 1 A l u r P e n e l i t i a n H u b u n g a n U s i a J e n i s K e i a m i n T i n g k a t

P e n d i d i k a n d a n R i w a y a t D i a b e t e s M e l i t u s d e n g a n

K e j a d i a n I n f e k s i S a i u r a n K e m i h p a d a P a s i e n R a w a t i n a p

d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g I e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1

D e s e m b e r 2 0 1 5 2 4

xi

DAFTAR LAMPIRAN

Lampiran Halaman

L a m p i r a n 1 D a t a R e k a m M e d i s P a s i e n R a w a t I n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 4 3

L a m p i r a n 2 H a s i l A n a l i s i s U n v i a r i a t 4 5

L a m p i r a n 3 H a s i l A n a l i s i s B i v a r i a t 5 1

L a m p i r a n 4 K a r t u B i m b i n g a n P r o p o s a l S k r i p s i 5 8

L a m p i r a n 5 K a r t u B i m b i n g a n S k r i p s i 5 9

L a m p i r a n 6 S u r a t P e n n o h o n a n I z i n P e n e l i t i a n 6 0

L a m p i r a n 7 S u r a t K e t e r a n g a n I z i n P e n g a m b i l a n D a t a d a n P e n e l i t i a n 6 1

L a m p i r a n 8 S u r a t K e t e r a n g a n S e l e s a i P e n e l i t i a n 6 2

xii

BAB I

PENDAHULUAN

11 Latar Belakang

I n f e k s i s a i u r a n k e m i h ( I S K ) m e n i p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m i i k a n d i R u m a h S a k i t a t a u t e m p a t p r a k t i k u m u m s e h a r i - h a r i I S K

a d a i a h s u a t u i n f e k s i y a n g m e n g e n a i t r a k t u s u r i n a r i u s m u l a i d a r i m e a t u s u r e t r a

s a m p a i d e n g a n k e g i n j a l S t r u k t u r y a n g t e n n a s u k d i d a l a m n y a a d a i a h u r e t r a

k a n d u n g k e m i h u r e t e r p e l v i s d a n p a r e n k i m g i n j a l S t r u k t u r y a n g b e r k a i t a n u n t u k

t e r j a d i n y a i n f e k s i d a n r e k u r e n i n f e k s i y a i t u p r o s t a t e p i d i d i m i s d a n fascia

perinephric I s t i l a h I S K m e n u n j u k k a n a d a n y a k e b e r a d a a n m i k r o o r g a n i s m e d i

d a l a m u r i n ( S u d o y o 2 0 0 6 R u b i n 2 0 1 0 ) D e n g a n k a t a l a i n b a h w a d i a g n o s i s I S K

d i t e g a k k a n d e n g a n m e m b u k t i k a n a d a n y a m i k r o o r g a n i s m e d i d a l a m s a i u r a n k e m i h

( R u b i n 2 0 1 0 )

S e b a n y a k 2 5 j u t a k e m a t i a n d i s e l u r u h d u n i a p a d a t a h u n 2 0 1 1 s e p e r t i g a n y a

d i s e b a b k a n o l e h p e n y a k i t i n f e k s i I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n i n f e k s i

d e n g a n k e t e r l i b a t a i i b a k t e r i t e r s e r i n g d i k o m u n i t a s d a n h a m p i r 1 0 o r a n g p e m a h

t e r k e n a I S K s e l a m a h i d u p n y a S e k i t a i - 1 5 0 j u t a p e n d i i d u k d i s e l u r u h d u n i a t i a p

t a l i u n n y a t e r d i a g n o s i s m e n d e r i t a i n f e k s i s a i u r a n k e m i h ( Y u n u s 2 0 1 2 )

I S K d a p a t m e n g e n a i s e m u a k e l o m p o k u m u r b a i k a n a k r e m a j a d e w a s a

m a u p u n u s i a l a n j u t P r e v a l e n s i a n a k u s i a s e k o l a h y a n g m e n d e r i t a I S K s e k i t a r 1 -

3 d a n m e n i n g k a t p a d a r e m a j a y a n g s u d a h m e l a k u k a n h u b i m g a n s e k s u a l

( K o m a r a 2 0 0 9 ) D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r 2 5 - 3 5

s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a S e l a m a

p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n c e n d e r u n g

m e n d e r i t a I S K d i b a n d i n g k a n l a k i - l a k i ( S u d o y o 2 0 0 9 )

R a s i o I S K p a d a w a n i t a d i b a n d i n g p r i a b e r k i s a r 3 0 1 d a n s e k i t a r 5 0 w a n i t a

y a n g t e r k e n a i n f e k s i a k a n b e r k e m b a n g m e n j a d i I S K b e m l a n g I S K m e n i p a k a n

i n f e k s i b a k t e r i y a n g p a l i n g s e r i n g p a d a a n a k - a n a k d e n g a n k e l u h a n d e m a m b a i k

p a d a a n a k p r i a m a u p u n w a n i t a P r e v a l e n s i y a n g p e m a h d i l a p o r k a n b e r k i s a r 4 1

I

2

s a m p a i 7 5 R e k u r e n s i c u k u p s e r i n g d a n t e r j a d i s e k i t a r 1 8 p a d a b a y i l a k i - i a k i

d a n 2 6 p a d a b a y i p e r e m p u a n U n t u k u s i a p r a s e k o l a h I S K l e b i h s e r i n g

m e n g e n a i w a n i t a I n s i d e n I S K p a d a a n a k - a n a k p r a s e k o l a h s e k i t a r 2 ( S y a h r i n i

2 0 1 1 )

D a r i b e r b a g a i p e n e l i t i a n e p i d e m i o l o g i s d i I n d o n e s i a d i d a p a t k a n p r e v a l e n s i

D M s e b e s a r 15 - 2 3 p a d a p e n d u d u k u s i a l e b i J i d a r i 1 5 t a h u n b a h k a n p a d a

s u a t u p e n e l i t i a n e p i d e m i o l o g i s d i M a n a d o d i d a p a t k a n p r e v a l e n s i D M a d a i a h 6 1

P r e v a l e n s i d i a b e t e s m e l i t u s p a d a p e n d u d u k u s i a 2 5 - 6 4 t a h u n d i J a w a d a n B a l i

s e b e s a r 7 5 P e n e l i t i a n y a n g d i l a k u k a n d i J a k a r t a S u r a b a y a M a k a s a r d a n k o t a -

k o t a l a i n d i I n d o n e s i a m e m b u k t i k a n a d a n y a k e n a i k a n p r e v a l e n s i d a r i t a h u n

k e t a h u n ( D E P K E S 2 0 1 4 W H O 2 0 1 0 )

I n f e k s i s a i u r a n k e m i h j u g a m e n i p a k a n m a s a l a h k l i n i s u m u m p a d a p e n d e r i t a

D M o l e h k a r e n a p e n d e r i t a D M m e m p u n y a i k e m u n g k i n a n m e n d e r i t a I S K l e b i h

t i n g g i d i b a n d i n g k a n d e n g a n b u k a n p e n d e r i t a D M d a n j u g a m e n d e r i t a i n f e k s i y a n g

l e b i h b e r a t y a n g a k a n m e n i n g k a t k a n risiko u n t u k m a s u k m m a h s a k i t ( H a r d i n g

d k k 2 0 1 0 ) P e n e l i t i a n y a n g d i l a k u k a n o l e h B o y k o d k k m e n d a p a t k a n w a n i t a D M

ripe 2 d e n g a n b a k t e r i u r i a s i m t o m a t i k s e t e l a h d i l a k u k a n p e m a n t a u a n s e l a m a 1 8

b u l a n m e n g a l a m i p e n i n g k a t a n r i s i k o m e n d a p a t k a n I S K s e b a n y a k 3 4

d i b a n d i n g k a n d e n g a n w a n i t a y a n g t i d a k m e n g a l a m i D M s e b e s a r 1 9 ( B o y k o d k k

2 0 0 2 )

B e r d a s a r k a n u r a i a n - u r a i a n d i a t a s s e r t a b e l u m a d a n y a p e n e l i t i a n y a n g

m e n e m u k a n k e t e r k a i t a n f a k t o r u s i a j e n i s k e l a m m t i n g k a t p e n d i d i k a n d a n r i w a y a t

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h d i K o t a P a l e m b a n g m a k a

p e n e l i t i t e r t a r i k i m t i i k m e l a k u k a n p e n e l i t i a n m e n g e n a i h u b u n g a n a n t a r a u s i a j e n i s

k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

3

12 Rumusan Masalah

1 B a g a i m a n a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s

m e l i t u s

2 A p a k a l i a d a h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

13 Tujuan Penelitian

131 Tujuan Umum

T u j u a n u m u m d a r i p e n e l i t i a n i n i a d a i a h d i k e t e m u k a n n y a h u b u n g a n a n t a i a

u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i m s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

132 Tujuan Khusus

T u j u a n k l i u s u s d a r i p e n e l i t i a n i n i y a i t u

1 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a

2 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n m f e k s i s a i u r a n k e m i b p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n j e n i s k e i a m i n

3 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

4

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n t i n g k a t p e n d i d i k a n

4 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n riwayat d i a b e t e s m e l i t u s

5 T e r a n a l i s i s n y a h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a i m n a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

6 T e r a n a l i s i s n y a h u b u n g a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

7 T e r a n a l i s i s n y a h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

8 T e r a n a l i s i s n y a h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i u i s d e n g a n k e j a d i a n

i n f e k s i s a l i u a i i k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

14 Manfaat Penelitian

141 Manfaat Teoritis

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t m e n a m b a h p e n g e t a h u a n p e n e l i t i

t e n t a n g h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i U i s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

5

142 Manfaat Praktis

A Bagi Peneliti

H a s i l p e n e l i t i a n i n i d i l i a r a p k a n d a p a t d i g u n a k a n s e b a g a i s a l a h s a t u b a h a n

r e f e r e n s i a t a u b a c a a n b a g i p e n e l i t i

B Bagi Institusi

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t d i g u n a k a n p i h a k R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g s e b a g a i s a l a l i s a t u b a h a n a c u a n d a l a m m e n g u p a y a k a n

p e n c e g a h a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

15 Keaslian Penelitian

T a b e l 1 1 K e a s l i a n P e n e l i t i a n

Nama Judul Penelitian Desain Hasil Penelitian

Peneliti Penelitian

Kugan P r e v a l e n s i I n f e k s i Cross D a r i p e n e l i t i a n i i i i

Kandasamy S a i u r a n K e m i l i P a d a seciUmal d i p e r o l e h b a l i w a

W a n i t a Y a n g M e n d e r i t a

D i a b e t e s M e l i t u s T i p e

I I Y a n g D i r a w a t I n a p

p a s i e n w a n i t a d i a b e t e s

m e l i t u s t i p e I y a n g

m e n d e r i t a I S K y a n g

D a n D i r a w a t J a l a n D i d i r a w a t m a p d a n

S u b b a g i a n

E n d o k r i n o l o g i B a g i a n

P e n y a k i t D a l a m D i

d i r a w a t j a l a n d i s u b

b a g i a n E n d o k r i n o l o g i

P e n y a k i t D a l a m

R S U P H A d a m M a l i k R S U P H A d a m

P a d a T a l i u n 2 0 0 9 M a l i k M e d a i i t e r d a p a t

s e b a n y a k 2 5 o r a n g

y a i t u ( 1 2 7 ) D a r i 2 5

o r a n g y a n g m e n d e r i t a

I S K t e r d a p a t 3 o r a n g

y a i t u ( 1 2 0 ) y a n g

d i r a w a t i n a p d a n 2 2

6

o r a n g ( 8 8 0 ) y a n g

d i r a w a t j a l a n

Edel Weisela P e r b e d a a n R i s i k o

Permata I n f e k s i N o s o k o m i a l

Sari dan S a i u r a n K e m i h

Prijono B e r d a s a r k a n

Satyabakti K a i e t e r i s a s i U r i n

U m u r D a n D i a b e t e s

M e l i t u s T a h u n 2 0 1 5

Case H a s i l p e n e l i t i a n y a n g

control d i 1 a k u k a n p a d a 2 0

s a m p e l k a s u s d a n

k o n t r o l m e n u n j u k k a n

b a h w a p a s i e n d e n g a n

u m u r gt 5 5 t a h u n

m e m p u n y a i r i s i k o

5 5 7 k a l i m e n g a l a m i

i n f e k s i n o s o k o m i a l

s a i u r a n k e m i h

d i b a n d i n g k a n p a s i e n

d e n g a n u m u r lt 5 5

t a h u n d e n g a n

p e r i l i t u n g a i i b e s a r

risiko d i p e r o l e h n i l a i

O R s e b e s a r 5 5 7

d e n g a n n i l a i 9 5

(onfidence Interval

l 1 9 lt O R lt 2 8 2 3

P a s i e n d e n g a n s t a t u s

D M m e m p u n y a i risiko

6 k a l i u n t u k

m e n g a l a m i i n f e k s i

n o s o k o m i a l s a i u r a n

k e m i h d i b a n d i n g k a n

d e n g a n p a s i e n y a n g

t i d a k m e n d e r i t a D M

d e n g a n n i l a i O R

7

s e b e s a r 6 0 0 d e n g a n

n i l a i 9 5 Confidence

Interval 1 22 lt O R lt

3 2 2 6

Andry K a r a k t e r i s t i k P a s i e n - D e s k r i p k i f H a s i i p e n e l i t i a n d a r i

Lukandy P a s i e n I n f e k s i S a i u r a n r e t r o s p e k t i f 4 3 o r a n g p e n d e r i t a

K e m i i i d i P o l i u r o l o g i

R S U D D r P i m g a d i

K o t a M e d a n T a h u n

2 0 1 2 - 2 0 1 3

I S K d i d a p a t k a n 5 3 5

p a d a k e l o m p o k u s i a

gt 5 0 t a h u n 5 1 2

b e i j e n i s k e i a m i n l a k i -

l a k i 1 0 0 t i d a k

m e n d e r i t a

v e s i c o u r e t r a l r e f l u x

7 0 Benign Prostatic

Hyperplasia 1 1 6

b a t u s a i u r a n k e m i h

2 7 9 d i a b e t e s t i p e 2

D a r i h a s i l p e n e l i t i a n

i n i d a p a t d i s i m p u l k a n

b a h w a p e n d e r i t a i S K

l e b i h b a n y a k t e r j a d i

p a d a l a k i - l a k i d a n

p e n d e r i t a I S K l e b i h

b a n y a k d i j u m p a i p a d a

k e l o m p o k u m u r gt 5 0

t a h u n s e r t a d i t e m u k a n

I S K d e n g a n B P H

B S K d a n D M T i p e 2

BAB 11

TINJAUAN PUSTAKA

21 Landasan Teori

211Infeksi Saiuran Keniih

A Definisi

I n f e k s i S a i u r a n K e m i h a d a i a h i n v a s i d a n m u l t i p l i k a s i m i k r o o r g a n i s m e a t a u

p a r a s i t d a l a m j a r i n g a n t u b u h k h u s u s n y a s a i u r a n k e m i h y a n g t e r d i r i d a r i g i n j a l

u r e t e r b u l i - b u l i d a n u r e t r a y a n g d i i a n d a i d e n g a n a d a n y a b a k t e r i 1 0 c f i i (colony

forming unit) p e r m l p a d a p e n g a m b i l a n c o n t o h u r i n ( P u m o m o 2 0 1 1 )

I n f e k s i s a i u r a n k e m i h a d a l a l i s u a t u i n f e k s i y a n g m e l i b a t k a n g i n j a l lU e ter

b u l i - b u l i a t a u p u n u r e t r a I n f e k s i s a i u r a n k e m i h ( I S K ) a d a l a l i i s t i l a h u m u m y a n g

m e n u n j u k k a n k e b e r a d a a n m i k r o o r g a n i s m e d a l a m u r i n ( S u d o y o 2 0 0 6 )

B a k t e r i u r i a b e r m a k n a (significant hacteriuria) a d a i a h s u a t u k e a d a a n y a n g

m e n u n j u k k a n p e n u m b u l i a n m i k r o o r g a n i s m e m u m i l e b i h d a r i 1 0 c f t L m l p a d a

b i a k a n u r i n B a k t e r i u r i a b e r m a k n a m u n g k i n t a n p a d i s e r t a i p r e s e n t a s i k l i n i s I S K

d a n d i n a m a k a n b a k t e r i u r i a a s i m t o m a t i k (convert hacteriuria) S e b a l i k n y a

b a k t e r i u r i a b e n n a k n a d i s e r t a i p e r s e n t a s i k l i n i s I S K d i n a m a k a n b a k t e r i u r i a

s i m t o m a t i k P a d a b e b e r a p a k e a d a a n t e r d a p a t p a s i e n d e n g a n p e r s e n t a s i k l i n i s I S K

n a m u n t a n p a b a k t e r i u r i a b e n n a k n a S e l a i n i t u d i k a t a k a n p i u r i a ( l e u k o s i t d a l a m

u r i n ) b e n n a k n a (significant pyuria) b i l a d i t e m u k a n n e u t r o f i l gt 1 0 s e l p e r l a p a n g a n

p a n d a n g ( S u d o y o 2 0 0 6 )

B Epidemiologi

I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m u k a n d i p r a k t i k u m u m w a i a u p u n b e n n a c a m - m a c a m a n t i b i o t i k a s u d a h

t e r s e d i a l u a s d i p a s a r a n D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r

2 5 - 3 5 s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a

S e l a m a p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n

9

10

c e n d e r u n g m e n d e r i t a i S K d i b a n d i n g k a n l a k i - l a k i I S K b e m l a n g p a d a l a k i - l a k i

j a r a n g d i l a p o r k a n k e c u a l i d i s e r t a i f a k t o r p r e d i s p o s i s i ( p e n c e t u s )

P r e v a l e n s i b a k t e r i u r i a a s i m t o m a t i k l e b i h s e r i n g d i t e m u k a n p a d a p e r e m p u a n

P r e v a l e n s i s e l a m a p e r i o d e s e k o l a h (school girls) 1 m e n i n g k a t m e n j a d i 5

s e l a m a p e r i o d e a k t i f s e c a r a s e k s u a l P r e v a l e n s i i n f e k s i a s i m t o m a t i k m e n i n g k a t

m e n c a p a i 3 0 b a i k l a k i - l a k i m a u p u n p e r e m p u a n b i l a d i s e r t a i f a k t o r p r e d i s p o s i s i

( S u d o y o 2 0 0 6 )

C Kiasifikasi

I n f e k s i s a i u r a n k e m i h d a p a t d i b a g i m e n j a d i d u a k a t e g o r i u m u m b e r d a s a r k a n

l o k a s i a n a t o m i y a i t u

1 ) I n f e k s i s a i u r a n k e m i h b a w a h

2 ) I n f e k s i s a i u r a n k e m i h a l a s

P r e s e n t a s i k l i n i s d a r i i n f e k s i s a i u r a n k e m i h b a w a l i t e r g a n t u n g d a r i gender

y a i t u

a ) P e r e m p u a n

a S i s t i t i s

S i s t i t i s a d a i a h p r e s e n t a s i k l i n i s i n f e k s i k a n d u n g k e m i h d i s e r t a i

b a k t e r i u r i a b e n n a k n a

b S i n d r o m U r e t r a A k u t ( S U A )

S i n d r o m a u r e t r a a k u t a d a i a h p r e s e n t a s i k l i n i s s i s t i t i s t a n p a d i t e m u k a n

a d a n y a m i k r o o r g a n i s m e d a l a m L u i n ( s t e r i l ) d a n s e r i n g d i n a m a k a n

s i s t i t i s b a k t e r i a l i s

b ) L a k i - l a k i

P r e s e n t a s i k l i n i s i n f e k s i s a i u r a n k e m i h p a d a l a k i - l a k i m u n g k i n s i s t i t i s

p r o s t a t i t i s e p i d i m i d i s d a n u r e t r i t i s

I n f e k s i s a i u r a n k e m i h a t a s t e r b a g i m e n j a d i 2 y a i t u

1 ) P i e l o n e f r i t i s A k u t ( P N A )

P i e l o n e f r i t i s a k u t a d a l a l i p r o s e s i n f l a m a s i p a r e n k i m g i n j a l y a n g d i s e b a b k a n

o l e h m f e k s i b a k t e r i

11

2 ) P i e l o n e f r i t i s K r o n i s ( P N K )

P i e l o n e f r i t i s k r o n i s m u n g k i n a k i b a t l a n j u t d a r i i n f e k s i b a k t e r i

b e r k e p a n j a n g a n a t a u i n f e k s i s e j a k m a s a k e c i i O b s t r u k s i s a i u r a n k e m i h d a n

r e f l u k s v e s i k o u r e t e r d e n g a n a t a u t a n p a b a k t e r i u r i a k r o n i k s e r i n g d i i k u t i

p e m b e n t u k a n j a r i n g a n i k a t p a r e n k i m g i n j a l y a n g d i t a n d a i d e n g a n

p i e l o n e f r i t i s k r o n i k y a n g s p e s i f i k ( S u d o y o 2 0 0 6 )

D Etiologi

P a d a k e a d a a n n o r m a l u r i n b e r s i f a t s t e r i l U m u m n y a I S K d i s e b a b k a n o l e h

k i i m a n g r a m n e g a t i f E s c h e r i c h i a c o l i m e m p a k a n p e n y e b a b t e r b a n y a k b a i k p a d a

y a n g s i m t o m a t i k m a u p u n y a n g a s i m t o m a t i k y a i t u 7 0 - 9 0 E n t e r o b a k t e r i a s e p e r t i

P r o t e u s m i r a b i l i s ( 3 0 d a r i i n f e k s i s a i u r a n k e m i h p a d a a n a k l a k i - l a k i t e t a p i

k u r a n g d a r i 5 p a d a a n a k p e r e m p u a n ) K l e b s i e l l a p n e u m o n i a d a n P s e u d o m o n a s

a e m g i n o s a d a p a t j u g a s e b a g a i p e n y e b a b O r g a n i s m e g r a m p o s i t i f s e p e r t i

S t r e p t o c o c c u s f a e c a l i s ( e n t e r o k o k u s ) S t a p h y l o c o c c u s e p i d e n n i d i s d a n

S t r e p t o c o c c u s v i r i d a n s j a r a n g d i t e m u k a n P a d a u r o p a t i o b s t m k t i f d a n k e l a i n a n

s t r u k t u r s a i u r a n k e m i h p a d a a n a k l a k i - l a k i s e r i n g d i t e m u k a n P r o t e u s s p e c i e s P a d a

I S K n o s o k o m i a l a t a u I S K k o m p l e k s l e b i h s e r i n g d i t e m u k a n k u m a n P r o t e u s d a n

P s e u d o m o n a s ( L u m b a n b a t u S M 2 0 0 3 )

E Patofisiologi

P a d a i n d i v i d u n o n n a l b i a s a n y a u r i n l a k i - l a k i m a u p u n p e r e m p u a n s e l a l u

d a l a m k e a d a a n s t e r i l k a r e n a d i p e r t a l i a n k a n o l e h j u m l a l i d a n f r e k u e n s i b e r k e m i h

U t e r o d i s t a l m e m p a k a n t e m p a t k o l o n i s a s i m i k r o o r g a n i s m e nonpathogenic

fastidious G r a m - p o s i t i f d a n g r a m n e g a t i f ( S u d o y o 2 0 0 6 )

H a m p i r s e m u a I S K d i s e b a b k a n i n v a s i m i k r o o r g a n i s m e ascending d a r i u r e t r a

k e d a l a m k a n d u n g k e m i b P a d a b e b e r a p a p a s i e n t e r t e n t u i n v a s i m i k r o o r g a n i s m e

d a p a t m e n c a p a i k e g i n j a l P r o s e s i n i d i p e n n u d a h o l e h k o n d i s i r e f l u k s

v e s i k o i i r e t e r a l P r o s e s i n v a s i m i k r o o r g a n i s m e h e m a t o g e n s a n g a t j a r a n g d i t e m u k a n

d i k l i n i k m u n g k i t a k i b a t l a n j u t d a r i b a k t e r e m i a G i n j a l d i d u g a m e n i p a k a n l o k a s i

12

i n f e k s i s e b a g a i a k i b a t l a n j u t d a r i s e p t i k e m i a a t a u e n d o k a r d i t i s a k i b a t S t a f i l o k o k u s

a u r e u s K e l a i n a n g i n j a l y a n g t e r k a i t d e n g a n e n d o k a r d i t i s ( S t a f i l o k k o k u s a u r e u s )

d i k e n a l d e n g a n N e p h r i t i s L o h e i n B e b e r a p a p e n e l i t i a n m e l a p o r k a n p i e l o n e f r i t i s

a k u t ( P N A ) s e b a g a i a k i b a t l a n j u t i n v a s i h e m a t o g e n ( S u d o y o 2 0 0 6 )

F Faktor Risiko

P a t o f i s i o l o g i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h d a p a t d i p e n g a n i h i o l e h

b e b e r a p a f a k t o r A d a p u n b e b e r a p a f a k t o r risiko y a n g m e m p e n g a n i l i i t e r j a d i n y a

i n f e k s i s a i u r a n k e m i h a n t a r a l a i n

1 ) U s i a

I n s i d e n I S K m e n i n g k a t b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i

m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n a d a n y a a b n o r m a l i t a s a n a t o m i y a n g

m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n k e m i h s e p e r t i p e m b e s a r a n p r o s t a t

d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e

P e n y e b a b l a i n t e r m a s u k p e r i n e u m y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s

p e n y a k i t n e u r o m u s k n l a r d a n k a t e t e r i s a s i b u l i - b u l i S e l a i n i t u i n s i d e n I S K

m e n c a p a i 1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o s e 2 0 0 9 F o x m a n e t a l 2 0 1 0

R o n a l d 2 0 1 1 )

M e n u m t t e o r i y a n g d i k e m u k a k a n o l e h S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a d a u s i a

l a n j u t a k a n t e r j a d i p e n i n g k a t a n k e r e n t a n a n t e r h a d a p p e n y a k i t P a d a u s i a d i a t a s 5 0

t a l i u n t e r j a d i p e n u m n a n k e m a m p u a n d a l a m m e m p e r t a h a n k a n s t e n l i t a s b a i k p a d a

k a n d u n g k e m i h m a u p u n u r e t r a H a l t e r s e b u t d i s e b a b k a n o l e h i n v o l u s i t i m u s

I n v o l u s i s e l t i m u s m e n y e b a b k a n j u m l a h se d a n k u a l i t a s r e s p o n s s e l T s e m a k i n

b e r k u r a n g J u m l a h s e l T m e m o r i m e n i n g k a t n a m u n s e m a k i n s u l i t u n t u k

b e r k e m b a n g t e r u t a m a s i t o t o k s i k s e l T ( C D ^ ) d a n s e l T h l ( C D ^ ^ ) k a r e n a t e r j a d i

a p o p t o s i s S i t o t o k s i k s e l T ( C D ^ ^ ) b e i p e r a n d a l a m r e s p o n s i m u n t e r h a d a p a n t i g e n

p a d a s e l y a n g d i i n f e k s i d e n g a n c a r a m e m b u n u l i s e l y a n g t e r i n f e k s i u n t u k

m e n c e g a h p e n y e b a r a n m f e k s i s e d a n g k a n s e l T h l ( C D ^ ^ ) b e r p e r a n m e m b a n t u s e l

B u n t u k m e m p r o d u k s i a n t i b o d i

13

2 ) J e n i s k e l a m m d a n a k t i v i t a s s e k s u a l

I n s i d e n s i I S K y a n g r e n d a h p a d a p r i a d i p e n g a n i h i o l e h 3 f a k t o r y a i t u

1 L e b i h s e d i k i t t e r j a d i k o l o n i s a s i s e k i t a r u r e t r a k a r e n a t i d a k a d a n y a t e m p a t

s e p e r t i v a g i n a p a d a p e r e m p u a n

2 M e m i l i k i u r e t r a y a n g p a n j a n g

3 A d a n y a s u b s t a n s i a n t i b a k t e r i a l p a d a c a i r a n p r o s t a t

U r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a h d e n g a n d e k a t n y a v a g i n a l

v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h l e b i h s e r i n g

p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a f l o r a n o n n a l p a d a d a e r a l i p e r i u r e t r a t e r d i r i

d a r i o r g a n i s m e s e p e r t i l a c t o b a c i l l i i s y a n g m e m b a n t u m e l a w a n k o l o n i s a s i b a k t e r i

p a t o g e n p a d a s a i u r a n k e m i h P e r u b a l i a n l i n g k i m g a n d a r i p e r i u r e t r a l s e p e r t i

p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k b i s a m e n g g a n g g u f l o r a

n o r m a l s e h i n g g a m e m u n g k i n k a n b a k t e r i p a t o g e n b e r k o l o n i s a s i d a n m e n y e b a b k a n

i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

P a d a w a n i t a l e b i h d a r i 5 0 t a h u n a t a u l e b i h m e n o p a u s e m e m p a k a n f a k t o r

l a i n y a n g m e n i n g k a t k a n P V R Post Void Residual) s e l a i n p e n u r u n a n k o i i t r a k t i i i t a s

o t o t d e t r u s o r P e n u m n a n e s t r o g e n y a n g d i s e b a b k a n m e n o p a u s e d a p a t

m e n i n g k a t k a n p H v a g i n a l d a n m e n u m n k a n j u m l a l i l a c t o b a c i l l i A k i b a m y a t e r j a d i

p e n i n g k a t k a n k o l o n i s a s i d a r i b a s i l g r a m n e g a t i f s e h i n g g a m e n i n g k a t k a n r e s i k o

t e r j a d i n y a I S K P a d a p r i a p r o s t a t m e n s e k r e s i k a n c a i r a n y a n g m e n g a n d i m g z i n k

y a n g m e m i l i k i a k t i f i t a s m i k r o b i a l ( K i m 2 0 1 2 )

S e l a i n i t u p i j a t a n u r e t r a s e p e r t i y a n g t e r j a d i s e l a m a h u b u n g a n s e k s u a l

m e n y e b a b k a n m a s u k n y a b a k t e r i k e d a l a m k a n d u n g k e m i h d a n m e m p a k a n h a l

y a n g p e n t i n g d a l a m p a t o g e n e s i s m f e k s i s a l i u a n k e m i h p a d a p e r e m p u a n m u d a

B u a n g a i r k e c i l s e t e l a h h u b u n g a n s e k s u a l t e r b u k t i m e n u m n k a n risiko s i s t i t i s

m u n g k i n k a r e n a t i n d a k a n i n i m e n i n g k a t k a n e r a d i k a s i b a k t e r i y a n g m a s u k s e l a m a

h u b u n g a n s e k s u a l ( K i m 2 0 1 2 )

3 ) T i n g k a t P e n d i d i k a n

P e n g e t a h u a n s e s e o r a n g t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t

p e n d i d i k a n S e s e o r a n g y a n g m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m i u i g k i n a n

p e n g e t a h u a n t e n t a n g k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o n n a s i y a n g d i d a p a t k a n

14

t e n t a n g k e s e h a t a n l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h

S e b a l i k n y a p e n d i d i k a n y a n g k u r a n g d a p a t m e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g

t e r h a d a p n i l a i - n i l a i y a n g b a n i d i k e n a l ( N o t o a d i n o j o 2 0 0 3 )

4 ) R i w a y a t D i a b e t e s M e l i t u s

M e n u r u t S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a s i e n d e n g a n s t a t u s D M s a n g a t

b e r i s i k o u n t u k m e n g a l a m i i n f e k s i s a i u r a n k e m i h A b n o n n a l i i a s s t n i k t u r d a n

k a n d u n g k e m i h n e u r o g e n i k a k i b a t n e u r o p a t i o t o n o m a t a u s t r o k e p a d a p a s i e n D M

m e n y e b a b k a n p e n g o s o n g a n k a n d u n g k e m i h t i d a k n o n n a l D M j u g a d a p a t

m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a h a n a n t u b u h y a n g b e r p o t e n s i m e n i n g k a t

risiko t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a h a n a n t u b u h t e r s e b u t d i a n t a r a n y a

a d a i a h k e g a g a l a n m i g r a s i s e l intracellular killing f a g o s i t o s i s d a n k e m o t a k s i s

p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n m e k a n i s m e p e r t a h a n a n

a l a m i a h i o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p i n f e k s i

5 ) K e h a m i i a n

K e c e n d e r u n g a n i n f e k s i s a i u r a n k e m i h b a g i a n a t a s s e l a m a k e h a m i i a n

d i s e b a b k a n o l e h p e n u m n a n k e k u a t a n u r e t e r p e n u m n a n p e r i s t a l t i k u r e t e r d a n

i n k o m p e t e n s i s e m e n t a r a k a l u p v e s i k o i u - e t e r a l y a n g t e r j a d i s e l a m a h a m i l

6 ) S u m b a t a i i

A d a n y a I i a i a n g a n a l i r a n b e b a s u r i n s e p e r t i t u m o r s t r i k t r a a b a t u a t a u

h i p e r t r o f i p r o s t a t d a p a t m e n y e b a b k a n h i d r o n e f r o s i s d a n risiko i n f e k s i s a i u r a n

k e m i l i y a n g s a n g a t t i n g g i S e l a i n i t u s u p e r i n f e k s i p a d a s u m b a t a n s a i u r a n k e m i h

d a p a t m e n y e b a b k a n k e m s a k a n j a r i n g a n g i n j a l y a n g c e p a t

7 ) D i s f u n g s i n e u r o g e n i k k a n d u n g k e m i h

G a n g g u a n s a r a f y a n g b e k e r j a p a d a k a n d m i g k e m i h s e p e r t i p a d a j e j a s k o r d a

s p i n a l i s t a b e s d o r s a i i s m u l t i p e l s k l e r o s i s d i a b e t e s m e l i t u s a t a u p e n y a k i t l a i n

d a p a t b e r h u b u n g a n d e n g a n i n f e k s i s a i u r a n k e m i h I n f e k s i d a p a t d i a w a l i o l e h

p e n g g u n a a n k a t e l e r u n t u k d r a i n a s e k a n d i u i g k e m i h d a n d i d u k i m g o l e h s t a t i s u r i n

d a l a m k a n d u n g k e m i l i u n t u k j a n g k a w a k t u y a n g l a m a

8 ) R e f l u k s v e s i k o m e t e r a

K e a d a a n i n i d i d e f i n i s i k a n s e b a g a i r e f l u k s u r i n d a r i k a n d u n g k e m i b k e u r e t e r

d a n k a d a n g s a m p a i k e p e l v i s r e n a l H a l i n i t e r j a d i s e l a m a b u a n g a i r k e c i l a t a u

15

d e n g a n p e n i n g k a t a n t e k a n a n p a d a k a n d u n g k e m i h R e f l u k s v e s i k o i i r e t e r a l d a p a t

d i b u k t i k a n d e n g a n a d a n y a g c r a k a n r e t r o g r a d z a t r a d i o o p a k a t a u r a d i o a k t i f m e l a l u i

s i s t o u r e t r o g r a m s e l a m a b u a n g a i r k e c i l R e f l u k s v e s i k o i i r e t e r a l b i a s a n y a

d i s e b a b k a n k a r e n a a d a n y a g a n g g u a n a n a t o m i s p a d a p e r t e m u a n v e s i k o i i r e t e r a l

y a n g d a p a t m e n y e b a b k a n r e f l u k s u r i n d i s e r t a i b a k t e r i d a n k a r e n a i t u t e r j a d i l a h

i n f e k s i s a l r a a n k e m i h

9 ) F a k t o r v i r u l e n s i b a k t e r i

F a k t o r v i r u l e n s i b a k t e r i m e m p e n g a r u b i k e m u n g k i n a n vragt7 t e r t e n m d a l a m

m e n y e b a b k a n i n f e k s i t r a k i u s u r i n a r i u s H a m p i r s e m u a strain F c o l i y a n g

m e n y e b a b k a n p i e l o n e f r i t i s p a d a p a s i e n d e n g a n t r a k i u s u r i n a r i u s n o m i a l s e c a r a

a n a t o m i k m e m p u n y a i p i l u s t e r t e n t u y a n g m e m p e r a n t a r a i p e r l e k a t a n p a d a b a g i a n

d i g a k t o s i d a d a n g l i k o s f i n g o l i p i d y a n g a d a d i u r o e p i t e l Strain y a n g m e n i m b u l k a n

p i e l o n e f r i t i s j u g a b i a s a n y a m e m p a k a n p e n g b a s i l h e m o l i s i n m e m p u n y a i

a e r o b a k t i n d a n r e s i s t e n t e r h a d a p k e r j a b a k t e r i s i d a l d a r i s e m m m a n u s i a

1 0 ) F a k t o r g e n e t i k

F a k t o r g e n e t i k p e n j a m u m e m p e n g a n i l i i k e r e n t a n a n t e r h a d a p i n f e k s i t r a k t u s

u r i n a r i u s J u m l a h d a n t i p e r e s e p t o r p a d a s e l u r o e p i t e l t e m p a t b a k t e r i d a p a t

m e n e m p e l s e l i d a k i i y a s e b a g i a i i d i t e n t u k a r i s e c a r a g e n e t i k ( I s s e l b a c h e r 2 0 0 9 )

G Manifestasi Klinis

G e j a l a k l i n i s d a r i i n f e k s i s a i u r a n k e m i h s e s u a i d e n g a n b a g i a n s a i u r a n k e m i h

y a n g t e r i n f e k s i a d a i a h s e b a g a i b e r i k u t

1 ) I n f e k s i s a i u r a n k e m i h b a g i a n b a w a l i

K e l u h a n p a s i e n b i a s a n y a b e m p a r a s a s a k i t a t a u r a s a p a n a s d i u r e t r a s e w a k t u

k e n c i n g d e n g a n a i r k e m i h s e d i k i t - s e d i k i t s e r t a r a s a t i d a k e n a k d i d a e r a h

s i i p r a p u b i k

2 ) I n f e k s i s a i u r a n k e m i h b a g i a n a t a s

P a d a i n t e k s i s a i u r a n k e m i h b a g i a n a t a s d a p a t d i t e m u k a n g e j a l a s e p e r t i s a k i t

k e p a l a m a l a i s e m u a l m m i t a h d e n i a m m e n g g i g i l r a s a t i d a k e n a k a t a u

n y e r i d i p i n g g a n g ( T e s s y d k k 2 0 0 1 )

16

H Tatalaksana

T u j u a n p e n a t a l a k s a n a a a n i n f e k s i s a i u r a n k e m i h a d a i a h m e n c e g a h d a n

m e n g h i l a n g k a n g e j a l a m e n c e g a h d a n m e n g o b a t i b a k t e n e m i a d a n b a k t e r i u r i a s e r t a

m e n c e g a h d a n m e n g u r a n g i r i s i k o k e r u s a k a n g i n j a l y a n g m u n g k i n t i m b u l d e n g a n

p e m b e r i a n o b a t - o b a t a n y a n g s e n s i t i f m u r a l i d a n a m a n d e n g a n e f e k s a m p i n g y a n g

m i n i m a l

a ) i n f e k s i s a i u r a n k e m i h ( I S K ) b a w a h

P r i n s i p p e n a t a l a k s a n a a n I S K b a w a h m e l i p u t i intake c a i r a n y a n g b a n y a k

a n t i b i o t i k y a n g a d e k u a t d a n b i l a p e r l u t e r a p i s i m t o m a t i k u n t u k a l k a l i s a s i

u r i n

i H a m p i r 8 0 p a s i e n a k a n m e m b e r i k a n r e s p o n s e t e l a h 4 8 j a m d e n g a n

a n t i b i o t i k a t u n g g a l s e p e r t i a m p i s i l i n 3 g r a m a t a u t r i m e t o p r i m 2 0 0 m g

i i B i l a i n f e k s i m e n e t a p d i s e r t a i k e l a i n a n u r i n a l i s i s ( l e u k o s i u i a ) d i p e r i u k a n

t e r a p i k o n v e n s i o n a l s e l a m a 5 - 1 0 h a r i

i i i P e m e r i k s a a n m i k r o s k o p i s u r i n d a n b i a k a n u r i n t i d a k d i p e r i u k a n b i l a

s e m u a g e j a l a h i l a n g d a n t a n p a l e u k o s u r i a

b ) I n f e k s i s a i u r a n k e m i h ( I S K ) a t a s

P a d a u m u m n y a p a s i e n d e n g a n p i e l o n e f r i t i s a k u t m e m e r l u k a n r a w a t i n a p

u n t u k m e m e l i h a r a s t a t u s h i d r a s i d a n t e r a p i a n t i b i o t i k a p a r e n t e r a l p a l i n g

s e d i k i t 4 8 j a m ( S u d o y o 2 0 0 6 )

i Komplikasi

K o m p l i k a s i i n f e k s i s a i u r a n k e m i h t e r g a n t u n g d a r i t i p e y a i t u i n f e k s i s a i u r a n

k e m i h t i p e s e d e r h a n a (uncomplicated) d a n t i p e b e r k o m p l i k a s i (complicated)

1 ) I n f e k s i s a i u r a n k e m i h s e d e r h a n a (uncomplicated)

I n f e k s i s a i u r a n k e m i h a k u t t i p e s e d e r h a n a ( s i s t i t i s ) y a i t u n o n - o b s t r u k s i d a n

b u k a n p e r e m p u a n h a m i l m e m p a k a n p e n y a k i t r i n g a n (self limited disiase)

d a n t i d a k m e n y e b a b k a n a k i b a t l a n j u t j a n g k a l a m a

2 ) I n f e k s i s a i u r a n k e m i h b e r k o m p l i k a s i (complicated)

a ) I n f e k s i s a i u r a n k e m i h s e l a m a k e h a m i i a n

b ) i n f e k s i s a i u r a n k e m i h p a d a d i a b e t e s m e l i t u s ( S u d o y o 2 0 0 6 )

17

22 Kerangka Teori

J

U s i a

J e n i s K e i a m i n

T i n g k a t P e n d i d i k a n

R i w a y a t D i a b e t e s M e l i m s

S u m b a t a n bullT

K e h a m i i a n

D i s f u n g s i n e u r o g e n i k

R e f l u k s v e s i k o i i r e t e r a l

V i r u l e n s i b a k t e r i

F a k t o r g e n e t i k

I n f e k s i b a k t e r i g r a m p o s i t i f a t a u n e g a t i v e p a d a s a i u r a n k e m i h

I n f e k s i S a i u r a n K e m i h

Keterangan

I j = V a r i a b e l y a n g t i d a k d i t e l i t i

= V a r i a b e l y a n g d i t e l i t i

18

Hipotesis

H i p o t e s i s d a l a m p e n e l i t i a n i n i a d a i a h

H O t i d a k t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n

t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

H I t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

BAB 111

M E T O D E PENELITIAN

31 Jenis Penelitian

P a d a p e n e l i t i a n i n i j e n i s p e n e l i t i a n y a n g d i g u n a k a n a d a i a h p e n e l i t i a n

o b s e r v a s i o n a i a n a l i t i k d e s a i n cross scclional d e n g a n m e n g g u n a k a n d a t a s e k u n d e r

d a r i r e k a m m e d i s p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1 D e s e m b e r

2 0 1 5

32 Waktu dan Tempat Penelitian

321 Waktu Penelitian

W a k t u p e n e l i t i a n d i l a k s a n a k a n p a d a t a n g g a l 1 O k t o b e r s a m p a i d e n g a n 3 0

O k t o b e r 2 0 1 6

322 Tempat Penelitian

P e n e l i t i a n i n i d i l a k s a n a k a n d i R u m a l i S a k i t M u h a m m a d i y a h P a e m b a n g ( d i

R u a n g R e k a m M e d i s )

33 Populasi dan Sampel Penelitian

331Populasi Penelitian

P a d a p e n e l i t i a n i n i p o p u l a s i t a r g e t a d a l a l i p a s i e n r a w a t i n a p d a n r a w a t j a l a n

d i R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g s e d a n g k a n p o p u l a s i t e r j a n g k a u n y a

a d a i a h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

332Sampel dan Besar Sampel Penelitian

P a d a p e n e l i t i a n i n i s a m p e l p e n e l i t i a n a d a i a h p a s i e n r a w a t i n a p d a n r a w a t

j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e

1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 y a n g m e m e n u h i k r i t e r i a i n k l u s i p e n e l i t i a n

1 9

20

d e n g a n b e s a r s a m p e l y a n g l a y a k d a l a m p e n e l i t i a n m e n u r u t t e o r i R o s c o e a d a i a h

a n t a r a t i g a p u l u h s a m p a i l i m a r a t i i s o r a n g ( S u g i y o n o 2 0 1 5 )

333 Krttena Inklusi dan Eksklusi

A Kriteria Inklusi

P a d a p e n e l i t i a n i n i k r i t e r i a i n k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t i n a p

d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i

P a l e m b a n g y a n g d i d i a g n o s a m e n g a l a m i i n f e k s i s a i u r a n k e m i h s e r t a m e m i l i k i d a t a

r e k a m m e d i s p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

B Kriteria Eksklusi

P a d a p e n e l i t i a n i n i k r i t e r i a e k s k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t

i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 d e n g a n d a t a r e k a m m e d i s

y a n g t i d a k l e n g k a p

334 Cara Pengambilan Sampel Penelitian

C a r a p e n g a m b i l a n s a m p e l y a n g d i g u n a k a n d a l a m p e n e l i t i a n i n i a d a l a l i

m e n g g u n a k a n t e k n i k consecutive sampling P a d a consecutive sampling s e t i a p

p a s i e n y a n g m e m e n u h i k r i t e r i a p e n e l i t i a n d i m a s u k k a n d a l a m p e n e l i t i a n s a m p a i

k u r u n w a k t u t e r t e n U i s e h i n g g a j u m l a h m i n i m a l y a n g d i p e r i u k a n t e r p e n u h i

( S a s t r o a s m o r o 2 0 1 1 )

34 Variabel Penelitian

341 Variabel Dependent

V a r i a b e l dependent f t e r i k a t ) d a l a m p e n e l i t i a n i n i a d a i a h i n f e k s i s a i u r a n

k e m i h

342 Variabel Independent

V a r i a b e l independent ( b e b a s ) d a l a m p e n e l i t i a n i n i a d a i a h u s i a j e n i s

k e l a i n i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

21

35 Definisi Operasional

Tabel 31 Definisi Operasional

Variabel Alat Cara ueiinisi rldsil L KUr I7 i l l 11 Lz fe 1 V

oKaia LiKur Penelitian Ukur Ukur

Infeksi P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Saiuran d i d i a g n o s a o l e h m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Keniih d o k t e r m e n g a l a m i m e d i s

i n f e k s i s a i u r a n

k e m i h d a n t e r c a n t u m

d i r e k a m m e d i s

U s i a L a m a n y a t a h u n R e k a m O b s e r v a s i 1 lt 5 0 t a h u n O r d i n a l

k e h i d u p a n p a s i e n m e d i s r e k a m 2 gt 5 0 t a l i u n ( k a t e g o r i k )

d a r i l a h i r s a m p a i m e d i s

s e k a r a n g d a n

t e r c a n t u m d i r e k a m

m e d i s

Jenis P r o f i l a n a t o m i a t a u R e k a m O b s e r v a s i 1- L a k i - l a k i N o m i n a l

Keiamin b i o l o g i s p a s i e n y a n g m e d i s r e k a m 2 P e r e m p u a n ( k a t e g o r i k )

d i b e d a k a n m e n j a d i m e d i s

i a k i - l a k i d a n

n e r e m m i a n s e r t a

t e r c a n t u m d i r e k a m

m e d i s

Tingkat P e n d i d i k a n f o n n a l R e k a m O b s e r v a s i 1 P e n d i d i k a n O r d i n a l

Pendidikan t e r a k h i r y a n g m e d i s r e k a m d a s a r ( S D ( k a t e g o r i k )

d i t e m p u h o l e h m e d i s M I S M P

p a s i e n d a n t e r c a n t u m d a n M T s )

d i r e k a m m e d i s 2 P e n d i d i k a n

m e n e n g a l i

d a n t i n g g i

22

( S M A M A

S M K

M A K

d i p l o m a

s a r j a n a

m a g i St e r

s p e s i a l i s

d a n d o k t o r )

Riwayat P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Diabetes d i d i a g n o s i s d e n g a n m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Melitus d i a b e t e s m e l i t u s d a n

t e r c a n t u m d i d a l a m

r e k a m m e d i s

m e d i s

36 Cara Pengumpulan Data

361 Data Sekunder

P e n g u m p u l a n d a t a p a d a p e n e l i t i a n i n i d i p e r o l e h d a r i d a t a s e k u n d e r y a i t u

r e k a m m e d i s p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

37 Metode Teknik Analisis Data

371Cara Pengolahan dan Analisis Data

P e n g o l a h a n d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n m e l a l u i e m p a t t a h a p y a i t u

i Oala Entry

P a d a t a i i a p i n i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n riwayat d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g y a n g t e l a h d i d a p a t d a n

r e k a m m e d i s d i k u m p u l k a n d a n d i m a s u k k a n k e d a l a m p r o g r a m spss

23

2 Editing

P a d a t a h a p i n i d a t a i i s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n y a n g t e l a h d i m a s u k k a n k e d a l a m p r o g r a m s p s s

d i p e r i k s a k e m b a l i a p a k a h s u d a h l e n g k a p d a n t i d a k a d a k e k e l i r u a n

3 ( oding

S e t e l a h m e l a l u i p r o s e s editing d a t a - d a t a t e r s e b u t d i b e r i k o d e t e r t e n t u a n t a r a

l a i n k o d e 1 u n t u k u s i a gt 5 0 t a h u n j e n i s k e i a m i n p e r e m p u a n t i n g k a t

p e n d i d i k a n d a s a r t e r d a p a t r i w a y a t d i a b e t e s m e l i t u s d a n i n f e k s i s a i u r a n

k e m i h s e d a n g k a n k o d e 2 u n t u k u s i a lt 5 0 t a h u n j e n i s k e i a m i n l a k i - l a k i

t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i t i d a k t e r d a p a t r i w a y a t d i a b e t e s

m e l i t u s d a n b u k a n i n f e k s i s a i u r a n k e m i h s e h i n g g a m e m u d a h k a n d a l a m

m e l a k u k a n a n a l i s i s d a t a

4 Tahulaling

P a d a t a h a p i n i d a t a y a n g s a m a d i k e l o m p o k k a n s e c a r a t e l i t i d a n t e r a t m

k e m u d i a n d i l i i t u n g d e n g a n m e n g g u n a k a n p r o g r a m sps s d a n d i j u m l a h k a i i

l a l u d i s a j i k a n d a l a m b e n t u k t a b e l - t a b e l

U n t u k m e n g a n a l i s i s d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n a n a l i s i s d a t a

u n i v a r i a t d a n b i v a r i a t d e n g a n m e n g g u n a k a n p r o g r a m s p s s s e b a g a i b e r i k u t

A A n a l i s i s u n i v a r i a t

A n a l i s i s u n i v a r i a t d i l a k u k a n d e n g a n c a r a m e l a k u k a n a n a l i s i s p a d a s e t i a p

v a r i a b e l h a s i l p e n e l i t i a n d e n g a n t u j u a n u n t u k m e n g e t a h u i d i s t r i b u s i p r o p o r s i p a d a

s e t i a p v a r i a b e l p e n e l i t i a n D a t a d i s a j i k a n d a l a m b e n t u k t a b e l d a n n a r a s i

B A n a l i s i s b i v a r i a t

A n a l i s i s b i v a r i a t d i l a k u k a n d e n g a n m e n g g u n a k a n u j i h i p o t e s i s chi-square

U j i h i p o t e s i s chi-square d a p a t d i g u n a k a n d e n g a n s y a r a t y a i t u lt 2 0 s e l y a n g

m e m p u n y a i n i l a i expected count k u r a n g d a r i l i m a s e h i n g g a j i k a t i d a k m e m e n u h i

s y a r a t u j i chi-square m a k a u j i y a n g d i g u n a k a n a d a i a h u] fisher ( D a h l a n 2 0 1 4 )

B a t a s k e m a k n a a n y a n g d i g u n a k a n a d a i a h a = 0 0 5 J i k a d i d a p a t k a n p value lt 0 0 5

p a d a u j i s t a t i s t i k m a k a t i d a k t e r d a p a t h u b u n g a n y a n g b e n n a k n a a n t a r a d u a

v a r i a b e l y a n g d i t e l i t i d a n H O d i t e r i m a S e d a n g k a n j i k a d i d a p a t k a n p value gt 0 0 5

24

p a d a u j i s t a t i s t i k m a k a t e r d a p a t l i u b u n g a n y a n g b e n n a k n a a n t a r a d u a v a r i a b e l

y a n g d i t e l i t i d a n H O d i t o l a k

38 Alur Penelitian

P e n e n t u a n p o p u l a s i d a n s a m p e l p e n e l i t i a n

K r i t e r i a i n k l u s i K r i t e r i a e k s k l u s i

P e n g a m b i l a n s a m p e l p e n e l i t i a n

P e n g o l a h a n d a n a n a l i s i s d a t a d e n g a n u j i chi-square

H a s i l d a n p e m b a h a s a n

K e s i m p u l a n d a n s a r a n

Gambar 31 Alur Penelitian Hubungan Usia Jenis Keiamin Tingkat Pendidikan dan Riwayat Diabetes Melitus dengan Kejadian Infeksi Saiuran Kemih pada Pasien Rawat Inap di Bagian Penyakit Dalam Rumah Sakit Muhammadiyah Palembang Periode 1 Januari 2015 sampai dengan 31 Desember 2015

BAB IV

HASIL DAN PEMBAHASAN

41 Hasil

P e n e l i t i a n i n i t e l a h d i l a k u k a n d i r u a n g r e k a m m e d i s R u m a h S a k i t

M u h a i m n a d i y a h P a l e m b a n g d a r i t a n g g a l 1 O k t o b e r 2 0 1 5 - 3 1 O k t o b e r 2 0 1 6

P e n e l i t i a n d i m u l a i d e n g a n p e n g a m b i l a n d a t a a w a l b e m p a d a t a r e k a m m e d i s

s e l u r u h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

S e l a n j u t n y a r e k a m m e d i s d i p i l i h s e s u a i d e n g a n k r i t e r i a i n k l u s i d a n e k s k l u s i u n t u k

d i j a d i k a n s a m p e l p e n e l i t i a n s a m p a i m i n i m a l b e s a r s a m p e l y a n g d i b u t u h k a n

t e r p e n u h i s e r t a d i l a k u k a n p e n e l i t i a n s e c a r a o b s e r v a s i o n a i O b s e r v a s i r e k a m m e d i s

d i l a k u k a n u n m k m e n g e t a h u i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t

d i a b e t e s m e l i t u s d a n d i a g n o s a p a s i e n

D a r i c a t a t a n r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g

d i d a p a t k a n s e b a n y a k 4 1 4 1 r e k a m m e d i s p a s i e n r a w a t i n a p d a n 1 4 5 3 r e k a m m e d i s

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 D a r i t o t a l r e k a m m e d i s

p a s i e n r a w a t i n a p d a n r a w a t j a l a n t e r s e b u t p e n e l i t i h a n y a m e n g a m b i l m i n i m a l

b e s a r s a m p e l y a n g d i b u t u h k a n y a i t u s e b a n y a k 9 8 r e k a m m e d i s u n t u k d i j a d i k a n

s a m p e l p e n e l i t i a n y a n g t e r d i r i d a r i 3 0 r e k a m m e d i s p a s i e n y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i h d a n 6 8 r e k a m m e d i s y a n g t i d a k m e n g a l a m i i n f e k s i s a i u r a n k e m i h

411 Hasil Analisis Univariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s u n i v a r i a t

a n t a r a l a i n d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p b e r d a s a r k a n u s i a d a n

j e n i s k e l a m m d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n b e r d a s a r k a n u s i a

d a n j e n i s k e i a m i n d i s t r i b u s i p r o p o r s i s a m p e l b e r d a s a r k a n k e j a d i a n m f e k s i s a i u r a n

k e m i h s e r t a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n u s i a

j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

25

26

A Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan IJsta

dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 41 Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan

Usia dan Jenis Keiamin

Paisen Rawat Inap N Persentase

Usia

1 7 - 2 5 t a h u n 678 1 6 4

2 6 - 3 5 t a h u n 952 2 3 0

3 6 - 4 5 t a l i u n 745 18 0

4 6 - 5 5 t a h u n 695 1 6 8

5 6 - 6 4 t a h u n 571 1 3 8

gt 6 4 t a h u n 500 1 2 1

U s i a r a t a - r a t a ( t a h u n j 43plusmn16543

Jenis Keiamin

P e r e m p u a n 2 6 3 8 6 3 7

L a k i - l a k i 1 5 0 3 3 6 3

Total 4141 100

B e r d a s a r k a n t a b e l 4 1 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R i u n a h S a k i t M u l i a m m a d i y a l i

P a l e m b a n g p e r i o d e J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 2 6 - 3 5 t a h u n y a i t u

s e b a n y a k 9 5 2 o r a n g ( 2 3 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 43plusmn16543 t a l i u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 2 6 3 8 o r a n g ( 6 3 7 )

27

B Distribusi Proporsi Karakteristik Pasien Rawat Jalan Berdasarkan

Usia dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 42 Distribusi Proporsi Karakteristik Pasien Rawat Jalan

Berdasarkan Usia dan Jenis Keiamin

Fasten Rawat Jalan N Persentase

Usia

1 7 - 2 5 t a h u n 9 2 6 3

2 6 - 3 5 t a l n i n 1 3 1 9 0

3 6 - 4 5 t a h u n 2 7 9 1 9 2

46-55 t a l i u n 4 2 1 2 9 0

5 6 - 6 4 t a h u n 3 1 6 2 1 7

gt 6 4 t a h u n 2 1 4 1 4 7

U s i a r a t a - r a t a ( t a h u n ) 50plusmn14120

Jenis Keiamin

P e r e m p u a n 8 9 0 6 1 3

L a k i - l a k i 5 6 3 3 8 7

Total 1453 100

B e r d a s a r k a n t a b e l 4 2 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 4 6 - 5 5 t a h u n y a i t u

s e b a n y a k 4 2 1 o r a n g ( 2 9 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 50plusmn14120 t a h u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 8 9 0 o r a n g ( 6 1 3 )

28

C Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Usia

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i b b e r d a s a r k a n u s i a d a p a t

d i i i h a t p a d a l a b e l d i b a w a h i n i

Tabel 43 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Usia

Usia N Persentase

lt 5 0 t a h u n 1 4 4 6 7

gt 5 0 t a l i u n 1 6 5 3 3

Total 30 100

B e r d a s a r k a n t a b e l 4 3 d i a t a s d a p a t d i k e t a h u i b a h w a u s i a t e r b a n y a k p a d a

s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h gt 5 0 t a h u n y a i t u s e b a n y a k

1 6 o r a n g ( 5 3 3 )

D Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Jenis

Keiamin

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n j e n i s

k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 44 Distribusi Proporsi Kejadian infeksi Saiuran Kemih Berdasarkan

Jenis Keiamin

Jenis Keiamin N Persentase

P e r e m p u a n 1 8 6 0 0

L a k i - l a k i 1 2 4 0 0

Total 30 100

B e r d a s a r k a n t a b e l 4 4 d i a t a s d a p a t d i k e t a h u i b a h w a j e n i s k e i a m i n

t e r b a n y a k p a d a s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h p e r e m p u a n

y a i t u s e b a n y a k 1 8 o r a n g ( 6 0 0 )

29

E Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n t i n g k a t

p e n d i d i k a n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 45 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

Tingkat Pendidikan N Persentase

P e n d i d i k a n d a s a r 20 6 6 7

P e n d i d i k a n m e n e n g a h d a n P e n d i d i k a n m e n e n g a h d a n 10 333

t i n g g i

Total J O 100

B e r d a s a r k a n t a b e l 4 5 d i a t a s d a p a t d i k e t a l i u i b a l i w a t i n g k a t p e n d i d i k a n

t e r b a n y a k p a d a s a m p e i y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h t i n g k a t

p e n d i d i k a n d a s a r y a i t u s e b a n y a k 20 o r a n g ( 6 6 7 )

P Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n riwayat

d i a b e t e s m e l i t u s d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 46 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

Riwayat Diabetes Melitus N Persentase

Y a 17 5 6 7

T i d a k 13 433

Total 30 100

B e r d a s a r k a n t a b e l 4 6 d i a t a s d a p a t d i k e t a h u i b a l i w a s a m p e l y a n g

m e n g a l a m i i n f e k s i s a i u r a n k e m i h t e r b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s

y a i t u s e b a n y a k 1 7 o r a n g ( 5 6 7 )

30

412 Hasil Analisis Bivariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s b i v a r i a t

a n t a r a I a i n h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h j e n i s

k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h t i n g k a t p e n d i d i k a n d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n

i n f e k s i s a l m a n k e m i h

A n a l i s i s y a n g d i g u n a k a n p a d a u j i d u a v a r i a b e l y a n g b e r s k a l a k a t e g o r i k

a d a l a l i d e n g a n u j i Chi-Square d e n g a n n i e i h a t n i l a i Pearson Chi-Square S e m u a

h a s i l d a r i u j i h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h m e n g g i u i a k a n u j i Chi-

Square k a i e n a m e m e n u h i s y a r a t u j i Chi-Square y a i t u lt 2 0 s e l y a n g m e m p u n y a i

n i l a i expected count lt 5

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 47 Hasil Uji Hubungan antara Usia dengan Kejadian Infeksi

Saiuran Kemih

Usia

Infeksi Saiuran Kemih

^a Tidak

n N Mgt

Jumlah P

value 95Cl

lt 50 t a h u n 1 4 1 9 2 5 9 8 0 8 7 3 0 0 0 0 2 7 4 7 - 2 0 4 3 1

gt 5 0 t a h u n 1 6 6 4 0 9 3 6 0 2 5

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 7 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R = 7 4 9 2

( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a u s i a gt

5 0 t a h u n a d a l a l i 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a u s i a lt 5 0 t a h u n

31

B Hubungan antara Jenis Keiamin dengan Kejadian Infeksi Saiuran

Kemih

H a s i l a n a l i s i s b i v a r i a t l i u b u n g a n a n t a r a j e n i s k e l a i n i n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

Tabel 48 Hasil Uji Hubungan antara Jenis Keiamin dengan Kejadian

Infeksi Saiuran Kemih

Infeksi Saiuran Kemih Jenis P

A Tidak Jumlah 95CI Keiamin value

N N

P e r e m p u a n 18 6 4 3 10 357laquoo 2 8 3 2 2 7 -P e r e m p u a n 0 0 0 0

L a k i - l a k i 12 1 7 1 5 8 8 2 9 7 0 2 3 4 5 9

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 8 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a l a l i

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k N 4 a k a a d a l i u b u n g a n y a n g s i g n i f i k a n a n t a r a

j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R ) = 8 7 0 0

f 9 5 C I = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a l a k i - l a k i

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e n i i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

32

Tabel 49 Hasil liji Hubungan antara Tingkat Pendidikan dengan

Kejadian Infeksi Saiuran Kemih

Infeksi Saiuran Kemih P

Y a T i d a k jumlah 95CI value

N

P e n d i d i k a n d a s a r 2 0 5 4 1 1 7 4 5 9 3 7

P e n d i d i k a n

m e n e n g a h d a n 10 1 6 4 5 1 8 3 6 6 1

t i n g g i

Jumlah JO 30 6 68 694 9H

B e r d a s a r k a n t a b e l 4 9 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( 0 R ) =

6 0 0 0 ( 9 5 C I = 2 3 5 1 - 1 5 3 1 0 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r a d a i a h 6 k a l i l e b i h b e s a r

d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i h a t

p a d a t a b e l d i b a w a h i n i

Tingkat

Pendidikan

2 3 5 1 -0 0 0 0

1 5 3 1 0

33

Tabel 4t0 Hasil I j i Hubungan antara Riwayat Diabetes Melitus dengan

Kejadian Infeksi Saiuran Kemih

Riwayat Infeksi Saiuran Kemih P

Diabetes Va Tidak Jumlah value

95CI

Melitus N bullVJ N

Y a

T i d a k

17

1 3

6 8 0

1 7 8

8

6 0

3 2 0

8 2 2

2 5

7 3 0 0 0 0

3 4 9 3 -

2 7 5 3 6

Jumlah 30 306 68 571 98

B e r d a s a r k a n t a b e l 4 1 0 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio

( O R ) = 9 8 0 8 ( 9 5 C I - 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r

d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s m e l i m s

42 Pembahasan

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a l a b e l 4 7 d i d a p a t k a n b a l i w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i b d e n g a n n i l a i s i g n i f i k a n n y a a d a l a l i 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k

Odds Ratio ( O R ) = 7 4 9 2 ( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a u s i a T 5 0 t a h u n a d a i a h 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a

u s i a lt 5 0 t a h u n

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n A n d r y L u k a n d y

( 2 0 1 4 ) m e n g e n a i k a r a k t e r i s t i k p a s i e n - p a s i e n i n f e k s i s a i u r a n k e m i h d i m a n a

p e n d e r i t a I S K d e n g a n k e l o m p o k u m u r gt 5 0 t a h u n s e b a n y a k 2 3 o r a n g s e d a n g k a n

j u m l a h p e n d e r i t a I S K d e n g a n k e l o m p o k u m m lt 5 0 t a l i u n s e b a n y a k 2 0 o r a n g

P e n e l i t i a n i n i j u g a d i p e i k u a t o l e h p e n l i t i a n L e w i s A l e t a l ( 2 0 1 4 ) m e n g e n a i

impact of host age and parity on susceptihility to severe urinary tract injection in

34

a murine mode d e n g a n u j i K r u s k a l - W a l l i s d e n g a n post-test D u n n u n t u k b e b e r a p a

p e r b a n d i n g a n d i m a n a u s i a d a n p a r i t a s s e b a g a i f a k t o r y a n g b e r k o n t r i b u s i d a l a m

k e r e n t a n a n i m t u k t e r j a d i n y a I S K d e n g a n n i l a i p lt 0 0 5

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n g a t a k a n b a h w a i n s i d e n I S K m e n i n g k a t

b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n

a d a n y a a b n o r m a l i t a s a n a t o m i y a n g m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n

k e m i h s e p e r t i p e m b e s a r a n p r o s t a t d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a

p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e ( R o s e 2 0 0 9 ) P e n y e b a b l a i n t e n n a s u k

p e r i n e i u n y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s p e n y a k i t n e u r o m u s k u l a r

d a n k a t e t e r i s a s i b u l i - b u l i ( F o x m a n e t a l 2 0 1 0 ) S e l a i n i t u i n s i d e n I S K m e n c a p a i

1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o n a l d 2 0 1 1 )

B Hubungan antara Jenis Keiamin dengan Kejadian infeksi Saiuran

Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 8 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d e n g a n n i l a i s i g n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O

d i t o l a k Odds Ratio ( O R ) = 8 7 0 0 ( 9 5 C l = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a risiko k e j a d i a n

i n f e k s i s a i u r a n k e m i h p a d a p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n

p a d a l a k i - i a k i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n M a g i i a n o e t a l

( 2 0 1 1 ) m e n g e n a i Gender and Age-Dependent Etiology of Community Acquired

y a n g m e l a k u k a n p e n g a m b i l a n 6 1 2 7 3 s a m p e l k u l t u r u r i n d a l a m p e r i o d e 2 2 b u l a n

d a r i s a m p e l i n i d i d a p a t k a n 1 3 8 2 0 ( 2 2 6 ) d i t e m u k a n p o s i t i f i n f e k s i b a k t e r i

h a m p i r 8 0 b a l i a n y a n g d i i s o l a s i b e r a s a l d a r i p e r e m p u a n P e n e l i t i a n i n i j u g a

d i p e r k u a t o l e h p e n e l i t i a n y a n g d i l a k u k a n o l e h Y u n i t a I ( 2 0 1 0 ) d i m a n a a d a

h u b m i g a n y a n g b e n n a k n a a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h ( P value=O049 R P = 3 2 7 3 ( 9 5 C I = I 0 1 6 - 1 0 5 4 0 )

H a l t e r s e b u t d a p a t t e r j a d i k a r e n a u r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a l i

d e n g a n d e k a t n y a v a g i n a l v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i

s a i u r a n k e m i h l e b i h s e r i n g p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a flora n o r m a l

3 5

p a d a d a e r a h p e r i u r e t r a t e r d i r i d a r i o r g a n i s m e s e p e r t i i a c t o b a c i l l u s y a n g m e m b a n t u

m e l a w a n k o l o n i s a s i b a k t e r i p a t o g e n p a d a s a i u r a n k e m i h P e r u b a h a n l i n g k i m g a n

d a r i p e r i u r e t r a l s e p e r t i p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k

b i s a m e n g g a n g g u f l o r a n o r m a l s e h i n g g a m e n u m g k i n k a n b a k t e r i p a t o g e n

b e r k o l o n i s a s i d a n m e n y e b a b k a n i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Scuare p a d a t a b e l 4 9 d i d a p a t k a n b a h w a

t e r d a p a t l i u b u n g a n y a n g s i g n i f i k a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a

H O d i t o l a k Odds Ratio ( O R ) - 6 0 0 0 ( 9 5 o C l = 2 3 5 1 - 1 5 3 I O ) a r t i n y a n s i k o

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r

a d a i a h 6 k a l i l e b i h b e s a r d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n

m e n e n g a h d a n t i n g g i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h T o r o n d e i B e t

a l ( 2 0 1 5 ) m e n g e n a i Menstrual Hygiene Practices WASH Access and the Risk of

Urogenital Infection in Women from Odisha India d i m a n a p e r e m p u a n y a n g

h a n y a m e n e m p u l i p e n d i d i k a n s e k o l a h d a s a r a t a u l e b i h r e n d a h d i b a n d i n g k a n

d e n g a n t i n g k a t p e n d i d i k a n m e n e n g a h a t a u t i n g g i m e m i l i k i r i s i k o 3 k a l i

k e m u n g k i n a n l e b i h b e s a r m e n g a l a m i i n f e k s i s a i u r a n k e m i h ( A d j O R = 3 l 9 5

C 1 = I 2 - 7 9 p = 0 0 2 )

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a p e n g e t a h u a n s e s e o r a n g

t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t p e n d i d i k a n S e s e o r a n g y a n g

m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m u n g k i n a n p e n g e t a l i u a n t e n t a n g

k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o r m a s i y a n g d i d a p a t k a n t e n t a n g k e s e h a t a n

l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h S e b a l i k n y a

p e n d i d i k a n y a n g k u r a n g d a p a t i n e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g t e r h a d a p

n i l a i - n i l a i y a n g b a r u d i k e n a l ( N o t o a d m o j o 2 0 0 3 )

3 6

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Keniih

B e r d a s a r k a n l i a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 1 0 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a r i w a y a t d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 )

s e h i n g g a H O d i t o l a k Odds Ratio ( O R ) = 9 8 0 8 ( 9 5 C I = 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a

risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h S a r i E W P d a n

S a t y a b a k t i P ( 2 0 1 5 ) m e n g e n a i p e r b e d a a n risiko i n f e k s i n o s o k o m i a l s a i u r a n k e m i h

b e r d a s a r k a n k a t e t e r i s a s i u r i n u m u r d a n d i a b e t e s m e l i m s d i m a n a d a r i 2 0 p a s i e n

i n f e k s i n o s o k o m i a l s a i u r a n k e m i h 1 2 o r a n g ( 6 0 ) d i a n t a r a n y a a d a i a h p a s i e n

d e n g a n s t a t u s D M s e d a n g k a n 8 o r a n g ( 4 0 ) l a i n n y a a d a i a h p a s i e n t a n p a s t a t u s

D M ( P v W w ^ = 0 0 2 4 O R = 6 0 0 9 5 C I = 1 2 2 - 3 2 2 6

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a b a l i w a b e b e r a p a b a g i a n

d a r i i i n u n i t a s p a d a p a s i e n d i a b e t e s m e n g a l a m i p e r u b a h a n F u n g s i

p o l i n i o r f o l e u k o s i t d i t e k a n p a d a k e a d a a n a s i d o s i s I k a t a n l e u k o s i t k e m o t a k s i s d a n

f a g o s i t o s i s j u g a b e m b a l i S i s t e m a n t i o k s i d a n y a n g b e r p e r a n p a d a a k t i f i t a s

b a k t e r i s i d a l j u g a t e r g a n g g u s e h i n g g a m e n y e b a b k a n t e r j a d i n y a I S K p a d a p a s i e n -

p a s i e n d e n g a n p e n y a k i t d i a b e t e s ( J u l k a 2 0 1 4 )

H a l y a n g s a m a j u g a d i i m g k a p k a n o l e b t e o r i S m e l t z e r d a n B a r e ( 2 0 1 0 )

b a l i w a D M d a p a t m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a l i a n a n t u b u h y a n g

b e r p o t e n s i m e n i n g k a t k a n r i s i k o t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a l i a n a n

t u b u h t e r s e b u t d i a n t a r a n y a a d a i a h k e g a g a l a n m i g r a s i s e l iniraceliular killing

f a g o s i t o s i s d a n k e m o t a k s i s p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n

m e k a n i s m e p e r t a l i a n a n a l a m i a h I o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p

i n f e k s i

BAB V

KESIMPULAN DAN SARAN

51 Kesimpulan

1 U s i a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 2 6 - 3 5 t a h u n y a i t u 2 3 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 3 7

2 U s i a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 4 6 - 5 5 t a l i u n y a i t u 2 9 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 1 3

3 U s i a j e n i s k e i a m i n d a n t i n g k a t p e n d i d i k a n s a m p e i y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i l i t e r b a n y a k y a i t u b e r u s i a gt 5 0 t a h u n ( 5 3 3 ) j e n i s k e i a m i n

p e r e m p u a n ( 6 0 0 ) d a n t i n g k a t p e n d i d i k a n d a s a r ( 6 6 7 ) s e r t a p a l i n g

b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s y a i t u 5 6 7

4 T e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 ( p = 0 0 0 0 )

52 Saran

1 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t d i l a k u k a n d e n g a n d e s a i n

p e n e l i t i a n b e r b e d a s e p e r t i cohort a t a u case control

2 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t m e i i c a r i v a r i a b e l independent

y a n g l a i n s e p e r t i v a r i a b e l p e k e r j a a n p e m a s a i i g a n k a t e t e r a t a u l a m a n y a

m e n d e r i t a d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

37

DAFTAR PUSTAKA

B o y k o E J d k k 2 0 0 2 D i a b e t i c A n d T h e R i s k O f A c u t e U r i n a r y T r a c t I n f e c t i o n A m o n g P o s t m e n o p a u s a l W o m e n D i a b e t e s C a r e 2 5 ( 1 0 )

D a h l a n S 2 0 1 4 B u k i i S t a t i s t i k u n t u k K e d o k t e r a n d a n K e s e h a t a n D e s k r i p t i f B i v a r i a t d a n M u l t i v a r i a t d i l e n g k a p i a p l i k a s i d e n g a n m e n g g u n a k a n S P S S E d i s i 6 E p i d e m i o l o g i I n d o n e s i a J a k a r t a I n d o n e s i a

D e p a r t e m e n K e s e h a t a n ( D E P K E S ) R l 2 0 1 4 [ O n l i n e ] K e m e n t e r i a n K e s e h a t a n R e p u b l i k I n d o n e s i a P u s a t D a t a d a n I n f o r m a s i K e m e n t e r a n K e s e h a t a n R l ( http 7depkesgoid diakses tanggal 15 Met 2016)

F o x m a n B e t a i 2 0 1 0 U r i i i a i y T r a c t I n f e c t i o n A m o n g W o m e n A g e d 4 0 T o 6 5 B e h a v i o r a l A n d S e x u a l R i s k F a c t o r s D a l a m T a n a g h o E A M c A n i n c h J W 1 7 t h S m i t h s G e n e r a l U r o l o g y U S A M c G r a w H i l l (http searchproqnestcom diakses tanggal 16 Met 2016)

H a r d i n g G K d k k 2 0 1 0 A n t i m i c r o b i a l T r e a t m e n t I n D i a b e t i c W o m e n W i t l i A s y m t o m a t i c B a c t e r i u r i a N E n g l J M e d 3 4 7 1 5 7 6 - 1 5 8 3 (http nejmorg diakses tanggal 16 Met 2016)

I s s e l b a c h e r d k k 2 0 0 9 I n f e k s i S a i u r a n K e m i h d a n P i e l o n e f r i t i s D a l a m S t a m m W a l t e r E e d H a r r i s o n P r i n s i p - P r i n s i p l l m u P e n y a k i t D a l a m e d V o l u m e 2 J a k a r t a E G C 6 1 6 - 6 2 3

J u l k a S 2 0 1 3 G e n i t o u r i n a r y I n f e c t i o n I n D i a b e t e s I n d i a n J o u m a l o f E n d o c r i n o l o g y a n d M e t a b o l i s m (http searchproquestcom diakses tanggal 16 Mei 2016)

K i m B d k k 2 0 1 2 [ e - b o o k ] T h e R e l a t i o n b e t w e e n P o s t v o i d R e s i d u a l a n d O c c u r r e n c e o f U r i n a r y T r a c t I n f e c t i o n a f t e r S t r o k e i n R e h a b i l i t a t i o n U n i t A n n a l s o f R e h a b i l i t a t i o n M e d i c i n e

K o m a r a A 2 0 0 9 P o l a K e p e k a a n B a k t e r i G r a m N e g a t i f d a r i P a s i e n I n f e k s i S a i u r a n K e m i l i t e r h a d a p A n t i b i o t i k G e n t a m i c i n d a n K o t r i m o k s a z o l y a n g D i k i r i m k e L a b o r a t o r i u m M i k r o b i o l o g i K l i n i k F K U l d a r i T a h u n 2 0 0 1 s a m p a i T a h u n 2 0 0 5 (http dontaruiacid diakses tanggal OH Agustiis 2016)

L e w i s A L e t a l 2 0 1 4 I m p a c t o f H o s t A g e a n d P a r i t y o n S u s c e p t i b i l i t y t o S e v e r e U r i n a r y T r a c t I n f e c t i o n i n a M u r i n e M o d e l P l o s O n e R e s e a r c h A r t i c l e P u b l i c L i b r a r y o f S c i e n c e 9 ( 5 ) (http searchproquestcom diakses pada langgal 30 Desember 2016)

38

DAFTAR LAMPIRAN

Lampiran Halaman

L a m p i r a n 1 D a t a R e k a m M e d i s P a s i e n R a w a t I n a p d a n R a w a t J a l a n d i B a g i a n P e n y a k i t D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 4 3

L a m p i r a n 2 H a s i l A n a l i s i s U n v i a r i a t 4 5

L a m p i r a n 3 H a s i l A n a l i s i s B i v a r i a t 5 1

L a m p i r a n 4 K a r t u B i m b i n g a n P r o p o s a l S k r i p s i 5 8

L a m p i r a n 5 K a r t u B i m b i n g a n S k r i p s i 5 9

L a m p i r a n 6 S u r a t P e n n o h o n a n I z i n P e n e l i t i a n 6 0

L a m p i r a n 7 S u r a t K e t e r a n g a n I z i n P e n g a m b i l a n D a t a d a n P e n e l i t i a n 6 1

L a m p i r a n 8 S u r a t K e t e r a n g a n S e l e s a i P e n e l i t i a n 6 2

xii

BAB I

PENDAHULUAN

11 Latar Belakang

I n f e k s i s a i u r a n k e m i h ( I S K ) m e n i p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m i i k a n d i R u m a h S a k i t a t a u t e m p a t p r a k t i k u m u m s e h a r i - h a r i I S K

a d a i a h s u a t u i n f e k s i y a n g m e n g e n a i t r a k t u s u r i n a r i u s m u l a i d a r i m e a t u s u r e t r a

s a m p a i d e n g a n k e g i n j a l S t r u k t u r y a n g t e n n a s u k d i d a l a m n y a a d a i a h u r e t r a

k a n d u n g k e m i h u r e t e r p e l v i s d a n p a r e n k i m g i n j a l S t r u k t u r y a n g b e r k a i t a n u n t u k

t e r j a d i n y a i n f e k s i d a n r e k u r e n i n f e k s i y a i t u p r o s t a t e p i d i d i m i s d a n fascia

perinephric I s t i l a h I S K m e n u n j u k k a n a d a n y a k e b e r a d a a n m i k r o o r g a n i s m e d i

d a l a m u r i n ( S u d o y o 2 0 0 6 R u b i n 2 0 1 0 ) D e n g a n k a t a l a i n b a h w a d i a g n o s i s I S K

d i t e g a k k a n d e n g a n m e m b u k t i k a n a d a n y a m i k r o o r g a n i s m e d i d a l a m s a i u r a n k e m i h

( R u b i n 2 0 1 0 )

S e b a n y a k 2 5 j u t a k e m a t i a n d i s e l u r u h d u n i a p a d a t a h u n 2 0 1 1 s e p e r t i g a n y a

d i s e b a b k a n o l e h p e n y a k i t i n f e k s i I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n i n f e k s i

d e n g a n k e t e r l i b a t a i i b a k t e r i t e r s e r i n g d i k o m u n i t a s d a n h a m p i r 1 0 o r a n g p e m a h

t e r k e n a I S K s e l a m a h i d u p n y a S e k i t a i - 1 5 0 j u t a p e n d i i d u k d i s e l u r u h d u n i a t i a p

t a l i u n n y a t e r d i a g n o s i s m e n d e r i t a i n f e k s i s a i u r a n k e m i h ( Y u n u s 2 0 1 2 )

I S K d a p a t m e n g e n a i s e m u a k e l o m p o k u m u r b a i k a n a k r e m a j a d e w a s a

m a u p u n u s i a l a n j u t P r e v a l e n s i a n a k u s i a s e k o l a h y a n g m e n d e r i t a I S K s e k i t a r 1 -

3 d a n m e n i n g k a t p a d a r e m a j a y a n g s u d a h m e l a k u k a n h u b i m g a n s e k s u a l

( K o m a r a 2 0 0 9 ) D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r 2 5 - 3 5

s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a S e l a m a

p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n c e n d e r u n g

m e n d e r i t a I S K d i b a n d i n g k a n l a k i - l a k i ( S u d o y o 2 0 0 9 )

R a s i o I S K p a d a w a n i t a d i b a n d i n g p r i a b e r k i s a r 3 0 1 d a n s e k i t a r 5 0 w a n i t a

y a n g t e r k e n a i n f e k s i a k a n b e r k e m b a n g m e n j a d i I S K b e m l a n g I S K m e n i p a k a n

i n f e k s i b a k t e r i y a n g p a l i n g s e r i n g p a d a a n a k - a n a k d e n g a n k e l u h a n d e m a m b a i k

p a d a a n a k p r i a m a u p u n w a n i t a P r e v a l e n s i y a n g p e m a h d i l a p o r k a n b e r k i s a r 4 1

I

2

s a m p a i 7 5 R e k u r e n s i c u k u p s e r i n g d a n t e r j a d i s e k i t a r 1 8 p a d a b a y i l a k i - i a k i

d a n 2 6 p a d a b a y i p e r e m p u a n U n t u k u s i a p r a s e k o l a h I S K l e b i h s e r i n g

m e n g e n a i w a n i t a I n s i d e n I S K p a d a a n a k - a n a k p r a s e k o l a h s e k i t a r 2 ( S y a h r i n i

2 0 1 1 )

D a r i b e r b a g a i p e n e l i t i a n e p i d e m i o l o g i s d i I n d o n e s i a d i d a p a t k a n p r e v a l e n s i

D M s e b e s a r 15 - 2 3 p a d a p e n d u d u k u s i a l e b i J i d a r i 1 5 t a h u n b a h k a n p a d a

s u a t u p e n e l i t i a n e p i d e m i o l o g i s d i M a n a d o d i d a p a t k a n p r e v a l e n s i D M a d a i a h 6 1

P r e v a l e n s i d i a b e t e s m e l i t u s p a d a p e n d u d u k u s i a 2 5 - 6 4 t a h u n d i J a w a d a n B a l i

s e b e s a r 7 5 P e n e l i t i a n y a n g d i l a k u k a n d i J a k a r t a S u r a b a y a M a k a s a r d a n k o t a -

k o t a l a i n d i I n d o n e s i a m e m b u k t i k a n a d a n y a k e n a i k a n p r e v a l e n s i d a r i t a h u n

k e t a h u n ( D E P K E S 2 0 1 4 W H O 2 0 1 0 )

I n f e k s i s a i u r a n k e m i h j u g a m e n i p a k a n m a s a l a h k l i n i s u m u m p a d a p e n d e r i t a

D M o l e h k a r e n a p e n d e r i t a D M m e m p u n y a i k e m u n g k i n a n m e n d e r i t a I S K l e b i h

t i n g g i d i b a n d i n g k a n d e n g a n b u k a n p e n d e r i t a D M d a n j u g a m e n d e r i t a i n f e k s i y a n g

l e b i h b e r a t y a n g a k a n m e n i n g k a t k a n risiko u n t u k m a s u k m m a h s a k i t ( H a r d i n g

d k k 2 0 1 0 ) P e n e l i t i a n y a n g d i l a k u k a n o l e h B o y k o d k k m e n d a p a t k a n w a n i t a D M

ripe 2 d e n g a n b a k t e r i u r i a s i m t o m a t i k s e t e l a h d i l a k u k a n p e m a n t a u a n s e l a m a 1 8

b u l a n m e n g a l a m i p e n i n g k a t a n r i s i k o m e n d a p a t k a n I S K s e b a n y a k 3 4

d i b a n d i n g k a n d e n g a n w a n i t a y a n g t i d a k m e n g a l a m i D M s e b e s a r 1 9 ( B o y k o d k k

2 0 0 2 )

B e r d a s a r k a n u r a i a n - u r a i a n d i a t a s s e r t a b e l u m a d a n y a p e n e l i t i a n y a n g

m e n e m u k a n k e t e r k a i t a n f a k t o r u s i a j e n i s k e l a m m t i n g k a t p e n d i d i k a n d a n r i w a y a t

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h d i K o t a P a l e m b a n g m a k a

p e n e l i t i t e r t a r i k i m t i i k m e l a k u k a n p e n e l i t i a n m e n g e n a i h u b u n g a n a n t a r a u s i a j e n i s

k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

3

12 Rumusan Masalah

1 B a g a i m a n a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s

m e l i t u s

2 A p a k a l i a d a h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

13 Tujuan Penelitian

131 Tujuan Umum

T u j u a n u m u m d a r i p e n e l i t i a n i n i a d a i a h d i k e t e m u k a n n y a h u b u n g a n a n t a i a

u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i m s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

132 Tujuan Khusus

T u j u a n k l i u s u s d a r i p e n e l i t i a n i n i y a i t u

1 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a

2 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n m f e k s i s a i u r a n k e m i b p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n j e n i s k e i a m i n

3 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

4

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n t i n g k a t p e n d i d i k a n

4 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n riwayat d i a b e t e s m e l i t u s

5 T e r a n a l i s i s n y a h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a i m n a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

6 T e r a n a l i s i s n y a h u b u n g a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

7 T e r a n a l i s i s n y a h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

8 T e r a n a l i s i s n y a h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i u i s d e n g a n k e j a d i a n

i n f e k s i s a l i u a i i k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

14 Manfaat Penelitian

141 Manfaat Teoritis

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t m e n a m b a h p e n g e t a h u a n p e n e l i t i

t e n t a n g h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i U i s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

5

142 Manfaat Praktis

A Bagi Peneliti

H a s i l p e n e l i t i a n i n i d i l i a r a p k a n d a p a t d i g u n a k a n s e b a g a i s a l a h s a t u b a h a n

r e f e r e n s i a t a u b a c a a n b a g i p e n e l i t i

B Bagi Institusi

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t d i g u n a k a n p i h a k R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g s e b a g a i s a l a l i s a t u b a h a n a c u a n d a l a m m e n g u p a y a k a n

p e n c e g a h a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

15 Keaslian Penelitian

T a b e l 1 1 K e a s l i a n P e n e l i t i a n

Nama Judul Penelitian Desain Hasil Penelitian

Peneliti Penelitian

Kugan P r e v a l e n s i I n f e k s i Cross D a r i p e n e l i t i a n i i i i

Kandasamy S a i u r a n K e m i l i P a d a seciUmal d i p e r o l e h b a l i w a

W a n i t a Y a n g M e n d e r i t a

D i a b e t e s M e l i t u s T i p e

I I Y a n g D i r a w a t I n a p

p a s i e n w a n i t a d i a b e t e s

m e l i t u s t i p e I y a n g

m e n d e r i t a I S K y a n g

D a n D i r a w a t J a l a n D i d i r a w a t m a p d a n

S u b b a g i a n

E n d o k r i n o l o g i B a g i a n

P e n y a k i t D a l a m D i

d i r a w a t j a l a n d i s u b

b a g i a n E n d o k r i n o l o g i

P e n y a k i t D a l a m

R S U P H A d a m M a l i k R S U P H A d a m

P a d a T a l i u n 2 0 0 9 M a l i k M e d a i i t e r d a p a t

s e b a n y a k 2 5 o r a n g

y a i t u ( 1 2 7 ) D a r i 2 5

o r a n g y a n g m e n d e r i t a

I S K t e r d a p a t 3 o r a n g

y a i t u ( 1 2 0 ) y a n g

d i r a w a t i n a p d a n 2 2

6

o r a n g ( 8 8 0 ) y a n g

d i r a w a t j a l a n

Edel Weisela P e r b e d a a n R i s i k o

Permata I n f e k s i N o s o k o m i a l

Sari dan S a i u r a n K e m i h

Prijono B e r d a s a r k a n

Satyabakti K a i e t e r i s a s i U r i n

U m u r D a n D i a b e t e s

M e l i t u s T a h u n 2 0 1 5

Case H a s i l p e n e l i t i a n y a n g

control d i 1 a k u k a n p a d a 2 0

s a m p e l k a s u s d a n

k o n t r o l m e n u n j u k k a n

b a h w a p a s i e n d e n g a n

u m u r gt 5 5 t a h u n

m e m p u n y a i r i s i k o

5 5 7 k a l i m e n g a l a m i

i n f e k s i n o s o k o m i a l

s a i u r a n k e m i h

d i b a n d i n g k a n p a s i e n

d e n g a n u m u r lt 5 5

t a h u n d e n g a n

p e r i l i t u n g a i i b e s a r

risiko d i p e r o l e h n i l a i

O R s e b e s a r 5 5 7

d e n g a n n i l a i 9 5

(onfidence Interval

l 1 9 lt O R lt 2 8 2 3

P a s i e n d e n g a n s t a t u s

D M m e m p u n y a i risiko

6 k a l i u n t u k

m e n g a l a m i i n f e k s i

n o s o k o m i a l s a i u r a n

k e m i h d i b a n d i n g k a n

d e n g a n p a s i e n y a n g

t i d a k m e n d e r i t a D M

d e n g a n n i l a i O R

7

s e b e s a r 6 0 0 d e n g a n

n i l a i 9 5 Confidence

Interval 1 22 lt O R lt

3 2 2 6

Andry K a r a k t e r i s t i k P a s i e n - D e s k r i p k i f H a s i i p e n e l i t i a n d a r i

Lukandy P a s i e n I n f e k s i S a i u r a n r e t r o s p e k t i f 4 3 o r a n g p e n d e r i t a

K e m i i i d i P o l i u r o l o g i

R S U D D r P i m g a d i

K o t a M e d a n T a h u n

2 0 1 2 - 2 0 1 3

I S K d i d a p a t k a n 5 3 5

p a d a k e l o m p o k u s i a

gt 5 0 t a h u n 5 1 2

b e i j e n i s k e i a m i n l a k i -

l a k i 1 0 0 t i d a k

m e n d e r i t a

v e s i c o u r e t r a l r e f l u x

7 0 Benign Prostatic

Hyperplasia 1 1 6

b a t u s a i u r a n k e m i h

2 7 9 d i a b e t e s t i p e 2

D a r i h a s i l p e n e l i t i a n

i n i d a p a t d i s i m p u l k a n

b a h w a p e n d e r i t a i S K

l e b i h b a n y a k t e r j a d i

p a d a l a k i - l a k i d a n

p e n d e r i t a I S K l e b i h

b a n y a k d i j u m p a i p a d a

k e l o m p o k u m u r gt 5 0

t a h u n s e r t a d i t e m u k a n

I S K d e n g a n B P H

B S K d a n D M T i p e 2

BAB 11

TINJAUAN PUSTAKA

21 Landasan Teori

211Infeksi Saiuran Keniih

A Definisi

I n f e k s i S a i u r a n K e m i h a d a i a h i n v a s i d a n m u l t i p l i k a s i m i k r o o r g a n i s m e a t a u

p a r a s i t d a l a m j a r i n g a n t u b u h k h u s u s n y a s a i u r a n k e m i h y a n g t e r d i r i d a r i g i n j a l

u r e t e r b u l i - b u l i d a n u r e t r a y a n g d i i a n d a i d e n g a n a d a n y a b a k t e r i 1 0 c f i i (colony

forming unit) p e r m l p a d a p e n g a m b i l a n c o n t o h u r i n ( P u m o m o 2 0 1 1 )

I n f e k s i s a i u r a n k e m i h a d a l a l i s u a t u i n f e k s i y a n g m e l i b a t k a n g i n j a l lU e ter

b u l i - b u l i a t a u p u n u r e t r a I n f e k s i s a i u r a n k e m i h ( I S K ) a d a l a l i i s t i l a h u m u m y a n g

m e n u n j u k k a n k e b e r a d a a n m i k r o o r g a n i s m e d a l a m u r i n ( S u d o y o 2 0 0 6 )

B a k t e r i u r i a b e r m a k n a (significant hacteriuria) a d a i a h s u a t u k e a d a a n y a n g

m e n u n j u k k a n p e n u m b u l i a n m i k r o o r g a n i s m e m u m i l e b i h d a r i 1 0 c f t L m l p a d a

b i a k a n u r i n B a k t e r i u r i a b e r m a k n a m u n g k i n t a n p a d i s e r t a i p r e s e n t a s i k l i n i s I S K

d a n d i n a m a k a n b a k t e r i u r i a a s i m t o m a t i k (convert hacteriuria) S e b a l i k n y a

b a k t e r i u r i a b e n n a k n a d i s e r t a i p e r s e n t a s i k l i n i s I S K d i n a m a k a n b a k t e r i u r i a

s i m t o m a t i k P a d a b e b e r a p a k e a d a a n t e r d a p a t p a s i e n d e n g a n p e r s e n t a s i k l i n i s I S K

n a m u n t a n p a b a k t e r i u r i a b e n n a k n a S e l a i n i t u d i k a t a k a n p i u r i a ( l e u k o s i t d a l a m

u r i n ) b e n n a k n a (significant pyuria) b i l a d i t e m u k a n n e u t r o f i l gt 1 0 s e l p e r l a p a n g a n

p a n d a n g ( S u d o y o 2 0 0 6 )

B Epidemiologi

I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m u k a n d i p r a k t i k u m u m w a i a u p u n b e n n a c a m - m a c a m a n t i b i o t i k a s u d a h

t e r s e d i a l u a s d i p a s a r a n D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r

2 5 - 3 5 s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a

S e l a m a p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n

9

10

c e n d e r u n g m e n d e r i t a i S K d i b a n d i n g k a n l a k i - l a k i I S K b e m l a n g p a d a l a k i - l a k i

j a r a n g d i l a p o r k a n k e c u a l i d i s e r t a i f a k t o r p r e d i s p o s i s i ( p e n c e t u s )

P r e v a l e n s i b a k t e r i u r i a a s i m t o m a t i k l e b i h s e r i n g d i t e m u k a n p a d a p e r e m p u a n

P r e v a l e n s i s e l a m a p e r i o d e s e k o l a h (school girls) 1 m e n i n g k a t m e n j a d i 5

s e l a m a p e r i o d e a k t i f s e c a r a s e k s u a l P r e v a l e n s i i n f e k s i a s i m t o m a t i k m e n i n g k a t

m e n c a p a i 3 0 b a i k l a k i - l a k i m a u p u n p e r e m p u a n b i l a d i s e r t a i f a k t o r p r e d i s p o s i s i

( S u d o y o 2 0 0 6 )

C Kiasifikasi

I n f e k s i s a i u r a n k e m i h d a p a t d i b a g i m e n j a d i d u a k a t e g o r i u m u m b e r d a s a r k a n

l o k a s i a n a t o m i y a i t u

1 ) I n f e k s i s a i u r a n k e m i h b a w a h

2 ) I n f e k s i s a i u r a n k e m i h a l a s

P r e s e n t a s i k l i n i s d a r i i n f e k s i s a i u r a n k e m i h b a w a l i t e r g a n t u n g d a r i gender

y a i t u

a ) P e r e m p u a n

a S i s t i t i s

S i s t i t i s a d a i a h p r e s e n t a s i k l i n i s i n f e k s i k a n d u n g k e m i h d i s e r t a i

b a k t e r i u r i a b e n n a k n a

b S i n d r o m U r e t r a A k u t ( S U A )

S i n d r o m a u r e t r a a k u t a d a i a h p r e s e n t a s i k l i n i s s i s t i t i s t a n p a d i t e m u k a n

a d a n y a m i k r o o r g a n i s m e d a l a m L u i n ( s t e r i l ) d a n s e r i n g d i n a m a k a n

s i s t i t i s b a k t e r i a l i s

b ) L a k i - l a k i

P r e s e n t a s i k l i n i s i n f e k s i s a i u r a n k e m i h p a d a l a k i - l a k i m u n g k i n s i s t i t i s

p r o s t a t i t i s e p i d i m i d i s d a n u r e t r i t i s

I n f e k s i s a i u r a n k e m i h a t a s t e r b a g i m e n j a d i 2 y a i t u

1 ) P i e l o n e f r i t i s A k u t ( P N A )

P i e l o n e f r i t i s a k u t a d a l a l i p r o s e s i n f l a m a s i p a r e n k i m g i n j a l y a n g d i s e b a b k a n

o l e h m f e k s i b a k t e r i

11

2 ) P i e l o n e f r i t i s K r o n i s ( P N K )

P i e l o n e f r i t i s k r o n i s m u n g k i n a k i b a t l a n j u t d a r i i n f e k s i b a k t e r i

b e r k e p a n j a n g a n a t a u i n f e k s i s e j a k m a s a k e c i i O b s t r u k s i s a i u r a n k e m i h d a n

r e f l u k s v e s i k o u r e t e r d e n g a n a t a u t a n p a b a k t e r i u r i a k r o n i k s e r i n g d i i k u t i

p e m b e n t u k a n j a r i n g a n i k a t p a r e n k i m g i n j a l y a n g d i t a n d a i d e n g a n

p i e l o n e f r i t i s k r o n i k y a n g s p e s i f i k ( S u d o y o 2 0 0 6 )

D Etiologi

P a d a k e a d a a n n o r m a l u r i n b e r s i f a t s t e r i l U m u m n y a I S K d i s e b a b k a n o l e h

k i i m a n g r a m n e g a t i f E s c h e r i c h i a c o l i m e m p a k a n p e n y e b a b t e r b a n y a k b a i k p a d a

y a n g s i m t o m a t i k m a u p u n y a n g a s i m t o m a t i k y a i t u 7 0 - 9 0 E n t e r o b a k t e r i a s e p e r t i

P r o t e u s m i r a b i l i s ( 3 0 d a r i i n f e k s i s a i u r a n k e m i h p a d a a n a k l a k i - l a k i t e t a p i

k u r a n g d a r i 5 p a d a a n a k p e r e m p u a n ) K l e b s i e l l a p n e u m o n i a d a n P s e u d o m o n a s

a e m g i n o s a d a p a t j u g a s e b a g a i p e n y e b a b O r g a n i s m e g r a m p o s i t i f s e p e r t i

S t r e p t o c o c c u s f a e c a l i s ( e n t e r o k o k u s ) S t a p h y l o c o c c u s e p i d e n n i d i s d a n

S t r e p t o c o c c u s v i r i d a n s j a r a n g d i t e m u k a n P a d a u r o p a t i o b s t m k t i f d a n k e l a i n a n

s t r u k t u r s a i u r a n k e m i h p a d a a n a k l a k i - l a k i s e r i n g d i t e m u k a n P r o t e u s s p e c i e s P a d a

I S K n o s o k o m i a l a t a u I S K k o m p l e k s l e b i h s e r i n g d i t e m u k a n k u m a n P r o t e u s d a n

P s e u d o m o n a s ( L u m b a n b a t u S M 2 0 0 3 )

E Patofisiologi

P a d a i n d i v i d u n o n n a l b i a s a n y a u r i n l a k i - l a k i m a u p u n p e r e m p u a n s e l a l u

d a l a m k e a d a a n s t e r i l k a r e n a d i p e r t a l i a n k a n o l e h j u m l a l i d a n f r e k u e n s i b e r k e m i h

U t e r o d i s t a l m e m p a k a n t e m p a t k o l o n i s a s i m i k r o o r g a n i s m e nonpathogenic

fastidious G r a m - p o s i t i f d a n g r a m n e g a t i f ( S u d o y o 2 0 0 6 )

H a m p i r s e m u a I S K d i s e b a b k a n i n v a s i m i k r o o r g a n i s m e ascending d a r i u r e t r a

k e d a l a m k a n d u n g k e m i b P a d a b e b e r a p a p a s i e n t e r t e n t u i n v a s i m i k r o o r g a n i s m e

d a p a t m e n c a p a i k e g i n j a l P r o s e s i n i d i p e n n u d a h o l e h k o n d i s i r e f l u k s

v e s i k o i i r e t e r a l P r o s e s i n v a s i m i k r o o r g a n i s m e h e m a t o g e n s a n g a t j a r a n g d i t e m u k a n

d i k l i n i k m u n g k i t a k i b a t l a n j u t d a r i b a k t e r e m i a G i n j a l d i d u g a m e n i p a k a n l o k a s i

12

i n f e k s i s e b a g a i a k i b a t l a n j u t d a r i s e p t i k e m i a a t a u e n d o k a r d i t i s a k i b a t S t a f i l o k o k u s

a u r e u s K e l a i n a n g i n j a l y a n g t e r k a i t d e n g a n e n d o k a r d i t i s ( S t a f i l o k k o k u s a u r e u s )

d i k e n a l d e n g a n N e p h r i t i s L o h e i n B e b e r a p a p e n e l i t i a n m e l a p o r k a n p i e l o n e f r i t i s

a k u t ( P N A ) s e b a g a i a k i b a t l a n j u t i n v a s i h e m a t o g e n ( S u d o y o 2 0 0 6 )

F Faktor Risiko

P a t o f i s i o l o g i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h d a p a t d i p e n g a n i h i o l e h

b e b e r a p a f a k t o r A d a p u n b e b e r a p a f a k t o r risiko y a n g m e m p e n g a n i l i i t e r j a d i n y a

i n f e k s i s a i u r a n k e m i h a n t a r a l a i n

1 ) U s i a

I n s i d e n I S K m e n i n g k a t b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i

m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n a d a n y a a b n o r m a l i t a s a n a t o m i y a n g

m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n k e m i h s e p e r t i p e m b e s a r a n p r o s t a t

d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e

P e n y e b a b l a i n t e r m a s u k p e r i n e u m y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s

p e n y a k i t n e u r o m u s k n l a r d a n k a t e t e r i s a s i b u l i - b u l i S e l a i n i t u i n s i d e n I S K

m e n c a p a i 1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o s e 2 0 0 9 F o x m a n e t a l 2 0 1 0

R o n a l d 2 0 1 1 )

M e n u m t t e o r i y a n g d i k e m u k a k a n o l e h S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a d a u s i a

l a n j u t a k a n t e r j a d i p e n i n g k a t a n k e r e n t a n a n t e r h a d a p p e n y a k i t P a d a u s i a d i a t a s 5 0

t a l i u n t e r j a d i p e n u m n a n k e m a m p u a n d a l a m m e m p e r t a h a n k a n s t e n l i t a s b a i k p a d a

k a n d u n g k e m i h m a u p u n u r e t r a H a l t e r s e b u t d i s e b a b k a n o l e h i n v o l u s i t i m u s

I n v o l u s i s e l t i m u s m e n y e b a b k a n j u m l a h se d a n k u a l i t a s r e s p o n s s e l T s e m a k i n

b e r k u r a n g J u m l a h s e l T m e m o r i m e n i n g k a t n a m u n s e m a k i n s u l i t u n t u k

b e r k e m b a n g t e r u t a m a s i t o t o k s i k s e l T ( C D ^ ) d a n s e l T h l ( C D ^ ^ ) k a r e n a t e r j a d i

a p o p t o s i s S i t o t o k s i k s e l T ( C D ^ ^ ) b e i p e r a n d a l a m r e s p o n s i m u n t e r h a d a p a n t i g e n

p a d a s e l y a n g d i i n f e k s i d e n g a n c a r a m e m b u n u l i s e l y a n g t e r i n f e k s i u n t u k

m e n c e g a h p e n y e b a r a n m f e k s i s e d a n g k a n s e l T h l ( C D ^ ^ ) b e r p e r a n m e m b a n t u s e l

B u n t u k m e m p r o d u k s i a n t i b o d i

13

2 ) J e n i s k e l a m m d a n a k t i v i t a s s e k s u a l

I n s i d e n s i I S K y a n g r e n d a h p a d a p r i a d i p e n g a n i h i o l e h 3 f a k t o r y a i t u

1 L e b i h s e d i k i t t e r j a d i k o l o n i s a s i s e k i t a r u r e t r a k a r e n a t i d a k a d a n y a t e m p a t

s e p e r t i v a g i n a p a d a p e r e m p u a n

2 M e m i l i k i u r e t r a y a n g p a n j a n g

3 A d a n y a s u b s t a n s i a n t i b a k t e r i a l p a d a c a i r a n p r o s t a t

U r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a h d e n g a n d e k a t n y a v a g i n a l

v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h l e b i h s e r i n g

p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a f l o r a n o n n a l p a d a d a e r a l i p e r i u r e t r a t e r d i r i

d a r i o r g a n i s m e s e p e r t i l a c t o b a c i l l i i s y a n g m e m b a n t u m e l a w a n k o l o n i s a s i b a k t e r i

p a t o g e n p a d a s a i u r a n k e m i h P e r u b a l i a n l i n g k i m g a n d a r i p e r i u r e t r a l s e p e r t i

p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k b i s a m e n g g a n g g u f l o r a

n o r m a l s e h i n g g a m e m u n g k i n k a n b a k t e r i p a t o g e n b e r k o l o n i s a s i d a n m e n y e b a b k a n

i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

P a d a w a n i t a l e b i h d a r i 5 0 t a h u n a t a u l e b i h m e n o p a u s e m e m p a k a n f a k t o r

l a i n y a n g m e n i n g k a t k a n P V R Post Void Residual) s e l a i n p e n u r u n a n k o i i t r a k t i i i t a s

o t o t d e t r u s o r P e n u m n a n e s t r o g e n y a n g d i s e b a b k a n m e n o p a u s e d a p a t

m e n i n g k a t k a n p H v a g i n a l d a n m e n u m n k a n j u m l a l i l a c t o b a c i l l i A k i b a m y a t e r j a d i

p e n i n g k a t k a n k o l o n i s a s i d a r i b a s i l g r a m n e g a t i f s e h i n g g a m e n i n g k a t k a n r e s i k o

t e r j a d i n y a I S K P a d a p r i a p r o s t a t m e n s e k r e s i k a n c a i r a n y a n g m e n g a n d i m g z i n k

y a n g m e m i l i k i a k t i f i t a s m i k r o b i a l ( K i m 2 0 1 2 )

S e l a i n i t u p i j a t a n u r e t r a s e p e r t i y a n g t e r j a d i s e l a m a h u b u n g a n s e k s u a l

m e n y e b a b k a n m a s u k n y a b a k t e r i k e d a l a m k a n d u n g k e m i h d a n m e m p a k a n h a l

y a n g p e n t i n g d a l a m p a t o g e n e s i s m f e k s i s a l i u a n k e m i h p a d a p e r e m p u a n m u d a

B u a n g a i r k e c i l s e t e l a h h u b u n g a n s e k s u a l t e r b u k t i m e n u m n k a n risiko s i s t i t i s

m u n g k i n k a r e n a t i n d a k a n i n i m e n i n g k a t k a n e r a d i k a s i b a k t e r i y a n g m a s u k s e l a m a

h u b u n g a n s e k s u a l ( K i m 2 0 1 2 )

3 ) T i n g k a t P e n d i d i k a n

P e n g e t a h u a n s e s e o r a n g t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t

p e n d i d i k a n S e s e o r a n g y a n g m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m i u i g k i n a n

p e n g e t a h u a n t e n t a n g k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o n n a s i y a n g d i d a p a t k a n

14

t e n t a n g k e s e h a t a n l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h

S e b a l i k n y a p e n d i d i k a n y a n g k u r a n g d a p a t m e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g

t e r h a d a p n i l a i - n i l a i y a n g b a n i d i k e n a l ( N o t o a d i n o j o 2 0 0 3 )

4 ) R i w a y a t D i a b e t e s M e l i t u s

M e n u r u t S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a s i e n d e n g a n s t a t u s D M s a n g a t

b e r i s i k o u n t u k m e n g a l a m i i n f e k s i s a i u r a n k e m i h A b n o n n a l i i a s s t n i k t u r d a n

k a n d u n g k e m i h n e u r o g e n i k a k i b a t n e u r o p a t i o t o n o m a t a u s t r o k e p a d a p a s i e n D M

m e n y e b a b k a n p e n g o s o n g a n k a n d u n g k e m i h t i d a k n o n n a l D M j u g a d a p a t

m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a h a n a n t u b u h y a n g b e r p o t e n s i m e n i n g k a t

risiko t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a h a n a n t u b u h t e r s e b u t d i a n t a r a n y a

a d a i a h k e g a g a l a n m i g r a s i s e l intracellular killing f a g o s i t o s i s d a n k e m o t a k s i s

p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n m e k a n i s m e p e r t a h a n a n

a l a m i a h i o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p i n f e k s i

5 ) K e h a m i i a n

K e c e n d e r u n g a n i n f e k s i s a i u r a n k e m i h b a g i a n a t a s s e l a m a k e h a m i i a n

d i s e b a b k a n o l e h p e n u m n a n k e k u a t a n u r e t e r p e n u m n a n p e r i s t a l t i k u r e t e r d a n

i n k o m p e t e n s i s e m e n t a r a k a l u p v e s i k o i u - e t e r a l y a n g t e r j a d i s e l a m a h a m i l

6 ) S u m b a t a i i

A d a n y a I i a i a n g a n a l i r a n b e b a s u r i n s e p e r t i t u m o r s t r i k t r a a b a t u a t a u

h i p e r t r o f i p r o s t a t d a p a t m e n y e b a b k a n h i d r o n e f r o s i s d a n risiko i n f e k s i s a i u r a n

k e m i l i y a n g s a n g a t t i n g g i S e l a i n i t u s u p e r i n f e k s i p a d a s u m b a t a n s a i u r a n k e m i h

d a p a t m e n y e b a b k a n k e m s a k a n j a r i n g a n g i n j a l y a n g c e p a t

7 ) D i s f u n g s i n e u r o g e n i k k a n d u n g k e m i h

G a n g g u a n s a r a f y a n g b e k e r j a p a d a k a n d m i g k e m i h s e p e r t i p a d a j e j a s k o r d a

s p i n a l i s t a b e s d o r s a i i s m u l t i p e l s k l e r o s i s d i a b e t e s m e l i t u s a t a u p e n y a k i t l a i n

d a p a t b e r h u b u n g a n d e n g a n i n f e k s i s a i u r a n k e m i h I n f e k s i d a p a t d i a w a l i o l e h

p e n g g u n a a n k a t e l e r u n t u k d r a i n a s e k a n d i u i g k e m i h d a n d i d u k i m g o l e h s t a t i s u r i n

d a l a m k a n d u n g k e m i l i u n t u k j a n g k a w a k t u y a n g l a m a

8 ) R e f l u k s v e s i k o m e t e r a

K e a d a a n i n i d i d e f i n i s i k a n s e b a g a i r e f l u k s u r i n d a r i k a n d u n g k e m i b k e u r e t e r

d a n k a d a n g s a m p a i k e p e l v i s r e n a l H a l i n i t e r j a d i s e l a m a b u a n g a i r k e c i l a t a u

15

d e n g a n p e n i n g k a t a n t e k a n a n p a d a k a n d u n g k e m i h R e f l u k s v e s i k o i i r e t e r a l d a p a t

d i b u k t i k a n d e n g a n a d a n y a g c r a k a n r e t r o g r a d z a t r a d i o o p a k a t a u r a d i o a k t i f m e l a l u i

s i s t o u r e t r o g r a m s e l a m a b u a n g a i r k e c i l R e f l u k s v e s i k o i i r e t e r a l b i a s a n y a

d i s e b a b k a n k a r e n a a d a n y a g a n g g u a n a n a t o m i s p a d a p e r t e m u a n v e s i k o i i r e t e r a l

y a n g d a p a t m e n y e b a b k a n r e f l u k s u r i n d i s e r t a i b a k t e r i d a n k a r e n a i t u t e r j a d i l a h

i n f e k s i s a l r a a n k e m i h

9 ) F a k t o r v i r u l e n s i b a k t e r i

F a k t o r v i r u l e n s i b a k t e r i m e m p e n g a r u b i k e m u n g k i n a n vragt7 t e r t e n m d a l a m

m e n y e b a b k a n i n f e k s i t r a k i u s u r i n a r i u s H a m p i r s e m u a strain F c o l i y a n g

m e n y e b a b k a n p i e l o n e f r i t i s p a d a p a s i e n d e n g a n t r a k i u s u r i n a r i u s n o m i a l s e c a r a

a n a t o m i k m e m p u n y a i p i l u s t e r t e n t u y a n g m e m p e r a n t a r a i p e r l e k a t a n p a d a b a g i a n

d i g a k t o s i d a d a n g l i k o s f i n g o l i p i d y a n g a d a d i u r o e p i t e l Strain y a n g m e n i m b u l k a n

p i e l o n e f r i t i s j u g a b i a s a n y a m e m p a k a n p e n g b a s i l h e m o l i s i n m e m p u n y a i

a e r o b a k t i n d a n r e s i s t e n t e r h a d a p k e r j a b a k t e r i s i d a l d a r i s e m m m a n u s i a

1 0 ) F a k t o r g e n e t i k

F a k t o r g e n e t i k p e n j a m u m e m p e n g a n i l i i k e r e n t a n a n t e r h a d a p i n f e k s i t r a k t u s

u r i n a r i u s J u m l a h d a n t i p e r e s e p t o r p a d a s e l u r o e p i t e l t e m p a t b a k t e r i d a p a t

m e n e m p e l s e l i d a k i i y a s e b a g i a i i d i t e n t u k a r i s e c a r a g e n e t i k ( I s s e l b a c h e r 2 0 0 9 )

G Manifestasi Klinis

G e j a l a k l i n i s d a r i i n f e k s i s a i u r a n k e m i h s e s u a i d e n g a n b a g i a n s a i u r a n k e m i h

y a n g t e r i n f e k s i a d a i a h s e b a g a i b e r i k u t

1 ) I n f e k s i s a i u r a n k e m i h b a g i a n b a w a l i

K e l u h a n p a s i e n b i a s a n y a b e m p a r a s a s a k i t a t a u r a s a p a n a s d i u r e t r a s e w a k t u

k e n c i n g d e n g a n a i r k e m i h s e d i k i t - s e d i k i t s e r t a r a s a t i d a k e n a k d i d a e r a h

s i i p r a p u b i k

2 ) I n f e k s i s a i u r a n k e m i h b a g i a n a t a s

P a d a i n t e k s i s a i u r a n k e m i h b a g i a n a t a s d a p a t d i t e m u k a n g e j a l a s e p e r t i s a k i t

k e p a l a m a l a i s e m u a l m m i t a h d e n i a m m e n g g i g i l r a s a t i d a k e n a k a t a u

n y e r i d i p i n g g a n g ( T e s s y d k k 2 0 0 1 )

16

H Tatalaksana

T u j u a n p e n a t a l a k s a n a a a n i n f e k s i s a i u r a n k e m i h a d a i a h m e n c e g a h d a n

m e n g h i l a n g k a n g e j a l a m e n c e g a h d a n m e n g o b a t i b a k t e n e m i a d a n b a k t e r i u r i a s e r t a

m e n c e g a h d a n m e n g u r a n g i r i s i k o k e r u s a k a n g i n j a l y a n g m u n g k i n t i m b u l d e n g a n

p e m b e r i a n o b a t - o b a t a n y a n g s e n s i t i f m u r a l i d a n a m a n d e n g a n e f e k s a m p i n g y a n g

m i n i m a l

a ) i n f e k s i s a i u r a n k e m i h ( I S K ) b a w a h

P r i n s i p p e n a t a l a k s a n a a n I S K b a w a h m e l i p u t i intake c a i r a n y a n g b a n y a k

a n t i b i o t i k y a n g a d e k u a t d a n b i l a p e r l u t e r a p i s i m t o m a t i k u n t u k a l k a l i s a s i

u r i n

i H a m p i r 8 0 p a s i e n a k a n m e m b e r i k a n r e s p o n s e t e l a h 4 8 j a m d e n g a n

a n t i b i o t i k a t u n g g a l s e p e r t i a m p i s i l i n 3 g r a m a t a u t r i m e t o p r i m 2 0 0 m g

i i B i l a i n f e k s i m e n e t a p d i s e r t a i k e l a i n a n u r i n a l i s i s ( l e u k o s i u i a ) d i p e r i u k a n

t e r a p i k o n v e n s i o n a l s e l a m a 5 - 1 0 h a r i

i i i P e m e r i k s a a n m i k r o s k o p i s u r i n d a n b i a k a n u r i n t i d a k d i p e r i u k a n b i l a

s e m u a g e j a l a h i l a n g d a n t a n p a l e u k o s u r i a

b ) I n f e k s i s a i u r a n k e m i h ( I S K ) a t a s

P a d a u m u m n y a p a s i e n d e n g a n p i e l o n e f r i t i s a k u t m e m e r l u k a n r a w a t i n a p

u n t u k m e m e l i h a r a s t a t u s h i d r a s i d a n t e r a p i a n t i b i o t i k a p a r e n t e r a l p a l i n g

s e d i k i t 4 8 j a m ( S u d o y o 2 0 0 6 )

i Komplikasi

K o m p l i k a s i i n f e k s i s a i u r a n k e m i h t e r g a n t u n g d a r i t i p e y a i t u i n f e k s i s a i u r a n

k e m i h t i p e s e d e r h a n a (uncomplicated) d a n t i p e b e r k o m p l i k a s i (complicated)

1 ) I n f e k s i s a i u r a n k e m i h s e d e r h a n a (uncomplicated)

I n f e k s i s a i u r a n k e m i h a k u t t i p e s e d e r h a n a ( s i s t i t i s ) y a i t u n o n - o b s t r u k s i d a n

b u k a n p e r e m p u a n h a m i l m e m p a k a n p e n y a k i t r i n g a n (self limited disiase)

d a n t i d a k m e n y e b a b k a n a k i b a t l a n j u t j a n g k a l a m a

2 ) I n f e k s i s a i u r a n k e m i h b e r k o m p l i k a s i (complicated)

a ) I n f e k s i s a i u r a n k e m i h s e l a m a k e h a m i i a n

b ) i n f e k s i s a i u r a n k e m i h p a d a d i a b e t e s m e l i t u s ( S u d o y o 2 0 0 6 )

17

22 Kerangka Teori

J

U s i a

J e n i s K e i a m i n

T i n g k a t P e n d i d i k a n

R i w a y a t D i a b e t e s M e l i m s

S u m b a t a n bullT

K e h a m i i a n

D i s f u n g s i n e u r o g e n i k

R e f l u k s v e s i k o i i r e t e r a l

V i r u l e n s i b a k t e r i

F a k t o r g e n e t i k

I n f e k s i b a k t e r i g r a m p o s i t i f a t a u n e g a t i v e p a d a s a i u r a n k e m i h

I n f e k s i S a i u r a n K e m i h

Keterangan

I j = V a r i a b e l y a n g t i d a k d i t e l i t i

= V a r i a b e l y a n g d i t e l i t i

18

Hipotesis

H i p o t e s i s d a l a m p e n e l i t i a n i n i a d a i a h

H O t i d a k t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n

t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

H I t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

BAB 111

M E T O D E PENELITIAN

31 Jenis Penelitian

P a d a p e n e l i t i a n i n i j e n i s p e n e l i t i a n y a n g d i g u n a k a n a d a i a h p e n e l i t i a n

o b s e r v a s i o n a i a n a l i t i k d e s a i n cross scclional d e n g a n m e n g g u n a k a n d a t a s e k u n d e r

d a r i r e k a m m e d i s p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1 D e s e m b e r

2 0 1 5

32 Waktu dan Tempat Penelitian

321 Waktu Penelitian

W a k t u p e n e l i t i a n d i l a k s a n a k a n p a d a t a n g g a l 1 O k t o b e r s a m p a i d e n g a n 3 0

O k t o b e r 2 0 1 6

322 Tempat Penelitian

P e n e l i t i a n i n i d i l a k s a n a k a n d i R u m a l i S a k i t M u h a m m a d i y a h P a e m b a n g ( d i

R u a n g R e k a m M e d i s )

33 Populasi dan Sampel Penelitian

331Populasi Penelitian

P a d a p e n e l i t i a n i n i p o p u l a s i t a r g e t a d a l a l i p a s i e n r a w a t i n a p d a n r a w a t j a l a n

d i R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g s e d a n g k a n p o p u l a s i t e r j a n g k a u n y a

a d a i a h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

332Sampel dan Besar Sampel Penelitian

P a d a p e n e l i t i a n i n i s a m p e l p e n e l i t i a n a d a i a h p a s i e n r a w a t i n a p d a n r a w a t

j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e

1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 y a n g m e m e n u h i k r i t e r i a i n k l u s i p e n e l i t i a n

1 9

20

d e n g a n b e s a r s a m p e l y a n g l a y a k d a l a m p e n e l i t i a n m e n u r u t t e o r i R o s c o e a d a i a h

a n t a r a t i g a p u l u h s a m p a i l i m a r a t i i s o r a n g ( S u g i y o n o 2 0 1 5 )

333 Krttena Inklusi dan Eksklusi

A Kriteria Inklusi

P a d a p e n e l i t i a n i n i k r i t e r i a i n k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t i n a p

d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i

P a l e m b a n g y a n g d i d i a g n o s a m e n g a l a m i i n f e k s i s a i u r a n k e m i h s e r t a m e m i l i k i d a t a

r e k a m m e d i s p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

B Kriteria Eksklusi

P a d a p e n e l i t i a n i n i k r i t e r i a e k s k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t

i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 d e n g a n d a t a r e k a m m e d i s

y a n g t i d a k l e n g k a p

334 Cara Pengambilan Sampel Penelitian

C a r a p e n g a m b i l a n s a m p e l y a n g d i g u n a k a n d a l a m p e n e l i t i a n i n i a d a l a l i

m e n g g u n a k a n t e k n i k consecutive sampling P a d a consecutive sampling s e t i a p

p a s i e n y a n g m e m e n u h i k r i t e r i a p e n e l i t i a n d i m a s u k k a n d a l a m p e n e l i t i a n s a m p a i

k u r u n w a k t u t e r t e n U i s e h i n g g a j u m l a h m i n i m a l y a n g d i p e r i u k a n t e r p e n u h i

( S a s t r o a s m o r o 2 0 1 1 )

34 Variabel Penelitian

341 Variabel Dependent

V a r i a b e l dependent f t e r i k a t ) d a l a m p e n e l i t i a n i n i a d a i a h i n f e k s i s a i u r a n

k e m i h

342 Variabel Independent

V a r i a b e l independent ( b e b a s ) d a l a m p e n e l i t i a n i n i a d a i a h u s i a j e n i s

k e l a i n i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

21

35 Definisi Operasional

Tabel 31 Definisi Operasional

Variabel Alat Cara ueiinisi rldsil L KUr I7 i l l 11 Lz fe 1 V

oKaia LiKur Penelitian Ukur Ukur

Infeksi P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Saiuran d i d i a g n o s a o l e h m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Keniih d o k t e r m e n g a l a m i m e d i s

i n f e k s i s a i u r a n

k e m i h d a n t e r c a n t u m

d i r e k a m m e d i s

U s i a L a m a n y a t a h u n R e k a m O b s e r v a s i 1 lt 5 0 t a h u n O r d i n a l

k e h i d u p a n p a s i e n m e d i s r e k a m 2 gt 5 0 t a l i u n ( k a t e g o r i k )

d a r i l a h i r s a m p a i m e d i s

s e k a r a n g d a n

t e r c a n t u m d i r e k a m

m e d i s

Jenis P r o f i l a n a t o m i a t a u R e k a m O b s e r v a s i 1- L a k i - l a k i N o m i n a l

Keiamin b i o l o g i s p a s i e n y a n g m e d i s r e k a m 2 P e r e m p u a n ( k a t e g o r i k )

d i b e d a k a n m e n j a d i m e d i s

i a k i - l a k i d a n

n e r e m m i a n s e r t a

t e r c a n t u m d i r e k a m

m e d i s

Tingkat P e n d i d i k a n f o n n a l R e k a m O b s e r v a s i 1 P e n d i d i k a n O r d i n a l

Pendidikan t e r a k h i r y a n g m e d i s r e k a m d a s a r ( S D ( k a t e g o r i k )

d i t e m p u h o l e h m e d i s M I S M P

p a s i e n d a n t e r c a n t u m d a n M T s )

d i r e k a m m e d i s 2 P e n d i d i k a n

m e n e n g a l i

d a n t i n g g i

22

( S M A M A

S M K

M A K

d i p l o m a

s a r j a n a

m a g i St e r

s p e s i a l i s

d a n d o k t o r )

Riwayat P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Diabetes d i d i a g n o s i s d e n g a n m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Melitus d i a b e t e s m e l i t u s d a n

t e r c a n t u m d i d a l a m

r e k a m m e d i s

m e d i s

36 Cara Pengumpulan Data

361 Data Sekunder

P e n g u m p u l a n d a t a p a d a p e n e l i t i a n i n i d i p e r o l e h d a r i d a t a s e k u n d e r y a i t u

r e k a m m e d i s p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

37 Metode Teknik Analisis Data

371Cara Pengolahan dan Analisis Data

P e n g o l a h a n d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n m e l a l u i e m p a t t a h a p y a i t u

i Oala Entry

P a d a t a i i a p i n i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n riwayat d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g y a n g t e l a h d i d a p a t d a n

r e k a m m e d i s d i k u m p u l k a n d a n d i m a s u k k a n k e d a l a m p r o g r a m spss

23

2 Editing

P a d a t a h a p i n i d a t a i i s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n y a n g t e l a h d i m a s u k k a n k e d a l a m p r o g r a m s p s s

d i p e r i k s a k e m b a l i a p a k a h s u d a h l e n g k a p d a n t i d a k a d a k e k e l i r u a n

3 ( oding

S e t e l a h m e l a l u i p r o s e s editing d a t a - d a t a t e r s e b u t d i b e r i k o d e t e r t e n t u a n t a r a

l a i n k o d e 1 u n t u k u s i a gt 5 0 t a h u n j e n i s k e i a m i n p e r e m p u a n t i n g k a t

p e n d i d i k a n d a s a r t e r d a p a t r i w a y a t d i a b e t e s m e l i t u s d a n i n f e k s i s a i u r a n

k e m i h s e d a n g k a n k o d e 2 u n t u k u s i a lt 5 0 t a h u n j e n i s k e i a m i n l a k i - l a k i

t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i t i d a k t e r d a p a t r i w a y a t d i a b e t e s

m e l i t u s d a n b u k a n i n f e k s i s a i u r a n k e m i h s e h i n g g a m e m u d a h k a n d a l a m

m e l a k u k a n a n a l i s i s d a t a

4 Tahulaling

P a d a t a h a p i n i d a t a y a n g s a m a d i k e l o m p o k k a n s e c a r a t e l i t i d a n t e r a t m

k e m u d i a n d i l i i t u n g d e n g a n m e n g g u n a k a n p r o g r a m sps s d a n d i j u m l a h k a i i

l a l u d i s a j i k a n d a l a m b e n t u k t a b e l - t a b e l

U n t u k m e n g a n a l i s i s d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n a n a l i s i s d a t a

u n i v a r i a t d a n b i v a r i a t d e n g a n m e n g g u n a k a n p r o g r a m s p s s s e b a g a i b e r i k u t

A A n a l i s i s u n i v a r i a t

A n a l i s i s u n i v a r i a t d i l a k u k a n d e n g a n c a r a m e l a k u k a n a n a l i s i s p a d a s e t i a p

v a r i a b e l h a s i l p e n e l i t i a n d e n g a n t u j u a n u n t u k m e n g e t a h u i d i s t r i b u s i p r o p o r s i p a d a

s e t i a p v a r i a b e l p e n e l i t i a n D a t a d i s a j i k a n d a l a m b e n t u k t a b e l d a n n a r a s i

B A n a l i s i s b i v a r i a t

A n a l i s i s b i v a r i a t d i l a k u k a n d e n g a n m e n g g u n a k a n u j i h i p o t e s i s chi-square

U j i h i p o t e s i s chi-square d a p a t d i g u n a k a n d e n g a n s y a r a t y a i t u lt 2 0 s e l y a n g

m e m p u n y a i n i l a i expected count k u r a n g d a r i l i m a s e h i n g g a j i k a t i d a k m e m e n u h i

s y a r a t u j i chi-square m a k a u j i y a n g d i g u n a k a n a d a i a h u] fisher ( D a h l a n 2 0 1 4 )

B a t a s k e m a k n a a n y a n g d i g u n a k a n a d a i a h a = 0 0 5 J i k a d i d a p a t k a n p value lt 0 0 5

p a d a u j i s t a t i s t i k m a k a t i d a k t e r d a p a t h u b u n g a n y a n g b e n n a k n a a n t a r a d u a

v a r i a b e l y a n g d i t e l i t i d a n H O d i t e r i m a S e d a n g k a n j i k a d i d a p a t k a n p value gt 0 0 5

24

p a d a u j i s t a t i s t i k m a k a t e r d a p a t l i u b u n g a n y a n g b e n n a k n a a n t a r a d u a v a r i a b e l

y a n g d i t e l i t i d a n H O d i t o l a k

38 Alur Penelitian

P e n e n t u a n p o p u l a s i d a n s a m p e l p e n e l i t i a n

K r i t e r i a i n k l u s i K r i t e r i a e k s k l u s i

P e n g a m b i l a n s a m p e l p e n e l i t i a n

P e n g o l a h a n d a n a n a l i s i s d a t a d e n g a n u j i chi-square

H a s i l d a n p e m b a h a s a n

K e s i m p u l a n d a n s a r a n

Gambar 31 Alur Penelitian Hubungan Usia Jenis Keiamin Tingkat Pendidikan dan Riwayat Diabetes Melitus dengan Kejadian Infeksi Saiuran Kemih pada Pasien Rawat Inap di Bagian Penyakit Dalam Rumah Sakit Muhammadiyah Palembang Periode 1 Januari 2015 sampai dengan 31 Desember 2015

BAB IV

HASIL DAN PEMBAHASAN

41 Hasil

P e n e l i t i a n i n i t e l a h d i l a k u k a n d i r u a n g r e k a m m e d i s R u m a h S a k i t

M u h a i m n a d i y a h P a l e m b a n g d a r i t a n g g a l 1 O k t o b e r 2 0 1 5 - 3 1 O k t o b e r 2 0 1 6

P e n e l i t i a n d i m u l a i d e n g a n p e n g a m b i l a n d a t a a w a l b e m p a d a t a r e k a m m e d i s

s e l u r u h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

S e l a n j u t n y a r e k a m m e d i s d i p i l i h s e s u a i d e n g a n k r i t e r i a i n k l u s i d a n e k s k l u s i u n t u k

d i j a d i k a n s a m p e l p e n e l i t i a n s a m p a i m i n i m a l b e s a r s a m p e l y a n g d i b u t u h k a n

t e r p e n u h i s e r t a d i l a k u k a n p e n e l i t i a n s e c a r a o b s e r v a s i o n a i O b s e r v a s i r e k a m m e d i s

d i l a k u k a n u n m k m e n g e t a h u i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t

d i a b e t e s m e l i t u s d a n d i a g n o s a p a s i e n

D a r i c a t a t a n r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g

d i d a p a t k a n s e b a n y a k 4 1 4 1 r e k a m m e d i s p a s i e n r a w a t i n a p d a n 1 4 5 3 r e k a m m e d i s

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 D a r i t o t a l r e k a m m e d i s

p a s i e n r a w a t i n a p d a n r a w a t j a l a n t e r s e b u t p e n e l i t i h a n y a m e n g a m b i l m i n i m a l

b e s a r s a m p e l y a n g d i b u t u h k a n y a i t u s e b a n y a k 9 8 r e k a m m e d i s u n t u k d i j a d i k a n

s a m p e l p e n e l i t i a n y a n g t e r d i r i d a r i 3 0 r e k a m m e d i s p a s i e n y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i h d a n 6 8 r e k a m m e d i s y a n g t i d a k m e n g a l a m i i n f e k s i s a i u r a n k e m i h

411 Hasil Analisis Univariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s u n i v a r i a t

a n t a r a l a i n d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p b e r d a s a r k a n u s i a d a n

j e n i s k e l a m m d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n b e r d a s a r k a n u s i a

d a n j e n i s k e i a m i n d i s t r i b u s i p r o p o r s i s a m p e l b e r d a s a r k a n k e j a d i a n m f e k s i s a i u r a n

k e m i h s e r t a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n u s i a

j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

25

26

A Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan IJsta

dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 41 Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan

Usia dan Jenis Keiamin

Paisen Rawat Inap N Persentase

Usia

1 7 - 2 5 t a h u n 678 1 6 4

2 6 - 3 5 t a h u n 952 2 3 0

3 6 - 4 5 t a l i u n 745 18 0

4 6 - 5 5 t a h u n 695 1 6 8

5 6 - 6 4 t a h u n 571 1 3 8

gt 6 4 t a h u n 500 1 2 1

U s i a r a t a - r a t a ( t a h u n j 43plusmn16543

Jenis Keiamin

P e r e m p u a n 2 6 3 8 6 3 7

L a k i - l a k i 1 5 0 3 3 6 3

Total 4141 100

B e r d a s a r k a n t a b e l 4 1 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R i u n a h S a k i t M u l i a m m a d i y a l i

P a l e m b a n g p e r i o d e J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 2 6 - 3 5 t a h u n y a i t u

s e b a n y a k 9 5 2 o r a n g ( 2 3 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 43plusmn16543 t a l i u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 2 6 3 8 o r a n g ( 6 3 7 )

27

B Distribusi Proporsi Karakteristik Pasien Rawat Jalan Berdasarkan

Usia dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 42 Distribusi Proporsi Karakteristik Pasien Rawat Jalan

Berdasarkan Usia dan Jenis Keiamin

Fasten Rawat Jalan N Persentase

Usia

1 7 - 2 5 t a h u n 9 2 6 3

2 6 - 3 5 t a l n i n 1 3 1 9 0

3 6 - 4 5 t a h u n 2 7 9 1 9 2

46-55 t a l i u n 4 2 1 2 9 0

5 6 - 6 4 t a h u n 3 1 6 2 1 7

gt 6 4 t a h u n 2 1 4 1 4 7

U s i a r a t a - r a t a ( t a h u n ) 50plusmn14120

Jenis Keiamin

P e r e m p u a n 8 9 0 6 1 3

L a k i - l a k i 5 6 3 3 8 7

Total 1453 100

B e r d a s a r k a n t a b e l 4 2 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 4 6 - 5 5 t a h u n y a i t u

s e b a n y a k 4 2 1 o r a n g ( 2 9 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 50plusmn14120 t a h u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 8 9 0 o r a n g ( 6 1 3 )

28

C Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Usia

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i b b e r d a s a r k a n u s i a d a p a t

d i i i h a t p a d a l a b e l d i b a w a h i n i

Tabel 43 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Usia

Usia N Persentase

lt 5 0 t a h u n 1 4 4 6 7

gt 5 0 t a l i u n 1 6 5 3 3

Total 30 100

B e r d a s a r k a n t a b e l 4 3 d i a t a s d a p a t d i k e t a h u i b a h w a u s i a t e r b a n y a k p a d a

s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h gt 5 0 t a h u n y a i t u s e b a n y a k

1 6 o r a n g ( 5 3 3 )

D Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Jenis

Keiamin

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n j e n i s

k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 44 Distribusi Proporsi Kejadian infeksi Saiuran Kemih Berdasarkan

Jenis Keiamin

Jenis Keiamin N Persentase

P e r e m p u a n 1 8 6 0 0

L a k i - l a k i 1 2 4 0 0

Total 30 100

B e r d a s a r k a n t a b e l 4 4 d i a t a s d a p a t d i k e t a h u i b a h w a j e n i s k e i a m i n

t e r b a n y a k p a d a s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h p e r e m p u a n

y a i t u s e b a n y a k 1 8 o r a n g ( 6 0 0 )

29

E Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n t i n g k a t

p e n d i d i k a n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 45 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

Tingkat Pendidikan N Persentase

P e n d i d i k a n d a s a r 20 6 6 7

P e n d i d i k a n m e n e n g a h d a n P e n d i d i k a n m e n e n g a h d a n 10 333

t i n g g i

Total J O 100

B e r d a s a r k a n t a b e l 4 5 d i a t a s d a p a t d i k e t a l i u i b a l i w a t i n g k a t p e n d i d i k a n

t e r b a n y a k p a d a s a m p e i y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h t i n g k a t

p e n d i d i k a n d a s a r y a i t u s e b a n y a k 20 o r a n g ( 6 6 7 )

P Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n riwayat

d i a b e t e s m e l i t u s d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 46 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

Riwayat Diabetes Melitus N Persentase

Y a 17 5 6 7

T i d a k 13 433

Total 30 100

B e r d a s a r k a n t a b e l 4 6 d i a t a s d a p a t d i k e t a h u i b a l i w a s a m p e l y a n g

m e n g a l a m i i n f e k s i s a i u r a n k e m i h t e r b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s

y a i t u s e b a n y a k 1 7 o r a n g ( 5 6 7 )

30

412 Hasil Analisis Bivariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s b i v a r i a t

a n t a r a I a i n h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h j e n i s

k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h t i n g k a t p e n d i d i k a n d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n

i n f e k s i s a l m a n k e m i h

A n a l i s i s y a n g d i g u n a k a n p a d a u j i d u a v a r i a b e l y a n g b e r s k a l a k a t e g o r i k

a d a l a l i d e n g a n u j i Chi-Square d e n g a n n i e i h a t n i l a i Pearson Chi-Square S e m u a

h a s i l d a r i u j i h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h m e n g g i u i a k a n u j i Chi-

Square k a i e n a m e m e n u h i s y a r a t u j i Chi-Square y a i t u lt 2 0 s e l y a n g m e m p u n y a i

n i l a i expected count lt 5

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 47 Hasil Uji Hubungan antara Usia dengan Kejadian Infeksi

Saiuran Kemih

Usia

Infeksi Saiuran Kemih

^a Tidak

n N Mgt

Jumlah P

value 95Cl

lt 50 t a h u n 1 4 1 9 2 5 9 8 0 8 7 3 0 0 0 0 2 7 4 7 - 2 0 4 3 1

gt 5 0 t a h u n 1 6 6 4 0 9 3 6 0 2 5

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 7 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R = 7 4 9 2

( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a u s i a gt

5 0 t a h u n a d a l a l i 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a u s i a lt 5 0 t a h u n

31

B Hubungan antara Jenis Keiamin dengan Kejadian Infeksi Saiuran

Kemih

H a s i l a n a l i s i s b i v a r i a t l i u b u n g a n a n t a r a j e n i s k e l a i n i n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

Tabel 48 Hasil Uji Hubungan antara Jenis Keiamin dengan Kejadian

Infeksi Saiuran Kemih

Infeksi Saiuran Kemih Jenis P

A Tidak Jumlah 95CI Keiamin value

N N

P e r e m p u a n 18 6 4 3 10 357laquoo 2 8 3 2 2 7 -P e r e m p u a n 0 0 0 0

L a k i - l a k i 12 1 7 1 5 8 8 2 9 7 0 2 3 4 5 9

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 8 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a l a l i

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k N 4 a k a a d a l i u b u n g a n y a n g s i g n i f i k a n a n t a r a

j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R ) = 8 7 0 0

f 9 5 C I = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a l a k i - l a k i

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e n i i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

32

Tabel 49 Hasil liji Hubungan antara Tingkat Pendidikan dengan

Kejadian Infeksi Saiuran Kemih

Infeksi Saiuran Kemih P

Y a T i d a k jumlah 95CI value

N

P e n d i d i k a n d a s a r 2 0 5 4 1 1 7 4 5 9 3 7

P e n d i d i k a n

m e n e n g a h d a n 10 1 6 4 5 1 8 3 6 6 1

t i n g g i

Jumlah JO 30 6 68 694 9H

B e r d a s a r k a n t a b e l 4 9 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( 0 R ) =

6 0 0 0 ( 9 5 C I = 2 3 5 1 - 1 5 3 1 0 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r a d a i a h 6 k a l i l e b i h b e s a r

d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i h a t

p a d a t a b e l d i b a w a h i n i

Tingkat

Pendidikan

2 3 5 1 -0 0 0 0

1 5 3 1 0

33

Tabel 4t0 Hasil I j i Hubungan antara Riwayat Diabetes Melitus dengan

Kejadian Infeksi Saiuran Kemih

Riwayat Infeksi Saiuran Kemih P

Diabetes Va Tidak Jumlah value

95CI

Melitus N bullVJ N

Y a

T i d a k

17

1 3

6 8 0

1 7 8

8

6 0

3 2 0

8 2 2

2 5

7 3 0 0 0 0

3 4 9 3 -

2 7 5 3 6

Jumlah 30 306 68 571 98

B e r d a s a r k a n t a b e l 4 1 0 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio

( O R ) = 9 8 0 8 ( 9 5 C I - 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r

d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s m e l i m s

42 Pembahasan

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a l a b e l 4 7 d i d a p a t k a n b a l i w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i b d e n g a n n i l a i s i g n i f i k a n n y a a d a l a l i 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k

Odds Ratio ( O R ) = 7 4 9 2 ( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a u s i a T 5 0 t a h u n a d a i a h 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a

u s i a lt 5 0 t a h u n

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n A n d r y L u k a n d y

( 2 0 1 4 ) m e n g e n a i k a r a k t e r i s t i k p a s i e n - p a s i e n i n f e k s i s a i u r a n k e m i h d i m a n a

p e n d e r i t a I S K d e n g a n k e l o m p o k u m u r gt 5 0 t a h u n s e b a n y a k 2 3 o r a n g s e d a n g k a n

j u m l a h p e n d e r i t a I S K d e n g a n k e l o m p o k u m m lt 5 0 t a l i u n s e b a n y a k 2 0 o r a n g

P e n e l i t i a n i n i j u g a d i p e i k u a t o l e h p e n l i t i a n L e w i s A l e t a l ( 2 0 1 4 ) m e n g e n a i

impact of host age and parity on susceptihility to severe urinary tract injection in

34

a murine mode d e n g a n u j i K r u s k a l - W a l l i s d e n g a n post-test D u n n u n t u k b e b e r a p a

p e r b a n d i n g a n d i m a n a u s i a d a n p a r i t a s s e b a g a i f a k t o r y a n g b e r k o n t r i b u s i d a l a m

k e r e n t a n a n i m t u k t e r j a d i n y a I S K d e n g a n n i l a i p lt 0 0 5

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n g a t a k a n b a h w a i n s i d e n I S K m e n i n g k a t

b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n

a d a n y a a b n o r m a l i t a s a n a t o m i y a n g m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n

k e m i h s e p e r t i p e m b e s a r a n p r o s t a t d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a

p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e ( R o s e 2 0 0 9 ) P e n y e b a b l a i n t e n n a s u k

p e r i n e i u n y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s p e n y a k i t n e u r o m u s k u l a r

d a n k a t e t e r i s a s i b u l i - b u l i ( F o x m a n e t a l 2 0 1 0 ) S e l a i n i t u i n s i d e n I S K m e n c a p a i

1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o n a l d 2 0 1 1 )

B Hubungan antara Jenis Keiamin dengan Kejadian infeksi Saiuran

Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 8 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d e n g a n n i l a i s i g n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O

d i t o l a k Odds Ratio ( O R ) = 8 7 0 0 ( 9 5 C l = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a risiko k e j a d i a n

i n f e k s i s a i u r a n k e m i h p a d a p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n

p a d a l a k i - i a k i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n M a g i i a n o e t a l

( 2 0 1 1 ) m e n g e n a i Gender and Age-Dependent Etiology of Community Acquired

y a n g m e l a k u k a n p e n g a m b i l a n 6 1 2 7 3 s a m p e l k u l t u r u r i n d a l a m p e r i o d e 2 2 b u l a n

d a r i s a m p e l i n i d i d a p a t k a n 1 3 8 2 0 ( 2 2 6 ) d i t e m u k a n p o s i t i f i n f e k s i b a k t e r i

h a m p i r 8 0 b a l i a n y a n g d i i s o l a s i b e r a s a l d a r i p e r e m p u a n P e n e l i t i a n i n i j u g a

d i p e r k u a t o l e h p e n e l i t i a n y a n g d i l a k u k a n o l e h Y u n i t a I ( 2 0 1 0 ) d i m a n a a d a

h u b m i g a n y a n g b e n n a k n a a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h ( P value=O049 R P = 3 2 7 3 ( 9 5 C I = I 0 1 6 - 1 0 5 4 0 )

H a l t e r s e b u t d a p a t t e r j a d i k a r e n a u r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a l i

d e n g a n d e k a t n y a v a g i n a l v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i

s a i u r a n k e m i h l e b i h s e r i n g p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a flora n o r m a l

3 5

p a d a d a e r a h p e r i u r e t r a t e r d i r i d a r i o r g a n i s m e s e p e r t i i a c t o b a c i l l u s y a n g m e m b a n t u

m e l a w a n k o l o n i s a s i b a k t e r i p a t o g e n p a d a s a i u r a n k e m i h P e r u b a h a n l i n g k i m g a n

d a r i p e r i u r e t r a l s e p e r t i p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k

b i s a m e n g g a n g g u f l o r a n o r m a l s e h i n g g a m e n u m g k i n k a n b a k t e r i p a t o g e n

b e r k o l o n i s a s i d a n m e n y e b a b k a n i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Scuare p a d a t a b e l 4 9 d i d a p a t k a n b a h w a

t e r d a p a t l i u b u n g a n y a n g s i g n i f i k a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a

H O d i t o l a k Odds Ratio ( O R ) - 6 0 0 0 ( 9 5 o C l = 2 3 5 1 - 1 5 3 I O ) a r t i n y a n s i k o

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r

a d a i a h 6 k a l i l e b i h b e s a r d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n

m e n e n g a h d a n t i n g g i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h T o r o n d e i B e t

a l ( 2 0 1 5 ) m e n g e n a i Menstrual Hygiene Practices WASH Access and the Risk of

Urogenital Infection in Women from Odisha India d i m a n a p e r e m p u a n y a n g

h a n y a m e n e m p u l i p e n d i d i k a n s e k o l a h d a s a r a t a u l e b i h r e n d a h d i b a n d i n g k a n

d e n g a n t i n g k a t p e n d i d i k a n m e n e n g a h a t a u t i n g g i m e m i l i k i r i s i k o 3 k a l i

k e m u n g k i n a n l e b i h b e s a r m e n g a l a m i i n f e k s i s a i u r a n k e m i h ( A d j O R = 3 l 9 5

C 1 = I 2 - 7 9 p = 0 0 2 )

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a p e n g e t a h u a n s e s e o r a n g

t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t p e n d i d i k a n S e s e o r a n g y a n g

m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m u n g k i n a n p e n g e t a l i u a n t e n t a n g

k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o r m a s i y a n g d i d a p a t k a n t e n t a n g k e s e h a t a n

l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h S e b a l i k n y a

p e n d i d i k a n y a n g k u r a n g d a p a t i n e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g t e r h a d a p

n i l a i - n i l a i y a n g b a r u d i k e n a l ( N o t o a d m o j o 2 0 0 3 )

3 6

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Keniih

B e r d a s a r k a n l i a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 1 0 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a r i w a y a t d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 )

s e h i n g g a H O d i t o l a k Odds Ratio ( O R ) = 9 8 0 8 ( 9 5 C I = 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a

risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h S a r i E W P d a n

S a t y a b a k t i P ( 2 0 1 5 ) m e n g e n a i p e r b e d a a n risiko i n f e k s i n o s o k o m i a l s a i u r a n k e m i h

b e r d a s a r k a n k a t e t e r i s a s i u r i n u m u r d a n d i a b e t e s m e l i m s d i m a n a d a r i 2 0 p a s i e n

i n f e k s i n o s o k o m i a l s a i u r a n k e m i h 1 2 o r a n g ( 6 0 ) d i a n t a r a n y a a d a i a h p a s i e n

d e n g a n s t a t u s D M s e d a n g k a n 8 o r a n g ( 4 0 ) l a i n n y a a d a i a h p a s i e n t a n p a s t a t u s

D M ( P v W w ^ = 0 0 2 4 O R = 6 0 0 9 5 C I = 1 2 2 - 3 2 2 6

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a b a l i w a b e b e r a p a b a g i a n

d a r i i i n u n i t a s p a d a p a s i e n d i a b e t e s m e n g a l a m i p e r u b a h a n F u n g s i

p o l i n i o r f o l e u k o s i t d i t e k a n p a d a k e a d a a n a s i d o s i s I k a t a n l e u k o s i t k e m o t a k s i s d a n

f a g o s i t o s i s j u g a b e m b a l i S i s t e m a n t i o k s i d a n y a n g b e r p e r a n p a d a a k t i f i t a s

b a k t e r i s i d a l j u g a t e r g a n g g u s e h i n g g a m e n y e b a b k a n t e r j a d i n y a I S K p a d a p a s i e n -

p a s i e n d e n g a n p e n y a k i t d i a b e t e s ( J u l k a 2 0 1 4 )

H a l y a n g s a m a j u g a d i i m g k a p k a n o l e b t e o r i S m e l t z e r d a n B a r e ( 2 0 1 0 )

b a l i w a D M d a p a t m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a l i a n a n t u b u h y a n g

b e r p o t e n s i m e n i n g k a t k a n r i s i k o t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a l i a n a n

t u b u h t e r s e b u t d i a n t a r a n y a a d a i a h k e g a g a l a n m i g r a s i s e l iniraceliular killing

f a g o s i t o s i s d a n k e m o t a k s i s p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n

m e k a n i s m e p e r t a l i a n a n a l a m i a h I o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p

i n f e k s i

BAB V

KESIMPULAN DAN SARAN

51 Kesimpulan

1 U s i a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 2 6 - 3 5 t a h u n y a i t u 2 3 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 3 7

2 U s i a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 4 6 - 5 5 t a l i u n y a i t u 2 9 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 1 3

3 U s i a j e n i s k e i a m i n d a n t i n g k a t p e n d i d i k a n s a m p e i y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i l i t e r b a n y a k y a i t u b e r u s i a gt 5 0 t a h u n ( 5 3 3 ) j e n i s k e i a m i n

p e r e m p u a n ( 6 0 0 ) d a n t i n g k a t p e n d i d i k a n d a s a r ( 6 6 7 ) s e r t a p a l i n g

b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s y a i t u 5 6 7

4 T e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 ( p = 0 0 0 0 )

52 Saran

1 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t d i l a k u k a n d e n g a n d e s a i n

p e n e l i t i a n b e r b e d a s e p e r t i cohort a t a u case control

2 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t m e i i c a r i v a r i a b e l independent

y a n g l a i n s e p e r t i v a r i a b e l p e k e r j a a n p e m a s a i i g a n k a t e t e r a t a u l a m a n y a

m e n d e r i t a d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

37

DAFTAR PUSTAKA

B o y k o E J d k k 2 0 0 2 D i a b e t i c A n d T h e R i s k O f A c u t e U r i n a r y T r a c t I n f e c t i o n A m o n g P o s t m e n o p a u s a l W o m e n D i a b e t e s C a r e 2 5 ( 1 0 )

D a h l a n S 2 0 1 4 B u k i i S t a t i s t i k u n t u k K e d o k t e r a n d a n K e s e h a t a n D e s k r i p t i f B i v a r i a t d a n M u l t i v a r i a t d i l e n g k a p i a p l i k a s i d e n g a n m e n g g u n a k a n S P S S E d i s i 6 E p i d e m i o l o g i I n d o n e s i a J a k a r t a I n d o n e s i a

D e p a r t e m e n K e s e h a t a n ( D E P K E S ) R l 2 0 1 4 [ O n l i n e ] K e m e n t e r i a n K e s e h a t a n R e p u b l i k I n d o n e s i a P u s a t D a t a d a n I n f o r m a s i K e m e n t e r a n K e s e h a t a n R l ( http 7depkesgoid diakses tanggal 15 Met 2016)

F o x m a n B e t a i 2 0 1 0 U r i i i a i y T r a c t I n f e c t i o n A m o n g W o m e n A g e d 4 0 T o 6 5 B e h a v i o r a l A n d S e x u a l R i s k F a c t o r s D a l a m T a n a g h o E A M c A n i n c h J W 1 7 t h S m i t h s G e n e r a l U r o l o g y U S A M c G r a w H i l l (http searchproqnestcom diakses tanggal 16 Met 2016)

H a r d i n g G K d k k 2 0 1 0 A n t i m i c r o b i a l T r e a t m e n t I n D i a b e t i c W o m e n W i t l i A s y m t o m a t i c B a c t e r i u r i a N E n g l J M e d 3 4 7 1 5 7 6 - 1 5 8 3 (http nejmorg diakses tanggal 16 Met 2016)

I s s e l b a c h e r d k k 2 0 0 9 I n f e k s i S a i u r a n K e m i h d a n P i e l o n e f r i t i s D a l a m S t a m m W a l t e r E e d H a r r i s o n P r i n s i p - P r i n s i p l l m u P e n y a k i t D a l a m e d V o l u m e 2 J a k a r t a E G C 6 1 6 - 6 2 3

J u l k a S 2 0 1 3 G e n i t o u r i n a r y I n f e c t i o n I n D i a b e t e s I n d i a n J o u m a l o f E n d o c r i n o l o g y a n d M e t a b o l i s m (http searchproquestcom diakses tanggal 16 Mei 2016)

K i m B d k k 2 0 1 2 [ e - b o o k ] T h e R e l a t i o n b e t w e e n P o s t v o i d R e s i d u a l a n d O c c u r r e n c e o f U r i n a r y T r a c t I n f e c t i o n a f t e r S t r o k e i n R e h a b i l i t a t i o n U n i t A n n a l s o f R e h a b i l i t a t i o n M e d i c i n e

K o m a r a A 2 0 0 9 P o l a K e p e k a a n B a k t e r i G r a m N e g a t i f d a r i P a s i e n I n f e k s i S a i u r a n K e m i l i t e r h a d a p A n t i b i o t i k G e n t a m i c i n d a n K o t r i m o k s a z o l y a n g D i k i r i m k e L a b o r a t o r i u m M i k r o b i o l o g i K l i n i k F K U l d a r i T a h u n 2 0 0 1 s a m p a i T a h u n 2 0 0 5 (http dontaruiacid diakses tanggal OH Agustiis 2016)

L e w i s A L e t a l 2 0 1 4 I m p a c t o f H o s t A g e a n d P a r i t y o n S u s c e p t i b i l i t y t o S e v e r e U r i n a r y T r a c t I n f e c t i o n i n a M u r i n e M o d e l P l o s O n e R e s e a r c h A r t i c l e P u b l i c L i b r a r y o f S c i e n c e 9 ( 5 ) (http searchproquestcom diakses pada langgal 30 Desember 2016)

38

BAB I

PENDAHULUAN

11 Latar Belakang

I n f e k s i s a i u r a n k e m i h ( I S K ) m e n i p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m i i k a n d i R u m a h S a k i t a t a u t e m p a t p r a k t i k u m u m s e h a r i - h a r i I S K

a d a i a h s u a t u i n f e k s i y a n g m e n g e n a i t r a k t u s u r i n a r i u s m u l a i d a r i m e a t u s u r e t r a

s a m p a i d e n g a n k e g i n j a l S t r u k t u r y a n g t e n n a s u k d i d a l a m n y a a d a i a h u r e t r a

k a n d u n g k e m i h u r e t e r p e l v i s d a n p a r e n k i m g i n j a l S t r u k t u r y a n g b e r k a i t a n u n t u k

t e r j a d i n y a i n f e k s i d a n r e k u r e n i n f e k s i y a i t u p r o s t a t e p i d i d i m i s d a n fascia

perinephric I s t i l a h I S K m e n u n j u k k a n a d a n y a k e b e r a d a a n m i k r o o r g a n i s m e d i

d a l a m u r i n ( S u d o y o 2 0 0 6 R u b i n 2 0 1 0 ) D e n g a n k a t a l a i n b a h w a d i a g n o s i s I S K

d i t e g a k k a n d e n g a n m e m b u k t i k a n a d a n y a m i k r o o r g a n i s m e d i d a l a m s a i u r a n k e m i h

( R u b i n 2 0 1 0 )

S e b a n y a k 2 5 j u t a k e m a t i a n d i s e l u r u h d u n i a p a d a t a h u n 2 0 1 1 s e p e r t i g a n y a

d i s e b a b k a n o l e h p e n y a k i t i n f e k s i I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n i n f e k s i

d e n g a n k e t e r l i b a t a i i b a k t e r i t e r s e r i n g d i k o m u n i t a s d a n h a m p i r 1 0 o r a n g p e m a h

t e r k e n a I S K s e l a m a h i d u p n y a S e k i t a i - 1 5 0 j u t a p e n d i i d u k d i s e l u r u h d u n i a t i a p

t a l i u n n y a t e r d i a g n o s i s m e n d e r i t a i n f e k s i s a i u r a n k e m i h ( Y u n u s 2 0 1 2 )

I S K d a p a t m e n g e n a i s e m u a k e l o m p o k u m u r b a i k a n a k r e m a j a d e w a s a

m a u p u n u s i a l a n j u t P r e v a l e n s i a n a k u s i a s e k o l a h y a n g m e n d e r i t a I S K s e k i t a r 1 -

3 d a n m e n i n g k a t p a d a r e m a j a y a n g s u d a h m e l a k u k a n h u b i m g a n s e k s u a l

( K o m a r a 2 0 0 9 ) D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r 2 5 - 3 5

s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a S e l a m a

p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n c e n d e r u n g

m e n d e r i t a I S K d i b a n d i n g k a n l a k i - l a k i ( S u d o y o 2 0 0 9 )

R a s i o I S K p a d a w a n i t a d i b a n d i n g p r i a b e r k i s a r 3 0 1 d a n s e k i t a r 5 0 w a n i t a

y a n g t e r k e n a i n f e k s i a k a n b e r k e m b a n g m e n j a d i I S K b e m l a n g I S K m e n i p a k a n

i n f e k s i b a k t e r i y a n g p a l i n g s e r i n g p a d a a n a k - a n a k d e n g a n k e l u h a n d e m a m b a i k

p a d a a n a k p r i a m a u p u n w a n i t a P r e v a l e n s i y a n g p e m a h d i l a p o r k a n b e r k i s a r 4 1

I

2

s a m p a i 7 5 R e k u r e n s i c u k u p s e r i n g d a n t e r j a d i s e k i t a r 1 8 p a d a b a y i l a k i - i a k i

d a n 2 6 p a d a b a y i p e r e m p u a n U n t u k u s i a p r a s e k o l a h I S K l e b i h s e r i n g

m e n g e n a i w a n i t a I n s i d e n I S K p a d a a n a k - a n a k p r a s e k o l a h s e k i t a r 2 ( S y a h r i n i

2 0 1 1 )

D a r i b e r b a g a i p e n e l i t i a n e p i d e m i o l o g i s d i I n d o n e s i a d i d a p a t k a n p r e v a l e n s i

D M s e b e s a r 15 - 2 3 p a d a p e n d u d u k u s i a l e b i J i d a r i 1 5 t a h u n b a h k a n p a d a

s u a t u p e n e l i t i a n e p i d e m i o l o g i s d i M a n a d o d i d a p a t k a n p r e v a l e n s i D M a d a i a h 6 1

P r e v a l e n s i d i a b e t e s m e l i t u s p a d a p e n d u d u k u s i a 2 5 - 6 4 t a h u n d i J a w a d a n B a l i

s e b e s a r 7 5 P e n e l i t i a n y a n g d i l a k u k a n d i J a k a r t a S u r a b a y a M a k a s a r d a n k o t a -

k o t a l a i n d i I n d o n e s i a m e m b u k t i k a n a d a n y a k e n a i k a n p r e v a l e n s i d a r i t a h u n

k e t a h u n ( D E P K E S 2 0 1 4 W H O 2 0 1 0 )

I n f e k s i s a i u r a n k e m i h j u g a m e n i p a k a n m a s a l a h k l i n i s u m u m p a d a p e n d e r i t a

D M o l e h k a r e n a p e n d e r i t a D M m e m p u n y a i k e m u n g k i n a n m e n d e r i t a I S K l e b i h

t i n g g i d i b a n d i n g k a n d e n g a n b u k a n p e n d e r i t a D M d a n j u g a m e n d e r i t a i n f e k s i y a n g

l e b i h b e r a t y a n g a k a n m e n i n g k a t k a n risiko u n t u k m a s u k m m a h s a k i t ( H a r d i n g

d k k 2 0 1 0 ) P e n e l i t i a n y a n g d i l a k u k a n o l e h B o y k o d k k m e n d a p a t k a n w a n i t a D M

ripe 2 d e n g a n b a k t e r i u r i a s i m t o m a t i k s e t e l a h d i l a k u k a n p e m a n t a u a n s e l a m a 1 8

b u l a n m e n g a l a m i p e n i n g k a t a n r i s i k o m e n d a p a t k a n I S K s e b a n y a k 3 4

d i b a n d i n g k a n d e n g a n w a n i t a y a n g t i d a k m e n g a l a m i D M s e b e s a r 1 9 ( B o y k o d k k

2 0 0 2 )

B e r d a s a r k a n u r a i a n - u r a i a n d i a t a s s e r t a b e l u m a d a n y a p e n e l i t i a n y a n g

m e n e m u k a n k e t e r k a i t a n f a k t o r u s i a j e n i s k e l a m m t i n g k a t p e n d i d i k a n d a n r i w a y a t

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h d i K o t a P a l e m b a n g m a k a

p e n e l i t i t e r t a r i k i m t i i k m e l a k u k a n p e n e l i t i a n m e n g e n a i h u b u n g a n a n t a r a u s i a j e n i s

k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

3

12 Rumusan Masalah

1 B a g a i m a n a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s

m e l i t u s

2 A p a k a l i a d a h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

13 Tujuan Penelitian

131 Tujuan Umum

T u j u a n u m u m d a r i p e n e l i t i a n i n i a d a i a h d i k e t e m u k a n n y a h u b u n g a n a n t a i a

u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i m s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

132 Tujuan Khusus

T u j u a n k l i u s u s d a r i p e n e l i t i a n i n i y a i t u

1 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a

2 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n m f e k s i s a i u r a n k e m i b p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n j e n i s k e i a m i n

3 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

4

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n t i n g k a t p e n d i d i k a n

4 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n riwayat d i a b e t e s m e l i t u s

5 T e r a n a l i s i s n y a h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a i m n a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

6 T e r a n a l i s i s n y a h u b u n g a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

7 T e r a n a l i s i s n y a h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

8 T e r a n a l i s i s n y a h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i u i s d e n g a n k e j a d i a n

i n f e k s i s a l i u a i i k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

14 Manfaat Penelitian

141 Manfaat Teoritis

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t m e n a m b a h p e n g e t a h u a n p e n e l i t i

t e n t a n g h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i U i s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

5

142 Manfaat Praktis

A Bagi Peneliti

H a s i l p e n e l i t i a n i n i d i l i a r a p k a n d a p a t d i g u n a k a n s e b a g a i s a l a h s a t u b a h a n

r e f e r e n s i a t a u b a c a a n b a g i p e n e l i t i

B Bagi Institusi

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t d i g u n a k a n p i h a k R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g s e b a g a i s a l a l i s a t u b a h a n a c u a n d a l a m m e n g u p a y a k a n

p e n c e g a h a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

15 Keaslian Penelitian

T a b e l 1 1 K e a s l i a n P e n e l i t i a n

Nama Judul Penelitian Desain Hasil Penelitian

Peneliti Penelitian

Kugan P r e v a l e n s i I n f e k s i Cross D a r i p e n e l i t i a n i i i i

Kandasamy S a i u r a n K e m i l i P a d a seciUmal d i p e r o l e h b a l i w a

W a n i t a Y a n g M e n d e r i t a

D i a b e t e s M e l i t u s T i p e

I I Y a n g D i r a w a t I n a p

p a s i e n w a n i t a d i a b e t e s

m e l i t u s t i p e I y a n g

m e n d e r i t a I S K y a n g

D a n D i r a w a t J a l a n D i d i r a w a t m a p d a n

S u b b a g i a n

E n d o k r i n o l o g i B a g i a n

P e n y a k i t D a l a m D i

d i r a w a t j a l a n d i s u b

b a g i a n E n d o k r i n o l o g i

P e n y a k i t D a l a m

R S U P H A d a m M a l i k R S U P H A d a m

P a d a T a l i u n 2 0 0 9 M a l i k M e d a i i t e r d a p a t

s e b a n y a k 2 5 o r a n g

y a i t u ( 1 2 7 ) D a r i 2 5

o r a n g y a n g m e n d e r i t a

I S K t e r d a p a t 3 o r a n g

y a i t u ( 1 2 0 ) y a n g

d i r a w a t i n a p d a n 2 2

6

o r a n g ( 8 8 0 ) y a n g

d i r a w a t j a l a n

Edel Weisela P e r b e d a a n R i s i k o

Permata I n f e k s i N o s o k o m i a l

Sari dan S a i u r a n K e m i h

Prijono B e r d a s a r k a n

Satyabakti K a i e t e r i s a s i U r i n

U m u r D a n D i a b e t e s

M e l i t u s T a h u n 2 0 1 5

Case H a s i l p e n e l i t i a n y a n g

control d i 1 a k u k a n p a d a 2 0

s a m p e l k a s u s d a n

k o n t r o l m e n u n j u k k a n

b a h w a p a s i e n d e n g a n

u m u r gt 5 5 t a h u n

m e m p u n y a i r i s i k o

5 5 7 k a l i m e n g a l a m i

i n f e k s i n o s o k o m i a l

s a i u r a n k e m i h

d i b a n d i n g k a n p a s i e n

d e n g a n u m u r lt 5 5

t a h u n d e n g a n

p e r i l i t u n g a i i b e s a r

risiko d i p e r o l e h n i l a i

O R s e b e s a r 5 5 7

d e n g a n n i l a i 9 5

(onfidence Interval

l 1 9 lt O R lt 2 8 2 3

P a s i e n d e n g a n s t a t u s

D M m e m p u n y a i risiko

6 k a l i u n t u k

m e n g a l a m i i n f e k s i

n o s o k o m i a l s a i u r a n

k e m i h d i b a n d i n g k a n

d e n g a n p a s i e n y a n g

t i d a k m e n d e r i t a D M

d e n g a n n i l a i O R

7

s e b e s a r 6 0 0 d e n g a n

n i l a i 9 5 Confidence

Interval 1 22 lt O R lt

3 2 2 6

Andry K a r a k t e r i s t i k P a s i e n - D e s k r i p k i f H a s i i p e n e l i t i a n d a r i

Lukandy P a s i e n I n f e k s i S a i u r a n r e t r o s p e k t i f 4 3 o r a n g p e n d e r i t a

K e m i i i d i P o l i u r o l o g i

R S U D D r P i m g a d i

K o t a M e d a n T a h u n

2 0 1 2 - 2 0 1 3

I S K d i d a p a t k a n 5 3 5

p a d a k e l o m p o k u s i a

gt 5 0 t a h u n 5 1 2

b e i j e n i s k e i a m i n l a k i -

l a k i 1 0 0 t i d a k

m e n d e r i t a

v e s i c o u r e t r a l r e f l u x

7 0 Benign Prostatic

Hyperplasia 1 1 6

b a t u s a i u r a n k e m i h

2 7 9 d i a b e t e s t i p e 2

D a r i h a s i l p e n e l i t i a n

i n i d a p a t d i s i m p u l k a n

b a h w a p e n d e r i t a i S K

l e b i h b a n y a k t e r j a d i

p a d a l a k i - l a k i d a n

p e n d e r i t a I S K l e b i h

b a n y a k d i j u m p a i p a d a

k e l o m p o k u m u r gt 5 0

t a h u n s e r t a d i t e m u k a n

I S K d e n g a n B P H

B S K d a n D M T i p e 2

BAB 11

TINJAUAN PUSTAKA

21 Landasan Teori

211Infeksi Saiuran Keniih

A Definisi

I n f e k s i S a i u r a n K e m i h a d a i a h i n v a s i d a n m u l t i p l i k a s i m i k r o o r g a n i s m e a t a u

p a r a s i t d a l a m j a r i n g a n t u b u h k h u s u s n y a s a i u r a n k e m i h y a n g t e r d i r i d a r i g i n j a l

u r e t e r b u l i - b u l i d a n u r e t r a y a n g d i i a n d a i d e n g a n a d a n y a b a k t e r i 1 0 c f i i (colony

forming unit) p e r m l p a d a p e n g a m b i l a n c o n t o h u r i n ( P u m o m o 2 0 1 1 )

I n f e k s i s a i u r a n k e m i h a d a l a l i s u a t u i n f e k s i y a n g m e l i b a t k a n g i n j a l lU e ter

b u l i - b u l i a t a u p u n u r e t r a I n f e k s i s a i u r a n k e m i h ( I S K ) a d a l a l i i s t i l a h u m u m y a n g

m e n u n j u k k a n k e b e r a d a a n m i k r o o r g a n i s m e d a l a m u r i n ( S u d o y o 2 0 0 6 )

B a k t e r i u r i a b e r m a k n a (significant hacteriuria) a d a i a h s u a t u k e a d a a n y a n g

m e n u n j u k k a n p e n u m b u l i a n m i k r o o r g a n i s m e m u m i l e b i h d a r i 1 0 c f t L m l p a d a

b i a k a n u r i n B a k t e r i u r i a b e r m a k n a m u n g k i n t a n p a d i s e r t a i p r e s e n t a s i k l i n i s I S K

d a n d i n a m a k a n b a k t e r i u r i a a s i m t o m a t i k (convert hacteriuria) S e b a l i k n y a

b a k t e r i u r i a b e n n a k n a d i s e r t a i p e r s e n t a s i k l i n i s I S K d i n a m a k a n b a k t e r i u r i a

s i m t o m a t i k P a d a b e b e r a p a k e a d a a n t e r d a p a t p a s i e n d e n g a n p e r s e n t a s i k l i n i s I S K

n a m u n t a n p a b a k t e r i u r i a b e n n a k n a S e l a i n i t u d i k a t a k a n p i u r i a ( l e u k o s i t d a l a m

u r i n ) b e n n a k n a (significant pyuria) b i l a d i t e m u k a n n e u t r o f i l gt 1 0 s e l p e r l a p a n g a n

p a n d a n g ( S u d o y o 2 0 0 6 )

B Epidemiologi

I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m u k a n d i p r a k t i k u m u m w a i a u p u n b e n n a c a m - m a c a m a n t i b i o t i k a s u d a h

t e r s e d i a l u a s d i p a s a r a n D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r

2 5 - 3 5 s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a

S e l a m a p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n

9

10

c e n d e r u n g m e n d e r i t a i S K d i b a n d i n g k a n l a k i - l a k i I S K b e m l a n g p a d a l a k i - l a k i

j a r a n g d i l a p o r k a n k e c u a l i d i s e r t a i f a k t o r p r e d i s p o s i s i ( p e n c e t u s )

P r e v a l e n s i b a k t e r i u r i a a s i m t o m a t i k l e b i h s e r i n g d i t e m u k a n p a d a p e r e m p u a n

P r e v a l e n s i s e l a m a p e r i o d e s e k o l a h (school girls) 1 m e n i n g k a t m e n j a d i 5

s e l a m a p e r i o d e a k t i f s e c a r a s e k s u a l P r e v a l e n s i i n f e k s i a s i m t o m a t i k m e n i n g k a t

m e n c a p a i 3 0 b a i k l a k i - l a k i m a u p u n p e r e m p u a n b i l a d i s e r t a i f a k t o r p r e d i s p o s i s i

( S u d o y o 2 0 0 6 )

C Kiasifikasi

I n f e k s i s a i u r a n k e m i h d a p a t d i b a g i m e n j a d i d u a k a t e g o r i u m u m b e r d a s a r k a n

l o k a s i a n a t o m i y a i t u

1 ) I n f e k s i s a i u r a n k e m i h b a w a h

2 ) I n f e k s i s a i u r a n k e m i h a l a s

P r e s e n t a s i k l i n i s d a r i i n f e k s i s a i u r a n k e m i h b a w a l i t e r g a n t u n g d a r i gender

y a i t u

a ) P e r e m p u a n

a S i s t i t i s

S i s t i t i s a d a i a h p r e s e n t a s i k l i n i s i n f e k s i k a n d u n g k e m i h d i s e r t a i

b a k t e r i u r i a b e n n a k n a

b S i n d r o m U r e t r a A k u t ( S U A )

S i n d r o m a u r e t r a a k u t a d a i a h p r e s e n t a s i k l i n i s s i s t i t i s t a n p a d i t e m u k a n

a d a n y a m i k r o o r g a n i s m e d a l a m L u i n ( s t e r i l ) d a n s e r i n g d i n a m a k a n

s i s t i t i s b a k t e r i a l i s

b ) L a k i - l a k i

P r e s e n t a s i k l i n i s i n f e k s i s a i u r a n k e m i h p a d a l a k i - l a k i m u n g k i n s i s t i t i s

p r o s t a t i t i s e p i d i m i d i s d a n u r e t r i t i s

I n f e k s i s a i u r a n k e m i h a t a s t e r b a g i m e n j a d i 2 y a i t u

1 ) P i e l o n e f r i t i s A k u t ( P N A )

P i e l o n e f r i t i s a k u t a d a l a l i p r o s e s i n f l a m a s i p a r e n k i m g i n j a l y a n g d i s e b a b k a n

o l e h m f e k s i b a k t e r i

11

2 ) P i e l o n e f r i t i s K r o n i s ( P N K )

P i e l o n e f r i t i s k r o n i s m u n g k i n a k i b a t l a n j u t d a r i i n f e k s i b a k t e r i

b e r k e p a n j a n g a n a t a u i n f e k s i s e j a k m a s a k e c i i O b s t r u k s i s a i u r a n k e m i h d a n

r e f l u k s v e s i k o u r e t e r d e n g a n a t a u t a n p a b a k t e r i u r i a k r o n i k s e r i n g d i i k u t i

p e m b e n t u k a n j a r i n g a n i k a t p a r e n k i m g i n j a l y a n g d i t a n d a i d e n g a n

p i e l o n e f r i t i s k r o n i k y a n g s p e s i f i k ( S u d o y o 2 0 0 6 )

D Etiologi

P a d a k e a d a a n n o r m a l u r i n b e r s i f a t s t e r i l U m u m n y a I S K d i s e b a b k a n o l e h

k i i m a n g r a m n e g a t i f E s c h e r i c h i a c o l i m e m p a k a n p e n y e b a b t e r b a n y a k b a i k p a d a

y a n g s i m t o m a t i k m a u p u n y a n g a s i m t o m a t i k y a i t u 7 0 - 9 0 E n t e r o b a k t e r i a s e p e r t i

P r o t e u s m i r a b i l i s ( 3 0 d a r i i n f e k s i s a i u r a n k e m i h p a d a a n a k l a k i - l a k i t e t a p i

k u r a n g d a r i 5 p a d a a n a k p e r e m p u a n ) K l e b s i e l l a p n e u m o n i a d a n P s e u d o m o n a s

a e m g i n o s a d a p a t j u g a s e b a g a i p e n y e b a b O r g a n i s m e g r a m p o s i t i f s e p e r t i

S t r e p t o c o c c u s f a e c a l i s ( e n t e r o k o k u s ) S t a p h y l o c o c c u s e p i d e n n i d i s d a n

S t r e p t o c o c c u s v i r i d a n s j a r a n g d i t e m u k a n P a d a u r o p a t i o b s t m k t i f d a n k e l a i n a n

s t r u k t u r s a i u r a n k e m i h p a d a a n a k l a k i - l a k i s e r i n g d i t e m u k a n P r o t e u s s p e c i e s P a d a

I S K n o s o k o m i a l a t a u I S K k o m p l e k s l e b i h s e r i n g d i t e m u k a n k u m a n P r o t e u s d a n

P s e u d o m o n a s ( L u m b a n b a t u S M 2 0 0 3 )

E Patofisiologi

P a d a i n d i v i d u n o n n a l b i a s a n y a u r i n l a k i - l a k i m a u p u n p e r e m p u a n s e l a l u

d a l a m k e a d a a n s t e r i l k a r e n a d i p e r t a l i a n k a n o l e h j u m l a l i d a n f r e k u e n s i b e r k e m i h

U t e r o d i s t a l m e m p a k a n t e m p a t k o l o n i s a s i m i k r o o r g a n i s m e nonpathogenic

fastidious G r a m - p o s i t i f d a n g r a m n e g a t i f ( S u d o y o 2 0 0 6 )

H a m p i r s e m u a I S K d i s e b a b k a n i n v a s i m i k r o o r g a n i s m e ascending d a r i u r e t r a

k e d a l a m k a n d u n g k e m i b P a d a b e b e r a p a p a s i e n t e r t e n t u i n v a s i m i k r o o r g a n i s m e

d a p a t m e n c a p a i k e g i n j a l P r o s e s i n i d i p e n n u d a h o l e h k o n d i s i r e f l u k s

v e s i k o i i r e t e r a l P r o s e s i n v a s i m i k r o o r g a n i s m e h e m a t o g e n s a n g a t j a r a n g d i t e m u k a n

d i k l i n i k m u n g k i t a k i b a t l a n j u t d a r i b a k t e r e m i a G i n j a l d i d u g a m e n i p a k a n l o k a s i

12

i n f e k s i s e b a g a i a k i b a t l a n j u t d a r i s e p t i k e m i a a t a u e n d o k a r d i t i s a k i b a t S t a f i l o k o k u s

a u r e u s K e l a i n a n g i n j a l y a n g t e r k a i t d e n g a n e n d o k a r d i t i s ( S t a f i l o k k o k u s a u r e u s )

d i k e n a l d e n g a n N e p h r i t i s L o h e i n B e b e r a p a p e n e l i t i a n m e l a p o r k a n p i e l o n e f r i t i s

a k u t ( P N A ) s e b a g a i a k i b a t l a n j u t i n v a s i h e m a t o g e n ( S u d o y o 2 0 0 6 )

F Faktor Risiko

P a t o f i s i o l o g i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h d a p a t d i p e n g a n i h i o l e h

b e b e r a p a f a k t o r A d a p u n b e b e r a p a f a k t o r risiko y a n g m e m p e n g a n i l i i t e r j a d i n y a

i n f e k s i s a i u r a n k e m i h a n t a r a l a i n

1 ) U s i a

I n s i d e n I S K m e n i n g k a t b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i

m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n a d a n y a a b n o r m a l i t a s a n a t o m i y a n g

m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n k e m i h s e p e r t i p e m b e s a r a n p r o s t a t

d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e

P e n y e b a b l a i n t e r m a s u k p e r i n e u m y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s

p e n y a k i t n e u r o m u s k n l a r d a n k a t e t e r i s a s i b u l i - b u l i S e l a i n i t u i n s i d e n I S K

m e n c a p a i 1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o s e 2 0 0 9 F o x m a n e t a l 2 0 1 0

R o n a l d 2 0 1 1 )

M e n u m t t e o r i y a n g d i k e m u k a k a n o l e h S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a d a u s i a

l a n j u t a k a n t e r j a d i p e n i n g k a t a n k e r e n t a n a n t e r h a d a p p e n y a k i t P a d a u s i a d i a t a s 5 0

t a l i u n t e r j a d i p e n u m n a n k e m a m p u a n d a l a m m e m p e r t a h a n k a n s t e n l i t a s b a i k p a d a

k a n d u n g k e m i h m a u p u n u r e t r a H a l t e r s e b u t d i s e b a b k a n o l e h i n v o l u s i t i m u s

I n v o l u s i s e l t i m u s m e n y e b a b k a n j u m l a h se d a n k u a l i t a s r e s p o n s s e l T s e m a k i n

b e r k u r a n g J u m l a h s e l T m e m o r i m e n i n g k a t n a m u n s e m a k i n s u l i t u n t u k

b e r k e m b a n g t e r u t a m a s i t o t o k s i k s e l T ( C D ^ ) d a n s e l T h l ( C D ^ ^ ) k a r e n a t e r j a d i

a p o p t o s i s S i t o t o k s i k s e l T ( C D ^ ^ ) b e i p e r a n d a l a m r e s p o n s i m u n t e r h a d a p a n t i g e n

p a d a s e l y a n g d i i n f e k s i d e n g a n c a r a m e m b u n u l i s e l y a n g t e r i n f e k s i u n t u k

m e n c e g a h p e n y e b a r a n m f e k s i s e d a n g k a n s e l T h l ( C D ^ ^ ) b e r p e r a n m e m b a n t u s e l

B u n t u k m e m p r o d u k s i a n t i b o d i

13

2 ) J e n i s k e l a m m d a n a k t i v i t a s s e k s u a l

I n s i d e n s i I S K y a n g r e n d a h p a d a p r i a d i p e n g a n i h i o l e h 3 f a k t o r y a i t u

1 L e b i h s e d i k i t t e r j a d i k o l o n i s a s i s e k i t a r u r e t r a k a r e n a t i d a k a d a n y a t e m p a t

s e p e r t i v a g i n a p a d a p e r e m p u a n

2 M e m i l i k i u r e t r a y a n g p a n j a n g

3 A d a n y a s u b s t a n s i a n t i b a k t e r i a l p a d a c a i r a n p r o s t a t

U r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a h d e n g a n d e k a t n y a v a g i n a l

v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h l e b i h s e r i n g

p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a f l o r a n o n n a l p a d a d a e r a l i p e r i u r e t r a t e r d i r i

d a r i o r g a n i s m e s e p e r t i l a c t o b a c i l l i i s y a n g m e m b a n t u m e l a w a n k o l o n i s a s i b a k t e r i

p a t o g e n p a d a s a i u r a n k e m i h P e r u b a l i a n l i n g k i m g a n d a r i p e r i u r e t r a l s e p e r t i

p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k b i s a m e n g g a n g g u f l o r a

n o r m a l s e h i n g g a m e m u n g k i n k a n b a k t e r i p a t o g e n b e r k o l o n i s a s i d a n m e n y e b a b k a n

i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

P a d a w a n i t a l e b i h d a r i 5 0 t a h u n a t a u l e b i h m e n o p a u s e m e m p a k a n f a k t o r

l a i n y a n g m e n i n g k a t k a n P V R Post Void Residual) s e l a i n p e n u r u n a n k o i i t r a k t i i i t a s

o t o t d e t r u s o r P e n u m n a n e s t r o g e n y a n g d i s e b a b k a n m e n o p a u s e d a p a t

m e n i n g k a t k a n p H v a g i n a l d a n m e n u m n k a n j u m l a l i l a c t o b a c i l l i A k i b a m y a t e r j a d i

p e n i n g k a t k a n k o l o n i s a s i d a r i b a s i l g r a m n e g a t i f s e h i n g g a m e n i n g k a t k a n r e s i k o

t e r j a d i n y a I S K P a d a p r i a p r o s t a t m e n s e k r e s i k a n c a i r a n y a n g m e n g a n d i m g z i n k

y a n g m e m i l i k i a k t i f i t a s m i k r o b i a l ( K i m 2 0 1 2 )

S e l a i n i t u p i j a t a n u r e t r a s e p e r t i y a n g t e r j a d i s e l a m a h u b u n g a n s e k s u a l

m e n y e b a b k a n m a s u k n y a b a k t e r i k e d a l a m k a n d u n g k e m i h d a n m e m p a k a n h a l

y a n g p e n t i n g d a l a m p a t o g e n e s i s m f e k s i s a l i u a n k e m i h p a d a p e r e m p u a n m u d a

B u a n g a i r k e c i l s e t e l a h h u b u n g a n s e k s u a l t e r b u k t i m e n u m n k a n risiko s i s t i t i s

m u n g k i n k a r e n a t i n d a k a n i n i m e n i n g k a t k a n e r a d i k a s i b a k t e r i y a n g m a s u k s e l a m a

h u b u n g a n s e k s u a l ( K i m 2 0 1 2 )

3 ) T i n g k a t P e n d i d i k a n

P e n g e t a h u a n s e s e o r a n g t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t

p e n d i d i k a n S e s e o r a n g y a n g m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m i u i g k i n a n

p e n g e t a h u a n t e n t a n g k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o n n a s i y a n g d i d a p a t k a n

14

t e n t a n g k e s e h a t a n l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h

S e b a l i k n y a p e n d i d i k a n y a n g k u r a n g d a p a t m e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g

t e r h a d a p n i l a i - n i l a i y a n g b a n i d i k e n a l ( N o t o a d i n o j o 2 0 0 3 )

4 ) R i w a y a t D i a b e t e s M e l i t u s

M e n u r u t S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a s i e n d e n g a n s t a t u s D M s a n g a t

b e r i s i k o u n t u k m e n g a l a m i i n f e k s i s a i u r a n k e m i h A b n o n n a l i i a s s t n i k t u r d a n

k a n d u n g k e m i h n e u r o g e n i k a k i b a t n e u r o p a t i o t o n o m a t a u s t r o k e p a d a p a s i e n D M

m e n y e b a b k a n p e n g o s o n g a n k a n d u n g k e m i h t i d a k n o n n a l D M j u g a d a p a t

m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a h a n a n t u b u h y a n g b e r p o t e n s i m e n i n g k a t

risiko t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a h a n a n t u b u h t e r s e b u t d i a n t a r a n y a

a d a i a h k e g a g a l a n m i g r a s i s e l intracellular killing f a g o s i t o s i s d a n k e m o t a k s i s

p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n m e k a n i s m e p e r t a h a n a n

a l a m i a h i o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p i n f e k s i

5 ) K e h a m i i a n

K e c e n d e r u n g a n i n f e k s i s a i u r a n k e m i h b a g i a n a t a s s e l a m a k e h a m i i a n

d i s e b a b k a n o l e h p e n u m n a n k e k u a t a n u r e t e r p e n u m n a n p e r i s t a l t i k u r e t e r d a n

i n k o m p e t e n s i s e m e n t a r a k a l u p v e s i k o i u - e t e r a l y a n g t e r j a d i s e l a m a h a m i l

6 ) S u m b a t a i i

A d a n y a I i a i a n g a n a l i r a n b e b a s u r i n s e p e r t i t u m o r s t r i k t r a a b a t u a t a u

h i p e r t r o f i p r o s t a t d a p a t m e n y e b a b k a n h i d r o n e f r o s i s d a n risiko i n f e k s i s a i u r a n

k e m i l i y a n g s a n g a t t i n g g i S e l a i n i t u s u p e r i n f e k s i p a d a s u m b a t a n s a i u r a n k e m i h

d a p a t m e n y e b a b k a n k e m s a k a n j a r i n g a n g i n j a l y a n g c e p a t

7 ) D i s f u n g s i n e u r o g e n i k k a n d u n g k e m i h

G a n g g u a n s a r a f y a n g b e k e r j a p a d a k a n d m i g k e m i h s e p e r t i p a d a j e j a s k o r d a

s p i n a l i s t a b e s d o r s a i i s m u l t i p e l s k l e r o s i s d i a b e t e s m e l i t u s a t a u p e n y a k i t l a i n

d a p a t b e r h u b u n g a n d e n g a n i n f e k s i s a i u r a n k e m i h I n f e k s i d a p a t d i a w a l i o l e h

p e n g g u n a a n k a t e l e r u n t u k d r a i n a s e k a n d i u i g k e m i h d a n d i d u k i m g o l e h s t a t i s u r i n

d a l a m k a n d u n g k e m i l i u n t u k j a n g k a w a k t u y a n g l a m a

8 ) R e f l u k s v e s i k o m e t e r a

K e a d a a n i n i d i d e f i n i s i k a n s e b a g a i r e f l u k s u r i n d a r i k a n d u n g k e m i b k e u r e t e r

d a n k a d a n g s a m p a i k e p e l v i s r e n a l H a l i n i t e r j a d i s e l a m a b u a n g a i r k e c i l a t a u

15

d e n g a n p e n i n g k a t a n t e k a n a n p a d a k a n d u n g k e m i h R e f l u k s v e s i k o i i r e t e r a l d a p a t

d i b u k t i k a n d e n g a n a d a n y a g c r a k a n r e t r o g r a d z a t r a d i o o p a k a t a u r a d i o a k t i f m e l a l u i

s i s t o u r e t r o g r a m s e l a m a b u a n g a i r k e c i l R e f l u k s v e s i k o i i r e t e r a l b i a s a n y a

d i s e b a b k a n k a r e n a a d a n y a g a n g g u a n a n a t o m i s p a d a p e r t e m u a n v e s i k o i i r e t e r a l

y a n g d a p a t m e n y e b a b k a n r e f l u k s u r i n d i s e r t a i b a k t e r i d a n k a r e n a i t u t e r j a d i l a h

i n f e k s i s a l r a a n k e m i h

9 ) F a k t o r v i r u l e n s i b a k t e r i

F a k t o r v i r u l e n s i b a k t e r i m e m p e n g a r u b i k e m u n g k i n a n vragt7 t e r t e n m d a l a m

m e n y e b a b k a n i n f e k s i t r a k i u s u r i n a r i u s H a m p i r s e m u a strain F c o l i y a n g

m e n y e b a b k a n p i e l o n e f r i t i s p a d a p a s i e n d e n g a n t r a k i u s u r i n a r i u s n o m i a l s e c a r a

a n a t o m i k m e m p u n y a i p i l u s t e r t e n t u y a n g m e m p e r a n t a r a i p e r l e k a t a n p a d a b a g i a n

d i g a k t o s i d a d a n g l i k o s f i n g o l i p i d y a n g a d a d i u r o e p i t e l Strain y a n g m e n i m b u l k a n

p i e l o n e f r i t i s j u g a b i a s a n y a m e m p a k a n p e n g b a s i l h e m o l i s i n m e m p u n y a i

a e r o b a k t i n d a n r e s i s t e n t e r h a d a p k e r j a b a k t e r i s i d a l d a r i s e m m m a n u s i a

1 0 ) F a k t o r g e n e t i k

F a k t o r g e n e t i k p e n j a m u m e m p e n g a n i l i i k e r e n t a n a n t e r h a d a p i n f e k s i t r a k t u s

u r i n a r i u s J u m l a h d a n t i p e r e s e p t o r p a d a s e l u r o e p i t e l t e m p a t b a k t e r i d a p a t

m e n e m p e l s e l i d a k i i y a s e b a g i a i i d i t e n t u k a r i s e c a r a g e n e t i k ( I s s e l b a c h e r 2 0 0 9 )

G Manifestasi Klinis

G e j a l a k l i n i s d a r i i n f e k s i s a i u r a n k e m i h s e s u a i d e n g a n b a g i a n s a i u r a n k e m i h

y a n g t e r i n f e k s i a d a i a h s e b a g a i b e r i k u t

1 ) I n f e k s i s a i u r a n k e m i h b a g i a n b a w a l i

K e l u h a n p a s i e n b i a s a n y a b e m p a r a s a s a k i t a t a u r a s a p a n a s d i u r e t r a s e w a k t u

k e n c i n g d e n g a n a i r k e m i h s e d i k i t - s e d i k i t s e r t a r a s a t i d a k e n a k d i d a e r a h

s i i p r a p u b i k

2 ) I n f e k s i s a i u r a n k e m i h b a g i a n a t a s

P a d a i n t e k s i s a i u r a n k e m i h b a g i a n a t a s d a p a t d i t e m u k a n g e j a l a s e p e r t i s a k i t

k e p a l a m a l a i s e m u a l m m i t a h d e n i a m m e n g g i g i l r a s a t i d a k e n a k a t a u

n y e r i d i p i n g g a n g ( T e s s y d k k 2 0 0 1 )

16

H Tatalaksana

T u j u a n p e n a t a l a k s a n a a a n i n f e k s i s a i u r a n k e m i h a d a i a h m e n c e g a h d a n

m e n g h i l a n g k a n g e j a l a m e n c e g a h d a n m e n g o b a t i b a k t e n e m i a d a n b a k t e r i u r i a s e r t a

m e n c e g a h d a n m e n g u r a n g i r i s i k o k e r u s a k a n g i n j a l y a n g m u n g k i n t i m b u l d e n g a n

p e m b e r i a n o b a t - o b a t a n y a n g s e n s i t i f m u r a l i d a n a m a n d e n g a n e f e k s a m p i n g y a n g

m i n i m a l

a ) i n f e k s i s a i u r a n k e m i h ( I S K ) b a w a h

P r i n s i p p e n a t a l a k s a n a a n I S K b a w a h m e l i p u t i intake c a i r a n y a n g b a n y a k

a n t i b i o t i k y a n g a d e k u a t d a n b i l a p e r l u t e r a p i s i m t o m a t i k u n t u k a l k a l i s a s i

u r i n

i H a m p i r 8 0 p a s i e n a k a n m e m b e r i k a n r e s p o n s e t e l a h 4 8 j a m d e n g a n

a n t i b i o t i k a t u n g g a l s e p e r t i a m p i s i l i n 3 g r a m a t a u t r i m e t o p r i m 2 0 0 m g

i i B i l a i n f e k s i m e n e t a p d i s e r t a i k e l a i n a n u r i n a l i s i s ( l e u k o s i u i a ) d i p e r i u k a n

t e r a p i k o n v e n s i o n a l s e l a m a 5 - 1 0 h a r i

i i i P e m e r i k s a a n m i k r o s k o p i s u r i n d a n b i a k a n u r i n t i d a k d i p e r i u k a n b i l a

s e m u a g e j a l a h i l a n g d a n t a n p a l e u k o s u r i a

b ) I n f e k s i s a i u r a n k e m i h ( I S K ) a t a s

P a d a u m u m n y a p a s i e n d e n g a n p i e l o n e f r i t i s a k u t m e m e r l u k a n r a w a t i n a p

u n t u k m e m e l i h a r a s t a t u s h i d r a s i d a n t e r a p i a n t i b i o t i k a p a r e n t e r a l p a l i n g

s e d i k i t 4 8 j a m ( S u d o y o 2 0 0 6 )

i Komplikasi

K o m p l i k a s i i n f e k s i s a i u r a n k e m i h t e r g a n t u n g d a r i t i p e y a i t u i n f e k s i s a i u r a n

k e m i h t i p e s e d e r h a n a (uncomplicated) d a n t i p e b e r k o m p l i k a s i (complicated)

1 ) I n f e k s i s a i u r a n k e m i h s e d e r h a n a (uncomplicated)

I n f e k s i s a i u r a n k e m i h a k u t t i p e s e d e r h a n a ( s i s t i t i s ) y a i t u n o n - o b s t r u k s i d a n

b u k a n p e r e m p u a n h a m i l m e m p a k a n p e n y a k i t r i n g a n (self limited disiase)

d a n t i d a k m e n y e b a b k a n a k i b a t l a n j u t j a n g k a l a m a

2 ) I n f e k s i s a i u r a n k e m i h b e r k o m p l i k a s i (complicated)

a ) I n f e k s i s a i u r a n k e m i h s e l a m a k e h a m i i a n

b ) i n f e k s i s a i u r a n k e m i h p a d a d i a b e t e s m e l i t u s ( S u d o y o 2 0 0 6 )

17

22 Kerangka Teori

J

U s i a

J e n i s K e i a m i n

T i n g k a t P e n d i d i k a n

R i w a y a t D i a b e t e s M e l i m s

S u m b a t a n bullT

K e h a m i i a n

D i s f u n g s i n e u r o g e n i k

R e f l u k s v e s i k o i i r e t e r a l

V i r u l e n s i b a k t e r i

F a k t o r g e n e t i k

I n f e k s i b a k t e r i g r a m p o s i t i f a t a u n e g a t i v e p a d a s a i u r a n k e m i h

I n f e k s i S a i u r a n K e m i h

Keterangan

I j = V a r i a b e l y a n g t i d a k d i t e l i t i

= V a r i a b e l y a n g d i t e l i t i

18

Hipotesis

H i p o t e s i s d a l a m p e n e l i t i a n i n i a d a i a h

H O t i d a k t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n

t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

H I t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

BAB 111

M E T O D E PENELITIAN

31 Jenis Penelitian

P a d a p e n e l i t i a n i n i j e n i s p e n e l i t i a n y a n g d i g u n a k a n a d a i a h p e n e l i t i a n

o b s e r v a s i o n a i a n a l i t i k d e s a i n cross scclional d e n g a n m e n g g u n a k a n d a t a s e k u n d e r

d a r i r e k a m m e d i s p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1 D e s e m b e r

2 0 1 5

32 Waktu dan Tempat Penelitian

321 Waktu Penelitian

W a k t u p e n e l i t i a n d i l a k s a n a k a n p a d a t a n g g a l 1 O k t o b e r s a m p a i d e n g a n 3 0

O k t o b e r 2 0 1 6

322 Tempat Penelitian

P e n e l i t i a n i n i d i l a k s a n a k a n d i R u m a l i S a k i t M u h a m m a d i y a h P a e m b a n g ( d i

R u a n g R e k a m M e d i s )

33 Populasi dan Sampel Penelitian

331Populasi Penelitian

P a d a p e n e l i t i a n i n i p o p u l a s i t a r g e t a d a l a l i p a s i e n r a w a t i n a p d a n r a w a t j a l a n

d i R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g s e d a n g k a n p o p u l a s i t e r j a n g k a u n y a

a d a i a h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

332Sampel dan Besar Sampel Penelitian

P a d a p e n e l i t i a n i n i s a m p e l p e n e l i t i a n a d a i a h p a s i e n r a w a t i n a p d a n r a w a t

j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e

1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 y a n g m e m e n u h i k r i t e r i a i n k l u s i p e n e l i t i a n

1 9

20

d e n g a n b e s a r s a m p e l y a n g l a y a k d a l a m p e n e l i t i a n m e n u r u t t e o r i R o s c o e a d a i a h

a n t a r a t i g a p u l u h s a m p a i l i m a r a t i i s o r a n g ( S u g i y o n o 2 0 1 5 )

333 Krttena Inklusi dan Eksklusi

A Kriteria Inklusi

P a d a p e n e l i t i a n i n i k r i t e r i a i n k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t i n a p

d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i

P a l e m b a n g y a n g d i d i a g n o s a m e n g a l a m i i n f e k s i s a i u r a n k e m i h s e r t a m e m i l i k i d a t a

r e k a m m e d i s p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

B Kriteria Eksklusi

P a d a p e n e l i t i a n i n i k r i t e r i a e k s k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t

i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 d e n g a n d a t a r e k a m m e d i s

y a n g t i d a k l e n g k a p

334 Cara Pengambilan Sampel Penelitian

C a r a p e n g a m b i l a n s a m p e l y a n g d i g u n a k a n d a l a m p e n e l i t i a n i n i a d a l a l i

m e n g g u n a k a n t e k n i k consecutive sampling P a d a consecutive sampling s e t i a p

p a s i e n y a n g m e m e n u h i k r i t e r i a p e n e l i t i a n d i m a s u k k a n d a l a m p e n e l i t i a n s a m p a i

k u r u n w a k t u t e r t e n U i s e h i n g g a j u m l a h m i n i m a l y a n g d i p e r i u k a n t e r p e n u h i

( S a s t r o a s m o r o 2 0 1 1 )

34 Variabel Penelitian

341 Variabel Dependent

V a r i a b e l dependent f t e r i k a t ) d a l a m p e n e l i t i a n i n i a d a i a h i n f e k s i s a i u r a n

k e m i h

342 Variabel Independent

V a r i a b e l independent ( b e b a s ) d a l a m p e n e l i t i a n i n i a d a i a h u s i a j e n i s

k e l a i n i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

21

35 Definisi Operasional

Tabel 31 Definisi Operasional

Variabel Alat Cara ueiinisi rldsil L KUr I7 i l l 11 Lz fe 1 V

oKaia LiKur Penelitian Ukur Ukur

Infeksi P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Saiuran d i d i a g n o s a o l e h m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Keniih d o k t e r m e n g a l a m i m e d i s

i n f e k s i s a i u r a n

k e m i h d a n t e r c a n t u m

d i r e k a m m e d i s

U s i a L a m a n y a t a h u n R e k a m O b s e r v a s i 1 lt 5 0 t a h u n O r d i n a l

k e h i d u p a n p a s i e n m e d i s r e k a m 2 gt 5 0 t a l i u n ( k a t e g o r i k )

d a r i l a h i r s a m p a i m e d i s

s e k a r a n g d a n

t e r c a n t u m d i r e k a m

m e d i s

Jenis P r o f i l a n a t o m i a t a u R e k a m O b s e r v a s i 1- L a k i - l a k i N o m i n a l

Keiamin b i o l o g i s p a s i e n y a n g m e d i s r e k a m 2 P e r e m p u a n ( k a t e g o r i k )

d i b e d a k a n m e n j a d i m e d i s

i a k i - l a k i d a n

n e r e m m i a n s e r t a

t e r c a n t u m d i r e k a m

m e d i s

Tingkat P e n d i d i k a n f o n n a l R e k a m O b s e r v a s i 1 P e n d i d i k a n O r d i n a l

Pendidikan t e r a k h i r y a n g m e d i s r e k a m d a s a r ( S D ( k a t e g o r i k )

d i t e m p u h o l e h m e d i s M I S M P

p a s i e n d a n t e r c a n t u m d a n M T s )

d i r e k a m m e d i s 2 P e n d i d i k a n

m e n e n g a l i

d a n t i n g g i

22

( S M A M A

S M K

M A K

d i p l o m a

s a r j a n a

m a g i St e r

s p e s i a l i s

d a n d o k t o r )

Riwayat P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Diabetes d i d i a g n o s i s d e n g a n m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Melitus d i a b e t e s m e l i t u s d a n

t e r c a n t u m d i d a l a m

r e k a m m e d i s

m e d i s

36 Cara Pengumpulan Data

361 Data Sekunder

P e n g u m p u l a n d a t a p a d a p e n e l i t i a n i n i d i p e r o l e h d a r i d a t a s e k u n d e r y a i t u

r e k a m m e d i s p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

37 Metode Teknik Analisis Data

371Cara Pengolahan dan Analisis Data

P e n g o l a h a n d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n m e l a l u i e m p a t t a h a p y a i t u

i Oala Entry

P a d a t a i i a p i n i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n riwayat d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g y a n g t e l a h d i d a p a t d a n

r e k a m m e d i s d i k u m p u l k a n d a n d i m a s u k k a n k e d a l a m p r o g r a m spss

23

2 Editing

P a d a t a h a p i n i d a t a i i s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n y a n g t e l a h d i m a s u k k a n k e d a l a m p r o g r a m s p s s

d i p e r i k s a k e m b a l i a p a k a h s u d a h l e n g k a p d a n t i d a k a d a k e k e l i r u a n

3 ( oding

S e t e l a h m e l a l u i p r o s e s editing d a t a - d a t a t e r s e b u t d i b e r i k o d e t e r t e n t u a n t a r a

l a i n k o d e 1 u n t u k u s i a gt 5 0 t a h u n j e n i s k e i a m i n p e r e m p u a n t i n g k a t

p e n d i d i k a n d a s a r t e r d a p a t r i w a y a t d i a b e t e s m e l i t u s d a n i n f e k s i s a i u r a n

k e m i h s e d a n g k a n k o d e 2 u n t u k u s i a lt 5 0 t a h u n j e n i s k e i a m i n l a k i - l a k i

t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i t i d a k t e r d a p a t r i w a y a t d i a b e t e s

m e l i t u s d a n b u k a n i n f e k s i s a i u r a n k e m i h s e h i n g g a m e m u d a h k a n d a l a m

m e l a k u k a n a n a l i s i s d a t a

4 Tahulaling

P a d a t a h a p i n i d a t a y a n g s a m a d i k e l o m p o k k a n s e c a r a t e l i t i d a n t e r a t m

k e m u d i a n d i l i i t u n g d e n g a n m e n g g u n a k a n p r o g r a m sps s d a n d i j u m l a h k a i i

l a l u d i s a j i k a n d a l a m b e n t u k t a b e l - t a b e l

U n t u k m e n g a n a l i s i s d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n a n a l i s i s d a t a

u n i v a r i a t d a n b i v a r i a t d e n g a n m e n g g u n a k a n p r o g r a m s p s s s e b a g a i b e r i k u t

A A n a l i s i s u n i v a r i a t

A n a l i s i s u n i v a r i a t d i l a k u k a n d e n g a n c a r a m e l a k u k a n a n a l i s i s p a d a s e t i a p

v a r i a b e l h a s i l p e n e l i t i a n d e n g a n t u j u a n u n t u k m e n g e t a h u i d i s t r i b u s i p r o p o r s i p a d a

s e t i a p v a r i a b e l p e n e l i t i a n D a t a d i s a j i k a n d a l a m b e n t u k t a b e l d a n n a r a s i

B A n a l i s i s b i v a r i a t

A n a l i s i s b i v a r i a t d i l a k u k a n d e n g a n m e n g g u n a k a n u j i h i p o t e s i s chi-square

U j i h i p o t e s i s chi-square d a p a t d i g u n a k a n d e n g a n s y a r a t y a i t u lt 2 0 s e l y a n g

m e m p u n y a i n i l a i expected count k u r a n g d a r i l i m a s e h i n g g a j i k a t i d a k m e m e n u h i

s y a r a t u j i chi-square m a k a u j i y a n g d i g u n a k a n a d a i a h u] fisher ( D a h l a n 2 0 1 4 )

B a t a s k e m a k n a a n y a n g d i g u n a k a n a d a i a h a = 0 0 5 J i k a d i d a p a t k a n p value lt 0 0 5

p a d a u j i s t a t i s t i k m a k a t i d a k t e r d a p a t h u b u n g a n y a n g b e n n a k n a a n t a r a d u a

v a r i a b e l y a n g d i t e l i t i d a n H O d i t e r i m a S e d a n g k a n j i k a d i d a p a t k a n p value gt 0 0 5

24

p a d a u j i s t a t i s t i k m a k a t e r d a p a t l i u b u n g a n y a n g b e n n a k n a a n t a r a d u a v a r i a b e l

y a n g d i t e l i t i d a n H O d i t o l a k

38 Alur Penelitian

P e n e n t u a n p o p u l a s i d a n s a m p e l p e n e l i t i a n

K r i t e r i a i n k l u s i K r i t e r i a e k s k l u s i

P e n g a m b i l a n s a m p e l p e n e l i t i a n

P e n g o l a h a n d a n a n a l i s i s d a t a d e n g a n u j i chi-square

H a s i l d a n p e m b a h a s a n

K e s i m p u l a n d a n s a r a n

Gambar 31 Alur Penelitian Hubungan Usia Jenis Keiamin Tingkat Pendidikan dan Riwayat Diabetes Melitus dengan Kejadian Infeksi Saiuran Kemih pada Pasien Rawat Inap di Bagian Penyakit Dalam Rumah Sakit Muhammadiyah Palembang Periode 1 Januari 2015 sampai dengan 31 Desember 2015

BAB IV

HASIL DAN PEMBAHASAN

41 Hasil

P e n e l i t i a n i n i t e l a h d i l a k u k a n d i r u a n g r e k a m m e d i s R u m a h S a k i t

M u h a i m n a d i y a h P a l e m b a n g d a r i t a n g g a l 1 O k t o b e r 2 0 1 5 - 3 1 O k t o b e r 2 0 1 6

P e n e l i t i a n d i m u l a i d e n g a n p e n g a m b i l a n d a t a a w a l b e m p a d a t a r e k a m m e d i s

s e l u r u h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

S e l a n j u t n y a r e k a m m e d i s d i p i l i h s e s u a i d e n g a n k r i t e r i a i n k l u s i d a n e k s k l u s i u n t u k

d i j a d i k a n s a m p e l p e n e l i t i a n s a m p a i m i n i m a l b e s a r s a m p e l y a n g d i b u t u h k a n

t e r p e n u h i s e r t a d i l a k u k a n p e n e l i t i a n s e c a r a o b s e r v a s i o n a i O b s e r v a s i r e k a m m e d i s

d i l a k u k a n u n m k m e n g e t a h u i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t

d i a b e t e s m e l i t u s d a n d i a g n o s a p a s i e n

D a r i c a t a t a n r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g

d i d a p a t k a n s e b a n y a k 4 1 4 1 r e k a m m e d i s p a s i e n r a w a t i n a p d a n 1 4 5 3 r e k a m m e d i s

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 D a r i t o t a l r e k a m m e d i s

p a s i e n r a w a t i n a p d a n r a w a t j a l a n t e r s e b u t p e n e l i t i h a n y a m e n g a m b i l m i n i m a l

b e s a r s a m p e l y a n g d i b u t u h k a n y a i t u s e b a n y a k 9 8 r e k a m m e d i s u n t u k d i j a d i k a n

s a m p e l p e n e l i t i a n y a n g t e r d i r i d a r i 3 0 r e k a m m e d i s p a s i e n y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i h d a n 6 8 r e k a m m e d i s y a n g t i d a k m e n g a l a m i i n f e k s i s a i u r a n k e m i h

411 Hasil Analisis Univariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s u n i v a r i a t

a n t a r a l a i n d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p b e r d a s a r k a n u s i a d a n

j e n i s k e l a m m d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n b e r d a s a r k a n u s i a

d a n j e n i s k e i a m i n d i s t r i b u s i p r o p o r s i s a m p e l b e r d a s a r k a n k e j a d i a n m f e k s i s a i u r a n

k e m i h s e r t a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n u s i a

j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

25

26

A Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan IJsta

dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 41 Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan

Usia dan Jenis Keiamin

Paisen Rawat Inap N Persentase

Usia

1 7 - 2 5 t a h u n 678 1 6 4

2 6 - 3 5 t a h u n 952 2 3 0

3 6 - 4 5 t a l i u n 745 18 0

4 6 - 5 5 t a h u n 695 1 6 8

5 6 - 6 4 t a h u n 571 1 3 8

gt 6 4 t a h u n 500 1 2 1

U s i a r a t a - r a t a ( t a h u n j 43plusmn16543

Jenis Keiamin

P e r e m p u a n 2 6 3 8 6 3 7

L a k i - l a k i 1 5 0 3 3 6 3

Total 4141 100

B e r d a s a r k a n t a b e l 4 1 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R i u n a h S a k i t M u l i a m m a d i y a l i

P a l e m b a n g p e r i o d e J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 2 6 - 3 5 t a h u n y a i t u

s e b a n y a k 9 5 2 o r a n g ( 2 3 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 43plusmn16543 t a l i u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 2 6 3 8 o r a n g ( 6 3 7 )

27

B Distribusi Proporsi Karakteristik Pasien Rawat Jalan Berdasarkan

Usia dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 42 Distribusi Proporsi Karakteristik Pasien Rawat Jalan

Berdasarkan Usia dan Jenis Keiamin

Fasten Rawat Jalan N Persentase

Usia

1 7 - 2 5 t a h u n 9 2 6 3

2 6 - 3 5 t a l n i n 1 3 1 9 0

3 6 - 4 5 t a h u n 2 7 9 1 9 2

46-55 t a l i u n 4 2 1 2 9 0

5 6 - 6 4 t a h u n 3 1 6 2 1 7

gt 6 4 t a h u n 2 1 4 1 4 7

U s i a r a t a - r a t a ( t a h u n ) 50plusmn14120

Jenis Keiamin

P e r e m p u a n 8 9 0 6 1 3

L a k i - l a k i 5 6 3 3 8 7

Total 1453 100

B e r d a s a r k a n t a b e l 4 2 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 4 6 - 5 5 t a h u n y a i t u

s e b a n y a k 4 2 1 o r a n g ( 2 9 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 50plusmn14120 t a h u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 8 9 0 o r a n g ( 6 1 3 )

28

C Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Usia

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i b b e r d a s a r k a n u s i a d a p a t

d i i i h a t p a d a l a b e l d i b a w a h i n i

Tabel 43 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Usia

Usia N Persentase

lt 5 0 t a h u n 1 4 4 6 7

gt 5 0 t a l i u n 1 6 5 3 3

Total 30 100

B e r d a s a r k a n t a b e l 4 3 d i a t a s d a p a t d i k e t a h u i b a h w a u s i a t e r b a n y a k p a d a

s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h gt 5 0 t a h u n y a i t u s e b a n y a k

1 6 o r a n g ( 5 3 3 )

D Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Jenis

Keiamin

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n j e n i s

k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 44 Distribusi Proporsi Kejadian infeksi Saiuran Kemih Berdasarkan

Jenis Keiamin

Jenis Keiamin N Persentase

P e r e m p u a n 1 8 6 0 0

L a k i - l a k i 1 2 4 0 0

Total 30 100

B e r d a s a r k a n t a b e l 4 4 d i a t a s d a p a t d i k e t a h u i b a h w a j e n i s k e i a m i n

t e r b a n y a k p a d a s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h p e r e m p u a n

y a i t u s e b a n y a k 1 8 o r a n g ( 6 0 0 )

29

E Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n t i n g k a t

p e n d i d i k a n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 45 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

Tingkat Pendidikan N Persentase

P e n d i d i k a n d a s a r 20 6 6 7

P e n d i d i k a n m e n e n g a h d a n P e n d i d i k a n m e n e n g a h d a n 10 333

t i n g g i

Total J O 100

B e r d a s a r k a n t a b e l 4 5 d i a t a s d a p a t d i k e t a l i u i b a l i w a t i n g k a t p e n d i d i k a n

t e r b a n y a k p a d a s a m p e i y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h t i n g k a t

p e n d i d i k a n d a s a r y a i t u s e b a n y a k 20 o r a n g ( 6 6 7 )

P Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n riwayat

d i a b e t e s m e l i t u s d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 46 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

Riwayat Diabetes Melitus N Persentase

Y a 17 5 6 7

T i d a k 13 433

Total 30 100

B e r d a s a r k a n t a b e l 4 6 d i a t a s d a p a t d i k e t a h u i b a l i w a s a m p e l y a n g

m e n g a l a m i i n f e k s i s a i u r a n k e m i h t e r b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s

y a i t u s e b a n y a k 1 7 o r a n g ( 5 6 7 )

30

412 Hasil Analisis Bivariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s b i v a r i a t

a n t a r a I a i n h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h j e n i s

k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h t i n g k a t p e n d i d i k a n d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n

i n f e k s i s a l m a n k e m i h

A n a l i s i s y a n g d i g u n a k a n p a d a u j i d u a v a r i a b e l y a n g b e r s k a l a k a t e g o r i k

a d a l a l i d e n g a n u j i Chi-Square d e n g a n n i e i h a t n i l a i Pearson Chi-Square S e m u a

h a s i l d a r i u j i h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h m e n g g i u i a k a n u j i Chi-

Square k a i e n a m e m e n u h i s y a r a t u j i Chi-Square y a i t u lt 2 0 s e l y a n g m e m p u n y a i

n i l a i expected count lt 5

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 47 Hasil Uji Hubungan antara Usia dengan Kejadian Infeksi

Saiuran Kemih

Usia

Infeksi Saiuran Kemih

^a Tidak

n N Mgt

Jumlah P

value 95Cl

lt 50 t a h u n 1 4 1 9 2 5 9 8 0 8 7 3 0 0 0 0 2 7 4 7 - 2 0 4 3 1

gt 5 0 t a h u n 1 6 6 4 0 9 3 6 0 2 5

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 7 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R = 7 4 9 2

( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a u s i a gt

5 0 t a h u n a d a l a l i 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a u s i a lt 5 0 t a h u n

31

B Hubungan antara Jenis Keiamin dengan Kejadian Infeksi Saiuran

Kemih

H a s i l a n a l i s i s b i v a r i a t l i u b u n g a n a n t a r a j e n i s k e l a i n i n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

Tabel 48 Hasil Uji Hubungan antara Jenis Keiamin dengan Kejadian

Infeksi Saiuran Kemih

Infeksi Saiuran Kemih Jenis P

A Tidak Jumlah 95CI Keiamin value

N N

P e r e m p u a n 18 6 4 3 10 357laquoo 2 8 3 2 2 7 -P e r e m p u a n 0 0 0 0

L a k i - l a k i 12 1 7 1 5 8 8 2 9 7 0 2 3 4 5 9

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 8 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a l a l i

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k N 4 a k a a d a l i u b u n g a n y a n g s i g n i f i k a n a n t a r a

j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R ) = 8 7 0 0

f 9 5 C I = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a l a k i - l a k i

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e n i i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

32

Tabel 49 Hasil liji Hubungan antara Tingkat Pendidikan dengan

Kejadian Infeksi Saiuran Kemih

Infeksi Saiuran Kemih P

Y a T i d a k jumlah 95CI value

N

P e n d i d i k a n d a s a r 2 0 5 4 1 1 7 4 5 9 3 7

P e n d i d i k a n

m e n e n g a h d a n 10 1 6 4 5 1 8 3 6 6 1

t i n g g i

Jumlah JO 30 6 68 694 9H

B e r d a s a r k a n t a b e l 4 9 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( 0 R ) =

6 0 0 0 ( 9 5 C I = 2 3 5 1 - 1 5 3 1 0 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r a d a i a h 6 k a l i l e b i h b e s a r

d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i h a t

p a d a t a b e l d i b a w a h i n i

Tingkat

Pendidikan

2 3 5 1 -0 0 0 0

1 5 3 1 0

33

Tabel 4t0 Hasil I j i Hubungan antara Riwayat Diabetes Melitus dengan

Kejadian Infeksi Saiuran Kemih

Riwayat Infeksi Saiuran Kemih P

Diabetes Va Tidak Jumlah value

95CI

Melitus N bullVJ N

Y a

T i d a k

17

1 3

6 8 0

1 7 8

8

6 0

3 2 0

8 2 2

2 5

7 3 0 0 0 0

3 4 9 3 -

2 7 5 3 6

Jumlah 30 306 68 571 98

B e r d a s a r k a n t a b e l 4 1 0 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio

( O R ) = 9 8 0 8 ( 9 5 C I - 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r

d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s m e l i m s

42 Pembahasan

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a l a b e l 4 7 d i d a p a t k a n b a l i w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i b d e n g a n n i l a i s i g n i f i k a n n y a a d a l a l i 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k

Odds Ratio ( O R ) = 7 4 9 2 ( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a u s i a T 5 0 t a h u n a d a i a h 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a

u s i a lt 5 0 t a h u n

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n A n d r y L u k a n d y

( 2 0 1 4 ) m e n g e n a i k a r a k t e r i s t i k p a s i e n - p a s i e n i n f e k s i s a i u r a n k e m i h d i m a n a

p e n d e r i t a I S K d e n g a n k e l o m p o k u m u r gt 5 0 t a h u n s e b a n y a k 2 3 o r a n g s e d a n g k a n

j u m l a h p e n d e r i t a I S K d e n g a n k e l o m p o k u m m lt 5 0 t a l i u n s e b a n y a k 2 0 o r a n g

P e n e l i t i a n i n i j u g a d i p e i k u a t o l e h p e n l i t i a n L e w i s A l e t a l ( 2 0 1 4 ) m e n g e n a i

impact of host age and parity on susceptihility to severe urinary tract injection in

34

a murine mode d e n g a n u j i K r u s k a l - W a l l i s d e n g a n post-test D u n n u n t u k b e b e r a p a

p e r b a n d i n g a n d i m a n a u s i a d a n p a r i t a s s e b a g a i f a k t o r y a n g b e r k o n t r i b u s i d a l a m

k e r e n t a n a n i m t u k t e r j a d i n y a I S K d e n g a n n i l a i p lt 0 0 5

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n g a t a k a n b a h w a i n s i d e n I S K m e n i n g k a t

b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n

a d a n y a a b n o r m a l i t a s a n a t o m i y a n g m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n

k e m i h s e p e r t i p e m b e s a r a n p r o s t a t d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a

p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e ( R o s e 2 0 0 9 ) P e n y e b a b l a i n t e n n a s u k

p e r i n e i u n y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s p e n y a k i t n e u r o m u s k u l a r

d a n k a t e t e r i s a s i b u l i - b u l i ( F o x m a n e t a l 2 0 1 0 ) S e l a i n i t u i n s i d e n I S K m e n c a p a i

1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o n a l d 2 0 1 1 )

B Hubungan antara Jenis Keiamin dengan Kejadian infeksi Saiuran

Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 8 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d e n g a n n i l a i s i g n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O

d i t o l a k Odds Ratio ( O R ) = 8 7 0 0 ( 9 5 C l = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a risiko k e j a d i a n

i n f e k s i s a i u r a n k e m i h p a d a p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n

p a d a l a k i - i a k i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n M a g i i a n o e t a l

( 2 0 1 1 ) m e n g e n a i Gender and Age-Dependent Etiology of Community Acquired

y a n g m e l a k u k a n p e n g a m b i l a n 6 1 2 7 3 s a m p e l k u l t u r u r i n d a l a m p e r i o d e 2 2 b u l a n

d a r i s a m p e l i n i d i d a p a t k a n 1 3 8 2 0 ( 2 2 6 ) d i t e m u k a n p o s i t i f i n f e k s i b a k t e r i

h a m p i r 8 0 b a l i a n y a n g d i i s o l a s i b e r a s a l d a r i p e r e m p u a n P e n e l i t i a n i n i j u g a

d i p e r k u a t o l e h p e n e l i t i a n y a n g d i l a k u k a n o l e h Y u n i t a I ( 2 0 1 0 ) d i m a n a a d a

h u b m i g a n y a n g b e n n a k n a a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h ( P value=O049 R P = 3 2 7 3 ( 9 5 C I = I 0 1 6 - 1 0 5 4 0 )

H a l t e r s e b u t d a p a t t e r j a d i k a r e n a u r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a l i

d e n g a n d e k a t n y a v a g i n a l v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i

s a i u r a n k e m i h l e b i h s e r i n g p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a flora n o r m a l

3 5

p a d a d a e r a h p e r i u r e t r a t e r d i r i d a r i o r g a n i s m e s e p e r t i i a c t o b a c i l l u s y a n g m e m b a n t u

m e l a w a n k o l o n i s a s i b a k t e r i p a t o g e n p a d a s a i u r a n k e m i h P e r u b a h a n l i n g k i m g a n

d a r i p e r i u r e t r a l s e p e r t i p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k

b i s a m e n g g a n g g u f l o r a n o r m a l s e h i n g g a m e n u m g k i n k a n b a k t e r i p a t o g e n

b e r k o l o n i s a s i d a n m e n y e b a b k a n i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Scuare p a d a t a b e l 4 9 d i d a p a t k a n b a h w a

t e r d a p a t l i u b u n g a n y a n g s i g n i f i k a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a

H O d i t o l a k Odds Ratio ( O R ) - 6 0 0 0 ( 9 5 o C l = 2 3 5 1 - 1 5 3 I O ) a r t i n y a n s i k o

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r

a d a i a h 6 k a l i l e b i h b e s a r d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n

m e n e n g a h d a n t i n g g i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h T o r o n d e i B e t

a l ( 2 0 1 5 ) m e n g e n a i Menstrual Hygiene Practices WASH Access and the Risk of

Urogenital Infection in Women from Odisha India d i m a n a p e r e m p u a n y a n g

h a n y a m e n e m p u l i p e n d i d i k a n s e k o l a h d a s a r a t a u l e b i h r e n d a h d i b a n d i n g k a n

d e n g a n t i n g k a t p e n d i d i k a n m e n e n g a h a t a u t i n g g i m e m i l i k i r i s i k o 3 k a l i

k e m u n g k i n a n l e b i h b e s a r m e n g a l a m i i n f e k s i s a i u r a n k e m i h ( A d j O R = 3 l 9 5

C 1 = I 2 - 7 9 p = 0 0 2 )

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a p e n g e t a h u a n s e s e o r a n g

t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t p e n d i d i k a n S e s e o r a n g y a n g

m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m u n g k i n a n p e n g e t a l i u a n t e n t a n g

k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o r m a s i y a n g d i d a p a t k a n t e n t a n g k e s e h a t a n

l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h S e b a l i k n y a

p e n d i d i k a n y a n g k u r a n g d a p a t i n e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g t e r h a d a p

n i l a i - n i l a i y a n g b a r u d i k e n a l ( N o t o a d m o j o 2 0 0 3 )

3 6

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Keniih

B e r d a s a r k a n l i a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 1 0 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a r i w a y a t d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 )

s e h i n g g a H O d i t o l a k Odds Ratio ( O R ) = 9 8 0 8 ( 9 5 C I = 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a

risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h S a r i E W P d a n

S a t y a b a k t i P ( 2 0 1 5 ) m e n g e n a i p e r b e d a a n risiko i n f e k s i n o s o k o m i a l s a i u r a n k e m i h

b e r d a s a r k a n k a t e t e r i s a s i u r i n u m u r d a n d i a b e t e s m e l i m s d i m a n a d a r i 2 0 p a s i e n

i n f e k s i n o s o k o m i a l s a i u r a n k e m i h 1 2 o r a n g ( 6 0 ) d i a n t a r a n y a a d a i a h p a s i e n

d e n g a n s t a t u s D M s e d a n g k a n 8 o r a n g ( 4 0 ) l a i n n y a a d a i a h p a s i e n t a n p a s t a t u s

D M ( P v W w ^ = 0 0 2 4 O R = 6 0 0 9 5 C I = 1 2 2 - 3 2 2 6

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a b a l i w a b e b e r a p a b a g i a n

d a r i i i n u n i t a s p a d a p a s i e n d i a b e t e s m e n g a l a m i p e r u b a h a n F u n g s i

p o l i n i o r f o l e u k o s i t d i t e k a n p a d a k e a d a a n a s i d o s i s I k a t a n l e u k o s i t k e m o t a k s i s d a n

f a g o s i t o s i s j u g a b e m b a l i S i s t e m a n t i o k s i d a n y a n g b e r p e r a n p a d a a k t i f i t a s

b a k t e r i s i d a l j u g a t e r g a n g g u s e h i n g g a m e n y e b a b k a n t e r j a d i n y a I S K p a d a p a s i e n -

p a s i e n d e n g a n p e n y a k i t d i a b e t e s ( J u l k a 2 0 1 4 )

H a l y a n g s a m a j u g a d i i m g k a p k a n o l e b t e o r i S m e l t z e r d a n B a r e ( 2 0 1 0 )

b a l i w a D M d a p a t m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a l i a n a n t u b u h y a n g

b e r p o t e n s i m e n i n g k a t k a n r i s i k o t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a l i a n a n

t u b u h t e r s e b u t d i a n t a r a n y a a d a i a h k e g a g a l a n m i g r a s i s e l iniraceliular killing

f a g o s i t o s i s d a n k e m o t a k s i s p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n

m e k a n i s m e p e r t a l i a n a n a l a m i a h I o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p

i n f e k s i

BAB V

KESIMPULAN DAN SARAN

51 Kesimpulan

1 U s i a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 2 6 - 3 5 t a h u n y a i t u 2 3 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 3 7

2 U s i a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 4 6 - 5 5 t a l i u n y a i t u 2 9 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 1 3

3 U s i a j e n i s k e i a m i n d a n t i n g k a t p e n d i d i k a n s a m p e i y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i l i t e r b a n y a k y a i t u b e r u s i a gt 5 0 t a h u n ( 5 3 3 ) j e n i s k e i a m i n

p e r e m p u a n ( 6 0 0 ) d a n t i n g k a t p e n d i d i k a n d a s a r ( 6 6 7 ) s e r t a p a l i n g

b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s y a i t u 5 6 7

4 T e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 ( p = 0 0 0 0 )

52 Saran

1 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t d i l a k u k a n d e n g a n d e s a i n

p e n e l i t i a n b e r b e d a s e p e r t i cohort a t a u case control

2 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t m e i i c a r i v a r i a b e l independent

y a n g l a i n s e p e r t i v a r i a b e l p e k e r j a a n p e m a s a i i g a n k a t e t e r a t a u l a m a n y a

m e n d e r i t a d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

37

DAFTAR PUSTAKA

B o y k o E J d k k 2 0 0 2 D i a b e t i c A n d T h e R i s k O f A c u t e U r i n a r y T r a c t I n f e c t i o n A m o n g P o s t m e n o p a u s a l W o m e n D i a b e t e s C a r e 2 5 ( 1 0 )

D a h l a n S 2 0 1 4 B u k i i S t a t i s t i k u n t u k K e d o k t e r a n d a n K e s e h a t a n D e s k r i p t i f B i v a r i a t d a n M u l t i v a r i a t d i l e n g k a p i a p l i k a s i d e n g a n m e n g g u n a k a n S P S S E d i s i 6 E p i d e m i o l o g i I n d o n e s i a J a k a r t a I n d o n e s i a

D e p a r t e m e n K e s e h a t a n ( D E P K E S ) R l 2 0 1 4 [ O n l i n e ] K e m e n t e r i a n K e s e h a t a n R e p u b l i k I n d o n e s i a P u s a t D a t a d a n I n f o r m a s i K e m e n t e r a n K e s e h a t a n R l ( http 7depkesgoid diakses tanggal 15 Met 2016)

F o x m a n B e t a i 2 0 1 0 U r i i i a i y T r a c t I n f e c t i o n A m o n g W o m e n A g e d 4 0 T o 6 5 B e h a v i o r a l A n d S e x u a l R i s k F a c t o r s D a l a m T a n a g h o E A M c A n i n c h J W 1 7 t h S m i t h s G e n e r a l U r o l o g y U S A M c G r a w H i l l (http searchproqnestcom diakses tanggal 16 Met 2016)

H a r d i n g G K d k k 2 0 1 0 A n t i m i c r o b i a l T r e a t m e n t I n D i a b e t i c W o m e n W i t l i A s y m t o m a t i c B a c t e r i u r i a N E n g l J M e d 3 4 7 1 5 7 6 - 1 5 8 3 (http nejmorg diakses tanggal 16 Met 2016)

I s s e l b a c h e r d k k 2 0 0 9 I n f e k s i S a i u r a n K e m i h d a n P i e l o n e f r i t i s D a l a m S t a m m W a l t e r E e d H a r r i s o n P r i n s i p - P r i n s i p l l m u P e n y a k i t D a l a m e d V o l u m e 2 J a k a r t a E G C 6 1 6 - 6 2 3

J u l k a S 2 0 1 3 G e n i t o u r i n a r y I n f e c t i o n I n D i a b e t e s I n d i a n J o u m a l o f E n d o c r i n o l o g y a n d M e t a b o l i s m (http searchproquestcom diakses tanggal 16 Mei 2016)

K i m B d k k 2 0 1 2 [ e - b o o k ] T h e R e l a t i o n b e t w e e n P o s t v o i d R e s i d u a l a n d O c c u r r e n c e o f U r i n a r y T r a c t I n f e c t i o n a f t e r S t r o k e i n R e h a b i l i t a t i o n U n i t A n n a l s o f R e h a b i l i t a t i o n M e d i c i n e

K o m a r a A 2 0 0 9 P o l a K e p e k a a n B a k t e r i G r a m N e g a t i f d a r i P a s i e n I n f e k s i S a i u r a n K e m i l i t e r h a d a p A n t i b i o t i k G e n t a m i c i n d a n K o t r i m o k s a z o l y a n g D i k i r i m k e L a b o r a t o r i u m M i k r o b i o l o g i K l i n i k F K U l d a r i T a h u n 2 0 0 1 s a m p a i T a h u n 2 0 0 5 (http dontaruiacid diakses tanggal OH Agustiis 2016)

L e w i s A L e t a l 2 0 1 4 I m p a c t o f H o s t A g e a n d P a r i t y o n S u s c e p t i b i l i t y t o S e v e r e U r i n a r y T r a c t I n f e c t i o n i n a M u r i n e M o d e l P l o s O n e R e s e a r c h A r t i c l e P u b l i c L i b r a r y o f S c i e n c e 9 ( 5 ) (http searchproquestcom diakses pada langgal 30 Desember 2016)

38

2

s a m p a i 7 5 R e k u r e n s i c u k u p s e r i n g d a n t e r j a d i s e k i t a r 1 8 p a d a b a y i l a k i - i a k i

d a n 2 6 p a d a b a y i p e r e m p u a n U n t u k u s i a p r a s e k o l a h I S K l e b i h s e r i n g

m e n g e n a i w a n i t a I n s i d e n I S K p a d a a n a k - a n a k p r a s e k o l a h s e k i t a r 2 ( S y a h r i n i

2 0 1 1 )

D a r i b e r b a g a i p e n e l i t i a n e p i d e m i o l o g i s d i I n d o n e s i a d i d a p a t k a n p r e v a l e n s i

D M s e b e s a r 15 - 2 3 p a d a p e n d u d u k u s i a l e b i J i d a r i 1 5 t a h u n b a h k a n p a d a

s u a t u p e n e l i t i a n e p i d e m i o l o g i s d i M a n a d o d i d a p a t k a n p r e v a l e n s i D M a d a i a h 6 1

P r e v a l e n s i d i a b e t e s m e l i t u s p a d a p e n d u d u k u s i a 2 5 - 6 4 t a h u n d i J a w a d a n B a l i

s e b e s a r 7 5 P e n e l i t i a n y a n g d i l a k u k a n d i J a k a r t a S u r a b a y a M a k a s a r d a n k o t a -

k o t a l a i n d i I n d o n e s i a m e m b u k t i k a n a d a n y a k e n a i k a n p r e v a l e n s i d a r i t a h u n

k e t a h u n ( D E P K E S 2 0 1 4 W H O 2 0 1 0 )

I n f e k s i s a i u r a n k e m i h j u g a m e n i p a k a n m a s a l a h k l i n i s u m u m p a d a p e n d e r i t a

D M o l e h k a r e n a p e n d e r i t a D M m e m p u n y a i k e m u n g k i n a n m e n d e r i t a I S K l e b i h

t i n g g i d i b a n d i n g k a n d e n g a n b u k a n p e n d e r i t a D M d a n j u g a m e n d e r i t a i n f e k s i y a n g

l e b i h b e r a t y a n g a k a n m e n i n g k a t k a n risiko u n t u k m a s u k m m a h s a k i t ( H a r d i n g

d k k 2 0 1 0 ) P e n e l i t i a n y a n g d i l a k u k a n o l e h B o y k o d k k m e n d a p a t k a n w a n i t a D M

ripe 2 d e n g a n b a k t e r i u r i a s i m t o m a t i k s e t e l a h d i l a k u k a n p e m a n t a u a n s e l a m a 1 8

b u l a n m e n g a l a m i p e n i n g k a t a n r i s i k o m e n d a p a t k a n I S K s e b a n y a k 3 4

d i b a n d i n g k a n d e n g a n w a n i t a y a n g t i d a k m e n g a l a m i D M s e b e s a r 1 9 ( B o y k o d k k

2 0 0 2 )

B e r d a s a r k a n u r a i a n - u r a i a n d i a t a s s e r t a b e l u m a d a n y a p e n e l i t i a n y a n g

m e n e m u k a n k e t e r k a i t a n f a k t o r u s i a j e n i s k e l a m m t i n g k a t p e n d i d i k a n d a n r i w a y a t

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h d i K o t a P a l e m b a n g m a k a

p e n e l i t i t e r t a r i k i m t i i k m e l a k u k a n p e n e l i t i a n m e n g e n a i h u b u n g a n a n t a r a u s i a j e n i s

k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

3

12 Rumusan Masalah

1 B a g a i m a n a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s

m e l i t u s

2 A p a k a l i a d a h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

13 Tujuan Penelitian

131 Tujuan Umum

T u j u a n u m u m d a r i p e n e l i t i a n i n i a d a i a h d i k e t e m u k a n n y a h u b u n g a n a n t a i a

u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i m s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

132 Tujuan Khusus

T u j u a n k l i u s u s d a r i p e n e l i t i a n i n i y a i t u

1 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a

2 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n m f e k s i s a i u r a n k e m i b p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n j e n i s k e i a m i n

3 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

4

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n t i n g k a t p e n d i d i k a n

4 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n riwayat d i a b e t e s m e l i t u s

5 T e r a n a l i s i s n y a h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a i m n a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

6 T e r a n a l i s i s n y a h u b u n g a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

7 T e r a n a l i s i s n y a h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

8 T e r a n a l i s i s n y a h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i u i s d e n g a n k e j a d i a n

i n f e k s i s a l i u a i i k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

14 Manfaat Penelitian

141 Manfaat Teoritis

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t m e n a m b a h p e n g e t a h u a n p e n e l i t i

t e n t a n g h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i U i s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

5

142 Manfaat Praktis

A Bagi Peneliti

H a s i l p e n e l i t i a n i n i d i l i a r a p k a n d a p a t d i g u n a k a n s e b a g a i s a l a h s a t u b a h a n

r e f e r e n s i a t a u b a c a a n b a g i p e n e l i t i

B Bagi Institusi

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t d i g u n a k a n p i h a k R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g s e b a g a i s a l a l i s a t u b a h a n a c u a n d a l a m m e n g u p a y a k a n

p e n c e g a h a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

15 Keaslian Penelitian

T a b e l 1 1 K e a s l i a n P e n e l i t i a n

Nama Judul Penelitian Desain Hasil Penelitian

Peneliti Penelitian

Kugan P r e v a l e n s i I n f e k s i Cross D a r i p e n e l i t i a n i i i i

Kandasamy S a i u r a n K e m i l i P a d a seciUmal d i p e r o l e h b a l i w a

W a n i t a Y a n g M e n d e r i t a

D i a b e t e s M e l i t u s T i p e

I I Y a n g D i r a w a t I n a p

p a s i e n w a n i t a d i a b e t e s

m e l i t u s t i p e I y a n g

m e n d e r i t a I S K y a n g

D a n D i r a w a t J a l a n D i d i r a w a t m a p d a n

S u b b a g i a n

E n d o k r i n o l o g i B a g i a n

P e n y a k i t D a l a m D i

d i r a w a t j a l a n d i s u b

b a g i a n E n d o k r i n o l o g i

P e n y a k i t D a l a m

R S U P H A d a m M a l i k R S U P H A d a m

P a d a T a l i u n 2 0 0 9 M a l i k M e d a i i t e r d a p a t

s e b a n y a k 2 5 o r a n g

y a i t u ( 1 2 7 ) D a r i 2 5

o r a n g y a n g m e n d e r i t a

I S K t e r d a p a t 3 o r a n g

y a i t u ( 1 2 0 ) y a n g

d i r a w a t i n a p d a n 2 2

6

o r a n g ( 8 8 0 ) y a n g

d i r a w a t j a l a n

Edel Weisela P e r b e d a a n R i s i k o

Permata I n f e k s i N o s o k o m i a l

Sari dan S a i u r a n K e m i h

Prijono B e r d a s a r k a n

Satyabakti K a i e t e r i s a s i U r i n

U m u r D a n D i a b e t e s

M e l i t u s T a h u n 2 0 1 5

Case H a s i l p e n e l i t i a n y a n g

control d i 1 a k u k a n p a d a 2 0

s a m p e l k a s u s d a n

k o n t r o l m e n u n j u k k a n

b a h w a p a s i e n d e n g a n

u m u r gt 5 5 t a h u n

m e m p u n y a i r i s i k o

5 5 7 k a l i m e n g a l a m i

i n f e k s i n o s o k o m i a l

s a i u r a n k e m i h

d i b a n d i n g k a n p a s i e n

d e n g a n u m u r lt 5 5

t a h u n d e n g a n

p e r i l i t u n g a i i b e s a r

risiko d i p e r o l e h n i l a i

O R s e b e s a r 5 5 7

d e n g a n n i l a i 9 5

(onfidence Interval

l 1 9 lt O R lt 2 8 2 3

P a s i e n d e n g a n s t a t u s

D M m e m p u n y a i risiko

6 k a l i u n t u k

m e n g a l a m i i n f e k s i

n o s o k o m i a l s a i u r a n

k e m i h d i b a n d i n g k a n

d e n g a n p a s i e n y a n g

t i d a k m e n d e r i t a D M

d e n g a n n i l a i O R

7

s e b e s a r 6 0 0 d e n g a n

n i l a i 9 5 Confidence

Interval 1 22 lt O R lt

3 2 2 6

Andry K a r a k t e r i s t i k P a s i e n - D e s k r i p k i f H a s i i p e n e l i t i a n d a r i

Lukandy P a s i e n I n f e k s i S a i u r a n r e t r o s p e k t i f 4 3 o r a n g p e n d e r i t a

K e m i i i d i P o l i u r o l o g i

R S U D D r P i m g a d i

K o t a M e d a n T a h u n

2 0 1 2 - 2 0 1 3

I S K d i d a p a t k a n 5 3 5

p a d a k e l o m p o k u s i a

gt 5 0 t a h u n 5 1 2

b e i j e n i s k e i a m i n l a k i -

l a k i 1 0 0 t i d a k

m e n d e r i t a

v e s i c o u r e t r a l r e f l u x

7 0 Benign Prostatic

Hyperplasia 1 1 6

b a t u s a i u r a n k e m i h

2 7 9 d i a b e t e s t i p e 2

D a r i h a s i l p e n e l i t i a n

i n i d a p a t d i s i m p u l k a n

b a h w a p e n d e r i t a i S K

l e b i h b a n y a k t e r j a d i

p a d a l a k i - l a k i d a n

p e n d e r i t a I S K l e b i h

b a n y a k d i j u m p a i p a d a

k e l o m p o k u m u r gt 5 0

t a h u n s e r t a d i t e m u k a n

I S K d e n g a n B P H

B S K d a n D M T i p e 2

BAB 11

TINJAUAN PUSTAKA

21 Landasan Teori

211Infeksi Saiuran Keniih

A Definisi

I n f e k s i S a i u r a n K e m i h a d a i a h i n v a s i d a n m u l t i p l i k a s i m i k r o o r g a n i s m e a t a u

p a r a s i t d a l a m j a r i n g a n t u b u h k h u s u s n y a s a i u r a n k e m i h y a n g t e r d i r i d a r i g i n j a l

u r e t e r b u l i - b u l i d a n u r e t r a y a n g d i i a n d a i d e n g a n a d a n y a b a k t e r i 1 0 c f i i (colony

forming unit) p e r m l p a d a p e n g a m b i l a n c o n t o h u r i n ( P u m o m o 2 0 1 1 )

I n f e k s i s a i u r a n k e m i h a d a l a l i s u a t u i n f e k s i y a n g m e l i b a t k a n g i n j a l lU e ter

b u l i - b u l i a t a u p u n u r e t r a I n f e k s i s a i u r a n k e m i h ( I S K ) a d a l a l i i s t i l a h u m u m y a n g

m e n u n j u k k a n k e b e r a d a a n m i k r o o r g a n i s m e d a l a m u r i n ( S u d o y o 2 0 0 6 )

B a k t e r i u r i a b e r m a k n a (significant hacteriuria) a d a i a h s u a t u k e a d a a n y a n g

m e n u n j u k k a n p e n u m b u l i a n m i k r o o r g a n i s m e m u m i l e b i h d a r i 1 0 c f t L m l p a d a

b i a k a n u r i n B a k t e r i u r i a b e r m a k n a m u n g k i n t a n p a d i s e r t a i p r e s e n t a s i k l i n i s I S K

d a n d i n a m a k a n b a k t e r i u r i a a s i m t o m a t i k (convert hacteriuria) S e b a l i k n y a

b a k t e r i u r i a b e n n a k n a d i s e r t a i p e r s e n t a s i k l i n i s I S K d i n a m a k a n b a k t e r i u r i a

s i m t o m a t i k P a d a b e b e r a p a k e a d a a n t e r d a p a t p a s i e n d e n g a n p e r s e n t a s i k l i n i s I S K

n a m u n t a n p a b a k t e r i u r i a b e n n a k n a S e l a i n i t u d i k a t a k a n p i u r i a ( l e u k o s i t d a l a m

u r i n ) b e n n a k n a (significant pyuria) b i l a d i t e m u k a n n e u t r o f i l gt 1 0 s e l p e r l a p a n g a n

p a n d a n g ( S u d o y o 2 0 0 6 )

B Epidemiologi

I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m u k a n d i p r a k t i k u m u m w a i a u p u n b e n n a c a m - m a c a m a n t i b i o t i k a s u d a h

t e r s e d i a l u a s d i p a s a r a n D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r

2 5 - 3 5 s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a

S e l a m a p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n

9

10

c e n d e r u n g m e n d e r i t a i S K d i b a n d i n g k a n l a k i - l a k i I S K b e m l a n g p a d a l a k i - l a k i

j a r a n g d i l a p o r k a n k e c u a l i d i s e r t a i f a k t o r p r e d i s p o s i s i ( p e n c e t u s )

P r e v a l e n s i b a k t e r i u r i a a s i m t o m a t i k l e b i h s e r i n g d i t e m u k a n p a d a p e r e m p u a n

P r e v a l e n s i s e l a m a p e r i o d e s e k o l a h (school girls) 1 m e n i n g k a t m e n j a d i 5

s e l a m a p e r i o d e a k t i f s e c a r a s e k s u a l P r e v a l e n s i i n f e k s i a s i m t o m a t i k m e n i n g k a t

m e n c a p a i 3 0 b a i k l a k i - l a k i m a u p u n p e r e m p u a n b i l a d i s e r t a i f a k t o r p r e d i s p o s i s i

( S u d o y o 2 0 0 6 )

C Kiasifikasi

I n f e k s i s a i u r a n k e m i h d a p a t d i b a g i m e n j a d i d u a k a t e g o r i u m u m b e r d a s a r k a n

l o k a s i a n a t o m i y a i t u

1 ) I n f e k s i s a i u r a n k e m i h b a w a h

2 ) I n f e k s i s a i u r a n k e m i h a l a s

P r e s e n t a s i k l i n i s d a r i i n f e k s i s a i u r a n k e m i h b a w a l i t e r g a n t u n g d a r i gender

y a i t u

a ) P e r e m p u a n

a S i s t i t i s

S i s t i t i s a d a i a h p r e s e n t a s i k l i n i s i n f e k s i k a n d u n g k e m i h d i s e r t a i

b a k t e r i u r i a b e n n a k n a

b S i n d r o m U r e t r a A k u t ( S U A )

S i n d r o m a u r e t r a a k u t a d a i a h p r e s e n t a s i k l i n i s s i s t i t i s t a n p a d i t e m u k a n

a d a n y a m i k r o o r g a n i s m e d a l a m L u i n ( s t e r i l ) d a n s e r i n g d i n a m a k a n

s i s t i t i s b a k t e r i a l i s

b ) L a k i - l a k i

P r e s e n t a s i k l i n i s i n f e k s i s a i u r a n k e m i h p a d a l a k i - l a k i m u n g k i n s i s t i t i s

p r o s t a t i t i s e p i d i m i d i s d a n u r e t r i t i s

I n f e k s i s a i u r a n k e m i h a t a s t e r b a g i m e n j a d i 2 y a i t u

1 ) P i e l o n e f r i t i s A k u t ( P N A )

P i e l o n e f r i t i s a k u t a d a l a l i p r o s e s i n f l a m a s i p a r e n k i m g i n j a l y a n g d i s e b a b k a n

o l e h m f e k s i b a k t e r i

11

2 ) P i e l o n e f r i t i s K r o n i s ( P N K )

P i e l o n e f r i t i s k r o n i s m u n g k i n a k i b a t l a n j u t d a r i i n f e k s i b a k t e r i

b e r k e p a n j a n g a n a t a u i n f e k s i s e j a k m a s a k e c i i O b s t r u k s i s a i u r a n k e m i h d a n

r e f l u k s v e s i k o u r e t e r d e n g a n a t a u t a n p a b a k t e r i u r i a k r o n i k s e r i n g d i i k u t i

p e m b e n t u k a n j a r i n g a n i k a t p a r e n k i m g i n j a l y a n g d i t a n d a i d e n g a n

p i e l o n e f r i t i s k r o n i k y a n g s p e s i f i k ( S u d o y o 2 0 0 6 )

D Etiologi

P a d a k e a d a a n n o r m a l u r i n b e r s i f a t s t e r i l U m u m n y a I S K d i s e b a b k a n o l e h

k i i m a n g r a m n e g a t i f E s c h e r i c h i a c o l i m e m p a k a n p e n y e b a b t e r b a n y a k b a i k p a d a

y a n g s i m t o m a t i k m a u p u n y a n g a s i m t o m a t i k y a i t u 7 0 - 9 0 E n t e r o b a k t e r i a s e p e r t i

P r o t e u s m i r a b i l i s ( 3 0 d a r i i n f e k s i s a i u r a n k e m i h p a d a a n a k l a k i - l a k i t e t a p i

k u r a n g d a r i 5 p a d a a n a k p e r e m p u a n ) K l e b s i e l l a p n e u m o n i a d a n P s e u d o m o n a s

a e m g i n o s a d a p a t j u g a s e b a g a i p e n y e b a b O r g a n i s m e g r a m p o s i t i f s e p e r t i

S t r e p t o c o c c u s f a e c a l i s ( e n t e r o k o k u s ) S t a p h y l o c o c c u s e p i d e n n i d i s d a n

S t r e p t o c o c c u s v i r i d a n s j a r a n g d i t e m u k a n P a d a u r o p a t i o b s t m k t i f d a n k e l a i n a n

s t r u k t u r s a i u r a n k e m i h p a d a a n a k l a k i - l a k i s e r i n g d i t e m u k a n P r o t e u s s p e c i e s P a d a

I S K n o s o k o m i a l a t a u I S K k o m p l e k s l e b i h s e r i n g d i t e m u k a n k u m a n P r o t e u s d a n

P s e u d o m o n a s ( L u m b a n b a t u S M 2 0 0 3 )

E Patofisiologi

P a d a i n d i v i d u n o n n a l b i a s a n y a u r i n l a k i - l a k i m a u p u n p e r e m p u a n s e l a l u

d a l a m k e a d a a n s t e r i l k a r e n a d i p e r t a l i a n k a n o l e h j u m l a l i d a n f r e k u e n s i b e r k e m i h

U t e r o d i s t a l m e m p a k a n t e m p a t k o l o n i s a s i m i k r o o r g a n i s m e nonpathogenic

fastidious G r a m - p o s i t i f d a n g r a m n e g a t i f ( S u d o y o 2 0 0 6 )

H a m p i r s e m u a I S K d i s e b a b k a n i n v a s i m i k r o o r g a n i s m e ascending d a r i u r e t r a

k e d a l a m k a n d u n g k e m i b P a d a b e b e r a p a p a s i e n t e r t e n t u i n v a s i m i k r o o r g a n i s m e

d a p a t m e n c a p a i k e g i n j a l P r o s e s i n i d i p e n n u d a h o l e h k o n d i s i r e f l u k s

v e s i k o i i r e t e r a l P r o s e s i n v a s i m i k r o o r g a n i s m e h e m a t o g e n s a n g a t j a r a n g d i t e m u k a n

d i k l i n i k m u n g k i t a k i b a t l a n j u t d a r i b a k t e r e m i a G i n j a l d i d u g a m e n i p a k a n l o k a s i

12

i n f e k s i s e b a g a i a k i b a t l a n j u t d a r i s e p t i k e m i a a t a u e n d o k a r d i t i s a k i b a t S t a f i l o k o k u s

a u r e u s K e l a i n a n g i n j a l y a n g t e r k a i t d e n g a n e n d o k a r d i t i s ( S t a f i l o k k o k u s a u r e u s )

d i k e n a l d e n g a n N e p h r i t i s L o h e i n B e b e r a p a p e n e l i t i a n m e l a p o r k a n p i e l o n e f r i t i s

a k u t ( P N A ) s e b a g a i a k i b a t l a n j u t i n v a s i h e m a t o g e n ( S u d o y o 2 0 0 6 )

F Faktor Risiko

P a t o f i s i o l o g i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h d a p a t d i p e n g a n i h i o l e h

b e b e r a p a f a k t o r A d a p u n b e b e r a p a f a k t o r risiko y a n g m e m p e n g a n i l i i t e r j a d i n y a

i n f e k s i s a i u r a n k e m i h a n t a r a l a i n

1 ) U s i a

I n s i d e n I S K m e n i n g k a t b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i

m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n a d a n y a a b n o r m a l i t a s a n a t o m i y a n g

m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n k e m i h s e p e r t i p e m b e s a r a n p r o s t a t

d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e

P e n y e b a b l a i n t e r m a s u k p e r i n e u m y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s

p e n y a k i t n e u r o m u s k n l a r d a n k a t e t e r i s a s i b u l i - b u l i S e l a i n i t u i n s i d e n I S K

m e n c a p a i 1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o s e 2 0 0 9 F o x m a n e t a l 2 0 1 0

R o n a l d 2 0 1 1 )

M e n u m t t e o r i y a n g d i k e m u k a k a n o l e h S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a d a u s i a

l a n j u t a k a n t e r j a d i p e n i n g k a t a n k e r e n t a n a n t e r h a d a p p e n y a k i t P a d a u s i a d i a t a s 5 0

t a l i u n t e r j a d i p e n u m n a n k e m a m p u a n d a l a m m e m p e r t a h a n k a n s t e n l i t a s b a i k p a d a

k a n d u n g k e m i h m a u p u n u r e t r a H a l t e r s e b u t d i s e b a b k a n o l e h i n v o l u s i t i m u s

I n v o l u s i s e l t i m u s m e n y e b a b k a n j u m l a h se d a n k u a l i t a s r e s p o n s s e l T s e m a k i n

b e r k u r a n g J u m l a h s e l T m e m o r i m e n i n g k a t n a m u n s e m a k i n s u l i t u n t u k

b e r k e m b a n g t e r u t a m a s i t o t o k s i k s e l T ( C D ^ ) d a n s e l T h l ( C D ^ ^ ) k a r e n a t e r j a d i

a p o p t o s i s S i t o t o k s i k s e l T ( C D ^ ^ ) b e i p e r a n d a l a m r e s p o n s i m u n t e r h a d a p a n t i g e n

p a d a s e l y a n g d i i n f e k s i d e n g a n c a r a m e m b u n u l i s e l y a n g t e r i n f e k s i u n t u k

m e n c e g a h p e n y e b a r a n m f e k s i s e d a n g k a n s e l T h l ( C D ^ ^ ) b e r p e r a n m e m b a n t u s e l

B u n t u k m e m p r o d u k s i a n t i b o d i

13

2 ) J e n i s k e l a m m d a n a k t i v i t a s s e k s u a l

I n s i d e n s i I S K y a n g r e n d a h p a d a p r i a d i p e n g a n i h i o l e h 3 f a k t o r y a i t u

1 L e b i h s e d i k i t t e r j a d i k o l o n i s a s i s e k i t a r u r e t r a k a r e n a t i d a k a d a n y a t e m p a t

s e p e r t i v a g i n a p a d a p e r e m p u a n

2 M e m i l i k i u r e t r a y a n g p a n j a n g

3 A d a n y a s u b s t a n s i a n t i b a k t e r i a l p a d a c a i r a n p r o s t a t

U r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a h d e n g a n d e k a t n y a v a g i n a l

v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h l e b i h s e r i n g

p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a f l o r a n o n n a l p a d a d a e r a l i p e r i u r e t r a t e r d i r i

d a r i o r g a n i s m e s e p e r t i l a c t o b a c i l l i i s y a n g m e m b a n t u m e l a w a n k o l o n i s a s i b a k t e r i

p a t o g e n p a d a s a i u r a n k e m i h P e r u b a l i a n l i n g k i m g a n d a r i p e r i u r e t r a l s e p e r t i

p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k b i s a m e n g g a n g g u f l o r a

n o r m a l s e h i n g g a m e m u n g k i n k a n b a k t e r i p a t o g e n b e r k o l o n i s a s i d a n m e n y e b a b k a n

i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

P a d a w a n i t a l e b i h d a r i 5 0 t a h u n a t a u l e b i h m e n o p a u s e m e m p a k a n f a k t o r

l a i n y a n g m e n i n g k a t k a n P V R Post Void Residual) s e l a i n p e n u r u n a n k o i i t r a k t i i i t a s

o t o t d e t r u s o r P e n u m n a n e s t r o g e n y a n g d i s e b a b k a n m e n o p a u s e d a p a t

m e n i n g k a t k a n p H v a g i n a l d a n m e n u m n k a n j u m l a l i l a c t o b a c i l l i A k i b a m y a t e r j a d i

p e n i n g k a t k a n k o l o n i s a s i d a r i b a s i l g r a m n e g a t i f s e h i n g g a m e n i n g k a t k a n r e s i k o

t e r j a d i n y a I S K P a d a p r i a p r o s t a t m e n s e k r e s i k a n c a i r a n y a n g m e n g a n d i m g z i n k

y a n g m e m i l i k i a k t i f i t a s m i k r o b i a l ( K i m 2 0 1 2 )

S e l a i n i t u p i j a t a n u r e t r a s e p e r t i y a n g t e r j a d i s e l a m a h u b u n g a n s e k s u a l

m e n y e b a b k a n m a s u k n y a b a k t e r i k e d a l a m k a n d u n g k e m i h d a n m e m p a k a n h a l

y a n g p e n t i n g d a l a m p a t o g e n e s i s m f e k s i s a l i u a n k e m i h p a d a p e r e m p u a n m u d a

B u a n g a i r k e c i l s e t e l a h h u b u n g a n s e k s u a l t e r b u k t i m e n u m n k a n risiko s i s t i t i s

m u n g k i n k a r e n a t i n d a k a n i n i m e n i n g k a t k a n e r a d i k a s i b a k t e r i y a n g m a s u k s e l a m a

h u b u n g a n s e k s u a l ( K i m 2 0 1 2 )

3 ) T i n g k a t P e n d i d i k a n

P e n g e t a h u a n s e s e o r a n g t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t

p e n d i d i k a n S e s e o r a n g y a n g m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m i u i g k i n a n

p e n g e t a h u a n t e n t a n g k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o n n a s i y a n g d i d a p a t k a n

14

t e n t a n g k e s e h a t a n l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h

S e b a l i k n y a p e n d i d i k a n y a n g k u r a n g d a p a t m e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g

t e r h a d a p n i l a i - n i l a i y a n g b a n i d i k e n a l ( N o t o a d i n o j o 2 0 0 3 )

4 ) R i w a y a t D i a b e t e s M e l i t u s

M e n u r u t S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a s i e n d e n g a n s t a t u s D M s a n g a t

b e r i s i k o u n t u k m e n g a l a m i i n f e k s i s a i u r a n k e m i h A b n o n n a l i i a s s t n i k t u r d a n

k a n d u n g k e m i h n e u r o g e n i k a k i b a t n e u r o p a t i o t o n o m a t a u s t r o k e p a d a p a s i e n D M

m e n y e b a b k a n p e n g o s o n g a n k a n d u n g k e m i h t i d a k n o n n a l D M j u g a d a p a t

m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a h a n a n t u b u h y a n g b e r p o t e n s i m e n i n g k a t

risiko t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a h a n a n t u b u h t e r s e b u t d i a n t a r a n y a

a d a i a h k e g a g a l a n m i g r a s i s e l intracellular killing f a g o s i t o s i s d a n k e m o t a k s i s

p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n m e k a n i s m e p e r t a h a n a n

a l a m i a h i o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p i n f e k s i

5 ) K e h a m i i a n

K e c e n d e r u n g a n i n f e k s i s a i u r a n k e m i h b a g i a n a t a s s e l a m a k e h a m i i a n

d i s e b a b k a n o l e h p e n u m n a n k e k u a t a n u r e t e r p e n u m n a n p e r i s t a l t i k u r e t e r d a n

i n k o m p e t e n s i s e m e n t a r a k a l u p v e s i k o i u - e t e r a l y a n g t e r j a d i s e l a m a h a m i l

6 ) S u m b a t a i i

A d a n y a I i a i a n g a n a l i r a n b e b a s u r i n s e p e r t i t u m o r s t r i k t r a a b a t u a t a u

h i p e r t r o f i p r o s t a t d a p a t m e n y e b a b k a n h i d r o n e f r o s i s d a n risiko i n f e k s i s a i u r a n

k e m i l i y a n g s a n g a t t i n g g i S e l a i n i t u s u p e r i n f e k s i p a d a s u m b a t a n s a i u r a n k e m i h

d a p a t m e n y e b a b k a n k e m s a k a n j a r i n g a n g i n j a l y a n g c e p a t

7 ) D i s f u n g s i n e u r o g e n i k k a n d u n g k e m i h

G a n g g u a n s a r a f y a n g b e k e r j a p a d a k a n d m i g k e m i h s e p e r t i p a d a j e j a s k o r d a

s p i n a l i s t a b e s d o r s a i i s m u l t i p e l s k l e r o s i s d i a b e t e s m e l i t u s a t a u p e n y a k i t l a i n

d a p a t b e r h u b u n g a n d e n g a n i n f e k s i s a i u r a n k e m i h I n f e k s i d a p a t d i a w a l i o l e h

p e n g g u n a a n k a t e l e r u n t u k d r a i n a s e k a n d i u i g k e m i h d a n d i d u k i m g o l e h s t a t i s u r i n

d a l a m k a n d u n g k e m i l i u n t u k j a n g k a w a k t u y a n g l a m a

8 ) R e f l u k s v e s i k o m e t e r a

K e a d a a n i n i d i d e f i n i s i k a n s e b a g a i r e f l u k s u r i n d a r i k a n d u n g k e m i b k e u r e t e r

d a n k a d a n g s a m p a i k e p e l v i s r e n a l H a l i n i t e r j a d i s e l a m a b u a n g a i r k e c i l a t a u

15

d e n g a n p e n i n g k a t a n t e k a n a n p a d a k a n d u n g k e m i h R e f l u k s v e s i k o i i r e t e r a l d a p a t

d i b u k t i k a n d e n g a n a d a n y a g c r a k a n r e t r o g r a d z a t r a d i o o p a k a t a u r a d i o a k t i f m e l a l u i

s i s t o u r e t r o g r a m s e l a m a b u a n g a i r k e c i l R e f l u k s v e s i k o i i r e t e r a l b i a s a n y a

d i s e b a b k a n k a r e n a a d a n y a g a n g g u a n a n a t o m i s p a d a p e r t e m u a n v e s i k o i i r e t e r a l

y a n g d a p a t m e n y e b a b k a n r e f l u k s u r i n d i s e r t a i b a k t e r i d a n k a r e n a i t u t e r j a d i l a h

i n f e k s i s a l r a a n k e m i h

9 ) F a k t o r v i r u l e n s i b a k t e r i

F a k t o r v i r u l e n s i b a k t e r i m e m p e n g a r u b i k e m u n g k i n a n vragt7 t e r t e n m d a l a m

m e n y e b a b k a n i n f e k s i t r a k i u s u r i n a r i u s H a m p i r s e m u a strain F c o l i y a n g

m e n y e b a b k a n p i e l o n e f r i t i s p a d a p a s i e n d e n g a n t r a k i u s u r i n a r i u s n o m i a l s e c a r a

a n a t o m i k m e m p u n y a i p i l u s t e r t e n t u y a n g m e m p e r a n t a r a i p e r l e k a t a n p a d a b a g i a n

d i g a k t o s i d a d a n g l i k o s f i n g o l i p i d y a n g a d a d i u r o e p i t e l Strain y a n g m e n i m b u l k a n

p i e l o n e f r i t i s j u g a b i a s a n y a m e m p a k a n p e n g b a s i l h e m o l i s i n m e m p u n y a i

a e r o b a k t i n d a n r e s i s t e n t e r h a d a p k e r j a b a k t e r i s i d a l d a r i s e m m m a n u s i a

1 0 ) F a k t o r g e n e t i k

F a k t o r g e n e t i k p e n j a m u m e m p e n g a n i l i i k e r e n t a n a n t e r h a d a p i n f e k s i t r a k t u s

u r i n a r i u s J u m l a h d a n t i p e r e s e p t o r p a d a s e l u r o e p i t e l t e m p a t b a k t e r i d a p a t

m e n e m p e l s e l i d a k i i y a s e b a g i a i i d i t e n t u k a r i s e c a r a g e n e t i k ( I s s e l b a c h e r 2 0 0 9 )

G Manifestasi Klinis

G e j a l a k l i n i s d a r i i n f e k s i s a i u r a n k e m i h s e s u a i d e n g a n b a g i a n s a i u r a n k e m i h

y a n g t e r i n f e k s i a d a i a h s e b a g a i b e r i k u t

1 ) I n f e k s i s a i u r a n k e m i h b a g i a n b a w a l i

K e l u h a n p a s i e n b i a s a n y a b e m p a r a s a s a k i t a t a u r a s a p a n a s d i u r e t r a s e w a k t u

k e n c i n g d e n g a n a i r k e m i h s e d i k i t - s e d i k i t s e r t a r a s a t i d a k e n a k d i d a e r a h

s i i p r a p u b i k

2 ) I n f e k s i s a i u r a n k e m i h b a g i a n a t a s

P a d a i n t e k s i s a i u r a n k e m i h b a g i a n a t a s d a p a t d i t e m u k a n g e j a l a s e p e r t i s a k i t

k e p a l a m a l a i s e m u a l m m i t a h d e n i a m m e n g g i g i l r a s a t i d a k e n a k a t a u

n y e r i d i p i n g g a n g ( T e s s y d k k 2 0 0 1 )

16

H Tatalaksana

T u j u a n p e n a t a l a k s a n a a a n i n f e k s i s a i u r a n k e m i h a d a i a h m e n c e g a h d a n

m e n g h i l a n g k a n g e j a l a m e n c e g a h d a n m e n g o b a t i b a k t e n e m i a d a n b a k t e r i u r i a s e r t a

m e n c e g a h d a n m e n g u r a n g i r i s i k o k e r u s a k a n g i n j a l y a n g m u n g k i n t i m b u l d e n g a n

p e m b e r i a n o b a t - o b a t a n y a n g s e n s i t i f m u r a l i d a n a m a n d e n g a n e f e k s a m p i n g y a n g

m i n i m a l

a ) i n f e k s i s a i u r a n k e m i h ( I S K ) b a w a h

P r i n s i p p e n a t a l a k s a n a a n I S K b a w a h m e l i p u t i intake c a i r a n y a n g b a n y a k

a n t i b i o t i k y a n g a d e k u a t d a n b i l a p e r l u t e r a p i s i m t o m a t i k u n t u k a l k a l i s a s i

u r i n

i H a m p i r 8 0 p a s i e n a k a n m e m b e r i k a n r e s p o n s e t e l a h 4 8 j a m d e n g a n

a n t i b i o t i k a t u n g g a l s e p e r t i a m p i s i l i n 3 g r a m a t a u t r i m e t o p r i m 2 0 0 m g

i i B i l a i n f e k s i m e n e t a p d i s e r t a i k e l a i n a n u r i n a l i s i s ( l e u k o s i u i a ) d i p e r i u k a n

t e r a p i k o n v e n s i o n a l s e l a m a 5 - 1 0 h a r i

i i i P e m e r i k s a a n m i k r o s k o p i s u r i n d a n b i a k a n u r i n t i d a k d i p e r i u k a n b i l a

s e m u a g e j a l a h i l a n g d a n t a n p a l e u k o s u r i a

b ) I n f e k s i s a i u r a n k e m i h ( I S K ) a t a s

P a d a u m u m n y a p a s i e n d e n g a n p i e l o n e f r i t i s a k u t m e m e r l u k a n r a w a t i n a p

u n t u k m e m e l i h a r a s t a t u s h i d r a s i d a n t e r a p i a n t i b i o t i k a p a r e n t e r a l p a l i n g

s e d i k i t 4 8 j a m ( S u d o y o 2 0 0 6 )

i Komplikasi

K o m p l i k a s i i n f e k s i s a i u r a n k e m i h t e r g a n t u n g d a r i t i p e y a i t u i n f e k s i s a i u r a n

k e m i h t i p e s e d e r h a n a (uncomplicated) d a n t i p e b e r k o m p l i k a s i (complicated)

1 ) I n f e k s i s a i u r a n k e m i h s e d e r h a n a (uncomplicated)

I n f e k s i s a i u r a n k e m i h a k u t t i p e s e d e r h a n a ( s i s t i t i s ) y a i t u n o n - o b s t r u k s i d a n

b u k a n p e r e m p u a n h a m i l m e m p a k a n p e n y a k i t r i n g a n (self limited disiase)

d a n t i d a k m e n y e b a b k a n a k i b a t l a n j u t j a n g k a l a m a

2 ) I n f e k s i s a i u r a n k e m i h b e r k o m p l i k a s i (complicated)

a ) I n f e k s i s a i u r a n k e m i h s e l a m a k e h a m i i a n

b ) i n f e k s i s a i u r a n k e m i h p a d a d i a b e t e s m e l i t u s ( S u d o y o 2 0 0 6 )

17

22 Kerangka Teori

J

U s i a

J e n i s K e i a m i n

T i n g k a t P e n d i d i k a n

R i w a y a t D i a b e t e s M e l i m s

S u m b a t a n bullT

K e h a m i i a n

D i s f u n g s i n e u r o g e n i k

R e f l u k s v e s i k o i i r e t e r a l

V i r u l e n s i b a k t e r i

F a k t o r g e n e t i k

I n f e k s i b a k t e r i g r a m p o s i t i f a t a u n e g a t i v e p a d a s a i u r a n k e m i h

I n f e k s i S a i u r a n K e m i h

Keterangan

I j = V a r i a b e l y a n g t i d a k d i t e l i t i

= V a r i a b e l y a n g d i t e l i t i

18

Hipotesis

H i p o t e s i s d a l a m p e n e l i t i a n i n i a d a i a h

H O t i d a k t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n

t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

H I t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

BAB 111

M E T O D E PENELITIAN

31 Jenis Penelitian

P a d a p e n e l i t i a n i n i j e n i s p e n e l i t i a n y a n g d i g u n a k a n a d a i a h p e n e l i t i a n

o b s e r v a s i o n a i a n a l i t i k d e s a i n cross scclional d e n g a n m e n g g u n a k a n d a t a s e k u n d e r

d a r i r e k a m m e d i s p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1 D e s e m b e r

2 0 1 5

32 Waktu dan Tempat Penelitian

321 Waktu Penelitian

W a k t u p e n e l i t i a n d i l a k s a n a k a n p a d a t a n g g a l 1 O k t o b e r s a m p a i d e n g a n 3 0

O k t o b e r 2 0 1 6

322 Tempat Penelitian

P e n e l i t i a n i n i d i l a k s a n a k a n d i R u m a l i S a k i t M u h a m m a d i y a h P a e m b a n g ( d i

R u a n g R e k a m M e d i s )

33 Populasi dan Sampel Penelitian

331Populasi Penelitian

P a d a p e n e l i t i a n i n i p o p u l a s i t a r g e t a d a l a l i p a s i e n r a w a t i n a p d a n r a w a t j a l a n

d i R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g s e d a n g k a n p o p u l a s i t e r j a n g k a u n y a

a d a i a h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

332Sampel dan Besar Sampel Penelitian

P a d a p e n e l i t i a n i n i s a m p e l p e n e l i t i a n a d a i a h p a s i e n r a w a t i n a p d a n r a w a t

j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e

1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 y a n g m e m e n u h i k r i t e r i a i n k l u s i p e n e l i t i a n

1 9

20

d e n g a n b e s a r s a m p e l y a n g l a y a k d a l a m p e n e l i t i a n m e n u r u t t e o r i R o s c o e a d a i a h

a n t a r a t i g a p u l u h s a m p a i l i m a r a t i i s o r a n g ( S u g i y o n o 2 0 1 5 )

333 Krttena Inklusi dan Eksklusi

A Kriteria Inklusi

P a d a p e n e l i t i a n i n i k r i t e r i a i n k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t i n a p

d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i

P a l e m b a n g y a n g d i d i a g n o s a m e n g a l a m i i n f e k s i s a i u r a n k e m i h s e r t a m e m i l i k i d a t a

r e k a m m e d i s p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

B Kriteria Eksklusi

P a d a p e n e l i t i a n i n i k r i t e r i a e k s k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t

i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 d e n g a n d a t a r e k a m m e d i s

y a n g t i d a k l e n g k a p

334 Cara Pengambilan Sampel Penelitian

C a r a p e n g a m b i l a n s a m p e l y a n g d i g u n a k a n d a l a m p e n e l i t i a n i n i a d a l a l i

m e n g g u n a k a n t e k n i k consecutive sampling P a d a consecutive sampling s e t i a p

p a s i e n y a n g m e m e n u h i k r i t e r i a p e n e l i t i a n d i m a s u k k a n d a l a m p e n e l i t i a n s a m p a i

k u r u n w a k t u t e r t e n U i s e h i n g g a j u m l a h m i n i m a l y a n g d i p e r i u k a n t e r p e n u h i

( S a s t r o a s m o r o 2 0 1 1 )

34 Variabel Penelitian

341 Variabel Dependent

V a r i a b e l dependent f t e r i k a t ) d a l a m p e n e l i t i a n i n i a d a i a h i n f e k s i s a i u r a n

k e m i h

342 Variabel Independent

V a r i a b e l independent ( b e b a s ) d a l a m p e n e l i t i a n i n i a d a i a h u s i a j e n i s

k e l a i n i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

21

35 Definisi Operasional

Tabel 31 Definisi Operasional

Variabel Alat Cara ueiinisi rldsil L KUr I7 i l l 11 Lz fe 1 V

oKaia LiKur Penelitian Ukur Ukur

Infeksi P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Saiuran d i d i a g n o s a o l e h m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Keniih d o k t e r m e n g a l a m i m e d i s

i n f e k s i s a i u r a n

k e m i h d a n t e r c a n t u m

d i r e k a m m e d i s

U s i a L a m a n y a t a h u n R e k a m O b s e r v a s i 1 lt 5 0 t a h u n O r d i n a l

k e h i d u p a n p a s i e n m e d i s r e k a m 2 gt 5 0 t a l i u n ( k a t e g o r i k )

d a r i l a h i r s a m p a i m e d i s

s e k a r a n g d a n

t e r c a n t u m d i r e k a m

m e d i s

Jenis P r o f i l a n a t o m i a t a u R e k a m O b s e r v a s i 1- L a k i - l a k i N o m i n a l

Keiamin b i o l o g i s p a s i e n y a n g m e d i s r e k a m 2 P e r e m p u a n ( k a t e g o r i k )

d i b e d a k a n m e n j a d i m e d i s

i a k i - l a k i d a n

n e r e m m i a n s e r t a

t e r c a n t u m d i r e k a m

m e d i s

Tingkat P e n d i d i k a n f o n n a l R e k a m O b s e r v a s i 1 P e n d i d i k a n O r d i n a l

Pendidikan t e r a k h i r y a n g m e d i s r e k a m d a s a r ( S D ( k a t e g o r i k )

d i t e m p u h o l e h m e d i s M I S M P

p a s i e n d a n t e r c a n t u m d a n M T s )

d i r e k a m m e d i s 2 P e n d i d i k a n

m e n e n g a l i

d a n t i n g g i

22

( S M A M A

S M K

M A K

d i p l o m a

s a r j a n a

m a g i St e r

s p e s i a l i s

d a n d o k t o r )

Riwayat P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Diabetes d i d i a g n o s i s d e n g a n m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Melitus d i a b e t e s m e l i t u s d a n

t e r c a n t u m d i d a l a m

r e k a m m e d i s

m e d i s

36 Cara Pengumpulan Data

361 Data Sekunder

P e n g u m p u l a n d a t a p a d a p e n e l i t i a n i n i d i p e r o l e h d a r i d a t a s e k u n d e r y a i t u

r e k a m m e d i s p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

37 Metode Teknik Analisis Data

371Cara Pengolahan dan Analisis Data

P e n g o l a h a n d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n m e l a l u i e m p a t t a h a p y a i t u

i Oala Entry

P a d a t a i i a p i n i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n riwayat d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g y a n g t e l a h d i d a p a t d a n

r e k a m m e d i s d i k u m p u l k a n d a n d i m a s u k k a n k e d a l a m p r o g r a m spss

23

2 Editing

P a d a t a h a p i n i d a t a i i s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n y a n g t e l a h d i m a s u k k a n k e d a l a m p r o g r a m s p s s

d i p e r i k s a k e m b a l i a p a k a h s u d a h l e n g k a p d a n t i d a k a d a k e k e l i r u a n

3 ( oding

S e t e l a h m e l a l u i p r o s e s editing d a t a - d a t a t e r s e b u t d i b e r i k o d e t e r t e n t u a n t a r a

l a i n k o d e 1 u n t u k u s i a gt 5 0 t a h u n j e n i s k e i a m i n p e r e m p u a n t i n g k a t

p e n d i d i k a n d a s a r t e r d a p a t r i w a y a t d i a b e t e s m e l i t u s d a n i n f e k s i s a i u r a n

k e m i h s e d a n g k a n k o d e 2 u n t u k u s i a lt 5 0 t a h u n j e n i s k e i a m i n l a k i - l a k i

t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i t i d a k t e r d a p a t r i w a y a t d i a b e t e s

m e l i t u s d a n b u k a n i n f e k s i s a i u r a n k e m i h s e h i n g g a m e m u d a h k a n d a l a m

m e l a k u k a n a n a l i s i s d a t a

4 Tahulaling

P a d a t a h a p i n i d a t a y a n g s a m a d i k e l o m p o k k a n s e c a r a t e l i t i d a n t e r a t m

k e m u d i a n d i l i i t u n g d e n g a n m e n g g u n a k a n p r o g r a m sps s d a n d i j u m l a h k a i i

l a l u d i s a j i k a n d a l a m b e n t u k t a b e l - t a b e l

U n t u k m e n g a n a l i s i s d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n a n a l i s i s d a t a

u n i v a r i a t d a n b i v a r i a t d e n g a n m e n g g u n a k a n p r o g r a m s p s s s e b a g a i b e r i k u t

A A n a l i s i s u n i v a r i a t

A n a l i s i s u n i v a r i a t d i l a k u k a n d e n g a n c a r a m e l a k u k a n a n a l i s i s p a d a s e t i a p

v a r i a b e l h a s i l p e n e l i t i a n d e n g a n t u j u a n u n t u k m e n g e t a h u i d i s t r i b u s i p r o p o r s i p a d a

s e t i a p v a r i a b e l p e n e l i t i a n D a t a d i s a j i k a n d a l a m b e n t u k t a b e l d a n n a r a s i

B A n a l i s i s b i v a r i a t

A n a l i s i s b i v a r i a t d i l a k u k a n d e n g a n m e n g g u n a k a n u j i h i p o t e s i s chi-square

U j i h i p o t e s i s chi-square d a p a t d i g u n a k a n d e n g a n s y a r a t y a i t u lt 2 0 s e l y a n g

m e m p u n y a i n i l a i expected count k u r a n g d a r i l i m a s e h i n g g a j i k a t i d a k m e m e n u h i

s y a r a t u j i chi-square m a k a u j i y a n g d i g u n a k a n a d a i a h u] fisher ( D a h l a n 2 0 1 4 )

B a t a s k e m a k n a a n y a n g d i g u n a k a n a d a i a h a = 0 0 5 J i k a d i d a p a t k a n p value lt 0 0 5

p a d a u j i s t a t i s t i k m a k a t i d a k t e r d a p a t h u b u n g a n y a n g b e n n a k n a a n t a r a d u a

v a r i a b e l y a n g d i t e l i t i d a n H O d i t e r i m a S e d a n g k a n j i k a d i d a p a t k a n p value gt 0 0 5

24

p a d a u j i s t a t i s t i k m a k a t e r d a p a t l i u b u n g a n y a n g b e n n a k n a a n t a r a d u a v a r i a b e l

y a n g d i t e l i t i d a n H O d i t o l a k

38 Alur Penelitian

P e n e n t u a n p o p u l a s i d a n s a m p e l p e n e l i t i a n

K r i t e r i a i n k l u s i K r i t e r i a e k s k l u s i

P e n g a m b i l a n s a m p e l p e n e l i t i a n

P e n g o l a h a n d a n a n a l i s i s d a t a d e n g a n u j i chi-square

H a s i l d a n p e m b a h a s a n

K e s i m p u l a n d a n s a r a n

Gambar 31 Alur Penelitian Hubungan Usia Jenis Keiamin Tingkat Pendidikan dan Riwayat Diabetes Melitus dengan Kejadian Infeksi Saiuran Kemih pada Pasien Rawat Inap di Bagian Penyakit Dalam Rumah Sakit Muhammadiyah Palembang Periode 1 Januari 2015 sampai dengan 31 Desember 2015

BAB IV

HASIL DAN PEMBAHASAN

41 Hasil

P e n e l i t i a n i n i t e l a h d i l a k u k a n d i r u a n g r e k a m m e d i s R u m a h S a k i t

M u h a i m n a d i y a h P a l e m b a n g d a r i t a n g g a l 1 O k t o b e r 2 0 1 5 - 3 1 O k t o b e r 2 0 1 6

P e n e l i t i a n d i m u l a i d e n g a n p e n g a m b i l a n d a t a a w a l b e m p a d a t a r e k a m m e d i s

s e l u r u h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

S e l a n j u t n y a r e k a m m e d i s d i p i l i h s e s u a i d e n g a n k r i t e r i a i n k l u s i d a n e k s k l u s i u n t u k

d i j a d i k a n s a m p e l p e n e l i t i a n s a m p a i m i n i m a l b e s a r s a m p e l y a n g d i b u t u h k a n

t e r p e n u h i s e r t a d i l a k u k a n p e n e l i t i a n s e c a r a o b s e r v a s i o n a i O b s e r v a s i r e k a m m e d i s

d i l a k u k a n u n m k m e n g e t a h u i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t

d i a b e t e s m e l i t u s d a n d i a g n o s a p a s i e n

D a r i c a t a t a n r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g

d i d a p a t k a n s e b a n y a k 4 1 4 1 r e k a m m e d i s p a s i e n r a w a t i n a p d a n 1 4 5 3 r e k a m m e d i s

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 D a r i t o t a l r e k a m m e d i s

p a s i e n r a w a t i n a p d a n r a w a t j a l a n t e r s e b u t p e n e l i t i h a n y a m e n g a m b i l m i n i m a l

b e s a r s a m p e l y a n g d i b u t u h k a n y a i t u s e b a n y a k 9 8 r e k a m m e d i s u n t u k d i j a d i k a n

s a m p e l p e n e l i t i a n y a n g t e r d i r i d a r i 3 0 r e k a m m e d i s p a s i e n y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i h d a n 6 8 r e k a m m e d i s y a n g t i d a k m e n g a l a m i i n f e k s i s a i u r a n k e m i h

411 Hasil Analisis Univariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s u n i v a r i a t

a n t a r a l a i n d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p b e r d a s a r k a n u s i a d a n

j e n i s k e l a m m d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n b e r d a s a r k a n u s i a

d a n j e n i s k e i a m i n d i s t r i b u s i p r o p o r s i s a m p e l b e r d a s a r k a n k e j a d i a n m f e k s i s a i u r a n

k e m i h s e r t a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n u s i a

j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

25

26

A Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan IJsta

dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 41 Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan

Usia dan Jenis Keiamin

Paisen Rawat Inap N Persentase

Usia

1 7 - 2 5 t a h u n 678 1 6 4

2 6 - 3 5 t a h u n 952 2 3 0

3 6 - 4 5 t a l i u n 745 18 0

4 6 - 5 5 t a h u n 695 1 6 8

5 6 - 6 4 t a h u n 571 1 3 8

gt 6 4 t a h u n 500 1 2 1

U s i a r a t a - r a t a ( t a h u n j 43plusmn16543

Jenis Keiamin

P e r e m p u a n 2 6 3 8 6 3 7

L a k i - l a k i 1 5 0 3 3 6 3

Total 4141 100

B e r d a s a r k a n t a b e l 4 1 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R i u n a h S a k i t M u l i a m m a d i y a l i

P a l e m b a n g p e r i o d e J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 2 6 - 3 5 t a h u n y a i t u

s e b a n y a k 9 5 2 o r a n g ( 2 3 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 43plusmn16543 t a l i u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 2 6 3 8 o r a n g ( 6 3 7 )

27

B Distribusi Proporsi Karakteristik Pasien Rawat Jalan Berdasarkan

Usia dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 42 Distribusi Proporsi Karakteristik Pasien Rawat Jalan

Berdasarkan Usia dan Jenis Keiamin

Fasten Rawat Jalan N Persentase

Usia

1 7 - 2 5 t a h u n 9 2 6 3

2 6 - 3 5 t a l n i n 1 3 1 9 0

3 6 - 4 5 t a h u n 2 7 9 1 9 2

46-55 t a l i u n 4 2 1 2 9 0

5 6 - 6 4 t a h u n 3 1 6 2 1 7

gt 6 4 t a h u n 2 1 4 1 4 7

U s i a r a t a - r a t a ( t a h u n ) 50plusmn14120

Jenis Keiamin

P e r e m p u a n 8 9 0 6 1 3

L a k i - l a k i 5 6 3 3 8 7

Total 1453 100

B e r d a s a r k a n t a b e l 4 2 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 4 6 - 5 5 t a h u n y a i t u

s e b a n y a k 4 2 1 o r a n g ( 2 9 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 50plusmn14120 t a h u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 8 9 0 o r a n g ( 6 1 3 )

28

C Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Usia

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i b b e r d a s a r k a n u s i a d a p a t

d i i i h a t p a d a l a b e l d i b a w a h i n i

Tabel 43 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Usia

Usia N Persentase

lt 5 0 t a h u n 1 4 4 6 7

gt 5 0 t a l i u n 1 6 5 3 3

Total 30 100

B e r d a s a r k a n t a b e l 4 3 d i a t a s d a p a t d i k e t a h u i b a h w a u s i a t e r b a n y a k p a d a

s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h gt 5 0 t a h u n y a i t u s e b a n y a k

1 6 o r a n g ( 5 3 3 )

D Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Jenis

Keiamin

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n j e n i s

k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 44 Distribusi Proporsi Kejadian infeksi Saiuran Kemih Berdasarkan

Jenis Keiamin

Jenis Keiamin N Persentase

P e r e m p u a n 1 8 6 0 0

L a k i - l a k i 1 2 4 0 0

Total 30 100

B e r d a s a r k a n t a b e l 4 4 d i a t a s d a p a t d i k e t a h u i b a h w a j e n i s k e i a m i n

t e r b a n y a k p a d a s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h p e r e m p u a n

y a i t u s e b a n y a k 1 8 o r a n g ( 6 0 0 )

29

E Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n t i n g k a t

p e n d i d i k a n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 45 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

Tingkat Pendidikan N Persentase

P e n d i d i k a n d a s a r 20 6 6 7

P e n d i d i k a n m e n e n g a h d a n P e n d i d i k a n m e n e n g a h d a n 10 333

t i n g g i

Total J O 100

B e r d a s a r k a n t a b e l 4 5 d i a t a s d a p a t d i k e t a l i u i b a l i w a t i n g k a t p e n d i d i k a n

t e r b a n y a k p a d a s a m p e i y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h t i n g k a t

p e n d i d i k a n d a s a r y a i t u s e b a n y a k 20 o r a n g ( 6 6 7 )

P Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n riwayat

d i a b e t e s m e l i t u s d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 46 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

Riwayat Diabetes Melitus N Persentase

Y a 17 5 6 7

T i d a k 13 433

Total 30 100

B e r d a s a r k a n t a b e l 4 6 d i a t a s d a p a t d i k e t a h u i b a l i w a s a m p e l y a n g

m e n g a l a m i i n f e k s i s a i u r a n k e m i h t e r b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s

y a i t u s e b a n y a k 1 7 o r a n g ( 5 6 7 )

30

412 Hasil Analisis Bivariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s b i v a r i a t

a n t a r a I a i n h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h j e n i s

k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h t i n g k a t p e n d i d i k a n d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n

i n f e k s i s a l m a n k e m i h

A n a l i s i s y a n g d i g u n a k a n p a d a u j i d u a v a r i a b e l y a n g b e r s k a l a k a t e g o r i k

a d a l a l i d e n g a n u j i Chi-Square d e n g a n n i e i h a t n i l a i Pearson Chi-Square S e m u a

h a s i l d a r i u j i h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h m e n g g i u i a k a n u j i Chi-

Square k a i e n a m e m e n u h i s y a r a t u j i Chi-Square y a i t u lt 2 0 s e l y a n g m e m p u n y a i

n i l a i expected count lt 5

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 47 Hasil Uji Hubungan antara Usia dengan Kejadian Infeksi

Saiuran Kemih

Usia

Infeksi Saiuran Kemih

^a Tidak

n N Mgt

Jumlah P

value 95Cl

lt 50 t a h u n 1 4 1 9 2 5 9 8 0 8 7 3 0 0 0 0 2 7 4 7 - 2 0 4 3 1

gt 5 0 t a h u n 1 6 6 4 0 9 3 6 0 2 5

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 7 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R = 7 4 9 2

( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a u s i a gt

5 0 t a h u n a d a l a l i 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a u s i a lt 5 0 t a h u n

31

B Hubungan antara Jenis Keiamin dengan Kejadian Infeksi Saiuran

Kemih

H a s i l a n a l i s i s b i v a r i a t l i u b u n g a n a n t a r a j e n i s k e l a i n i n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

Tabel 48 Hasil Uji Hubungan antara Jenis Keiamin dengan Kejadian

Infeksi Saiuran Kemih

Infeksi Saiuran Kemih Jenis P

A Tidak Jumlah 95CI Keiamin value

N N

P e r e m p u a n 18 6 4 3 10 357laquoo 2 8 3 2 2 7 -P e r e m p u a n 0 0 0 0

L a k i - l a k i 12 1 7 1 5 8 8 2 9 7 0 2 3 4 5 9

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 8 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a l a l i

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k N 4 a k a a d a l i u b u n g a n y a n g s i g n i f i k a n a n t a r a

j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R ) = 8 7 0 0

f 9 5 C I = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a l a k i - l a k i

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e n i i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

32

Tabel 49 Hasil liji Hubungan antara Tingkat Pendidikan dengan

Kejadian Infeksi Saiuran Kemih

Infeksi Saiuran Kemih P

Y a T i d a k jumlah 95CI value

N

P e n d i d i k a n d a s a r 2 0 5 4 1 1 7 4 5 9 3 7

P e n d i d i k a n

m e n e n g a h d a n 10 1 6 4 5 1 8 3 6 6 1

t i n g g i

Jumlah JO 30 6 68 694 9H

B e r d a s a r k a n t a b e l 4 9 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( 0 R ) =

6 0 0 0 ( 9 5 C I = 2 3 5 1 - 1 5 3 1 0 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r a d a i a h 6 k a l i l e b i h b e s a r

d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i h a t

p a d a t a b e l d i b a w a h i n i

Tingkat

Pendidikan

2 3 5 1 -0 0 0 0

1 5 3 1 0

33

Tabel 4t0 Hasil I j i Hubungan antara Riwayat Diabetes Melitus dengan

Kejadian Infeksi Saiuran Kemih

Riwayat Infeksi Saiuran Kemih P

Diabetes Va Tidak Jumlah value

95CI

Melitus N bullVJ N

Y a

T i d a k

17

1 3

6 8 0

1 7 8

8

6 0

3 2 0

8 2 2

2 5

7 3 0 0 0 0

3 4 9 3 -

2 7 5 3 6

Jumlah 30 306 68 571 98

B e r d a s a r k a n t a b e l 4 1 0 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio

( O R ) = 9 8 0 8 ( 9 5 C I - 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r

d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s m e l i m s

42 Pembahasan

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a l a b e l 4 7 d i d a p a t k a n b a l i w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i b d e n g a n n i l a i s i g n i f i k a n n y a a d a l a l i 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k

Odds Ratio ( O R ) = 7 4 9 2 ( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a u s i a T 5 0 t a h u n a d a i a h 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a

u s i a lt 5 0 t a h u n

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n A n d r y L u k a n d y

( 2 0 1 4 ) m e n g e n a i k a r a k t e r i s t i k p a s i e n - p a s i e n i n f e k s i s a i u r a n k e m i h d i m a n a

p e n d e r i t a I S K d e n g a n k e l o m p o k u m u r gt 5 0 t a h u n s e b a n y a k 2 3 o r a n g s e d a n g k a n

j u m l a h p e n d e r i t a I S K d e n g a n k e l o m p o k u m m lt 5 0 t a l i u n s e b a n y a k 2 0 o r a n g

P e n e l i t i a n i n i j u g a d i p e i k u a t o l e h p e n l i t i a n L e w i s A l e t a l ( 2 0 1 4 ) m e n g e n a i

impact of host age and parity on susceptihility to severe urinary tract injection in

34

a murine mode d e n g a n u j i K r u s k a l - W a l l i s d e n g a n post-test D u n n u n t u k b e b e r a p a

p e r b a n d i n g a n d i m a n a u s i a d a n p a r i t a s s e b a g a i f a k t o r y a n g b e r k o n t r i b u s i d a l a m

k e r e n t a n a n i m t u k t e r j a d i n y a I S K d e n g a n n i l a i p lt 0 0 5

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n g a t a k a n b a h w a i n s i d e n I S K m e n i n g k a t

b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n

a d a n y a a b n o r m a l i t a s a n a t o m i y a n g m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n

k e m i h s e p e r t i p e m b e s a r a n p r o s t a t d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a

p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e ( R o s e 2 0 0 9 ) P e n y e b a b l a i n t e n n a s u k

p e r i n e i u n y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s p e n y a k i t n e u r o m u s k u l a r

d a n k a t e t e r i s a s i b u l i - b u l i ( F o x m a n e t a l 2 0 1 0 ) S e l a i n i t u i n s i d e n I S K m e n c a p a i

1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o n a l d 2 0 1 1 )

B Hubungan antara Jenis Keiamin dengan Kejadian infeksi Saiuran

Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 8 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d e n g a n n i l a i s i g n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O

d i t o l a k Odds Ratio ( O R ) = 8 7 0 0 ( 9 5 C l = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a risiko k e j a d i a n

i n f e k s i s a i u r a n k e m i h p a d a p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n

p a d a l a k i - i a k i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n M a g i i a n o e t a l

( 2 0 1 1 ) m e n g e n a i Gender and Age-Dependent Etiology of Community Acquired

y a n g m e l a k u k a n p e n g a m b i l a n 6 1 2 7 3 s a m p e l k u l t u r u r i n d a l a m p e r i o d e 2 2 b u l a n

d a r i s a m p e l i n i d i d a p a t k a n 1 3 8 2 0 ( 2 2 6 ) d i t e m u k a n p o s i t i f i n f e k s i b a k t e r i

h a m p i r 8 0 b a l i a n y a n g d i i s o l a s i b e r a s a l d a r i p e r e m p u a n P e n e l i t i a n i n i j u g a

d i p e r k u a t o l e h p e n e l i t i a n y a n g d i l a k u k a n o l e h Y u n i t a I ( 2 0 1 0 ) d i m a n a a d a

h u b m i g a n y a n g b e n n a k n a a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h ( P value=O049 R P = 3 2 7 3 ( 9 5 C I = I 0 1 6 - 1 0 5 4 0 )

H a l t e r s e b u t d a p a t t e r j a d i k a r e n a u r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a l i

d e n g a n d e k a t n y a v a g i n a l v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i

s a i u r a n k e m i h l e b i h s e r i n g p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a flora n o r m a l

3 5

p a d a d a e r a h p e r i u r e t r a t e r d i r i d a r i o r g a n i s m e s e p e r t i i a c t o b a c i l l u s y a n g m e m b a n t u

m e l a w a n k o l o n i s a s i b a k t e r i p a t o g e n p a d a s a i u r a n k e m i h P e r u b a h a n l i n g k i m g a n

d a r i p e r i u r e t r a l s e p e r t i p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k

b i s a m e n g g a n g g u f l o r a n o r m a l s e h i n g g a m e n u m g k i n k a n b a k t e r i p a t o g e n

b e r k o l o n i s a s i d a n m e n y e b a b k a n i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Scuare p a d a t a b e l 4 9 d i d a p a t k a n b a h w a

t e r d a p a t l i u b u n g a n y a n g s i g n i f i k a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a

H O d i t o l a k Odds Ratio ( O R ) - 6 0 0 0 ( 9 5 o C l = 2 3 5 1 - 1 5 3 I O ) a r t i n y a n s i k o

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r

a d a i a h 6 k a l i l e b i h b e s a r d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n

m e n e n g a h d a n t i n g g i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h T o r o n d e i B e t

a l ( 2 0 1 5 ) m e n g e n a i Menstrual Hygiene Practices WASH Access and the Risk of

Urogenital Infection in Women from Odisha India d i m a n a p e r e m p u a n y a n g

h a n y a m e n e m p u l i p e n d i d i k a n s e k o l a h d a s a r a t a u l e b i h r e n d a h d i b a n d i n g k a n

d e n g a n t i n g k a t p e n d i d i k a n m e n e n g a h a t a u t i n g g i m e m i l i k i r i s i k o 3 k a l i

k e m u n g k i n a n l e b i h b e s a r m e n g a l a m i i n f e k s i s a i u r a n k e m i h ( A d j O R = 3 l 9 5

C 1 = I 2 - 7 9 p = 0 0 2 )

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a p e n g e t a h u a n s e s e o r a n g

t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t p e n d i d i k a n S e s e o r a n g y a n g

m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m u n g k i n a n p e n g e t a l i u a n t e n t a n g

k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o r m a s i y a n g d i d a p a t k a n t e n t a n g k e s e h a t a n

l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h S e b a l i k n y a

p e n d i d i k a n y a n g k u r a n g d a p a t i n e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g t e r h a d a p

n i l a i - n i l a i y a n g b a r u d i k e n a l ( N o t o a d m o j o 2 0 0 3 )

3 6

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Keniih

B e r d a s a r k a n l i a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 1 0 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a r i w a y a t d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 )

s e h i n g g a H O d i t o l a k Odds Ratio ( O R ) = 9 8 0 8 ( 9 5 C I = 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a

risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h S a r i E W P d a n

S a t y a b a k t i P ( 2 0 1 5 ) m e n g e n a i p e r b e d a a n risiko i n f e k s i n o s o k o m i a l s a i u r a n k e m i h

b e r d a s a r k a n k a t e t e r i s a s i u r i n u m u r d a n d i a b e t e s m e l i m s d i m a n a d a r i 2 0 p a s i e n

i n f e k s i n o s o k o m i a l s a i u r a n k e m i h 1 2 o r a n g ( 6 0 ) d i a n t a r a n y a a d a i a h p a s i e n

d e n g a n s t a t u s D M s e d a n g k a n 8 o r a n g ( 4 0 ) l a i n n y a a d a i a h p a s i e n t a n p a s t a t u s

D M ( P v W w ^ = 0 0 2 4 O R = 6 0 0 9 5 C I = 1 2 2 - 3 2 2 6

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a b a l i w a b e b e r a p a b a g i a n

d a r i i i n u n i t a s p a d a p a s i e n d i a b e t e s m e n g a l a m i p e r u b a h a n F u n g s i

p o l i n i o r f o l e u k o s i t d i t e k a n p a d a k e a d a a n a s i d o s i s I k a t a n l e u k o s i t k e m o t a k s i s d a n

f a g o s i t o s i s j u g a b e m b a l i S i s t e m a n t i o k s i d a n y a n g b e r p e r a n p a d a a k t i f i t a s

b a k t e r i s i d a l j u g a t e r g a n g g u s e h i n g g a m e n y e b a b k a n t e r j a d i n y a I S K p a d a p a s i e n -

p a s i e n d e n g a n p e n y a k i t d i a b e t e s ( J u l k a 2 0 1 4 )

H a l y a n g s a m a j u g a d i i m g k a p k a n o l e b t e o r i S m e l t z e r d a n B a r e ( 2 0 1 0 )

b a l i w a D M d a p a t m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a l i a n a n t u b u h y a n g

b e r p o t e n s i m e n i n g k a t k a n r i s i k o t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a l i a n a n

t u b u h t e r s e b u t d i a n t a r a n y a a d a i a h k e g a g a l a n m i g r a s i s e l iniraceliular killing

f a g o s i t o s i s d a n k e m o t a k s i s p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n

m e k a n i s m e p e r t a l i a n a n a l a m i a h I o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p

i n f e k s i

BAB V

KESIMPULAN DAN SARAN

51 Kesimpulan

1 U s i a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 2 6 - 3 5 t a h u n y a i t u 2 3 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 3 7

2 U s i a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 4 6 - 5 5 t a l i u n y a i t u 2 9 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 1 3

3 U s i a j e n i s k e i a m i n d a n t i n g k a t p e n d i d i k a n s a m p e i y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i l i t e r b a n y a k y a i t u b e r u s i a gt 5 0 t a h u n ( 5 3 3 ) j e n i s k e i a m i n

p e r e m p u a n ( 6 0 0 ) d a n t i n g k a t p e n d i d i k a n d a s a r ( 6 6 7 ) s e r t a p a l i n g

b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s y a i t u 5 6 7

4 T e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 ( p = 0 0 0 0 )

52 Saran

1 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t d i l a k u k a n d e n g a n d e s a i n

p e n e l i t i a n b e r b e d a s e p e r t i cohort a t a u case control

2 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t m e i i c a r i v a r i a b e l independent

y a n g l a i n s e p e r t i v a r i a b e l p e k e r j a a n p e m a s a i i g a n k a t e t e r a t a u l a m a n y a

m e n d e r i t a d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

37

DAFTAR PUSTAKA

B o y k o E J d k k 2 0 0 2 D i a b e t i c A n d T h e R i s k O f A c u t e U r i n a r y T r a c t I n f e c t i o n A m o n g P o s t m e n o p a u s a l W o m e n D i a b e t e s C a r e 2 5 ( 1 0 )

D a h l a n S 2 0 1 4 B u k i i S t a t i s t i k u n t u k K e d o k t e r a n d a n K e s e h a t a n D e s k r i p t i f B i v a r i a t d a n M u l t i v a r i a t d i l e n g k a p i a p l i k a s i d e n g a n m e n g g u n a k a n S P S S E d i s i 6 E p i d e m i o l o g i I n d o n e s i a J a k a r t a I n d o n e s i a

D e p a r t e m e n K e s e h a t a n ( D E P K E S ) R l 2 0 1 4 [ O n l i n e ] K e m e n t e r i a n K e s e h a t a n R e p u b l i k I n d o n e s i a P u s a t D a t a d a n I n f o r m a s i K e m e n t e r a n K e s e h a t a n R l ( http 7depkesgoid diakses tanggal 15 Met 2016)

F o x m a n B e t a i 2 0 1 0 U r i i i a i y T r a c t I n f e c t i o n A m o n g W o m e n A g e d 4 0 T o 6 5 B e h a v i o r a l A n d S e x u a l R i s k F a c t o r s D a l a m T a n a g h o E A M c A n i n c h J W 1 7 t h S m i t h s G e n e r a l U r o l o g y U S A M c G r a w H i l l (http searchproqnestcom diakses tanggal 16 Met 2016)

H a r d i n g G K d k k 2 0 1 0 A n t i m i c r o b i a l T r e a t m e n t I n D i a b e t i c W o m e n W i t l i A s y m t o m a t i c B a c t e r i u r i a N E n g l J M e d 3 4 7 1 5 7 6 - 1 5 8 3 (http nejmorg diakses tanggal 16 Met 2016)

I s s e l b a c h e r d k k 2 0 0 9 I n f e k s i S a i u r a n K e m i h d a n P i e l o n e f r i t i s D a l a m S t a m m W a l t e r E e d H a r r i s o n P r i n s i p - P r i n s i p l l m u P e n y a k i t D a l a m e d V o l u m e 2 J a k a r t a E G C 6 1 6 - 6 2 3

J u l k a S 2 0 1 3 G e n i t o u r i n a r y I n f e c t i o n I n D i a b e t e s I n d i a n J o u m a l o f E n d o c r i n o l o g y a n d M e t a b o l i s m (http searchproquestcom diakses tanggal 16 Mei 2016)

K i m B d k k 2 0 1 2 [ e - b o o k ] T h e R e l a t i o n b e t w e e n P o s t v o i d R e s i d u a l a n d O c c u r r e n c e o f U r i n a r y T r a c t I n f e c t i o n a f t e r S t r o k e i n R e h a b i l i t a t i o n U n i t A n n a l s o f R e h a b i l i t a t i o n M e d i c i n e

K o m a r a A 2 0 0 9 P o l a K e p e k a a n B a k t e r i G r a m N e g a t i f d a r i P a s i e n I n f e k s i S a i u r a n K e m i l i t e r h a d a p A n t i b i o t i k G e n t a m i c i n d a n K o t r i m o k s a z o l y a n g D i k i r i m k e L a b o r a t o r i u m M i k r o b i o l o g i K l i n i k F K U l d a r i T a h u n 2 0 0 1 s a m p a i T a h u n 2 0 0 5 (http dontaruiacid diakses tanggal OH Agustiis 2016)

L e w i s A L e t a l 2 0 1 4 I m p a c t o f H o s t A g e a n d P a r i t y o n S u s c e p t i b i l i t y t o S e v e r e U r i n a r y T r a c t I n f e c t i o n i n a M u r i n e M o d e l P l o s O n e R e s e a r c h A r t i c l e P u b l i c L i b r a r y o f S c i e n c e 9 ( 5 ) (http searchproquestcom diakses pada langgal 30 Desember 2016)

38

3

12 Rumusan Masalah

1 B a g a i m a n a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s

m e l i t u s

2 A p a k a l i a d a h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n

r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

13 Tujuan Penelitian

131 Tujuan Umum

T u j u a n u m u m d a r i p e n e l i t i a n i n i a d a i a h d i k e t e m u k a n n y a h u b u n g a n a n t a i a

u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i m s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

132 Tujuan Khusus

T u j u a n k l i u s u s d a r i p e n e l i t i a n i n i y a i t u

1 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n u s i a

2 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n m f e k s i s a i u r a n k e m i b p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n j e n i s k e i a m i n

3 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

4

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n t i n g k a t p e n d i d i k a n

4 T e r i d e n t i f i k a s i n y a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

b e r d a s a r k a n riwayat d i a b e t e s m e l i t u s

5 T e r a n a l i s i s n y a h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a i m n a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r

2 0 1 5

6 T e r a n a l i s i s n y a h u b u n g a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

7 T e r a n a l i s i s n y a h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5

8 T e r a n a l i s i s n y a h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i u i s d e n g a n k e j a d i a n

i n f e k s i s a l i u a i i k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a r i

2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

14 Manfaat Penelitian

141 Manfaat Teoritis

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t m e n a m b a h p e n g e t a h u a n p e n e l i t i

t e n t a n g h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i U i s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

5

142 Manfaat Praktis

A Bagi Peneliti

H a s i l p e n e l i t i a n i n i d i l i a r a p k a n d a p a t d i g u n a k a n s e b a g a i s a l a h s a t u b a h a n

r e f e r e n s i a t a u b a c a a n b a g i p e n e l i t i

B Bagi Institusi

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t d i g u n a k a n p i h a k R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g s e b a g a i s a l a l i s a t u b a h a n a c u a n d a l a m m e n g u p a y a k a n

p e n c e g a h a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

15 Keaslian Penelitian

T a b e l 1 1 K e a s l i a n P e n e l i t i a n

Nama Judul Penelitian Desain Hasil Penelitian

Peneliti Penelitian

Kugan P r e v a l e n s i I n f e k s i Cross D a r i p e n e l i t i a n i i i i

Kandasamy S a i u r a n K e m i l i P a d a seciUmal d i p e r o l e h b a l i w a

W a n i t a Y a n g M e n d e r i t a

D i a b e t e s M e l i t u s T i p e

I I Y a n g D i r a w a t I n a p

p a s i e n w a n i t a d i a b e t e s

m e l i t u s t i p e I y a n g

m e n d e r i t a I S K y a n g

D a n D i r a w a t J a l a n D i d i r a w a t m a p d a n

S u b b a g i a n

E n d o k r i n o l o g i B a g i a n

P e n y a k i t D a l a m D i

d i r a w a t j a l a n d i s u b

b a g i a n E n d o k r i n o l o g i

P e n y a k i t D a l a m

R S U P H A d a m M a l i k R S U P H A d a m

P a d a T a l i u n 2 0 0 9 M a l i k M e d a i i t e r d a p a t

s e b a n y a k 2 5 o r a n g

y a i t u ( 1 2 7 ) D a r i 2 5

o r a n g y a n g m e n d e r i t a

I S K t e r d a p a t 3 o r a n g

y a i t u ( 1 2 0 ) y a n g

d i r a w a t i n a p d a n 2 2

6

o r a n g ( 8 8 0 ) y a n g

d i r a w a t j a l a n

Edel Weisela P e r b e d a a n R i s i k o

Permata I n f e k s i N o s o k o m i a l

Sari dan S a i u r a n K e m i h

Prijono B e r d a s a r k a n

Satyabakti K a i e t e r i s a s i U r i n

U m u r D a n D i a b e t e s

M e l i t u s T a h u n 2 0 1 5

Case H a s i l p e n e l i t i a n y a n g

control d i 1 a k u k a n p a d a 2 0

s a m p e l k a s u s d a n

k o n t r o l m e n u n j u k k a n

b a h w a p a s i e n d e n g a n

u m u r gt 5 5 t a h u n

m e m p u n y a i r i s i k o

5 5 7 k a l i m e n g a l a m i

i n f e k s i n o s o k o m i a l

s a i u r a n k e m i h

d i b a n d i n g k a n p a s i e n

d e n g a n u m u r lt 5 5

t a h u n d e n g a n

p e r i l i t u n g a i i b e s a r

risiko d i p e r o l e h n i l a i

O R s e b e s a r 5 5 7

d e n g a n n i l a i 9 5

(onfidence Interval

l 1 9 lt O R lt 2 8 2 3

P a s i e n d e n g a n s t a t u s

D M m e m p u n y a i risiko

6 k a l i u n t u k

m e n g a l a m i i n f e k s i

n o s o k o m i a l s a i u r a n

k e m i h d i b a n d i n g k a n

d e n g a n p a s i e n y a n g

t i d a k m e n d e r i t a D M

d e n g a n n i l a i O R

7

s e b e s a r 6 0 0 d e n g a n

n i l a i 9 5 Confidence

Interval 1 22 lt O R lt

3 2 2 6

Andry K a r a k t e r i s t i k P a s i e n - D e s k r i p k i f H a s i i p e n e l i t i a n d a r i

Lukandy P a s i e n I n f e k s i S a i u r a n r e t r o s p e k t i f 4 3 o r a n g p e n d e r i t a

K e m i i i d i P o l i u r o l o g i

R S U D D r P i m g a d i

K o t a M e d a n T a h u n

2 0 1 2 - 2 0 1 3

I S K d i d a p a t k a n 5 3 5

p a d a k e l o m p o k u s i a

gt 5 0 t a h u n 5 1 2

b e i j e n i s k e i a m i n l a k i -

l a k i 1 0 0 t i d a k

m e n d e r i t a

v e s i c o u r e t r a l r e f l u x

7 0 Benign Prostatic

Hyperplasia 1 1 6

b a t u s a i u r a n k e m i h

2 7 9 d i a b e t e s t i p e 2

D a r i h a s i l p e n e l i t i a n

i n i d a p a t d i s i m p u l k a n

b a h w a p e n d e r i t a i S K

l e b i h b a n y a k t e r j a d i

p a d a l a k i - l a k i d a n

p e n d e r i t a I S K l e b i h

b a n y a k d i j u m p a i p a d a

k e l o m p o k u m u r gt 5 0

t a h u n s e r t a d i t e m u k a n

I S K d e n g a n B P H

B S K d a n D M T i p e 2

BAB 11

TINJAUAN PUSTAKA

21 Landasan Teori

211Infeksi Saiuran Keniih

A Definisi

I n f e k s i S a i u r a n K e m i h a d a i a h i n v a s i d a n m u l t i p l i k a s i m i k r o o r g a n i s m e a t a u

p a r a s i t d a l a m j a r i n g a n t u b u h k h u s u s n y a s a i u r a n k e m i h y a n g t e r d i r i d a r i g i n j a l

u r e t e r b u l i - b u l i d a n u r e t r a y a n g d i i a n d a i d e n g a n a d a n y a b a k t e r i 1 0 c f i i (colony

forming unit) p e r m l p a d a p e n g a m b i l a n c o n t o h u r i n ( P u m o m o 2 0 1 1 )

I n f e k s i s a i u r a n k e m i h a d a l a l i s u a t u i n f e k s i y a n g m e l i b a t k a n g i n j a l lU e ter

b u l i - b u l i a t a u p u n u r e t r a I n f e k s i s a i u r a n k e m i h ( I S K ) a d a l a l i i s t i l a h u m u m y a n g

m e n u n j u k k a n k e b e r a d a a n m i k r o o r g a n i s m e d a l a m u r i n ( S u d o y o 2 0 0 6 )

B a k t e r i u r i a b e r m a k n a (significant hacteriuria) a d a i a h s u a t u k e a d a a n y a n g

m e n u n j u k k a n p e n u m b u l i a n m i k r o o r g a n i s m e m u m i l e b i h d a r i 1 0 c f t L m l p a d a

b i a k a n u r i n B a k t e r i u r i a b e r m a k n a m u n g k i n t a n p a d i s e r t a i p r e s e n t a s i k l i n i s I S K

d a n d i n a m a k a n b a k t e r i u r i a a s i m t o m a t i k (convert hacteriuria) S e b a l i k n y a

b a k t e r i u r i a b e n n a k n a d i s e r t a i p e r s e n t a s i k l i n i s I S K d i n a m a k a n b a k t e r i u r i a

s i m t o m a t i k P a d a b e b e r a p a k e a d a a n t e r d a p a t p a s i e n d e n g a n p e r s e n t a s i k l i n i s I S K

n a m u n t a n p a b a k t e r i u r i a b e n n a k n a S e l a i n i t u d i k a t a k a n p i u r i a ( l e u k o s i t d a l a m

u r i n ) b e n n a k n a (significant pyuria) b i l a d i t e m u k a n n e u t r o f i l gt 1 0 s e l p e r l a p a n g a n

p a n d a n g ( S u d o y o 2 0 0 6 )

B Epidemiologi

I n f e k s i s a i u r a n k e m i h ( I S K ) m e m p a k a n s a l a h s a t u p e n y a k i t i n f e k s i y a n g

s e r i n g d i t e m u k a n d i p r a k t i k u m u m w a i a u p u n b e n n a c a m - m a c a m a n t i b i o t i k a s u d a h

t e r s e d i a l u a s d i p a s a r a n D a t a p e n e l i t i a n e p i d e m i o l o g i k l i n i k m e l a p o r k a n h a m p i r

2 5 - 3 5 s e m u a p e r e m p u a n d e w a s a p e m a h m e n g a l a m i I S K s e l a m a h i d u p n y a

S e l a m a p e r i o d e u s i a b e b e r a p a b u l a n d a n l e b i h d a r i 6 5 t a h u n p e r e m p u a n

9

10

c e n d e r u n g m e n d e r i t a i S K d i b a n d i n g k a n l a k i - l a k i I S K b e m l a n g p a d a l a k i - l a k i

j a r a n g d i l a p o r k a n k e c u a l i d i s e r t a i f a k t o r p r e d i s p o s i s i ( p e n c e t u s )

P r e v a l e n s i b a k t e r i u r i a a s i m t o m a t i k l e b i h s e r i n g d i t e m u k a n p a d a p e r e m p u a n

P r e v a l e n s i s e l a m a p e r i o d e s e k o l a h (school girls) 1 m e n i n g k a t m e n j a d i 5

s e l a m a p e r i o d e a k t i f s e c a r a s e k s u a l P r e v a l e n s i i n f e k s i a s i m t o m a t i k m e n i n g k a t

m e n c a p a i 3 0 b a i k l a k i - l a k i m a u p u n p e r e m p u a n b i l a d i s e r t a i f a k t o r p r e d i s p o s i s i

( S u d o y o 2 0 0 6 )

C Kiasifikasi

I n f e k s i s a i u r a n k e m i h d a p a t d i b a g i m e n j a d i d u a k a t e g o r i u m u m b e r d a s a r k a n

l o k a s i a n a t o m i y a i t u

1 ) I n f e k s i s a i u r a n k e m i h b a w a h

2 ) I n f e k s i s a i u r a n k e m i h a l a s

P r e s e n t a s i k l i n i s d a r i i n f e k s i s a i u r a n k e m i h b a w a l i t e r g a n t u n g d a r i gender

y a i t u

a ) P e r e m p u a n

a S i s t i t i s

S i s t i t i s a d a i a h p r e s e n t a s i k l i n i s i n f e k s i k a n d u n g k e m i h d i s e r t a i

b a k t e r i u r i a b e n n a k n a

b S i n d r o m U r e t r a A k u t ( S U A )

S i n d r o m a u r e t r a a k u t a d a i a h p r e s e n t a s i k l i n i s s i s t i t i s t a n p a d i t e m u k a n

a d a n y a m i k r o o r g a n i s m e d a l a m L u i n ( s t e r i l ) d a n s e r i n g d i n a m a k a n

s i s t i t i s b a k t e r i a l i s

b ) L a k i - l a k i

P r e s e n t a s i k l i n i s i n f e k s i s a i u r a n k e m i h p a d a l a k i - l a k i m u n g k i n s i s t i t i s

p r o s t a t i t i s e p i d i m i d i s d a n u r e t r i t i s

I n f e k s i s a i u r a n k e m i h a t a s t e r b a g i m e n j a d i 2 y a i t u

1 ) P i e l o n e f r i t i s A k u t ( P N A )

P i e l o n e f r i t i s a k u t a d a l a l i p r o s e s i n f l a m a s i p a r e n k i m g i n j a l y a n g d i s e b a b k a n

o l e h m f e k s i b a k t e r i

11

2 ) P i e l o n e f r i t i s K r o n i s ( P N K )

P i e l o n e f r i t i s k r o n i s m u n g k i n a k i b a t l a n j u t d a r i i n f e k s i b a k t e r i

b e r k e p a n j a n g a n a t a u i n f e k s i s e j a k m a s a k e c i i O b s t r u k s i s a i u r a n k e m i h d a n

r e f l u k s v e s i k o u r e t e r d e n g a n a t a u t a n p a b a k t e r i u r i a k r o n i k s e r i n g d i i k u t i

p e m b e n t u k a n j a r i n g a n i k a t p a r e n k i m g i n j a l y a n g d i t a n d a i d e n g a n

p i e l o n e f r i t i s k r o n i k y a n g s p e s i f i k ( S u d o y o 2 0 0 6 )

D Etiologi

P a d a k e a d a a n n o r m a l u r i n b e r s i f a t s t e r i l U m u m n y a I S K d i s e b a b k a n o l e h

k i i m a n g r a m n e g a t i f E s c h e r i c h i a c o l i m e m p a k a n p e n y e b a b t e r b a n y a k b a i k p a d a

y a n g s i m t o m a t i k m a u p u n y a n g a s i m t o m a t i k y a i t u 7 0 - 9 0 E n t e r o b a k t e r i a s e p e r t i

P r o t e u s m i r a b i l i s ( 3 0 d a r i i n f e k s i s a i u r a n k e m i h p a d a a n a k l a k i - l a k i t e t a p i

k u r a n g d a r i 5 p a d a a n a k p e r e m p u a n ) K l e b s i e l l a p n e u m o n i a d a n P s e u d o m o n a s

a e m g i n o s a d a p a t j u g a s e b a g a i p e n y e b a b O r g a n i s m e g r a m p o s i t i f s e p e r t i

S t r e p t o c o c c u s f a e c a l i s ( e n t e r o k o k u s ) S t a p h y l o c o c c u s e p i d e n n i d i s d a n

S t r e p t o c o c c u s v i r i d a n s j a r a n g d i t e m u k a n P a d a u r o p a t i o b s t m k t i f d a n k e l a i n a n

s t r u k t u r s a i u r a n k e m i h p a d a a n a k l a k i - l a k i s e r i n g d i t e m u k a n P r o t e u s s p e c i e s P a d a

I S K n o s o k o m i a l a t a u I S K k o m p l e k s l e b i h s e r i n g d i t e m u k a n k u m a n P r o t e u s d a n

P s e u d o m o n a s ( L u m b a n b a t u S M 2 0 0 3 )

E Patofisiologi

P a d a i n d i v i d u n o n n a l b i a s a n y a u r i n l a k i - l a k i m a u p u n p e r e m p u a n s e l a l u

d a l a m k e a d a a n s t e r i l k a r e n a d i p e r t a l i a n k a n o l e h j u m l a l i d a n f r e k u e n s i b e r k e m i h

U t e r o d i s t a l m e m p a k a n t e m p a t k o l o n i s a s i m i k r o o r g a n i s m e nonpathogenic

fastidious G r a m - p o s i t i f d a n g r a m n e g a t i f ( S u d o y o 2 0 0 6 )

H a m p i r s e m u a I S K d i s e b a b k a n i n v a s i m i k r o o r g a n i s m e ascending d a r i u r e t r a

k e d a l a m k a n d u n g k e m i b P a d a b e b e r a p a p a s i e n t e r t e n t u i n v a s i m i k r o o r g a n i s m e

d a p a t m e n c a p a i k e g i n j a l P r o s e s i n i d i p e n n u d a h o l e h k o n d i s i r e f l u k s

v e s i k o i i r e t e r a l P r o s e s i n v a s i m i k r o o r g a n i s m e h e m a t o g e n s a n g a t j a r a n g d i t e m u k a n

d i k l i n i k m u n g k i t a k i b a t l a n j u t d a r i b a k t e r e m i a G i n j a l d i d u g a m e n i p a k a n l o k a s i

12

i n f e k s i s e b a g a i a k i b a t l a n j u t d a r i s e p t i k e m i a a t a u e n d o k a r d i t i s a k i b a t S t a f i l o k o k u s

a u r e u s K e l a i n a n g i n j a l y a n g t e r k a i t d e n g a n e n d o k a r d i t i s ( S t a f i l o k k o k u s a u r e u s )

d i k e n a l d e n g a n N e p h r i t i s L o h e i n B e b e r a p a p e n e l i t i a n m e l a p o r k a n p i e l o n e f r i t i s

a k u t ( P N A ) s e b a g a i a k i b a t l a n j u t i n v a s i h e m a t o g e n ( S u d o y o 2 0 0 6 )

F Faktor Risiko

P a t o f i s i o l o g i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h d a p a t d i p e n g a n i h i o l e h

b e b e r a p a f a k t o r A d a p u n b e b e r a p a f a k t o r risiko y a n g m e m p e n g a n i l i i t e r j a d i n y a

i n f e k s i s a i u r a n k e m i h a n t a r a l a i n

1 ) U s i a

I n s i d e n I S K m e n i n g k a t b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i

m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n a d a n y a a b n o r m a l i t a s a n a t o m i y a n g

m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n k e m i h s e p e r t i p e m b e s a r a n p r o s t a t

d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e

P e n y e b a b l a i n t e r m a s u k p e r i n e u m y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s

p e n y a k i t n e u r o m u s k n l a r d a n k a t e t e r i s a s i b u l i - b u l i S e l a i n i t u i n s i d e n I S K

m e n c a p a i 1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o s e 2 0 0 9 F o x m a n e t a l 2 0 1 0

R o n a l d 2 0 1 1 )

M e n u m t t e o r i y a n g d i k e m u k a k a n o l e h S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a d a u s i a

l a n j u t a k a n t e r j a d i p e n i n g k a t a n k e r e n t a n a n t e r h a d a p p e n y a k i t P a d a u s i a d i a t a s 5 0

t a l i u n t e r j a d i p e n u m n a n k e m a m p u a n d a l a m m e m p e r t a h a n k a n s t e n l i t a s b a i k p a d a

k a n d u n g k e m i h m a u p u n u r e t r a H a l t e r s e b u t d i s e b a b k a n o l e h i n v o l u s i t i m u s

I n v o l u s i s e l t i m u s m e n y e b a b k a n j u m l a h se d a n k u a l i t a s r e s p o n s s e l T s e m a k i n

b e r k u r a n g J u m l a h s e l T m e m o r i m e n i n g k a t n a m u n s e m a k i n s u l i t u n t u k

b e r k e m b a n g t e r u t a m a s i t o t o k s i k s e l T ( C D ^ ) d a n s e l T h l ( C D ^ ^ ) k a r e n a t e r j a d i

a p o p t o s i s S i t o t o k s i k s e l T ( C D ^ ^ ) b e i p e r a n d a l a m r e s p o n s i m u n t e r h a d a p a n t i g e n

p a d a s e l y a n g d i i n f e k s i d e n g a n c a r a m e m b u n u l i s e l y a n g t e r i n f e k s i u n t u k

m e n c e g a h p e n y e b a r a n m f e k s i s e d a n g k a n s e l T h l ( C D ^ ^ ) b e r p e r a n m e m b a n t u s e l

B u n t u k m e m p r o d u k s i a n t i b o d i

13

2 ) J e n i s k e l a m m d a n a k t i v i t a s s e k s u a l

I n s i d e n s i I S K y a n g r e n d a h p a d a p r i a d i p e n g a n i h i o l e h 3 f a k t o r y a i t u

1 L e b i h s e d i k i t t e r j a d i k o l o n i s a s i s e k i t a r u r e t r a k a r e n a t i d a k a d a n y a t e m p a t

s e p e r t i v a g i n a p a d a p e r e m p u a n

2 M e m i l i k i u r e t r a y a n g p a n j a n g

3 A d a n y a s u b s t a n s i a n t i b a k t e r i a l p a d a c a i r a n p r o s t a t

U r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a h d e n g a n d e k a t n y a v a g i n a l

v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i s a i u r a n k e m i h l e b i h s e r i n g

p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a f l o r a n o n n a l p a d a d a e r a l i p e r i u r e t r a t e r d i r i

d a r i o r g a n i s m e s e p e r t i l a c t o b a c i l l i i s y a n g m e m b a n t u m e l a w a n k o l o n i s a s i b a k t e r i

p a t o g e n p a d a s a i u r a n k e m i h P e r u b a l i a n l i n g k i m g a n d a r i p e r i u r e t r a l s e p e r t i

p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k b i s a m e n g g a n g g u f l o r a

n o r m a l s e h i n g g a m e m u n g k i n k a n b a k t e r i p a t o g e n b e r k o l o n i s a s i d a n m e n y e b a b k a n

i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

P a d a w a n i t a l e b i h d a r i 5 0 t a h u n a t a u l e b i h m e n o p a u s e m e m p a k a n f a k t o r

l a i n y a n g m e n i n g k a t k a n P V R Post Void Residual) s e l a i n p e n u r u n a n k o i i t r a k t i i i t a s

o t o t d e t r u s o r P e n u m n a n e s t r o g e n y a n g d i s e b a b k a n m e n o p a u s e d a p a t

m e n i n g k a t k a n p H v a g i n a l d a n m e n u m n k a n j u m l a l i l a c t o b a c i l l i A k i b a m y a t e r j a d i

p e n i n g k a t k a n k o l o n i s a s i d a r i b a s i l g r a m n e g a t i f s e h i n g g a m e n i n g k a t k a n r e s i k o

t e r j a d i n y a I S K P a d a p r i a p r o s t a t m e n s e k r e s i k a n c a i r a n y a n g m e n g a n d i m g z i n k

y a n g m e m i l i k i a k t i f i t a s m i k r o b i a l ( K i m 2 0 1 2 )

S e l a i n i t u p i j a t a n u r e t r a s e p e r t i y a n g t e r j a d i s e l a m a h u b u n g a n s e k s u a l

m e n y e b a b k a n m a s u k n y a b a k t e r i k e d a l a m k a n d u n g k e m i h d a n m e m p a k a n h a l

y a n g p e n t i n g d a l a m p a t o g e n e s i s m f e k s i s a l i u a n k e m i h p a d a p e r e m p u a n m u d a

B u a n g a i r k e c i l s e t e l a h h u b u n g a n s e k s u a l t e r b u k t i m e n u m n k a n risiko s i s t i t i s

m u n g k i n k a r e n a t i n d a k a n i n i m e n i n g k a t k a n e r a d i k a s i b a k t e r i y a n g m a s u k s e l a m a

h u b u n g a n s e k s u a l ( K i m 2 0 1 2 )

3 ) T i n g k a t P e n d i d i k a n

P e n g e t a h u a n s e s e o r a n g t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t

p e n d i d i k a n S e s e o r a n g y a n g m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m i u i g k i n a n

p e n g e t a h u a n t e n t a n g k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o n n a s i y a n g d i d a p a t k a n

14

t e n t a n g k e s e h a t a n l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h

S e b a l i k n y a p e n d i d i k a n y a n g k u r a n g d a p a t m e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g

t e r h a d a p n i l a i - n i l a i y a n g b a n i d i k e n a l ( N o t o a d i n o j o 2 0 0 3 )

4 ) R i w a y a t D i a b e t e s M e l i t u s

M e n u r u t S m e l t z e r d a n B a r e ( 2 0 1 0 ) p a s i e n d e n g a n s t a t u s D M s a n g a t

b e r i s i k o u n t u k m e n g a l a m i i n f e k s i s a i u r a n k e m i h A b n o n n a l i i a s s t n i k t u r d a n

k a n d u n g k e m i h n e u r o g e n i k a k i b a t n e u r o p a t i o t o n o m a t a u s t r o k e p a d a p a s i e n D M

m e n y e b a b k a n p e n g o s o n g a n k a n d u n g k e m i h t i d a k n o n n a l D M j u g a d a p a t

m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a h a n a n t u b u h y a n g b e r p o t e n s i m e n i n g k a t

risiko t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a h a n a n t u b u h t e r s e b u t d i a n t a r a n y a

a d a i a h k e g a g a l a n m i g r a s i s e l intracellular killing f a g o s i t o s i s d a n k e m o t a k s i s

p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n m e k a n i s m e p e r t a h a n a n

a l a m i a h i o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p i n f e k s i

5 ) K e h a m i i a n

K e c e n d e r u n g a n i n f e k s i s a i u r a n k e m i h b a g i a n a t a s s e l a m a k e h a m i i a n

d i s e b a b k a n o l e h p e n u m n a n k e k u a t a n u r e t e r p e n u m n a n p e r i s t a l t i k u r e t e r d a n

i n k o m p e t e n s i s e m e n t a r a k a l u p v e s i k o i u - e t e r a l y a n g t e r j a d i s e l a m a h a m i l

6 ) S u m b a t a i i

A d a n y a I i a i a n g a n a l i r a n b e b a s u r i n s e p e r t i t u m o r s t r i k t r a a b a t u a t a u

h i p e r t r o f i p r o s t a t d a p a t m e n y e b a b k a n h i d r o n e f r o s i s d a n risiko i n f e k s i s a i u r a n

k e m i l i y a n g s a n g a t t i n g g i S e l a i n i t u s u p e r i n f e k s i p a d a s u m b a t a n s a i u r a n k e m i h

d a p a t m e n y e b a b k a n k e m s a k a n j a r i n g a n g i n j a l y a n g c e p a t

7 ) D i s f u n g s i n e u r o g e n i k k a n d u n g k e m i h

G a n g g u a n s a r a f y a n g b e k e r j a p a d a k a n d m i g k e m i h s e p e r t i p a d a j e j a s k o r d a

s p i n a l i s t a b e s d o r s a i i s m u l t i p e l s k l e r o s i s d i a b e t e s m e l i t u s a t a u p e n y a k i t l a i n

d a p a t b e r h u b u n g a n d e n g a n i n f e k s i s a i u r a n k e m i h I n f e k s i d a p a t d i a w a l i o l e h

p e n g g u n a a n k a t e l e r u n t u k d r a i n a s e k a n d i u i g k e m i h d a n d i d u k i m g o l e h s t a t i s u r i n

d a l a m k a n d u n g k e m i l i u n t u k j a n g k a w a k t u y a n g l a m a

8 ) R e f l u k s v e s i k o m e t e r a

K e a d a a n i n i d i d e f i n i s i k a n s e b a g a i r e f l u k s u r i n d a r i k a n d u n g k e m i b k e u r e t e r

d a n k a d a n g s a m p a i k e p e l v i s r e n a l H a l i n i t e r j a d i s e l a m a b u a n g a i r k e c i l a t a u

15

d e n g a n p e n i n g k a t a n t e k a n a n p a d a k a n d u n g k e m i h R e f l u k s v e s i k o i i r e t e r a l d a p a t

d i b u k t i k a n d e n g a n a d a n y a g c r a k a n r e t r o g r a d z a t r a d i o o p a k a t a u r a d i o a k t i f m e l a l u i

s i s t o u r e t r o g r a m s e l a m a b u a n g a i r k e c i l R e f l u k s v e s i k o i i r e t e r a l b i a s a n y a

d i s e b a b k a n k a r e n a a d a n y a g a n g g u a n a n a t o m i s p a d a p e r t e m u a n v e s i k o i i r e t e r a l

y a n g d a p a t m e n y e b a b k a n r e f l u k s u r i n d i s e r t a i b a k t e r i d a n k a r e n a i t u t e r j a d i l a h

i n f e k s i s a l r a a n k e m i h

9 ) F a k t o r v i r u l e n s i b a k t e r i

F a k t o r v i r u l e n s i b a k t e r i m e m p e n g a r u b i k e m u n g k i n a n vragt7 t e r t e n m d a l a m

m e n y e b a b k a n i n f e k s i t r a k i u s u r i n a r i u s H a m p i r s e m u a strain F c o l i y a n g

m e n y e b a b k a n p i e l o n e f r i t i s p a d a p a s i e n d e n g a n t r a k i u s u r i n a r i u s n o m i a l s e c a r a

a n a t o m i k m e m p u n y a i p i l u s t e r t e n t u y a n g m e m p e r a n t a r a i p e r l e k a t a n p a d a b a g i a n

d i g a k t o s i d a d a n g l i k o s f i n g o l i p i d y a n g a d a d i u r o e p i t e l Strain y a n g m e n i m b u l k a n

p i e l o n e f r i t i s j u g a b i a s a n y a m e m p a k a n p e n g b a s i l h e m o l i s i n m e m p u n y a i

a e r o b a k t i n d a n r e s i s t e n t e r h a d a p k e r j a b a k t e r i s i d a l d a r i s e m m m a n u s i a

1 0 ) F a k t o r g e n e t i k

F a k t o r g e n e t i k p e n j a m u m e m p e n g a n i l i i k e r e n t a n a n t e r h a d a p i n f e k s i t r a k t u s

u r i n a r i u s J u m l a h d a n t i p e r e s e p t o r p a d a s e l u r o e p i t e l t e m p a t b a k t e r i d a p a t

m e n e m p e l s e l i d a k i i y a s e b a g i a i i d i t e n t u k a r i s e c a r a g e n e t i k ( I s s e l b a c h e r 2 0 0 9 )

G Manifestasi Klinis

G e j a l a k l i n i s d a r i i n f e k s i s a i u r a n k e m i h s e s u a i d e n g a n b a g i a n s a i u r a n k e m i h

y a n g t e r i n f e k s i a d a i a h s e b a g a i b e r i k u t

1 ) I n f e k s i s a i u r a n k e m i h b a g i a n b a w a l i

K e l u h a n p a s i e n b i a s a n y a b e m p a r a s a s a k i t a t a u r a s a p a n a s d i u r e t r a s e w a k t u

k e n c i n g d e n g a n a i r k e m i h s e d i k i t - s e d i k i t s e r t a r a s a t i d a k e n a k d i d a e r a h

s i i p r a p u b i k

2 ) I n f e k s i s a i u r a n k e m i h b a g i a n a t a s

P a d a i n t e k s i s a i u r a n k e m i h b a g i a n a t a s d a p a t d i t e m u k a n g e j a l a s e p e r t i s a k i t

k e p a l a m a l a i s e m u a l m m i t a h d e n i a m m e n g g i g i l r a s a t i d a k e n a k a t a u

n y e r i d i p i n g g a n g ( T e s s y d k k 2 0 0 1 )

16

H Tatalaksana

T u j u a n p e n a t a l a k s a n a a a n i n f e k s i s a i u r a n k e m i h a d a i a h m e n c e g a h d a n

m e n g h i l a n g k a n g e j a l a m e n c e g a h d a n m e n g o b a t i b a k t e n e m i a d a n b a k t e r i u r i a s e r t a

m e n c e g a h d a n m e n g u r a n g i r i s i k o k e r u s a k a n g i n j a l y a n g m u n g k i n t i m b u l d e n g a n

p e m b e r i a n o b a t - o b a t a n y a n g s e n s i t i f m u r a l i d a n a m a n d e n g a n e f e k s a m p i n g y a n g

m i n i m a l

a ) i n f e k s i s a i u r a n k e m i h ( I S K ) b a w a h

P r i n s i p p e n a t a l a k s a n a a n I S K b a w a h m e l i p u t i intake c a i r a n y a n g b a n y a k

a n t i b i o t i k y a n g a d e k u a t d a n b i l a p e r l u t e r a p i s i m t o m a t i k u n t u k a l k a l i s a s i

u r i n

i H a m p i r 8 0 p a s i e n a k a n m e m b e r i k a n r e s p o n s e t e l a h 4 8 j a m d e n g a n

a n t i b i o t i k a t u n g g a l s e p e r t i a m p i s i l i n 3 g r a m a t a u t r i m e t o p r i m 2 0 0 m g

i i B i l a i n f e k s i m e n e t a p d i s e r t a i k e l a i n a n u r i n a l i s i s ( l e u k o s i u i a ) d i p e r i u k a n

t e r a p i k o n v e n s i o n a l s e l a m a 5 - 1 0 h a r i

i i i P e m e r i k s a a n m i k r o s k o p i s u r i n d a n b i a k a n u r i n t i d a k d i p e r i u k a n b i l a

s e m u a g e j a l a h i l a n g d a n t a n p a l e u k o s u r i a

b ) I n f e k s i s a i u r a n k e m i h ( I S K ) a t a s

P a d a u m u m n y a p a s i e n d e n g a n p i e l o n e f r i t i s a k u t m e m e r l u k a n r a w a t i n a p

u n t u k m e m e l i h a r a s t a t u s h i d r a s i d a n t e r a p i a n t i b i o t i k a p a r e n t e r a l p a l i n g

s e d i k i t 4 8 j a m ( S u d o y o 2 0 0 6 )

i Komplikasi

K o m p l i k a s i i n f e k s i s a i u r a n k e m i h t e r g a n t u n g d a r i t i p e y a i t u i n f e k s i s a i u r a n

k e m i h t i p e s e d e r h a n a (uncomplicated) d a n t i p e b e r k o m p l i k a s i (complicated)

1 ) I n f e k s i s a i u r a n k e m i h s e d e r h a n a (uncomplicated)

I n f e k s i s a i u r a n k e m i h a k u t t i p e s e d e r h a n a ( s i s t i t i s ) y a i t u n o n - o b s t r u k s i d a n

b u k a n p e r e m p u a n h a m i l m e m p a k a n p e n y a k i t r i n g a n (self limited disiase)

d a n t i d a k m e n y e b a b k a n a k i b a t l a n j u t j a n g k a l a m a

2 ) I n f e k s i s a i u r a n k e m i h b e r k o m p l i k a s i (complicated)

a ) I n f e k s i s a i u r a n k e m i h s e l a m a k e h a m i i a n

b ) i n f e k s i s a i u r a n k e m i h p a d a d i a b e t e s m e l i t u s ( S u d o y o 2 0 0 6 )

17

22 Kerangka Teori

J

U s i a

J e n i s K e i a m i n

T i n g k a t P e n d i d i k a n

R i w a y a t D i a b e t e s M e l i m s

S u m b a t a n bullT

K e h a m i i a n

D i s f u n g s i n e u r o g e n i k

R e f l u k s v e s i k o i i r e t e r a l

V i r u l e n s i b a k t e r i

F a k t o r g e n e t i k

I n f e k s i b a k t e r i g r a m p o s i t i f a t a u n e g a t i v e p a d a s a i u r a n k e m i h

I n f e k s i S a i u r a n K e m i h

Keterangan

I j = V a r i a b e l y a n g t i d a k d i t e l i t i

= V a r i a b e l y a n g d i t e l i t i

18

Hipotesis

H i p o t e s i s d a l a m p e n e l i t i a n i n i a d a i a h

H O t i d a k t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n

t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

H I t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d i p o l i p e n y a k i t d a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g

BAB 111

M E T O D E PENELITIAN

31 Jenis Penelitian

P a d a p e n e l i t i a n i n i j e n i s p e n e l i t i a n y a n g d i g u n a k a n a d a i a h p e n e l i t i a n

o b s e r v a s i o n a i a n a l i t i k d e s a i n cross scclional d e n g a n m e n g g u n a k a n d a t a s e k u n d e r

d a r i r e k a m m e d i s p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a l i P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 s a m p a i d e n g a n 3 1 D e s e m b e r

2 0 1 5

32 Waktu dan Tempat Penelitian

321 Waktu Penelitian

W a k t u p e n e l i t i a n d i l a k s a n a k a n p a d a t a n g g a l 1 O k t o b e r s a m p a i d e n g a n 3 0

O k t o b e r 2 0 1 6

322 Tempat Penelitian

P e n e l i t i a n i n i d i l a k s a n a k a n d i R u m a l i S a k i t M u h a m m a d i y a h P a e m b a n g ( d i

R u a n g R e k a m M e d i s )

33 Populasi dan Sampel Penelitian

331Populasi Penelitian

P a d a p e n e l i t i a n i n i p o p u l a s i t a r g e t a d a l a l i p a s i e n r a w a t i n a p d a n r a w a t j a l a n

d i R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g s e d a n g k a n p o p u l a s i t e r j a n g k a u n y a

a d a i a h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

332Sampel dan Besar Sampel Penelitian

P a d a p e n e l i t i a n i n i s a m p e l p e n e l i t i a n a d a i a h p a s i e n r a w a t i n a p d a n r a w a t

j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e

1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 y a n g m e m e n u h i k r i t e r i a i n k l u s i p e n e l i t i a n

1 9

20

d e n g a n b e s a r s a m p e l y a n g l a y a k d a l a m p e n e l i t i a n m e n u r u t t e o r i R o s c o e a d a i a h

a n t a r a t i g a p u l u h s a m p a i l i m a r a t i i s o r a n g ( S u g i y o n o 2 0 1 5 )

333 Krttena Inklusi dan Eksklusi

A Kriteria Inklusi

P a d a p e n e l i t i a n i n i k r i t e r i a i n k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t i n a p

d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a l i

P a l e m b a n g y a n g d i d i a g n o s a m e n g a l a m i i n f e k s i s a i u r a n k e m i h s e r t a m e m i l i k i d a t a

r e k a m m e d i s p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

B Kriteria Eksklusi

P a d a p e n e l i t i a n i n i k r i t e r i a e k s k l u s i y a n g d i g u n a k a n a d a l a l i p a s i e n r a w a t

i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 d e n g a n d a t a r e k a m m e d i s

y a n g t i d a k l e n g k a p

334 Cara Pengambilan Sampel Penelitian

C a r a p e n g a m b i l a n s a m p e l y a n g d i g u n a k a n d a l a m p e n e l i t i a n i n i a d a l a l i

m e n g g u n a k a n t e k n i k consecutive sampling P a d a consecutive sampling s e t i a p

p a s i e n y a n g m e m e n u h i k r i t e r i a p e n e l i t i a n d i m a s u k k a n d a l a m p e n e l i t i a n s a m p a i

k u r u n w a k t u t e r t e n U i s e h i n g g a j u m l a h m i n i m a l y a n g d i p e r i u k a n t e r p e n u h i

( S a s t r o a s m o r o 2 0 1 1 )

34 Variabel Penelitian

341 Variabel Dependent

V a r i a b e l dependent f t e r i k a t ) d a l a m p e n e l i t i a n i n i a d a i a h i n f e k s i s a i u r a n

k e m i h

342 Variabel Independent

V a r i a b e l independent ( b e b a s ) d a l a m p e n e l i t i a n i n i a d a i a h u s i a j e n i s

k e l a i n i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

21

35 Definisi Operasional

Tabel 31 Definisi Operasional

Variabel Alat Cara ueiinisi rldsil L KUr I7 i l l 11 Lz fe 1 V

oKaia LiKur Penelitian Ukur Ukur

Infeksi P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Saiuran d i d i a g n o s a o l e h m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Keniih d o k t e r m e n g a l a m i m e d i s

i n f e k s i s a i u r a n

k e m i h d a n t e r c a n t u m

d i r e k a m m e d i s

U s i a L a m a n y a t a h u n R e k a m O b s e r v a s i 1 lt 5 0 t a h u n O r d i n a l

k e h i d u p a n p a s i e n m e d i s r e k a m 2 gt 5 0 t a l i u n ( k a t e g o r i k )

d a r i l a h i r s a m p a i m e d i s

s e k a r a n g d a n

t e r c a n t u m d i r e k a m

m e d i s

Jenis P r o f i l a n a t o m i a t a u R e k a m O b s e r v a s i 1- L a k i - l a k i N o m i n a l

Keiamin b i o l o g i s p a s i e n y a n g m e d i s r e k a m 2 P e r e m p u a n ( k a t e g o r i k )

d i b e d a k a n m e n j a d i m e d i s

i a k i - l a k i d a n

n e r e m m i a n s e r t a

t e r c a n t u m d i r e k a m

m e d i s

Tingkat P e n d i d i k a n f o n n a l R e k a m O b s e r v a s i 1 P e n d i d i k a n O r d i n a l

Pendidikan t e r a k h i r y a n g m e d i s r e k a m d a s a r ( S D ( k a t e g o r i k )

d i t e m p u h o l e h m e d i s M I S M P

p a s i e n d a n t e r c a n t u m d a n M T s )

d i r e k a m m e d i s 2 P e n d i d i k a n

m e n e n g a l i

d a n t i n g g i

22

( S M A M A

S M K

M A K

d i p l o m a

s a r j a n a

m a g i St e r

s p e s i a l i s

d a n d o k t o r )

Riwayat P a s i e n y a n g R e k a m O b s e r v a s i 1 Y a N o m i n a l

Diabetes d i d i a g n o s i s d e n g a n m e d i s r e k a m 2 T i d a k ( k a t e g o r i k )

Melitus d i a b e t e s m e l i t u s d a n

t e r c a n t u m d i d a l a m

r e k a m m e d i s

m e d i s

36 Cara Pengumpulan Data

361 Data Sekunder

P e n g u m p u l a n d a t a p a d a p e n e l i t i a n i n i d i p e r o l e h d a r i d a t a s e k u n d e r y a i t u

r e k a m m e d i s p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h

S a k i t M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

37 Metode Teknik Analisis Data

371Cara Pengolahan dan Analisis Data

P e n g o l a h a n d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n m e l a l u i e m p a t t a h a p y a i t u

i Oala Entry

P a d a t a i i a p i n i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n riwayat d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g y a n g t e l a h d i d a p a t d a n

r e k a m m e d i s d i k u m p u l k a n d a n d i m a s u k k a n k e d a l a m p r o g r a m spss

23

2 Editing

P a d a t a h a p i n i d a t a i i s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t d i a b e t e s

m e l i t u s d a n d i a g n o s e p a s i e n y a n g t e l a h d i m a s u k k a n k e d a l a m p r o g r a m s p s s

d i p e r i k s a k e m b a l i a p a k a h s u d a h l e n g k a p d a n t i d a k a d a k e k e l i r u a n

3 ( oding

S e t e l a h m e l a l u i p r o s e s editing d a t a - d a t a t e r s e b u t d i b e r i k o d e t e r t e n t u a n t a r a

l a i n k o d e 1 u n t u k u s i a gt 5 0 t a h u n j e n i s k e i a m i n p e r e m p u a n t i n g k a t

p e n d i d i k a n d a s a r t e r d a p a t r i w a y a t d i a b e t e s m e l i t u s d a n i n f e k s i s a i u r a n

k e m i h s e d a n g k a n k o d e 2 u n t u k u s i a lt 5 0 t a h u n j e n i s k e i a m i n l a k i - l a k i

t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i t i d a k t e r d a p a t r i w a y a t d i a b e t e s

m e l i t u s d a n b u k a n i n f e k s i s a i u r a n k e m i h s e h i n g g a m e m u d a h k a n d a l a m

m e l a k u k a n a n a l i s i s d a t a

4 Tahulaling

P a d a t a h a p i n i d a t a y a n g s a m a d i k e l o m p o k k a n s e c a r a t e l i t i d a n t e r a t m

k e m u d i a n d i l i i t u n g d e n g a n m e n g g u n a k a n p r o g r a m sps s d a n d i j u m l a h k a i i

l a l u d i s a j i k a n d a l a m b e n t u k t a b e l - t a b e l

U n t u k m e n g a n a l i s i s d a t a d a l a m p e n e l i t i a n i n i d i l a k u k a n a n a l i s i s d a t a

u n i v a r i a t d a n b i v a r i a t d e n g a n m e n g g u n a k a n p r o g r a m s p s s s e b a g a i b e r i k u t

A A n a l i s i s u n i v a r i a t

A n a l i s i s u n i v a r i a t d i l a k u k a n d e n g a n c a r a m e l a k u k a n a n a l i s i s p a d a s e t i a p

v a r i a b e l h a s i l p e n e l i t i a n d e n g a n t u j u a n u n t u k m e n g e t a h u i d i s t r i b u s i p r o p o r s i p a d a

s e t i a p v a r i a b e l p e n e l i t i a n D a t a d i s a j i k a n d a l a m b e n t u k t a b e l d a n n a r a s i

B A n a l i s i s b i v a r i a t

A n a l i s i s b i v a r i a t d i l a k u k a n d e n g a n m e n g g u n a k a n u j i h i p o t e s i s chi-square

U j i h i p o t e s i s chi-square d a p a t d i g u n a k a n d e n g a n s y a r a t y a i t u lt 2 0 s e l y a n g

m e m p u n y a i n i l a i expected count k u r a n g d a r i l i m a s e h i n g g a j i k a t i d a k m e m e n u h i

s y a r a t u j i chi-square m a k a u j i y a n g d i g u n a k a n a d a i a h u] fisher ( D a h l a n 2 0 1 4 )

B a t a s k e m a k n a a n y a n g d i g u n a k a n a d a i a h a = 0 0 5 J i k a d i d a p a t k a n p value lt 0 0 5

p a d a u j i s t a t i s t i k m a k a t i d a k t e r d a p a t h u b u n g a n y a n g b e n n a k n a a n t a r a d u a

v a r i a b e l y a n g d i t e l i t i d a n H O d i t e r i m a S e d a n g k a n j i k a d i d a p a t k a n p value gt 0 0 5

24

p a d a u j i s t a t i s t i k m a k a t e r d a p a t l i u b u n g a n y a n g b e n n a k n a a n t a r a d u a v a r i a b e l

y a n g d i t e l i t i d a n H O d i t o l a k

38 Alur Penelitian

P e n e n t u a n p o p u l a s i d a n s a m p e l p e n e l i t i a n

K r i t e r i a i n k l u s i K r i t e r i a e k s k l u s i

P e n g a m b i l a n s a m p e l p e n e l i t i a n

P e n g o l a h a n d a n a n a l i s i s d a t a d e n g a n u j i chi-square

H a s i l d a n p e m b a h a s a n

K e s i m p u l a n d a n s a r a n

Gambar 31 Alur Penelitian Hubungan Usia Jenis Keiamin Tingkat Pendidikan dan Riwayat Diabetes Melitus dengan Kejadian Infeksi Saiuran Kemih pada Pasien Rawat Inap di Bagian Penyakit Dalam Rumah Sakit Muhammadiyah Palembang Periode 1 Januari 2015 sampai dengan 31 Desember 2015

BAB IV

HASIL DAN PEMBAHASAN

41 Hasil

P e n e l i t i a n i n i t e l a h d i l a k u k a n d i r u a n g r e k a m m e d i s R u m a h S a k i t

M u h a i m n a d i y a h P a l e m b a n g d a r i t a n g g a l 1 O k t o b e r 2 0 1 5 - 3 1 O k t o b e r 2 0 1 6

P e n e l i t i a n d i m u l a i d e n g a n p e n g a m b i l a n d a t a a w a l b e m p a d a t a r e k a m m e d i s

s e l u r u h p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

S e l a n j u t n y a r e k a m m e d i s d i p i l i h s e s u a i d e n g a n k r i t e r i a i n k l u s i d a n e k s k l u s i u n t u k

d i j a d i k a n s a m p e l p e n e l i t i a n s a m p a i m i n i m a l b e s a r s a m p e l y a n g d i b u t u h k a n

t e r p e n u h i s e r t a d i l a k u k a n p e n e l i t i a n s e c a r a o b s e r v a s i o n a i O b s e r v a s i r e k a m m e d i s

d i l a k u k a n u n m k m e n g e t a h u i d a t a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n r i w a y a t

d i a b e t e s m e l i t u s d a n d i a g n o s a p a s i e n

D a r i c a t a t a n r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g

d i d a p a t k a n s e b a n y a k 4 1 4 1 r e k a m m e d i s p a s i e n r a w a t i n a p d a n 1 4 5 3 r e k a m m e d i s

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a i a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 D a r i t o t a l r e k a m m e d i s

p a s i e n r a w a t i n a p d a n r a w a t j a l a n t e r s e b u t p e n e l i t i h a n y a m e n g a m b i l m i n i m a l

b e s a r s a m p e l y a n g d i b u t u h k a n y a i t u s e b a n y a k 9 8 r e k a m m e d i s u n t u k d i j a d i k a n

s a m p e l p e n e l i t i a n y a n g t e r d i r i d a r i 3 0 r e k a m m e d i s p a s i e n y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i h d a n 6 8 r e k a m m e d i s y a n g t i d a k m e n g a l a m i i n f e k s i s a i u r a n k e m i h

411 Hasil Analisis Univariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s u n i v a r i a t

a n t a r a l a i n d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p b e r d a s a r k a n u s i a d a n

j e n i s k e l a m m d i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n b e r d a s a r k a n u s i a

d a n j e n i s k e i a m i n d i s t r i b u s i p r o p o r s i s a m p e l b e r d a s a r k a n k e j a d i a n m f e k s i s a i u r a n

k e m i h s e r t a d i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n u s i a

j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat d i a b e t e s m e l i m s

25

26

A Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan IJsta

dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 41 Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan

Usia dan Jenis Keiamin

Paisen Rawat Inap N Persentase

Usia

1 7 - 2 5 t a h u n 678 1 6 4

2 6 - 3 5 t a h u n 952 2 3 0

3 6 - 4 5 t a l i u n 745 18 0

4 6 - 5 5 t a h u n 695 1 6 8

5 6 - 6 4 t a h u n 571 1 3 8

gt 6 4 t a h u n 500 1 2 1

U s i a r a t a - r a t a ( t a h u n j 43plusmn16543

Jenis Keiamin

P e r e m p u a n 2 6 3 8 6 3 7

L a k i - l a k i 1 5 0 3 3 6 3

Total 4141 100

B e r d a s a r k a n t a b e l 4 1 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R i u n a h S a k i t M u l i a m m a d i y a l i

P a l e m b a n g p e r i o d e J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 2 6 - 3 5 t a h u n y a i t u

s e b a n y a k 9 5 2 o r a n g ( 2 3 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 43plusmn16543 t a l i u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e I J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 2 6 3 8 o r a n g ( 6 3 7 )

27

B Distribusi Proporsi Karakteristik Pasien Rawat Jalan Berdasarkan

Usia dan Jenis Keiamin

D i s t r i b u s i p r o p o r s i k a r a k t e r i s t i k p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 b e r d a s a r k a n u s i a d a n j e n i s k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i

b a w a h i n i

Tabel 42 Distribusi Proporsi Karakteristik Pasien Rawat Jalan

Berdasarkan Usia dan Jenis Keiamin

Fasten Rawat Jalan N Persentase

Usia

1 7 - 2 5 t a h u n 9 2 6 3

2 6 - 3 5 t a l n i n 1 3 1 9 0

3 6 - 4 5 t a h u n 2 7 9 1 9 2

46-55 t a l i u n 4 2 1 2 9 0

5 6 - 6 4 t a h u n 3 1 6 2 1 7

gt 6 4 t a h u n 2 1 4 1 4 7

U s i a r a t a - r a t a ( t a h u n ) 50plusmn14120

Jenis Keiamin

P e r e m p u a n 8 9 0 6 1 3

L a k i - l a k i 5 6 3 3 8 7

Total 1453 100

B e r d a s a r k a n t a b e l 4 2 d i a t a s d a p a t d i k e t a l i u i b a h w a u s i a t e r b a n y a k p a d a

p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5 a d a i a h 4 6 - 5 5 t a h u n y a i t u

s e b a n y a k 4 2 1 o r a n g ( 2 9 0 ) d e n g a n r a t a - r a t a u s i a y a i t u 50plusmn14120 t a h u n

S e d a n g k a n j e n i s k e i a m i n t e r b a n y a k p a d a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t

D a l a m R m n a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a i i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 a d a i a h p e r e m p u a n y a i t u s e b a n y a k 8 9 0 o r a n g ( 6 1 3 )

28

C Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Usia

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i b b e r d a s a r k a n u s i a d a p a t

d i i i h a t p a d a l a b e l d i b a w a h i n i

Tabel 43 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Usia

Usia N Persentase

lt 5 0 t a h u n 1 4 4 6 7

gt 5 0 t a l i u n 1 6 5 3 3

Total 30 100

B e r d a s a r k a n t a b e l 4 3 d i a t a s d a p a t d i k e t a h u i b a h w a u s i a t e r b a n y a k p a d a

s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h gt 5 0 t a h u n y a i t u s e b a n y a k

1 6 o r a n g ( 5 3 3 )

D Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan Jenis

Keiamin

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n j e n i s

k e i a m i n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 44 Distribusi Proporsi Kejadian infeksi Saiuran Kemih Berdasarkan

Jenis Keiamin

Jenis Keiamin N Persentase

P e r e m p u a n 1 8 6 0 0

L a k i - l a k i 1 2 4 0 0

Total 30 100

B e r d a s a r k a n t a b e l 4 4 d i a t a s d a p a t d i k e t a h u i b a h w a j e n i s k e i a m i n

t e r b a n y a k p a d a s a m p e l y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h p e r e m p u a n

y a i t u s e b a n y a k 1 8 o r a n g ( 6 0 0 )

29

E Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n t i n g k a t

p e n d i d i k a n d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 45 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Tingkat Pendidikan

Tingkat Pendidikan N Persentase

P e n d i d i k a n d a s a r 20 6 6 7

P e n d i d i k a n m e n e n g a h d a n P e n d i d i k a n m e n e n g a h d a n 10 333

t i n g g i

Total J O 100

B e r d a s a r k a n t a b e l 4 5 d i a t a s d a p a t d i k e t a l i u i b a l i w a t i n g k a t p e n d i d i k a n

t e r b a n y a k p a d a s a m p e i y a n g m e n g a l a m i i n f e k s i s a i u r a n k e m i h a d a i a h t i n g k a t

p e n d i d i k a n d a s a r y a i t u s e b a n y a k 20 o r a n g ( 6 6 7 )

P Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

D i s t r i b u s i p r o p o r s i k e j a d i a n i n f e k s i s a i u r a n k e m i h b e r d a s a r k a n riwayat

d i a b e t e s m e l i t u s d a p a t d i i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 46 Distribusi Proporsi Kejadian Infeksi Saiuran Kemih Berdasarkan

Riwayat Diabetes Melitus

Riwayat Diabetes Melitus N Persentase

Y a 17 5 6 7

T i d a k 13 433

Total 30 100

B e r d a s a r k a n t a b e l 4 6 d i a t a s d a p a t d i k e t a h u i b a l i w a s a m p e l y a n g

m e n g a l a m i i n f e k s i s a i u r a n k e m i h t e r b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s

y a i t u s e b a n y a k 1 7 o r a n g ( 5 6 7 )

30

412 Hasil Analisis Bivariat

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d i d a p a t k a n h a s i l a n a l i s i s b i v a r i a t

a n t a r a I a i n h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h j e n i s

k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h t i n g k a t p e n d i d i k a n d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d a n r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n

i n f e k s i s a l m a n k e m i h

A n a l i s i s y a n g d i g u n a k a n p a d a u j i d u a v a r i a b e l y a n g b e r s k a l a k a t e g o r i k

a d a l a l i d e n g a n u j i Chi-Square d e n g a n n i e i h a t n i l a i Pearson Chi-Square S e m u a

h a s i l d a r i u j i h u b u n g a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t p e n d i d i k a n d a n riwayat

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h m e n g g i u i a k a n u j i Chi-

Square k a i e n a m e m e n u h i s y a r a t u j i Chi-Square y a i t u lt 2 0 s e l y a n g m e m p u n y a i

n i l a i expected count lt 5

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t i i h a t p a d a t a b e l d i b a w a h i n i

Tabel 47 Hasil Uji Hubungan antara Usia dengan Kejadian Infeksi

Saiuran Kemih

Usia

Infeksi Saiuran Kemih

^a Tidak

n N Mgt

Jumlah P

value 95Cl

lt 50 t a h u n 1 4 1 9 2 5 9 8 0 8 7 3 0 0 0 0 2 7 4 7 - 2 0 4 3 1

gt 5 0 t a h u n 1 6 6 4 0 9 3 6 0 2 5

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 7 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R = 7 4 9 2

( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a u s i a gt

5 0 t a h u n a d a l a l i 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a u s i a lt 5 0 t a h u n

31

B Hubungan antara Jenis Keiamin dengan Kejadian Infeksi Saiuran

Kemih

H a s i l a n a l i s i s b i v a r i a t l i u b u n g a n a n t a r a j e n i s k e l a i n i n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

Tabel 48 Hasil Uji Hubungan antara Jenis Keiamin dengan Kejadian

Infeksi Saiuran Kemih

Infeksi Saiuran Kemih Jenis P

A Tidak Jumlah 95CI Keiamin value

N N

P e r e m p u a n 18 6 4 3 10 357laquoo 2 8 3 2 2 7 -P e r e m p u a n 0 0 0 0

L a k i - l a k i 12 1 7 1 5 8 8 2 9 7 0 2 3 4 5 9

Jumlah 30 306 68 694 98

B e r d a s a r k a n t a b e l 4 8 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a l a l i

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k N 4 a k a a d a l i u b u n g a n y a n g s i g n i f i k a n a n t a r a

j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( O R ) = 8 7 0 0

f 9 5 C I = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a l a k i - l a k i

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e n i i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i l i a t p a d a t a b e l

d i b a w a h i n i

32

Tabel 49 Hasil liji Hubungan antara Tingkat Pendidikan dengan

Kejadian Infeksi Saiuran Kemih

Infeksi Saiuran Kemih P

Y a T i d a k jumlah 95CI value

N

P e n d i d i k a n d a s a r 2 0 5 4 1 1 7 4 5 9 3 7

P e n d i d i k a n

m e n e n g a h d a n 10 1 6 4 5 1 8 3 6 6 1

t i n g g i

Jumlah JO 30 6 68 694 9H

B e r d a s a r k a n t a b e l 4 9 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio ( 0 R ) =

6 0 0 0 ( 9 5 C I = 2 3 5 1 - 1 5 3 1 0 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a

o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r a d a i a h 6 k a l i l e b i h b e s a r

d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n m e n e n g a h d a n t i n g g i

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Kemih

H a s i l a n a l i s i s b i v a r i a t h u b u n g a n a n t a r a riwayat d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n m e n g g u n a k a n u j i Chi-Square d a p a t l i h a t

p a d a t a b e l d i b a w a h i n i

Tingkat

Pendidikan

2 3 5 1 -0 0 0 0

1 5 3 1 0

33

Tabel 4t0 Hasil I j i Hubungan antara Riwayat Diabetes Melitus dengan

Kejadian Infeksi Saiuran Kemih

Riwayat Infeksi Saiuran Kemih P

Diabetes Va Tidak Jumlah value

95CI

Melitus N bullVJ N

Y a

T i d a k

17

1 3

6 8 0

1 7 8

8

6 0

3 2 0

8 2 2

2 5

7 3 0 0 0 0

3 4 9 3 -

2 7 5 3 6

Jumlah 30 306 68 571 98

B e r d a s a r k a n t a b e l 4 1 0 d i a t a s d i d a p a t k a n b a h w a n i l a i s i g n i f i k a n n y a a d a i a h

0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k M a k a a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a

r i w a y a t d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h Odds Ratio

( O R ) = 9 8 0 8 ( 9 5 C I - 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a r i s i k o k e j a d i a n i n f e k s i s a i u r a n k e m i h

p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r

d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s m e l i m s

42 Pembahasan

A Hubungan antara Usia dengan Kejadian Infeksi Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a l a b e l 4 7 d i d a p a t k a n b a l i w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i b d e n g a n n i l a i s i g n i f i k a n n y a a d a l a l i 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O d i t o l a k

Odds Ratio ( O R ) = 7 4 9 2 ( 9 5 C I = 2 7 4 7 - 2 0 4 3 1 ) a r t i n y a risiko k e j a d i a n i n f e k s i

s a i u r a n k e m i h p a d a u s i a T 5 0 t a h u n a d a i a h 7 5 k a l i l e b i h b e s a r d i b a n d i n g k a n p a d a

u s i a lt 5 0 t a h u n

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n A n d r y L u k a n d y

( 2 0 1 4 ) m e n g e n a i k a r a k t e r i s t i k p a s i e n - p a s i e n i n f e k s i s a i u r a n k e m i h d i m a n a

p e n d e r i t a I S K d e n g a n k e l o m p o k u m u r gt 5 0 t a h u n s e b a n y a k 2 3 o r a n g s e d a n g k a n

j u m l a h p e n d e r i t a I S K d e n g a n k e l o m p o k u m m lt 5 0 t a l i u n s e b a n y a k 2 0 o r a n g

P e n e l i t i a n i n i j u g a d i p e i k u a t o l e h p e n l i t i a n L e w i s A l e t a l ( 2 0 1 4 ) m e n g e n a i

impact of host age and parity on susceptihility to severe urinary tract injection in

34

a murine mode d e n g a n u j i K r u s k a l - W a l l i s d e n g a n post-test D u n n u n t u k b e b e r a p a

p e r b a n d i n g a n d i m a n a u s i a d a n p a r i t a s s e b a g a i f a k t o r y a n g b e r k o n t r i b u s i d a l a m

k e r e n t a n a n i m t u k t e r j a d i n y a I S K d e n g a n n i l a i p lt 0 0 5

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n g a t a k a n b a h w a i n s i d e n I S K m e n i n g k a t

b e r s a m a a n d e n g a n u s i a P a d a l a k i - l a k i m e n i n g k a t n y a k e j a d i a n i n i d i k a r e n a k a n

a d a n y a a b n o r m a l i t a s a n a t o m i y a n g m e n j a d i f a k t o r risiko t e r j a d i n y a i n f e k s i s a i u r a n

k e m i h s e p e r t i p e m b e s a r a n p r o s t a t d a n p e r u b a h a n p a d a v a g i n a l d a n f l o r a

p e r i u r e t r a l p a d a w a n i t a m e n o p a u s e ( R o s e 2 0 0 9 ) P e n y e b a b l a i n t e n n a s u k

p e r i n e i u n y a n g t i d a k b e r s i h a k i b a t d a r i f e k a l i n k o n t i n e n s p e n y a k i t n e u r o m u s k u l a r

d a n k a t e t e r i s a s i b u l i - b u l i ( F o x m a n e t a l 2 0 1 0 ) S e l a i n i t u i n s i d e n I S K m e n c a p a i

1 0 p a d a w a n i t a l e b i h d a r i 6 0 t a h u n ( R o n a l d 2 0 1 1 )

B Hubungan antara Jenis Keiamin dengan Kejadian infeksi Saiuran

Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 8 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i

s a i u r a n k e m i h d e n g a n n i l a i s i g n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a H O

d i t o l a k Odds Ratio ( O R ) = 8 7 0 0 ( 9 5 C l = 3 2 2 7 - 2 3 4 5 9 ) a r t i n y a risiko k e j a d i a n

i n f e k s i s a i u r a n k e m i h p a d a p e r e m p u a n a d a i a h 8 7 k a l i l e b i h b e s a r d i b a n d i n g k a n

p a d a l a k i - i a k i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n M a g i i a n o e t a l

( 2 0 1 1 ) m e n g e n a i Gender and Age-Dependent Etiology of Community Acquired

y a n g m e l a k u k a n p e n g a m b i l a n 6 1 2 7 3 s a m p e l k u l t u r u r i n d a l a m p e r i o d e 2 2 b u l a n

d a r i s a m p e l i n i d i d a p a t k a n 1 3 8 2 0 ( 2 2 6 ) d i t e m u k a n p o s i t i f i n f e k s i b a k t e r i

h a m p i r 8 0 b a l i a n y a n g d i i s o l a s i b e r a s a l d a r i p e r e m p u a n P e n e l i t i a n i n i j u g a

d i p e r k u a t o l e h p e n e l i t i a n y a n g d i l a k u k a n o l e h Y u n i t a I ( 2 0 1 0 ) d i m a n a a d a

h u b m i g a n y a n g b e n n a k n a a n t a r a j e n i s k e i a m i n d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h ( P value=O049 R P = 3 2 7 3 ( 9 5 C I = I 0 1 6 - 1 0 5 4 0 )

H a l t e r s e b u t d a p a t t e r j a d i k a r e n a u r e t r a y a n g p e n d e k p a d a w a n i t a d i t a m b a l i

d e n g a n d e k a t n y a v a g i n a l v e s t i b u l e d a n r e k t u m m e m p e n g a r u b i t e r j a d i n y a i n f e k s i

s a i u r a n k e m i h l e b i h s e r i n g p a d a w a n i t a d a r i p a d a p r i a P a d a w a n i t a flora n o r m a l

3 5

p a d a d a e r a h p e r i u r e t r a t e r d i r i d a r i o r g a n i s m e s e p e r t i i a c t o b a c i l l u s y a n g m e m b a n t u

m e l a w a n k o l o n i s a s i b a k t e r i p a t o g e n p a d a s a i u r a n k e m i h P e r u b a h a n l i n g k i m g a n

d a r i p e r i u r e t r a l s e p e r t i p e r u b a h a n p H k a d a r e s t r o g e n a t a u p e n g g u n a a n a n t i b i o t i k

b i s a m e n g g a n g g u f l o r a n o r m a l s e h i n g g a m e n u m g k i n k a n b a k t e r i p a t o g e n

b e r k o l o n i s a s i d a n m e n y e b a b k a n i n f e k s i p a d a s a i u r a n k e m i h ( R o s e 2 0 0 9 )

C Hubungan antara Tingkat Pendidikan dengan Kejadian Infeksi

Saiuran Kemih

B e r d a s a r k a n h a s i l a n a l i s i s u j i Chi-Scuare p a d a t a b e l 4 9 d i d a p a t k a n b a h w a

t e r d a p a t l i u b u n g a n y a n g s i g n i f i k a n a n t a r a t i n g k a t p e n d i d i k a n d e n g a n k e j a d i a n

i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 ) s e h i n g g a

H O d i t o l a k Odds Ratio ( O R ) - 6 0 0 0 ( 9 5 o C l = 2 3 5 1 - 1 5 3 I O ) a r t i n y a n s i k o

k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i t i n g k a t p e n d i d i k a n d a s a r

a d a i a h 6 k a l i l e b i h b e s a r d i b a n d i n g k a n y a n g m e m i l i k i t i n g k a t p e n d i d i k a n

m e n e n g a h d a n t i n g g i

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h T o r o n d e i B e t

a l ( 2 0 1 5 ) m e n g e n a i Menstrual Hygiene Practices WASH Access and the Risk of

Urogenital Infection in Women from Odisha India d i m a n a p e r e m p u a n y a n g

h a n y a m e n e m p u l i p e n d i d i k a n s e k o l a h d a s a r a t a u l e b i h r e n d a h d i b a n d i n g k a n

d e n g a n t i n g k a t p e n d i d i k a n m e n e n g a h a t a u t i n g g i m e m i l i k i r i s i k o 3 k a l i

k e m u n g k i n a n l e b i h b e s a r m e n g a l a m i i n f e k s i s a i u r a n k e m i h ( A d j O R = 3 l 9 5

C 1 = I 2 - 7 9 p = 0 0 2 )

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a p e n g e t a h u a n s e s e o r a n g

t e n t a n g k e s e h a t a n d a p a t d i p e n g a n i h i o l e h t i n g k a t p e n d i d i k a n S e s e o r a n g y a n g

m e m i l i k i p e n d i d i k a n t i n g g i m e m p u n y a i k e m u n g k i n a n p e n g e t a l i u a n t e n t a n g

k e s e h a t a n y a n g j u g a t i n g g i k a r e n a i n f o r m a s i y a n g d i d a p a t k a n t e n t a n g k e s e h a t a n

l e b i h b a n y a k d i b a n d i n g k a n d e n g a n y a n g b e r p e n d i d i k a n r e n d a h S e b a l i k n y a

p e n d i d i k a n y a n g k u r a n g d a p a t i n e n g h a m b a t p e r k e i n b a n g a n s e s e o r a n g t e r h a d a p

n i l a i - n i l a i y a n g b a r u d i k e n a l ( N o t o a d m o j o 2 0 0 3 )

3 6

D Hubungan antara Riwayat Diabetes Melitus dengan Kejadian Infeksi

Saiuran Keniih

B e r d a s a r k a n l i a s i l a n a l i s i s u j i Chi-Square p a d a t a b e l 4 1 0 d i d a p a t k a n b a h w a

t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a r i w a y a t d i a b e t e s m e l i t u s d e n g a n

k e j a d i a n i n f e k s i s a i u r a n k e m i h d e n g a n n i l a i s i g i n i f i k a n n y a a d a i a h 0 0 0 0 ( p lt 0 0 5 )

s e h i n g g a H O d i t o l a k Odds Ratio ( O R ) = 9 8 0 8 ( 9 5 C I = 3 4 9 3 - 2 7 5 3 6 ) a r t i n y a

risiko k e j a d i a n i n f e k s i s a i u r a n k e m i h p a d a o r a n g y a n g m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s a d a l a l i 9 8 k a l i l e b i h b e s a r d i b a n d i n g k a n t i d a k m e m i l i k i r i w a y a t d i a b e t e s

m e l i t u s

P e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h S a r i E W P d a n

S a t y a b a k t i P ( 2 0 1 5 ) m e n g e n a i p e r b e d a a n risiko i n f e k s i n o s o k o m i a l s a i u r a n k e m i h

b e r d a s a r k a n k a t e t e r i s a s i u r i n u m u r d a n d i a b e t e s m e l i m s d i m a n a d a r i 2 0 p a s i e n

i n f e k s i n o s o k o m i a l s a i u r a n k e m i h 1 2 o r a n g ( 6 0 ) d i a n t a r a n y a a d a i a h p a s i e n

d e n g a n s t a t u s D M s e d a n g k a n 8 o r a n g ( 4 0 ) l a i n n y a a d a i a h p a s i e n t a n p a s t a t u s

D M ( P v W w ^ = 0 0 2 4 O R = 6 0 0 9 5 C I = 1 2 2 - 3 2 2 6

H a l i n i s e s u a i d e n g a n t e o r i y a n g m e n y a t a k a n b a h w a b a l i w a b e b e r a p a b a g i a n

d a r i i i n u n i t a s p a d a p a s i e n d i a b e t e s m e n g a l a m i p e r u b a h a n F u n g s i

p o l i n i o r f o l e u k o s i t d i t e k a n p a d a k e a d a a n a s i d o s i s I k a t a n l e u k o s i t k e m o t a k s i s d a n

f a g o s i t o s i s j u g a b e m b a l i S i s t e m a n t i o k s i d a n y a n g b e r p e r a n p a d a a k t i f i t a s

b a k t e r i s i d a l j u g a t e r g a n g g u s e h i n g g a m e n y e b a b k a n t e r j a d i n y a I S K p a d a p a s i e n -

p a s i e n d e n g a n p e n y a k i t d i a b e t e s ( J u l k a 2 0 1 4 )

H a l y a n g s a m a j u g a d i i m g k a p k a n o l e b t e o r i S m e l t z e r d a n B a r e ( 2 0 1 0 )

b a l i w a D M d a p a t m e n y e b a b k a n k e l a i n a n p a d a s i s t e m p e r t a l i a n a n t u b u h y a n g

b e r p o t e n s i m e n i n g k a t k a n r i s i k o t e r h a d a p i n f e k s i K e l a i n a n s i s t e m p e r t a l i a n a n

t u b u h t e r s e b u t d i a n t a r a n y a a d a i a h k e g a g a l a n m i g r a s i s e l iniraceliular killing

f a g o s i t o s i s d a n k e m o t a k s i s p a d a l e u k o s i t polymorphonuclear s e r t a m e l e m a h k a n

m e k a n i s m e p e r t a l i a n a n a l a m i a h I o k a l s e h i n g g a p a s i e n D M l e b i h r e n t a n t e r h a d a p

i n f e k s i

BAB V

KESIMPULAN DAN SARAN

51 Kesimpulan

1 U s i a p a s i e n r a w a t i n a p d i B a g i a n P e n y a k i t D a l a m R u m a l i S a k i t

M u h a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 2 6 - 3 5 t a h u n y a i t u 2 3 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 3 7

2 U s i a p a s i e n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m R u m a h S a k i t

M u l i a m m a d i y a h P a l e m b a n g p e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1 D e s e m b e r 2 0 1 5

t e r b a n y a k a d a i a h 4 6 - 5 5 t a l i u n y a i t u 2 9 0 d a n j e n i s k e i a m i n t e r b a n y a k

a d a i a h p e r e m p u a n y a i t u 6 1 3

3 U s i a j e n i s k e i a m i n d a n t i n g k a t p e n d i d i k a n s a m p e i y a n g m e n g a l a m i i n f e k s i

s a i u r a n k e m i l i t e r b a n y a k y a i t u b e r u s i a gt 5 0 t a h u n ( 5 3 3 ) j e n i s k e i a m i n

p e r e m p u a n ( 6 0 0 ) d a n t i n g k a t p e n d i d i k a n d a s a r ( 6 6 7 ) s e r t a p a l i n g

b a n y a k m e m i l i k i r i w a y a t d i a b e t e s m e l i t u s y a i t u 5 6 7

4 T e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a u s i a j e n i s k e i a m i n t i n g k a t

p e n d i d i k a n d a n riwayat d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n

k e m i h p a d a p a s i e n r a w a t i n a p d a n r a w a t j a l a n d i B a g i a n P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g P e r i o d e 1 J a n u a r i 2 0 1 5 - 3 1

D e s e m b e r 2 0 1 5 ( p = 0 0 0 0 )

52 Saran

1 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t d i l a k u k a n d e n g a n d e s a i n

p e n e l i t i a n b e r b e d a s e p e r t i cohort a t a u case control

2 U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n d a p a t m e i i c a r i v a r i a b e l independent

y a n g l a i n s e p e r t i v a r i a b e l p e k e r j a a n p e m a s a i i g a n k a t e t e r a t a u l a m a n y a

m e n d e r i t a d i a b e t e s m e l i t u s d e n g a n k e j a d i a n i n f e k s i s a i u r a n k e m i h

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DAFTAR PUSTAKA

B o y k o E J d k k 2 0 0 2 D i a b e t i c A n d T h e R i s k O f A c u t e U r i n a r y T r a c t I n f e c t i o n A m o n g P o s t m e n o p a u s a l W o m e n D i a b e t e s C a r e 2 5 ( 1 0 )

D a h l a n S 2 0 1 4 B u k i i S t a t i s t i k u n t u k K e d o k t e r a n d a n K e s e h a t a n D e s k r i p t i f B i v a r i a t d a n M u l t i v a r i a t d i l e n g k a p i a p l i k a s i d e n g a n m e n g g u n a k a n S P S S E d i s i 6 E p i d e m i o l o g i I n d o n e s i a J a k a r t a I n d o n e s i a

D e p a r t e m e n K e s e h a t a n ( D E P K E S ) R l 2 0 1 4 [ O n l i n e ] K e m e n t e r i a n K e s e h a t a n R e p u b l i k I n d o n e s i a P u s a t D a t a d a n I n f o r m a s i K e m e n t e r a n K e s e h a t a n R l ( http 7depkesgoid diakses tanggal 15 Met 2016)

F o x m a n B e t a i 2 0 1 0 U r i i i a i y T r a c t I n f e c t i o n A m o n g W o m e n A g e d 4 0 T o 6 5 B e h a v i o r a l A n d S e x u a l R i s k F a c t o r s D a l a m T a n a g h o E A M c A n i n c h J W 1 7 t h S m i t h s G e n e r a l U r o l o g y U S A M c G r a w H i l l (http searchproqnestcom diakses tanggal 16 Met 2016)

H a r d i n g G K d k k 2 0 1 0 A n t i m i c r o b i a l T r e a t m e n t I n D i a b e t i c W o m e n W i t l i A s y m t o m a t i c B a c t e r i u r i a N E n g l J M e d 3 4 7 1 5 7 6 - 1 5 8 3 (http nejmorg diakses tanggal 16 Met 2016)

I s s e l b a c h e r d k k 2 0 0 9 I n f e k s i S a i u r a n K e m i h d a n P i e l o n e f r i t i s D a l a m S t a m m W a l t e r E e d H a r r i s o n P r i n s i p - P r i n s i p l l m u P e n y a k i t D a l a m e d V o l u m e 2 J a k a r t a E G C 6 1 6 - 6 2 3

J u l k a S 2 0 1 3 G e n i t o u r i n a r y I n f e c t i o n I n D i a b e t e s I n d i a n J o u m a l o f E n d o c r i n o l o g y a n d M e t a b o l i s m (http searchproquestcom diakses tanggal 16 Mei 2016)

K i m B d k k 2 0 1 2 [ e - b o o k ] T h e R e l a t i o n b e t w e e n P o s t v o i d R e s i d u a l a n d O c c u r r e n c e o f U r i n a r y T r a c t I n f e c t i o n a f t e r S t r o k e i n R e h a b i l i t a t i o n U n i t A n n a l s o f R e h a b i l i t a t i o n M e d i c i n e

K o m a r a A 2 0 0 9 P o l a K e p e k a a n B a k t e r i G r a m N e g a t i f d a r i P a s i e n I n f e k s i S a i u r a n K e m i l i t e r h a d a p A n t i b i o t i k G e n t a m i c i n d a n K o t r i m o k s a z o l y a n g D i k i r i m k e L a b o r a t o r i u m M i k r o b i o l o g i K l i n i k F K U l d a r i T a h u n 2 0 0 1 s a m p a i T a h u n 2 0 0 5 (http dontaruiacid diakses tanggal OH Agustiis 2016)

L e w i s A L e t a l 2 0 1 4 I m p a c t o f H o s t A g e a n d P a r i t y o n S u s c e p t i b i l i t y t o S e v e r e U r i n a r y T r a c t I n f e c t i o n i n a M u r i n e M o d e l P l o s O n e R e s e a r c h A r t i c l e P u b l i c L i b r a r y o f S c i e n c e 9 ( 5 ) (http searchproquestcom diakses pada langgal 30 Desember 2016)

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