Research Article

Perbedaan jenis kuman pada pasien Diabetes Mellitus Tipe-2 (DM-2) dengan infeksi saluran kemih dan bakteriuria asimtomatik di RSUP H. Adam Malik, Medan, Indonesia

Deby Novayanti , Ricke Loesnihari, Muzahar Muzahar

Deby Novayanti
Program Pendidikan Dokter Spesialis Patologi Klinik, Fakultas Kedokteran, Universitas Sumatera Utara /RSUP H. Adam Malik, Medan, Indonesia. Email: debynovayanti55@gmail.com

Ricke Loesnihari
Departemen Patologi Klinik, Fakultas Kedokteran, Universitas Sumatera Utara/RSUP H. Adam Malik, Medan, Indonesia

Muzahar Muzahar
Departemen Patologi Klinik, Fakultas Kedokteran, Universitas Sumatera Utara/RSUP H. Adam Malik, Medan, Indonesia
Online First: April 01, 2020 | Cite this Article
Novayanti, D., Loesnihari, R., Muzahar, M. 2020. Perbedaan jenis kuman pada pasien Diabetes Mellitus Tipe-2 (DM-2) dengan infeksi saluran kemih dan bakteriuria asimtomatik di RSUP H. Adam Malik, Medan, Indonesia. Intisari Sains Medis 11(1): 333-339. DOI:10.15562/ism.v11i1.569


Background: Patients with Diabetes Mellitus Type-2 (DM-2) have a high probability of suffering from urinary tract infections (UTIs) and asymptomatic bacteriuria (AB). AB is the presence of significant bacteriuria > 105 cfu/ml in urine cultures without clinical symptoms (asymptomatic). This study aims to find out the different types of the pathogen in DM-2 patients with urinary tract infections and bacteriuria asymptomatic at H. Adam Malik Hospital, Medan, Indonesia. 

Methods: A total of 18 DM-2 patients with UTIs and 18 patients with AB who met the criteria were included in this study from H. Adam Malik Hospital, Medan, Indonesia. Fasting blood glucose and blood glucose levels in 2 hours postprandial were examined. The middle portion of urine sample using a sterile container was conducted for urinalysis test using dipstick (Combur10 Test M, Roche Mannheim, Germany) and a Cobas U 411 ROCHE urine analyzer. Urine leukocytes were evaluated using leukocyte esterase. The urine culture for identification of bacterial and antibiotic sensitivity tests was conducted if leukocytes count > 5 / LPB. Data were analyzed using SPSS version 17 for Windows. 

Results: Most of the DM-2 respondents were females in both Urinary Tract Infection (UTI) group (77.8%) and Asymptomatic Bacteriuria (AB) group (88.9%). The age group of 39-50 years was predominant in the UTIs group (50.0%) compared with AB group in age 51-62 years old group (44.4%). Data were normally distributed between types of bacterial infection on both groups (p=0.945). However, based on the sensitivity and resistance of antibiotics, no significant difference was found between both groups (P>0.05) except for cefixime (p=0.018) from the Chi-square test.  

Conclusion: There were no differences in the types of pathogen in UTIs and AB among DM-2 patients. Besides, no significant difference for bacterial sensitivity and resistance found between groups except in cefixime. 

 

Latar Belakang: Pasien Diabetes Mellitus Tipe-2 (DM-2) memiliki kemungkinan tinggi menderita Infeksi Saluran Kemih (ISK) dan Bakteriuria Asimptomatik (BAS). BAS adalah adanya bakteriuria yang signifikan >105 cfu/ml dalam kultur urin tanpa gejala klinis (asimptomatik). Penelitian ini bertujuan untuk mengetahui berbagai jenis patogen pada pasien DM-2 dengan infeksi saluran kemih dan bakteriuria asimptomatik di Rumah Sakit H. Adam Malik, Medan, Indonesia.

Metode: Sebanyak 18 pasien DM-2 dengan ISK dan 18 pasien dengan BA yang memenuhi kriteria dimasukkan dalam penelitian ini dari Rumah Sakit H. Adam Malik, Medan, Indonesia. Glukosa darah puasa dan kadar glukosa darah dalam 2 jam post-prandial diperiksa. Bagian tengah sampel urin menggunakan wadah steril diambil untuk menjalani tes urinalisis menggunakan dipstick (Combur10 Test M, Roche Mannheim, Jerman) dan alat analisis urin Cobas U 411 ROCHE. Leukosit urin dievaluasi menggunakan leukosit esterase. Kultur urin untuk identifikasi tes sensitivitas bakteri dan antibiotik dilakukan jika jumlah leukosit > 5/LPB. Data dianalisis menggunakan SPSS versi 17 untuk Windows.

Hasil: Sebagian besar responden DM-2 adalah perempuan dalam kelompok Infeksi Saluran Kemih (ISK) (77,8%) dan kelompok Bakteriuria Asimtomatik (BAS) (88,9%). Kelompok usia 39-50 tahun dominan pada kelompok ISK (50,0%) dibandingkan dengan BA pada kelompok usia 51-62 tahun (44,4%). Data terdistribusi secara normal terhadap jenis infeksi bakteri pada kedua kelompok (p = 0,945). Namun, berdasarkan sensitivitas dan resistensi antibiotik, tidak ada perbedaan bermakna yang ditemukan antara kedua kelompok (P> 0,05) kecuali untuk sefiksim (p = 0,018) dari uji Chi-square.

Kesimpulan: Tidak ada perbedaan dalam jenis patogen pada ISK dan AB pada pasien DM-2. Selain itu, tidak ada perbedaan bermakna untuk sensitivitas dan resistensi bakteri yang ditemukan antara kelompok kecuali pada sefiksim.

References

Nitzan O, Elias M, Chazan B, Saliba W. Urinary tract infections in patients with type 2 diabetes mellitus: review of prevalence, diagnosis, and management. Diabetes Metab Syndr Obes. 2015;8:129–136. Published 2015 Feb 26. doi:10.2147/DMSO.S51792

Longdoh NA, Assob JCN, Nsagha SD, Nde PF, Kamga HLF, Nkume AF, et al. Urophatogens from Diabetic Patients with Asymptomatic Bacteriuria and Urinary Tract Infections. The West London Medical Journal. 2013;5(1):7-14

Zheng Y, Ley SH, Hu FB. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nat Rev Endocrinol. 2018;14(2):88–98.

Aguayo-Mazzucato C, Diaque P, Hernandez S, Rosas S, Kostic A, Caballero AE. Understanding the growing epidemic of type 2 diabetes in the Hispanic population living in the United States. Diabetes Metab Res Rev. 2019;35(2):e3097.

Carey IM, Critchley JA, DeWilde S, Harris T, Hosking FJ, Cook DG. Risk of Infection in Type 1 and Type 2 Diabetes Compared With the General Population: A Matched Cohort Study. Diabetes Care. 2018;41(3):513–521.

Joshi N, Caputo GM, Weitekamp MR, Karchmer AW. Infections in patients with diabetes mellitus. N Engl J Med. 1999;341(25):1906–1912.

Harding GK, Zhanel GG, Nicolle LE, Cheang M; Manitoba Diabetes Urinary Tract Infection Study Group. Antimicrobial treatment in diabetic women with asymptomatic bacteriuria. N Engl J Med. 2002;347(20):1576–1583.

Warren JW, Brown V, Jacobs S, Horne L, Langenberg P, Greenberg P. Urinary tract infection and inflammation at onset of interstitial cystitis/painful bladder syndrome. Urology. 2008;71(6):1085–1090.

Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015;13(5):269–284.

Schmiemann G, Kniehl E, Gebhardt K, Matejczyk MM, Hummers-Pradier E. The diagnosis of urinary tract infection: a systematic review. Dtsch Arztebl Int. 2010;107(21):361–367.

Saleem M, Daniel B. Prevalence of urinary tract infection among patients with diabetes in Bangalore City. Int J Emerg Sci. 2011;1(2):133-142.

Jha PK, Baral R, Khanal B. Prevalence of Uropathogens in Diabetic Patient and Their Susceptibility Pattern at a tertiery Care Center in Nepal–A Retrospective Study. Internal Journal of Biomedical Laboratory Science (IJBLS). 2014;3(2):29-34

Gurjar D, Mathur A, Sai R, Lakesar A, Saxena P. Asymptomatic Bacteriuria and Its Associated Factors in Type II Diabetes Mellitus. Int J Adv Med. 2017;4(6):1633-1637.

Ahmed AA. Prevalence of urinary tract infection in diabetic patients and identification of the causal microorganisms. Zanco J Med Sci. 2013;17(1):363-369.

Colleen S, Myhrberg H, Mårdh PA. Bacterial colonization of human urethral mucosa. I. Scanning electron microscopy. Scand J Urol Nephrol. 1980;14(1):9–15.

Geerlings SE. Urinary tract infections in patients with diabetes mellitus: epidemiology, pathogenesis and treatment. Int J Antimicrob Agents. 2008;31 Suppl 1:S54–S57.

Girishbabu RJ, Prakash R, Prashanth HV, Chandrasekar SC. Asymptomatic Bacteriuria in Patients with Diabetes Mellitus. National Journal of Laboratory Medicine. 2013;2(2):11-13.

Ariwijaya M, Suwitra K. Prevalensi, Karakteristik dan Faktor - faktor yang Terkait dengan ISK pada Penderita DM-2 yang Rawat Inap. Jurnal Penyakit Dalam. 2007;8(2):112-127.

Bissong ME, Fon PN, Tabe-Besong FO, Akenji TN. Asymptomatic bacteriuria in diabetes mellitus patients in Southwest Cameroon. Afr Health Sci. 2013;13(3):661–666.

Chiţă T, Timar B, Muntean D, Bădiţoiu L, Horhat F, Hogea E, et al. Urinary tract infections in Romanian patients with diabetes: prevalence, etiology, and risk factors. Ther Clin Risk Manag. 2016;13:1–7.

Goswami R, Bal CS, Tejaswi S, Punjabi GV, Kapil A, Kochupillai N. Prevalence of urinary tract infection and renal scars in patients with diabetes mellitus. Diabetes Res Clin Pract. 2001;53(3):181–186.

Omoregie R, Erebor JO,Ahonkhai I, Isibor JO, Ogefere HO. Observed changes in the prevalence of uropathogens in Benin City, Nigeria. N Z J Med Lab Sci. 2008;62:29-31

Ipe DS, Sundac L, Benjamin WH Jr, Moore KH, Ulett GC. Asymptomatic bacteriuria: prevalence rates of causal microorganisms, etiology of infection in different patient populations, and recent advances in molecular detection. FEMS Microbiol Lett. 2013;346(1):1–10.

Vishwanath S, Sarda R, D’Souza AO, Mukhopadhyay C. Asymptomatic Bacteriuria among Patients with Diabetes Mellitus at a Tertiary Care Center. National Journal of Laboratory Medicine. 2013;2(3):16-19


No Supplementary Material available for this article.
Article Views      : 40
PDF Downloads : 19