Sensitivitas dan Spesifisitas Uji Nitrit Urin dan Pewarnaan Gram pada Infeksi Saluran Kemih Anak

Abstract

Background: Urine culture is a gold standard for the diagnosis of urinary tract infection (UTI) in children. More simple tests are often used instead of urine cultures. Nitrite test is one of them, but its accuracy compared to urine culture is still controversial. Gram staining is one of the simple tests with high accuracy. Objective: To compare sensitivity and specificity of urine nitrite test and gram staining to urine culture as the gold standard for UTI. Method:A cross-sectional study was conducted at RSUP H Adam Malik from February to July 2017. Samples were recruited with consecutive sampling. Data collected were sample characteristics, clinical manifestation, organism that cause UTI in children, nitrite test, gram staining, and urine culture results. Data were analyzed using Fisher exact test with p<0.05 was considered statistically significant. Results: A total of 60 samples participated in this study. The sample proportion of boys and girls were same. The most commonly encountered organism was Escherichia Coli (21.6%). Clinical manifestation that was often found was fever, which was 56.8% of 37 children with UTI. The sensitivity, specificity, and accuracy of nitrite test were 64.8%, 86.9%, and 73.3%, respectively, sensitivity, specificity, and accuracy of gram staining density were 94.5%, 100%, and 96.6%, respectively. Conclusion: This study showed that the nitrite test and gram staining are good alternatives for diagnostic test in diagnosing UTI in children in areas with limited facilities and health workers. Further researches with larger simple size are still needed to evaluate sensitivity, specificity, and accuracy of nitrite test.

Latar belakang: Kultur urin adalah baku emas menegakkan diagnosa ISK. Banyak uji yang mudah dilakukan. Uji nitrit salah satunya, namun akurasi dibandingkan kultur urin masih kontroversi. Pewarnaan gram juga salah satu yang mudah dilakukan dengan akurasi tinggi. Tujuan: Membandingkan sensitivitas dan spesifisitas uji nitrit urin dan pewarnaan gram dibandingkan kultur urin sebagai baku emas dalam menegakkan ISK. Metode: Penelitian cross sectional, dilakukan di RSUP H. Adam Malik, Februari sampai Juli 2017, secara consecutive sampling. Data dikumpulkan berdasar karakteristik sampel, manifestasi klinis, organisme penyebab ISK, uji nitrit, pewarnaan gram, dan hasil kultur urin. Data dianalisis menggunakan Fisher exact test dengan p<0.05. Hasil dari 60 total sampel yang ikut berpartisipasi. Organisme penyebab yang terbanyak adalah Eschericia coli (21.6%). Manifestasi klinis yang sering dijumpai adalah demam 56.8% dari 37 anak ISK. Sensitivitas, spesifisitas, dan akurasi uji nitrit urin adalah 64.8%, 86.9%, dan 73.3%. Sensitivitas, spesifisitas, dan akurasi pewarnaan gram adalah 94.5%, 100%, dan 96.6%. Kesimpulan: Uji nitrit dan pewarnaan gram dapat digunakan sebagai alternatif uji diagnosis ISK. Namun penelitian dengan sampel yang lebih besar masih diperlukan untuk mengevaluasi sensitivitas, spesifisitas, dan akurasi untuk uji nitrit.