H U B U N G A N A N T A R A USIA, J E N I S K E L A M I N , T I N G K A T
P E N D I D I K A N DAN 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 U R A N K E M I H
PADA P A S I E N R A W A T INAP DAN R A W A T
J A L A N D I B A G I A N P E N Y A K I T D A L A M
R U M A H S A K I T M U H A 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 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
PENDIDIKAN DAN RIWAYAT DIABETES M E L I T U S
DENGAN KEJADIAN I N F E K S I SALURAN K E M I H
PADA PASIEN RAWAT INAP DAN RAWAT
JALAN DI BAGIAN P E N Y A K I T 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 S p . P D - K G E H ., FINASIM.. MARS. Perabimbing Pcrtama
Mcnyctujui:
P E R N Y A T A A N
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
J e n i s 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
H A L A M A N P E R S E M B A H A N DAN M O T T O
"OfaBjrdafi ada sesuatuyan^ menanttmu sedpas Battya^BgsaSaran (yang Bpu jaCani), yang a^n memStiatmu terpana Singga /(au Cupa Setapa pedifinya rasa
saSit \ - (Jid <BinABi TltadB)
Dengan izin-Mu ya Allah, ku persembahkan karya ini untuk:
• Kedua orangtuaku yang tercinta, Riza! Efendi, S.H„ M.H. dan Dra. Yusdiami yang selalu memberikan motivasi, nasihat dan semangat untuk meraih cita-citaku, serta do'a 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 i'm trying to he the best i n everything for you and absolutely, you a r e my entire worlct.
• Saudara kandungku tersayang, Eka Satriawan, A. Md Im., S.H., M.H. dan Threenita Sari Sepgi Putri yang telah banyak membantu, menemani, serta menghibur di setiap hari-hariku. "I'm so g r a t e f u l to have you kak, g r a . You a r e truly my beloved siblings ".
• Pembimbing skripsiku, dr. M. Ayus Astoni, Sp. PD., K G E H . , FINASIM., MARS dan dr. Ratika Febriani yang telah memberikan nasihat, saran dan ilmu yang bermanfaat, serta meluangkan waktunya untuk membimbing skripsi ini bingga selesai.
• 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!"
• 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!".
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
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 Ho.spilal 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 0,000). gender (p 0,000). education level (p 0,000) and diabetes melitus (p 0,000). In conclusion, there are significantly relationships between age. gender, education level, diabetes melitus history and the incidence of urinary tract infections in ho.spitalizedpatients and outpatients at Internal Medicine of Muhammadiyah Palembang Hospital during P' January 20J5-3P'December 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
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
D A F T A R ISI
H A L A M A N J D D U L
H A L A M A N P E N C E S A H A N i H A L A M A N PERNN A T A A N ii H A L A M A N P E R S E M B A H A N iii
A B S T R A K iv
A B S T R A C T v
K A T A P E N G A N T A R vi
D A F T A R ISI vii D A F T A R T A B E I ix D A F T A R G A M B A R x D A F T A R L A M P I R A N xi
B A B I . Pendahuluan 1 1 . 1 . L a t a r B e l a k a n g 1 1.2. R i i m u s a n M a s a l a h 3 1.3. T u j u a n P e n e l i t i a n 3 1.4. M a n l a a t P e n e l i t i a n 4 1.5. K e a s l i a n P e n e l i t i a n 5 B A B 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 1 1 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 B A B III. 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
3 . 8 . A l u r P e n e l i t i a n 2 4 B A B IV. H A S I L DAN P E M B A H A S A N 25
4 . 1 . H a s i l 2 5 4 . 2 . P e m b a h a s a n 3 3 B A B V. K E S I M P L I L A N 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 P U S T A K A 38
L A M P I R A N 41 B I O D A T A 63
D A F T A R 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
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
D A F T A R L A M P I R A N
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
1.1. 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 %
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 1,5 - 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 ) .
1.2. 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 ?
1.3. Tujuan Penelitian 1.3.1. 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 antai"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 .
1.3.2. 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
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 .
1.4. Manfaat Penelitian 1.4.1. Manfaat Teoritis
1.4.2. 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 .
1.5. 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
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 > 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 < 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 < O R < 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
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 < O R < 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 > 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
BAB 11
TINJAUAN PUSTAKA
2.1. Landasan Teori
2.1.1.Infeksi 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'eter,
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 > 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
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 )
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 ) .
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 ) .
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
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 !
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 .v/ra/>7 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
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
17
2.2. 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 •T
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
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 .
BAB 111
M E T O D E P E N E L I T I A N
3.1. 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 .
3.2. Waktu dan Tempat Penelitian 3.2.1. 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 .
3.2.2. 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 ) .
3.3. Populasi dan Sampel Penelitian 3.3.1.Populasi 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 .
3.3.2.Sampel 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
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 ) .
3.3.3. 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 .
3.3.4. 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 ) .
3.4. Variabel Penelitian 3.4.1. 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 .
3.4.2. Variabel Independent
21
3.5. Definisi Operasional
Tabel 3.1. 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. < 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 . > 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
( 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
3.6. Cara Pengumpulan Data 3.6.1. 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 .
3.7. Metode Teknik Analisis Data 3.7.1.Cara 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
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 > 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 < 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 s p s 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
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 .
3.8. 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
BAB I V
H A S I L DAN PEMBAHASAN
4.1. 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 . 4.1.1. 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 .
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 4.1. Distribusi Proporsi Karakteristik Pasien Rawat Inap Berdasarkan Usia dan Jenis Keiamin
Paisen Rawat Inap
