05 lg.cdr

Women are three times more likely to get urinary

tract infection (UTI) than men, due to women's

shorter urethra, sexual activity, pregnancy, and

hormonal changes that occur very quickly (Mitchell et

al. 2002). Hormonal changes of both estrogen and

progesterone during the menstrual cycle affect

urodynamic. Estrogen deficiency can increase the

resistance of the urethra as it can cause an increase in

the threshold of the bladder or can boost the sensitivity

of the receptors -adenoreseptor on the urethral muscle

(Robinson et al. 2013). Estrogen deficiency also

Vol.10, No.1, March 2016, p 30-37
DOI: 10.5454/mi.10.1.5

Comparison of Microbial Pattern Causing Urinary Tract Infection
in Female Out- and Hospitalized Patients in Jakarta

1 2 3
YEVA ROSANA *, DWIANA OCVIYANTI , AND SYADZA RHIZKY PUTRI AKHMAD

1
Department of Microbiology, Faculty of Medicine, Universitas Indonesia,

Jalan Pegangsaan Timur 16, Jakarta 10320, Indonesia;
2
Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia

Jalan Salemba Raya 6, Jakarta 10430, Indonesia;
3
Faculty of Medicine, Universitas Indonesia,

Jalan Salemba Raya 6, Jakarta Pusat 10430, Indonesia

Urinary Tract Infection (UTI) is an infection in any part of the urinary system. Women are 3 times more likely
to have UTI than men. The UTI accounts for 15% infection cases in outpatients and 24% cases in hospitalized
patients. Although the most common cause of UTI is certain bacteria, but it was not easy to choose the appropriate
antimicrobial therapy. Strategy for choosing empiric antimicrobial treatments for UTI in female out- and
hospitalized patients should be based on the pattern of the causative organisms. The aim of this study was to
understand the microbial pattern causing UTI in female out- and hospitalized patients in Jakarta. The UTI

-1
causative microorganisms were obtained from urine culture containing 100,000 cfu mL . Twenty nine
microorganisms were found as the causative agents of UTI in 317 pregnant women who came to six Community
Health Centres (Puskesmas) in Jakarta: Makassar; Pulogadung, Cakung, Pasar Rebo, Duren Sawit and Kramat
Jati for antenatal care. Twenty nine microorganisms were isolated from 114 urine samples of female hospitalized
patients who were diagnosed of UTI. The samples were obtained from the Microbiology Laboratory Clinic of
FKUI-RSCM. The most common microorganisms causing UTI in female out- and hospitalized patients were
Gram negative bacteria. In female outpatients, Klebsiella sp was the most common causative bacteria (31%),
followed by Escherichia coli (24.1%). In female hospitalized patients, Escherichia coli was the most common
causative bacteria (30%), followed by Candida sp (24.1%) and Klebsiella pneumonia (6.8%). There was more
variation in the pattern of UTI causative organisms in hospitalized female patients in comparison to that of the
outpatients. Candida sp. was only found in hospitalized UTI patients but not in outpatients.

Key words: causative agent, female, inpatient, outpatient, UTI

Infeksi Saluran Kemih (ISK) adalah infeksi yang terjadi pada berbagai bagian saluran kemih. Wanita
memiliki risiko 3 kali lebih besar mengalami ISK dibandingkan pria. Kejadian ISK mencapai 15% pada pasien
rawat jalan dan 24% pada pasien rawat inap di rumah sakit. Walaupun etiologi ISK yang paling umum adalah
bakteri tertentu, tetapi tidak mudah untuk memilih antimikroba yang tepat untuk terapi. Strategi untuk memilih
antimikroba empiris untuk ISK pada pasien wanita rawat jalan dan rawat inap harus didasarkan pada pola
mikroorganisme dari etiologi. Tujuan penelitian ini adalah untuk melihat pola mikroorganisme penyebab ISK
pada pasien wanita rawat jalan dan rawat inap di Jakarta. Pola mikrooganisme penyebab ISK didapatkan melalui

-1
metode kultur urin, dengan jumlah koloni 100.000 cfu mL urin. Sejumlah 29 bakteri didapatkan sebagai
mikroorganisme penyebab ISK pada 317 wanita hamil yang melakukan pemeriksaan kehamilan di 6 puskesmas
di Jakarta: Puskesmas Makassar, Pulogadung, Cakung, Pasar Rebo, Duren Sawit, dan Kramat Jati. Sebanyak 29
bakteri didapatkan dari 114 sampel urin wanita rawat inap yang didiagnosis sebagai ISK. Sampel urin
diperiksakan di Laboratorium Mikrobiologi Klinik FKUI-RSCM. Pola mikroorganisme penyebab terbanyak
ISK pada rawat jalan dan rawat inap adalah mikroorganisme Gram negatif. Pada rawat jalan Klebsiella
pneumoniae sebagai penyebab terbanyak ISK (31%), diikuti Escherichia coli (24,1%). Pada rawat inap
Escherichia coli menjadi penyebab terbanyak ISK (30%), diikuti oleh Candida sp (24,1%) dan Klebsiella
pneumoniae (6,8%). Pola mikroorganisme ISK pada rawat inap lebih bervariasi dibandingkan rawat jalan.
Candida sp hanya ditemukan pada ISK rawat inap, tetapi tidak pada rawat jalan.

Kata kunci: ISK, penyebab infeksi, rawat jalan, rawat inap, wanita

MICROBIOLOGY
INDONESIA

Available online at
http://jurnal.permi.or.id/index.php/mionline

ISSN 1978-3477, eISSN 2087-8575

*Corresponding author; Phone: +62-21-3160492; Email:
yeva.rosana@ui.ac.id

disturbed the roles of the hormone in stimulating the

proliferation of Lactobacillus in the vaginal

epithelium, reducing pH and avoiding vaginal

colonization by Enterobacteriaceae, which are the

main pathogens of the urinary tract (Raz R 2011).

These conditions play an important role in the

development of bacteriuria.

Around 35% of women aged between 20-50 years

had experienced a UTI in their lifetime (Samirah et al.

2006). Most women aged about 24 years old

(reproductive age) have experienced a UTI at least

once in their life time. The high incidence of UTI

during the reproductive age might be related to the high

sexual activity. Therefore, the incidence of UTI in

sexually active women are generally higher than non

sexually active women.

Other risk factors for UTI include pregnancy,

diabetes, obstruction of the urinary tract, older men

with enlarged prostate, and other factors that disturb

the physiology of the urinary tract (Mitchell et al.

2002). UTI acquired in hospitals are often associated

with long term catheter use. Data from research

conducted on healthcare-associated infections (HAIs)

in Indonesia reported that the rate of hospital-acquired

UTI was between 0.9 to 3.5% (Duerink et al. 2006).

Common bacteria causing urinary tract infection

(UTI) include Escherichia coli, Klebsiella

p n e u m o n i a e , P ro t e u s s p , E n t e ro b a c t e r s p ,

Streptococcus sp, and Staphylococcus saprophyticus.

In asymptomatic urinary tract infection, the number of

significant bacteria to support UTI diagnosis is
-1

100,000 mL urine.

Appropriate therapy should be given as early as

possible to prevent progression of the infection, such as

development of pyelonephritis due to ascending spread

or sepsis due to hematogenous spread. Rational

antimicrobial treatment should be based on the pattern

of the causative microbes. Selection of antimicrobial

therapy in outpatient will be different from

hospitalized patients, because the pattern of the

causative microbes is also different. Increased risk

factors and exposure to antibiotics in hospitalized

patients, can lead to more varied pattern of the

causative microbes, that it is necessary to understand

the difference of the causative microbial pattern in

female out- and hospitalized patient.

MATERIALS AND METHODS

The Pattern of UTI Causative Microbes in

Female Outpatients. Urine was obtained in 2015 from

female outpatients in six Community Health Centers in

Jakarta, including Makassar, Pulogadung, Cakung,

Pasar Rebo, Duren Sawit, and Kramat Jati Community

Health Centers. The subjects were pregnant women

who get antenatal care in the six Community Health

Centers. The urine was cultured at the Clinical

Microbiology Laboratory, Faculty of Medicine,

Universitas Indonesia. Urine samples used in this study

were midstream urine from women with no risk factor.

Before culturing, urine sample was mixed well. Urine

was taken using sterile calibrated loop with 0.001 mL

size and streaked on blood and McConkey agar plates,

followed by incubation at 35-37 °C, for 18-24 h. Only

urine samples containing microbes at ³100,000 cfu
-1

mL urine were used for bacterial identification.

The Pattern of UTI Causative Microbes in

Female Hospitalized Patients. The information of

causative microbial pattern was obtained as secondary

data from the Clinical Microbiology Laboratory,

Faculty of Medicine, Universitas Indonesia. Culture of

midstream urine from female patients hospitalized in

several hospitals in Jakarta were analyzed. Only urine
-1

samples containing microbes at ³100,000 cfu mL of

urine used for bacterial identification.

Identification of Uropathogen. Identification of

the UTI-causing microorganisms from both clinical

specimens were done using VITEK 2 compact

system® (bioMérieux). Colonies of a pure culture were

taken and placed in a test tube containing 3.0 mL

sterile saline (0.45%-0.50% NaCl, pH 4.5-7.0) to make

a suspension. Suspension turbidity was adjusted to 0.5
8 -1

McFarland, which was comparable to 1.5x10 cfu mL .

Test tube containing the microorganism suspension

was placed into a special rack (cassette) and

identification card was placed in the neighboring slot

while inserting the transfer tube into the corresponding

suspension tube. Rack or cassette containing test tubes

and the identification card was inserted into the

machine. The filled cassette was placed manually into a

vacuum chamber station. After the vacuum was applied

and air was re-introduced into the station, the

microorganism suspension was forced through the

transfer tube into micro-channels that fill all the test

wells. The cassette was incubated at 35.5±1.0 °C.

Each card was removed from the carousel incubator

once every 15 min, transported to the optical system for

reaction readings, and then returned to the incubator

until the next reading. The identification results will

appear on the monitor screen after 3-7 h. The databases

of the VITEK 2 identification machine were

constructed with large strain sets of well-characterized

Volume 10, 2016 Microbiol Indones 31

microorganisms tested under various culture

conditions. Each of the composite values was

compared to the others to determine if the data are

sufficiently unique or close to one or more of the other

database taxa. If a unique identification pattern was not

recognized, a list of possible organisms was given, or

the strain was determined to be outside the scope of the

database. An unknown biopattern was compared to the

database of reactions for each taxon, and a numerical

probability calculation was performed. Various

qualitative levels of identification are assigned based

on the numerical probability calculation.

Bacterial identification system used two types of

Vitek card, GN card for identification of Gram-

negative bacilli and GP card for identification of Gram-

positive (primarily cocci). The YST card was used for

identification of yeast-like microorganisms.
The data in this study was analyzed by SPSS 20.0

for windows, using Chi-Square method.

RESULTS

The Pattern of UTI Causative Microbes in

Female Outpatients. There were 27 of 317 urine

samples from the female outpatients contained bacteria
-1

at ³100,000 cfu mL . Two of the samples indicated

double infection (the presence of two bacteria in an

i n d i v i d u a l ) . T h e r e f o r e , i t w a s f o u n d 2 9

microorganisms pattern in this study (Table 1).

Gram-negative bacteria was the most common

cause of UTI found in female outpatient (found in 22

cases, (75.9%), while only 7 cases (24.1%) was caused

by Gram-positive bacteria found. Klebsiella

pneumoniae, a Gram-negative bacteria, was found as

the most common cause of UTI in female outpatient in

this study (found in 31% cases), while Escherichia

coli, which is also Gram-negative, was found as the

second most common cause of UTI in female

outpatients (24.1%).

Distribution pattern of the causative microbes by

age group can be seen in Table 2. In the age group 16-20

years, four species of bacteria were found, Klebsiella

pneumoniae, Enterococcus cloacae, Staphylococcus

hemolyticus, and Alcaligenes faecalis. However, these

four microbes were found at equal frequency. In the age

groups 21-30 and 31-40 years, Escherichia coli was the

most common UTI-causing microbe.

Distribution pattern of the causative microbes by

trimester of pregnancy can be seen in Table 3. In the

first trimester of pregnancy, three species of bacteria

were found, Acinetobacter baumannii, Streptococcus

agalactiae, and Streptococcus viridans. There was no

specific pattern in the frequency of occurence of the

three UTI-causing microorganisms in the first semester

of pregnancy. In the second trimester, the most

commonly found causative agent was Escherichia

coli, whereas in the third trimester of pregnancy,

Escherichia coli and Klebsiella pneumoniae were the

two most common causative bacteria found.

The Pattern of UTI Causative Microbes in

Female Hospitalized Patients. Of the 114 urine

samples from female hospitalized patients, 29 of them

showed significant positive culture results (containing
-1

microbes at ³100,000 cfu mL of urine). The most

common microbial cause of UTI in hospitalized

females were Gram-negative bacteria (found in 55.2%

cases), followed by fungi (24.1% cases), and Gram-

positive bacteria (20.6% cases). Among Gram-

negative bacteria, Escherichia coli was the most

common cause of infection (56.3% cases). However,

all Gram-positive bacteria were found at equal

frequency. Candida sp. was the only fungus found as a

causative agent.

Comparison of the UTI Causative Microbes in

F e m a l e O u t - a n d H o s p i t a l i z e d P a t i e n t s .

Microorganisms pattern of Gram-negative as the most

common cause of UTI in female outpatient and

hospitalized showed the same results of chi-square

analysis (Table 5). There were 75.9% UTI in

outpatients and 55.2% in hospitalized patients caused

by Gram-negative bacteria.

In this study, Klebsiella pneumoniae, a Gram-

negative bacteria, was found as the most common

cause of UTI in outpatients (31%) and the second most

common cause in hospitalized patients (6.8%).

Escherichia coli is the most common UTI causative

bacteria in women. In this study, however, E.coli was

found as the most common cause of UTI in hospitalized

patients (31%), while in outpatient E. coli was the

second most common cause (24.1%).

Gram-positive microorganisms caused 24.1% UTI

in outpatients and the 48.3% in hospitalized patients.

Candida caused 24.1% (7/29) UTI in inpatient,

however, no fungus was found in outpatient (Table 7).

DISCUSSION

The Pattern of UTI Causative Microbes in

Female Outpatients. Gram-negative bacteria was the

most common cause of UTI in female outpatients in

this study. The Enterobacteriaceae found as the main

pathogen in the urinary tract might have come from the

32 ROSANA ET AL. Microbiol Indones

Table 1 The pattern of UTI-causing microbes found in female outpatients

Gram Bacteria
Number of

Infected Patients
Percentage

Negative Klebsiella pneumoniae 31%

Escherichia coli 24.1%

Alcaligenes faecalis ssp faecalis 3.4%

Enterobacter cloacae ssp cloacae 3.4%

Pseudomonas stutzeri 3.4%

Stenotrophomonas maltophilia 3.4%

Positive Streptococcus viridans, alpha-hem 6.9%

Leuconostoc mesenteroides ss. cremoris 3.4%

Staphylococcus aureus ss. aureus 3.4%

Acinetobacter baumannii 6.9%

Streptococcus agalactiae 3.4%

Streptococcus sanguinis 3.4%

Total 100%

Staphylococcus haemolyticus

1 3.4%

Table 2 UTI-causing microbes in female outpatient distributed by age

Age
(in years)

Microbes

16-20 (n=4) 25% (1)

25% (1)

21-30 (n=10) 20% (2)

31-40 (n=6) 50% (3)

No data (n=9) 66.7% (6)

25% (1)

Klebsiella pneumonia

Enterococcus cloacae

Alicaligenes faecalis

Escherichia coli

Klebsiella pneumonia

Staphylococcus hemolyticus

Percentage
(Number of Infected Patients)

Table 3 UTI-causing microbes in female outpatients distributed by trimester of pregnancy

Trimester
Pregnancy

Microbes

I (n=3) 33.3% (1)

33.3% (1)

50% (3)

III (n=12) 25% (3)

25% (3)

No data (n=8) 75% (6)

33.3% (1)

Acinetobacter baumanii

Streptococcus agalacte

Escherichia coli

Klebsiella pneumonia

Streptococcus viridan

Percentage
(Number of Infected Patients)

II (n=6)

Volume 10, 2016 Microbiol Indones 33

34 ROSANA ET AL. Microbiol Indones

Table 5 Comparison of Gram-Negative and non-Gram-Negative Caused UTI in Female Out- and Hospitalized Patients

PGram negative

0.09722

Outpatients

Hospitalized Patients

Total

Bacteria Pattern

Table 4 The composition of UTI-causing microorganisms found in female hospitalized patients

Gram Bacteria
Number of

Infected Patients
Percentage

Negative Escherichia coli 31%

Klebsiella pneumonia 6.8%

Enterococcus faecalis 3.4%

Pseudomonas aeruginosa 3.4%

Stenotrophomonas maltophilia 3.4%

Proteus mirabilis 3.4%

Positive Aerococcus urinae 3.4%

Leuconostoc mesentroides ss cremoris 3.4%

Actinomyces odontolyticus 3.4%

Alcaligenes faecalis (odorans) 3.4%

Staphylococcus haemolyticus 3.4%

Streptococcus sanguinis 3.4%

Streptococcus agalactiae

1 3.4%

Fungal

Candida sp. 24.1%

Total 100%

75.9

55.2

65.5

24.1

44.8

34.5

Non Gram negative
n % n %

intestinal microbiota. Instead of E. coli, this study

found that Klebsiella pneumoniae, which is also a

member of Enterobacteriaceae, to be the most common

cause of UTI in female outpatients. This result was

similar to a study reported by Rajaratnam et al. in India

(2013), showing that the most common bacteria

causing UTI in female outpatients was Klebsiella

pneumoniae (50%) and E. coli (14.2%).
Klebsiella pneumoniae is a Gram negative bacteria,

one of normal microorganisms in human's intestine.

Morphology of this bacteria is rod-shape, non-motile,

and lactose fermenting. K. pneumoniae is a facultative

anaerobe, therefore it is able to grow either with or

without free oxygene. Capsule as a virulence factor of

this bacteria that act as physical barrier to overcome the

host's immune response. This capsule surround this

bacteria also protects the cell from desiccation.

Although found as normal microorganism, K.

pneumoniae can progress into bacterial infections,

including urinary tract infections.
In the age groups 21-30 and 31-40 years, the most

frequently found UTI-causing microorganism in

female outpatient in this study was Escherichia coli.

This bacteria is an enteric bacteria residing in the

periurethral introitus of the vagina and can migrate up

to the bladder through urethra. The lack of hygiene in

the female reproductive tract and sexual activity can

lead to the migration. E.coli infection in women can

also come from the rectum, this is due to the close

proximity between the rectum and urethral meatus.
Escherichia coli was also the most common UTI

causative microbe in the second and third trimesters of

Volume 10, 2016 Microbiol Indones 35

pregnancy. Although UTI in pregnant women often

asymptomatic but it can develop to pyelonephritis.

Risk of life-threatening illness such as perinatal and

neonatal morbidity can increase because of

pyelonephritis. Therefore, all pregnant women should

be screened for bacteriuria and subsequently treated

with appropriate antibiotics.

The Pattern of UTI Causative Microbes in

Female Hospitalized Patients. The most common

microorganisms causing UTI in hospitalized females

were Gram-negative bacteria (55.2%), of which,

Escherichia coli consituted 56.3%. This result is

similar to the study by Alkhyat et al. in Yaman (2013),

where it was reported that the most common bacteria

causing UTI in hospitalized females was Escherichia

coli (46.7%).

The emerging resistance of Escherichia coli to

several antibiotics was a challenge for UTI treatment of

hospitalized patients. Evidence-based prevention

guidelines is strongly recommended to reduce the

morbidity and prevent the dissemination of drug-

resistant Gram-negative microorganisms in hospital.

The most effective management should be followed by

removal of the risk factor such as urinary catheter.

This study showed that 20.6% of the UTI cases

found in hospitalized females were caused by Gram-

positive bacteria. This is similar to research conducted

by Beyene et al. (2011), who reported that 19.1% of

UTI cases in hospitalized females were caused by

Gram-positive bacteria. Although Gram-positive

bacteria are fairly uncommon UTI causative agents,

investigating the efficacy of treatment is very

important to reduce morbidity caused by UTI in

hospitalized patients. The predisposing factors in the

urinary tract, such as obstruction, indwelling catheters,

surgery and chronic debilitating diseases should be

removed.

Fungi was the second most common UTI causing

microorganism in hospitalized females in this study

(24.2%). This is supported by research conducted by

Wilson et al. (2004), who reported that the frequency of

Candida-caused UTI in hospitalized patients ranged

between 9.4-15.8%. The use of broad-spectrum

antibiotics in hospitalized patients could cause an

imbalance of the normal flora of the body. The

imbalance condition could cause overgrowth of

Candida as part of normal flora in gastrointestinal tract

that can lead to opportunistic UTI in hospitalized

patients.
Comparison of the UTI Causative Microbes in

Female Out- and Hospitalized Patients. Gram-

negatives were found to be the most common UTI-

causing microbes in female out- and hospitalized

patients with frequency of occurence 75.9% and

55.2%, respectively. This result was slightly different

from Angami et al. (2015), reported that Gram-

negative microorganisms caused 46% UTI in

outpatients and 61.8% in hospitalized patients in India.

This result also showed that enteric Gram-negative

microorganisms were the most common cause of UTI

in female out- and hospitalized patients. Therefore,

e m p i r i c a l t h e r a p y a g a i n s t G r a m - n e g a t i v e

microorganisms can be recommended for UTIs in

women.

0.010

Outpatients

Hospitalized Patients

Total

24.1

12.1

100

75.9

87.9

Table 6 Comparison of Gram Positive and non-Gram Positive Caused UTI in Female Outpatients and Hospitalized Patients

PGram positive

0.7537

Outpatients

Hospitalized Patients

Total

Bacteria Pattern

24.1

20.7

22.4

75.9

79.3

77.6

Non Gram positive
n % n %

Table 7 Comparison fungal and non-fungal caused UTI in female Outpatients and hospitalized patients

PGram positive
Bacteria Pattern

Non Gram positive
n % n %

36 ROSANA ET AL. Microbiol Indones

In this study, Klebsiella pneumoniae, a Gram-

negative bacteria, was found as the most common

cause of UTI in outpatients, while in hospitalized

patients it was only the second most common. Study

conducted by Tajbakhsh et al. (2015) showed that 8.2%

of UTI were caused by Klebsiella pneumoniae both in

outpatients and hospitalized patients. Considering

Klebsiella pneumonia has a great potential to be

resistant to many antibiotics, strategies for treatment

will differ between UTI in outpatients and inpatients.

The choice of a specific antibiotic depends on local

susceptibility patterns. Uncomplicated cases caused by

susceptible strains may be treated orally, while

intravenous agents are used only if fever is found.
E.coli, a Gram-negative bacteria, was found as the

most common cause of UTI in hospitalized patients in

this study, while in outpatients, it was the second most

common cause of UTI. Although antibiotics are still the

standard treatments for UTIs, some strains of E. coli,

called extended-spectrum beta-lactamase (ESBL) E.

coli, are resistant to most drugs. ESBL enzymes are

able to hydrolyze most of the beta-lactam antibiotics,

including third-generation cephalosporins. In addition,

ESBL- (EC) might also express co-resistance to E. coli

SMX/TMP, fluoroquinolones, and aminoglycosides.

Carbapenems are generally considered the drug of

choice for intravenous treatment of ESBL-EC UTI.

Some ESBL-EC isolates will have in vitro

susceptibility to piperacillin/tazobactam. However, the

use of this antibiotic remains controversial. There are

limited oral options for the treatment of ESBL-EC

cystitis. An alternative is Fosfomycin, an oral

antibiotic agent with broad activity against multi-drug

resistant pathogens including ESBL-EC.
There is no significant difference in the frequency

of Gram-positive microorganisms in the female

outpatients and hospitalized patients. However, there is

a striking difference between fungal-caused UTI in

female outpatients and hospitalized patients. Candida

was the only UTI-causing fungus found in female

hospitalized patients in this study, while there was no

fungal-caused UTI in female outpatients. According to

our study, the most common UTI-causing microbes in

female outpatients in Jakarta was Klebsiella

pneumoniae (31%) and Escherichia coli (24.1%),

whereas in female hospitalized patients, the most

commons were Escherichia coli (31%), Candida sp

(24.1%) and Klebsiella pneumoniae (6.8%). There was

no significant difference between the occurence of

Gram-negative and Gram-positive bacteria in out- and

hospitalized patients (p>0.05). However, fungal

infection caused by Candida sp. was only found in

hospitalized patients (p=0.01). This result proved that

the UTI-causing microbes found in hospitalized female

patients were more varied in comparison to those found

in female outpatients.
The results of this study suggested that periodic

surveys are necessary to determine the distribution and

pattern of UTI-causing microorganisms and that it

would be beneficial as guidance for empirical

antimicrobial therapy in UTI patients while waiting for

the results of urine culture.

ACKNOWLEDGMENT

This study was funded by Zambon Indonesia. We

thank the teams from the Department of Microbiology

and the Department of Obstetrics/ Gynecology,

Faculty of Medicine, Universitas Indonesia for their

technical assistance, support, and cooperation.

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