Bacteriology of Urinary Tract Infection of Chronic Renal Failure Patients Undergoing for Hemodialysis

Abstract

Introduction: Urinary tract infections (UTIs) are the second most common bacterial infectious diseases in human, and they occur in all age group, and usually require urgent treatment. Usually asymptomatic UTI is most common among Hemodialysis (HD) patients with Chronic Renal Failure (CRF) due to their disturbed defense mechanism. Clinically, UTI is defined as the presence of bacteria undergoing multiplication in urine more than 105 colony forming unit (CFU) or organism/ml in the clean catch midstream urine.1,2 Objectives: To examine the prevalence of urinary tract infection in CRF patients undergoing for hemodialysis and to evaluate the emerging pattern of MDR isolates. Methods: A cross-sectional study was designed in CRF patients on HD in the National Kidney Center of Nepal from June 2013 to November 2013. Clean-catch midstream urine samples were collected from study patients and inoculated in Blood agar and MacConkey agar and incubated aerobically at 37 °C for 18-24 hours. Macroscopic and microscopic observations were done and conventional biochemical tests were done to identify the isolated organisms. The isolated organisms were tested for antimicrobial susceptibility by using modified Kirby Bauer technique. Results: In total, 150 urine cultures from CRF patients undergoing for hemodialysis were evaluated. Gram-negative organisms were isolated in 33(84.6%) of 39 cases with Escherichia coli 13(33.3%), Proteus vulgaris 7(17.9%), Klebsiella oxytoca and Pseudomonas aeruginosa 3(7.7%), Proteus mirabilisand Enterobacter aerogenes 2(5.1%) and Klebsiella pneumoniae, Providencia alcalifacience and Morgnella morganii 1(2.6%). In case of Gram positive, Staphylococcus saprophyticus 6(15.4%), was the only one organism isolated. In antibiotic sensitivity patterns of the isolated organisms, Gram-negative microorganisms were found to be most effective towards imipeneme and gentamicin whereas Gram-positive microorganisms were most effective against imipeneme and oxacillin. Out of the total isolates 23 isolates were found to be multidrug resistant. Conclusion: In CRF patients on HD, asymptomatic urinary tract infection was detected significantly. E. coli was found to be predominant organisms and resistant towards most of the studied antibiotics.