Urinary Tract Infection in Chronic Kidney Disease Patients Undergoing Hemodialysis

Abstract

Hemodialysis patients are more susceptible to urinary tract infection (UTI). The frequent receipt of antimicrobials for treatment of the infections has added the antimicrobial resistance hazard. Hence, the study was aimed to determine and describe the status of UTI in hemodialysis patients and to assess the antimicrobial susceptibility pattern of the isolated organisms. This descriptive cross sectional study was conducted in National Kidney Centre (NKC), Banasthali from November 2011- May 2012. The overall prevalence of UTI in hemodialysis was about one-fourth (22.6%, 31/137). The symptomatic UTI (54.8%) was more prevalent than asymptomatic UTI. The highest prevalence of UTI was found in females (24.5%) as compared to males (21.6%) however, the difference is statistically insignificant. The highest growth rate (22.6%) was found in the age group 71-80 years. The Gram negative organisms were more fre¬quently isolated than Gram positive organisms. The organisms isolated were E. coli (32.2%), Coagulase Negative Staphylococci (22.6%), Klebsiella pneumoniae (12.9%), Staphylococcus aureus (9.7%), Morganella morganii (6.5%), Proteus mirabilis (6.5%), Streptococcus spp. (6.5%) and Candida albicans (3.2%). It is noteworthy fact that the more frequently used antimicrobials for gram-negative organisms like Nalidixic acid, Cephalexin, Cefoxitin, Cotrimoxazole, Norfloxacin and Ofloxacin revealed lowest levels of sensitivity (<30%). In contrast, Amikacin, Nitrofurantoin and Imipenam demonstrated the best sensitivity and most consistent activity (>70%). Almost, one-fourth of the hemodialysis patients were prone to UTI and antimicrobial resistance epidemic. Therefore, a regular screening of UTI and monitoring of antimicrobial susceptibility rates by standardized sampling and measurement procedures is necessary.