DOI: http://dx.doi.org/10.18203/2349-3933.ijam20192263

A clinical and microbiological profile of urinary tract infection in patients with chronic kidney diseases

Siddharth Pugalendhi, Tarun Kumar Dutta, Hemachandar R., Lokesh S.

Abstract


Background: Urinary tract infections (UTIs) are a major public health problem in terms of morbidity and financial cost in CKD patients in India. The resistance pattern of community acquired uropathogens in CKD patients has not been extensively studied. Thus, knowledge of local antimicrobial susceptibility patterns of common uropathogens is essential for prudent empiric therapy of community acquired UTIs.

Methods: It is a cross sectional study conducted in a tertiary care hospital involving 65 chronic kidney disease patients with UTI who attended general medicine OPD and those admitted in wards after fulfilling the inclusion and exclusion criteria, after obtaining written informed consent. Blood sample and urine samples were collected from these patients and sent for blood analysis, urine analysis and urine culture and sensitivity.

Results: Among 65 CKD participants with UTI who were studied, E. coli (47.7%) and K. pneumoniae (15.4%) were the most common isolates which were sensitive in order of colistin, polymyxin B, meropenem (carbapenem) and less sensitive to other commonly used antibiotics.

Conclusions: The main purpose of this study was to find the various common local uropathogens in CKD patients and their antibiotic profile which will help in formulating antibiotic therapies. As previously stated, there are very few studies regarding profile and management of UTI in CKD patients. Hence this study can throw some light into this area.


Keywords


Antibiotic sensitivity, Chronic kidney disease, Urinary tract infection

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References


REFERENCES

Gales AC, Sader HS, Jones RN, SENTRY Participants Group (Latin America). Urinary tract infection trends in Latin American hospitals: report from the SENTRY antimicrobial surveillance program (1997-2000). Diagn Microbiol Infect Dis. 2002 Nov;44(3):289–99.

Karlowsky JA, Kelly LJ, Thornsberry C, Jones ME, Sahm DF. Trends in antimicrobial resistance among urinary tract infection isolates of Escherichia coli from female outpatients in the United States. Antimicrob Agents Chemother. 2002 Aug;46(8):2540–5.

Habte TM, Dube S, Ismail N, Hoosen AA. Hospital and community isolates of uropathogens at a tertiary hospital in South Africa. South Afr Med J Suid-Afr Tydskr Vir Geneeskd. 2009 Aug;99(8):584–7.

Naqvi SB, Collins AJ. Infectious complications in chronic kidney disease. Adv Chronic Kidney Dis. 2006 Jul;13(3):199–204.

Biswas D, Gupta P, Prasad R, Singh V, Arya M, Kumar A. Choice of antibiotic for empirical therapy of acute cystitis in a setting of high antimicrobial resistance. Indian J Med Sci. 2006 Feb;60(2):53–8.

Collee JG, Mackie TJ, McCartney JE. Mackie & McCartney practical medical microbiology. New York: Churchill Livingstone; 1996.

Bauer AW, Kirby WM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol. 1966 Apr;45(4):493–6.

Eshwarappa M, Dosegowda R, Aprameya IV, Khan MW, Kumar PS, Kempegowda P. Clinico-microbiological profile of urinary tract infection in south India. Indian J Nephrol. 2011 Jan;21(1):30–6.

Manjunath GN PR. Changing trends in the spectrum of antimicrobial drug resistance pattern of uropathogens isolated from hospitals and community patients with urinary tract infections in tumkur and bangalore. Int J BiolMed Res.2011; 2(2):504-7

Orrett FA, Shurland SM. The changing patterns of antimicrobial susceptibility of urinary pathogens in Trinidad. Singapore Med J. 1998 Jun;39(6):256–9.

Gales AC, Jones RN, Gordon KA, Sader HS, Wilke WW, Beach ML, et al. Activity and spectrum of 22 antimicrobial agents tested against urinary tract infection pathogens in hospitalized patients in Latin America: report from the second year of the SENTRY antimicrobial surveillance program (1998). J Antimicrob Chemother. 2000 Mar;45(3):295–303.

Tambekar DH, Dhanorkar DV, Gulhane SR, Khandelwal VK, Dudhane MN. Antibacterial susceptibility of some urinary tract pathogens to commonly used antibiotics. Afr J Biotechnol. 2006;5(17).

Adedeji BAM, Abdulkadir OA. Etiology and Antimicrobial Resistance Pattern of Bacterial Agents of Urinary Tract Infections in Students of Tertiary Institutions in Yola Metropolis.

Kebira AN, Ochola P, Khamadi SA (2009).Isolation and antimicrobialsusceptibility testing of Escherichia coli causing urinary tract infections. J. Appl.Biosci., 22:1320-25.

Mahesh E, Medha Y, Indumathi VA, Prithvi S. Kumar, Mohammed WasimKhan, Punith K.Community-acquired urinary tract infection in the elderly. British J Medical Practisioners.2011;4(1):6-9

Pappas PG. Laboratory in the diagnosis and management of urinary tract infections. Med Clin North Am. 1991 Mar;75(2):313–25.

Fasolo LR, Rocha LM, Campbell S, Peixoto AJ. Diagnostic relevance of pyuria in dialysis patients. Kidney Int. 2006 Dec 1;70(11):2035–8.

KimSM, CorwinHL. Urinalysis.In:SchrierRW(ed). Diseases of the Kidney, 7th edn.Lippincott Williams & Wilkins: Philadelphia, 2001, pp 317–31.

Stamm WE. Measurement of pyuria and its relation to bacteriuria. Am J Med. 1983 Jul 28;75(1B):53–8.

Linhares I, Raposo T, Rodrigues A, Almeida A. Frequency and antimicrobial resistance patterns of bacteria implicated in community urinary tract infections: a ten-year surveillance study (2000-2009). BMC Infect Dis. 2013Jan 18;13:19.

Stapleton A. Urinary tract infections in patients with diabetes. Am J Med.2002 Jul 8;113Suppl 1A:80S–84S.

Bonadio M, Costarelli S, Morelli G, Tartaglia T. The influence of diabetes mellitus on the spectrum of uropathogens and the antimicrobial resistance in elderly adult patients with urinary tract infection. BMC Infect Dis. 2006 Mar17;6:54.

Oluremi BB, Idowu AO, Olaniyi JF. Antibiotic susceptibility of common bacterial pathogens in urinary tract infections in a Teaching hospital in Southwestern Nigeria. Afr J Microbiol Res. 2011 Oct 16;5(22):3658–63

Kattel HP, Mishra SK, Acharya J, Sigdel MR, Prasad N, Shah ASS, et al. Antibiotic sensitivity profile of different uropathogens in a tertiary care center in Nepal. J Nepal Assoc Med Lab Sci. 2012;11(1):19–33.

European Centre for Disease Prevention and Control,Antimicrobial resistance surveillance in Europe 2009. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm:ECDC; 2010, 47–56.

Popescu G-A, Codita I, Szekely E, Serban R, Ruja G, Tălăpan D. Ghidprivind Enterobacteriaceae producătoare de carbapenemaze: diagnosticul, Prevenirea transmiterii interumaneși tratamentul infecțiilorproduse. MAR-T. Infectioro. 2010, (22): 36–42.

Souli M, Galani I, Antoniadou A, Papadomichelakis E, Poulakou G, Panagea T, et al. An outbreak of infection due to beta-Lactamase KlebsiellapneumoniaeCarbapenemase 2-producing K. pneumoniae in a Greek University Hospital: molecular characterization,epidemiology, and outcomes.Clin Infect Dis Off Publ Infect Dis Soc Am. 2010 Feb

;50(3):364–73.

Arias CA, Murray BE. Antibiotic-resistant bugs in the 21st century--a clinical super-challenge. N Engl J Med. 2009 Jan 29;360(5):439–43.