Introduction:
Introduction: Kidney Disease is a significant global health challenge, affecting over 750 million people and contributing to high morbidity and mortality rates. Base. The rising prevalence of CKD is driven by factors such as diabetes, hypertension, obesity and an aging population. As CKD progresses, it not only impairs kidney function but also weakens the immune system, making patients more susceptible to infections, particularly urinary tract infections (UTIs). These infections, if recurrent or untreated, can further deteriorate kidney function and accelerate the progression of CKD. Pyuria, the presence of white blood cells in urine, is common in CKD patients and can be indicative of either UTI (UTI – pyuria) or renal inflammation (Sterile pyuria). Differentiating between UTI-pyuria and sterile pyuria is crucial, as it guides appropriate treatment strategies. Given the global burden of CKD and its complications, ongoing monitoring and understanding of antimicrobial resistance patterns are essential for effective management and prevention of further kidney damage.
Methods:
The present study was conducted as an institution-based descriptive cross-sectional study. After obtaining informed written consent appropriate urine samples were collected into sterile, screw-caped, wide-mouthed containers from the 203 patients who attended the Nephrology Clinic, Teaching Hospital, Jaffna. Patients were selected in convenient sampling technique. All the samples were transported to the Microbiology Laboratory, Teaching Hospital Jaffna according to the standard transport procedures given by the laboratory manual. Then urine samples were inoculated on Cysteine Lactose Electrolyte Deficient Agar (CLED) media and Pure growth concentrations of ≥105 CFU/ml or 104 -105 CFU/ml were considered culture positive. After that urine microscopy was performed in every sample and the presence of >1 pus cells/ 7HPF (>10 pus cells/ mm3) in the uncentrifuged samples was considered as significant pyuria. Relevant biochemical tests were performed to identify the isolated organism. Antibiotic sensitivity was performed on all isolated bacteria by the CLSI disk diffusion method. Obtained data was analyzed using SPSS version 26 and the findings were presented through graphical representations and tables. Association between categorical variables was found by the chi-square test, and a P-value < 0.05 was considered statistically significant.
Results:
Among the analyzed urine samples, 27.6% (56 out of 203) showed significant pyuria whereas 12.8% (26 out of 203) revealed bacterial growth. Among the pyuria cases, the majority of the bacteria isolated from the samples were Coliforms (76.9%) followed by Acinetobacter species (7.7%), and Enterococcus species (7.7%), Pseudomonas species (3.8%), and Coagulase-negative Staphylococcus (3.8%). The study has revealed that Gentamicin is highly effective against coliforms (80% efficacy), while coliforms have an 80% resistance rate to Ampicillin in the studied area. Furthermore, it was revealed a high level of resistance was seen in all the species to Ampicillin. Additionally, the study found factors such as gender, urolithiasis, and culture positivity were statistically associated with pyuria, CKD stage is specifically correlated with sterile pyuria with a significance level of P < 0.05.
Conclusions:
This study suggests that Gentamicin, Amikacin, Meropenem, Nitrofurantoin, and Piperacillin-tazobactam are sensitive antibiotics for treating Gram-negative bacilli and resistant to Ampicillin group. Also, the research has revealed that in CKD patients, certain uropathogens are more likely to cause significant pyuria, with sterile pyuria being more common than infectious pyuria. Importantly the results have indicated CKD stage is specifically correlated with sterile pyuria.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.