MICROBIOLOGICAL EVALUATION OF URINARY SAMPLES IN A COHORT OF PATIENTS WITH CHRONIC KIDNEY DISEASE: A DESCRIPTIVE STUDY

Introduction:

Urinary tract infections (UTIs) is one of the most common healthcare-associated infections (HAI) in patients with chronic kidney disease (CKD). The objective of the study was to evaluate the incidence of UTI and possible risk factors in this cohort of patients under various categories of CKD. Uropathogens and their antimicrobial susceptibility pattern (AST) were also evaluated in this group of patients. 

Methods:

This retrospective study was carried out over a period of 22 months in a tertiary care hospital in Delhi.  A total 310 urine samples were received in the department of microbiology from patients of nephrology unit with impaired renal function (IRF). Urine samples were processed on Cysteine Lactose Electrolyte Deficient (CLED) agar and incubated aerobically at 37°C for 24-48 hrs.  was done in case of significant growth (SG) with colony count ≥104 CFU/ml. Complete work-up was done in case of significant growth (SG) [Samples with significant bacteriuria (SB) with colony count ≥105 CFU/ml and samples with doubtful significance (DS) with colony count ≥104 CFU/ml] of a single potential pathogen or for each of two potential pathogens. Rest was considered as either no growth (NG), insignificant growth (IG) when colony count is <10,000 CFU/ml or mixed growth (MG) when growth is >=three organisms.

Identification and antimicrobial susceptibility testing (AST) were done by Vitek 2 Compact System 8.01 (bioMérieux, Inc. Durham, North Carolina/USA). Control strains used were Staphylococcus aureus ATCC 29213, Escherichia coli ATCC 25922, Candida albicans ATCC 14053 and Candida parapsilosis ATCC 22019.

Results:

Indwelling catheter, previous history of UTI and pyuria (>=10/ high power field) were found to have strong association with SG (p value <0.05). Hyperglycaemia, dialysis, and grade of CKD were not found to have statistically significant correlation with SG (p value >0.05). The most common isolate among the patients of CKD was E. coli, 36 (28.57%) followed by Enterococcus spp. 22 (17.46%) and Klebsiella pneumoniae 20 (15.87%). Out of 22 isolates of Enterococcus spp., E. faecium 14 (63.64%) was predominating over E. faecalis 8(36.36%). Among the uropathogens, 20% (25/126) belonged to yeast and yeast like fungus (YYLF). Among Candida spp., non-albicans group of Candida, predominated 24 (87.50%) over Candida albicans 3 (12.50%). AST pattern of enterobacterales 63 (51.22%) (E. coli, Klebsiella pneumoniae, Morganella morganii, Enterobacter spp. and Citrobacter freundii) showed 97.22% (35/36) resistance to ampicillin and 78.95% resistance to ceftriaxone. Carbapenem resistance ranged from 49.12% (31/57) in meropenem to 54.39% (28/57) in ertapenem. Colistin resistance was found to be 5.71% (2/35). [Fig 1]

Conclusions:

CKD is associated with a proinflammatory milieu with impaired innate and acquired immunity leading to infections. Minimal invasive procedures along with judicious use of antibiotics based on local antibiogram can provide better outcome among these patients.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.