CLINICAL AND MICROBIOLOGICAL PROFILE OF URINARY TRACT INFECTION IN CHRONIC KIDNEY DISEASE POPULATION

Abstract

Introduction: Chronic kidney disease (CKD) is a chronic inflammatory state which reduces immunity and increases the risk of infection.Urinary tract infection (UTI) is the second most common community acquired infection. There is increased susceptibility for community acquired infections in CKD population. Most of the CKD patients have Diabetes mellitus and Hypertension, which increases the risk of infection even more. The clinical presentation and microbiological profile of urinary tract infection may vary in CKD population when compared to the general population.There are very few studies of UTI in CKD population in India. The knowledge of the microbiological profile will help us formulate empirical antibiotic policy for urinary tract infection in this population. Formulation of a particular antibiotic policy will prevent the inadvertent use of antibiotics and development of antibiotic resistance in the community.For this purpose, we have studied the clinical presentation and the pattern of microbiological growth and antibiotic sensitivity profile of urinary tract infections in CKD population.

Materials and Methods: It is retrospective descriptive study of 129 CKD( defined as per KDOQI guidelines) patients, conducted at a tertiary care referral centre, Institute of Nephro -Urology, Bengaluru from December 2019 to May 2020. Outpatients and Inpatients who fulfilled the inclusion criteria were included in the study. Only those with urine culture proven urinary tract infection were included. Patients who were on immunosuppressive medications and on antibiotics prior to visiting our hospital were excluded from the study.The urine samples were collected aseptically and cultured within two hours on to Cystine-Lactose-Electrolyte-Deficient (CLED) medium by Mayo’s semiquantitative method and incubated overnight at 37⁰C. Antibiotic susceptibility test was performed and interpreted using Kirby-Bauer disc diffusion method on Mueller Hinton agar medium according to CLSI guidelines.

Results: UTI in CKD patients was most common in elderly males.25.58% of the affected patients were in the age group of 60 to 70 years. 76.2% were males. 94% of the culture isolates constituted gram negative bacteria, 3% were gram positive bacteria and 3% were Candida species. E.coli (61.8%)was the most common isolate across all age groups and in both males and females. Klebsiella was the second most common isolate (13.74%).  Among the gram positive bacteria, Enterococci was the most common (75%). The gram negative bacteria were resistant to quinolones and amoxycillin- clavulanic acid. They were sensitive to amikacin and carbapenems. The gram positive bacteria were resistant to quinolones and penicillin. They showed 100% sensitivity towards cephalosporins, cotrimoxazole, vancomycin, linezolid, teicoplanin. All Candida species were sensitive to fluconazole and Amphotericin B.

Conclusion: As mentioned earlier, there are hardly any studies of clinical and microbiological profile of UTI in CKD population. The knowledge of local uropathogens is important for us to formulate empirical antibiotic policy.Our aim is to prevent inadvertent use of antibiotics, which contributes to multi drug resistance.

Keywords: Urinary tract infection, microbiological culture, chronic kidney disease, Drug resistance, Uropathogens.