Bacteriological Study of Urinary Tract Infection in Male Patients Undergoing Dialysis due to Chronic Kidney Disease in Tertiary Care Hospitals in Nepal

Abstract

Chronic kidney disease (CKD) is a common problem among males compared to females due to stress, alcoholism, hypertension and diabetes mellitus. Due to urinary stagnation, alkalization of urine and absence of flushing action, the presence of urinary tract infection (UTI) in CKD of males is higher compared to normal males. Bacterial species causing UTI are Escherichia coli, Staphylococcus aureus, Streptococcus spp., Klebsiella spp., Micrococcus spp., Enterococcus spp., Proteus spp., Coagulase Negative Staphylococcus (CONS), etc. A total of 50 patients undergoing hemodialysis due to CKD at Western Regional Hospital and National Kidney Centre were recruited for the study during the period from 20th April to 13th September, 2012. Diagnosis of UTI was made by urinalysis and urine culture. Further identification of the spp. was done by biochemical tests. The presence of UTI in male with CKD was found to be 30%. And the bacterial spp. in diagnosis of UTI was 33.33%. E. coli which was predominating bacteria isolated followed by S. aureus, Klebsiella spp., S. spp. and CONS by 26.66%, 13.33%, 13.33%, and 13.33% respectively. E. coli was 100% sensitive to Nitrofurantoin and ciprofloxacin also Klebsiella spp. was 100% sensentive to Nitrofurantoin and Ciprofloxacin. Similarly, Nitrofurantoin and Gentamycin were 100% sensitive to S. aureus. With significant pyuria, the chance of isolation of bacteria was very high. Specific gravity measurement could predict the isolation of bacteria. In CKD patients with diabetes mellitus, with increase in urine sugar concentration, the chance of isolation of UTI-causing bacteria was significantly higher. 

Keywords:CKD, UTI, hemodialysis, pyuria, E. coli