Prevalence of Urinary Tract Infection and Diagnostic Accuracy of Pyuria as Screening Tool among Hemodialysis Patients in Mosul City
DOI:
https://doi.org/10.56286/tfw0s454Keywords:
Hemodialysis, Urinary tract infection, Pyuria, BacteriuriaAbstract
Background: Urinary tract infections (UTIs) are common among hemodialysis (HD) patients and are associated with an increased risk of complications; however, their diagnosis is often challenging due to frequent subclinical or atypical presentations. This study aimed to investigate the prevalence of UTIs in HD patients with renal failure and to evaluate the diagnostic accuracy of pyuria as a screening tool. Patients and Methods: A total of 200 hemodialysis patients were enrolled in the study, comprising 100 males and 100 females. Midstream, clean-catch urine samples were collected and subjected to standard urinalysis and culture. Significant bacteriuria was defined as ?10? CFU/mL in males and ?10? CFU/mL in females. Pyuria was defined as ?10 neutrophils per high-power field. Results: Bacterial growth was detected in 75 urine samples (37.5%), while 125 samples (62.5%) showed no significant growth. Escherichia coli was the most frequently isolated organism (40%, n=30), followed by Klebsiella pneumoniae (n=10). Pyuria was present in (85/200) patients (42.5%), of whom 55 (64.7%) had culture-confirmed UTIs. Pyuria demonstrated a sensitivity of 73.3%, specificity of 76%, a positive predictive value of 65%, and a negative predictive value of 83%. Conclusions: The study demonstrated that UTIs among HD patients are more prevalent in females and the elderly, with E. coli as the predominant multidrug-resistant pathogen, While pyuria proved to be a useful supportive indicator for diagnosis, it should be interpreted in conjunction with urine culture to avoid both overdiagnosis and missed infections in hemodialysis patients.
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Novaliendry D, Yang CH, Desnelita Y, Sanjaya R, Lizar Y, Ardi N. Hemodialysis patient death prediction using logistic regression. Int J Online Biomed Eng. 2023;19(9).
Khanin Y. Hemodialysis. Elsevier eBooks. 2022. p. 149–52. Available from: [https://doi.org/10.1016/b978-0-323-79007-9.00033-7](https://doi.org/10.1016/b978-0-323-79007-9.00033-7)
Vanegas Múnera JM, Jiménez Quiceno JN. Colonization and risk of infection by multidrug-resistant bacteria in hemodialysis patients: a topic of concern. Infectio. 2019;23(2):205–11.
Puspitawati I, Purwanto AP, Suromo LB. Balance of proinflammatory and anti-inflammatory markers in routine hemodialyzed patients (a study of end-stage renal failure patients at the Dr. Sardjito Hospital Yogyakarta). Indones J Clin Pathol Med Lab. 2018;24(2):160–4.
Aloob HMT. The bacterial causes urinary tract infection among hemodialysis patients in Khartoum State, Sudan. J Clin Invest Med. 2024;1–4. Available from: [https://doi.org/10.46889/jcim.2024.5207](https://doi.org/10.46889/jcim.2024.5207)
El Nekidy WS, Soong D, Mooty M, Ghazi IM. Treatment of recurrent urinary tract infections in anuric hemodialysis patient, do we really need antimicrobial urinary concentration? IDCases. 2020;20:e00748.
Richa C, Bhushan CS, Kumar SP, Dev PN, Nabaraj P. Bacteriology of urinary tract infection of chronic renal failure patients undergoing hemodialysis. J Microbiol Exp. 2016;3(3):89.
Bartoletti M, Bussini L, Bavaro DF, Azzolini E. Dialysis-associated infection prevention and surveillance trial: an easy, feasible and effective bundle for infection prevention. Clin Microbiol Infect. 2024;30(9):1100–1.
Dadi BR, Abebe T, Zhang L, Mihret A, Abebe W, Amogne W. Distribution of virulence genes and phylogenetics of uropathogenic Escherichia coli among urinary tract infection patients in Addis Ababa, Ethiopia. BMC Infect Dis. 2020;20:1–12.
Yamashita K, Ishiyama Y, Yoshino M, Tachibana H, Toki D, Konda R, et al. Urinary tract infection in hemodialysis-dependent end-stage renal disease patients. Res Reports Urol. 2022;14:7–15.
Khosravi AD, Abasi Montazeri E, Ghorbani A, et al. Bacterial urinary tract infection in renal transplant recipients and their antibiotic resistance pattern: a four-year study. Iran J Microbiol. 2014;6(2):74–8.
Nguyen TV, Pham TTX, Nguyen TN. The burden of cardiovascular disease and geriatric syndromes in older patients undergoing chronic hemodialysis. Int J Environ Res Public Health. 2024;21(6):812.
Semet C. Descriptive characteristics, etiological agents, and risk factors for mortality of urinary tract infections in older adults. Kocatepe T?p Derg. 2024;25(3):370–6.
Gilbert DN. Urinary tract infections in patients with chronic renal insufficiency. Clin J Am Soc Nephrol. 2006;1(2):327–31.
Nitzan O, Elias M, Chazan B, Saliba W. Urinary tract infections in patients with type 2 diabetes mellitus: review of prevalence, diagnosis, and management. Diabetes Metab Syndr Obes. 2015;8:129–36.
Singh P, Chandola J, Shahi MS, Sharma N, Gupta K, Singh S. Microbiological enumeration of pathogens associated with urinary tract infection: current scenario and its medical relevance. Asian J Med Health. 2020;18(12):26–31.
Manyawu M. Antimicrobial resistance patterns of urinary tract infection pathogens at Victoria Chitepo Provincial Hospital Laboratory from January to December 2023. 2024.
Zhang K, Zhang Y, Chao M, Hao Z. Prevalence, pathogenic bacterial profile and antimicrobial susceptibility pattern of urinary tract infection among children with congenital anomalies of the kidney and urinary tract. Infect Drug Resist. 2023;16:4101–12.
Emran MR, Chowdhury AAT, Mohsin MM. Bacteriological profile of urinary tract infection and antibiotic susceptibility pattern in a tertiary care hospital in Bangladesh. Mol Mech Res. 2024;2(2):7858.
Oikonomou KG, Alhaddad A. The diagnostic value of urinalysis in hemodialysis patients with fever, sepsis or suspected urinary tract infection. J Clin Diagn Res. 2016;10(10):OC11.
Falah SM, Mohammed AA, KHA. Urinary tract infection in hemodialysis patients with renal failure. J Fac Med Baghdad. 2012;54(1):38–41.
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