Asymptomatic Urinary Tract Infections in Patients with End Stage Renal Disease on Regular Hemodialysis

Abstract

Background: Isolation of a specific quantitative count of bacteria in an appropriately collected urine sample from a patient who does not exhibit any symptoms or signs indicative of an asymptomatic urinary infection. In this study, we aimed to estimate correlation between asymptomatic urinary tract infection and hemodialysis (HD)-dependent end-stage renal disease patients.Methods: Sixty patients with End Stage Renal Disease who were on long-term hemodialysis in this prospective cohort study were classified into 42 patients with positive pus in urine (70%) and 18 patients with non-pyuria (30%). Urina analysis, routine culture, and count of bacteria were assessed among other laboratory investigations in all patients.Results: Significant higher levels of erythrocyte sedimentation rate (ESR), C- reactive protein (CRP), and neutrophils levels among cases with pyuria versus cases with non-pyuria (p–value 0.032, 0.020, 0.046 respectively), the majority of culture and sensitivity are 11 patients (36.7%) for Levofloxacin followed by nine patients (30%) for Ciprofloxacin. Multivariate regression analysis revealed that most significant predictors of pyuria were DM, SBP (mmHg), ESR (mm/hr), CRP (mg/L), Neutrophils and Decrease Hb (gm/dL) with [OR (C.I.95%), p-value] [[1.855 (0.505- 5.679), p= 0.024; 1.761 (0.244- 4.600), p= 0.029; 1.061 (0.969- 3.742), p= 0.036; 1.790 (0.457- 6.823), p= 0.022; 1.981 (0.895- 3.460), p= 0.040 and 1.730 (0.422- 5.384), p= 0.025], respectively.Conclusion: In asymptomatic urinary tract infection patients, pyuria was a good marker of significant bacteriuria. Asymptomatic bacteriuria was more prevalent in female patients, patients with elevated ESR, CRP, and neutrophils levels, high blood pressure, comorbidities and diabetes, and anemia.