Urinary tract infection in patients with chronic kidney disease: a retrospective observational study at outpatient nephrology clinics

Abstract

Background Chronic kidney disease (CKD) patients are more susceptible to urinary tract infections (UTIs) associated with a rapid increase in antibiotic resistance and multidrug-resistant organisms worldwide. We aimed to investigate the etiology, risk factors, and microbiological and antibiotic sensitivity patterns of UTIs in CKD patients. Patients and methods Adult CKD patients’ medical records were screened in this retrospective cross-sectional study. Results One hundred and twenty-four CKD patients with UTIs, with a mean age of 62.5 years, female sex (68%), and a mean estimated glomerular filtration rate of 38.3 ml/min, were included in the study. The highest prevalence of UTIs occurred between 65 and 74 years of age (34.7%). Hypertension (79.8%) and diabetes mellitus (57.3%) were the most common comorbid conditions. A history of urologic procedures, recent hospitalization, or recent urinary catheterization was significantly more common among male patients. More patients were diagnosed with cystitis than with pyelonephritis (106 vs. 18 occasions). Escherichia coli was the most frequently isolated microorganism (60.4%), followed by Klebsiella pneumoniae (20.7%). The most frequent resistance pattern identified was extended-spectrum beta-lactamase-producing Enterobacteriaceae (57.6%) followed by nonsusceptibility to carbapenems (10.8%). E. coli isolates showed resistance to cefotaxime (58%), meropenem (6%), sulfamethoxazole-trimethoprim (73%), fosfomycin (72%), nitrofurantoin (52%), levofloxacin (45%), and ciprofloxacin (43%). Conclusions Female sex, older age, diabetes mellitus, hypertension, a history of urologic procedures, recent hospitalization, and recent urinary catheterization were common risk factors for UTIs in CKD patients. The extended-spectrum beta-lactamase-producing Enterobacteriaceae are the most commonly identified resistant organisms. There were alarming resistance findings in E. coli isolates.