The Bacterial Causes Urinary Tract Infection among Hemodialysis Patients in Khartoum State, Sudan

Husham M Taha Aloob^1*, Shamsoun Khamis Kafi^2
1Department of Microbiology Faculty of Medical Laboratory Sciences, Dongla University, Sudan
²Department of Microbiology, Faculty of Medical Laboratory Sciences, The National Ribat University, Sudan

*Correspondence author: Husham M Taha Aloob, Department of Microbiology Faculty of Medical Laboratory Sciences, Dongla University, Sudan; Email: [email protected]

Published Date: 29-07-2024

Copyright^© 2024 by Aloob HMT, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract 

Renal failure is inability of the kidneys to perform excretory function leading to retention of nitrogenous waste products from the blood. hemodialysis is a procedure that is a substitute for many of the normal duties of the kidneys. Urinary tract infections (UTIs) are common in dialysis patients, associated with increased rate of complications and may be difficult to diagnose due to often subclinical presentation. A hospital cross-sectional based study includes 103 Hemodialysis Patients clinically suspected cases of urinary tract infections attended different hospital in Khartoum. Midstream urine samples were collected and pure isolates of pathogenic microorganisms were characterized by colony morphology, gram-stain and standard biochemical procedures. A standard method of agar disc diffusion susceptibility testing method was used to determine susceptibility patterns of the isolates. The most common pathogens isolated were E. coli (16), S. saprophyticus (8), S. aureus (7), Klebsiella species (4), E. faecales(3), P. vulgaris (2) and S. pyogens(2).

Keywords: Hemodialysis; E. coli; End-Stage Renal Disease; Kidney

Introduction                                                                      

Dialysis is the process of removing waste products and excess fluids from the body. There are two types of dialysis: hemodialysis and peritoneal dialysis. In Hemodialysis (HD), blood is removed from the body and pumped by a machine outside the body into a dialyzer (artificial kidney). Doctors decide to place a person on dialysis when the person’s kidney failure is causing certain conditions such as uremic encephalopathy, pericarditis, acidosis, heart failure, pulmonary edema and hyperkalemia [1]. For patients with End-Stage Renal Disease (ESRD), renal replacement therapy is achieved by dialysis (hemodialysis or peritoneal dialysis) or kidney transplantation. Although true and complete replacement of renal function is not provided by dialysis, this modality removes metabolic wastes and excess body water and replenishes body buffers in order to sustain life [2]. Renal failure describes a medical condition in which the kidneys fail to filter toxins and waste products from blood adequately; dialysis including hemodialysis is a procedure that is a substitute for many of the normal duties of the kidneys [3]. The number of patients with end-stage renal disease is increasing by 9% per year, among those undergoing hemodialysis, the majority will require at least one hospitalization every year [4,5]. Once hospitalized, these patients have an intrinsic susceptibility to developing an infection as a result of numerous is morbid conditions, uremic toxicity and anemia of chronic renal failure, all of which contribute to an immunocompromised state [6- 9]. In addition, chronic hemodialysis patients depend on vascular access, which increases the risk for developing bacteremia, the nosocomial infection with the greatest mortality rate, nosocomial infections contribute directly to a substantial number of hospital deaths and extra hospital days, these infections have not been extensively investigated in chronic hemodialysis patients, even though they are a high-risk population. To develop effective and customized prevention strategies, the epidemiological characteristics of nosocomial infections need to be fully elucidated in this population [10].

Urinary tract infections are the most common bacterial infections in humans, both as community-acquired and healthcare-associated infections. It is the most common nonsurgical nosocomial infection in postoperative patients and the second most common healthcare associated infection [11,12]. Proliferation of bacteria in the urinary tract is the cause of urinary tract infection. The clinical manifestations of UTI depend on the portion of the urinary tract involved, the etiologic organism(s), the severity of the infection and the patient’s ability to mount an immune response to it [13]. Signs and symptoms may include fever, chills, dysuria, urinary urgency, frequency and cloudy or malodorous urine. Infections are almost always ascending in origin and caused by bacteria in the periurethral flora and the distal urethra. These bacteria inhabit the distal gastrointestinal tract and colonize the perineal area.

E. coli usually causes a child’s first infection but other gram-negative bacilli and Enterococci may also cause infection [14]. Staphylococcal infections, especially those due to Staphylococcus saprophyticus are common causes of urinary tract infection among female adolescents.

Material and Methods

Collection of Urine Samples

Each patient was instructed how to collect a Clean-Catch midstream urine in a sterile tube (4-5 ml) labeled, leak proof and sterile containers. The specimens immediately transported to the laboratory under aseptic technique.

Data Collection

A structured questionnaire and referring to the patient clinical sheet were being used; demographic data and other Data (clinical symptoms, previous antibiotic, duration of antibiotic used) verbal consent was obtained from each patient enrolled in this study.

Isolation and Identification of Organisms

Using calibrated wire inoculating loop (0.001 ml) urine samples were inoculated into Cystine Lactose Electrolyte Deficient medium (Oxoid, Ltd., Basingstoke, Hampshire, England). CLED medium is recommended for diagnostic urinary bacteriology because it supports the growth of both gram positive and gram negative urinary potential pathogens and gives good colonial differentiation. Cultures were incubated in aerobic atmosphere at 37^◦C for 24 h. Colonies were counted to check the presence of significant bacteriuria. colonies were selected and characterized on the basis of morphological, cultural and biochemical features [20,21].

Results

A total of one hundred and three hemodialysis patients (66.9%) of the patients from Sudanese Kidney Transplant Association Hospital (SKTA) and (33.1%) of patients from Selma center for kidney diseases (Table 1). The most frequenty age group was (31- 40 y), followed by the age group (21-30 y). The rate of urinary tract infection was higher among the age group twenty-one to thirty, followed by age group thirty-one to forty (Table 2). Regarding the duration of renal dialysis most of them were on hemodialysis for one to two years (Table 3). Bacterial pathogens were isolated from forty-two (40.7%) urine samples, the rate of urine specimen with significant growth was higher in males than females (Fig. 1). The most isolated organism was include: E. coli (16), S. saprophyticus (8), S. aureus (7), Klebsiella species (4), E. faecalis (3), P. vulgaris (2) and S. pyogens (2) (Table 4).

Table 1: Distribution of the participant according to site of collection.

Table 2: The rate of specimen with bacterial growth according to age groups.

Table 3: Distribution of patient with bacterial urinary tract infection according to duration of renal dialysis.

Table 4: The frequency of bacteria species isolated from the urine specimen.

Figure 1: The rate of specimen with bacterial growth according to gender.

Discussion

A total of one hundred and three urine sample were enrolled in this study. Forty-two (40.7%) revealed significant bacterial growth. This result is nearly in agreement with the reparted that 37% of his patients revealed significant bacterial growth []15. This study revealed slightly higher rate of urinary tract infection among females (43.1%) than males (38.9%). Which in disagreement within which the rate of urinary tract infection was 29.4% and 10.7% among females and males respectively. The rate of urinary tract infection among males (38.9%) was very close to what was observed by (30%) [16,17]. The isolated bacteria that cause urinary tract infection were S.aureus , S.saprophyticus, S.pyogenes , E.faecales, E.coli, P.vulgaris, Klebsiella species, which were found to be the most causative agents of urinary tract infection in other studies.

Conclusion

It is concluded that Gram-negative bacilli (Enterobacteracea) were responsible for urinary tract infections. Drink plenty of water daily, wipe from front to back to prevent bacterial around the anus from entering the vagina or urethra, avoid smoking, clean genital area before sexual intercourse, avoid using feminine hygiene sprays and scented douches which may irritate urethra.

Conflict of Interests

The authors declare no conflicts of interest.

References

1. Beers Kidney and urinary tract disorders. The Merck Manual of Medical Information. Merck Research Laboratories, USA. 2003;833-4.
2. Schmidt RJ, Holley JL, Schwab SJ, Post TW. Non-access related infections in chronic dialysis patients. Last literature review Up-To-Date version 18.3. 2010.
3. Klahr S, Miller S. Acute Oilguria. New Engl J Med. 1998;338(10):671-5.
4. Ad Hoc Committee on Nephrology Manpower Needs: Estimating workforce and training requirement for nephrologists through the year 2010. J Am Soc Nephrol. 1997;8:S1-32.
5. US Renal Data System: USRDS 1997 Annual Data Report. The National Institutes of Health, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda. 1997.
6. Descamps-Latscha B, Herbelin A. Long-term dialysis and cellular immunity: A critical survey. Kidney Int. 1993;43:S135-42.
7. Miller T, Ormrod D, Collins J. Host defense and infection in dialysis patients, in Nissenson AR, Fine RN, Gentiel DE (eds): Clinical Dialysis. East Norwalk, CT, Appleton and Lange. 1990;559-78.
8. Goldblum SE, Reed WP. Host defenses and immunologic alterations associated with chronic hemodialysis. Ann Intern Med. 1980;93:597-613.
9. VanHolder R, Ringoir S. Polymorphonuclear cell function and infection in dialysis. Kidney Int. 1992;38:S91-5.
10. Emori TG, Ganynes RP. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev. 1993;6:428-42.
11. Allegranzi B, Nejad SB, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. The Lancet. 2011;377(9761):228-41.
12. Gastmeier P, Kampf G, Wischnewski NA, Hauer T, Schulgen G, Schumacher M, et al. Prevalence of nosocomial infections in representative German hospitals. J Hosp Infect. 1998;38(1):37-49.
13. Foxman B, Brown P. Epidemiology of urinary tract infections: transmission and risk factors, incidence and costs. Infectious disease clinics of North America. 2003;17(2):227-41.
14. Brkic K. An overview of traffic sign detection methods. Zagreb: Department of Electronics, Microelectronics, Computer and Intelligent Systems, Faculty of Electrical Engineering and Computing. 2010.
15. Falah SM, Ammer AM, Kais HA, Urinary tract infection in Hemodialysis patients with renal failure. Fac Med Baghdad. 2012;54(1).
16. Mortazavi M, Seyrafian S, Shahidi S, Abadpour Z, Shahbazi F. Pyuria as a screening test for detection of urinary tract infection in patients on long-term hemodialysis. IJKD. 2011;5:50-2.
17. Jaiswal S, Das R, Sharma S, Paudel P, Lamichhane SR. Bacteriological study of urinary tract infection in male patients undergoing dialysis due to chronic kidney disease in tertiary care hospitals in Nepal. Medical Care. 2013;1(2).

Article Type

Research Article

Publication History

Received Date: 01-07-2024 
Accepted Date: 22-07-2024 
Published Date: 29-07-2024

Copyright© 2024 by Aloob HMT, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation: Aloob HMT, et al. The Bacterial Causes Urinary Tract Infection among Hemodialysis Patients in Khartoum State, Sudan. J Clin Immunol Microbiol. 2024;5(2):1-4.

Figure 1: The rate of specimen with bacterial growth according to gender.

Table 1: Distribution of the participant according to site of collection.

Table 2: The rate of specimen with bacterial growth according to age groups.

Table 3: Distribution of patient with bacterial urinary tract infection according to duration of renal dialysis.

Table 4: The frequency of bacteria species isolated from the urine specimen.