FREQUENCY AND PREDICTORS OF MULTIDRUGRESISTANT URINARY TRACT INFECTIONS IN CHRONIC KIDNEY DISEASE PATIENTS
Abstract
Background: Multidrug-resistant (MDR) urinary tract infections (UTIs) have emerged as a major healthcare concern, particularly among patients with chronic kidney disease (CKD), who are more susceptible to infections due to impaired immune function and frequent healthcare exposure. MDR infections can complicate treatment, increase hospitalization rates, and worsen clinical outcomes. This study aimed to determine the frequency of MDR UTIs and identify their predictors among CKD patients. Methods: A cross-sectional study was conducted among CKD patients diagnosed with urinary tract infections at a tertiary care hospital Sindh Pakistan. Data regarding demographic characteristics, clinical history, comorbidities, previous antibiotic use, hospitalization, and urinary catheterization were collected. Urine specimens were cultured, and antimicrobial susceptibility testing was performed using standard laboratory procedures. MDR was defined as resistance to at least one antimicrobial agent in three or more antibiotic classes. Statistical analysis was performed to assess the frequency of MDR UTIs and identify associated risk factors. Results: Among the enrolled CKD patients, a substantial proportion were found to have MDR urinary tract infections. The most frequently isolated pathogens were Escherichia coli and Klebsiella pneumoniae . Factors significantly associated with MDR UTIs included prior antibiotic exposure, recurrent urinary tract infections, diabetes mellitus, prolonged hospitalization, advanced stages of CKD, and urinary catheter use. Patients with these risk factors demonstrated a higher likelihood of developing MDR infections compared to those without such exposures. Conclusion: MDR urinary tract infections are common among patients with chronic kidney disease and are associated with several identifiable clinical risk factors. Strengthening antimicrobial stewardship programs, promoting rational antibiotic use, and implementing routine surveillance strategies may help reduce the burden of MDR infections and improve patient outcomes in this high-risk population.