Work

Clinical Significance of Urine Culture in Patients on Maintenance Hemodialysis: Asymptomatic Presentation of Urinary Tract Infection and Chronic Cystitis in Routine Practice

Year: 2026

Type: article

Abstract: Purpose: In patients on maintenance hemodialysis, urine culture is often not obtained because urine collection is difficult and urinary symptoms are indistinct. We examined how urinary tract infection (UTI) presents, and what a positive urine culture signifies, when cultures are obtained in routine practice. Patients and Methods: In this single-center retrospective study, 131 urine culture events obtained between January 2016 and April 2026 from 95 of 435 patients on maintenance hemodialysis were analyzed at the patient level. True UTI-related disease was defined as a final diagnosis of UTI, acute cystitis or infected renal cyst. Results: Sixty of 95 patients (63.2%) had true UTI-related disease, of whom 11 (18.3%; 95% confidence interval [CI] 9.5– 30.4) had no urinary symptoms or attributable fever; an event-level analysis gave 18.5%. Final diagnoses were made by the attending physician and incorporated the culture result, so this proportion describes routine practice rather than a diagnosis of asymptomatic UTI. Bacteriuria or pyuria not treated as acute infection accounted for 17 patients (17.9%; 95% CI 10.8– 27.1), of whom only 4 (23.5%) received antimicrobial agents. Among 81 culture-positive patients, Escherichia coli accounted for 39 (48.1%; 95% CI 36.9– 59.5), remaining between 44.3% and 48.1% across three alternative aggregation rules. All 11 extended-spectrum β-lactamase (ESBL)-producing isolates were resistant to levofloxacin, yet 4 of these patients received a quinolone. Conclusion: A substantial minority of patients diagnosed with UTI in routine practice lacked urinary symptoms and attributable fever, while about one in six patients undergoing urine culture had bacteriuria or pyuria not treated as acute infection. The microbial distribution differed markedly from that of uncomplicated UTI, raising the possibility that empirical regimens developed for uncomplicated UTI may not provide adequate coverage; because susceptibility was not evaluated in all isolates, this inference rests on organism distribution rather than susceptibility data. Keywords: hemodialysis, end-stage renal disease, dialysis, urine culture, urinary tract infection, asymptomatic bacteriuria

Source: Research and Reports in Urology

DOI: 10.2147/rru.s650380