Prevalence and antibiogram of uropathogens among Jordanian patients with chronic kidney disease
-
Esraa Mashhur Al-Zawahra
,
Rania Al-Groom
,
Rabaa Yousef Athamneh
,
Mohd Sajjad Ahmad Khan
,
Mohamad Shatnawi
,
Fuad Alhawarat
,
Abdullah Al-Adayleh
,
Sameeha Al-Thnaibat
,
Mustafa Alquran
,
Emad Alrwashdeh
,
Ahmed Aljafari
,
Tamara Tarawneh
,
Afnan Belal Mfarej
Abstract
Background and Objectives: Chronic kidney disease (CKD) poses a worldwide health issue that greatly heightens the risk of infections, especially urinary tract infections (UTIs), which are often caused by antibiotic-resistant pathogens. The purpose of this research was to examine the occurrence, and responsiveness of bacterial strains from UTI patients with chronic kidney disease in Jordan.
Materials and Methods: A cross-sectional study was carried out with 150 participants, comprising 100 individuals with CKD and 50 as control. Urine samples were collected, cultured, and bacterial isolates were examined through biochemical assessments, and tests for antimicrobial susceptibility.
Results: Among 107 bacterial isolates, a significant number (85%) were identified as Gram-negative, with the most common being Escherichia coli (30%) and Klebsiella pneumoniae (18.7%). Gram-positive bacteria made up 15% of the isolates, including Enterococcus faecalis and Staphylococcus saprophyticus. There was a notable resistance to norfloxacin (59.4%) and ciprofloxacin (56.1%), whereas colistin was the most effective, showing 94.5% susceptibility. Multidrug resistance (MDR) was widespread, particularly in E. coli, which had the highest MDR rate at 82.2%.
Conclusion: The study emphasizes the predominance of Gram-negative bacteria, along with alarming rates of antibiotic resistance in CKD patients with UTIs. The findings of the study highlight the importance of customized antibiotic treatments and strong antimicrobial stewardship initiatives to effectively address UTIs in this vulnerable group.
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2. Shankar M, Narasimhappa S, N S M. Urinary Tract Infection in Chronic Kidney Disease Population: A Clinical Observational Study. Cureus 2021; 13: e12486.
3. Vacaroiu IA, Cuiban E, Geavlete BF, Gheorghita V, David C, Ene CV, et al. Chronic kidney disease-an underestimated risk factor for antimicrobial resistance in patients with urinary tract infections. Biomedicines 2022; 10: 2368.
4. Chao CT, Lee SY, Wang J, Chien KL, Huang JW. Frailty increases the risk for developing urinary tract infection among 79,887 patients with diabetic mellitus and chronic kidney disease. BMC Geriatr 2021; 21: 349.
5. Pinchera B, Trucillo E, D'Agostino A, Gentile I. Urinary tract infections in kidney transplant pPatients: an open challenge-update on epidemiology, risk Factors and management. Microorganisms 2024; 12: 2217.
6. Sujith S, Solomon AP, Rayappan JBB. Comprehensive insights into UTIs: from pathophysiology to precision diagnosis and management. Front Cell Infect Microbiol 2024; 14: 1402941.
7. Klein RD, Hultgren SJ. Urinary tract infections: microbial pathogenesis, host-pathogen interactions and new treatment strategies. Nat Rev Microbiol 2020; 18: 211-226.
8. Salam MA, Al-Amin MY, Salam MT, Pawar JS, Akhter N, Rabaan AA, et al. Antimicrobial resistance: a growing serious threat for global public health. Healthcare (Basel) 2023; 11: 1946.
9. McNulty CA, Boyle P, Nichols T, Clappison P, Davey P. Don't wear me out--the public's knowledge of and attitudes to antibiotic use. J Antimicrob Chemother 2007; 59: 727-738.
10. André M, Vernby A, Berg J, Lundborg CS. A survey of public knowledge and awareness related to antibiotic use and resistance in Sweden. J Antimicrob Chemother 2010; 65: 1292-1296.
11. Lim KK, Teh CC. A cross sectional study of public knowledge and attitude towards antibiotics in Putrajaya, Malaysia. South Med Rev 2012; 5: 26-33.
12. Shehadeh M, Suaifan G, Darwish RM, Wazaify M, Zaru L, Alja'fari S. Knowledge, attitudes and behavior regarding antibiotics use and misuse among adults in the community of Jordan. A pilot study. Saudi Pharm J 2012; 20: 125-133.
13. Awad AI, Aboud EA. Knowledge, attitude and practice towards antibiotic use among the public in Kuwait. PLoS One 2015; 10(2): e0117910.
14. Nazer LH, Tuffaha H. Health care and pharmacy practice in Jordan. Can J Hosp Pharm 2017; 70: 150-155.
15. Albsoul-Younes A, Wazaify M, Yousef AM, Tahaineh L. Abuse and misuse of prescription and nonprescription drugs sold in community pharmacies in Jordan. Subst Use Misuse 2010; 45: 1319-1329.
16. CLSI (2023). Performance Standards for Antimicrobial susceptibility testing. 33rd ed. CLSI supplement M100. Clinical and Laboratory Standards Institute. Wayne, PA, USA.
17. Whitman WB (Ed.) (2015). Bergey's Manual of Systematics of Archaea and Bacteria. Wiley. Hoboken, NJ, USA.
18. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18: 268-281.
19. Alam A, Amanullah F, Baig-Ansari N, Lotia-Farrukh I, Khan FS. Prevalence and risk factors of kidney disease in urban Karachi: baseline findings from a community cohort study. BMC Res Notes 2014; 7: 179.
20. Thapa TB, Pokhrel S, Lamichhane A, Singh VK, Shrestha O, Sapkota M, et al. Prevalence and antibiogram of bacteria causing urinary tract infection among patients with chronic kidney disease. Open Med (Wars) 2023; 18: 20230824.
21. Odoki M, Kizito S, Nanteza A, Tumusiime D. Prevalence of antibiotic-resistant Escherichia coli in Ugandan hospitals. J Glob Antimicrob Resist 2019; 17: 23-29.
22. Adhikari B, Mishra SR, Schwarz D, Kallestrup P. Community health workers in noncommunicable disease prevention and control in low-income countries. Bull World Health Organ 2019; 97: 109-116.
23. Scherberich JE, Fünfstück R, Naber KG. Urinary tract infections in patients with renal insufficiency and dialysis - epidemiology, pathogenesis, clinical symptoms, diagnosis and treatment. GMS Infect Dis 2021; 9: Doc07.
24. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int 2024; 105(4S): S117-S314.
25. Pradhan MM, Sharma S, Poudyal S, Gnyawali D, Adhikari S, Chapagain S, et al. Prevalence and antimicrobial susceptibility of multi-drug resistant uropathogens in a tertiary hospital in Nepal: a one-year audit. JNMA J Nepal Med Assoc 2025; 63: 523-528.
26. Haque Sumon AHMS, Al-Mahmood MR, Islam KA, Karim ANME, Aker P, Ullah A, et al. Multidrug resistance urinary tract infection in chronic kidney disease patients: an observational study. Cureus 2023; 15: e38571.
27. Alghoribi MF, Gibreel TM, Farnham G, Al Johani SM, Balkhy HH, Upton M. Antibiotic-resistant ST38, ST131 and ST405 strains are the leading uropathogenic Escherichia coli clones in Riyadh, Saudi Arabia. J Antimicrob Chemother 2015; 70: 2757-2762.
28. Abdel-Qader DH, Albassam A, Ismael NS, El-Shara' AA, Shehri A, Almutairi FS, et al. Awareness of antibiotic use and resistance in Jordanian Community. J Prim Care Community Health 2020; 11: 2150132720961255.
29. Enany ME, El-Mahallawy HS, Mohammed WEI, Hassan WMM, Aboueisha AM. Emergence of extensively drug-resistant Klebsiella pneumoniae from broiler chickens and clinical samples in Egypt. BMC Microbiol 2025; 25: 469.
30. Mo L, Wang J, Qian J, Peng M. Antibiotic sensitivity of Proteus mirabilis urinary tract infection in patients with urinary calculi. Int J Clin Pract 2022; 2022: 7273627.
31. Aqel AA, Al-Matarneh TM, Al-Tarawneh TK, Alnawayseh T, Alsbou M, Gaber Y. Monitoring of antibiotic resistance patterns within Al-Karak Governmental Hospital, Jordan, in 2022. Antibiotics (Basel) 2024; 13: 1172.
32. Gembillo G, Siligato R, Santoro D. Personalized medicine in kidney disease. J Pers Med 2023; 13: 1501.
33. Jarab AJ, Mukattash TL, Nusairat B, Khdour M. Appropriateness of antibiotic prescription among hospitalized patients with urinary tract infection in Jordan. J Appl Pharm Sci 2023; 13: 109-114.
34. Alkhawaldeh R, Gharaibeh L, Khan AH, Abu Hammour K, Zawiah M, Shilbayeh SA, et al. Exploring antibiotic resistance patterns in Escherichia coli isolates from urinary tract infections: a retrospective study. J Clin Med 2025; 14: 3196.
35. Alsheikh A, Abuawwad A, Yousef I, Abueswailem D, Al-Momani H, Aburayyan W, et al. Epidemiology, antibiotic resistance, and molecular detection of blaOXA and blaCTX-M Genes in ESBL-Producing Escherichia coli from urinary tract infections in Jordanian hospitals. BMC Microbiol 2025; 25: 557.
36. Scherberich JE, Fünfstück R, Naber KG. Urinary tract infections in patients with renal insufficiency and dialysis-epidemiology, pathogenesis, clinical symptoms, diagnosis and treatment. GMS Infect Dis 2021; 9: Doc07.
37. Birlutiu V, Birlutiu RM. Characteristics of infections in hemodialysis patients: results from a single-center 29-month observational cohort study from Romania. Microorganisms 2026; 14: 230.
38. Anton CI, Sima CS, Ion Ș, Jinga V. Predictors of multidrug-resistant urinary tract infections in women: a large retrospective cohort study in a Romanian University Hospital. Microorganisms 2026; 14: 157.
39. Dicu-Andreescu I, Penescu MN, Căpușă C, Verzan C. Chronic kidney disease, urinary tract infections and antibiotic nephrotoxicity: are there any relationships? Medicina (Kaunas) 2022; 59: 49.
40. Simoni A, Schwartz L, Junquera GY, Ching CB, Spencer JD. Current and emerging strategies to curb antibiotic-resistant urinary tract infections. Nat Rev Urol 2024; 21: 707-722.
2. Shankar M, Narasimhappa S, N S M. Urinary Tract Infection in Chronic Kidney Disease Population: A Clinical Observational Study. Cureus 2021; 13: e12486.
3. Vacaroiu IA, Cuiban E, Geavlete BF, Gheorghita V, David C, Ene CV, et al. Chronic kidney disease-an underestimated risk factor for antimicrobial resistance in patients with urinary tract infections. Biomedicines 2022; 10: 2368.
4. Chao CT, Lee SY, Wang J, Chien KL, Huang JW. Frailty increases the risk for developing urinary tract infection among 79,887 patients with diabetic mellitus and chronic kidney disease. BMC Geriatr 2021; 21: 349.
5. Pinchera B, Trucillo E, D'Agostino A, Gentile I. Urinary tract infections in kidney transplant pPatients: an open challenge-update on epidemiology, risk Factors and management. Microorganisms 2024; 12: 2217.
6. Sujith S, Solomon AP, Rayappan JBB. Comprehensive insights into UTIs: from pathophysiology to precision diagnosis and management. Front Cell Infect Microbiol 2024; 14: 1402941.
7. Klein RD, Hultgren SJ. Urinary tract infections: microbial pathogenesis, host-pathogen interactions and new treatment strategies. Nat Rev Microbiol 2020; 18: 211-226.
8. Salam MA, Al-Amin MY, Salam MT, Pawar JS, Akhter N, Rabaan AA, et al. Antimicrobial resistance: a growing serious threat for global public health. Healthcare (Basel) 2023; 11: 1946.
9. McNulty CA, Boyle P, Nichols T, Clappison P, Davey P. Don't wear me out--the public's knowledge of and attitudes to antibiotic use. J Antimicrob Chemother 2007; 59: 727-738.
10. André M, Vernby A, Berg J, Lundborg CS. A survey of public knowledge and awareness related to antibiotic use and resistance in Sweden. J Antimicrob Chemother 2010; 65: 1292-1296.
11. Lim KK, Teh CC. A cross sectional study of public knowledge and attitude towards antibiotics in Putrajaya, Malaysia. South Med Rev 2012; 5: 26-33.
12. Shehadeh M, Suaifan G, Darwish RM, Wazaify M, Zaru L, Alja'fari S. Knowledge, attitudes and behavior regarding antibiotics use and misuse among adults in the community of Jordan. A pilot study. Saudi Pharm J 2012; 20: 125-133.
13. Awad AI, Aboud EA. Knowledge, attitude and practice towards antibiotic use among the public in Kuwait. PLoS One 2015; 10(2): e0117910.
14. Nazer LH, Tuffaha H. Health care and pharmacy practice in Jordan. Can J Hosp Pharm 2017; 70: 150-155.
15. Albsoul-Younes A, Wazaify M, Yousef AM, Tahaineh L. Abuse and misuse of prescription and nonprescription drugs sold in community pharmacies in Jordan. Subst Use Misuse 2010; 45: 1319-1329.
16. CLSI (2023). Performance Standards for Antimicrobial susceptibility testing. 33rd ed. CLSI supplement M100. Clinical and Laboratory Standards Institute. Wayne, PA, USA.
17. Whitman WB (Ed.) (2015). Bergey's Manual of Systematics of Archaea and Bacteria. Wiley. Hoboken, NJ, USA.
18. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18: 268-281.
19. Alam A, Amanullah F, Baig-Ansari N, Lotia-Farrukh I, Khan FS. Prevalence and risk factors of kidney disease in urban Karachi: baseline findings from a community cohort study. BMC Res Notes 2014; 7: 179.
20. Thapa TB, Pokhrel S, Lamichhane A, Singh VK, Shrestha O, Sapkota M, et al. Prevalence and antibiogram of bacteria causing urinary tract infection among patients with chronic kidney disease. Open Med (Wars) 2023; 18: 20230824.
21. Odoki M, Kizito S, Nanteza A, Tumusiime D. Prevalence of antibiotic-resistant Escherichia coli in Ugandan hospitals. J Glob Antimicrob Resist 2019; 17: 23-29.
22. Adhikari B, Mishra SR, Schwarz D, Kallestrup P. Community health workers in noncommunicable disease prevention and control in low-income countries. Bull World Health Organ 2019; 97: 109-116.
23. Scherberich JE, Fünfstück R, Naber KG. Urinary tract infections in patients with renal insufficiency and dialysis - epidemiology, pathogenesis, clinical symptoms, diagnosis and treatment. GMS Infect Dis 2021; 9: Doc07.
24. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int 2024; 105(4S): S117-S314.
25. Pradhan MM, Sharma S, Poudyal S, Gnyawali D, Adhikari S, Chapagain S, et al. Prevalence and antimicrobial susceptibility of multi-drug resistant uropathogens in a tertiary hospital in Nepal: a one-year audit. JNMA J Nepal Med Assoc 2025; 63: 523-528.
26. Haque Sumon AHMS, Al-Mahmood MR, Islam KA, Karim ANME, Aker P, Ullah A, et al. Multidrug resistance urinary tract infection in chronic kidney disease patients: an observational study. Cureus 2023; 15: e38571.
27. Alghoribi MF, Gibreel TM, Farnham G, Al Johani SM, Balkhy HH, Upton M. Antibiotic-resistant ST38, ST131 and ST405 strains are the leading uropathogenic Escherichia coli clones in Riyadh, Saudi Arabia. J Antimicrob Chemother 2015; 70: 2757-2762.
28. Abdel-Qader DH, Albassam A, Ismael NS, El-Shara' AA, Shehri A, Almutairi FS, et al. Awareness of antibiotic use and resistance in Jordanian Community. J Prim Care Community Health 2020; 11: 2150132720961255.
29. Enany ME, El-Mahallawy HS, Mohammed WEI, Hassan WMM, Aboueisha AM. Emergence of extensively drug-resistant Klebsiella pneumoniae from broiler chickens and clinical samples in Egypt. BMC Microbiol 2025; 25: 469.
30. Mo L, Wang J, Qian J, Peng M. Antibiotic sensitivity of Proteus mirabilis urinary tract infection in patients with urinary calculi. Int J Clin Pract 2022; 2022: 7273627.
31. Aqel AA, Al-Matarneh TM, Al-Tarawneh TK, Alnawayseh T, Alsbou M, Gaber Y. Monitoring of antibiotic resistance patterns within Al-Karak Governmental Hospital, Jordan, in 2022. Antibiotics (Basel) 2024; 13: 1172.
32. Gembillo G, Siligato R, Santoro D. Personalized medicine in kidney disease. J Pers Med 2023; 13: 1501.
33. Jarab AJ, Mukattash TL, Nusairat B, Khdour M. Appropriateness of antibiotic prescription among hospitalized patients with urinary tract infection in Jordan. J Appl Pharm Sci 2023; 13: 109-114.
34. Alkhawaldeh R, Gharaibeh L, Khan AH, Abu Hammour K, Zawiah M, Shilbayeh SA, et al. Exploring antibiotic resistance patterns in Escherichia coli isolates from urinary tract infections: a retrospective study. J Clin Med 2025; 14: 3196.
35. Alsheikh A, Abuawwad A, Yousef I, Abueswailem D, Al-Momani H, Aburayyan W, et al. Epidemiology, antibiotic resistance, and molecular detection of blaOXA and blaCTX-M Genes in ESBL-Producing Escherichia coli from urinary tract infections in Jordanian hospitals. BMC Microbiol 2025; 25: 557.
36. Scherberich JE, Fünfstück R, Naber KG. Urinary tract infections in patients with renal insufficiency and dialysis-epidemiology, pathogenesis, clinical symptoms, diagnosis and treatment. GMS Infect Dis 2021; 9: Doc07.
37. Birlutiu V, Birlutiu RM. Characteristics of infections in hemodialysis patients: results from a single-center 29-month observational cohort study from Romania. Microorganisms 2026; 14: 230.
38. Anton CI, Sima CS, Ion Ș, Jinga V. Predictors of multidrug-resistant urinary tract infections in women: a large retrospective cohort study in a Romanian University Hospital. Microorganisms 2026; 14: 157.
39. Dicu-Andreescu I, Penescu MN, Căpușă C, Verzan C. Chronic kidney disease, urinary tract infections and antibiotic nephrotoxicity: are there any relationships? Medicina (Kaunas) 2022; 59: 49.
40. Simoni A, Schwartz L, Junquera GY, Ching CB, Spencer JD. Current and emerging strategies to curb antibiotic-resistant urinary tract infections. Nat Rev Urol 2024; 21: 707-722.
| Files | ||
| Issue | Vol 18 No 5 (2026) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v18i5.22854 | |
| Keywords | ||
| Antibiotic resistance Chronic kidney disease Gram-negative bacteria Jordan Multidrug resistance Urinary tract infection | ||
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How to Cite
1.
Al-Zawahra E, Al-Groom R, Athamneh RY, Khan MSA, Shatnawi M, Alhawarat F, Al-Adayleh A, Al-Thnaibat S, Alquran M, Alrwashdeh E, Aljafari A, Tarawneh T, Mfarej AB. Prevalence and antibiogram of uropathogens among Jordanian patients with chronic kidney disease. Iran J Microbiol. 2026;18(5):655-669.
