Tracking of Klebsiella pneumoniae and Klebsiella aerogenes in Urinary Tract Infection Cases among Hemodialysis patients by Conventional and Advanced Molecular Methods

Abstract

Bacteria cause the majority of urinary tract infections (UTIs). Accurate detection of the pathogens especially in hemodialysis patients is crucial for effective treatment. The development of a promising metagenomic next-generation sequencing (mNGS) technology that enables the detection of pathogens is gaining popularity in clinical diagnosis. Aims: This study aims to reanalyze samples where traditional culture and commercial system identified Klebsiella pneumoniae and Klebsiella aerogenes as the pathogens by mNGS and compare the results of the two methods. Methods: Midstream 10 ml urine samples were collected from 150 male and female patients under more than one year of hemodialysis therapy from private laboratory and two hospitals in Baghdad and urine analysis started within 2 hours of collection. Results: From 150 samples 71 (47.3%) patients were positive for UTI by microscopic examination form these 59 (83.1%) were positive for UTI by urine culture and 12 (16.9%) samples produced negative urine culture. From the positive urine culture using Viteck-2 system we found that the majority of pathogenic isolates 49 (80.3%) were Gram negative bacteria the rest 12 (19.7 %) were Gram positive. The percentage of presence of Klebsiella pneumonia and Enterobacter aerogenes was 18 % and 6.55 % respectively. Four patients' samples detected with K. pneumoniae and K. aerogenes and three control samples tested using mNGS and the results revealed the dominance of K.  variicola and K. granulomatis. Conclusion: This study showed that the majority of UTIs bacteria were gram negative, the limitations in sensitivity and accuracy of traditional detection methods compared to NGS and highlighted the importance of integrating advanced molecular techniques in diagnostic workflows.