Prevalence of Urinary Tract Infection and Diagnostic Accuracy of Pyuria as Screening Tool among Hemodialysis Patients in Mosul City

Background: Urinary tract infections (UTIs) are common among hemodialysis (HD) patients and are associated with an increased risk of complications; however, their diagnosis is often challenging due to frequent subclinical or atypical presentations. This study aimed to investigate the prevalence of UTIs in HD patients with renal failure and to evaluate the diagnostic accuracy of pyuria as a screening tool. Patients and Methods: A total of 200 hemodialysis patients were enrolled in the study, comprising 100 males and 100 females. Midstream, clean-catch urine samples were collected and subjected to standard urinalysis and culture. Significant bacteriuria was defined as ?10? CFU/mL in males and ?10? CFU/mL in females. Pyuria was defined as ?10 neutrophils per high-power field. Results: Bacterial growth was detected in 75 urine samples (37.5%), while 125 samples (62.5%) showed no significant growth. Escherichia coli was the most frequently isolated organism (40%, n=30), followed by Klebsiella pneumoniae (n=10). Pyuria was present in (85/200) patients (42.5%), of whom 55 (64.7%) had culture-confirmed UTIs. Pyuria demonstrated a sensitivity of 73.3%, specificity of 76%, a positive predictive value of 65%, and a negative predictive value of 83%. Conclusions: The study demonstrated that UTIs among HD patients are more prevalent in females and the elderly, with E. coli as the predominant multidrug-resistant pathogen, While pyuria proved to be a useful supportive indicator for diagnosis, it should be interpreted in conjunction with urine culture to avoid both overdiagnosis and missed infections in hemodialysis patients.