KADER UĞUR, İsa Ahmet BAL, AYŞE SAĞMAK TARTAR, NEVZAT GÖZEL, Bedrettin ORHAN, EMİR DÖNDER, Abdullah Mübin ÖZERCAN

Ciprofloxacin is not a better choice in the patients with diabetes suffering urinary tract infection

Objective: The aim of this study is to determine antibacterial susceptibilities of Gram-negative bacteria isolated fromdiabetic and non-diabetic patients as infectious agents of community-acquired urinary tract infections (UTI) and tocompare their rates of resistance to the antibiotics frequently used in empirical treatment.Methods: Ninety-six diabetic and sixty-eight non-diabetic (total n=164) patients’ data were evaluated retrospectivelywho diagnosed as community-acquired urinary system infection and consulted to outpatient clinics of Department ofEndocrinology and Infectious Diseases of Firat University School of Medicine between January 1st , 2014 andDecember 31st, 2014 whose urine cultures demonstrated Gram-negative bacteria were included in the study.Antibiotic susceptibilities of the isolated bacteria were determined using Vitek 2 automated system and the resultswere evaluated as sensitive and resistant. Results: In both diabetic and non-diabetic patient groups, most frequently Escherichia coli (88.5% in diabetic and85.3% in non-diabetic groups) were isolated. In the diabetic group, microorganisms mostly demonstrated the highestrates of resistance against ampicillin, cephalosporins, ciprofloxacin, amoxicillin-clavulanic acid and in the non-diabeticgroup ampicillin, amoxicillin-clavulanic acid, cefuroxime and trimethoprim-sulfamethoxazole.Conclusion: Resistance to ciprofloxacin was at a significantly higher rate in the diabetic group. In diabetic patients, itwill be more appropriate to give antibiotherapy in urinary system infections based on the antibacterial susceptibilitytest results.

İdrar Yolu Enfeksiyonu Geçiren Diyabetli Hastalarda Siprofloksasin İyi Bir Seçenek Değildir

Amaç: Bu çalışmanın amacı diyabetik ve diyabeti olmayan bireylerden izole edilen Gram-negatif bakterilerin toplum kaynaklı idrar yolu enfeksiyonlarının enfeksiyöz ajanları olarak antibakteriyel duyarlılıklarını saptamak ve ampirik tedavide sıklıkla kullanılan antibiyotiklere direnç oranlarını karşılaştırmaktır. Yöntemler: 1 Ocak- 31 Aralık 2014 tarihleri arasında Fırat Üniversitesi Endokrinoloji ve Enfeksiyon Hastalıkları kliniklerine başvuran toplum kaynaklı idrar yolu enfeksiyonu tanısı almış ve idrar kültürlerinde gram negatif bakteri üremesi olan 96 diyabetik ve 68 diyabetik olmayan hastanın dosyaları retrospektif olarak incelendi. İzole edilen bakterilerin antibiyotik duyarlılıkları, Vitek 2 otomatik sistem kullanılarak belirlenmişti ve sonuçlar duyarlı ve dirençli olarak değerlendirildi. Bulgular: Hem diyabetik hem de diyabetik olmayan hasta gruplarında en sık Escherichia coli (diyabetiklerde %88,5 ve diyabetik olmayan grupta %85,3) izole edildi. Diyabetik grupta mikroorganizmalar, ampisiline, sefalosporinlere, siprofloksasine, amoksisilin-klavulanik aside ve diyabetik olmayan grup ampisilin, amoksisilin-klavulanik asit, sefuroksim ve trimetoprim-sülfametoksazole karşı en yüksek direnç oranlarını göstermiştir. Sonuç: Diyabetik grupta Siprofloksasin direnci anlamlı olarak daha yüksekti. Üriner sistem enfeksiyonları olan diyabetik hastalarda, antibiyotik verileceği zaman antibakteriyel duyarlılık testi sonuçlarına dayanarak verilmesi daha uygun olacaktır.

PDF

___

International Diabetes Federation. Diabetes Atlas. 6th edition, update 2014. http://www.idf.org/diabetes atlas

Simkhada R. Urinary tract infection and antibiotic sensitivity pattern among diabetics. Nepal Med Coll J. 2013; 15 :1-4.

Yu S, Fu AZ, Qiu Y, et al. Disease burden of urinary tract infections among type 2 diabetes mellitus patients in the US. J Diabetes Complications 2014; 28 :621–6.

Wang MC, Tseng CC, Wu AB, et al. Bacterial characteristics and glycemic control in diabetic patients with Escherichia coli urinary tract infection. J Microbiol Immunol Infect 2013; 46 :24-9.

Sewify M, Nair S, Warsame S, et all. Prevalence of Urinary Tract Infection and Antimicrobial Susceptibility among Diabetic Patients with Controlled and Uncontrolled Glycemia in Kuwait. J Diabetes Res. 2016; 6573215.

Rawat V, Singhai M, Kumar A, et all. Bacteriological and resistance profile in isolates from diabetic patients. N Am J Med Sci. 2012; 4 :563-8.

Nitzan O, Elias M, Chazan B, et all. Urinary tract infections in patients with type 2 diabetes mellitus: review of prevalence, diagnosis, and management. Diabetes Metab Syndr Obes 2015; 8: 129-36.

American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 2015; 38: 1-93.

Catry B, Latour K, Bruyndonckx R, et all. Characteristics of the antibiotic regimen that affect antimicrobial resistance in urinary pathogens. Antimicrob Resist Infect Control. 2018; 7: 76.

Kahlmeter G, Poulsen HO. Antimicrobial susceptibility of Escherichia coli from communityacquired urinary tract infections in Europe: the ECO.SENS study revisited. Int J Antimicrob Agents 2012; 39: 45-51.

Tsakiridou E, Makris D, Chatzipantazi V, et all. Diabetes and hemoglobin a1c as risk factors for nosocomial infections in critically ill patients. Crit Care Res Pract. 2013: 279479.

Aswani SM, Chandrashekar UK, Shivashankara KN et all. Clinical profile of urinary tract infections in diabetics and non-diabetics. Australasian Medical Journal 2014; 7: 29-34.

Fünfstück R, Nicolle LE, Hanefeld M, et all. Urinary tract infection in patients with diabetes mellitus. Clin Nephrol 2012; 77 :40-8.

Geerlings S, Fonseca V, Castro-Diaz D, et all. Genital and urinary tract infections in diabetes: impact of pharmacologically-induced glucosuria. Diabetes Res Clin Pract. 2014; 103 :373-81.

Hirji I, Guo Z, Anderrson S.W, et all. Incidence of urinary tract infection among patients with type 2 diabetes in the UK General Practice Research Database 2012; 26: 513-6.

Hammar N, Farahmand B, Gran M, et all. Incidence of urinary tract infection in patients with type 2 diabetes. Experience from adverse event reporting in clinical trials. Pharmacoepidemiol Drug Saf 2010; 19: 1287-92.

Akhtar MS, Mohsin N, Zahak A, et all. Antimicrobial sensitivity pattern of bacterial pathogens in urinary tract infections in South Delhi, India. Rev Recent Clin Trials. 2014; 9 :271-5.

Choe HS, Lee SJ, Cho YH, et all.; GPIU Asian Investigators. Aspects of urinary tract infections and antimicrobial resistance in hospitalized urology patients in Asia: 10-Year results of the Global Prevalence Study of Infections in Urology (GPIU). J Infect Chemother 2018; 24 :278-83.

Naz H, Cevik FC, Aykın N. Hastane kökenli üriner sistem infeksiyonları ve antibiyotik direnç profili. Dicle Med J 2009; 36: 85-90.

Fasugba O, Gardner A, Mitchell BG, et all. Ciprofloxacin resistance in community-and hospitalacquired Escherichia coli urinary tract infections: a systematic review and meta-analtsis of observational studies.BMC Infectious Diseases 2015; 15: 545-60.

Frei CR, Labreche MJ, Attridge RT. Fluoroguinolones in community-acguired pneumonia: guide to selection and appropiate use. Drugs 2011; 71: 757-70.

Cıkman A, Gundem NS, Gulhan B, et all. İdrar kültürlerinden soyutlanan Enterobacteriaceae türlerinin GSBL üretimi ile ertapenem ve diğer antibiyotiklere direncinin belirlenmesi. Dicle Med J. 2014; 41 :474-8.

Ijaz M, Khan SM, Hassan M, Bangash IH. Urinary tract infection in diabetic patients; causative bacteria and antibiotic sensitivity J. Med. Sci. 2014; 22 :110-4.

Erden S, Çalangu S. Poliklinik hastalarında üriner sistem infeksiyonlarından izole edilen Escherichia coli suşlarının çeşitli antibiyotiklere in vitro duyarlılıkları. İstanbul Tıp Fakültesi Mecmuası 2002; 65: 147-9.

Redgrave LS, Sutton SB, Webber MA, Piddock LJ. Fluoroquinolone resistance: mechanisms, impact on bacteria, and role inevolutionary success. Trends Microbiol. 2014; 22 :438-45.

Kim ES, Hooper DC.Clinical importance and epidemiology of quinolone resistance. Infect Chemother. 2014; 46: 641-6.

Aral M, Kireçci E, Doğan SŞ. İdrar örneklerinden izole edilen gram negatif bakteriler ve antibiyotiklere direnç oranlarının retrospektif olarak değerlendirilmesi. Türk Mikrobiyoloji Cemiyeti Derg 2011; 41: 139-42.

Gangcuangco LM, Alejandria M, Henson KE, et all. Prevalence and risk factors for trimethoprimsulfamethoxazole-resistant Escherichia coli among women with acute uncomplicated urinary tract infection in a developing country. Int J Infect Dis 2015; 34: 55-60.

Vinken JEM, Mol HE, Verheij TJM, et all. Antimicrobial resistance in women with urinary tract infection in primary care: No relation with type 2 diabetes mellitus. Prim Care Diabetes. 2018; 12 :80-6.

Yismaw G, Asrat D, Woldemanuel Y, et all. Urinary tract ınfection: Bacterial etiologies, drug resistance profile and associated risk factors in diabetic patients attending Gondar University Hospital, Gondar, Ethiopia. European Journal of Experimental Biology 2012; 2: 889-98.