Urinary tract infection in diabetes: Susceptible organisms and antibiogram patterns in an outpatient clinic of a tertiary health care center

We aimed to determine the influence of diabetes mellitus (DM) on uropathogens and antibiotic resistance pattern in urinary tract infection (UTI) in our center. Three hundred fifty-five DM patients and 165 non-DM patients with UTI were included in this retrospective study. Urine samples were processed in the laboratory following standard protocol. Mean age was higher in DM group (63.9 ± 12.4 vs 59.6 ± 17.3 years, respectively, P = 0.001). Females showed much higher UTI prevalence in both groups (85.6% in DM vs 70.3% in non-DM group, P = 0.000). Mean HbA1c level on admission was 9.3% (78 mmol/mol). Mean duration of DM was 13.9 ± 8.5 yr. E.coli was the predominant uropathogen for both (67.3% in DM and 61.8% in non-DM group). Most isolated microorganisms were sensitive to nitrofurantoin (87.0% in DM, vs 83.6% in non-DM group, P = 0.265). Mean DM duration of higher than 10,5 years showed greatest risk of multidrug resistance (MDR) (AUC = 0.58, sensitivity of 63.7% and specificity of 50%, P = 0.019). Diabetic patients with UTI had poor glycemic control and long-standing DM. Nitrofurantoin was the most appropriate antimicrobial agent for empirical use. The MDR was higher in patients with DM lasting longer than 10.5 years.

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Hirji I, Guo Z, Andersson SW, et al. Incidence of urinary tract infection among patients with type 2 diabetes in the UK General Practice Research Database (GPRD). J Diabetes Complications. 2012;26:513-6.

Fu AZ, Iglay K, Qui Y, et al. Risk characterization for urinary tract infections in subjects with newly diagnosed type 2 diabetes. J Diabetes Copmlications. 2014;28:805-10.

Wilke T, Boettger B, Berg B, et al. Epidemiology of urinary tract infections in type 2 diabetes mellitus patients: An analysis based on a large sample of 456,586 German T2DM patients. J Diabetes Complications. 2015;29:101523.

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

Geerlings SE, Hoepelman AI. Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol. 1999;26:259-65.

Schneeberger C, Stolk R, DeVries H, et al. Differences in the Pattern of Antibiotic Prescription Profile and Recurrence Rate for Possible Urinary Tract Infections in Women With and Without Diabetes. Diabetes Care. 2008;31:1380–5.

Aswani SM, Chandrashekar U, Shivashankara K, et al. Clinical profile of urinary tract infections in diabetics and non-diabetics. Australas Med J. 2014;7:29-34.

Garcia L, Isenberg H. Specimen Collection, Transport, and Acceptability. In: Clinical Microbiology Procedures Handbook. Volume 1 (2nd edition). ASM Press, Washington DC, 2007.

American Diabetes Association. Glycemic Targets: Standards of Medical Care in Diabetes. Diabetes Care 2018;41:55-64.

10. Sewify M, Nair S, Warsame S, et al. Prevalence of urinary tract infection and antimicrobial susceptibility among diabetic patients with controlled and uncontrolled glycemia in kuwait. J Diabetes Res. 2016; 2016: 6573215.

11. Geerlings SE, Meiland R, Hoepelman IM. Urinary tract infections in women with diabetes mellitus. Ned Tijdschr Geneeskd. 2001;145:1832-6.

12. Boyko EJ, Fihn SD, Scholes D, et al. Risk of urinary tract infection and asymptomatic bacteriuria among diabetic and nondiabetic postmenopausal women. Am J Epidemiol. 2005;161:557-64.

13. Chiţă T, Timar B, Muntean D, et al. Urinary tract infections in Romanian patients with diabetes: prevalence, etiology, and risk factors. Ther Clin Risk Manag. 2016;13:1-7.

14. Garg V, Bose A, Jindal J, et al. Comparison of clinical presentation and risk factors in diabetic and non-diabetic females with urinary tract infection assessed as per the european association of urology classification. J Clin Diagn Res. 2015;9:12-4.

15. Renko M, Tapanainen P, Tossavainen P, et al. Meta-analysis of the significance of asymptomatic bacteriuria in diabetes. Diabetes Care. 2011;34:230-5.

16. Tseng CC, Wu JJ, Liu HL, et al. Roles of host and bacterial virulence factors in the development of upper urinary tract infection caused by Escherichia coli. Am J Kidney Dis. 2002;39:744-52.

17. Bonadio M, Costarelli S, Morelli G, et al. The influence of diabetes mellitus on the spectrum of uropathogens and the antimicrobial resistance in elderly adult patients with urinary tract infection. BMC Infectious Diseases. 2006;6:54.

18. Malmartel A, Ghasarossian C. Bacterial resistance in urinary tract infections with diabetes matched with patients without diabetes. J Diabetes Complications. 2016;30:705-9.

19. Boyko EJ, Fihn SD, Scholes D, et al. Diabetes and the risk of acute urinary tract infection among postmenopausal women. Diabetes Care. 2002;25:177883.

20. Mandal J, Acharya NS, Buddhapriya D, et al. Antibiotic resistance pattern among common bacterial uropathogens with a special reference to ciprofloxacin resistant Escherichia coli. Indian J Med Res. 2012;136:842-9.

21. Geerling SE. Urinary tract infections in patients with diabetes mellitus: epidemiology, pathogenesis and treatment. Int J Antimicrob Agents. 2008;31:54-7.

22. Hamdan HZ, Kubbara E, Adam AM, et al. Urinary tract infections and antimicrobial sensitivity among diabetic patients at Khartoum, Sudan. Ann Clin Microbiol Antimicrob. 2015;14:26.

23. Ubrig B, Böhme M, Merklinghaus A, et al. Community acquired urinary tract infections - association with risk factors : Changes in causative organisms and resistance over time. Urologe A. 2017;56:773-8.

24. Nigussie D, Amsalu A. Prevalence of uropathogen and their antibiotic resistance pattern among diabetic patients. Turk J Urol. 2017;43:85-92.

25. Boroumand MA, Sam L, Abbasi SH, et al. Asymptomatic bacteriuria in type 2 Iranian diabetic women: a cross sectional study. BMC Womens Health. 2006;6:4.

26. Meiland R, Geerlings SE, De Neeling AJ, et al. Diabetes mellitus in itself is not a risk factor for antibiotic resistance in Escherichia coli isolated from patients with bacteriuria. Diabet Med. 2004;21:1032–4.

27. Borowczyk M, Chmielarz-Czarnocińska A, Faner-Szczepańska P, et al. Urinary tract infections in postmenopausal women with type 2 diabetes: clinical correlates and quinolone susceptibility. Pol Arch Intern Med. 2017;127:336-42.

28. Woldemariam HK, Geleta DA, Tulu KD, et al. Common uropathogens and their antibiotic susceptibility pattern among diabetic patients. BMC Infect Dis. 2019;19:43.
Medicine Science-Cover
  • ISSN: 2147-0634
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2012
  • Yayıncı: Effect Publishing Agency ( EPA )
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