Background and Aim: Patients with diabetes mellitus(DM) are at increased risk of infections, with the urinary tract being the most frequent infection site. High rates of antibiotic prescription, including broad-spectrum antibiotics, for urinary tract infection (UTI) in these patients may further induce the development of antibiotic-resistant urinary pathogens. The aim of our study is to determine the epidemiology of UTI and resistance patterns of bacterial isolates in patients with DM.
Methods: A total of 70 patients with DM presenting UTI admitted to a Tunisian university hospital from 2018 to 2020 were studied retrospectively. Socio-demographic and clinical data, urin culture results and antimicrobial susceptibility patterns of the isolates were collected.
Results: Mean age was 48 years ±15 with female predominance (80%). In female subgroup,57.14% were postmenopausal. Mean body mass index (BMI) was 27.95±10.5 kg/m2. Mean HbA1C was 11.3%±3.6. Diabetes was insulin-treated in 70% of cases. Mean duration of diabetes was 10 years±3.7. Of our study population, 68.57% and 11.42% had lower and upper UTI, respectively. UTI was asymptomatic in 50% of cases. The predominant isolate was Escherichia coli (55.71%) followed by klebsiella Pneumoniae (14.28%), Enterobacter cloacae (2.85%), Entercoccus fecalis (1.42%), Acinetobacter (1.42%), Coagulase negative Staphylococcus (1.42%) and Raoutella terrigena (1.42 %). Extended Spectrum Beta-Lactamase Escherichia coli was isolated in 22% of cases and 70% of Klebsiella pneumoniae isolates were resistant to amoxicillin-clavulanic acid, ceftazidime, nitrofurantoin, ceftiraxone, ticarcillin, and piperacillin. The rate of resistance to two or more antimicrobials was 40%. UTI was significantly more prevalent in type 2 DM(67,14% vs 32,86%; P=0,04). Upper UTI was significantly associated with female sex (8.5% vs 5.1%; P=0.002) and with shorter duration of DM (6.5 years ±5.1 vs 11.5 years ±8.81; P=0.04) while age, DM type and treatment and BMI were not significantly associated with upper UTI.
Conclusion: Escherichia coli was the most frequent isolate in both symptomatic and asymptomatic DM patients. More resistant pathogens are a commun finding. Our results are in line with other studies. Investigation of bacteriuria in diabetic patients for UTI is important for treatment and prevention of the development of renal complications.
13 May 2023 - 16 May 2023