Urinary tract infection in type 2 diabetic patients: risk factors and antimicrobial pattern
Keywords:Urinary tract infection, Type 2 Diabetes, Risk factors, Antimicrobial pattern, Glycosylated hemoglobin
Background: Diabetes increases the risk of infection and the commonest amongst them are the ones involving the genitourinary tract. Diabetic patients are found to have an increase in the risk of developing urinary tract infection (UTI) by 60%. The study aimed to determine the causative pathogens and their antimicrobial pattern, identify risk factors associated in type 2 diabetic subjects having UTI.
Methods: This was an observational study conducted in the medicine unit of a tertiary care hospital over a period of 8 months. A total of 619 (M:F 289:330) type 2 diabetic subjects were studied. History, clinical examinations, and the duration of diabetes were recorded in all patients at admission. Diabetes was diagnosed based on the WHO criteria. An immunoturbidimetric method was used to estimate glycosylated hemoglobin (HbA1C%). Diagnosis of UTI was made from midstream urine samples of patients if the urine cultures has >103 to >105 colony forming units (CFUs)/mL of a pathogen.
Results: Among the 619 diabetic patients 220 patients had pus cells in urine but 72 patients had insignificant colony count. 90 (60.8%) patients were more than 60 years old, 48 (32.4%) were in the age group of 40-60 years and 10 (6.7%) were less than 40 years old. Among the 148 patients studied 52 (35.1%) were males and 96 (64.9%) were females. 116 (78.4%) had diabetes for more than 15 years and the rest had a duration lesser than 15 years. The HbA1C of patients with and without UTI were 10.2 ± 1.6 and 8.4 ± 1.3 respectively. Gram negative bacilli were isolated from 129 (87.2%) patients which included E. coli in 75 (50.7%), Klebsiella in 30 (20.3%), Pseudomonas species in 12 (8.1%) and Citrobacter in 12 (8.1%). Gram positive cocci were responsible for UTI in 15(10.1%) of subjects including Enterococcus in 13 (8.9%) and Staphylococcus in 2 (1.3%). Gram negative bacilli including E. coli, the Klebsiella species, pseudomonas and Citrobacter had good response to piperacillin-tazobactum, cefoperazone sulbactum, imipenam and amikacin. Gram positive cocci (Enterococcus and Staphylococcus) responsible for UTI showed good susceptibility to vancomycin (81 and 94% respectively) but a high resistance to ciprofloxacin and tetracyclines (68 and 57% respectively).
Conclusions: Female gender, age and duration of diabetes were found to have increased risk factors for developing UTI in diabetes. Escherichia coli was the commonest organism causing UTI in diabetes which showed good response to piperacillin/tazobactum, cefoperazone-sulbactum, imipenam and amikacin.
Hirji I, Guo Z, Andersson SW, Hammar N, Caminero AG. Incidence of urinary tract infection among patient with type 2 diabetes in the UK general practice and research database (GPRD). J Diabetes Complications. 2012;26:513-6.
Joshi N, Caputo GM, Weitecamp MR. Infections in patient with diabetes mellitus. N Engl J Med. 1999:341;1906-12.
Sridhar CB, Anjana S, Mathew JT. Acute infections. In: Ahuja MMS, Tripathy BB, Sam Moses GP, Chandalia HB, Das AK, Rao PV, eds. RSSDI Text Book of Diabetes Mellitus. 1st ed. Hyderabad, India: Jaypee Brothers Medical Publishers; 2002: 471-478.
Meiland R, Geerlings GE, Hoepelman AI. Management of bacterial urinary tract infections in adult patients with diabetes mellitus. Drugs. 2002;62:1859-68.
Guy Neild H. Urinary tract infection. In: Guy Neild H, eds. Medicine. UK: The Medicine Publishing Company Ltd; 2003: 85-90.
World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications; Part 1: Diagnosis and classification of diabetes mellitus. Geneva: Department of Non-communicable Disease Surveillance, WHO; 1999.
Seshasai SR, Kaptoge S, Thompson A, Di Angelantonio E, Gao P, Sarwar N, et al. Diabetes mellitus, fasting glucose and risk of cause-specific death. Emerging Risk Factors Collaboration Group. N Engl J Med. 2011;364:829-41.
Janifer J, Geethalakshmi S, Satyavani K, Viswanathan V. Prevalence of lower urinary tract infection in South Indian type 2 diabetic subjects. Indian J Nephrol. 2009;19:107.
Al-Rubeaan KA, Moharram O, Al-Naqeb D, Hassan A, Rafiullah MR. Prevalence of urinary tract infection and risk factors among Saudi patients with diabetes. World J Urol. 2013;31:573-8.
Hammar N, Farahmand B, Gran M, Joelson S, Andersson SW. 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.
Boyko EJ, Fihn SD, Scholes D, Chen CL, Normand EH, Yarbro P. Diabetes and the risk of acute urinary tract infection among postmenopausal women. Diabetes Care. 2002;25:1778-83.
Geerlings SE, Stolk RP, Camps MJ, Netten PM, Collet TJ, Hoepelman AI, et al. Risk factors for symptomatic urinary tract infection in women with diabetes. Diabetes Care. 2000;23:1737-41.
Yu S, Fu AZ, Qiu Y, Engel SS, Shankar R, Brodovicz KG, et al. Disease burden of urinary tract infections among type 2 diabetes mellitus patients in the US. J Diabetes Complications. 2014;28:621-6.
Goswami R, Bal CS, Tejaswi S, Punjabi GV, Kapil A, Kochupillai N. Prevalence of urinary tract infection and renal scars in patients with diabetes mellitus. Diab Res Clin Pract. 2001;53:181-6.
Mandal J, Acharya SN, Buddhapriya D, Parija SC. Antibiotic resistance pattern among common bacterial uropathogens with a special reference to ciprofloxacin resistant Escherichia coli. Indian J Med Res. 2012;136:842.