Microbiological analysis of urinary tract infection in diabetic patients

Sarita Otta, Bichitrananda Swain, Priyadarshini Bhoi


Background: Diabetes mellitus is a predisposing condition to different infections especially the complicated urinary tract infection (UTI). The susceptibility pattern of organisms in diabetics is different from their counterparts. So, there is always a dilemma while administering empirical regimen for UTI in diabetics. The study aims to find the common organisms implicated in the UTI in diabetic patients and their sensitivity pattern.

Methods: Properly collected urine specimen from all the diabetic (cases) and non-diabetic (controls) patients included in this study was processed. Sensitivity pattern and extended spectrum beta lactamase (ESBL) production for the isolated uropathogens was noted.

Results: E. coli was the most common organism isolated from both 68 cases and 85 controls in this study. Most of UTI patients with diabetes, 46 (67.7 %) had uncontrolled blood sugar level. Diabetics are more prone for catheter associated UTI (CAUTI) and fungal UTI. Most of the E coli and Atypical E coli isolated were ESBL positive for the diabetic patients (60.5%) than that for the non-diabetics (40.4%). Antimicrobial resistance pattern was similar in both the groups with maximum patients’ sensitivity to tigecycline, colistin, fosphomycin and least susceptibility to cefixime. Both E. coli and Klebsiella also showed high resistance to the fluoroquinolones.

Conclusions: E. coli is the predominant uropathogen for both the diabetic & non-diabetic cases. But diabetics are more prone to get ESBL positive UTI. CAUTI and the fungal UTI are more common in diabetics. Diabetic condition does not affect the antimicrobial resistance pattern of uropathogens. But their rising resistance to fluoroquinolones, cephalosporins is a matter of concern while prescribing empiric regimen.


CAUTI, Diabetes mellitus, Extended spectrum beta-lactamase positive, Fluoroquinolones, Urinary tract infection

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Hakeem LM, Bhattacharyya DN, Lafong C, Janjua KS, Serhan JT, Campbell IW. Diversity and complexity of urinary tract infection in diabetes mellitus. Br J Diabetes Vasc Dis. 2009;9:119-25.

Mnif MF, Kamoun M, Kacem FH, Bouaziz Z, Charfi N, Mnif F, et al. Complicated urinary tract infections associated with diabetes mellitus: Pathogenesis, diagnosis and management. Ind J Endocrinol Metab. 2013;17:442-5.

Papadimitriou-Olivgeris M, Drougka E, Fligou F, Kolonitsiou F, Liakopoulos A, Dodou V, et al. Risk factors for enterococcal infection and colonization by vancomycin resistant enterococci in critically ill patients. Infection. 2014;42:1013-22.

Yadav K, Prakash S, Serayi RC, Shilpkar T, Shrestha S. Antimicrobial susceptibility test of pathogens isolated from urinary tract infection suspected cases. Jan Medic Col J Medic Sci. 2014;2(1):28-34.

Patterson JE, Andriole VT. Bacterial urinary tract infections in diabetes. Infect Dis Clin North Am. 1997;11(3):735-50.

Geerlings SE. Consequences of asymptomatic bacteriuria in women with diabetes mellitus. Arch Intern Med. 2001;161(11):1421-7.

Colle JG, Duguid JP, Fraser AG, Marmion BP, Simmons A (eds). Laboratory diagnosis of infective syndromes. Mackieand McCartney Practical Medical Microbiology, 14thedn, Churchill-Livingstone Edinburg, 1996;53-64.

CLSI. Performance standards for antimicrobial disc susceptibility tests. 27th edition. CLSI supplement M100, Clinical Laboratory Standards Institute. 2017.

Zhanel GG, Harding GK, Nicolle LE. Asymptomatic bacteriuria in patients with diabetes mellitus. Rev Infect Dis. 1991;13:150-4.

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.

Scholes D, Hooton T, Roberts P, Gupta K, Stapleton A, Stamm W. Risk factors associated with acute pyelonephritis in healthy women. Ann Inter Medic. 2005;142(1):20-7.

Walsh C, Collyns T. The pathophysiology of Urinary tract infections. Surgery. 2017;293-8.

Srinivas M, Chandrashekar UK, Shivashankara KN, Pruthvi BC. Clinical profile of urinary tract infections in diabetics and non-diabetics. Austral Med J. 2014;7(1):29-34.

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

Kiranmala K, Johnson R, Savio J, Idiculla J. Microbiologic profile and clinical practices in urinary tract infections in a tertiary care center in Southern India. J Family Med Prim Care. 2019;8:2888-92.

Saber MH, Barai L, Haq JA, Jilani MSA, Begum J. The pattern of organism causing urinary tract infection in diabetic and non-diabetic patients in Bangladesh. Bangladesh J Med Microbiol. 2010; 4(1):6-8.

Khatib QM. Guidelines for the prevention, management and care of diabetes mellitus WHO Report. EMRO Technical Publications; 2006;32:56.

Mubarak AA, Ashraf AM, El-hag M, Raza MA, Majed A, Al-Sharbatti S et al. Prevalence of urinary tract infections among diabetes mellitus and non-diabetic patients attending a teaching hospital in Ajman, UAE. GMJ, ASM. 2012;1(S1):S228-32.

Madigan MT, Martinko JM, Bender KS, Buckley DH, Stahl DA, Brock T. Brock Biology of Microorganisms. New York, Pearson Education, 2014.

Kalaichelvi S, Daranendaranchellapa. Prevalence of urinary tract infection in type 2 diabetic patients at Government Hospital, Chengalpattu District. Int Arch Integ Medic. 2018;5(5):51-6.

Longdoh NA, Assob JCN, Nsagha SD, Nde PF, Kamgo HLF, Nkume AF, et al. Uropathogens from diabetic patients with asymptomatic bacteriuria and urinary tract infections. West London Med J. 2013; 5(1):7-14.

MacVane SH, Tuttle LO, Nicolau DP. Impact of extended-spectrum β lactamase-producing organisms on clinical and economic outcomes in patients with urinary tract infection, J Hosp Med. 2014;9(4):232-8.

Joshi N, Caputo GM, Weitekamp MR, Karchmer AW. Infections in patients with diabetes mellitus. N Engl J Med. 1999;341(25):1906-12.