Epidemiology of urinary tract infections in type 2 diabetes mellitus patients: An analysis based on a large sample of 456,586 German T2DM patients

Wilke, Thomas; Boettger, B.; Berg, Bjorn P.; Groth, Antje; Mueller, Sebastian; Botteman, Marc; Yu, Shan‐Fu; Fuchs, Andreas; Maywald, Ulf

doi:10.1016/j.jdiacomp.2015.08.021

Cited by 56 publications

(51 citation statements)

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“…Damage to the genitourinary system caused by diabetic neuropathy results in bladder dysfunction, and increases the probability of UTI [3]. High levels of urine glucose (UGLU) can favor a proper microenvironment for UTI due to increased bacterial overgrowth [4]. Female patients are known to have higher prevalence of UTI than males [5], which may be associated with the anatomical and structural differences in the urethra between genders.…”

Section: Introductionmentioning

confidence: 99%

“…SUC limitations include: 90% of bacteria cannot be cultured via standard culture media [7], SUC technique favors fast-growing bacteria but cannot consider the fastidious pathogens [8], and SUC techniques are unable to detect the presence of bacteria embedded within biofilms [9]. Fastidious pathogens may not lead to a UTI diagnosis because they are below the 10 5 CFU/mL threshold, but can still cause urinary disorders [4]. …”

Section: Introductionmentioning

confidence: 99%

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Dysbiosis of urinary microbiota is positively correlated with Type 2 diabetes mellitus

et al. 2016

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Type 2 diabetes mellitus (T2DM) may be associated with altered urinary microbiota in female patients. We investigated alterations of urinary microbiota in Chinese female T2DM patients, and explored the associations between urinary microbiota and a patient’s fasting blood glucose (FBG), urine glucose (UGLU), age, menstrual status, and body mass index (BMI). Midstream urine was collected from 70 female T2DM patients and 70 healthy females. Microbial diversity and composition were analyzed using the Illumina MiSeq sequencing platform by targeting the hypervariable V3-V4 regions of the 16S rRNA gene. We found that bacterial diversity was decreased in T2DM patients. Increased Actinobacteria phylum was positively correlated with FBG, UGLU, and BMI; Lactobacillus abundance decreased with age and menopause; and increased Lactobacillus correlated positively with FBG and UGLU. Decreased Akkermansia muciniphila was associated with FBG and UGLU. Escherichia coli abundance did not differ between the two cohorts. Carbohydrate and amino acid metabolism was reduced in T2DM patients, which were associated with bacterial richness indices such as Chao1 and ACE. Detailed microbiota analysis of well-characterized T2DM patients and healthy controls indicate that Chinese T2DM female patients exhibit dysbiosis of urinary microbiota.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dysbiosis of urinary microbiota is positively correlated with Type 2 diabetes mellitus

et al. 2016

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“…(1) The association between diabetes (DM) and infection is well known clinically, (2; 3), and has been linked to a number of causal pathways including impaired immune responses within the hyperglycaemic environment (4), as well as potentially other abnormalities associated with diabetes such as neuropathy and altered lipid metabolism. It has been described in other studies and populations, (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) however not all have consistently controlled for confounding factors such as smoking, which are more common in people with diabetes and associated with infection. (18) Initially, studies mainly considered predominately common infections, (6; 8; 12) with few able to include important but rare infections,(7) such as endocarditis, or considered the whole range of infection outcomes from health service use, (17) to hospitalisation (16) and mortality.…”

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confidence: 99%

Risk of Infection in Type 1 and Type 2 Diabetes Compared With the General Population: A Matched Cohort Study

et al. 2018

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ObjectiveWe describe in detail the burden of infections in adults with diabetes mellitus (DM) within a large national population cohort. We also compare infection rates between Type 1 (T1DM) and Type 2 (T2DM) patients. Research Design and MethodsA retrospective cohort study compared 102,493 English primary care patients aged 40-89 years with a DM diagnosis by 2008 (n=5,863 T1DM, n=96,630 T2DM) to 203,518 age-sex-practice matched controls without DM. Infection rates during 2008-15, compiled from primary care and linked hospital and mortality records, were compared across 19 individual infection categories.These were further summarised as any requiring a prescription, hospitalisation, or as cause of death. Poisson regression was used to estimate incidence rate ratios (IRRs) between: (i) people with diabetes and controls; (ii) T1DM and T2DM adjusted for age, sex, smoking, BMI and deprivation. ResultsCompared to controls without diabetes, DM patients had higher rates for all infections, with the highest IRRs seen for bone and joint infections, sepsis and cellulitis. IRRs for infectionrelated hospitalisations were 3.71 (95%CI 3.27-4.21) for T1DM and 1.88 (95%CI 1.83-1.92) for T2DM. A direct comparison of types confirmed higher adjusted risks for T1DM vs. T2DM(death from infection IRR = 2.19, 95%CI 1.75-2.74). We estimate 6% of infection-related hospitalisations and 12% of infection-related deaths were attributable to DM. Conclusions 3People with diabetes, particularly T1DM, are at increased risk of serious infection representing an important population burden. Strategies that reduce the risk of developing severe infections and poor treatment outcomes are under-researched and should be explored. Words: 2494 Diabetes mellitus (DM) is one of the leading causes of morbidity and mortality across the globe and the burden of disease is projected to increase from 415 to 642 million adults between 2015 and 2040.(1) The association between diabetes (DM) and infection is well known clinically,(2;3), and has been linked to a number of causal pathways including impaired immune responses within the hyperglycaemic environment(4), as well as potentially other abnormalities associated with diabetes such as neuropathy and altered lipid metabolism. It has been described in other studies and populations,(5-17) however not all have consistently controlled for confounding factors such as smoking, which are more common in people with diabetes and associated with infection.(18) Initially, studies mainly considered predominately common infections,(6; 8; 12) with few able to include important but rare infections,(7) such as endocarditis, or considered the whole range of infection outcomes from health service use, (17) to hospitalisation(16) and mortality.(9) Also, few studies have included large numbers of older people, for whom infections may be frequent and more serious.(5) Larger recent studies, primarily from higher income countries using national datasets have overcome some of these limitations,(7-13) but do not always separate...

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“…Globally, about 1 in 11 adults have DM (90% have type 2 diabetes mellitus (T2DM)) (Zheng et al, 2018). Infections were more common prevalent with T2DM than among respondents without diabetes (Carey et al, 2018), especially urinary tract infection (UTI) (Wilke et al, 2015). UTI is of major concern, and many studies have demonstrated an increased prevalence of UTI in T2DM patients (Wilke et al, 2015;Hirji et al, 2012;Nichols et al, 2017), especially in female patients (Hirji et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Peer Review #2 of "Moderation effects of food intake on the relationship between urinary microbiota and urinary interleukin-8 in female type 2 diabetic patients (v0.1)"

Morris¹

2020

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Background. Our previous study demonstrated that the composition of the urinary microbiota in female patients with type 2 diabetes mellitus (T2DM) was correlated with the concentration of urinary interleukin (IL)-8. As the composition of urine is mainly determined by diet, diet might mediate the correlation. Methods. Seventy female T2DM patients and 70 healthy controls (HCs) were recruited. Midstream urine was used for the urine specimens. Urinary IL-8 was determined by enzyme-linked immunosorbent assay. A Chinese Food Frequency Questionnaire was used to collect food intake data. The independent variables in the hierarchical regression analysis were the relative abundances of the bacterial genera and species that were significantly different between the T2DM and HCs and between the T2DM patients with and without detectable urinary IL-8, and the bacterial genera associated with IL-8 concentration in the multiple regression model reported in our previous research. IL-8 concentration was the dependent variable, and nutrient intakes were moderator variables. Results. Fiber and vitamin B3 and E intake exerted enhancing effects, and water intake exerted a buffering effect, on the positive relationship between the relative abundance of Ruminococcus and IL-8 concentration (p < 0.05). Cholesterol and magnesium intake exerted enhancing effects on the positive relationship between the relative abundance of Comamonas and IL-8 concentration (p < 0.05). Conclusion. Modulating T2DM patients' dietary patterns may prevent bladder inflammation.

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Epidemiology of urinary tract infections in type 2 diabetes mellitus patients: An analysis based on a large sample of 456,586 German T2DM patients

Cited by 56 publications

References 29 publications

Dysbiosis of urinary microbiota is positively correlated with Type 2 diabetes mellitus

Dysbiosis of urinary microbiota is positively correlated with Type 2 diabetes mellitus

Risk of Infection in Type 1 and Type 2 Diabetes Compared With the General Population: A Matched Cohort Study

Peer Review #2 of "Moderation effects of food intake on the relationship between urinary microbiota and urinary interleukin-8 in female type 2 diabetic patients (v0.1)"

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