Prevalence of Bacterial Urinary Tract Infection and Antimicrobial Susceptibility Patterns Among Diabetes Mellitus Patients Attending Zewditu Memorial Hospital, Addis Ababa, Ethiopia

Abstract

Background Urinary tract infection (UTI) is caused by colonization and growth of microorganisms within the urinary system. Diabetic patients are more prone to bacterial UTI due to impaired host defense and high glucose concentration in urine. Surveillance of uropathogens and their antibiogram is a key to patient management. Methods A hospital-based cross-sectional study was conducted from May to July, 2018. Urine samples were collected for culture and identification based on the standard protocol. An antimicrobial susceptibility test (AST) was done for all isolates using the Kirby–Bauer disk diffusion method. Data were entered into Epi-data version 3.2.1 and exported to the Statistical Package for the Social Science (SPSS) version 20. Results Out of 225 participants, significant bacteriuria was reported in 9.8% of the cultures. Five species of bacteria were isolated and E. coli (63.6%) was the leading uropathogen, followed by K. pneumoniae (13.6%). Duration of diabetes, previous history of UTIs and symptomatic UTI were found to be strongly associated with significant bacteriuria. Gram-negative bacterial isolates showed high sensitivity to nitrofurantoin and meropenem (100%). In contrast, a high level of resistance to ampicillin, doxycycline and cefuroxime (100%) and to amoxicillin-clavulanate (94.4%) was observed. Gram-positive bacteria showed high level of resistance to penicillin (100%). Multiple-drug resistance (MDR) was high for Gram-negative bacteria (100%). Conclusion Previous history of UTIs and duration of diabetes were found to be important factors that increase the prevalence of UTI among diabetes patients. This study also showed a high prevalence of drug resistance to doxycycline, amoxicillin-clavulanate, cefuroxime and penicillin for both Gram-negative and Gram-positive bacteria. Since therapeutic selection for empirical treatment and management should be based on knowledge of the local bacterial profile and antimicrobial response, we suggest physicians take this high resistance profile in to consideration when prescribing antimicrobials against the pathogens in question.

Urinary tract infection in diabetics hospitalized in Befelatanana Hospital, Antananarivo: Epidemiological, clinical, biological profiles and risk factors for multidrug‐resistant bacterial infection

“…The frequency of MDR identified in our study (21.31%) was comparable to that reported by Hamdan et al 6 in Sudan (28.2%) but was much lower than that reported by Yenehun Worku et al 14 in Ethiopia (100%). The variations in MDR frequencies found in these different studies could be explained in part by the difference of the inclusion criteria.…”

“…Among the GPC, Staphylococcus aureus was predominant (8.77%). These main bacterial uropathogens were also found by other authors such as Zubair et al 28 in Pakistan (71% for Escherichia coli , 7.48% for Klebsiella pneumoniae and 9.35% for Staphylococcus aureus ) and Yenehun Worku et al 14 in Ethiopia (63.6% for Escherichia coli and 13.7% for Klebsiella pneumoniae ).The predominance of Enterobacteriaceae, especially Escherichia coli , is not surprising since itis the most frequent flora of the gastrointestinal tract from where it ascends to the urinary tract and uses its well‐characterized virulence factors to colonize the urinary tract 29,30 …”

“…The prevalence of UTI found in this study (4.64%) was similar to that reported by Norafika et al in Indonesia (3.93%) 13 but differed from those reported by other authors including Yenehun Worku et al in Ethiopia (9.8%) 14 and Raherison et al in Madagascar (18.52%) 4 . The variability of the frequency of UTI reported in diabetics can be likely explained by the difference in the study methodologies used.…”

“…Yenehun Worku et al, the study was carried out on all diabetic patients followed up at the Zewditu Memorial Hospital in Addis Ababa, whether they were symptomatic or not. 14 For Raherison et al, although the study was performed at the same site as ours, the frequency of UTI found was higher than ours since their diagnosis of UTI was based mainly on clinical criteria and the presence of leukocyturia and nitrite on urine test strip examination. 4 The average age of our patients (59.06 years) was similar to that of Affes et al (57 years).…”

Pattern of uropathogens and antibiotic sensitivity in diabetes patients attending to out – Patient department and diabetes clinic of a teaching hospital

“…But the resistant pattern revealed in this study was comparable to study in Ethiopia. [ 20 ] High resistance to fluoroquinolones and ampicillin observed in our study was probably due to erroneous use in empirical treatment in our country. Easy availability and indiscriminate use of commonly prescribed antibiotic such as cotrimoxazole, ciprofloxacin, levofloxacin, and ampicillin may explain the observed resistance.…”