The influence of diabetes mellitus on the spectrum of uropathogens and the antimicrobial resistance in elderly adult patients with urinary tract infection

Abstract

BackgroundThe role of Diabetes mellitus (DM) in the etiology and in the antimicrobial resistance of uropathogens in patients with urinary tract infection has not been well clarified. For this reason we have evaluated the spectrum of uropathogens and the profile of antibiotic resistance in both diabetic and non diabetic patients with asymptomatic urinary tract infection (UTI).MethodsUrinary isolates and their patterns of susceptibility to the antimicrobials were evaluated in 346 diabetics (229 females and 117 males) and 975 non diabetics (679 females and 296 males) who were screened for significant bacteriuria (≥105 CFU/mL urine). The mean age of diabetic and non diabetic patients was respectively 73.7 yrs ± 15 S.D. and 72.7 ± 24 (p = NS).ResultsMost of our patients had asymptomatic UTI. The most frequent causative organisms of bacteriuria in females with and without DM were respectively : E. coli 54.1% vs 58.2% (p = NS), Enterococcus spp 8.3% vs 6.5% (p = NS), Pseudomonas spp 3.9 vs 4.7% (p = NS). The most frequent organisms in diabetic and non diabetic males were respectively E. coli 32.5% vs 31.4% (p = NS), Enterococcus spp 9.4% vs 14.5% (p = NS), Pseudomonas spp 8.5% vs 17.2% (p = <0.02). A similar isolation rate of E. coli, Enterococcus spp and Pseudomonas spp was also observed in patients with indwelling bladder catheter with and without DM. No significant differences in resistance rates to ampicillin, nitrofurantoin, cotrimoxazole and ciprofloxacin of E. coli and Enteroccus spp were observed between diabetic and non diabetic patients.ConclusionIn our series of patients with asymptomatic UTI (mostly hospital acquired), diabetes mellitus per se does not seem to influence the isolation rate of different uropathogens and their susceptibility patterns to antimicrobials.

Diabetes mellitus and Urinary Tract Infection: Spectrum of Uropathogens and their Antibiotic Sensitivity

“…It is stated that UTI is predominantly a disease of the female due to a short urethra and proximity to the anal opening. The majority of the study all over the world has concluded female predominance to UTI over male [8,13]. Our finding of female predominance is not in accordance with the results from a study [14] where male were more infected than female among diabetic patients.…”

“…Pseudomonas sps is another gram negative bacterium that is associated with UTI [8]. Irrespective of the status of diabetes, Staphylococcus sps and Pseudomonas sps were not isolated from UTI patients in our study.…”

“…It has been reported elsewhere that the occurrence of UTI in diabetic patients is more in people with low socioeconomic status and the resistant pattern of antibiotic agents against organisms isolated in diabetic patients were different to the non diabetic patients [7]. However, previous studies also have reported that there was no influence of diabetes in the isolation rate of different uropathogens and their susceptibility patterns to antimicrobials [8].…”

“…A similar study [19] reported 20 % UTI in diabetic patients in their study. However, a study on a large series of diabetic and non diabetic patients from a hospital in Italy, the culture positivity rate was 15% and 14% in diabetic and non diabetic population respectively [8]. This could be due to the differences in the sample size in these different studies.…”

Profile of urinary tract infection in diabetic patients. Data from a general hospital at Jammu and Kashmir, India

“…coli are the most common bacterial pathogens causing UTI in diabetic patients, other organisms being Klebsiella pneumoniae, Proteus mirabilis, Streptococcus and Staphylococcus, etc. [10,11,12,17]. Fungal UTIs especially Candidal occur in hospitalised diabetics with indwelling Foley catheters receiving broad-spectrum antibacterial therapy [13,14].…”