Asymptomatic urinary tract infections and associated risk factors in Pakistani Muslim type 2 diabetic patients

Jaffer Bin Baqar,Irshad Ahmed Khosa,Mahwish Raza,Saeed Ahmed Mahar,Umar Yousuf Raja,Mohammad Imtiaz Hasan,Syed Abbas Raza,Amna Riaz,Tahir Ghaffar,Faisal Masood Qureshi,Azizul Hasan Aamir,Jamal Zafar,Ibrar Ahmed,Jahanzeb Khan,Ali Asghar

doi:10.1186/s12879-021-06106-7

Abstract

BackgroundOne of the leading long-term complications of type 2 diabetes mellitus (T2DM) includes renal dysfunction and urinary tract infections (UTI) which are considered to be prevalent in uncontrolled diabetes. Moreover, physiological factors like age, gender, duration of diabetes, other diabetic complications like neuropathy, autonomic neuropathy and glycosuria are also considered as predisposing factors for increased prevalence of UTI in diabetes which can be symptomatic or asymptomatic.MethodsThis was a cross-sectional, multi-centre study including diabetic patients from 12 clinical sites spread across major cities of Pakistan. The inclusion criteria were adult Pakistani population of age between 18 to 75 years both genders and suffering from T2DM irrespective of duration. A detailed clinical history of the past 3 months was recorded and, biochemical investigations of blood samples were conducted. Urine culture analysis performed identified the type of pathogen present and was done only for asymptomatic patients.ResultsA total of 745 type 2 diabetic patients were initially screened, out of 545 patients considered for final analysis 501 (91.92%) were negative and the rest 44 (8.08%) had positive urine culture. Female gender had a significantly higher proportion of positive urine culture (77.27%, p-value< 0.001). Body mass index and mean age had insignificant distribution among the two groups of positive and negative urine culture, with age 40–59 years having higher proportion (70.45%) in the positive group. Escherichia coli was detected in most of the positive samples (52.3%). All bacterial samples were found resistant to Ciprofloxacin.ConclusionDiabetic Pakistani muslim female patients are identified to be at high risk of suffering from asymptomatic UTI and age more than 40 years is an important risk factor. Escherichia coli was the most common causative organism among people living in this geographical area.

Highlights

One of the leading long-term complications of type 2 diabetes mellitus (T2DM) includes renal dysfunction and urinary tract infections (UTI) which are considered to be prevalent in uncontrolled diabetes
Physiological factors like age, gender, duration of diabetes, long term use of antidiabetic drugs, other diabetic complications like neuropathy, glycosuria are considered as predisposing factors for increased prevalence of UTI in diabetics
Along with urine culture biochemical investigations of blood samples were conducted at designated laboratories for the estimation of glycosylated haemoglobin (HbA1c) levels, serum ketones, liver function tests including Alanine aminotransferase (ALT), Alkaline phosphatase (ALP), Aspartate aminotransferase (AST) and estimated glomerular filtration rate

Summary

Introduction

One of the leading long-term complications of type 2 diabetes mellitus (T2DM) includes renal dysfunction and urinary tract infections (UTI) which are considered to be prevalent in uncontrolled diabetes. Physiological factors like age, gender, duration of diabetes, other diabetic complications like neuropathy, autonomic neuropathy and glycosuria are considered as predisposing factors for increased prevalence of UTI in diabetes which can be symptomatic or asymptomatic. High glucose concentration in urine promotes urinary colonization of microorganisms, and the patient becomes more prone to microvascular disease of the kidneys This has become a major concern as many studies have reported a high prevalence of UTI in T2DM patients [6]. Physiological factors like age, gender, duration of diabetes, long term use of antidiabetic drugs, other diabetic complications like neuropathy, glycosuria are considered as predisposing factors for increased prevalence of UTI in diabetics. UTI can be symptomatic or asymptomatic in patients with diabetes and encompasses asymptomatic bacteriuria (ABU), urethritis, cystitis, prostatitis and pyelonephritis [8]

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Conclusion