Abstract
Background Diabetic patients are more susceptible to urinary tract infection compared to nondiabetic patients, Escherichia coli being the most common uropathogen causing UTI. Unreasonable and incorrect antibiotic prescription for UTI in these patients may induce the development of antibiotic-resistant urinary pathogens resulting in delayed recovery and longer hospitalization. In addition to these, biofilm forming capacity of the pathogen may worsen the problem. The main aim of this cross-sectional study (conducted from March to September 2015) is to detect the biofilm forming capacity of UTI causing micro-organisms and compare the antibiotic resistance pattern of Escherichia coli, the most common cause of UTI, which will help the physician in choosing the best antibiotic. Method Total of 1,099 clean-catch mid stream urine (CCMSU) was processed by standard microbiological technique; 182 were from the diabetic group and 917 nondiabetic. Following identification, all isolates were subjected to antibiotic susceptibility testing using modified Kirby-Bauer disc diffusion method. In-vitro biofilm forming capacity of the isolates were detected by Microtitre plate method. The data were analyzed using SPSS software 16. Result Urinary tract infection was found to be significantly higher in diabetic patients (42.9%) compared to nondiabetic patients (17.4%) with Escherichia coli as the most common uropathogen in both diabetic and nondiabetic groups. Similarly, UTI was more common in elderly population (29.5%). Imipenem, nitrofurantoin and amikacin were found to be the most effective drug for uropathogenic E. coli in both diabetic and nondiabetic patients, whereas amoxicillin, ciprofloxacin, and cotrimoxazole were least effective. Of the total bacterial isolates, 43.3% showed positive results for in-vitro biofilm production by the Microtitre plate method. A significantly higher resistance rate was observed among biofilm producing E. coli for quinolones, cotrimoxazole, and third generation cephalosporin ceftriaxone. Most of the biofilm producers (79.5%) were found to be MDR (p-value 0.015). ConclusionElderly populations with diabetes are at a higher risk of UTI. Higher biofilm production and resistance to in-use antimicrobial agents in this study render its inefficacy for empirical treatment and point out the importance of biofilm screening to ensure the effective management of infection.
Highlights
Diabetes is a chronic, metabolic disease characterized by increased levels of blood glucose, which on overtime leads to serious damage to heart, kidney blood vessels, nerves, and eyes. e number of people with diabetes has increased from 108 million (1980) to 422 million (2014) worldwide, causing 1.6 million deaths in 2015 [1, 2]
Diabetic patients are more susceptible to infection compared to nondiabetic counterparts, urinary tract infection being the most common bacterial infection encountered in these patients
Total of 1099 urine samples were collected from diabetic patients (182) and nondiabetic patients (917). e mean age of diabetic patient suspecting UTI was 56.5 ± 18.9 and nondiabetic was 41.2 ± 21.2. e incidence of diabetes was higher in older age group i.e., patients over 65 years of age (65,31.6%) compared to other groups (Figure 1)
Summary
Metabolic disease characterized by increased levels of blood glucose, which on overtime leads to serious damage to heart, kidney blood vessels, nerves, and eyes. e number of people with diabetes has increased from 108 million (1980) to 422 million (2014) worldwide, causing 1.6 million deaths in 2015 [1, 2]. Diabetic patients are more susceptible to urinary tract infection compared to nondiabetic patients, Escherichia coli being the most common uropathogen causing UTI. Unreasonable and incorrect antibiotic prescription for UTI in these patients may induce the development of antibiotic-resistant urinary pathogens resulting in delayed recovery and longer hospitalization. E main aim of this cross-sectional study (conducted from March to September 2015) is to detect the bio lm forming capacity of UTI causing micro-organisms and compare the antibiotic resistance pattern of Escherichia coli, the most common cause of UTI, which will help the physician in choosing the best antibiotic. Urinary tract infection was found to be signi cantly higher in diabetic patients (42.9%) compared to nondiabetic patients (17.4%) with Escherichia coli as the most common uropathogen in both diabetic and nondiabetic groups. Higher bio lm production and resistance to in-use antimicrobial agents in this study render its ine cacy for empirical treatment and point out the importance of bio lm screening to ensure the e ective management of infection
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