Symptomatic Urinary tract infection in patients with type 2 diabetes: A prospective study

Abstract

Background: Patients with type 2 diabetes (T2D) are at increased risk of urinary tract infection (UTI). Objective: The aim was to study clinical, etiological profile, complications, and follow-up of symptomatic UTI in T2D patients and the effect on glycemic control and renal parameters. Materials and Methods: This was a hospital-based prospective study done on admitted 200 T2D symptomatic UTI patients. Various clinical, biochemical parameters and urine examination and culture were monitored. All patients were followed for 6 months with respect to the number of UTIs, glycemic control, and renal parameters. Results: UTI was common in females (81%) compared to males (19%). Lower UTI (cystitis) was present in 55.5% and pyelonephritis 44.5%, emphysematous pyelonephritis in 9.5%, and bacteremia in 58.1% of UTI patients. Bacteriuria was present in 69%. Escherichia coli (55%) was the most common organism isolated from urine culture. Severe hyperglycemia was present in 83.5%, diabetic ketoacidosis in 8%, hyperglycemic hyperosmolar state in 13%, shock in 14.5%, and multiorgan dysfunction syndrome in 10.5% of UTI patients. UTI in females was significantly associated with postmenopausal state, longer duration of diabetes, retinopathy, nephropathy, poor glycemic control, acute kidney injury, cystopathy, and upper UTI. The prevalence of recurrent UTI was 39.6%. Recurrent UTI patients had significantly higher glycosylated hemoglobin at follow-up than at baseline, but renal parameters did not improve despite intensive treatment. Conclusion: Symptomatic UTI in T2D patients is common in postmenopausal females with longer duration of diabetes, poor glycemic control, cystopathy, and chronic diabetic complications. Recurrent UTI patients have poor glycemic control on follow-up while renal parameters do not improve.