Uropathogenic Escherichia Coli (UPEC)causing Asymptomatic Bacteriuria(ASB) in patients with type 2 diabetes mellitus - To treat or not to treat

Abstract

There is paucity of Indian data on asymptomatic bacteriuria in patients with Type 2 diabetes mellitus There is controversy regarding treatment of ASB in diabetes especially with reference to the most commonly isolated organism Eschrechia Coli. Objectives of the Study: To determine the frequency of Asymptomatic bacteriuria due to Uropathogenic E. Coli in Type 2 diabetes, to identify risk factors for ASB in Type 2 diabetes and to detect the frequency of resistant and virulent E Coli strain detected by phenotypic methods in ASB in Type 2 diabetes. Methods: Urine samples from 900 diabetic patients were cultured to isolate significant bacteriuria Symptomatic patients, those who received antibiotics in the recent past were excluded. Samples were cultured and characteristics of E .Coli studies for sensitivity pattern, ESBL production and virulence factors such as alpha toxin and biofilm production. Results: Asymptomatic bacteriuria was found in 185 samples (20.4%) of which E Coli was isolated from 116 samples (12.8%). Female gender, perimenopausal status, advancing age and poor glycemic controlar risk factors 43.9 % of the Isolates were multidrug resistant and ESBL producers.80.1% of the strains were lactose fermenters indicating they were pathogens.13.7% of the strains produced alpha toxin and 88.7% of the strains produced biofilm thus protecting themselves. Conlusion: ASB in Type 2 diabetes is common. Nearly half of E Coli isolated from diabetic patients with ASB were multidrug resistant and eradicating them is difficult .They are potential pathogens and can cause invasive infections if host factors and virlence of the organism changes. Guidelines do not support treatment of ASB with antibiotics. Active surveillance for infection and early treatment with appropriate antibiotics, good glycemic control will probably prevent morbidity and mortality in this population.