Urinary Tract Infections In Type Research Articles

Estimation of Risk Associated with ADR of Drugs that Cause Urinary Tract Infection in Type 2 DM Patients: A Retrospective Case Control Study

Estimation of Risk Associated with ADR of Drugs that Cause Urinary Tract Infection in Type 2 DM Patients: A Retrospective Case Control Study

A personalized prediction model for urinary tract infections in type 2 diabetes mellitus using machine learning.

Patients with type 2 diabetes mellitus (T2DM) are at higher risk for urinary tract infections (UTIs), which greatly impacts their quality of life. Developing a risk prediction model to identify high-risk patients for UTIs in those with T2DM and assisting clinical decision-making can help reduce the incidence of UTIs in T2DM patients. To construct the predictive model, potential relevant variables were first selected from the reference literature, and then data was extracted from the Hospital Information System (HIS) of the Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital for analysis. The data set was split into a training set and a test set in an 8:2 ratio. To handle the data and establish risk warning models, four imputation methods, four balancing methods, three feature screening methods, and eighteen machine learning algorithms were employed. A 10-fold cross-validation technique was applied to internally validate the training set, while the bootstrap method was used for external validation in the test set. The area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA) were used to evaluate the performance of the models. The contributions of features were interpreted using the SHapley Additive ExPlanation (SHAP) approach. And a web-based prediction platform for UTIs in T2DM was constructed by Flask framework. Finally, 106 variables were identified for analysis from a total of 119 literature sources, and 1340 patients were included in the study. After comprehensive data preprocessing, a total of 48 datasets were generated, and 864 risk warning models were constructed based on various balancing methods, feature selection techniques, and a range of machine learning algorithms. The receiver operating characteristic (ROC) curves were used to assess the performances of these models, and the best model achieved an impressive AUC of 0.9789 upon external validation. Notably, the most critical factors contributing to UTIs in T2DM patients were found to be UTIs-related inflammatory markers, medication use, mainly SGLT2 inhibitors, severity of comorbidities, blood routine indicators, as well as other factors such as length of hospital stay and estimated glomerular filtration rate (eGFR). Furthermore, the SHAP method was utilized to interpret the contribution of each feature to the model. And based on the optimal predictive model a user-friendly prediction platform for UTIs in T2DM was built to assist clinicians in making clinical decisions. The machine learning model-based prediction system developed in this study exhibited favorable predictive ability and promising clinical utility. The web-based prediction platform, combined with the professional judgment of clinicians, can assist to make better clinical decisions.

Association of SGLT-2 inhibitors with bacterial urinary tract infection in type 2 diabetes

ObjectiveWe aimed to investigate the factors associated with UTI in patients with T2D whether being treated with SGLT-2i or not.MethodsAdult patients with T2D, whose urine culture results were available, were analyzed retrospectively. Urine culture was obtained from mid-flow urine. Antibacterial treatment was given to the patients with UTI, which was defined by positive urine cultures and/or clinical findings. We grouped the patients as follows: Group A, those treated with SGLT-2i; and Group B, those not treated with SGLT-2i.ResultsA total of 101 patients were included. Median age was 56 (45–67), 56.4% (n = 57) of the patients were female. Urine culture was positive in 54.9% (n = 28) and 16% (n = 8) of Group A (n = 51) and Group B (n = 50), respectively. Of those for whom urine culture was positive, Escherichia coli was isolated in 83.3% (n = 30), and both Escherichia coli and Klebsiella pneumoniae (K.pneumoniae) were isolated in 16.7% (n = 6). Klebsiella pneumoniae was isolated only from Group A. The need for and duration of hospitalization were higher in Group A (p < 0.001). UTI was detected in 60 patients. ROC analysis showed that a HbA1c of > 5.8% was associated with UTI with good accuracy (AUC: 0.835, p < 0.001). In multiple logistic regression analysis, SGLT-2i use and glucosuria were positive predictors for UTI (p = 0.004, Odds Ratio: 1984.013; and p = 0.028, and Odds Ratio: 12.480, respectively).ConclusionBesides the association of HbA1c and BMI with UTI, SGLT-2i use and glucosuria predicted UTI. Urine culture is important with respect to the choice of antibacterial treatment, especially in those patients under SGLT-2i treatment. The effect of SGLT-2i on the development of UTI is independent of baseline BMI score or HbA1c.

Occurence of urinary tract infections in type 2 diabetes mellitus patients taking sodium-glucose co-transporter-2 (SGLT-2) inhibitors to regulate their blood sugar levels

Occurence of urinary tract infections in type 2 diabetes mellitus patients taking sodium-glucose co-transporter-2 (SGLT-2) inhibitors to regulate their blood sugar levels

Occurence of urinary tract infections in type 2 diabetes mellitus patients taking Sodium-Glucose Co-Transporter-2 (SGLT-2) inhibitors to regulate their blood sugar levels

Background and Aim: The occurrence of urinary tract infection (UTI) in type 2 diabetes (T2DM) administered with sodium glucose co-transporter-2 (SGLT2) inhibitors are still debatable. The present study aimed to assess the occurrence of UTI in T2DM patients taking SGLT-2 inhibitors to regulate their blood sugar levels. Patients and Methods: This cross-sectional study was carried out on 369 T2DM patients investigated in the Nephrology division of Khyber Teaching Hospital, Peshawar from January 2022 to December 2022. Dapagliflozin and empagliflozin were SGLT-2 inhibitors drugs given to each individual. Patient’s detailed history and genitourinary infections were noted from medical records. Pain during micturition, micturition urgency, redness, abdominal pain, vomiting, and frequency of micturition, fever, soreness, and diarrhea were recorded using questionnaire based proforma. Results: Of the total 369 patients, the frequency of patients administered with dapagliflozin and empagliflozin was 178 (48.2%) and 191 (51.8%) respectively. Among 178 patients, there were 112 (62.9%) male and 66 (37.1%) females. Among 191 patients, there were 136 (71.2%) male and 55 (28.8%) females. The occurrence of UTIs in patients using dapagliflozin and empagliflozin was 18 (10.1%) and 28 (14.7%) respectively.

Effect of Glycemic Control on Urinary Tract Infections in Type 2 Diabetic Mellitus

Effect of Glycemic Control on Urinary Tract Infections in Type 2 Diabetic Mellitus

Effect of Berberine Supplement in Iraqi Sample of Type 2 Diabetic Patients with Recurrent Urinary Tract Infections

In recent years, in vitro and in vivo research has shown that the Chinese traditional herb berberine, commonly used to treat bacterial diarrhea, decreases blood glucose levels. Berberine’s efficacy and safety in treating patients with recurrent urinary tract infections (UTIs) in type 2 diabetes were assessed in this randomized, single-blind controlled study. Metformin was given to 60 persons with documented type 2 diabetes and UTIs for 12 weeks. According to the study, group A (Control group) received metformin (0.5 g t.i.d.) and group B received a mixture of berberine (0.5 g b.i.d.) and metformin (0.5 g t.i.d.) with a 24 weeks follow-up period. After 12 weeks of treatment, the medicinal plant berberine reduces the recurrence of UTIs in patients with type 2 diabetes mellitus (T2DM) by significantly lowering pyuria (WBCs/HPF), bacteriuria (&gt;105 CFU/mL), and hematuria (RBCs/HPF) in patients compared to pre-treatment values and the control group. Fasting plasma glucose levels in both groups decreased significantly after 12 weeks of treatment for type 2 diabetes, relative to pre-treatment values and between groups. The berberine group saw a statistically significant decrease in urea, but not in creatinine or uric acid. In conclusion, this randomized study indicates that using berberine supplements to treat, prevent, and reduce recurring urinary tract infections in type 2 diabetes.

The prevalence of urinary tract infections in type 2 diabetic patients: a systematic review and meta-analysis

BackgroundUrinary tract infection is the most common infection in type 2 diabetic patients. Various studies have reported different outbreaks of urinary tract infections in type 2 diabetic patients. Therefore, the present study aimed to determine the prevalence of urinary tract infections in type 2 diabetic patients during a systematic review and meta-analysis in order to develop interventions to reduce the incidence of urinary tract infections in type 2 diabetic patients.MethodsIn this study, systematic review and meta-analysis of study data related to the prevalence of urinary tract infection in type 2 diabetic patients were conducted using keywords including type 2 diabetes, urinary tract infection, diabetes, prevalence, meta-analysis and their English equivalents in SID, MagIran, IranMedex, IranDoc, Google Scholar, Cochrane, Embase, Science Direct, Scopus, PubMed and Web of Science (WoS) databases from 1993 to 2020. In order to perform the analysis of qualified studies, the model of random-effects was used, and the inconsistency of studies with the I2 index was investigated. Data analysis was performed with Comprehensive Meta-Analysis (Version 2).ResultsBased on a total of 15 studies with a sample size of 827,948 in meta-analysis, the overall prevalence of urinary tract infection in patients with type 2 diabetes was 11.5% (95% confidence interval: 7.8–16.7%). The prevalence of urinary tract infections in diabetic Iranian patients increased with increasing number of years of research, (p < 0.05), and with increasing age of participants (p < 0.05), but however the prevalence decreased with increasing sample size (p < 0.05).ConclusionThis study shows that urinary tract infections are highly prevalent in patients with type 2 diabetes. Therefore, due to the growing prevalence of diabetes and its complications such as urinary tract infections, the need for appropriate screening programs and health care policies is becoming more apparent.

Frequency of Urinary Tract Infections in Type 2 Diabetic Patients Taking Dapagliflozin.

BackgroundUrinary tract infections (UTIs) are common in patients with diabetes. The use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) to achieve good glycemic control increases glucose levels in urine. This glycosuria further enhances the risk of UTIs. This study aimed to evaluate the frequency of UTIs in patients with type 2 diabetes receiving the SGLT2i dapagliflozin as an add-on therapy.MethodsWe conducted this cross-sectional study at the Endocrinology Department of Hayatabad Medical Complex in Peshawar from April 2020 to September 2020. A total of 400 patients with diabetes receiving either 5 mg or 10 mg of dapagliflozin as an add-on therapy for the treatment of type 2 diabetes were included in this study. We collected blood and urine samples from participants and measured glycosylated hemoglobin levels. Urine samples were cultured on cysteine lactose electrolyte deficient agar. We used IBM SPSS Statistics for Windows, version 25.0 (IBM Corp., Armonk, NY) to analyze our data.ResultsThe prevalence of UTIs in diabetic patients receiving 5 mg or 10 mg of dapagliflozin was 5.3%. Women were more affected (76.2%) than men (p < 0.05). UTIs were more prevalent in patients older than 50 years (85.7%) than in any other age group. The dose strength of dapagliflozin was not associated with UTIs (p > 0.05).ConclusionThis study examined UTIs in patients taking dapagliflozin for the treatment of type 2 diabetes. These infections were mild to moderate and were treated easily. None of these infections caused the patient to discontinue the treatment. Dapagliflozin is well-tolerated in patients with diabetes but should be used with appropriate caution and monitoring.

Clinico-bacteriological Profile of Urinary Tract Infection in Selected Patients of Type 2 Diabetes Mellitus in a Tertiary Care Hospital, Eastern India: An Observational Study

Background: The incidence of diabetes mellitus (DM) throughout the world is increasing strikingly and is becoming a serious public health problem especially in the developing countries. Infections are important cause of death in diabetes and remain a very important cause of morbidity and mortality in people with diabetes. Most common type of diabetes in Indian population is type 2 DM. Most common infection associated with DM found to be urinary tract infections (UTI). Objective: The main objectives of this study were to isolate, identify and to determine antimicrobial susceptibility pattern of microbiological agents of UTI in type 2 DM patients and assess prognosis of these patients with prescribed antimicrobial treatment regimen. Results and Discussions: We conducted the study from December 2013 to December 2018 in the department of microbiology from the patients attending the outpatients department of a tertiary care hospital. In this study, total 774 non-repetitive patients’ samples were included but 14 samples were contaminated and lost from follow-up. Thus, available data for analysis were 760 samples. Total 254 samples showed significant growth (32.82%). Most common isolated pathogen was Escherichia coli. In our study, 17.82% patients were asymptomatic but culture positive. The asymptomatic patients with positive urine culture turn up with symptomatic UTI, often with complications. Conclusion: UTI with multidrug-resistant organism in outpatients has emerged; limiting the treatment options in the high-risk groups. The need for an antibiotic policy based on adequate and continuous monitoring of susceptibility patterns in the institutions is recommended.

Recurrent and Complicated Urinary Tract Infection in Type 2 Diabetes

Urinary tract infection (UTI) is a common infection in patients with type 2 diabetes (T2DM). We present a case series of recurrent and complicated UTI requiring hospitalization in people with T2DM. Recurrence of UTI, especially when severe or complicated, causes multiple renal and extra renal complications and even death if not intervened early. Recurrent UTI is often caused by resistant pathogens in people with long duration of diabetes and uncontrolled glucose levels. In recurrent and complicated/severe UTI, empirical broad-spectrum antimicrobial therapy and early urological intervention will help early recovery and helps to prevent complications.

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English

Blood Neutrophil-to-Lymphocyte Ratio and Urine IL-8 Levels Predict the Type of Bacterial Urinary Tract Infection in Type 2 Diabetes Mellitus Patients.

BackgroundExtended-spectrum ß-lactamase (ESBL)-producing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) are the most common uropathogens causing UTI (urinary tract infection) in type 2 diabetes mellitus (T2DM). Circulatory inflammatory markers such as C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) are usually dysregulated during UTI. However, the differential regulation of these inflammatory signatures during E. coli and K. pneumoniae UTI in T2DM has not been determined.MethodsA case–control study on 466 patients was performed to investigate the inflammatory signatures indicative of ESBL-E. coli and K. pneumoniae UTIs in T2DM. Serum CRP levels and blood NLR for these patients were determined and associated with E. coli and K. pneumoniae ESBL uropathogen using multivariate logistic regression analysis. Urinary interleukin 8 (IL-8) levels were also assessed and associated with these two UTI uropathogens in T2DM. The association of the two ESBL-uropathogens with the survival outcomes of T2DM patients was also analyzed using Cox-proportional hazard model.ResultsT2DM patients with ESBL-E. coli UTI had lower serum CRP levels (median, CRP mg/dL 33.7 vs 39.8, respectively; P=0.023) and higher blood NLR (median, NLR 3.2 vs 2.6, respectively; P=0.010) compared to those with K. pneumoniae UTIs (P<0.001). Moreover, in T2DM, the urinary IL-8 levels was higher in ESBL-E. coli compared to those with K. pneumoniae UTIs (P<0.0001). After adjusting for confounders, including age, gender, serum albumin, hemoglobulin, leukocytes, and platelet counts, T2DM patients with blood NLR ≥ 3.5 were at higher risk for ESBL-E. coli UTIs than ESBL-K. pneumoniae UTIs (odds ratio [OR], 3.61, 95% confidence interval, Cl, 1.49–8.73; P=0.004). Moreover, T2DM patients with ESBL-E. coli UTIs had higher all-cause mortality (hazard ratio [HR], 4.09; 95%, 1.14–14.59) than those with K. pneumoniae UTIs.ConclusionSerum CRP levels, blood NLR, and IL-8 urinary levels differentiate ESBL-E. coli from K. pneumoniae UTIs in T2DM.

Características sociodemográficas y clínicas y antecedentes patológicos asociados a infección del tracto urinario en diabéticos

Objetivo. Determinar qué características sociodemográficas y clínicas y antecedentes patológicos constituyen un mayor riesgo para tener infección del tracto urinario (ITU), según el estudio de casos/controles, en población diabética tipo 2. Material y MétOdOs. Estudio comparativo, transversal, retrospectivo y explicativo realizado en el servicio de medicina interna del Hospital Loayza el año 2016. Se revisaron historias de 163 pacientes diabéticos con ITU y 163 diabéticos sin ITU. Se aplicó ji cuadrado inicialmente y luego regresión logística con estadístico de Wald para análisis multivariado. resultadOs. Las características sociodemográficas no tuvieron relación estadística con la ocurrencia de ITU (p &gt; 0,05). El tiempo de enfermedad ≥ 10 años (OR = 3,978 (IC95% 1,467-10,790); p = 0,007), la insuficiencia renal crónica (OR = 8,412 (IC95% 1,832-38,615), p = 0,006), la litiasis renal (OR = 10,604 (IC95% 2,144-52,459), p = 0,004), la vejiga neurogénica (OR = 12,290 (IC95% 1,447-104,386), p = 0,022), el uso de corticoides (OR = 17,850 (IC95% 3,789-84,087), p = 0,000), la ITU previa (OR = 27,757 (IC95% 9,280-83,027), p = 0,000) y la infección vaginal o la patología prostática (OR=4,958 (IC95% 2,149-11,439), p = 0,000) estuvieron asociados de forma independiente con la ocurrencia de ITU. COnClusión. Las características sociodemográficas no tienen relación estadística con ITU. Un tiempo de enfermedad de 10 años o más, la insuficiencia renal crónica, litiasis renal, vejiga neurogénica, uso de corticoides, ITU previa e infección vaginal o patología prostática están asociadas estadísticamente con la ocurrencia de ITU en la población de diabéticos tipo 2.

Use of sodium-glucose cotransporter-2 inhibitors and urinary tract infections in type 2 diabetes patients: a systematic review.

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are drugs that act by maintaining glycosuria. Recent studies have shown promising effects of these in the treatment of type 2 diabetes mellitus (DM2). However, there may be an increased risk of developing urinary tract infections (UTIs) in patients treated with these. Our study aims to analyze the association between the risk of UTI in patients treated with SGLT2i. A systematic review of the literature was carried out by randomized clinical trials, totalizing at the end of the selection 23 articles that were statistically evaluated. The incidence of UTI was generally demonstrated in articles and in different subgroups: patients on SGLT2i monotherapy or on combination therapy; according to specific comorbidities of each sample or according to the drug used. They noticed an increase in the chance of UTI in the SGLT2i groups compared to the control groups on placebo or other oral antidiabetic agents. This increased chance was found predominantly with the use of Dapagliflozin, Canagliflozin, and Tofogliflozin, regardless of the dosing. Lastly, stands out that the dimension of UTI chances for DM2 patients who use SGLT2i remains to be more strictly determined.

Bacterial causes of community-acquired and nosocomial urinary tract infection in type 2 diabetes: A comparative approach

Introduction: Urinary tract infection (UTI) in type 2 diabetes (T2D) is one of the most common infectious diseases diagnosed both in community and in hospital. Due to increased prevalence of disease and rising antibiotic resistance among uropathogens, it is important to have local community- and hospital-based knowledge of the organisms causing UTI in T2D and their sensitivity pattern to choose correct treatment regimen. Methodology: Samples were collected from both Outpatient Department (OPD) and Inpatient Department (IPD) of endocrinology, KIMS. The study was selected to compare the prevalence among the bacterial isolates from community-acquired UTI (CUTI) and nosocomial UTI (NUTI) in T2D individuals and compare the antibiogram pattern. Results: Of the total 92 culture-positive samples, 40 were CUTI and 52 were NUTI. Culture positivity was directly proportional to the presence of increased number of pus cell and glycaemic status. The most commonly isolated bacterium was Escherichia coli both in OPD and IPD followed by Enterococcus, Staphylococcus saprophyticus, Staphylococcus aureus, Klebsiella spp., Pseudomonas aeruginosa and Proteus species except the Citrobacter spp. and Candida spp. which were isolated from ward patients. Conclusion: There was no significant difference of resistance pattern between CUTI and NUTI. Inappropriate use of antibiotics results in increase of antibiotic resistance, and hence, proper care should be taken regarding infection treatment guidelines promoting rational antibiotic prescribing in hyperglycaemic UTI cases.

Testing an association between TLR4 and CXCR1 gene polymorphisms with susceptibility to urinary tract infection in type 2 diabetes in north Indian population

BackgroundGenetic variations of Toll like receptor 4 (TLR4) and CXC-chemokine receptor type1 (CXCR1), the key elements of innate immune system and their association with urinary tract infection (UTI) were studied in general population. In present study we investigate genetic variation of these genes in diabetic patients (3 to 4 times higher prevalence of UTI in comparison to general population). MethodsA total 1100 subjects (318 diabetic patients with UTI, 324 diabetic patients without UTI, 200 non-diabetic UTI patients and 260 age matched healthy control) were enrolled in the study. SNPs of TLR4 rs4986790, rs4986791 and CXCR1 rs2234671 was assessed by PCR-RFLP and PCR-SSP respectively. ResultsStatistical analysis revealed that A/G genotype and G allele of TLR4 rs4986790 are significantly associated with UTI in both diabetics and nondiabetic patients in comparison to healthy control. Similarly CT genotype and T allele of TLR4 rs4986791 are also significantly associated with UTI in both groups. We also found that prevalence of A/G genotype of TLR4 rs4986790 and CT genotype of TLR4 rs4986791 are significantly higher in patients of diabetes with UTI in comparison to diabetic patients without UTI. We did not find any association of CXCR1 rs2234671 polymorphism with UTI by comparing with any group. ConclusionWe found that TLR4 rs4986790 and rs4986791 gene polymorphism is a risk for UTI development in both diabetic and nondiabetic patients in north Indian population.

Clinical and Laboratory Profile of Urinary Tract Infections in Type 2 Diabetics Aged over 60 Years.

Urinary tract infections are frequently encountered among diabetic patients and the incidence rate increases with age. There have been growing research to identify the clinical profile of urinary tract infections in diabetic patients. However, such studies on elderly patients are rare. To determine the risk factors, clinical/laboratory profiles, causative organisms and antimicrobial susceptibilities in type 2 diabetics aged over 60 years. This prospective single centre study was conducted at NRI Medical College and General Hospital, Guntur, India, between November 2012 and November 2014. A total of 100 consecutive patients with type 2 diabetes mellitus, aged over 60 years, with symptoms suggestive of urinary tract infection were examined. Subsequently, the demographic characteristics, detailed medical history, signs/symptoms of urinary tract infections, laboratory investigations for blood and urine samples, ultrasound abdomen findings were compared between bacteriuric and non bacteriuric patients. In addition, the organisms in urine cultures and antibiotic sensitivity patterns were investigated for bacteriuric patients. Two groups were compared using the Mann-Whitney test for continuous variables and the Chi-square or the Fisher's exact test for categorical respectively. Bacteriuria was found in 43% of type 2 diabetic patients aged over 60 years. Comparative analysis revealed that bacteriuria was more common among patients with female gender (p=0.028), diabetes duration of >15 years (p=0.011) and diabetes complications such as neuropathy (p=0.027) and diabetic foot (p=0.003). Age and uncontrolled fasting blood sugar or HbA1c levels did show an increased propensity for developing urinary tract infections. Increased frequency (76.7%), and urgency (67.4%), dysuria (65.1%) were significantly more common among bacteriuric patients than that in nonbacteriuric patients (p<0.05). Urine culture analysis revealed that E. coli (69.8%) was the most common causative organism, followed by Klebsiella (16.3%). Majority of isolated organisms were sensitive to antimicrobial agents like nitrofurantoin and imipenem. Bacteriuria was very common in elderly patients with diabetes. The observed trends in risk factors, clinical profile, laboratory profile, causative organism patterns, and antimicrobial susceptibilities will help to add the growing literature on this topic.

Healthcare Burden and Costs Associated with Urinary Tract Infections in Type 2 Diabetes Mellitus Patients: An Analysis Based on a Large Sample of 456,586 German Patients

Objectives: We examined the real-world treatment of urinary tract infections (UTIs) in a type 2 diabetes mellitus (T2DM) population, evaluated UTI-related healthcare resource use and direct treatment costs, and assessed factors that may predict UTI-related costs. Methods: We analyzed an anonymized dataset from a regional German healthcare fund (2010-2012). UTI-associated resource use was described by the number of UTI-associated outpatient visits, the number and length of UTI-related acute hospital visits, and the number of UTI-related antibiotics prescriptions. UTI-related direct treatment costs were studied both based on these resource use numbers and, additionally, based on a comparison of all-cause annual healthcare costs of T2DM-patients who were or were not affected by a UTI. To identify factors that might predict direct treatment costs related to UTI treatment, we conducted generalized linear regression model analyses (based on gamma distribution) using sociodemographic and clinical characteristics of observed patients as available in the database as independent variables. Results: A total of 456,586 T2DM-patients were included with a mean age of 73.8, a percentage of 56.3 female patients, and a mean Charlson comorbidity index of 7.3. In our database, we observed 48,337 UTI events. The direct mean resource-based costs were €315.90 per UTI event. Older age, higher comorbidity status, at least one previous non-UTI infection, and poorer renal function were associated with higher costs, while female gender and at least one previous UTI event were associated with lower costs. In the all-cause cost analysis, healthcare costs per patient year were €3,916 higher in the UTI group than in the non-UTI group. Conclusion: Our study confirms that UTI is a common complication in patients with T2DM. Patients with T2DM who have had previous infections, who are older, and who are male, as well as patients who have more comorbidities or severe renal insufficiency, face above-average UTI treatment costs. These patient groups, therefore, should receive special attention in the real-world treatment of T2DM, which should include a regular screening of UTI risk.

Epidemiology of urinary tract infections in type 2 diabetes mellitus patients: An analysis based on a large sample of 456,586 German T2DM patients

IntroductionThis analysis was conducted to investigate urinary tract infection (UTI) incidence among Type 2 Diabetes mellitus (T2DM) patients in Germany in a real-world setting and to identify risk factors associated with UTI incidence/recurrence. MethodsOur cohort study was conducted based on an anonymized dataset from a regional German sickness fund (2010–2012). A UTI event was mainly identified through observed outpatient/inpatient UTI diagnoses. We reported the number of UTI events per 1000 patient-years. Furthermore, the proportion of patients affected by ≥1 and ≥2 UTI events in the observational period was separately reported. Finally, three multivariate Cox regression analyses were conducted to identify factors that may be associated with UTI event risk or recurrent UTI event risk. ResultsA total of 456,586 T2DM-prevalent patients were identified (mean age 72.8years, 56.1% female, mean Charlson Comorbidity Index (CCI) of 7.3). Overall, the UTI event rate was 87.3 events per 1000 patient-years (111.8/55.8 per 1000 patient-years for women/men (p<0.001)). The highest UTI event rates were observed for those aged >89years. After 730days after first observed T2DM diagnosis, the proportion of women/men still UTI-event-free was 80.9%/90.2% (p<0.001). Most important factors associated with UTI risk in our three models were older age (Hazard Ratio (HR)=1.56–1.70 for >79years), female gender (HR=1.38–1.57), UTIs in the previous two years (HR=2.77–5.94), number of comorbidities as measured by the CCI (HR=1.32–1.52 for CCI>6) and at least one cystoscopy in the previous year (HR=2.06–5.48). Furthermore, high HbA1c values in the previous year (HR=1.29–1.4 referring to HbA1c>9.5%) and a poor kidney function (HR=1.11–1.211 referring to glomerular filtration rate (GFR)<60ml/min) increased the UTI event risk. DiscussionOur study confirms that UTI event risk is high in T2DM patients. Older female patients having experienced previous UTIs face an above-average UTI risk, especially if these risk factors are associated with poor glycemic control and poor kidney function.