Urinary Tract Infections In Diabetics Research Articles

MOST COMMON PATHOGENIC ORGANISMS CAUSING URINARY TRACT INFECTION IN DIABETIC VERSUS NONDIABETIC PATIENTS AND THEIR ANTIBIOTIC SENSITIVITY PATTERNS

Background: To identify the most common pathogen causing urinary tract infection in diabetics versus nondiabetics and their antibiotic susceptibility. Material and Method: This case control study was conducted Combined Military Hospital Mardan, August 2022 - January 2023. Using a stratified sampling technique 90 patients were divided into Group DM and Group NDM with 45 participants in each group. History, demographic characteristics, symptomatology and empirical treatment prescribed was recorded for each patient and midstream urine sample was collected. Urine culture and sensitivity was performed to identify the organisms and antibiotic susceptibility of the causative agent. Recorded variables included the organisms identified and their sensitivity patterns. Results: Gender distribution revealed males were 17(37.8%) versus 12(26.7%) from Group DM and Group NDM with a mean age of the participants was 54.64 ± 9.74 years. Clinical features like history of UTI, history of catheterization, asymptomatic bacteriuria was seen more in diabetics as compared to non-diabetics with a p value of < 0.05. Escherichia Coli was the most common causative organism found in 44 (48.5%) out of 90 patients in both diabetic and non-diabetic patients. Antibiotic susceptibility revealed increased sensitivity of Escherichia Coli to Fosfomycin (88.6%) followed by nitrofurantoin (81.8%) and meropenem (75%). Conclusion: Escherichia coli is the most common isolate causing urinary tract infection in diabetic and non-diabetic patients which shows greatest sensitivity to Fosfomycin, nitrofurantoin and meropenem. Key Words: Antibiotic susceptibility, Culture, Pathogen, Sensitivity.

A study of clinical and laboratory profile of UTI in diabetics in Sir T. Hospital, Bhavnagar — observnational cross-sectional study

Diabetes Mellitus (DM) is a chronic metabolic disorder characterized by hyperglycaemia caused by defects in insulin secretion, action, or both. Immune dysfunction is a major issue in the disease course, and it can manifest as either autoimmune disease or a poor immune response, the latter of which leads to a higher incidence of infections. The link between a higher incidence of urinary tract infections (UTI) and diabetes has been attributed to immune system impairments, poor metabolic control, and incomplete bladder emptying due to autonomic neuropathy. Poor glycaemic control may predispose to more severe UTI and greatly increase the risk of complications in UTI.200 diabetic patients were screened for UTI admitted at Sir T. General Hospital, Bhavnagar over the period of 6 months from 1st November 2021 to 30 the April.2022. The various measures of central tendencies and graphical representations were used to analyse the data.Majority subjects were from age group of 46 – 60 years 74 (37%) followed by 31-45 years 59 (29.5%), > 60 years was 44 (22%) and 18-30 years was 23 (11.5%) respectively. It was found that female patients 103 (51.5%) marginally higher than male 97 (48.5%). The ratio of male: female was 1:1.06. UTI was found to be significantly associated with advanced age and poorly controlled Diabetes.

Systematic Review of Literature Examining Bacterial Urinary Tract Infections in Diabetes.

This systematic review addresses the central research question, “what is known from the published, peer-reviewed literature about the impact of diabetes on the risk of bacterial urinary tract infections (UTI)?” We examine the results from laboratory studies where researchers have successfully adapted mouse models of diabetes to study the pathophysiology of ascending UTI. These studies have identified molecular and cellular effectors shaping immune defenses against infection of the diabetic urinary tract. In addition, we present evidence from clinical studies that in addition to diabetes, female gender, increased age, and diabetes-associated hyperglycemia, glycosuria, and immune impairment are important risk factors which further increase the risk of UTI in diabetic individuals. Clinical studies also show that the uropathogenic genera causing UTI are largely similar between diabetic and nondiabetic individuals, although diabetes significantly increases risk of UTI by drug-resistant uropathogenic bacteria.

Epidemiological, Clinical, Paraclinical and Evolutionary Aspects of Urinary Tract Infection in Diabetics Hospitalized at the Department of Medicine of Abass Ndao Hospital from January 01, 2018, to December 31, 2018

Epidemiological, Clinical, Paraclinical and Evolutionary Aspects of Urinary Tract Infection in Diabetics Hospitalized at the Department of Medicine of Abass Ndao Hospital from January 01, 2018, to December 31, 2018

Bacterial drug-resistance patterns and genetic diversity of bacteria-associated bacteriuria in diabetic patients in Ghana

Our study aimed to determine the etiology of urinary tract infections (UTIs), resistance profiles of isolated bacteria, and virulence factors of Escherichia coli associated with bacteriuria in diabetic patients in Ghana. Midstream urine samples from 982 diabetic patients were tested for uropathogens at the National Diabetes Management and Research Centre in Ghana, using standard bacteriological methods, with antibiogram testing of the isolates using the Kirby-Bauer disk diffusion, as per CLSI guidelines. Polymerase chain reaction (PCR) was used to investigate the phylogenetic groupings and virulence factor (VF) genes of isolated E. coli. The overall prevalence of UTIs was 9.2%, and the main uropathogens were Klebsiella spp. (55.6%) and Escherichia coli (31.3%). Age, duration of diabetes, and a previous history of UTIs were risk factors associated with UTI (p-value < 0.05). High levels of antibacterial resistance to cefuroxime (84%), ampicillin (80%), and gentamicin (70.7%) were observed. The distribution of VFs in each phylogenetic group revealed that sfa-iutA-KpsTMII-KpsTMIII genes were associated with group B2, and iutA-ibe were associated with group D. The isolated uropathogens were highly resistant, and the E. coli isolates possessed varying VFs. Continuous monitoring of bacteria associated with UTI in diabetics is highly recommended.

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

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.

A clinical study of urinary tract infections in diabetics and non-diabetics patients

Background: The main aim of the present study is to investigate the differences in clinical, microbiological, characteristics of Urinary tract infection between diabetic and non-diabetic patients and influence of diabetes on the spectrum of URO pathogens and the antimicrobial resistance in patients with urinary tract infections.Methods: The present study is conducted from February 2018-April 2019 in Narayana general hospital. A total of 181 diabetics and 124 non-diabetics are included. A thorough history examination investigations done. The final data was analysed using statistical package SPSS. The percentages in different categories were compared using chi square test and means were compared using student ‘t’ test.Results: The mean age among diabetic and non-diabetic patients was 60.2+/-13.79 years and 53.47+/-18.56 years. Fever is the most common presenting symptom. BPH was the most common predisposing factor in both diabetes and non-diabetes followed by indwelling catherization but there was no statistically significant difference. Diabetics with UTI majority (87.14%) had glyco HBA1C &gt;6.5% with p&lt;0.001. The prevalence of recurrent UTI is higher in diabetics compared to non-diabetics however difference was not statistically significant. Recurrent UTI is higher in females in both diabetics and non-diabetics. The presence of E coli is significantly higher in diabetics compared to non- diabetics. The antimicrobial resistance pattern was similar in both diabetic and no-diabetic subjects in E coli with maximum sensitivity to meropenem and least to ampicillin and there is no statistically significant difference.Conclusion: The host factors found to be associated with UTI are female sex, presence of diabetes, poor glycemic control, presence of fever. No correlation was noted with age, duration of diabetes and type of treatment for diabetes. An elevated HBA1C correlates with occurrence of UTI. Escherichia coli (E. coli) was the most frequent uropathogen. The resistance of uropathogens to antibiotics are similar in patients with and without diabetes and non-diabetes.

Biochemical and bacteriological profile of urinary tract infections in diabetics and non-diabetics

Introduction: The aim of this study was to investigate if differences exist in the clinical and microbiological characteristics of UTI between diabetic and non-diabetic patients and to study the influence of diabetes mellitus on the spectrum of uropathogens and antimicrobial resistance pattern in patients with UTI.Materials and Methods: The study included 152 diabetic (69 males and 83 females) and 113 non-diabetic patients (46 males and 67 females) with culture positive UTIs. Patients with negative urine culture (n= 42), those diagnosed and treated outside (n= 58), not willing to participate in the study (n= 9) or with an age < 20 years were excluded. The following data including age, sex, occupation and symptomatology were taken and clinical examination was done.Results: There was no significant statistical difference in clinical symptoms between diabetic and non-diabetic subjects calculated by Chi-square test. Although fever was the most common presenting symptom, almost 28% of the patients (both diabetics and non-diabetics) did not present with any urinary symptoms as shown.Conclusion: Achieving an HbA1c < 6.5 per cent appears to protect those diabetics who do not have other underlying predisposing factors for UTI. An HbA1c > 8.0 per cent in patients with diabetes mellitus increases the chance of developing UTI and its recurrence. E. coli is the most frequent pathogen responsible for UTI and recurrent UTI among both diabetics and non-diabetics followed by Klebsiella and Enterococcus.

Urinary Tract Infection in Diabetics - A Five Year Retrospective Study on the Prevalence of Bacterial Isolates and its Antibiotic Susceptibility Patterns in A Tertiary Care Hospital in South India

Urinary Tract Infection in Diabetics - A Five Year Retrospective Study on the Prevalence of Bacterial Isolates and its Antibiotic Susceptibility Patterns in A Tertiary Care Hospital in South India

Urinary Tract Infection in Patients with Diabetes Mellitus

Background: urinary tract infections (UTI) are one of the most common types of bacterial infection in patients with diabetes mellitus (DM). There are certain aspects to diabetes that makes it a risk factor for getting urinary tract infection and additionally, diabetes may also predispose to certain complications. Methodology: in this paper we aim to carry out a systematic review on observational (nonrandomized) studies on PUBMED. Aim: to evaluate the prevalence, pathogenesis, diagnosis, management and complications of UTI in patients with DM. Conclusion: the proper management of UTI in diabetics is crucial, as prompt diagnosis and correct use of antibiotics is vital for treatment. Future research in this regard will hopefully decrease the burden of UTI in diabetic patients.

Impaired cytokine expression, neutrophil infiltration and bacterial clearance in response to urinary tract infection in diabetic mice.

Diabetic patients have increased susceptibility to infections, and urinary tract infections (UTI) are the most common type in women with diabetes mellitus. Knowledge of bacterial clearance effectiveness following UTI in diabetics is sparse. In this study, the effects of diabetes on bacterial clearance efficiency and components of the innate immune system in response to UTI in a murine model were investigated. Streptozotocin-induced diabetic and control female C57BL/6J mice were infected with uropathogenic Escherichia coli, and bacterial load, expression of chemokines, and neutrophil infiltration in the bladder over time were investigated. Expression levels of histone deacetylases were also measured to address a potential mechanism underlying the phenotype. Bacterial clearance during UTI was significantly prolonged in diabetic mice relative to controls. Neutrophil infiltration in bladder tissue and urine, and both mRNA and protein expression of chemokines MIP-2, KC, MCP-1 and IL-6 in bladder tissue were diminished at early time points after infection in diabetic mice relative to controls. In addition, mRNA levels of histone deacetylases 1-5 were increased in diabetic mice. This is the first study to show an association of impaired bacterial clearance in diabetic mice with suppression of UTI-induced chemokine expression and neutrophil infiltration in the bladder.

Clinical profile of urinary tract infections in diabetics and non-diabetics

The risk of urinary tract infection (UTI) is higher in diabetics compared to non-diabetics. The aetiology and the antibiotic resistance of uropathogens have been changing over the past years. Hence the study was undertaken to determine if there are differences in clinical and microbiological features of UTI between diabetic and non-diabetic subjects, to study the influence of diabetes mellitus on the uropathogens and antibiotic sensitivity pattern in patients with UTI. A total of 181 diabetics (83 males and 98 females) and 124 non-diabetic subjects (52 males and 72 females) with culture positive UTI were studied. Patients with negative urine culture (n= 64), those diagnosed and treated outside (n= 83) and not willing to participate in the study (n= 24) were excluded. Almost 30 per cent of the patients (both diabetics and nondiabetics) presented with asymptomatic bacteriuria and the prevalence of pyelonephritis was significantly higher (p= 0.04) in diabetics compared to non-diabetic patients. The majority of the diabetics with UTI (87.14 per cent) had glycosylated haemoglobin (HbA1c) > 6.5 per cent with p < 0.001. The isolation rate of Escherichia coli (E. coli) from urine culture was higher (64.6 per cent) among diabetic patients followed by Klebsiella (12.1 per cent) and Enterococcus (9.9 per cent). The prevalence of extendedspectrum beta-lactamase (ESBL) producing E.coli was significantly higher in diabetics (p= 0.001) compared to nondiabetics. E.coli showed maximum sensitivity to carbapenems in both diabetic and non-diabetic subjects and least susceptibility to ampicillin. The prevalence of pyelonephritis is significantly higher in diabetics than in non-diabetic subjects, with E. coli being the most common isolate. Elevated glycosylated hemoglobin (HbA1c) predisposes diabetics to UTI. Investigation of bacteriuria in diabetic patients for urinary tract infection is important for treatment and prevention of renal complications.

Clinical profile of urinary tract infections in diabetics and non-diabetics

Clinical profile of urinary tract infections in diabetics and non-diabetics

Urinary tract infection in patients with diabetes mellitus

Urinary tract infection occurs with increased frequency and severity in patients with diabetes mellitus. General host factors enhancing risk for urinary tract infection in diabetics include age, metabolic control, and long term complications, primarily diabetic nephropathy and cystopathy. Alterations in the innate immune system have been described and may also contribute. Treatment of asymptomatic bacteriuria in diabetic patients is not indicated. Early diagnosis and prompt intervention is recommended to limit morbidity of symptomatic infection. Clinical studies comparing management of urinary tract infection in persons with diabetes compared to those without as well as diabetic patients with good or poor glucose control will be necessary to improve care of urinary infection in persons with diabetes mellitus.

Abstract A76: Diabetes and risk of bladder cancer among postmenopausal women in the Iowa Women's Health Study

Abstract Several epidemiological studies investigated diabetes as a risk factor for bladder cancer. A meta-analysis of 16 studies reported a relative risk of bladder cancer of 1.24 in adults with diabetes. However, many of those studies did not adjust for potential confounders. The Iowa Women's Health Study (IWHS) was included in that meta-analysis, but during the follow-up (1986–1998), there were only 112 incident bladder cancer cases, 12 of which had diabetes reported at baseline. We updated the analysis of the association between diabetes and bladder cancer occurrence (n=265) in the IWHS with follow-up through 2008. Our goal was to more accurately estimate the risk of bladder cancer in relation to diabetes at baseline and during follow-up: 1987, 1989, 1992, and 1997. We also studied whether the association varied by the time between the self-reported onset of diabetes and bladder cancer (diabetes duration), and by obesity measures – body mass index (BMI) and waist-to-hip ratio (WHR). We used Cox proportional hazards regression to estimate hazard ratio (HR) of bladder cancer and 95% confidence interval (CI) for baseline diabetes, and extended Cox regression to conduct a time-dependent analysis for diabetes during follow-up. To examine an association of diabetes duration with bladder cancer incidence, we conducted a nested case-control analysis. For each case, 4 controls were randomly chosen among all IWHS participants who were alive and free of cancer on the date of cancer diagnosis. Controls were matched to cases by year of birth and were assigned an index date, equivalent to the diagnosis date of the matched case. Conditional logistic regression was used to estimate the odds ratio (OR) of bladder cancer. The cohort for the person-time analysis included 37,459 initially cancer-free post-menopausal women (mean age at baseline was 61.7 y, 99.9% were white). In the multivariate analysis diabetics at baseline had an HR=1.51 (95% CI, 0.91;2.50) compared to non-diabetics. The weaker association in the present than in an earlier analysis (HR=2.5, 95% CI, 1.3;4.5) could be due to a prolonged follow-up and non-differential misclassification of diabetes status and/or survival bias. In the time-dependent analysis accounting for incident diabetes after the baseline, the HR for bladder cancer was 1.77 (95% CI, 1.24;2.51) for yes versus no diabetes. The association did not markedly change after excluding women with an onset of diabetes before 30 years of age or with diabetes duration &amp;lt;2 y. There was no interaction between diabetes and smoking. After stratification by BMI, HRs of bladder cancer for diabetics versus non-diabetics were 1.29 (95%CI, 0.60;2.79), 1.52 (95%CI, 0.83;2.79), and 2.60 (95%CI, 1.46;4.61) for BMI&amp;lt;25, 25–30 and &amp;gt;30 kg/m2, respectively. Associations between diabetes and bladder cancer were stronger for higher WHR. Finally, in the nested case-control analysis, the HRs of bladder cancer for patients with diabetes duration &amp;lt;5, 5–10, and &amp;gt;10 y were 1.65 (95%CI, 0.76; 3.60), 2.18 (95%CI, 0.85;5.60), 3.37 (95%CI, 0.88;12.87) (p-trend=0.03). In summary, we have confirmed a statistically significant positive association between diabetes and bladder cancer risk among white post-menopausal women. It may be explained by the mitogenic properties of insulin and/or increased likelihood of urinary tract infections in diabetics. The association was stronger with longer diabetes duration and with increasing adiposity. The latter association may reflect more severe diabetes among obese individuals and its larger influence on bladder carcinogenesis. Citation Information: Cancer Prev Res 2011;4(10 Suppl):A76.

Diversity and complexity of urinary tract infection in diabetes mellitus

Urinary tract infections (UTIs) are a common burden in patients with diabetes mellitus. Cystitis, ascending infections leading to pyelonephritis, emphysematous complications and renal and perinephric abscesses are well recognised in this group of patients especially if glycaemic control is poor. Despite the clinical significance of UTI in diabetes, it is inadequately understood and management regimens are mostly not evidence based. Anticipation of potential complications and earlier interventions are vital to reduce serious adverse outcomes. Herein we discuss the aetiology, pathogenesis and management of UTI and its local and more remote complications.

Streptozocin-Induced Diabetic Mouse Model of Urinary Tract Infection

Diabetics have a higher incidence of urinary tract infection (UTI), are infected with a broader range of uropathogens, and more commonly develop serious UTI sequelae than nondiabetics. To better study UTI in the diabetic host, we created and characterized a murine model of diabetic UTI using the pancreatic islet beta-cell toxin streptozocin in C3H/HeN, C3H/HeJ, and C57BL/6 mouse backgrounds. Intraperitoneal injections of streptozocin were used to initiate diabetes in healthy mouse backgrounds, as defined by consecutive blood glucose levels of >250 mg/dl. UTIs caused by uropathogenic Escherichia coli (UTI89), Klebsiella pneumoniae (TOP52 1721), and Enterococcus faecalis (0852) were studied, and diabetic mice were found to be considerably more susceptible to infection. All three uropathogens produced significantly higher bladder and kidney titers than buffer-treated controls. Uropathogens did not have as large an advantage in the Toll-like receptor 4-defective C3H/HeJ diabetic mouse, arguing that the dramatic increase in colonization seen in C3H/HeN diabetic mice may partially be due to diabetic-induced defects in innate immunity. Competition experiments demonstrated that E. coli had a significant advantage over K. pneumoniae in the bladders of healthy mice and less of an advantage in diabetic bladders. In the kidneys, K. pneumoniae outcompeted E. coli in healthy mice but in diabetic mice E. coli outcompeted K. pneumoniae and caused severe pyelonephritis. Diabetic kidneys contained renal tubules laden with communities of E. coli UTI89 bacteria within an extracellular-matrix material. Diabetic mice also had glucosuria, which may enhance bacterial replication in the urinary tract. These data support that this murine diabetic UTI model is consistent with known characteristics of human diabetic UTI and can provide a powerful tool for dissecting this infection in the multifactorial setting of diabetes.

Urinary Tract Infection in Diabetic Patients

Aim: The aim of the study was to compare the epidemiological, microbiological and clinical features of diabetic patients with urinary tract infection (UTI) to those of nondiabetic ones. Methods: A prospective study was performed on 490 consecutive patients with proven UTI. The patients were studied on the basis of a specific questionnaire and hospital records. Results: Of 490 enrolled patients, 89 (18.1%) had diabetes mellitus. The mean age of diabetics and nondiabetics was respectively 64.9 ± 13.2 (SD) and 54.4 ± 23.3 years. Most diabetics had asymptomatic bacteriuria and had undergone bladder catheterization more frequently than the nondiabetics. The most frequent causative agents of UTI in diabetics and nondiabetics were: E. coli (respectively, 56.1 vs. 56.8%), Proteus sp. (7.9% vs. 7.2%), Pseudomonas sp. (6.7 vs. 8.2%), Enterococcus sp. (6.7 vs. 7.2%). More than 50% of the isolated Pseudonomas sp. strains in both groups were resistant to gentamicin, piperacillin and norfloxacin. Both diabetics (52.8%) and nondiabetics (42.2%) had recurrent UTI during the follow-up period; the difference in the incidences did not reach statistical significance. Conclusion: No significant differences in epidemiological, clinical and microbiological evaluated features of diabetics and nondiabetics were pointed out, except for the higher frequency of bladder catheterization of diabetics than nondiabetics. However, the eradication of UTI seemed to be more difficult in diabetics than in nondiabetics.

Bacterial Urinary Tract Infections in Diabetes

Diabetes mellitus has a number of long-term effects on the genitourinary system. These effects predispose to bacterial urinary tract infections in the patient with diabetes mellitus. Bacteriuria is more common in diabetic women than in nondiabetic women because of a combination of host and local risk factors. Upper tract infection complications are also more common in this group. Diabetic patients are at higher risk for intrarenal abscess, with a spectrum of disease ranging from acute focal bacterial pyelonephritis to renal corticomedullary abscess, to the renal carbuncle. A number of uncommon complicated urinary tract infection complications occur more frequently in diabetics, such as emphysematous pyelonephritis and emphysematous pyelitis. Because of the frequency and severity of urinary tract infection in diabetic patients, prompt diagnosis and early therapy is warranted. A plain abdominal radiograph is recommended as a minimum radiographic screening tool in the patient with diabetes presenting with systemic signs of urinary tract infection. Ultrasonography or further radiographic studies such as CT scanning may also be warranted, depending on the clinical picture, to identify upper urinary tract complications early for appropriate intervention.

Bacterial Urinary Tract Infections in Diabetes

Bacterial Urinary Tract Infections in Diabetes