Endocrine Abstracts

Background and Aim: Patients with diabetes mellitus(DM) are at increased risk of infections, with the urinary tract being the most frequent infection site. High rates of antibiotic prescription, including broad-spectrum antibiotics, for urinary tract infection (UTI) in these patients may further induce the development of antibiotic-resistant urinary pathogens. The aim of our study is to determine the epidemiology of UTI and resistance patterns of bacterial isolates in patients with DM.

Methods: A total of 70 patients with DM presenting UTI admitted to a Tunisian university hospital from 2018 to 2020 were studied retrospectively. Socio-demographic and clinical data, urin culture results and antimicrobial susceptibility patterns of the isolates were collected.

Results: Mean age was 48 years ±15 with female predominance (80%). In female subgroup,57.14% were postmenopausal. Mean body mass index (BMI) was 27.95±10.5 kg/m². Mean HbA1C was 11.3%±3.6. Diabetes was insulin-treated in 70% of cases. Mean duration of diabetes was 10 years±3.7. Of our study population, 68.57% and 11.42% had lower and upper UTI, respectively. UTI was asymptomatic in 50% of cases. The predominant isolate was Escherichia coli (55.71%) followed by klebsiella Pneumoniae (14.28%), Enterobacter cloacae (2.85%), Entercoccus fecalis (1.42%), Acinetobacter (1.42%), Coagulase negative Staphylococcus (1.42%) and Raoutella terrigena (1.42 %). Extended Spectrum Beta-Lactamase Escherichia coli was isolated in 22% of cases and 70% of Klebsiella pneumoniae isolates were resistant to amoxicillin-clavulanic acid, ceftazidime, nitrofurantoin, ceftiraxone, ticarcillin, and piperacillin. The rate of resistance to two or more antimicrobials was 40%. UTI was significantly more prevalent in type 2 DM(67,14% vs 32,86%; P=0,04). Upper UTI was significantly associated with female sex (8.5% vs 5.1%; P=0.002) and with shorter duration of DM (6.5 years ±5.1 vs 11.5 years ±8.81; P=0.04) while age, DM type and treatment and BMI were not significantly associated with upper UTI.

Conclusion: Escherichia coli was the most frequent isolate in both symptomatic and asymptomatic DM patients. More resistant pathogens are a commun finding. Our results are in line with other studies. Investigation of bacteriuria in diabetic patients for UTI is important for treatment and prevention of the development of renal complications.