Prevalence of uropathogens and their antimicrobial resistance pattern among adult diabetic patients

Abstract

Background: The high prevalence of diabetes, urinary tract infection (UTI) in persons with diabetes, and antibiotic resistance throughout the world including India is a cause of concern for health-care providers. Objectives: The study aimed to assess the prevalence of uropathogens, their resistance pattern, and associated factors of UTI among adults with diabetes. Methods: A cross-sectional study was conducted during the year 2018–2019 among 504 adult diabetic patients attending a tertiary care hospital of Bhubaneswar, Eastern India. Using recommended culture methods, clean-catch midstream urine samples were examined for the presence of pathogenic bacteria and their antimicrobial susceptibility pattern. Results: The prevalence of UTI was 75.4% and the predominant isolates were Escherichia coli (25.6%), Enterococcus spp. (18.7%), and Klebsiella spp. (8.1%). Most of the bacteria isolates were sensitive to nitrofurantoin (80.8%), gentamicin (76.8%), and amikacin (72.1%) whereas resistant to cefpodoxime (77.6%), cefixime (70.8%), and cefadroxil (65.0%). The overall multidrug resistance (MDR) to two or more antimicrobial agents was observed in 87.4% bacterial isolates. The odds of developing UTIs were significantly higher in females with diabetes (adjusted odds ratio [AOR]: 2.04; 95% confidence interval CI: 1.33–3.13), those with Stage I/II hypertension (AOR: 1.77; 95% CI: 1.04–3.008), and those having glycated hemoglobin level >9% (75 mmol) (AOR: 2.15; 95% CI: 1.13–4.10) compared with their counterparts. Conclusion: The prevalence of UTI and MDR to commonly used antibiotics among diabetic patients is alarming, and thus, isolation of uropathogenic bacteria and antimicrobial susceptibility testing is crucial for the treatment of UTI in persons with diabetes.

Keywords

• diabetes mellitus
• glycated hemoglobin
• hypertension
• multidrug resistance
• urinary tract infection