Prevalence of urinary tract infection in type 2 diabetic patients at Government Hospital, Chengalpattu District

Introduction: Diabetes is a polygenic disease characterized by abnormally high glucose levels in the blood. There is evidence that patients with diabetes have an increased risk of Urinary Tract Infections (UTIs). UTI is the most common bacterial infection in diabetic patients. They are also more often caused by resistant pathogens. Various impairments in the immune system, poor metabolic control, and incomplete bladder emptying due to autonomic neuropathy may all contribute to the enhanced risk of urinary tract infections in these patients. The aim of the study: To determine the clinical characteristics, risk factors, causative organisms and antimicrobial susceptibility in diabetics. Materials and methods: This was an observational study conducted in the medical unit of a tertiary care hospital over a period of 6 months. A total of 100 type 2 diabetic subjects were studied. History, clinical examinations, and the duration of diabetes were recorded in all patients at admission. Diabetes was diagnosed based on the WHO criteria. An immunoturbidimetric method was used to estimate glycosylated hemoglobin (HbA1CDiagnosis of UTI was made from Midstream urine samples of patients if the urine cultures have>103 to >105 colony forming units (CFU)/mL of a pathogen. A pure culture of Staphylococcus aureus was considered to be significant regardless of the number of CFUs. Results: Gram-negative bacilli were isolated from 129 (87.2%) patients which included E. coli in 75 (50.7%), Klebsiella in 30 (20.3%), Pseudomonas species in 12 (8.1%) and Citrobacter in 12 (8.1%). Gram-positive cocci were responsible for UTI in 15(10.1%) of subjects including Enterococcus in 13 (8.9%) and Staphylococcus in 2 (1.3%). Gram-negative bacilli including E. coli, the Klebsiella species, Pseudomonas and Citrobacter had a good response to piperacillin-tazobactam, cefoperazone- sulbactam, imipenam, and amikacin. Gram-positive cocci (Enterococcus and Staphylococcus) responsible for UTI showed good susceptibility to vancomycin (81 and 94% respectively) but a high resistance to ciprofloxacin and tetracyclines (68 and 57% respectively). Conclusion: There is no indication to treat diabetic patients with asymptomatic bacteriuria. Escherichia coli is the most common isolate in the community and hospital-acquired infections in non-diabetics, while Escherichia coli was common in community-acquired infection and pseudomonas was the predominant isolate in hospital-acquired the infection in diabetics.