Prevalence, aetiology and antimicrobial resistance profile of diabetic individuals suffering from community-acquired urinary tract infection.

Abstract

Introduction. The rise in antimicrobial resistance poses a significant threat to global health, particularly among diabetic patients who are prone to urinary tract infections (UTIs).Hypothesis. Pathogens that cause UTI among diabetic patients exhibit significant multidrug resistance (MDR) patterns, necessitating more precise empirical treatment strategies.Aim. This study aimed to determine the prevalence of UTI among diabetic patients and study the antimicrobial susceptibility profiles of uropathogens, detected and identified the potential differences in age groups and between genders, focusing on MDR and gender-based variations, causing a global concern in deciding empirical treatment.Methodology. A prospective study was conducted from August 2021 to December 2023 in Gujarat, India. During the period, 1023 diabetic patients with symptoms of UTI were diagnosed by urine culture and 280 individuals tested positive for UTIs. Antibiotic susceptibility testing was carried out on these 280 micro-organism isolates.Results. Among the 280 UTI-positive patients, 166 (59.29%) were females and 114 (40.71%) were males, with the prevalence of UTI in diabetic females being 27.34% (166/607) and males being 27.40% (114/416). Among the isolated uropathogens, Escherichia coli (56.78%) was the predominant organism followed by Pseudomonas aeruginosa (13.57%) and Klebsiella (13.21%). High resistance was noted to various antibiotics in Gram-negative bacteria including both genders. In E. coli, resistance was predominantly high against the penicillin sub-class of the beta-lactam group (70.23%, 69.58%), cephalosporins (66.23%, 76.52%) and least against nitrofurans (30.10%, 40%) in males and females, respectively. Klebsiella has shown higher resistance to cephalosporins (66.23%, 76.52%) and aminoglycosides (60.92%, 62.66%) and least resistance to carbapenem (41.67%) and phosphonic (33.33%) in males and females, respectively. A high proportion of isolates, ~82.5%, exhibited MDR. Among these MDR isolates, those from female patients accounted for a higher percentage (58.44%) compared with males (41.55%). The highest prevalence of MDR was observed in the 41-60-year age group. This pattern highlights notable differences in MDR prevalence across gender and age groups.Conclusion. The high prevalence of UTI caused by MDR organisms based on gender and age group highlights the need for clinicians to choose antibiotics more judiciously for empirical treatment, thereby reducing misuse and overuse in the community. For diabetic UTI patients in this region, nitrofurantoin may be recommended for uncomplicated cases due to low resistance in E. coli, while fosfomycin could be a viable alternative for Klebsiella-related infections. Carbapenems may be reserved for severe cases with MDR pathogens, and combination therapy could be considered for complicated infections, particularly in high-risk age groups.