Urinary Tract Infection in Diabetic Microalbuminuric Patients Visiting B & B Hospital

Abstract

Diabetes is a heterogeneous group of diseases, characterized by a state of chronic hyperglycemia, resulting from a diversity of etiologies, environmentally and genetically or jointly. The underlying cause of diabetes is the defective production or action of insulin. Micro-albuminuria is a state of increase in urinary albumin too subtle to be measured by ordinary chemical procedures. Preceding Micro-albuminuria is highly predictive of diabetic nephropathy and end-stage of renal disease. Urinary tract infections (UTI) are commonly encountered in patients with diabetic microalbuminuria as asymptomatic bacteriuria (ASB) which can lead to serious infection. Infections of the urinary tract are the second most common type of infection in the body. The present study was conducted in B & B hospital among visiting Patients suspected of Urinary Tract Infection (UTI) who had been diagnosed as diabetic micro-albuminuric Patients (cases) and non-diabetic non-micro-albuminuric patients (controls) who visited during April 10, 2007 to August 20, 2007. The aim of research was to study the prevalence of UTI in diabetic micro-albuminuric patients. Altogether, 300 samples (both blood and urine) were collected, 150 were screened for diabetic micro-albuminuric samples and 150 were screened for non-diabetic non-microalbuminuric samples (controls). Out of 150 diabetic micro-albuminuric samples, 77(51.4%) showed significant growth and out of 77, 49(63.7%) were Multiple Drug Resistant (MDR) strains. Similarly, out of 150 non-diabetic non-microalbuminuric samples, 38(33.0%) showed significant growth and out of 38, 22(57.9%) were MDR-strains. Nine different bacteria were isolated, among them Escherichia coli was found to be the most predominant isolate from cases and controls. Out of 77, 42(54.5%) were E. coli isolates, and out of 42, 33 (68.8%) were MDR-strains. The predominant gram positive organism isolated was Staphylococcus aureus (N=2) and both were MDR strains. Most of the organisms isolated from diabetic microalbuminic patients were susceptible to Imipenem and Meropenem and almost all gram negative organisms isolated from non-diabetic non-microalbuminic patients were susceptible to Nitrofurantoin whereas, Gram positive isolates were sensitive to tetracycline. Diabetic microalbuminuria showed the significant association with the urine culture positivity (p<0.05) as increase in concentration of urine microalbumin from 2.1 mg/dl to 20.0 mg/dl, there was the increase in growth positive as same as there is significant association between culture positivity and gender (p>0.05). Higher proportion of significant growth seen as the level of urinary micro-albumin increases was found statistically significant (p<0.05) but there is no significant association between types of diabetic patient and UTI (p>0.05).The sensitivity and specificity of urine culture test on the basis of level of urinary sugar and micro-albumin to diagnose UTI were found 67% and 60.5% respectively. Key Words: Urinary tract infection, Diabetic microalbuminuria, Multi-drug resistance