Study on the Incidence of Urinary Tract Infection in Diabetic Patients and the Prevalence of Multidrug Resistant Strains among the Bacterial Pathogenic Isolates

Abstract

Diabetes is a chronic disorder of carbohydrates, fat and protein metabolism due to insulin deficiency and /or insulin resistance. It has been noted that diabetic patients can have severe medical complications. Urinary tract infections (UTI) are very often encountered in patients with diabetes mellitus. They may present themselves as asymptomatic bacteriuria, but may also lead to more serious infection.

Urinary tract infection is a common medical problem; sometimes, leading to the number of deaths either from acute infection or from chronic renal failure. Bacteriological examination of the urine is an important tool in the diagnosis of infection. This study was conducted in “OM” Hospital and Research Center, Kathmandu among diabetic patients suspected of UTI from March 24, 2006 to June 13, 2006. The aim of this study was to investigate the incidence of UTI in diabetic patients, etiology of UTI, antibiotic susceptibility profile, to isolate the multi-drug resistant strains (MDR-strains) and to compare the results with control patients. Altogether, 100 samples from diabetic patients as test and 100 samples from nondiabetic patients as control were included in this work, which were investigated by glucose oxidase test for blood sugar level, conventional semi-quantitative culture technique, pus cell count, red blood cell count, epithelial cell count and albumin test for detection of UTI. Out of 100 test urine samples, 22.0% showed significant growth while 4.0% samples showed mixed growth and 8.0% showed non significant growth. Out of 100 control urine samples, 12.0% showed significant growth while 1 sample showed mixed growth and 2.0% showed non significant growth. The highest number of growth positive samples from test 7 (31.8%) and from control patients 3 (25.0%) belonged to the same age group 51-60 years. Also, among the 22 isolates from test, 13 (59.5%) and among 12 isolates from control, 10 (83.3%) were from female patients. Escherichia coli was found to be the most predominant isolate (40.9%) followed by Citrobacter fruendii (27.2%) and Staphylococcus aureus (18.1%) in test and in control it was 83.3%. Out the total isolates, 20 (90.9%) in test and 9 (75.0%) in control patients were MDR. In case of test out of 9 E. coli isolates, 8 were MDR-strains while all the isolates of Citrobacter fruendii, Pseudomonas aeruginosa, Klebsiella pneumoniae and Proteus vulgaris and out of four S. aureus isolates, three were MDR strains. Nitrofurantoin was found to be the most effective drug for all Gram negative isolates followed by Ofloxacillin. Erythromycin was the drug of choice for Gram positive isolates. Microscopy for pyuria showed the sensitivity of 59.0% vs 66.6% and specificity of 93.5% vs 96.5% in diabetic and control patients respectively. Similarly albuminuria showed sensitivity of 59.0% vs 66.6% and specificity of 89.7% vs 92.0%. Higher proportion of positive cases seen among test patients was found to be statistically non significant (P>0.05) with control patients, whereas no significant association was found between MDR and non MDR strains and significant and non significant pyuria between test and control patients.