Urinary tract infections and antimicrobial sensitivity among diabetic patients at Khartoum, Sudan

Abstract

BackgroundPatients with diabetes mellitus (DM) are more susceptible to urinary tract infection (UTI) than non-diabetics. Due to the emergence of multidrug resistant (MDR) uropathogenic strains, the choice of antimicrobial agent is restricted. This study investigated the epidemiology of UTI, antimicrobial susceptibility, and resistance patterns of bacterial isolates from adult diabetic patients.MethodsA cross-sectional study was conducted at Khartoum Hospital, Sudan during the period of March − September 2013. Consecutive patients (men and women) were approached to participate in the study, irrespective of UTI symptoms. Socio-demographic and clinical data were obtained from each participant using pre-tested questionnaires. Clean-catch, midstream urine samples were collected and cultured for UTI diagnosis and antimicrobial susceptibility. Symptomatic bacteriuria was defined as a positive urine culture (≥105 colony-forming units [CFU]/mL of a single bacterial species) from patients with symptoms associated with UTI; asymptomatic bacteriuria was defined as a positive urine culture from patients without symptoms associated with UTI.ResultsA total of 200 diabetic patients were enrolled, 121 (60.5%) men and 79 (39.5%) women; 193 (96.5%) had type II DM. The overall prevalence of UTI was 39 (19.5%). Among the total population, 17.1% and 20.9% had symptomatic and asymptomatic bacteriuria, respectively. According to multivariate logistic regression, none of the investigated factors (age, sex, type of DM and duration) were associated with UTI. The predominant isolates were Escherichia coli (22, [56.4%]), and Klebsiella pneumoniae, [9, (23%)]. Eight of 22 E. coli, four of nine K. pneumoniae and one of five Enterococcus faecalis isolates originated from symptomatic patients. Six, four, three, and two of 22 E. coli isolates showed resistance to ampicillin, co-trimoxazole, nitrofurantoin, and amoxicillin-clavulanic acid, respectively. Two, two, one and one of nine K. pneumoniae isolates were resistant to ampicillin, co-trimoxazole, cephalexin, and amoxicillin-clavulanic acid. All 22 E. coli isolates were sensitive (100%) to gentamicin and cephalexin. All nine K. pneumoniae were sensitive to gentamicin (100%) and 88.8% were sensitive to cephalexin.ConclusionIn Sudan, about one-fifth of diabetic patients have UTI. E. coli is the most frequent isolate followed by K. pneumoniae.

A Study on the Detection of Biofilm Formation by Multidrug Resistant Uropathogenic Isolates in a Tertiary Care Hospital

“…It correlates with the study done by Ramanath Katta Venkatesh et al, [12] which tells that 43% of diabetic patients have UTI. It also correlates with the study of Hamdan Z Hamdan et al [13] and S Niveditha et al [1] In our study, the polymicrobial pattern of growth was found to be 8%. It was around 2.9% in the study done by J. Janifer et al [14] In this study Gram negative bacilli (73.15%) were more common than Gram positive cocci (26.25%), which correlates with the finding of Devanand Prakash et al [11] that out of 155 bacterial uropathogens, 140 (90.32%) were Gram negative and 15 (9.68%) were Gram positive isolates.…”

Antibiogram of Urinary Pathogens in Patients with Diabetes Mellitus - Experience from a Tertiary Care Hospital

“…Earlier studies by Mishra et al, 9 , Khan et al, 11 , Choudhary et al, 15 and Jennifer et al, 10 shows E.coli was the most predominant isolated organism, followed by Klebsiella spp., These results suggestive of several factors are responsible for attachment of Enterobacteriaceae to the uroepithelium like, they colonize the urogenital mucosa with adhesin and pili. 12,13,14 Among Gram positive isolates, Enterococcus Species were the most commonly isolated organism 21 (11.4%) followed by Staphylococcus aureus 13 (7.02%), in contrast with other study where Enterococcus species were found as the most frequent organism (15%), followed by Coagulase negative Staphylococcus (1.6%). Study by Mishra et In the present study, E.coli were highly sensitive to Imepenem(93%), followed by Amikacin (84%), Gentamicin (74%), Amoxyclav (65%).…”

“…Study by Hamdan et al, (2015) in Sudan shows that there is no association between pyuria and prevalence of UTI. Studies by Mishra et al, 9 , Akram et al, 16 and Jennifer et al, 10 revealed the involvement of Gram negative enteric organisms that commonly causes urinary tract infections, such as E. coli, the Klebsiella species, and the Proteus species similarly, the predominant number of pathogens isolated in our study were also Gram negative bacilli (Table 4).…”

Distribution of Virulence Factors and Antimicrobial Resistance Properties of Uropathogenic Escherichia coli Isolated from Diabetic and Healthy Males Suffered from Urinary Tract Infections

“…Besides, resistance against cefixime and ceftriaxone was moderate and amoxicillin and ciprofloxacin showed the highest resistances in all these cases which wall were similar to our results. In a study which was conducted by Hamdan et al (2015) 18 , the predominant isolates were E. coli (56.4%). Six, four, three, and two of 22 E. coli isolates showed resistance to ampicillin, co-trimoxazole, nitrofurantoin, and amoxicillinclavulanic acid, respectively.…”