Prevalence, risk factors and microorganisms of urinary tract infections in patients with type 2 diabetes mellitus: a retrospective study in China

Abstract

Background: Urinary tract infections (UTIs) occur more frequently in diabetic patients. This study was conducted to investigate the prevalence, risk factors and microorganisms of UTIs in Chinese patients with type 2 diabetes (T2D).

Patients and methods: A total of 3,652 Chinese inpatients with T2D were reviewed and data on their clinical characteristics, symptoms of UTIs, random blood glucose, HbA1c, glutamic acid decarboxylase antibody, insulin autoantibody, albumin excretion rate in 24-hour urine, urine culture and susceptibility to antibiotics, and so on were collected. Binary logistic analysis was performed to look for risk factors of UTIs.

Results: There were 409 (11.2%) patients suffering from UTIs. Gender, age, random blood glucose, insulin autoantibody and albumin excretion rate in 24-hour urine were the risk factors of UTIs in diabetic patients. The percentage of positive urine cultures was higher in the asymptomatic bacteriuria patients than in symptomatic patients (P<0.001). The incidence of septicemia was considerable in the UTIs and asymptomatic bacteriuria groups. Escherichia coli was the most common pathogenic microorganism isolated in diabetic patients with UTIs, and one-half of the E. coli infections were multidrug resistant. Furthermore, meropenem was the most effective antibiotic on E. coli.

Conclusion: We suggest that a routine urine analysis or urine culture should be conducted in patients with T2D diabetes who have the identified risk factors. The UTIs might affect the islet function or blood glucose control in patients with T2D. Before a doctor decides to prescribe antibiotics to a diabetic patient with UTIs, the drug sensitivity test should be performed.

Keywords: asymptomatic bacteriuria; diabetes; multidrug resistant; urinary tract infections.

Figure 1

Urine cultures in diabetic patients. Notes: Exactly 84.9% patients with positive UTI symptoms underwent positive urine cultures and 44.08% of them were positive. Also, 87.33% patients without UTI symptoms underwent positive urine cultures and 70.47% were positive. The percentage of positive urine cultures in the two groups was similar; however, the rate of positive urine cultures was significantly higher in symptom (−) group than in symptom (+) group (P<0.0001). Abbreviation: UTI, urinary tract infection.

Figure 2

The antibiotic resistance to various pathogens in urine culture of diabetic patients. Notes: (A) Resistance pattern of various commonly used antibiotics in the two most popular Gram-negative organisms. (B) Resistance pattern of various commonly used antibiotics in the two most popular Gram-positive organisms.