Prevalence of Bacterial Urinary Tract Infection and Antimicrobial Susceptibility Patterns Among Diabetes Mellitus Patients Attending Zewditu Memorial Hospital, Addis Ababa, Ethiopia

Abstract

Background: Urinary tract infection (UTI) is caused by colonization and growth of microorganisms within the urinary system. Diabetic patients are more prone to bacterial UTI due to impaired host defense and high glucose concentration in urine. Surveillance of uropathogens and their antibiogram is a key to patient management.

Methods: A hospital-based cross-sectional study was conducted from May to July, 2018. Urine samples were collected for culture and identification based on the standard protocol. An antimicrobial susceptibility test (AST) was done for all isolates using the Kirby-Bauer disk diffusion method. Data were entered into Epi-data version 3.2.1 and exported to the Statistical Package for the Social Science (SPSS) version 20.

Results: Out of 225 participants, significant bacteriuria was reported in 9.8% of the cultures. Five species of bacteria were isolated and E. coli (63.6%) was the leading uropathogen, followed by K. pneumoniae (13.6%). Duration of diabetes, previous history of UTIs and symptomatic UTI were found to be strongly associated with significant bacteriuria. Gram-negative bacterial isolates showed high sensitivity to nitrofurantoin and meropenem (100%). In contrast, a high level of resistance to ampicillin, doxycycline and cefuroxime (100%) and to amoxicillin-clavulanate (94.4%) was observed. Gram-positive bacteria showed high level of resistance to penicillin (100%). Multiple-drug resistance (MDR) was high for Gram-negative bacteria (100%).

Conclusion: Previous history of UTIs and duration of diabetes were found to be important factors that increase the prevalence of UTI among diabetes patients. This study also showed a high prevalence of drug resistance to doxycycline, amoxicillin-clavulanate, cefuroxime and penicillin for both Gram-negative and Gram-positive bacteria. Since therapeutic selection for empirical treatment and management should be based on knowledge of the local bacterial profile and antimicrobial response, we suggest physicians take this high resistance profile in to consideration when prescribing antimicrobials against the pathogens in question.

Keywords: UTI; antibiotic susceptibility; diabetes mellitus; significant bacteriuria.

Figure 1

Distribution of bacterial uropathogens isolated from symptomatic and asymptomatic urinary tract infections among diabetic patients at Zewditu Memorial Hospital, Addis Ababa, Ethiopia, May to July, 2018. The bar graph shows the frequency of bacterial isolation versus types of bacterial isolates. The vertical axis indicates the frequency of bacterial isolation and the horizontal axis indicates types of bacterial isolate. Blue indicates symptomatic UTIs and red indicates asymptomatic UTIs among diabetes mellitus study subjects. A total of 22 bacteria were isolated, of which 18 were Gram-negative and 4 were Gram-positive. E. coli was the most frequently isolated uropathogen, with a total of 14 isolates; 10 were isolated from symptomatic UTI DM patients and 4 from asymptomatic UTI DM participants. K. pneumoniae was the second most frequently isolated pathogen, accounting for 1 symptomatic UTI DM participant and 2 asymptomatic UTI DM participants. Of the total 22 isolates, 15 were isolated from symptomatic UTI DM participants and the remaining 7 isolates were from asymptomatic UTI DM participants.