Journal of Research in Biology
A Study On Uropathogens In Diabetic Patients from a tertiary care
Hospital in Kanchipuram
Keywords:
Diabetes, UTI, Asymptomatic bacteriuria.
ABSTRACT:
Diabetes has long been one of the predisposing factors of UTI. There were several studies about the role of DM in etiology and resistance pattern of uropathogens with UTI. Hence this study was aimed to know the prevalence of Asymptomatic Bacteriuria (ASB) among diabetic patients
Materials and Methods:
This Study was conducted from May 2008 - Oct 2009. A total of 220 urine samples were collected from patients above 40yrs who attended the OPD with the history of diabetes and 100 urine samples were collected from non diabetics patients screened for and asymptomatic bacteriuria (>105 CFU /ml Urine). All urine samples were processed according to the standard protocol. Antibiotic sensitivity was done by kirby Bauer disc diffusion method.
Results:
Out of 220 diabetic patients, 52 had significant bacterial growth, and out of 100 non diabetic patients 22 had significant growth. UTI was more common in female patients in diabetes but more common in males in non diabetes. E.coli was the commonest isolate in both diabetic and non diabetic patients. The antibiotic resistance pattern in diabetics and non diabetics were found to be similar.
Conclusion:
Our study with asymptomatic UTI in diabetes mellitus, shows the antimicrobial resistance patternfor formulating antibiotic policies.
580-584 | JRB | 2012 | Vol 2 | No 6
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Journal of Research in Biology
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Authors:
Sivasankari S,
Senthamarai S, Anitha C, Amsavathani Sk, Venugopal V.
Institution:
Dept of Microbiology, Meenakshi Medical
College and Research
Institute, Enathur,
Kanchipuram - 631 552.
Corresponding author:
Anitha C.
Email:
ani.phd@gmail.com
Web Address:
http://jresearchbiology.com/documents/RA0265.pdf.
Dates:
Received: 14 Jul 2012 Accepted: 28 Jul 2012 Published: 20 Aug 2012
Article Citation:
Sivasankari S, Senthamarai S, Anitha C, Amsavathani Sk, Venugopal V.
A Study On Uropathogens In Diabetic Patients from a tertiary care Hospital in Kanchipuram.
Journal of Research in Biology (2012) 2(6): 580-584
Journal of Research in Biology
Original Research
An International Scientific Research Journal
INTRODUCTION:
Urinary tract infection is a major problem in developing countries of all ages ( Eshwarappa et al., 2011). Diabetes mellitus is considered to be a predisposing factor for urinary tract infection (Jenifer and Geethalakshmi, 2009). Most UTI’s are asymptomatic especially in women. Asymptomatic infections go unnoticed by the patient himself due to lack of signs and symptoms. Bacteruria is the second most common infection in developing countries (Jhan and Singh, 2009). The role of DM in etiology and in the antimicrobial resistance of uropathogens with UTI has not been studied by many authors in India ( Eshwarappa et al., 2011). Diabetes causes several abnormalities in the host defence system that might result in higher risk of UTI (Bokyko et al., 2005). Several studies showed a higher prevalence of asymptomatic bacteriuria among women with diabetes (Bonadio and costarella, 2006). Hence asymptomatic infections are important in regard to health hazard.
Hence this study was aimed to know the prevalence of Asymptomatic bacteriuria (ASB) among elderly diabetic patients for the bacteriological profile and the antimicrobial resistance pattern of uropathogens.
MATERIALS AND METHODS:
Our study was conducted from May 2008 - Oct 2009. A total of 220 diabetic patients above 40 yrs of age attending our OPD were included in the study. A brief clinical history was taken from all the patients. Inclusion criteria is all patients with Type-2 DM or proven cases of diabetes. Exclusion criteria include the pregnancy, known urinary tract anomalies, use of antimicrobial drugs. The fasting blood sugar level of the patients was estimated. Midstream clean voiding Urine samples were collected and streaked on to bloodagar, MacConkey agar plates and were incubated aerobically at 37°C for 24 hours. Bacteriuria was confirmed as the presence of atleast 105CFU/ml of urine and they were subjected to a repeat culture for confirmation. Presence of 3 or more than 3 types of colonies were considered as contamination of urine and were asked for repeat culture. All the organisms were identified as per standard protocols.
Antibiogram was done by kirby Bauer disc diffusion method as per CLSI protocol 2009.
RESULTS:
Out of 220 diabetic patients, only 52(24.8%) had significant bacterial growth, 124(56.3%) had insignificant growth and 44(20%) had no growth. Among 100 non diabetic patients only 18(18%) had significant growth.
DISCUSSION:
In our study we tried to find whether there is any difference in the bacteriological profile of UTI and the antibiogram pattern of diabetic and non diabetic patients. The risk of UTI is higher in diabetic patients due to abnormalities in the metabolic control which leads to
weakness in the host defense and glycosuria provides a favourable environment to micro organsims in the urinary tract (Joshi and Gregory, 1999).
Out of 220 diabetic patients only 52(23.62%) had significant bacterial growth, 124(56.4%) had insignificant growth and 44(20%) had no growth. Among the 100 control patients only 18(18%) had significant bacterial growth, 27(27%) had insignificant growth and 12(12%) had no growth.
In our study ASB are seen in 23.6% of people. This is slightly lower than (Jenifer and Geethalakshmi, 2009) who had reported ASB 30.3%. Many reports world wide reported ASB ranging from 5% to 30% (Sarah Wild et al., 2004).
In our study ASB is seen in diabetic patients who are suffering from diabetes for a longer duration and bacteriuria more after the 6th decade of life. This is concordant with other studies. In non diabetics also ASB is seen more after the 6th decade of life (Ramzan et al., 2004). This could be due to neutropathic complications (incomplete bladder emptying) and increased glucose concentration in urine, which may provide a good culture medium which favours the seeding of bacteria and genesis of infection in urinary tract in diabetics (Thomas and Jeyaraman, 2010).
Evidence from various epidemological studies showed that UTI is more common in women with diabetes (Patterson and Andriole, 1997). Our study is also concordant with the other studies which report to be that UTI is more common in women with diabetes. But in non diabetes UTI is more common in males here our study is concordant with (Moorthy et al., 2011). Our study reveals that GNB is more common than GPC in UTI in diabetic and non diabetic patients. E.coli is the common isolate in both the diabetics and non diabetics. This is concordant with other studies done (Bonadio and costarella, 2006).
A study done by Jeniffer et al showed that E.coli (71%) and Klebsiella spp (13%) and Enterobacter spp (4%) were isolated from female diabetic patients. Several other studies showed that E.coli is the common isolate (Goswami and Tejasmi, 2001). The higher prevalence of E.coli may be due to poor hygenic condition of the patients and especially higher among females due to the contamination of perineum through fecal flora (Park K, 2008).
The antimicrobial resistance pattern in diabetics was found to be higher.
(Akram et al., 2007) reported the ciprofloxacin resistance of 47 to 69% among gram negative organisms in India. Our study showed 22% resistance to ciprofloxacin.
In our study all the gram negative isolates were resistant to amikacin and gentamicin. This is concordant with (Eshwarappa et al., 2011) who has also reported nearly half of uropathogens showing resistance to amikacin and gentamicin. All our GNB isolates were sensitive to Imipenem.
In the non diabetics gram negative isolates showed maximum resistance to aminoglycosides and quinolones.
In our study with asymptomatic UTI, diabetes mellitus could not be considered as the risk factor for UTI.
CONCLUSION:
From our study ASB is more common after the 6th decade of life in diabetic females.
E.coli was the most frequent isolate in diabetics and non diabetics. Diabetics has large post void residual urine than non diabetic-this difference may be the higher risk of UTI. Hence diabetic patients must be regularly screened for urine examination for detection of ASB along with blood sugar.
REFERENCES:
Akram M, Shahid M, Khan AU. 2007. Etiology and antibiotic resistance patterns of community-acquired urinary tract infections in JNMC Hospital Aligarh. India. Ann Clin Microbiol Antimicrob. 6:4.
Bokyko, Edward, Stephan D fink. 2005. Risk of UTI and asymptomatic bacteriuria among diabetic and non diabetic post menopausal women. American Journal of Epidermology. 161:557-564 .
Eshwarappa M, Dosegowda R, Vrithmani Aprameya I, Khan MW, Shiva Kumar P, Kempegowda P. 2011. Clinico-microbiological profile of urinary tract infection in South India. India journal of Nephrology. 21:30-36
Goswami Tejasmi. 2001. Prevalence of UTI and renal Scar in patients with DM. Dia Res clin pract 53:181-6.
Jenifer J, Geethalakshmi S. 2009. Prevalence of lower urinary tract infection in South Indian type 2 diabetic subjects. Indian Journal of Nephrology 19:107.
Jhan BK, Singh Y. 2009. Prevalence of asymptomatic bacteria among elderly patients residing in Chitwan. Kattmandu Medical Journal. 7:157-161 .
Mario Bonadio, Sibia costarella. 2006. The influence of diabetes mellitus on the specturm of uropathogens and the antimicrobial resistance in elderly adult patients with UTI. Journal of Infections Disease. 6:54
Moorthy K, Pargavi B, Thamarai A. 2011. Prevalence of urinary tract infection among diabetic patients in Vandavasi. International Journal of Biological Technology. 2(2):42-45.
Nihal Thomas, Kanakamani Jeyaraman. 2010. A practical guide to diabetes mellitus 5th edition. 255-256.
Nirmal Joshi MD, Gregory. 1999. Infection in patients with Diabetes mellitus. The New England Journal of Medicine. 341:1906-1912 .
Park K. 2008. Infections Disease. In: K. Park, editor Park’s test book of Preventive and social medicine 311-15.
Patterson JE , Andriole VT . 1997. Bacterial Urinary tract infection in diabetes Infect Dis Clin North Am. 11(3):735-50.
Ramzan M, Bakhsh S, Salam A, Khan GM. 2004. Ghulam Mustafa. Risk factors in Urinary tract infections. Gomal Journal of medical sciences. 2:1-4.
Sarah Wild, Bchir MB, Richard Sicree. 2004. Global prevalence of Diabetes, Estimates for the year 2000 and projections for 2030. Diabetic care. 27.
Sivasankari et al.,2012
581 Journal of Research in Biology (2012) 2(6): 580-584
Table I: Age and sex distribution of Diabetics and Non diabetics with ASB
From the above table, it is clear that ASB is present more in females in diabetic patients where as in non diabetics the males have more predominance. The incidence is more after the 6th decade of life in both diabetics and non diabetics.
Diabetes N = 52 |
Non Diabetes N = 18 |
|||||
Age% |
Male% |
Female% |
Total% |
Male% |
Female% |
Total% |
40 – 49 yrs |
4 |
7 |
11 |
1 |
1 |
2 |
50 – 59 yrs |
7 |
10 |
17 |
4 |
2 |
6 |
>60yrs |
11 |
13 |
24 |
6 |
4 |
10 |
Total |
22(42.3%) |
30(57.7%) |
52(100%) |
11(61.1%) |
7(38.8%) |
18 (100%) |
Sivasankari et al.,2012
Journal of Research in Biology (2012) 2(6): 580-584 582
Table II: Isolation of Uropathogens in male and
female patients of diabetes.
The gram negative organisms were more common than gram positive organisms in both Male and Female Diabetic patients. With E.coli to be the predominant isolate in both the sexes, there were more than one isolate in some patients.
Uropathogens |
Diabetic Male N = 22 |
Diabetic Female N = 30 |
||
No |
Percentage % |
No |
Percentage % |
|
E.coli |
12 |
35.2% |
18 |
46.1% |
Klebsiella spp. |
9 |
26.4% |
12 |
30.7% |
Proteus spp |
9 |
26.4% |
5 |
12.8% |
Enterococci spp |
2 |
5.8% |
3 |
7.6% |
S.aureus |
2 |
5.8% |
1 |
2.5% |
Total |
34 |
100% |
39 |
100% |
Uropathogens |
Non diabetic(18) |
|||
Male n = 11 |
Female n =7 |
|||
No |
Percentage % |
No |
Percentage % |
|
E.coli |
5 |
38.4% |
4 |
50.0% |
Pseudomonas spp. |
3 |
23.1% |
1 |
12.5% |
Klebsiella spp |
3 |
23.1% |
2 |
25.0% |
S.aureus |
2 |
15.3% |
1 |
12.5% |
Total |
13 |
100% |
8 |
100% |
Among the non diabetic population E.coli was found to be the predominant
isolate followed by Pseudomonas spp.
Table-III Isolation of Uropathogens in Male and Female patients of non diabetics
583 Journal of Research in Biology (2012) 2(6): 580-584
Sivasankari et al.,2012
Diabetics n = 52 |
Non Diabetics n = 18 |
||||||||
Antibiotic used |
E.coli n = 30 |
Klebsiella n=21 |
Proteus n = 14 |
Enterococci n=5 |
S.aureus n=3 |
E.coli n=9 |
Pseudomonas n=4 |
Klebsiella n=5 |
S.aureus n=3 |
Ciprofloxacin |
22% |
11.1% |
8.5% |
2.1% |
1% |
24% |
10.1% |
8.5% |
1% |
Amikacin |
9.8% |
7.1% |
9.1% |
1% |
1% |
10.4% |
6.4% |
9.1% |
1% |
Gentamycin |
20% |
6.2% |
5.2% |
- |
- |
18.4% |
5.1% |
5.2% |
- |
Norfloxacin |
12.4% |
9.1% |
3% |
|
|
14% |
8% |
1% |
- |
Ofloxacin |
10.4% |
6.2% |
3% |
1% |
|
11.5% |
5.4% |
1% |
- |
Ceftrioxone |
11.9% |
8.9% |
5.2% |
- |
- |
9.8% |
7% |
5% |
- |
Ceftazidime |
15.4% |
3.1% |
6.1% |
- |
- |
13.2% |
4.1% |
4.1% |
- |
Table IV Resistance pattern of various isolates from diabetic and non diabetic patients
E.coli n = 30
Klebsiella n=21
Proteus n = 14
Enterococci n=5
S.aureus n=3
E.coli n=9
Pseudomonas n=4
Klebsiella n=5
S.aureus n=3
Sivasankari et al.,2012
Journal of Research in Biology (2012) 2(6): 580-584 584
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