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

Acknowledgments

The authors would like to thank Addis Ababa University, Department of Microbiology, Immunology and Parasitology, Faculty of Medicine for sponsoring the research. Our special thanks and appreciation go to the staff members of Zewditu Memorial Hospital, the medical director, physicians, nurses and laboratory staff working in the diabetic clinic for their support in screening of symptomatic and asymptomatic study participants and organizing the preconditions of sample and data collection. Our deepest thanks also go to the Addis Ababa Public Health Research and Emergency Management Directorate for their unreserved material and reagent supply that made this study possible. We also extend our profound gratitude to the study participants for their willingness to engage, without whom this research would not have been possible.

Abbreviations

AAU, Addis Ababa University; ATCC, American type culture collection; ASB, asymptomatic bacteriuria; CLSI, Clinical Laboratory Standard Institute; CoNs, coagulase negative staphylococci; COR, crude odds ratio; DMIP, Department of Microbiology, Immunology and Parasitology; DM, diabetes mellitus; MSU, midstream urine; NDM, non-diabetes mellitus; PYR, pyrrolidonyl acrylamides, SPSS, Statistical Package for the Social Science; SB, symptomatic bacteriuria; UTI, urinary tract infection; WHO, World Health Organization; ZMH, Zewditu Memorial Hospital.

Data Sharing Statement

Data is available upon request.

Ethics Approval and Consent

Ethical clearance was obtained from the Research and Ethical Review Committee and was approved by the Department of Microbiology, Immunology and Parasitology, School of Medicine, Addis Ababa University. Ethical clearance was also secured from Addis Ababa Public Health Research and Emergency Management Directorate. Official permission was also obtained from ZMH. In addition, written informed consent was obtained from the study participants before the initiation of data collection and all participants were informed about the purpose of the study, and told that it was conducted in accordance with the Declaration of Helsinki. The individual results of investigations remained confidential. The laboratory findings of the study participants were communicated to the responsible health professional assigned to the diabetic clinic for the purpose of managing the cases accordingly.

Consent for Publication

Not applicable. This study does not contain any individual or personal data.

Author Contributions

All authors made a significant contribution to the work reported, whether that was in the conception, study design, execution, acquisition of data, analysis and interpretation or in all of these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; agreed on the journal to which the article was submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no conflicts of interest for this work.