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

Figures & data

Table 1 Socio-Demographic Characteristics of Diabetes Mellitus Patients Investigated for Urinary Tract Infection at Zewditu Memorial Hospital, Addis Ababa, Ethiopia, May to July, 2018

Variables		Frequency	Percentage
Gender	Male	75	33.3
	Female	150	66.7
Marital status	Single	28	12.4
	Married	158	70.2
	Separated/divorced	39	17.3
Residence	Urban	225	100
	Rural	0	0
Educational status	No modern schooling	47	20.9
	Primary schooling	71	31.6
	Secondary schooling	71	31.6
	Above secondary schooling	36	16.0
Average monthly income in birr	≤1650	86	38.2
	1651–5250	111	49.3
	>5250	28	12.4

Table 2 Frequency of Symptoms Suggestive of UTI in Diabetes Mellitus Patients in Zewditu Memorial Hospital, Addis Ababa, Ethiopia, May to July, 2018

Symptoms of UTI	Frequency	Percentage
Flank/loin pain	90	40.00
Frequent urination	80	35.56
Urgent urination	66	29.33
Fever	52	23.11
Dysuria	42	18.67
Suprapubic pain	38	11.56
Nausea	26	16.89
Vomiting	5	2.22

Table 3 Isolation Rate of UTI in Diabetes Mellitus Patients Investigated for Urinary Tract Infection in Relation to Associated Factors at Zewditu Memorial Hospital, Addis Ababa, Ethiopia, May to July, 2018

Category	Significant Bacteriuria		Crude		Adjusted
	Yes N (%)	No N (%)	P-value	Odds Ratio (95% CI)	p-value	Odd Ratio (95% CI)
Gender
Male	3 (4.0)	72 (96.0)		1
Female	19 (12.7)	131 (87.3)	0.051	3.481 [0.974–1.036]
Total	22 (100%)	203 (100%)
Age in years
20–34	5 (9.4)	48 (90.6)		1
35–49	9 (10.8)	74 (89.2)	0.792	1.168 [0.369–3.695]
50–64	3 (4.7)	61 (95.3)	0.320	0.472 [0.107–2.075]
>64	5 (20.0)	20 (80.0)	0.202	2.40 [0.625–9.210]
Marital status
Single	4 (14.3)	24 (85.7)		1
Married	14 (8.9)	144 (90.1)	0.376	0.583 [0.177–1.922]
Divorced	4 (10.3)	35 (89.7)	0.617	0.686 [0.156–3.012]
Educational status
No schooling	7 (14.9)	40 (85.1)	0.098	6.125 [0.718–52.259]
Primary	9 (12.7)	62 (87.3)	0.131	5.081 [0.618–41.786]
Secondary	5 (7.0)	66 (93.0)	0.382	2.652 [0.298–23.592]
Above secondary	1 (2.8)	35 (97.2)		1
Average monthly income in birr
≤1650	14 (16.3)	72 (83.7)	0.118	5.250 [0.658–41.873]
1651–5250	7 (6.3)	104 (93.7)	0.584	1.817 [0.214–15.409]
>5250	1 (3.6)	27 (96.4)		1
Type of DM
Type 1 DM	3 (15.8)	16 (84.2)		1
Type 2 DM	19 (9.2)	187 (90.8)	0.363	0.542 [0.145–2.029]
Duration of DM
≤10 years	6 (4.5)	126 (95.5)		1		1
>10 years	16 (17.2)	77 (82.8)	0.003	4.364 [1.637–11.629]	0.016	3.477 [1.266–9.554]
Fasting blood glucose
<126 mg/dl	3 (5.4)	53 (94.6)		1
≥126 mg/dl	19 (11.2)	150 (88.8)	0.209	2.238 [(0.636–7.868)]
Previous history of UTIs
No	8 (5.1)	148 (94.9)		1
Yes	14 (20.3)	55 (79.7)	0.001	4.709 [1.873–11.842]	0.008	3.645 [1.403–9.473]
Frequency of previous UTIs
Once	6 (15.8)	32 (84.2)		1
Twice	2 (12.5)	14 (87.5)	0.757	0.762 [0.137–4.251]
Three and above	6 (40.0)	9 (60.0)	0.066	3.556 [0.920–13.740]
Present symptoms of UTI
Asymptomatic	7 (5.5)	121 (94.5)		1		1
Symptomatic	15 (15.5)	82 (84.5)	0.016	3.162 [1.235–8.094]	0.088	2.354 [0.881–6.294]

Abbreviation: mg/dl, milligram per deciliter.

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.

Table 4 Antimicrobial Susceptibility Patterns of Gram-Negative Bacteria Isolated from Diabetes Mellitus Patients Investigated for UTI at Zewditu Memorial Hospital, Addis Ababa, Ethiopia, May to July, 2018

Antimicrobial Agents	Bacterial Isolates
	E. coli (n = 14)		K. pneumoniae (n = 3)		P. rettgeri (n = 1)		Total (n = 18)
	S N (%)	R N (%)	S N (%)	R N (%)	S N (%)	R N (%)	S N (%)	R N (%)
Meropenem	14 (100)	0 (0)	3 (100)	0 (0)	1 (100)	0 (0)	18 (100)	0 (0)
Nitrofurantoin	14 (100)	0 (0)	3 (100)	0 (0)	1 (100)	0 (0)	18 (100)	0 (0)
Co-trimoxazole	4 (28.6)	10 (71.4)	1 (33.3)	2 (66.7)	0 (0)	1 (100)	5 (27.8)	13 (72.2)
Gentamicin	12 (85.7)	2 (14.3)	3 (100)	0 (0)	1 (100)	0 (0)	16 (88.9)	2 (11.1)
Ciprofloxacin	6 (42.9)	8 (57.1)	0 (0)	3 (100)	1 (100)	0 (0)	7 (38.9)	11 (61.1)
Doxycycline	0 (0)	14 (100)	0 (0)	3 (100)	0 (0)	1 (100)	0 (0)	18 (100)
Amoxicillin-clavulanate	1 (7.1)	13 (92.9)	0 (0)	3 (100)	0 (0)	1 (100)	1 (5.6)	17 (94.4)
Ampicillin	0 (0)	14 (100)	0 (0)	3 (100)	0 (0)	1 (100)	0 (0)	18 (100)
Cefuroxime	0 (0)	14 (100)	0 (0)	3 (100)	0 (0)	1 (100)	0 (0)	18 (100)
Cefotaxime	8 (57.1)	6 (42.9)	1 (33.3)	2 (66.7)	1 (100)	0 (0)	10 (55.6)	8 (44.4)
Ceftazidime	10 (71.4)	4 (28.6)	0 (0)	3 (100)	1 (100)	0 (0)	11 (61.1)	7 (38.9)
Cefepime	11 (78.6)	3 (21.4)	2 (66.7)	1 (33.3)	1 (100)	0 (0)	14 (77.8)	4 (22.2)

Abbreviations: N (n), number; R, resistance; S, sensitivity.

Table 5 Antimicrobial Susceptibility Patterns of Gram-Positive Bacteria Isolated from Diabetic Mellitus Patients Investigated for UTI at Zewditu Memorial Hospital, Addis Ababa, Ethiopia, May to July, 2018

Antimicrobial Agents	Bacterial Isolates
	Enterococcus spp. (n = 2)		Coagulase Negative Staphylococcus (n = 2)		Total (n = 4)
	S N (%)	R N (%)	S N (%)	R N (%)	S N (%)	R N (%)
Nitrofurantoin	2 (100)	0 (0)	2 (100)	0 (0)	4 (100)	0 (0)
Ciprofloxacin	1 (50)	1 (50)	2 (100)	0 (0)	3 (75)	1 (25)
Doxycycline	0 (0)	2 (100)	2 (100)	0 (0)	2 (50)	2 (50)
Ampicillin	2 (100)	0 (0)	ND	ND	2 (100)	0 (0)
Vancomycin	2 (100)	0 (0)	ND	ND	2 (100)	0 (0)
Co-trimoxazole	ND	ND	2 (100)	0 (0)	2 (100)	0 (0)
Gentamicin	ND	ND	2 (100)	0 (0)	2 (100)	0 (0)
Cefoxitin	ND	ND	2 (100)	0 (0)	2 (100)	0 (0)
Penicillin	ND	ND	0 (0%)	2 (100)	0 (0)	2 (100)

Abbreviations: ND, not done; N, number; R, resistance; S, sensitivity; SPP, species.

Table 6 Multi-Drug Resistance Patterns of Gram-Negative Bacterial Isolates from Midstream Urine Samples Among Diabetes Mellitus Patients at Zewditu Memorial Hospital, Addis Ababa, Ethiopia, May to July, 2018

Antimicrobial Agents	Bacterial Isolates and Their Resistance to Different Classes of Antimicrobials
	E. coli (n = 14) Resistance, n (%)	K. pneumoniae (n = 3) Resistance n (%)	P. rettgeri (n = 1) Resistance n (%)
Cotr, Cip, Dox, Amp, AMC, Cetz, Cef, Cft, Cep, Gen	1 (7.14)	0	0
Cotr, Cip, Dox, Amp, AMC, Cetz, Cef, Cft, Cep	2 (14.29)	1 (33.33)	0
Cotr, Cip, Dox, Amp, AMC, Cetz, Cef, Cft	0	1 (33.33)	0
Cotr, Cip, Dox, Amp, AMC, Cetz, Cef	1 (7.14)	0	0
Cotr, Cip, Dox, Amp, AMC, Cef, Cft	2 (14.29)	0	0
Cotr, Cip, Dox, Amp, AMC, Cef, Gen	1 (7.14)	0	0
Cotr, Cip, Dox, Amp, AMC, Cef,	1 (7.14)	0	0
Cotr, Dox, Amp, AMC, Cef, Cft	1 (7.14)	0	0
Cotr, Dox, Amp, AMC, Cef	1 (7.14)	0	1 (100)
Cip, Dox, Amp, AMC, Cetz, Cef	0	1 (33.33)	0
Dox, Amp, AMC, Cef,	3 (21.42)	0	0
Dox, Amp, Cef	1 (7.14)	0	0
Total	14 (100)	3 (100)	1 (100)

Abbreviations: Cotr, co-trimoxazole; Gen, gentamicin; Cip, ciprofloxacin; Dox, doxycycline; Amp, ampicillin; AMC, amoxicillin-clavulanate; Cetz, ceftazidime; Cef, cefuroxime; Cft, cefotaxime; Cep, cefepime.