Mama Mohammedaman, Manilal Aseer, Gezmu Tigist, Kidanewold Aschalew, Gosa Firew, Gebresilasie Atsede
Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
Turk J Urol. 2018 Nov 21;45(1):56-62. doi: 10.5152/tud.2018.32855. Print 2019 Nov.
Urinary tract infection (UTI) is a common and grave health problem in the world. In fact, patients with diabetes mellitus have an immense risk for developing UTI. The development of resistance among uropathogens to antibiotics is a major crisis which limits the use of drug of choice for the treatment of UTI. On this view point, the aim of the present study is to elucidate the prevalence of UTI, associated factors, causative agents and their antimicrobial susceptibility amongst diabetic patients attending Arba Minch Hospital, Arba Minch, Ethiopia.
A facility based cross-sectional study was carried out in diabetic patients visiting the Internal Medicine Unit of Arba Minch Hospital (AMH) during the study period (March to May 2016). Pre-tested structured questionnaire was used for collecting the data pertaining to socio-demographic characteristics and possible risk factors. In order to quantify the uropathogens, midstream urine samples were collected in sterile leak proof culture bottles and streaked onto diverse bacteriological media. All the positive urine cultures showing significant bacteriuria as per the Kass count (>10 organisms/mL) were further subjected to biochemical tests. The antimicrobial susceptibility test was performed to determine the resistance/susceptibility pattern of isolated uropathogens. Data entry and analysis were done using Statistical Package for Social Services, version 20.
In total, 239 diabetic patients were included in the study of which 60.2% (n=144) were females. A total of 81 (33.8%) diabetic patients had positive urine cultures. Sixty-eight (83.9%) female diabetic patients had significant bacteriuria (p=0.000). Fifty-two (64.1%) participants had drinking habit and 79 (97.5%) of respondents had higher glucose levels (≥126 mg/dL) (p=0.004 and p=0.003), respectively. According to the biochemical tests, in a total of 90 isolates from patients with significant bacteriuria, eight species of uropathogens such as Escherichia coli, Klebsiella sp., Proteus sp., Citrobacter spp., Staphylococcus aureus, Coagulase negative Staphylococcus (CNS), Enterococcus faecalis and yeast isolates were identified. The antibiogram evidenced that 79.6% (n=51) of Gram-negative bacteria were invariably resistant to amoxicillin and penicillin whereas 73.4% (n=47) and 65.6 % (n=42) of them were resistant to trimethoprim, erythromycin and chloramphenicol, respectively. Regarding the Gram-positive bacteria, high degree of resistance was exhibited towards penicillin and trimethoprim (100%, n=24) followed by amoxicillin (83.3%, n=20) and gentamicin (62.5%, n=15). Invariably, all the Gram-positive cocci and Gram-negative bacilli were susceptible (100%) to amikacin, doxycycline, ceftriaxone and nitrofurantoin.
The prevalence of UTI is higher in diabetic patients. Results revealed that the predominant pathogens of UTI were Gram-negative bacilli (Enterobacteriaceae), particularly E. coli. Significant bacteriuria had an association with the consumption of alcohol, gender and glucose level. Based on the results of antimicrobial susceptibility tests, it might be inferred that the antibiotics such as amikacin, doxycycline, ceftriaxone and nitrofurantoin are the drugs of choice for the management of both Gram-negative and Gram-positive uropathogenic bacteria in the study area.
尿路感染（UTI）是全球常见且严重的健康问题。事实上，糖尿病患者发生UTI的风险极大。尿路致病菌对抗生素耐药性的产生是一个重大危机，限制了治疗UTI的首选药物的使用。基于此观点，本研究旨在阐明埃塞俄比亚阿巴明奇市阿巴明奇医院糖尿病患者中UTI的患病率、相关因素、病原体及其抗菌药敏情况。
在研究期间（2016年3月至5月），对前往阿巴明奇医院（AMH）内科就诊的糖尿病患者进行了一项基于机构的横断面研究。使用预先测试的结构化问卷收集有关社会人口学特征和可能危险因素的数据。为了对尿路致病菌进行定量，在无菌防漏培养瓶中收集中段尿样本，并接种到不同的细菌学培养基上。所有根据卡斯计数（>10个菌落形成单位/mL）显示有显著菌尿的阳性尿培养物都进一步进行生化试验。进行抗菌药敏试验以确定分离出的尿路致病菌的耐药/敏感模式。数据录入和分析使用社会科学统计软件包第20版完成。
本研究共纳入239例糖尿病患者，其中60.2%（n = 144）为女性。共有81例（33.8%）糖尿病患者尿培养呈阳性。68例（83.9%）女性糖尿病患者有显著菌尿（p = 0.000）。52例（64.1%）参与者有饮酒习惯，79例（97.5%）受访者血糖水平较高（≥126 mg/dL）（分别为p = 0.004和p = 0.003）。根据生化试验，在总共90株来自有显著菌尿患者的分离株中，鉴定出8种尿路致病菌，如大肠杆菌、克雷伯菌属、变形杆菌属、柠檬酸杆菌属、金黄色葡萄球菌、凝固酶阴性葡萄球菌（CNS）、粪肠球菌和酵母菌分离株。抗菌谱表明，79.6%（n = 51）的革兰氏阴性菌对阿莫西林和青霉素始终耐药，而其中73.4%（n = 47）和65.6%（n = 42）分别对甲氧苄啶、红霉素和氯霉素耐药。对于革兰氏阳性菌，对青霉素和甲氧苄啶的耐药程度较高（100%，n = 24），其次是阿莫西林（83.3%，n = 20）和庆大霉素（62.5%，n = 15）。所有革兰氏阳性球菌和革兰氏阴性杆菌对阿米卡星、多西环素、头孢曲松和呋喃妥因均敏感（100%）。
糖尿病患者中UTI的患病率较高。结果显示，UTI的主要病原体是革兰氏阴性杆菌（肠杆菌科），尤其是大肠杆菌。显著菌尿与饮酒、性别和血糖水平有关。根据抗菌药敏试验结果，可以推断阿米卡星、多西环素、头孢曲松和呋喃妥因等抗生素是研究区域治疗革兰氏阴性和革兰氏阳性尿路致病菌的首选药物。
