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      Urinary tract infections in Romanian patients with diabetes: prevalence, etiology, and risk factors

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          Abstract

          Aim

          Patients with diabetes mellitus (DM) have an increased risk of infections, especially urinary tract infections (UTIs). The aim of this study was to assess the prevalence and etiology of UTIs and identify the risk factors for their development in patients with DM.

          Patients and methods

          In this retrospective, noninterventional study, the medical records of 2,465 adult patients with DM who were hospitalized in a Diabetes Clinic were reviewed. Data regarding the presence of UTI and possible associated risk factors were collected and their possible relation was analyzed. The study protocol and procedures were approved by the Ethics Committee of Timișoara Emergency Hospital. All data were collected and analyzed using SPSS v.17 statistical software.

          Results

          The prevalence of UTIs in patients with DM was 12.0% (297 cases), being higher in females than in males and higher in patients with type 2 DM compared with patients with type 1 DM. In univariate logistic regression analysis, risk factors associated with UTIs were female gender, age, type 2 DM, longer duration of DM, and the presence of chronic kidney disease and coronary artery disease. Multivariate analysis identified age, duration of DM, and metabolic control (hemoglobin A1c levels) as independent risk factors for UTIs. The gram-negative bacilli from the Enterobacteriaceae family were predominant, with Escherichia coli being the most frequent of them (70.4%).

          Conclusion

          UTIs are a frequent condition associated with DM. It is necessary to improve the care and the screening of UTIs in patients with DM to prevent the occurrence of possible associated severe renal complications.

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          Most cited references 23

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          Urinary tract infections in patients with diabetes.

           Ann Stapleton (2002)
          Results of various epidemiologic studies suggest that bacteriuria and urinary tract infection (UTI) occur more commonly in women with diabetes than in women without this disease. Similar findings have been demonstrated for asymptomatic bacteriuria (ASB), with ASB being a risk factor for pyelonephritis and subsequent decline in renal function. Although ASB is not associated with serious health outcomes in healthy patients, further research needs to be undertaken regarding the impact of ASB in patients with diabetes. Patients with diabetes often have increased complications of UTI, including such rare complications as emphysematous cystitis and pyelonephritis, fungal infections (particularly Candida species), and increased severity and unusual manifestations (e.g., gram-negative pathogens other than Escherichia coli). Anatomic and functional abnormalities of the urinary tract are also associated with diabetes. Such abnormalities result in greater instrumentation of the urinary tract, thereby increasing the risk of secondary UTI. In addition, these abnormalities complicate UTI and require specialized treatment strategies. There is a greater likelihood of UTI affected by antimicrobial resistance or atypical uropathogens, and the risk of upper tract involvement is increased. Pre- and posttherapy urine cultures are therefore indicated. The initial choice of empiric antimicrobial therapy should be based on Gram stain and urine culture. Choice of antibiotic therapy should integrate local sensitivity patterns of the infecting organism. Fluoroquinolones are a reasonable empiric choice for many patients with diabetes. For seriously ill patients, including patients infected with Pseudomonas spp., such agents as imipenem, ticarcillin-clavulanate, and piperacillin-tazobactam may also be considered. Treatment of ASB in patients with diabetes is often recommended to prevent the risk of symptomatic UTI. However, the management of ASB in patients with diabetes is complex, with no single preferred approach.
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            Epidemiology, risk factors and comorbidity for urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing enterobacteria.

            Urinary tract infection (UTI) caused by resistant bacteria is becoming more prevalent. We investigate characteristics and associated risk factors for UTIs resulting from extended-spectrum beta-lactamase (ESBL)-producing enterobacteria. Retrospective study of urinary tract isolates of ESBL-producing enterobacteria in adults (2009 and 2010). We included 400 patients and 103 controls (UTI caused by non-ESBL Escherichia coli). Clinical and demographic information was obtained from medical records. Comorbidity was evaluated using Charlson Index (CI). Strains were identified using VITEK 2 system. A total of 400 isolates were obtained (93%E. coli and 7%Klebsiella spp). In 2009, 6% of cultures were ESBL-producing E. coli and 7% in 2010. 37% of patients were men and 81% were aged ≥60years. CI was 2.3±1.8 (high comorbidity: 42.8%). 41.5% of strains were susceptible to amoxicillin-clavulanate, 85.8% to fosfomycin and 15.5% to ciprofloxacin. The total number of ESBL E. coli positive urine cultures during hospital admission was 97 and, compared with 103 controls, risk factors for UTI caused by ESBL- E. coli strains in hospitalised patients were nursing home residence (p<0.001), diabetes (p=0.032), recurrent UTI (p=0.032) and high comorbidity (p=0.002). In addition, these infections were associated with more symptoms (p<0.001) and longer admission (p=0.004). Urinary tract infection caused by ESBL are a serious problem and identifying risk factors facilitates early detection and improved prognosis. Male sex, hospitalisation, institutionalisation, diabetes, recurrent UTI and comorbidity were risk factors and were associated with more symptoms and longer hospital stay. © 2012 Blackwell Publishing Ltd.
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              Performance Standards for Antimicrobial Susceptibility Testing: Twentieth Informational Supplement, M100–S20

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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2017
                16 December 2016
                : 13
                : 1-7
                Affiliations
                [1 ]Victor Babes University of Medicine and Pharmacy Timisoara
                [2 ]Pius Brinzeu Emergency Hospital
                [3 ]Regional Centre of Public Health, Timisoara, Romania
                Author notes
                Correspondence: Bogdan Timar, Victor Babes University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu, Timisoara 300041, Romania, Tel +40 741 528 093, Fax +40 256 462 856, Email timar.bogdan@ 123456umft.ro
                Article
                tcrm-13-001
                10.2147/TCRM.S123226
                5179217
                © 2017 Chiţă et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Medicine

                urinary tract infections, diabetes mellitus, epidemiology, incidence

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