1. Healthcare

453
Diabetes mellitus as a risk factor for resistant strains on female patients with recurrent urinary
tract infection: A study of 493 patients
Eur Urol Suppl 2014;13;e453 Print!
Print!
Hisano M. 1 , Bruschini H.1 , Nicodemo A.C. 2 , Lucon M. 1 , Gomes C.M. 1 , Baracat F.1 , Figueiredo J.A.1 , Srougi M. 1
1 Hospital
Das Clinicas, University of Sao Paulo, Dept. of Urology, Sao Paulo, Brazil, 2 Hospital Das Clinicas, University of Sao Paulo, Dept.
of Infectious Disease, Sao Paulo, Brazil
INTRODUCTION & OBJECTIVES: Diabetes mellitus (DM) is a prevalent chronic disease in adult population. This condition is a well-known
risk and complicating factor for others disease, such as urinary tract infection (UTI). General host factors enhancing risk for urinary tract
infection in diabetics include age, metabolic control, and long term complications, primarily diabetic nephropathy and cystopathy. This study
aims to identify a potential effect of DM on bacteriology and susceptibility profile for UTI.
MATERIAL & METHODS: Between January/2007 and December/2012, we retrospectively review the clinical data and laboratory findings of
493 female patients with diagnosis of simple or recurrent uncomplicated urinary tract infection, treated at our University Hospital. Patients
were divided in two groups: the first with patients without DM (group 1); and the second with diabetic patients (group 2). Bacteriology of
urine culture and susceptibility tests for nalidixic acid, amoxicillin/clavulanate, ampicillin, cefoxitin, ciprofloxacin, gentamicin, levofloxacin,
norfloxacin, nitrofurantoin and TMP-SMX were performed. The results of each group were compared. Statistical analysis was performed
with X 2 test or Fisher´s exact test with significance of p<0.05.
RESULTS: Of these patients, 46 (9.3%) had diabetes mellitus. Recurrent UTI was more frequent in group 2 (67.4% versus 41.9% at group
1 - p=0.001). The bacteriological profile showed a higher frequency of Enterococcus faecalis on group 2 (table 1), comparing to group 1
(15.2% versus 5.6%, p=0.02). The susceptibility profile showed a significant decrease when comparing groups 1 and 2 for: nalidixic acid
(81.3% x 60%); ciprofloxacin (84.9% x 63.6%); gentamicin (97.1% x 83.3%); levofloxacin (86.2% x 68.4%); norfloxacin (86.9% x 64.3%);
and TMP-SMX (67.3% x 51.2%), respectively, with p<0.05. No significant changes on susceptibility profile comparing groups 1 and 2 were
identified for amoxicillin/clavulanate (94.3% x 93.9%), ampicillin (47.3% x 43.2%), cefoxitin (95.5% x 93.3%) and nitrofurantoin (92.4% x
97.1%), respectively, although ampicillin already has a high resistance profile in both groups. Data are summarized on table 2.
Table 1
Bacteriology
Group 1 Group 2 p
Escherichia coli
74.5%
80.4%
0.38
Enterococcus faecalis
5.6%
15.2%
0.02
Staphylococcus saprophyticus 7.4%
0%
0.06
Klebsiella pneumoniae
3.6%
6.5%
0.41
Proteus mirabilis
4.3%
2.2%
>0.99
Streptococcus agalactiae
3.5%
2.3%
>0.99
Other species
7.6%
8.7%
0.77
Table 2
Antimicrobial
Nalidixic acid
Group 1
Group 2
p
Susceptible(%) Resistant(%) Susceptible(%) Resistant(%) 81.3
18.7
60
40
0.002
Amoxicillin/clavulanate 94.3
5.7
93.9
6.1
>0.99
Ampicillin
47.3
52.7
43.2
56.8
0.60
Cefoxitin
95.5
4.5
93.3
6.7
0.64
Ciprofloxacin
84.9
15.1
63.6
36.4
<0.001
Gentamicin
97.1
2.9
83.3
16.7
0.001
Levofloxacin
86.2
13.8
68.4
31.6
0.004
Norfloxacin
86.9
13.1
64.3
35.7
0.04
Nitrofurantoin
92.4
7.6
97.1
2.9
0.49
TMP-SMX
67.3
32.7
51.2
48.8
0.04
CONCLUSIONS: Diabetic patients present increased chance of recurrent UTI. The different bacteriology profile and decreased
susceptibility to most of antimicrobials make the urine culture recommended before treatment. In our environment, in case of immediate
oral empiric treatment, amoxicillin/clavulanate and nitrofurantoin should be indicated until urine culture result.