Date Published: February 09, 2017
Author(s): Barbara I. Nabaigwa, Bashir Mwambi, John Okiria, Caesar Oyet.
Between June 2015 and October 2015, 159 mid-stream urine samples from diabetic patients were cultured. The prevalence of urinary tract infection was high at 22% and women were more affected compared with men (P = 0.017). Factors associated with urinary tract infection in these patients were age, sex and high blood glucose levels. Diabetic patients should be screened periodically for urinary tract infection.
Urinary tract infection (UTI) is common among both adults and children. According to Tandogdu and Wagenlehner,1 prevalence of UTI varies greatly worldwide from 0.7% to 20%. Patients with diabetes mellitus are highly susceptible to UTI,2,3 and up to 35% of diabetic patients experience a UTI. A number of factors predispose patients with diabetes to UTI. These factors include weak host immune systems with impaired neutrophil function, depressed T-cell-mediated immune response, decreased production of prostaglandin E, thromboxane B2 and leukotriene B44 and depressed antioxidant systems,5 all of which expose such patients to infection. Urinary incontinence due to disorders of the autonomic nervous system leads to incomplete bladder emptying, which in turn allows uropathogens to colonise and invade the urogenital niches.4 Presence of glucose in urine of the diabetic patients, coupled with poor metabolic control, provides a conducive environment for pathogenic bacteria to flourish and cause UTIs.6
A total of 210 diabetic patients consented and were recruited, of whom 122 (76.7%) were women. The rapid dipstick test showed that a total of 159 (75.7%) of the urine specimens were positive for either nitrites, leukocytes or both; these were cultured and included in the analysis. Thirty-five of the 159 cultures were positive for bacterial growth (> 105 CFU/mL of urine) giving the prevalence of UTI at 22.0%. Of the 122 female participants, a total of 29 (23.8%) had a UTI compared with 14 (15.9%) of 88 men (P = 0.017). Also, 22 out of the 35 positive culture were from patients aged over 50 years (P = 0.003) (Table 1), and 28 of 35 (80%) uropathogens were isolated from participants with hyperglycaemia (P = 0.0026). Only 7 of the 35 (20%) isolates were obtained from participants with a normal glucose level, whereas no isolate was obtained from participants with low fasting blood glucose (P < 0.0001). Eighteen of the 35 (51.4%) isolates were Staphylococcus saprophyticus, 12 (34.3%) were Escherichia coli, 3 (8.6 %) were Klebsiella spp., 1 (2.85%) was Citrobacter spp. and 1 (2.85%) were enterococci. Urinary tract infection, defined as the presence of > 105 CFU of bacteria per mL of fresh urine,9 is a common type of infection. The risk of UTI is two to three times higher among patients with diabetes than among their non-diabetic counterparts.9 The overall prevalence of UTI in our study was 22.0%, which is high compared to a study conducted among Romanian patients where the prevalence of UTI was 12.0%.10 This difference in prevalence could be due to, among other causes, variations in socioeconomic status.2 Diabetes management is expensive; thus, low-income countries such as Uganda are more prone to advanced effects, including UTI, compared with middle-income countries such as Romania. However, the prevalence of UTI in our study was similar to that of a study in Sudan where prevalence was 19.5%12 and the socio-demographic environment is similar to Uganda. These findings call for earlier interventions to control diabetes in low-income countries.