| Backgrounds and aims:Diabetes (Diabetes Mellitus, DM) is a common clinical metabolic disease, and the prevalence of DM in the worldwide is rapidly increasing in recent years. In the year2007-2008, an investigation including42thousand people in the11provinces of China showed that the prevalence of diabetes was9.7%among the people over20years old. Because of abnormal metabolism and immune function reduction, patients with DM have a higher risk of infections than normal individuals, and urinary tract infection (UTI) is a common type of infections in patients with DM.Although mechanism of urinary tract infection in patients with DM has not been determined so far, some researches proposed following possibilities:decline of neutrophil function, reduction of cytokines secretion, metabolic disorder, neurogenic bladder, and microvascular complications in diabetic patients.Urinary tract infection is commonly seen in women of all ages, and mainly postmenopausal women. Some epidemiological statistic data indicated that women with asymptomatic bacteriuria accounted for30%in diabetic patients. Therefore, it is important to analyze related risk factors and prevent urinary infection in patients with DM. Besides the traditional use of antibiotics for treatment, blood glucose controlling and normal body weight maintaining, preventive therapeutic measures specifically for menopausal females are also important.Methods:In this study, we first compared pathogen distribution and drug resistance between diabetic patients with positive urine culture and simple urinary tract infection patients with positive urine culture, in order to investigate rational use of antibiotics for diabetic patients with UTI. Then, we compared the basic and laboratory test data between diabetic patients with and without urinary tract infections, to further analyse risk factors, mechanism, and measures for prevention and treatment of diabetes complicated with UTI.Methods(1) Comparison of pathogen distribution and drug resistance between diabetic and simple urinary tract infection groups:In this study we first collected medical records of1128cases of hospitalized patients with positive urine bacterial culture in Qilu Hospital of Shandong University from January2011to December2012. In ordel to avoid the affect to the result. According to the exclusion criteria in "materials and methods", we removed the urinary tract infection patients with other underlying diseases, such as stones, surgery, use of immunosuppressive agents, minors, etc. Eventually464hospitalized patients with positive urine culture were chosen by screening in the first part of this research, including82cases of diabetic patients with positive urine culture and382cases of simple urinary tract infection patients with positive urine culture. Medical records of both groups were reviewed including type of pathogens isolated and their antibiotic resistance.(2) A total of315hospitalized patients with diabetes recruited in the second part of this research were divided into infection group (151cases of diabetic patients complicated with UTI) and non-infection group (164cases of diabetic patients without UTI) according to the presence or absence of urinary tract infections. We reviewed patients’medical records including gender, age (years), menopausal status, glycosylated hemoglobin level (%), urine glucose, body mass index (BMI, kg/m2), together with glomerular filtration rate (GFR, ml/min) and analyzed the correlationship between urinary tract infections and above mentioned factors in patients with diabetes.Results:1. Comparison of pathogen distribution and drug resistance between diabetic patients with positive urine culture and simple urinary tract infection patients with positive urine culture.The most frequent UTI pathogens in those groups were respectively:Escherichia coli (58.5%vs49.0%,P>0.05), Enterococcus faecium (7.3%vs6.5%, P>0.05), Enterococcus faecalis (4.9%vs7.9%, P>0.05), and Candida albicans (9.8%vs7.6%, P>0.05). We observed no significant difference regarding pathogen distribution in the tow groups. By comparing resistance data of E. coli for different antibiotics between two groups, we found the resistance of uropathogenic E. coli in diabetic patients with positive urine culture is not higher than that seen in simple urinary tract infection patients with positive urine culture group.2. Comparison of basic data between diabetic infection and non-infection groups A total of151diabetic patients were selected into the infection group, including15males and136females, and127women were in postmenopausal stage. One hundred sixty-four diabetic patients were selected into non-infection group, including95males and69females, and54women were in postmenopausal stage. There was significant difference in gender distribution (P<0.01) between two groups. The infection group was mainly composed of females, especially postmenopausal women, the percentage of which was significantly higher than that in non-infection group (P<0.01). The average age of infection group and non-infection group was65.46±11.28and58.60±15.03years, respectively. There was significant difference (P<0.01) between two groups. The BMI of infection group and non-infection group was25.17±3.8kg/m2and25.34±4.1kg/m2, respectively. There was no significant difference (P>0.05) between two groups.3. Comparison of laboratory test data between diabetic infection and non-infection groupsThe average glycosylated hemoglobin level of infection group and non-infection group was8.87±2.3%and9.33±3.2%, respectively. There was no significant difference (P>0.05) between two groups. The GFR of infection group and non-infection group was80.44±30.4ml/min and89.16±34.7ml/min, respectively. There was significant difference (P<0.01) between two groups. Urine glucose of infection group and non-infection group was positive in63patients (41.7%) and50(30.5%) patients, respectively. There was significant difference (P<0.05) between two groups.Conclusions:1.Urine bacteriological analysis indicated that there was no significant difference regarding pathogen distribution in diabetic patients with positive urine culture and simple urinary tract infection patients with positive urine culture. We also observed the resistance of uropathogenic E. coli in diabetic group is not higher than that seen in simple urinary tract infection patients with positive urine culture.2.Univariate analysis indicated that elder age, female, postmenopausal status, decreased GFR, and positive urinary glucose were risk factors of diabetic patients complicated with urinary tract infections. BMI and glycosylated hemoglobin levels were not related with urinary tract infections in patients with DM. Multivariate Logistic regression revealed that elder age, female, positive urine glucose were independent risk factors of diabetic patients complicated with urinary tract infections. |
PDF Full Text Request