**11. Antimicrobial agents**

cultures. In this population, almost 78% of patients were having asymptomatic bacteriuria.

**Gram-negative microorganisms Frequency (%) Gram-positive microorganisms Frequency (%)**

*Escherichia coli* 56.75 Alpha *Streptococci* 33.33 *Klebsiella pneumonia* 21.62 *Staphylococcus aureus* 66.66 *Pseudomonas aeruginosa* 9.54 *S. epidermidis* 0 *Enterobacter aerogenes* 4.05 **— —** *Proteus mirabilis* 4.05 **— —** *Citrobacter freundii* 4.05 **— —**

54 Microbiology of Urinary Tract Infections - Microbial Agents and Predisposing Factors

About 10.5% of type 2 and 12.8% of type 1 diabetic patients had UTI. There is no significant difference between type 1 and type 2 diabetes (p = 0.45); 4.5% of men and 15.3% of women

Chiţă et al*.* concluded that urinary tract infections are more prevalent in diabetic patients. Because of the high proportion of asymptomatic forms among diabetic patients, the urine

The pathogens involved in causing urinary tract infection in diabetic patients and their fre-

Generally, treatment of UTI is similar in both diabetic patients and nondiabetic patients [5]; however, the choice of antibiotics in UTI patients with diabetes is one of the important considerations in the therapeutic management. Possible drug interactions between antimicrobials

• Presence of infection in the bladder (lower UTI) or also involves the kidney (upper UTI)

Moreover, UTI treatment varies based on patient's age, sex, infecting agent, underlying disease, and whether there is lower or upper urinary tract involvement. Several clinical trials revealed that increasing trends of resistance to many antimicrobials with the increasing trend

and antidiabetics or certain antibiotics may lead to impaired glucose homeostasis.

UTI treatment in diabetes patients depends on various factors including [5];

The most frequent bacteria involved in UTI are *Escherichia coli* (68.9%) [9].

developed UTI, an extremely significant difference (p < 0.0001)

culture should be done in all hospitalized patients with diabetes.

**10. Management of urinary tract infections in diabetics**

quency are mentioned in **Table 2**.

**Table 2.** Pathogens of UTI in diabetes.

• Presence of symptoms

• Presence of urologic abnormalities

• Occur with metabolic alterations and renal function

• Severity of systemic symptoms

There are several types of antimicrobial agents such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics. Likewise, there are several types of microorganisms such as bacteria, fungi, viruses, and parasites. Microorganisms are responsible for various infectious diseases and sometimes leading to death. Antimicrobial agents play an essential role in decreasing morbidity and mortality associated with infections. Antimicrobial agents increased the life expectancy and quality of life. Different antimicrobial agents and their mechanism of action are mentioned in **Table 3**.

#### **11.1. Benefits of antimicrobial agents**



Gram-negative bacilli in 1983, emergence of VRE in 1986, increased infections with MRSA, PRSP, BLNAR, etc. and increase of resistant *gonococci* in 1990s, increase of MDRP, and increase

Urinary Tract Infection in Diabetics

57

http://dx.doi.org/10.5772/intechopen.79575

of quinolone-resistant *E. coli* in 2000s are the emergence of drug resistance bacteria.

• Using sub-optimal dose of antibiotics for prophylaxis and treatment of infection

• Mutation in the antimicrobial agent's target which reduces the antimicrobial agent binding. • Posttranslational or posttranscriptional modification of the antimicrobial agent's target,

Urinary tract infections are more common in the diabetic patients. Diabetic patients are severely affected with urinary tract infection. Treatment of UTI without proper diagnosis may lead to antimicrobial drug resistance. Treatment with antimicrobial agents should be started on the basis of culture reports. Only bacteriuria with symptoms of UTI should be treated with antibiotics to avoid the spread of drug resistant pathogens in the society. This practice can reduce the morbidity and mortality in diabetic patients suffering from urinary tract infection.

Major reasons for increasing antimicrobial resistance:

• Noncompliance with infection-control practices

• Multiple comorbidities in hospitalized patients

• Increased number and duration of intensive care unit stays

• Grouping of colonized patients in long-term-care facilities

• Colonized patients transfer from hospital to hospital

Major mechanisms for acquired antimicrobial resistance:

which reduces binding of the antimicrobial agent

The multidrug resistant pathogens are a challenge to society.

• Enzyme that degrades the antimicrobial agent

• Enzyme that alters the antimicrobial agent

• Reduced uptake of the antimicrobial agent

• Antimicrobial agent target overproduction

• Active efflux of the antimicrobial agent

**13. Conclusion**

• Ineffective infection-control practices

• Prolonged hospitalization

**Table 3.** Different antimicrobial agents and its mechanism of action.
