**9. Pathogens of UTI in diabetes**

**iv.** Classification based on microbiological findings

**7. Diagnosis of urinary tract infection in diabetics**

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

instead of infection, when there is bacteriuria [32].

• **Dipstick:** Tests for the presence of urinary nitrite.

voided, clean-catch, and midstream urine) [33].

**Table 1.** Symptomatic difference between upper and lower UTI.

**7.1. Diagnosis of UTI in women patients**

**Lower UTI Upper UTI**

• Frequency • Urgency • Dysuria • Suprapubic pain

Diagnosis of urinary tract infection can be done by following methods.

• **Microscopic examination:** Allows for visualizing bacteria in urine.

ability to reduce nitrate to nitrite (mostly Gram-positive bacteria).

○ **Positive test:** Indicates the presence of bacteria in urine.

tract symptoms

Upper and lower UTI can be suspected in diabetic patients with most common symptoms. Symptoms vary in upper and lower UTI. **Table 1** highlights the symptomatic difference

• **Examination of midstream urine specimen:** After the symptomatic identification, a midstream urine sample should be examined for the presence of WBCs, as pyuria is present in

• **Pyuria detection:** Pyuria can be detected either by microscopic examination (defined as >10

• **Colonization:** An absence of pyuria on microscopic assessment can suggest colonization,

○ **Negative test:** is the product of low count bacteriuria or bacterial species that lack the

• **Urine culture:** Should be done in all cases of suspected UTI in diabetic patients, prior to initiation of treatment (preferred method of obtaining a urine sample for culture is from

All women with recurrent UTI should undergo a physical examination to evaluate urogenital anatomy and vaginal tissues estrogenization. Postvoid residual urine volume also should

Costovertebral angle pain/tenderness fever and chills, with or without lower urinary

) or by dipstick leukocyte esterase test (sensitivity of 75–96% and specific-

**v.** Classification based on complications

between upper and lower UTI.

almost all cases of UTI.

leukocytes/mm<sup>3</sup>

ity of 94–98%).

A descriptive, cross sectional study was conducted on UTI and antibiotic sensitivity pattern among diabetic patients in National Academy of Medical Sciences (NAMS), Mahabouddha, Kathmandu, Nepal. According to this study, *E. coli* is the most common organism followed by *Klebsiella, Proteus,* and *Pseudomonas*. Most of the urinary isolates were sensitive to Ceftriaxone, Ciprofloxacin, and Cotrimoxazole, whereas resistance was high for ampicillin [35].

A study was conducted to find out the prevalence of UTI in diabetic patients. A total of 1470 diabetic patients (847 women and 623 men) were included in the study, admitted to the Diabetes Clinic of the Emergency Clinical County Hospital Timişoara between January and December 2012. According to this study, 10.7% in overall population had positive urine


of antibiotic resistance in *E. coli*, with limited therapeutic options, the management of urinary

Urinary Tract Infection in Diabetics

55

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

Acute cystitis treatment should be tailored according to culture results, if obtained. Apart from proper glucose control, one of the following UTI treatments is mandatory for acute cystitis management [36]. **First line treatment management**: Nitrofurantoin 100 mg three times daily for 5 days or fosfomycin trometamol 3 g single dose, or trimethoprim-sulfamethoxazole 960 mg twice daily for 3 days (can be used empirically only if resistance prevalence is known to be less than 20% and medication was not used in previous 3 months). **Second line manage-**

Hospitalization should be done for the patients with severe symptoms for initial intravenous antibiotic therapy [5, 36]. Empiric antibiotics treatment: broad-spectrum cephalosporins, aminoglycosides, fluoroquinolones, piperacillin-tazobactam, or carbapenems should be started [37]. Severe sepsis presenting patients or those known to harbor-resistant uropathogens or the patients who have received multiple antibiotic courses should receive broad-spectrum coverage, guided by current urinary culture report. Treatment should be tailored when culture reports are available.

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

• Prevent or treat infection after surgery (C section, organ transplants, joint replacements, etc.)

• Antimicrobial drugs decrease the morbidity and mortality caused by food-borne, water-

**10.1. Treatment recommendations for UTI in diabetes according to Infectious** 

tract infections is likely to become complicated.

*10.1.1. Acute cystitis management in patients with type II diabetes*

*10.1.2. Pyelonephritis management in patients with type II diabetes*

**Diseases Society of America (IDSA)**

**ment**: Quinolones and β-lactams.

**11. Antimicrobial agents**

action are mentioned in **Table 3**.

• Prevent and treat infection

**11.1. Benefits of antimicrobial agents**

• Increased the expected life spans of human being

borne, and other poverty-related infections

• Prevent or treat infection at the time of chemotherapy treatments

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

cultures. In this population, almost 78% of patients were having asymptomatic bacteriuria. The most frequent bacteria involved in UTI are *Escherichia coli* (68.9%) [9].

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

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 culture should be done in all hospitalized patients with diabetes.

The pathogens involved in causing urinary tract infection in diabetic patients and their frequency are mentioned in **Table 2**.
