Prevalence Some Pathogenic Bacteria Causing UTI in Diabetic Patients In / Specialized Center For Endocrinology and Diabetes of Baghdad

Nihad Khalawe Tektook,Khalid Ibrahim Al- Lehibi,Raad K. Al-Husseinei
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Keywords : Urinary tract infections, Diabetes Mellitus, bacteria, Escherichia coli.
Medical Journal of Babylon  14:2 , 2017 doi:1812-156X-14-2
Published :15 October 2017

Abstract

Urinary tract infections (UTIs) are caused by microorganisms but Bacteria are the most common cause when they overcome the natural defenses and causing infection, especially in patients with diabetes mellitus and its may present as asymptomatic bacteriuria, leading more serious infections. The aim of this study was to assess the prevalence of bacteria causing UTIs among diabetic patients. Collected one hundred and seventy five samples of sera and urine form diabetic patients with & without UTIs were studied from the specialized center for Endocrinology and diabetes All urine samples were tested by General urine examination (G.U.E) in addition to urine culture. On MacConkey and blood agar then identify the presence of the bacteria. Urinary tract infection increased with aging and increase percentage of UTI among individuals above 40 years so, high incidence of UTI among diabetic females (75%) rather that in diabetic males (25%). prominent UTI among females (68.8%) rather than males (31.1%) either diabetic or non-diabetic patients, as well as prevalence of smoking among males (74 %) than females (26%), So, Escherichia coli (15 isolates) most of them (13 isolates) in the urine sample of type II D.M particulary, the elderly ?40 years females (11 isolates), and conclude from this study the duration of diabetes can affect the development of complication especially UTI complications, where their prevalence increases with longer duration of disease,Women with diabetes have more frequent and more sever UTI, and Escherichia.coli was the most common pathogen isolated in both groups.

Introduction

Urinary tract infection (UTI) is one of the most common bacterial infections in Iraqi population[1]. However, it is common in many diabetic patients [2]. UTI is common in Iraqi population, and its prevalence rate is 23% from all infections [3]. Urinary tract infection is defined as the presence of both significant bacteriuria (105 CFU/ml) and symptoms [4]. Microorganisms which are known to involve in UTI are bacteria, mycoplasma in addition to fungi. The Bacteria that can live in the digestive tract, vagina or around the urethra , can enter the urinary tract . The most often these bacteria enter the urethra and travel to the bladder and kidney [5], enteric bacteria are common pathogens especially proteus sp., E. coli, Klebsiella and Pseudomonas aeruginosa. These bacteria are found in patients with previous experience of antimicrobial therapy [6]. While Streptococcus agalactiae (group B Streptococcus) may be found in diabetic patients with poor glycemic control. Chlamydia and Mycoplasma may also cause UTIs, but these infections tend to remain limited to the urethra and reproductive system, due to sexually transmitted, and infections require treatment of both partners [7]. Studies revealed that people with diabetes have a higher risk of UTI because of changes in the immune system, immune defenses prevent infection, but despite these safe guards, infections still occurs. There are two important aspects of host defense against UTIs; First the innate immune response to an infection in the bladder or kidneys, so the second , a UTI will be spontaneously resolved in most cases, children and women who don’t get UTIs are more likely to have normal levels of immunoglobulins in their genital and urinary tract [8]. There are two types of diabetes: Type I, when the pancreas is not able to make insulin while Type II occur when pancreas does not make enough insulin or the cells ignore it [9]. The urinary tract infections can be defined as a significant bacteriuria in the presence of symptoms [7], According to Pingle, UTI: is an inflammatory response of the urothelium to bacteria, invasion that is usually associated with bacteriuria and pyuria [10], as well as UTIs are caused by microorganisms – usually bacteria that enter the urethra and bladder, causing inflammation and infection. The bacteria also may travel up the ureters and infect the kidneys [7]. Careful diagnosis and treatment result in successful resolution of infections in most instances. It was reported that UTIs are occurring in two out of every 100 people in America [11], It was noticed that most organisms cause urinary tract infections are bowel commensals and the bacteria can reach the bladder via the urethra from the lower bowel or the perineum [12]. The aim of this study was to study the correlated between UTIs and diabetes mellitus, study many important factors that may play important role in incident the UTIs in diabetes and non- diabetic patients.

Materials and methods

Study Design
    This study includes one hundred and seventy five diabetic Iraqi patients,(one hundred of them are with of Urinary Tract Infections and seventy five without UTI) compared with seventy non-diabetes have UTI as a patient controls, were admitted to specialized center for Endocrinology and diabetes, at  period from August 2013-May 2014.
Collection of Urine Specimens
    The urine specimens were collected as aseptic technique  as possible in a sterile tubes. After preliminary cleaning of the genitalia, Mid-stream urine (MSU) was taken from the patients and the control individuals [10].
     The collected specimens were transported to the laboratory within 30 minutes of collection [13].
If we could not, then the urine specimen were stored at 4?C to prevent the bacterial multiplication in the urine outside the body [14, 15]. 
Laboratory Testing
     Routine urinalysis was carried out for each specimen to determine the Colour; Turbidity; Reaction; Specific gravity; Albumin; Sugar and Keton bodies.
Sugar In Urine was detected using standard method [16].
Keton Bodies In Urine
       Keton bodies in urine were detected by using a dipstick [16].
Microscopical Examination of urine sample was also carried out to identify the components of the urinary sediment [16].
Urine Culture
    The urine specimens were inoculated on both blood and sterilized standard MacConkey’s agar plates by direct  streaking method [14].
Identification of Isolated Bacteria
Cultural Characteristics including Colony size, color, elevation, edges, haemolysis, were determined. Gram Stain and API 20 E strips was used for confirm bacterial identification [16].
Statistical Analysis:
       Analysis of the data were performed by measuring percentage and means value, according to [17].




Results

Table 1: Distribution of the study groups (Diabetic &non- Diabetic patients with UTI & without UTI) according to age patients. Table (1) shows an increase in UTI with aging & according to the age group it is observed that UTI is predominate among individuals at age ?40 years (76.7%) in both diabetic and non-diabetic. These observations are compatible with those of [1] as (95%). The increase percentage of UTI among individuals above 40 years is due to hormonal change in the case of females which affect the immune response after menopause [18], While most of the males complain of prostate problems after the 50 age of years which enhances UTI [19], Moreover the natural killer cells NK & the phagocytic activities remarkably decrease with aging resulting in recurrent infections frequently in old people [20], Similar results were reported by [21,7].

Discussions

Table 1: Distribution of the study groups (Diabetic &non- Diabetic patients with UTI & without UTI) according to age patients. Table (1) shows an increase in UTI with aging & according to the age group it is observed that UTI is predominate among individuals at age ?40 years (76.7%) in both diabetic and non-diabetic. These observations are compatible with those of [1] as (95%). The increase percentage of UTI among individuals above 40 years is due to hormonal change in the case of females which affect the immune response after menopause [18], While most of the males complain of prostate problems after the 50 age of years which enhances UTI [19], Moreover the natural killer cells NK & the phagocytic activities remarkably decrease with aging resulting in recurrent infections frequently in old people [20], Similar results were reported by [21,7].

Conclusions

Women with diabetes have more frequent and more sever UTI . UTI is predominate among individuals above 40 years. smoker patients with diabetes mellitus more than in non- diabetes mellitus, E..coli was the most common pathogen isolated in both groups.

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