Research Article
Prevalence of Urinary Tract Infection and Antimicrobial
Susceptibility among Diabetic Patients with Controlled and
Uncontrolled Glycemia in Kuwait
May Sewify,
1
Shinu Nair,
1
Samia Warsame,
2
Mohamed Murad,
1
Asma Alhubail,
1
Kazem Behbehani,
1,2
Faisal Al-Refaei,
1
and Ali Tiss
2
1
Clinical Services Department, Dasman Diabetes Institute, P.O. Box 1180, 15462 Kuwait, Kuwait
2
Biochemistry & Molecular Biology Unit, Dasman Diabetes Institute, P.O. Box 1180, 15462 Kuwait, Kuwait
Correspondence should be addressed to Ali Tiss; ali.tiss@dasmaninstitute.org
Received 9 July 2015; Revised 1 November 2015; Accepted 4 November 2015
Academic Editor: Giovanni Annuzzi
Copyright © 2016 May Sewify et al. Tis is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Diabetic patients have higher risk of urinary tract infection (UTI). In the present study, we investigated the impact of glycemic
control in diabetic patients on UTI prevalence, type of strains, and their antimicrobial drugs susceptibility. Tis study was conducted
on urine samples from 722 adult diabetic patients from which 252 (35%) samples were positive for uropathogens. Most UTI cases
occurred in the uncontrolled glycemic group (197 patients) versus 55 patients with controlled glycemia. Higher glycemic levels
were measured in uncontrolled glycemia group (HbA1c = 8.3 ± 1.5 and 5.4 ± 0.4, resp., < 0.0001). Females showed much higher
prevalence of UTI than males in both glycemic groups (88.5% and 11.5%, resp., < 0.0001). In the uncontrolled glycemia group
90.9% of the UTI cases happened at ages above 40 years and a clear correlation was obtained between patient age ranges and number
of UTI cases ( = 0.94; = 0.017), whereas in the group with controlled glycemia no trend was observed. Escherichia coli was the
predominant uropathogen followed by Klebsiella pneumoniae and they were together involved in 76.2% of UTI cases. Tose species
were similarly present in both diabetic groups and displayed comparable antibiotic resistance pattern. Tese results highlight the
importance of controlling glycemia in diabetic patients to reduce the UTI regardless of age and gender.
1. Introduction
Urinary tract infections (UTIs) are one of the most common
microbial diseases encountered in medical practice afecting
people of all ages [1]. Worldwide, UTIs’ prevalence was
estimated to be around 150 million persons per year [2].
Diabetic patients have a higher incidence of UTI than
their nondiabetic counterparts [3, 4] with a higher severity
UTI which can be a cause of complications, ranging from
dysuria (pain or burning sensation during urination) to
organ damage and sometimes even death due to complicated
UTI (pyelonephritis) [5]. In 2012, the direct medical costs
associated with managing UTIs in the 22 million diabetic
patients in USA were estimated to be more than $2.3 billion
[6]. Moreover, diabetic patients encounter further urinary
urgency and incontinence during night, a condition ofen
manifested by painful urination and retention of urine in
the bladder [7]. Furthermore, those patients frequently sufer
from bacterial cystitis with higher prevalence in diabetic
women including higher prevalence of both asymptomatic
bacteriuria and symptomatic UTI added to recurrent compli-
cations as compared to healthy women [8, 9]. In women, pre-
menopausal and postmenopausal periods aside with sexual
activity are considered increased risk factors for developing
UTI [3, 8, 10]. Finally, diabetic women have up to four times
more UTI risk when they are in oral treatment or insulin
injection [10].
Potential explanation of the increased UTI in diabetic
patients might be the nerve damage caused by high blood
glucose levels, afecting the ability of the bladder to sense
the presence of urine and thus allowing urine to stay for a
long time in the bladder and increasing infection probability
[8, 11]. Another explanation is that high glucose levels in
urine improve the growth of the bacteria in the urine [12].
Hindawi Publishing Corporation
Journal of Diabetes Research
Volume 2016, Article ID 6573215, 7 pages
http://dx.doi.org/10.1155/2016/6573215