Antimicrobial resistance of uropathogens in diabetic patients

Patients with Diabetes mellitus (DM) have higher rates of urinary tract infections (UTIs). This study evaluated the antimicrobial resistance (AMR) of uropathogens and whether uropathogens isolated from DM patients exhibit greater AMR.

A cross-sectional multicenter study included adults with UTI symptoms and a positive urine culture from December 2020 to January 2021. Patients were categorized into uncomplicated UTI (G1, n = 133), complicated UTI without (G2, n = 215), or with DM (G3, n = 217). Patient data, microbiology results, and associations between DM, antibiotic resistance, and bacterial isolates were analyzed using Kruskal-Wallis followed by Dunn's multiple comparisons or Fisher's exact test, as appropriate.

E. coli from the complicated UTI groups G2 and G3 were resistant to more antibiotics and antibiotic classes, with a higher percentage of non- E. coli isolates than G1. The percentage of multidrug-resistant E. coli in G1, G2, and G3 was 30.5%, 61.8%, and 59.0%, respectively. In G1, resistance to fluoroquinolones and trimethoprim-sulfamethoxazole exceeded 20%, but remained below 20% for nitrofurantoin and fosfomycin. Although G2 and G3 had similar resistance profiles, differences occurred for specific antibiotics. E. coli from G3 exhibited higher resistance to nitrofurantoin (10.2% vs. 34.3%, p-value < 0.001) and piperacillin-tazobactam (31.3% vs. 16.6%, p-value = 0.061). In contrast, G2 Uropathogens had higher resistance to nalidixic acid, norfloxacin, and ofloxacin compared to G3.

These findings suggest a possible association between DM and the chance of recovering an isolate resistant to nitrofurantoin. Stratifying patients by risk factors like DM could improve empiric therapy outcomes and contribute to reducing AMR.