Incidence microbiological profile and drug resistance pattern of uropathogens causing asymptomatic bacteriuria among below poverty line diabetic male patients

Abstract

Introduction: With the prevalence of DM increasing among rural population in developing countries, factors associated with diabetes and its complications also becomes more important. More than half of diabetic patients with ASB have upper urinary tract involvement and the frequency of symptomatic UTI had been significantly higher. Symptomatic UTIs tends to be more common in diabetic subjects with ASB than in those without ASB. Although ASB is of major concern in diabetic population, the long-term consequences of ASB in patients with DM are poorly documented, Almost all studies were performed among elderly women with type 2 diabetes and there is very little information on the occurrence of ASB among BPL diabetic males in our local setting. Hence in the present study the incidence and etiology of ASB among BPL diabetic male patients was monitored along with the resistance pattern of bacterial isolates to antimicrobial agents.

Materials and methods: Clean catch voided midstream urine samples were collected from 1131 BPL Diabetic male patients enrolled for the study. Wet film of centrifuged urine was performed to detect the presence of pus cells, epithelial cells, erythrocytes, microorganisms, cast. Culture was performed using standard loop method and antimicrobial susceptibility of the isolates was studied using Kirby Bauer disc diffusion method following CLSI guidelines.

Results: Out of 1131 BPL diabetic male patients screened for ASB, 155 (13.7%) were culture positive. Among the uropathogens Gram negative bacilli was the most commonest type (72.7%) and the most prevalent organisms isolated was Klebsiella spp (35.2%), Enterococcus spp (22.4%), followed by E. coli (19.4 %) ,Pseudomonas aeruginosa ( 7.3%), etc.,. 87.5% of E.coli isolated were ESBL, followed by 77.6 % of Klebsilla spp and 11.1 % Enteroabacter spp. Pseudomonas aeruginosa reported in this study were 100% ESBL and 16.6% Metallo β lactamase (MBL) producers.8.1 % of Vancomycin resistant Enterococcus (VRE) was also found in this study.

Conclusion: This study demonstrated a high occurrence of ASB in BPL diabetic males (13.7%). Klebsiella was the most commonest uropathogen found in our study followed by Enterococcus , E.coli and Pseudomonas. E.coli and Pseudomonas showed high rates of drug resistance. Nitrofurantoin and Amikacin was the most effective drugs for majority of the isolates. Hence routine monitoring and screening for ASB in this population is essential. Moreover patients in rural parts of developing countries with diabetes has to be sensitized about the complications of ASB and regarding maintenance of their glycemic control which is of major importance in prevention of the condition.