Urinary Tract Infection: Prevalence, Risk Factors, Bacterial Etiologies and Antimicrobial Resistance Profile among Egyptian Diabetic Patients


  •   Dalia E. Desouky

  •   Hala M. Gabr

  •   Mohammed El-Helbawy

  •   Hanan M. Hathout


Diabetic patients are more prone to infections due to impaired immune status. One of most frequent infections in diabetic patients are urinary tract infection (UTI). The aim of the work was to study the prevalence and associated risk factors of UTI among diabetic patients attending the outpatient clinics of Menoufia university hospital, and to assess the pattern of antimicrobial sensitivity of isolated organisms. A pre-designed questionnaire was used to collect information about age, sex and residence, smoking habits, and type and duration of diabetes. Laboratory investigations including blood analysis for glucose level, HBA1c, leucocytic count, urine culture and antimicrobial sensitivity testing were done. The prevalence of UTI was 51.3%, and the most significant risk factors associated with infection were older age, being female, BMI > 30, duration of diabetes > 10 years, together with uncontrolled diabetes. Residence, smoking, and type of diabetes were found to be insignificantly associated with UTI. Age, duration of diabetes, and HBA1c were found to be independently associated with UTI. Common isolated organisms in order of frequency were E. coli, Klebsiella, and Coagulase negative staph. More than 50% of isolates were resistant to one or more antibiotic on antimicrobial antibiotic sensitivity testing. The study concluded a high prevalence of UTI among studied patients. Proper control of diabetes with regular screening for HBA1c and UTI among diabetic patients is needed.

Keywords: Egyptian, infection, risk, urinary


World Health Organization (WHO). WHO The top 10 causes of death. Fact sheet Nr. 310. Updated June 2011. htttp://www.who.int/mediacentre/factsheets/fs310/en/index.html.

NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants. Lancet 2016; 387:1513–30.

Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract 2014;103(2):137–49.

Benfield T, Jensen JS, Nordestgaard BG. Influence of diabetes and hyperglycemia on infectious disease hospitalization and outcome. Diabetologia 2007; 50:549–54.

Schneeberger C, Kazemier BM, Geerlings SE. Asymptomatic bacteriuria and urinary tract infections in special patient groups: women with diabetes mellitus and pregnant women. Curr Opin Infect Dis 2014;27(1):108–14.

Yu S, Fu AZ, Qiu Y, Engel SS, Shankar R, G. Brodovicz K, et al Disease burden of urinary tract infections among type 2 diabetes mellitus patients in the U.S. J Diabetes Complications 2014;28:621-26.

American Diabetes Association. Position statement. Standards of medical care in diabetes 2012. Diabetes Care 2012; 35: S11-S63.

Kofteridis DP, Papadimitraki E, Mantadakis E, Maraki S, Papadakis JA, Tzifa G, et al. Effect of diabetes mellitus on the clinical and microbiological features of hospitalized elderly patients with acute pyelonephritis. J Am Geriatr Soc 2009; 57(11):2125–8.

Saleem M, Daniel B. Prevalence of Urinary Tract Infection among Patients with Diabetes in Bangalore City. International Journal of Emerging Sciences 2011; 1(2): 133-42.

Hakeem LM, Bhattacharyya DN, Lafong C, Janjua KS, Serhan JT, Campbell IW. Diversity and complexity of urinary tract infection in diabetes mellitus. The British Journal of Diabetes & Vascular Disease 2009; 9(3): 119-25.

Funfstuck R, Nicolle LE, Hanefeld M, Naber KG. Urinary tract infection in patients with diabetes mellitus. Clin Nephrol 2012; 77:40–8.

Aswani SM, Chandrashekar UK, Shivashankara KN, Pruthvi BC. Clinical profile of urinary tract infections in diabetics and non-diabetics. Australasian Medical Journal 2014; 7(1): 29–34.

Hegazi R, El-Gamal M, Abdel-Hady N, Hamdy O. Epidemiology of and Risk Factors for Type 2 Diabetes in Egypt. Annals of global health 2015;81(6):814-20.

El-Nagara MMG, Dawooda AEE, Gabrb HM, Abd El-Nabya EEM. Prevalence of urinary tract infection in Damietta diabetic patients. Menoufia Medical Journal 2015; 28:559–64.

Alberti KGM, Zimmet P, Shaw J. Metabolic syndrome: a new worldwide definition. A consensus statement from the International Diabetes Federation. Diabetic Med 2008; 23:469–80.

American diabetes association. Executive Summary: Standards of Medical Care in Diabetes—2009. Diabetes care 2009; 32: Suppl 1: S6-12.

Forbes B, Sahm D and Weissfeld A. (2007). Infection of the urinary tract. Bailey and Scott’s Diagnostic Microbiology, 12th ed., Mosby, USA.

National Committee for Clinical Laboratory Standards (NCCLS). Performance standards of antimicrobial susceptibility, NCCLS approved standards M 100-59 National Committee for Clinical Laboratory Standards, Wayne PA. 2002.

Adly NN, Ragab YM, Hashem AM, Ahmady AK. Effect of diabetes on occurrence of urinary tract infection and asymptomatic bacteriuria among diabetic and ketacidosis patients in Egypt. International Research Journal of Microbiology (IRJM) 2015; 6(3):27-36.

Goswami R, Bal CS, Tejaswi S, Punjabi GV, Kapil A, Kochupillai N. Prevalence of urinary tract infection and renal scars in patients with diabetes mellitus. Diab Res Clin Pract 2001; 53:181–6.

He K, Hu Y, Shi JC, Zhu YQ, Mao XM. Prevalence, risk factors and microorganisms of urinary tract infections in patients with type 2 diabetes mellitus: a retrospective study in China. Therapeutics and Clinical Risk Management 2018;14 403–8.

Hamdan HZ, Kubbara E, Adam AM, Hassan OS, Suliman SO, Adam I. Urinary tract infections and antimicrobial sensitivity among diabetic patients at Khartoum, Sudan. Annals of Clinical Microbiology and Antimicrobials 2015; 14:26-32.

Nitzan O, Elias M, Chazan B, Saliba W. Urinary tract infections in patients with type 2 diabetes mellitus: review of prevalence, diagnosis, and management. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2015, 8:129–36.

Akter T, Mia Z, Shahriar M. Antibiotic Sensitivity of Pathogens Causing Urinary Tract Infection. Bangladesh Pharmaceutical Journal 2013;16(1): 53-8.

Tektook NK, Al- Lehibi KI, Al-Husseinei RK. Prevalence Some Pathogenic Bacteria Causing UTI in Diabetic Patients in Specialized Center for Endocrinology and Diabetes of Baghdad City–Iraq. Medical Journal of Babylon 2017; 14(2):260 – 6.

Al-Rubeaan KA, Moharram O, Al-Naqeb D, Hassan A, Rafiullah MRز Prevalence of urinary tract infection and risk factors among Saudi patients with diabetes. World J Urol 2013; 31: 573-8.

Abdulla MC, Jenner FP, Alunga J. Urinary tract infection in type 2 diabetic patients: risk factors and antimicrobial pattern. Int J Res Med Sci 2015;3(10):2576-9.

Njunda AL, Assob NJC, Nsagha SD, Nde FP, Kamga FHL, Nkume AF, Emmanuel TK, et al. Uropathogens from diabetic patients with asymptomatic bacteriuria and Urinary tract infections. Sci J Microb 2012; 1: 141-6.

Pargavi B, Mekala T, Selvi AT, Moorthy K. Prevalence of Urinary Tract Infection (UTI) among diabetics' patients in Vandavasi, Tamil Nadu, India. IJBT 2011;2(2): 42-5.

Nawaz M. Isolation and characterization of tetracycline resistant Citrobacter spp. from catfish. Food Microbiol 2008;25: 85-91.

Carey IM, Critchley JA, De- Wilde S, Harris T, Hosking FJ, Cook DG. Risk of Infection in Type 1 and Type 2 Diabetes Compared with the General Population: A Matched Cohort Study. Diabetes Care 2018; 41:513–21.

Kilpatrick ES, Bloomgarden ZT, Zimmet PZ. Is hemoglobin A1C a step forward for diagnosing diabetes?. BMJ 2009; 339: b4432.

Olayemi-Abdul I, Osazuwa F, Osilume D. Association between elevated HbA1c levels and urinary tract infection among diabetic women. Zahedan J Res Med Sci2015; 17(6):e994.

Abbott SL. Klebsiella, Enterobacter, Citrobacter, Serratia, Plesiomonas, and Other Enterobacteriaceae. In P.R. Murray, E. J. Baron, J. H. Jorgensen, M. A. Pfaller and M. L. Landry (Eds.), Manual of Clinical Microbiology 9th ed., 2007: 698-715.

Geerlings SE. Urinary tract infections in patients with diabetes mellitus: epidemiology, pathogenesis and treatment. International Journal of Antimicrobial Agents 2008;31(1):54–7.

Baral P, Neupane S, Marasini BP, Ghimire KR, Lekhak B, Shrestha B. High prevalence of multidrug resistance in bacterial uropathogens from Kathmandu, Nepal. BMC Res Notes 2012;19(5):38-47.

Craig J, Simpson J, Williams G, Lowe A, Reynolds G, McTaggart S, et al. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med 2009; 361:1748-59.

Papadimitriou-Olivgeris M, Drougka E, Fligou F, Kolonitsiou F, Liakopoulos A, Dodou V, et al. Risk factors for enterococcal infection and colonization by vancomycin-resistant entero¬cocci in critically ill patients. Infection 2014;42(6):1013–22.

Giesen LG, Cousins G, Dimitrov BD, van de Laar FA, Fahey T. Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs. BMC Fam Pract 2010; 11:78-92.

US department of health and human services (Centers for Disease Control and Prevention). Antibiotic Use in the United States, 2017: Progress and Opportunities. 2017. https://stacks.cdc.gov/veiw/cdc/46911.


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How to Cite
Desouky, D., Gabr, H., El-Helbawy, M., & Hathout, H. (2020). Urinary Tract Infection: Prevalence, Risk Factors, Bacterial Etiologies and Antimicrobial Resistance Profile among Egyptian Diabetic Patients. European Journal of Medical and Health Sciences, 2(4). https://doi.org/10.24018/ejmed.2020.2.4.390