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Sorescu T, Licker M, Timar R, Musuroi C, Muntean D, Voinescu A, Vulcanescu DD, Cosnita A, Musuroi SI, Timar B. Characteristics of Urinary Tract Infections in Patients with Diabetes from Timișoara, Romania: Prevalence, Etiology, and Antimicrobial Resistance of Uropathogens. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1870. [PMID: 39597055 PMCID: PMC11596453 DOI: 10.3390/medicina60111870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Revised: 11/11/2024] [Accepted: 11/13/2024] [Indexed: 11/29/2024]
Abstract
Background and Objectives: Diabetic patients are more likely to develop infections compared to the general population, especially urinary tract infections (UTIs). The aim of this study was to assess the prevalence of UTIs in a population of patients with diabetes (DM) from Romania, to identify the most common uropathogens and their antimicrobial resistance (AMR) patterns, as well as to determine the correlations between resistance behavior and particularities of patients with UTIs according to DM type. Materials and Methods: The hospital records of 1282 type 1 (T1D) and type 2 DM (T2D) adult inpatients who were ordered urine cultures during hospitalization were reviewed, and all 241 patients who presented a positive urine culture were included in the present study analysis. Results: The prevalence of UTIs in diabetic patients was 18.8% and higher in patients with T2D vs. T1D. Patients with UTIs and T2D had a significantly older age, longer duration of DM, higher waist circumference and body mass index, lower levels of estimated glomerular filtration rate, and more frequent chronic complications of DM than patients with T1D. E. coli was the most frequently isolated uropathogen (56.4%), with a significantly higher incidence for T2D, followed by K. pneumoniae (12.9%) and Enterococcus spp. (9.5%). Although the acquired resistance phenotypes were more frequently isolated in T2D patients (over 90% of the multidrug-resistant and extended-spectrum beta-lactamase-producing isolates, respectively, and 75% of the total carbapenem-resistant organisms), no statistically significant correlation was found regarding the distribution of AMR patterns in the two types of DM. Conclusions: The present study brings new data regarding the prevalence of UTIs in diabetic patients from Western Romania. By identifying the spectrum of uropathogens and their AMR pattern, this paper may contribute to improving UTI management in diabetic patients, thus reducing antibiotic overuse and preventing recurrent UTIs.
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Affiliation(s)
- Teodora Sorescu
- Department of Internal Medicine II: Diabetes, Nutrition, Metabolic Diseases, and Systemic Rheumatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (T.S.); (R.T.); (B.T.)
- Department of Diabetes, Nutrition and Metabolic Diseases, “Pius Brînzeu” Emergency Clinical County Hospital, 300723 Timisoara, Romania
| | - Monica Licker
- Microbiology Department, Multidisciplinary Research Center of Antimicrobial Resistance, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.M.); (D.M.); (A.V.); (D.D.V.)
- Microbiology Laboratory, “Pius Brinzeu” Emergency Clinical County Hospital, 300723 Timisoara, Romania
| | - Romulus Timar
- Department of Internal Medicine II: Diabetes, Nutrition, Metabolic Diseases, and Systemic Rheumatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (T.S.); (R.T.); (B.T.)
- Department of Diabetes, Nutrition and Metabolic Diseases, “Pius Brînzeu” Emergency Clinical County Hospital, 300723 Timisoara, Romania
| | - Corina Musuroi
- Microbiology Department, Multidisciplinary Research Center of Antimicrobial Resistance, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.M.); (D.M.); (A.V.); (D.D.V.)
- Microbiology Laboratory, “Pius Brinzeu” Emergency Clinical County Hospital, 300723 Timisoara, Romania
| | - Delia Muntean
- Microbiology Department, Multidisciplinary Research Center of Antimicrobial Resistance, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.M.); (D.M.); (A.V.); (D.D.V.)
- Microbiology Laboratory, “Pius Brinzeu” Emergency Clinical County Hospital, 300723 Timisoara, Romania
| | - Adela Voinescu
- Microbiology Department, Multidisciplinary Research Center of Antimicrobial Resistance, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.M.); (D.M.); (A.V.); (D.D.V.)
- Microbiology Laboratory, “Pius Brinzeu” Emergency Clinical County Hospital, 300723 Timisoara, Romania
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Dan Dumitru Vulcanescu
- Microbiology Department, Multidisciplinary Research Center of Antimicrobial Resistance, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.M.); (D.M.); (A.V.); (D.D.V.)
- Microbiology Laboratory, “Pius Brinzeu” Emergency Clinical County Hospital, 300723 Timisoara, Romania
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Andrei Cosnita
- Department IX, Surg & Ophthalmol, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Silvia-Ioana Musuroi
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department of Clinical Practical Skills, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Bogdan Timar
- Department of Internal Medicine II: Diabetes, Nutrition, Metabolic Diseases, and Systemic Rheumatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (T.S.); (R.T.); (B.T.)
- Department of Diabetes, Nutrition and Metabolic Diseases, “Pius Brînzeu” Emergency Clinical County Hospital, 300723 Timisoara, Romania
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Inoue S, Yasuda H, Yoshida K, Mori K, Ogawa K, Yokotsuka Y, Okamoto H. A Diabetic Patient with Prolonged Hyperammonemia Due to Urinary Tract Infection Caused by Urease-producing Bacteria. Intern Med 2024; 63:1945-1949. [PMID: 37926530 PMCID: PMC11272500 DOI: 10.2169/internalmedicine.2817-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/24/2023] [Indexed: 11/07/2023] Open
Abstract
Obstructive tract infection caused by urease-producing bacteria can lead to hyperammonemia. We herein report a 73-year-old woman with diabetes and compensated liver cirrhosis who developed obstructive pyelonephritis. Her consciousness level declined on day 3 of hospitalization. Blood tests revealed an elevated ammonia level of 140 μg/dL. Urine and blood cultures identified Proteus mirabilis as a urease-producing bacterium. The treatment included double J (WJ) catheter insertion and administration of antimicrobial agents. On day 7 of hospitalization, the ammonia level gradually decreased, and the patient's consciousness improved. However, despite these interventions, perinephric overflow of urine persisted, necessitating nephrectomy.
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El-Kady RA, Alotaibi SA, Aljabri TT, Haraka RR, Ibrahim IM, Mousa AI, Bashbeshi MW. Antimicrobial Susceptibility Trends of Proteeae Isolates From a Tertiary-Care Hospital in Western Saudi Arabia. Cureus 2023; 15:e47494. [PMID: 38021780 PMCID: PMC10663529 DOI: 10.7759/cureus.47494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The tribe Proteeae comprises Proteus, Providencia, and Morganella species. TheseGram-negative rods are of concern in that they are involved in diverse human infections, particularly in hospital settings. In the last two decades, there has been a sharp increase in infections by multidrug-resistant (MDR) Proteeae. Therefore, the objectives of this study were to: (i) assess the prevalence of infections caused by tribe Proteeae, (ii)determine the antimicrobial susceptibility profile of the test isolates, and (iii) identify the underlying risk factors for acquisition of infection by MDR strains. METHODS During the period from January 2019 to December 2020, we conducted a retrospective review of the electronic medical and laboratory records of adult patients who received care at our institution. In addition, we analyzed the risk factors associated with acquisition of infections by members of the tribe Proteeae using univariate and multivariate regression models. RESULTS Overall 403 adult patients (average age 59.69 ± 20.33 years) were enrolled into this study (196 males; 48.6%, and 207 females; 51.4%). Proteus mirabilis was the leading pathogen (70.7%; n=285), followed by Morganella morganii (20.1%; n=81), and Providencia species (9.2%; n=37). Most of the isolates were recovered from urine (59.3%; n=239), followed by wound swabs (23.1%; n=93), with the least from blood samples (1.7%; n=7). Out of 403 Proteeae isolates, 27.3% (n=110) were found to be extended-spectrum β-lactamase (ESBL)-producers, whereas 18.4% (n=74) were MDR. Patient's age, concomitant diabetes mellitus (DM), and long hospital stays were independently associated with infection by MDR strains. CONCLUSION Infections by MDR Proteeae are leading causes for morbidity in our tertiary-care facility. Strict adherence to infection control precautions, as well as effective implementation of antimicrobial stewardship programs, are crucial to overcome these superbugs.
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Affiliation(s)
- Rania A El-Kady
- Medical Microbiology and Immunology, Faculty of Medicine, Mansoura University, Mansoura, EGY
- Pathological Sciences, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Samah A Alotaibi
- Medical School, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Taef T Aljabri
- Medical School, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Razan R Haraka
- Medical School, Fakeeh College for Medical Sciences, Jeddah, SAU
| | | | - Amal I Mousa
- Medical Laboratory Sciences, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Mayar W Bashbeshi
- Medical Laboratory Sciences, Fakeeh College for Medical Sciences, Jeddah, SAU
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Chen J, Yang Y, Yu N, Sun W, Yang Y, Zhao M. Relationship between gut microbiome characteristics and the effect of nutritional therapy on glycemic control in pregnant women with gestational diabetes mellitus. PLoS One 2022; 17:e0267045. [PMID: 35427393 PMCID: PMC9012359 DOI: 10.1371/journal.pone.0267045] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/31/2022] [Indexed: 12/15/2022] Open
Abstract
The purpose of this study was to explore the relationship between the characteristics of gut microbiome and the effect of medical nutrition therapy (MNT) on glycemic control in pregnant women with gestational diabetes mellitus (GDM). Seventy-four pregnant women newly diagnosed with GDM received MNT for one-week. The effect of glycemic control was evaluated by fasting and 2-hour postprandial blood glucose; and stool samples of pregnant women were collected to detect the gut microbiome before and after MNT. We used a nested case-control study design, with pregnant women with GDM who did not meet glycemic standards after MNT as the ineffective group and those with an age difference of ≤5 years, matched for pre-pregnancy body mass index (BMI) 1:1, and meeting glycemic control criteria as the effective group. Comparison of the gut microbiome characteristics before MNT showed that the ineffective group was enriched in Desulfovibrio, Aeromonadales, Leuconostocaceae, Weissella, Prevotella, Bacillales_Incertae Sedis XI, Gemella and Bacillales, while the effective group was enriched in Roseburia, Clostridium, Bifidobacterium, Bifidobacteriales, Bifidobacteriaceae, Holdemania and Proteus. After treatment, the effective group was enriched in Bifidobacterium and Actinomycete, while the ineffective group was enriched in Holdemania, Proteus, Carnobacteriaceae and Granulicatella. In conclusion, the decrease in the abundance of characteristic gut microbiome positively correlated with blood glucose may be a factor influencing the poor hypoglycemic effect of MNT in pregnant women with GDM. Abundance of more characteristic gut microbiome negatively correlated with blood glucose could help control blood glucose in pregnant women with GDM.
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Affiliation(s)
- Jing Chen
- School of Nursing, Anhui Medical University, Hefei, Anhui Province, The people’s Republic of China
| | - Yuying Yang
- Division of Life Sciences and Medicine, Department of Nursing, Hefei Ion Medical Center, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui Province, The people’s Republic of China
| | - Ningning Yu
- School of Nursing, Anhui Medical University, Hefei, Anhui Province, The people’s Republic of China
| | - Wanxiao Sun
- School of Nursing, Anhui Medical University, Hefei, Anhui Province, The people’s Republic of China
| | - Yuanyuan Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, The people’s Republic of China
| | - Mei Zhao
- School of Nursing, Anhui Medical University, Hefei, Anhui Province, The people’s Republic of China
- * E-mail:
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