23/02/2022
URINARY TRACT INFECTION IN DIABETIC PATIENTS
Diabetes mellitus is a group of related conditions characterized by variable degrees of insulin resistance, impaired insulin secretion, and increased glucose production
Patient with diabetes are at increased risk of infection with urinary tract being the most frequent site. Various factors responsible for urinary tract infection in diabetic patients include impaired immune system, poor sugar control, features of diabetic cystopathy.
Disease spectrum of urinary tract infection (UTI) ranges from asymptomatic bacteruria to lower UTI, Pyelonephritis & severe urosepsis. Severe complications include emphysematous pyelonephritis, emphysematous cystitis, renal abscess, renal papillary necrosis etc.
Patients are more prone to develop resistant pathogens as cause to UTI and also fungal UTIs.
Diabetes is also associated with worse outcomes of UTI including longer hospitalization and increased mortality.
HOW TO SUSPECT
Symptoms may vary from increased frequency of urination to increased urgency, pain in lower abdomen to sides of abdomen to burning in urine with fever and chills. Occasionally these symptoms may be accompanied with decreased urine output.
Urine examination is an important tool in diagnosing UTI. For a lay person, bad smelling urine or brown /turbid coloured urine is a clear warning sign. Increased pus cells (pyuria) can be detected in macroscopic examination. Urine culture sensitivity is necessary in all suspected cases of UTI in diabetics (notable exception being cystitis of diabetic pregnant women). The sample should be voided, clean catch, mid-stream urine. In patients on long term catheter, preferred method is replacing the catheter and collecting a fresh sample of urine.
TREATMENT OPTIONS
Treatment options depend upon factors like localization of infection to bladder (lower UTI) or involvement of kidneys (upper UTI), presence of urological abnormalities, severity of symptoms, renal function, presence of emphysematous changes, and native or graft kidney status.
Antibiotic therapy must be guided by local susceptibility patterns. Patients with hemodynamic instability, comorbid conditions, and deranged kidney functions may require hospitalization
COMPLICATIONS
Over 90 percent of emphysematous pyelonephritis (gas in the kidney) and 67 percent of emphysematous cystitis (gas in the bladder) occur in patients with diabetes and may represent threat to life and require prompt intervention/hospitalization
OUTCOMES
Diabetics have worse outcome of UTI as compared to non- diabetics. Diabetes is also associated with longer hospitalization, general sepsis, and worsening kidney function.
Mortality from UTI is five times higher in patients with diabetes aged 65 or above. Recurrence of UTI is higher in diabetic patients.
PRECAUTIONS
Good hygienic genitourinary behavior and its practice needs to be inculcated in diabetic patients especially females. Education regarding clean toilet practices is also very important like wiping from front to back post urination and bowel movement; avoidance of feminine products like douches and powders. Emptying of bladder post in*******se is also helpful.
Drinking plentiful fluids also helps to flush the bacteria and reduces the incidence of UTI.
Optimal blood sugar control is of prime significance. Early identification of symptoms and prompt treatment may result in decreased morbidity and mortality and reduced burden of hospitalization. Identification of high risk cases and early intervention may be lifesaving in certain situations as already discussed.
Dr. RAKESH BHAT
MBBS, MD, DrNB Nephrology
Presently working in AMANDEEP HOSPITAL Pathankot as Consultant Nephrologist.
