Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Urinary Tract Infections and Antimicrobial Sensitivity Patterns of Uropathogens Isolated from Diabetic and Non-diabetic Patients Attending Some Hospitals in Awka

Ekwealor Chito Clare*, Alaribe Oluchi Juliet, Ogbukagu Chioma Maureen, Alaribe James Romeo, Kyrian-Ogbonna Evelyn Ada

Department of Applied Microbiology & Brewing, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria

Abstract: Background: Diabetic patients have been found to be prone to urinary tract infections, and there is a wide gap of information in developing countries regarding the prevalence and antibiotic sensitivity of the pathogens causing this infection. This study was carried out to determine the prevalence, predisposing factors and antibiotic sensitivity of organisms causing urinary tract infections among diabetic patients and non-diabetics in four hospitals in Awka, Anambra State, Nigeria. Method: A total of four hundred and sixty participants (230 diabetic patients and 230 non-diabetics) were enrolled in a cross- sectional study design with 249 males (54.13%) and 211 (45.87 %) females. Clean catch mid-stream urine samples were collected from all participants in sterile containers and analyzed macroscopically and microscopically. Each urine specimen was streaked onto Nutrient agar, MacConkey agar, Cysteine Lactose Electrolyte Deficient agar and Sabouraud’s Dextrose agar, incubated at 37°C for 24h and identified using standard methods. The sensitivity of the isolates to different antibiotics was tested using Kirby-Bauer disc diffusion method. Data obtained were analyzed statistically. Result: The overall prevalence of urinary tract infections among diabetic patients, 63 (27.39%), was significantly higher than that among non-diabetics, 41 (17.83%) (p= 0.014). Gender and previous history of UTI were found to have significant association with urinary tract infection (0.000). Organisms isolated were Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, Citrobacter spp, Coagulase negative Staphylococcus, Staphylococcus aureus, Enterococcus faecalis, and Candida albicans. The isolates were sensitive to tested antibiotics with Gentamicin (10µg) and Ceftriaxone (30µg) as most effective against Gram negative bacteria isolates while Ampicillin (10µg) and Chloramphenicol (30µg) were most effective against Gram positive bacteria isolates. Conclusion: The prevalence of UTI is significantly higher in diabetics than in non-diabetics with E. coli being the most common isolate.The importance of antibiotic sensitivity testing before treatment is highly recommended.

Keywords: urinary tract infection, diabetics, risk factors of UTI, non-diabetics, antibiotics

Received June 12, 2021; Revised July 19, 2021; Accepted August 02, 2021

Citation: Ekwealor Chito Clare, Alaribe Oluchi Juliet, Ogbukagu Chioma Maureen, Alaribe James Romeo, Kyrian-Ogbonna Evelyn Ada, Urinary Tract Infections and Antimicrobial Sensitivity Patterns of Uropathogens Isolated from Diabetic and Non-diabetic Patients Attending Some Hospitals in Awka. American Journal of Microbiological Research, 9 (3). 83-91. January 2021. doi:10.12691/ajmr-9-3-3

1. Introduction

Diabetes Mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia, resulting from defects in insulin secretion, insulin action or both [1]. The prevalence of diabetes mellitus has increased over the past decades, and global reports show that it is now approaching epidemic proportions [2,3,4]. In 2017, the global prevalence of diabetes among adults aged 20-70 years was 8.4% and was responsible for 10.7% of all cases of deaths worldwide [5]. An estimated 463 million adults aged 20–79 years are living with diabetes [4]. This represents 9.3% of the world’s population in this age group. The prevalence is expected to rise from 135 million in 1995 to 300 million in the year 2025, 578 million (10.2%) by 2030 and to 700 million (10.9%) by 2045 [4]. According to WHO [3], the number of people with diabetes in Africa has increased from 4 million in 1980 to 25 million in 2014, and the number is expected to reach 47.1 million by 2045 [4]. The disease was responsible for more than 366,200 deaths in Africa in 2019 [4]. The estimated prevalence of diabetes is 2.4% in rural areas, up to 5.9% in urban sub-Sahara Africa [4] and between 8-13% in more developed areas such as South Africa [6].

Urinary tract infection (UTI) is the most common infection among patients with diabetes mellitus [7,8], with estimates of diabetics suffering from UTI reaching 10% of patients visiting hospitals [9]. It is more common among diabetic patients than non-diabetics [10]. Evidence from various epidemiological studies showed that UTI is more common in females with diabetes than in non-diabetic females [1,12,13].

The chronic hyperglycemia of diabetes is associated with long term damage, dysfunction, and failure of various organs especially the eyes, genitourinary system, nerves, heart, and blood vessels [14] and low immunity [15], and these complications predispose diabetics to urinary tract infections (UTIs) [4]. Other risk factors associated with increased incidence of urinary tract infections among diabetic patients include low socioeconomic status, advancing age, [1], sexual intercourse, and type of diabetes mellitus [2], metabolic control, and long term complications [16]. UTI in diabetics is associated with a number of serious side effects which include carcinoma of the bladder, gram negative bacteriaemia, sepsis, pyrexia of unknown origin, end point renal failure, hypertension or hypotension, increased prematurity, low birth weight and fetal death [6].

Generally, the common etiologic agents of UTI include Escherichia coli, Klebsiella spp., Staphylococcus aureus, Pseudomonas aeruginosa, Enterobacter spp., Enterococcus spp., Proteus spp., Citrobacter spp., Acinetobacter spp. [17], Staphylococcus saprophyticus, Candida spp. and other pathogenic yeasts [18]. Escherichia coli causes 80-90% of acute uncomplicated bacterial lower tract infections (cystitis) in young women [17]. These agents have also been reported to be associated with UTI in diabetic patients [6,16,19].

Antimicrobial agents commonly used in UTI therapy include beta-lactam antibiotics: Ampicillin, Amoxicillin; Fluoroquinolones: Norfloxacin, Ciprofloxacin; third generation Cephalosporins: Cephalexin, Cotrimoxazole, Gentamycin and Nitrofurantoin [18,19]. Uropathogens show wide differences in their susceptibility to these antimicrobial drugs from place to place and time to time [19]. Reports show that diabetic patients using antibiotics experience more intense UTI when compared to those not using the drugs [20]. This is as a result of the resistance posed by uncontrolled use of these drugs, thereby exposing them to more serious infections. The aim of this study, therefore, was to determine the prevalence, predisposing factors and antibiotic sensitivity pattern of the organisms causing urinary tract infections among diabetic patients and non-diabetics in four hospitals in Awka, Anambra State, Nigeria.

2. Materials and Methods

2.1. Study Design

The study was a hospital based comparative cross- sectional study conducted from April 2020 to September 2020.

2.2. Study Area

The study was conducted in Awka, the capital city of Anambra State in the South-East geopolitical zone of Nigeria. It covers a land area of about 522 km². Awka has an estimated population of 301,657 as of the 2006 National population census [21], and over 2.5million by 2018. Four hospitals, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital (COOUTH), Crest Specialist Hospital, Regina-Caeli Specialist Hospital and Nnamdi Azikiwe University Medical Center, all in Awka South Local Government Area, were used. The study area was an appropriate location as it attends to many patients from the nine towns in the Local Government Area and thus minimizes sample bias due to the wide area covered.

2.3. Study Population

The study population comprised both adult male and female diabetic patients and non-diabetics, aged between 20-80 years, attending both outpatients and inpatients of the selected hospitals, between 8 April 2020 and 30 September 2020.

2.4. Specimen Collection

Socio-demographic data were collected from each study participant using a structured questionnaire. A “clean-catch” midstream urine specimen was collected following the method described by [1]. About 20 ml of urine specimen collected in a sterile, dry, screw capped and wide-mouthed plastic container was labeled with unique sample number, date, and time of collection. The specimens were then transported in ice-pack containers to the laboratory of Applied Microbiology and Brewing, Nnamdi Azikiwe University, Awka, within 2h of collection for further studies [22].

2.5. Isolation of Microorganisms

Using a sterile standard calibrated wire loop (0.002ml), a loopful of each urine specimen was directly inoculated onto Nutrient agar, Cysteine-lactose-electrolyte-deficient (CLED) agar and MacConkey agar culture media by streak plate method. The inoculated plates were incubated at 37°C for 24h and examined for bacterial growth. The approximate number of colonies were counted and the number of bacteria (colony forming units (cfu) per millimeter of voided urine) was estimated. A colony count of more than 100,000 (≥10⁵ cfu/ml) was considered a significant bacterial count for positive urinary tract infection [23]. Urine specimens inoculated on Sabouraud Dextrose agar were examined macroscopically for yeast growth after 48h incubation at 30°C. Significant candiduria was determined as urine culture growth ≥10⁴CFU/ml.

2.6. Identification of Bacterial and Fungal Isolates

A single colony was suspended into Nutrient broth and streaked onto Nutrient agar plates for further identification [24]. The inoculated plates were incubated at 37°C for 24h. Pure cultures of bacterial isolates were identified using colony characteristics, Gram reaction and biochemical reactions following standard procedures [23].The morphological appearance of the fungal isolates were noted as presumptive identification. Following standard procedures, the germ tube test and sugar fermentation tests were carried out on all yeast isolates [25].

2.7. Antibiotic Sensitivity Tests

Antibiotic sensitivity tests were carried out on pure cultures of bacterial isolates using Kirby-Bauer disc diffusion method [24]. The isolates were tested against 13 antibiotics; Ampicillin (AMP) (30µg), Amoxicillin (AMX) (30µg), Ceftriaxone (CEF) (30µg), Ciprofloxacin (CIP) (10µg), Norfloxacin (NOR) (5µg), Nitrofurantoin (NIT) (200µg), Gentamicin (GEN) (10µg), Oxacillin (OX) (10µg), Tetracycline(TET) (10µg), Doxycycline (DOX) (10µg), Chloramphenicol (CHL) (30µg), Erythromycin (ERY) (10µg) and Cotrimoxazole (COT) (25µg). Using sterile wire loop, colonies of each pure culture was suspended in 3ml of physiological saline and the suspension thoroughly mixed. One milliliter of the suspension was transferred into a bijou bottle and diluted with peptone water until the optical density of the suspension matched that of 0.5 McFarland standard solution [25]. The standardized test inoculum, (test organism) was inoculated evenly over the entire surface of Muller-Hinton agar (Oxoid), in triplicates using sterile cell spreaders. The antibiotic-impregnated discs were placed on the surface of the culture media using sterile forceps, and after 24h incubation at 37°C, the diameters of the zones of growth inhibition were measured to the nearest whole millimeter using a caliper. The zones of inhibition were interpreted as susceptible (S) or resistant (R) following the [25] guideline.

2.8. Statistical Analysis

The data obtained from this study were analyzed using the Statistical Package for the Social Sciences (SPSS) software for windows (version 25). Percentages, frequencies, and cross tabulations were used to summarize descriptive statistics. Pearson Chi-square test was employed to test the existence of association between discrete variables. P-value of <0.05 at 95% confidence interval was considered to indicate statistically significant differences. Odds ratio (OR); Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) were used in the analysis. Both bivariate and multivariate logistic regression analyses were employed to ascertain the degree of association between the outcome variable (positive UTI) and independent variables (socio-demographic characteristics and health related risk factors) [26].

3. Results

3.1. Socio-Demographic Characteristics of the Study Participants

A total of 460 participants (230 diabetic patients and 230 non-diabetics) were included in the study. Of these, 249(54.13%) were males and 211 (45.87%) females. The participants were aged between 20 to 80 years for both diabetic and non-diabetic participants. The mean age of the diabetic group was 48.8±15.7. One hundred and twenty- three (53.48%) diabetic participants were males while 107 (46.52%) were females. The socio-demographic characteristics of diabetic and non-diabetic patients are as shown in Table 1.

3.1.1. Prevalence of Urinary Tract Infection in Diabetic Patients and Non-Diabetics

The overall prevalence of UTI was 27.39% among diabetic patients and 17.83% among non-diabetic participants. There was significant difference between the prevalence of UTI among diabetic and non-diabetic participants (P = 0.014). Table 2 shows the prevalence of UTI according to socio-demographic characteristics in diabetic patients and non-diabetics.

3.1.2. Risk Factors Associated with UTI in Diabetic Patients.

In the bivariate analysis, the prevalence of UTI was significantly associated with gender, marital status, place of residence, occupation, and previous history of UTI. No significant association was observed betweenage, educational level, smoking habit and UTI in diabetic patients. Inthe multivariate analysis, the prevalence of UTI was significantly associated with gender and previous history of UTI. The female diabetic patients had higher odds of UTI compared with the males (Table 3). Similarly, diabetic patients with previous history of UTI had higher odds of UTI compared with those without any previous history of UTI (Table 3). However, marital status, place of residence and occupation were not significantly associated with UTI (Table 3).

3.2. Spectrum of Uropathogens Associated with Diabetic Patients and Non-Diabetics.

Sixty-three bacteria and forty-one yeasts were recovered from urine samples of diabetic and non-diabetic participants, respectively. Gram-negative bacteria were the predominant isolates from urine samples of 38 (60.32%) diabetic and 21 (51.22%) non-diabetic participants. Among the diabetic group, eight bacteria and one yeast species were isolated from the urine cultures. The most prevalent bacterial isolates were Escherichia coli 25 (39.68%) while the least isolate was Citrobacter spp. 1 (1.6%). Among the non-diabetics, six bacteria and one fungal species were isolated from urine cultures. The most prevalent was also Escherichia coli 17 (41.46%), while the least was Enterococcus feacalis (2.44%) and Proteus mirabilis (2.44%). The prevalence of organisms isolated from diabetic and non-diabetic participants are presented in Table 4.

3.3. Antibiotic Sensitivity Profile of Bacterial Isolates

Antimicrobial susceptibility patterns of the bacterial isolates from diabetic and non-diabetic participants are presented in Table 5a and Table 5b. Most of the isolates showed 100% sensitivity to Ceftriaxone, Ciprofloxacin, Gentamicin and Chloramphenicol while Escherichia coli, which is the most predominant isolate among the diabetics, showed high level of resistance to Amoxicillin (76%) (Table 5a). Predominant gram-positive isolate, Coagulase negative Staphylococcus (CoNS) showed sensitivity to Ceftriaxone (83.3%), Nitrofurantoin (83.3%), Doxycycline (100%) and Erythromycin (100%) but resisted Ciprofloxacin (50%) and Oxacillin (50%). Staphylococcus aureus isolates also showed 100% sensitivity to Ampicillin, Nitrofurantoin and Chloramphenicol (Table 5b).

Table 1. Socio-demographic characteristics of diabetic patients and non-diabetics attending some hospitals

Table 2. Prevalence of urinary tract infection by socio-demographic characteristics in diabetic and non-diabetics attending hospitals

Table 3. Risk factors associated with UTI among diabetic patients attending hospitals

Table 4. Prevalence of organisms isolated from urine culture of diabetic patients and non-diabetics

Table 5a. Antimicrobial susceptibility profile of gram negative bacterial isolates from urine of diabetic and non-diabetic patients attending hospitals

Table 5b. Antimicrobial susceptibility profile of gram positive bacterial isolates from urine of diabetic and non-diabetic patients attending hospitals

4. Discussion

Studies have demonstrated greater susceptibility of diabetics than non-diabetics to urinary tract infections [27] [12]. The prevalence of urinary tract infections among diabetic and non-diabetic patients, risk factors associated with urinary tract infections in diabetics, spectrum of uropathogens responsible for UTI in diabetic patients and non-diabetics and the sensitivity patterns of the bacterial isolates to antibiotics were investigated.

The findings from this study showed that the overall prevalence of urinary tract infections among diabetic patients (27.4%) was higher than those of non-diabetic patients (17.8%). The high prevalence of UTI among diabetic patients is in line with that of [28], who reported a prevalence of 32.0% among diabetics and 22.0% in non- diabetics. It also agreed with the studies of [29,30], in which they recorded 25.2% and 33.8% UTI among diabetic patients, respectively. In contrast, [2,24], reported lower prevalence rates of 19.5% and 13.8%, respectively among diabetic patients. Worku et al. [26], also recorded a low prevalence of 10.9% among diabetics and 4.7% among non-diabetics.

Some other researchers reported higher prevalence of urinary tract infections among diabetic patients and non- diabetics. Prevalence rates of 40% to 50.7% have been reported among diabetics [10,11,13,31]. The high prevalence rate could be attributed to emergence of antibiotic resistant bacteria that cause urinary tract infection in diabetics.

There was a significant difference (P < 0.5) in the prevalence of UTI among diabetic patients when compared to non-diabetics and this finding supports the work of many other researchers [1,12,27,32].

Among diabetic patients, a significant difference in the prevalence of UTI was observed among various age groups. A higher prevalence of UTI was observed among age group 40-49 years (54.2%) and age group 50-59 (34.9%) (Table 2). This result agrees with those of [33,34], who observed a high prevalence in age groups 30-49 years and 51-60 years, respectively. The result obtained is contrary to that of [35], who observed an increase in UTI with increasing order of age. The high prevalence of UTI recorded among the age group 40-49 years could be due to increased rate of sexual activity in this age group.

The incidence of urinary tract infections was found to be significantly higher in female diabetics (43.0%) than in male patients (13.8%) (P = 0.000) (Table 2). This finding is in line with the reports of [11,13], who reported higher prevalence of UTI among female diabetics. A higher prevalence of UTI was also observed among female non- diabetics (27.9%) than male non-diabetics (9.5%) and this result supports the works of other researchers [6,30,36]. Contrary to our findings, [37], reported a higher prevalence of UTI in male diabetic patients than in females. The higher prevalence of UTI recorded among female diabetic and non-diabetic patients may be caused by decrease in normal vaginal flora (Lactobacilli), less acidic pH of vaginal surfaces, poor hygienic condition, short and wider urethra, and proximity to the anus [2].

Table 3 shows the assessment of the association between various risk factors and UTI in diabetic patients. Age was one of the factors considered and the bivariate logistic regression analysis showed no significant association between age and incidence of UTI in diabetic patients. This finding agrees with the work of [24,30,38]. In contrast to this result, [39], reported a significant association between age of diabetic patients and UTIs. It was observed (Table 3) that gender and previous history of UTI were associated with high prevalence of UTI in diabetic patients. There was no significant association betweeneducational status, smoking habit of patients and the incidence of UTI in diabetic patients (Table 3). However, [30] reported a significant association between drinking habit, high level of glucose and high prevalence of UTI.

The organisms causing UTI in diabetic patients were similar to those in non-diabetics but with variations in the number of isolates obtained (Table 4). This result corroborates the reports of [40], who studied the impact of diabetes mellitus on the spectrum of uropathogens in patients with UTI. The incidence of Pseudomonas aeruginosa and Citrobacter spp. was found only among diabetic patients (Table 4). This observation agrees with the findings by [30]. The results (Table 4) also showed that the etiologic agents of UTIs in both diabetics and non- diabetics were mainly bacterial species, and this is in accordance with the report of [36]. Most of the isolates from this study belonged to Gram-negative bacteria, with Escherichia coli being the most predominant (40.38%). This finding supports the reports of other researchers [6,10,22,37,41]. The high incidence of Escherichia coli, as suggested by [10], could be attributed to the fact that they are commensals of the intestines and that infections are most likely to be by faecal contamination due to poor hygiene. The findings, however, disagree with reports by [11] who observed that Coagulase-Negative Staphylococcus was the most prevalent isolate accounting for 37.5%.

Escherichia coli was responsible for 39.7% and 41.5% of urinary tract infections among the diabetic and non-diabetic groups respectively, and this is in line with the reports of [12]. Contrary to our findings, [40] reported a prevalence of 67.3% in diabetic patients and 61.8% in non- diabetic group. The lower isolation rate of E. coli in this study when compared with the findings of [40], could be attributed to the smaller sample size examined. Klebsiella pneumonia (7.7%) and Proteus mirabilis (4.8%) were the second and third most prevalent bacterial isolates respectively amongst Gram-negative bacteria. The prevalence of Klebsiella pneumoniae among diabetics (7.94%) and non-diabetics (7.32%) supports the reports of [40]. They isolated 9.3% of Klebsiella pneumoniae among diabetics and 7.3% among non-diabetics. Jagadeeswaran et al. [37], also isolated 8.6% of the organism among diabetics. Obeagu et al. [6], however, reported a 31.42% isolation of Klebsiella pneumoniae among diabetics and 28.57% in non-diabetics. Similarly, [12], also reported the high rate of 20.14% of the organism in diabetics and 19.40% in non-diabetics. The variations in the isolation rates may be as a result of the isolation media used by the researchers.

Table 4 shows a 6.34% isolation of Proteus mirabilis among diabetics and 2.44% in non-diabetics, and the result is comparable with the report of [2], who isolated 7.65% of the organism in diabetics. Contrary to our findings, [12], recorded a 12.23% of the organism in diabetics and 10.44% in non-diabetics, while [30], had 9.3% isolation in diabetics.

As presented in Table 4, Coagulase Negative Staphylococcus (18.27%) and Staphylococcus aureus (17.31%) were the second and third most prevalent Gram positive bacterial isolates, respectively. This result supports the findings of [24] who observed CoNS (24.2%) and Staphylococcus aureus (18.2%) to be the second and third most common isolates, respectively. Woldemariam et al. [42], also reported Coagulase Negative Staphylococcus as the second most isolated bacteria after E. coli. In contrast, the second most common isolate in the report by [36], was Enterococcus feacalis (10.9%). The isolation rate of Coagulase Negative Staphylococcus from diabetic patients (19.04%) and non-diabetics (17.07%) is as presented in Table 4. This result is comparable with that of [30]. Gram-positive bacteria are not common uropathogens [2], however, due to contamination, they have been found to always invade the urinary tract infection and cause UTI [43]. The prevalence of Staphylococcus aureus among diabetics (14.29%) and non-diabetics (21.95%) (Table 4), is higher than that (0.8% in diabetics and 0.6% in non- diabetics) reported by [40]. The least isolated gram positive bacteria in this study were Enterococcus feacalis, with a prevalence rate of 3.17% in diabetics and 2.44% in non-diabetics. This result agrees with that found by [3]. However, much higher results of 9.3% and 16.2% were reported by [30] and [42] respectively.

Yeasts, particularly Candida spp. are a common predisposing factor of UTI in diabetes mellitus patients [43]. Candida albicans isolated from diabetics (3.17%) and non-diabetics (7.32%) are shown in Table 4. The results obtained are comparable with 2.2% in diabetics reported by [30]. However, higher rate of 17.9% was reported by [42]. Mogaka et al. [39], reported an increase in resistance of isolated bacterial organisms to available antibiotics among diabetic patients. Tables 5a and Table 5b show that, a number of bacterial isolates from diabetic and non- diabetic patients were sensitive to the tested antibiotics. Most of the gram negative bacterial isolates from diabetic patients were sensitive to Beta-lactams, Quinolones and Aminoglycosides (Table 5a). Among the antibiotics tested, Gentamicin (10µg) and Ceftriaxone (30µg) were found to be the most effective drugs against gram negative bacterial isolates. While this finding agrees with the report of [2], it disagrees with that of [44], who observed quinolones to be the most effective agents against isolated gram negative bacilli. This variation in susceptibility may be due to changing trends of antimicrobial susceptibility pattern of these urinary tract pathogens from place to place [36].

In the present study, Tetracycline (10μg), Ampicillin (30μg) and Amoxicillin(30μg) were the least effective antimicrobials against gram negative bacterial isolates as most of the organisms showed high level of resistance to the antibiotics.

Most of the isolated gram positive organisms were susceptible to the antibiotics tested (Table 5b). Ampicillin and Chloramphenicol were found to be the most effective drugs against gram positive bacterial isolates. While [39], recorded 50.0% of resistance to Ampicillin and Ciprofloxacin, [2], reported a lower resistance to Ampicillin and Ciprofloxacin (20.0%), which is supported by the result obtained in this study.

5. Conclusions

The prevalence of UTI was significantly higher in diabetics than in non-diabetics. Gender and previous history of UTI were observed to be risk factors of UTI among diabetic patients. Escherichia coli was observed to be the most prevalent bacterial isolate. Routine urine cultures and antibiotic sensitivity testing of samples from patients is indispensable in the prevention and treatment of UTI.

Ethical Consideration

Ethical approval was obtained from the Ethical Research Committee of Chukwuemeka Odimegwu Ojukwu University Teaching Hospital, Awka before conducting the study.

References

[1]   | Acharya, D., Bogati. B., Shrestha, G. T. and Gyawali. P. Diabetes mellitus and Urinary Tract Infection: Spectrum of Uropathogens and their Antibiotic Sensitivity Pattern. Journal of Manamohan Memorial Institute of Health Sciences, 1(4):24-28. Feb 2015.
[2]   | Hamdan, H. Z., Eman, K., Amar, M. A., Onab, S. H., Sarah, O. S. and Ishag, A. Urinary tract infections and antimicrobial sensitivity among diabetic patients at Khartoum, Sudan. Annals of Clinical Microbiology and Antimicrobials, 14(26):1-6. Apr 2015.
[3]   | World Health Organization (WHO). (2016). Global report on diabetes. https://www.who.int/diabetes/global-report/en/(Accessed 7 March, 2019).
[4]   | International Diabetes Federation (IDF). (2019). Diabetes Atlas. 9th Edition, International Diabetes Federation, Belgium, 2019.
[5]   | International Diabetes Federation (IDF). Diabetes Atlas. 8th Edition, International Diabetes Federation, Belgium, December, 2017.
[6]   | Obeagu, E. I., Ifediora, A. C., Akahara, I. C. and Eguzouwa, U. P. Prevalence of urinary tract infection in diabetic patient attending Umuahia health care facilities. Journal of Biological Innovation, 5(1): 68-82. Jan 2016.
[7]   | Gupta, U. P., Jaiswal, S., Thapa, L., Paraju1i, N. and Nepali, S. Prevalence of UTI infection among suspected female patients attending Manipal teaching hospital, Pokhra. Nepal Journal of Microbiology and Virology, 3(2): 1-10, 2013.

[8]  
Prakash, D., Shekhar, P., Sharma, N., Adekhandi, S., Juyal, D. and Gaurav, V. Diversity of uropathogens and their resistogram in diabetic and non-diabetic patients in sub Himalayan region of Uttarakhand, India: A case control study. International Journal of Medicine and Public Health, 4(1): 15-119. Feb 2014.

[9]   | Flores-Mireles, A. L., Walker, J. N., Caparon, M. and Hultgren, S. J. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nature Reviews Microbiology, 13(5): 269-84. May 2015.
[10]   | Akinnibosun, F. I. and Iriakpe, H. J. Prevalence of Uropathogens in Diabetic Patients and their Antimicrobial Susceptibility Pattern. Nigerian Journal of Microbiology, 30(1): 3235-3240. 2016.

[11]  
Anejo-Okopi, J. A., Okojokwu, O. J., Ramyil, S. M., Bakwet, P. B., Okechalu, J., Agada, G., Bassi, P. A. and Adeniyi. S. D. Bacterial and antibiotic susceptibility pattern of urinary tract infection isolated from asymptomatic and symptomatic diabetic patients attending tertiary hospital in Jos. Nigeria. Trends in Medicine, 17: 1-5. Nov 2017.

[12]   | Jameel, A., and Artoshi, D. Prevalence of Urinary Tract Infections and Their Antimicrobial Sensitivity among Diabetic and Non-Diabetic Patients in Zakho. Science Journal of University of Zakho, 7(4): 25-131. Dec 2019.
[13]   | Shah, M. A., Kassab, Y. W., Anwar, M.F., Al-dahoul, H.K. and Menon, S. Prevalence and associated factors of urinary tract infections among diabetic patients. Health Science Journal, 13(2): 646. Apr 2019.
[14]   | Abdelhafiz, A. H., Russell, J. J., Key, A. and Sinclair, A. J. Older people with diabetes - avoiding hospitalization. Diabetes Management, 5(4): 1-16, 2015.
[15]   | Funfstuck, R., Nicolle, L. E., Hanefeld, M. and Naber, K. O. Urinary tract infection in patients with diabetes mellitus. Clinical Nephrology, 77:40-8. Jan 2012.
[16]   | Nitzan, O., Elias, M., Chazan, B. and 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, 8: 129-136. Feb 2015.
[17]   | Brooks, G. F., Caroll, K. C., Butel, J. S., Morse, S. A and Mietzner, T. A. Cases and clinical correlations. Adelberg‘s and Jawetz Melnick Medical Microbiology. 26th edition by McGraw-Hill International Edition; Pp 800-801. 2013.
[18]   | Mgbakogu, R. A. and Eledo, B. O. Studies on Urinary Tract Infection among Diabetics in Some Eastern States of Nigeria. Advances in Life Science and Technology, 34: 4246. 2015.
[19]   | Santosh, K. and Siddiqui, S. Prevalence and Antibiogram of Uropathogens from Patients Attending Tertiary Care Hospital: An overview. International Journal of Medical Microbiology and Tropical Diseases, 3(1):20-23. Mar 2017.
[20]   | Chukwuocha, U. M., Emerole, C. O., Njokuobi, T. N. and Nwawume I. C. Urinary Tract Infections (UTIs) Associated with Diabetic Patients in the Federal Medical Center Owerri, Nigeria. Global Advanced Research Journal of Microbiology, 1 (5):062-066. Jun 2012.
[21]   | National Population Commission (NPC). (2006). The Nigeria Population Census, 2006. http://www.population.gov.ng/index.php?option=com_ content&view=artide&id=89 (Accessed on December, 2018).
[22]   | Ogbukagu, C. M., Anakwenze, V. N., Ekwealor, C. C., Ezemba, C. C., and Ekwealor, I. A. Incidence of Urinary Tract Infections (UTI) amongst Patients Attending Primary Health Centres in Anambra State. Advances in Microbiology, 6:537-547. Jun 2016.
[23]   | Cheesbrough, M. District Laboratory Practice in Tropical Countries. Cambridge University Press, UK. 2010, 434.
[24]   | Nigussie, D. and Amsalu, A. Prevalence of uropathogen and their antibiotic resistance pattern among diabetic patients. Turkish Journal of Urology, 43(1)85-92. Jan 2017.
[25]   | Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Disk Susceptibility Tests. Twenty-second informational supplement. Clinical and Laboratory Standards Institute, 32(3):M100–S22. Jan 2014.
[26]   | Worku, S., Derbie, A., AlemnehSinishaw, M., Adem, Y. and Biadglegne, F. Prevalence of bacteriuria and antimicrobial susceptibility patterns among diabetic and nondiabetic patients attending at Debre Tabor Hospital, Northwest Ethiopia. International Journal of Microbiology, 2017:8. Mar 2017.
[27]   | Akhand, A., Biswas, D., Tilkar, M., Tenguriya, M. and Tilkar, Y. Comparative study of urinary tract infection in patients with or without diabetes: A prospective study from central India. International Journal of Medicine Research, 3(1):75-78. Jan 2018.

[28]  
Borj, M. R., Taghizadehborojeni, S., Shokati, A., Sanikhani, N., Pourghadamyari, H., Mohammadi, A, Abbariki, E., Golmohammadi, T. and Hoseiniharouni, S. M. Urinary tract infection among diabetic patients with regard to the risk factors, causative organisms and then antimicrobial susceptibility profiles. International Journal of Life Science and Pharmaceutical Research, 7(3): 38-47. Jul 2017.

[29]   | Al-Rubeaan, K., Moharram, O., Al-Naqeb, D. and Rubbean, H. A. Prevalence of urinary tract infection and risk factors among Saudi patients with diabetes. World Journal of Urology, 31(3):573-578. June 2013.
[30]   | Mama, M., Manilal, A., Gezmu, T., Kidanewold, A., Gosa, F., and Gebresilasie, A. Prevalence and associated factors of urinary tract infections among diabetic patients in Arba Minch Hospital, Arba Minch Province, South Ethiopia. Turkish Journal of Urology, 45910:56-62. Nov 2019.
[31]   | Yadav, K. and Prakash, S. Antimicrobial resistance pattern of uropathogens causing urinary tract infection (UTI) among diabetics. Biomedical Research International, 1: 07-15. Feb 2016.
[32]   | Schlievert, P. M., Salgado-Pabón, W. and Klingelhutz, A. J. Does Staphylococcus aureus have a role in the development of Type 2 diabetes mellitus? Future Medicine, 10(10):1-5. Oct 2015.
[33]   | Oluwafemi, T. T., Akinbodewa, A. A., Ogunleye, A. and Adejumo, O. A. Urinary tract infections and antibiotic sensitivity pattern of uropathogens in a tertiary hospital in South West, Nigeria. Sahel Medical Journal, 21: 18-22. May 2018.
[34]   | Zubair, K. U., Shah, A. H., Fawwad, A., Sabir, R. and Butt, A. Frequency of urinary tract infection and antibiotic sensitivity of uropathogens in patients with diabetes. Pakistan Journal of Medical Sciences, 35(6): 1664-1668. Nov-Dec 2019.
[35]   | Gautam, S. and Sapkota, R.. Comparative study of isolates associated with urinary tract infection among diabetic and non-diabetic patients attending tertiary care hospital, Chitwan, Nepal. International Journal of Innovative Science and Research, 5(2): 531. 2020.
[36]   | Seifu, W. D. and Gebissa, A. D. (2018). Prevalence and antibiotic susceptibility of Uropathogens from cases of urinary tract infections (UTI) in Shashemene referral hospital, Ethiopia. Bio-Medical Central Infectious Diseases, 18: 30. Jan 2018

[37]  
Jagadeeswaran, G., Mohammad, Z. A. and Tolstoy, R. Urinary tract infection in diabetics - a five year retrospective study on the prevalence of bacterial isolates and its antibiotic susceptibility patterns in a tertiary care hospital in South India. International Journal of Contemporary Medical Research, 5(4):D33-D38. Apr 2018.

[38]   | Aswani, S. M., Chandrashekar, U., Shivashankara, K. and Pruthvi, B. Clinical profile of urinary tract infections in diabetics and non-diabetics. The Australasian Medical Journal, 7(1): 29-34. Jan 2014.
[39]   | Mogaka, V. M., Gatwiri, M. S. and Njoroge, W. (2018). Uropathogens antibiotic resistance patterns among type 2 diabetic patients in Kisii Teaching and Referral Hospital, Kenya. Pan African Medical Journal, 30:286. Aug 2018.
[40]   | Bagir, G. S., Haydardedeoglu, F.E., Colakoglu, S., Bakiner, O. S., Ozsahin, K. A., and Ertorer, M. E. Urinary tract infection in diabetes: Susceptible organisms and antibiogram patterns in an outpatient clinic of a tertiary health care center. Medicine Science, 8(4): 881-6. Oct 2019.
[41]   | Gurjar, D., Mathur, A., Sai, R., Lakesar, A. and Saxena, P. Recent trends in the antimicrobial susceptibility patterns of urinary pathogens in type II diabetes mellitus. International Journal of Research in Medical Science, 6:1288-91. Mar 2018.
[42]   | Woldemariam, H. K., Geleta, D. A., Tulu, K. D., Aber, N. A., Legese, M. H., Fenta, G. M. and Ali, I. (2019). Common uropathogens and their antibiotic susceptibility pattern among diabetic patients. BMC Infectious Diseases, 19(1):43.
[43]   | Hirji, I., Guo, Z., Andersson, S., Hammar, N., and Gomez-Caminero, A. Incidence of urinary tract infection among patients with type 2 diabetes in the UK General Practice Research Database (GPRD). Journal of Diabetes Complications, 26(6): 513-516. Nov-Dec. 2012.
[44]   | Yismaw, G., Asrat, D., Woldeamanuel, Y., and Unakal, C. G. (2012). Urinary Tract Infection: Bacterial etiologies, drug resistance profile and associated risk factors in diabetic patients. European Journal of Experimental Biology, 2: 89-98.
[45]   | Ehinmidu, J. O. Antibiotic susceptibility pattern of urine bacterial isolates in Zaria, Nigeria. Tropical Journal of Pharmaceutical Research, 2(2):223-8. Dec 2003.