title: Urinary tract infections and antimicrobial sensitivity among diabetic patients at Khartoum, Sudan.
abstract: BACKGROUND
  Patients with diabetes mellitus (DM) are more susceptible to urinary tract infection (UTI) than non-diabetics. Due to the emergence of multidrug resistant (MDR) uropathogenic strains, the choice of antimicrobial agent is restricted. This study investigated the epidemiology of UTI, antimicrobial susceptibility, and resistance patterns of bacterial isolates from adult diabetic patients.
  
  
  METHODS
  A cross-sectional study was conducted at Khartoum Hospital, Sudan during the period of March - September 2013. Consecutive patients (men and women) were approached to participate in the study, irrespective of UTI symptoms. Socio-demographic and clinical data were obtained from each participant using pre-tested questionnaires. Clean-catch, midstream urine samples were collected and cultured for UTI diagnosis and antimicrobial susceptibility. Symptomatic bacteriuria was defined as a positive urine culture (≥10(5) colony-forming units [CFU]/mL of a single bacterial species) from patients with symptoms associated with UTI; asymptomatic bacteriuria was defined as a positive urine culture from patients without symptoms associated with UTI.
  
  
  RESULTS
  A total of 200 diabetic patients were enrolled, 121 (60.5%) men and 79 (39.5%) women; 193 (96.5%) had type II DM. The overall prevalence of UTI was 39 (19.5%). Among the total population, 17.1% and 20.9% had symptomatic and asymptomatic bacteriuria, respectively. According to multivariate logistic regression, none of the investigated factors (age, sex, type of DM and duration) were associated with UTI. The predominant isolates were Escherichia coli (22, [56.4%]), and Klebsiella pneumoniae, [9, (23%)]. Eight of 22 E. coli, four of nine K. pneumoniae and one of five Enterococcus faecalis isolates originated from symptomatic patients. Six, four, three, and two of 22 E. coli isolates showed resistance to ampicillin, co-trimoxazole, nitrofurantoin, and amoxicillin-clavulanic acid, respectively. Two, two, one and one of nine K. pneumoniae isolates were resistant to ampicillin, co-trimoxazole, cephalexin, and amoxicillin-clavulanic acid. All 22 E. coli isolates were sensitive (100%) to gentamicin and cephalexin. All nine K. pneumoniae were sensitive to gentamicin (100%) and 88.8% were sensitive to cephalexin.
  
  
  CONCLUSIONS
  In Sudan, about one-fifth of diabetic patients have UTI. E. coli is the most frequent isolate followed by K. pneumoniae.
authors.affiliation: Department of Biochemistry and Molecular Biology, Faculty of Medicine, Al-Neelain University, P.O. Box 12702, Khartoum, Sudan. hamdanology@hotmail.com.
authors.forename: Hamdan Z
authors.initials: HZ
authors.lastname: Hamdan
authors.affiliation: Department of Biochemistry and Molecular Biology, Faculty of Medicine, Al-Neelain University, P.O. Box 12702, Khartoum, Sudan. emankubbara@gmail.com.
authors.forename: Eman
authors.initials: E
authors.lastname: Kubbara
authors.affiliation: Department of Biochemistry and Molecular Biology, Faculty of Medicine, Al-Neelain University, P.O. Box 12702, Khartoum, Sudan. amarshow@hotmail.com.
authors.forename: Amar M
authors.initials: AM
authors.lastname: Adam
authors.affiliation: Faculty of Pharmacy, Al-Yarmouk University College, Khartoum, Sudan. onabs@hotmail.com.
authors.forename: Onab S
authors.initials: OS
authors.lastname: Hassan
authors.affiliation: Faculty of Medical Laboratory, Omdurman Al-Ahlia University, Omdurman, Sudan. osartosh@yahoo.com.
authors.forename: Sarah O
authors.initials: SO
authors.lastname: Suliman
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Khartoum University, P.O. Box 102, Khartoum, Sudan. ishagadam@hotmail.com.
authors.forename: Ishag
authors.initials: I
authors.lastname: Adam
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001419:Bacteria / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000453:epidemiology / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D013397:Sudan / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents