Characterization of Bacterial Pathogens of the Urinary Tract in Type 2 Diabetes Patients at Mzuzu Central Hospital, Northern Malawi

Abstract

Background: People with type 2 diabetes are more vulnerable to infections due to a weakened immune system caused by diabetes-related factors. Urinary tract infections caused by bacteria are associated with antibiotic resistance and severe recurrent disease. Methods: This cross-sectional study characterized uropathogenic bacteria and assessed beta-lactamases linked to antibiotic resistance with a sample size of 294. In this research, bacteria from urine culture were identified by mass spectrometry-MALDI-TOF-MS and standard biochemical assays. A phenotypic confirmatory disc diffusion test (PCDDT) was utilized to assess Extended Spectrum Beta Lactamase (ESBL) generating isolates. Results: The prevalence of Urinary Tract Infection was 11% (n = 294). Prevalence was significantly higher in those with a mean Random Blood Sugar (RBS) of >190 g/dl (13.1%) than in those with a mean RBS of ≤190 g/dl (X2: p = 0.029). The prevalence of UTIs was also significantly higher among traders (29%, X2: p = 0.019) than among employed (16.6%) and unemployed (7.2%) participants. UTI prevalence was significantly higher among those with type 2 diabetes between 5 and 10 years since medical diagnosis (17%, X2: p = 0.029) than among those diagnosed E. coli (43.8%), Klebsiella spp. (34.4%), and Enterobacter spp. (12.5%). E. coli exhibited the highest level of antibiotic resistance, including resistance to 3rd generation Cephalosporin. Phenotypic ESBL confirmatory test showed 62.5% of the E. coli being positive for ESBL production. Conclusion: UTIs were common in type 2 diabetics, especially in those with >190 g/dl mean RBS. There was a concerning 62.5% ESBL-producing E. coli that were resistant to antibiotics, which is a serious threat to public health. Thus, regular UTI screening and AST should be utilized before prescription to facilitate Antibiotic resistance surveillance and promote early diagnosis, treatment, and infection control.