year 16, Issue 2 (March - April 2022)                   Iran J Med Microbiol 2022, 16(2): 98-115 | Back to browse issues page

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Kaur P, Sachan R S K, Karnwal A, Devgon I. A Review on Clinical Manifestation and Treatment Regimens of UTI in Diabetic Patients. Iran J Med Microbiol. 2022; 16 (2) :98-115
1- Adesh Institute of Pharmacy and Biomedical Sciences, Bathinda, Punjab, India
2- Department of Microbiology, Lovely Professional University, Phagwara, Punjab, India
3- Department of Microbiology, Lovely Professional University, Phagwara, Punjab, India ,
Abstract:   (677 Views)

The pervasiveness of urinary tract infections (UTIs) with their clinical manifestations in patients with diabetes mellitus has escalated amidst the past decade or so, as myriad predisposing factors contribute to its occurrence. Although the causative agent of UTI is Escherichia coli, the etiopathogenesis can be traced back to glycosuria in the renal parenchymal region. This has precipitated pyelonephritis and renal complications, including cytopathic and altered metabolism. Furthermore, impaired immunity with scarce IL-6, 8 in urine, urinary retention, and dysfunctional voiding raise susceptibility towards uropathogens, mainly E. coli. Treatment for UTI with diabetes is based on symptoms and severity, urologic abnormalities, renal function, bladder infections, and metabolic alteration. The treatment process or regimens for patients with type 2 diabetes with asymptomatic bacteriuria are very low or negligible. Adequate management with antibiotic regimens in symptomatic patients after critical diagnosis is crucial for prophylaxis and effective treatment.

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Type of Study: Review Article | Subject: Medical Bacteriology
Received: 2021/07/30 | Accepted: 2022/01/14 | ePublished: 2022/02/10

1. Shah MA, Kassab YW, Anwar MF, Al Dahoul H¬K, Menon S, Kaur HJ, et al. Prevalence and associated factors of urinary tract infections among diabetic patients. Health Sci J. 2019; 13(2), 1-5.
2. Nitzan O, Elias M, Chazan B, Saliba W. Urinary tract infections in patients with type 2 diabetes mellitus: review of prevalence, diagnosis, and management. Diabetes Metab Syndr Obes: Targets Ther. 2015; 8, 129. [DOI:10.2147/DMSO.S51792] [PMID] [PMCID]
3. Seifu WD, Gebissa AD. Prevalence and antibiotic susceptibility of Uropathogens from cases of urinary tract infections (UTI) in Shashemene referral hospital, Ethiopia. BMC Infect Dis. 2018; 18(1), 1-9. [DOI:10.1186/s12879-017-2911-x] [PMID] [PMCID]
4. Woldemariam HK, Geleta DA, Tulu KD, Aber NA, Legese MH, Fenta GM, et al. Common uropathogens and their antibiotic susceptibility pattern among diabetic patients. BMC Infect Dis. 2019; 19(1), 1-10. [DOI:10.1186/s12879-018-3669-5] [PMID] [PMCID]
5. Andersen-Nissen E, Hawn TR, Smith KD, et al. Cutting edge: Tlr5−/− mice are more susceptible to Escherichia coli urinary tract infection. J Immunol. 2007;78(8): 4717-20. [DOI:10.4049/jimmunol.178.8.4717] [PMID]
6. Prajapati AK. Urinary tract infection in diabetics. In Microbiology of Urinary Tract Infections-Microbial Agents and Predisposing Factors 2018 Nov 16 (Vol. 30, pp. 2-5). IntechOpen.
7. Raya S, Belbase A, Dhakal L, Govinda Prajapati K, Baidya R. In-vitro biofilm formation and antimicrobial resistance of Escherichia coli in diabetic and nondiabetic patients. BioMed Res Int. 2019. [DOI:10.1155/2019/1474578] [PMID] [PMCID]
8. Acharya D, Sullivan MJ, Duell BL, Goh KG, Katupitiya L, Gosling D, et al. Rapid Bladder Interleukin-10 Synthesis in Response to Uropathogenic Escherichia coli Is Part of a Defense Strategy Triggered by the Major Bacterial Flagellar Filament FliC and Contingent on TLR5. Msphere. 2019 ;4(6):e00545-19. [DOI:10.1128/mSphere.00545-19] [PMID] [PMCID]
9. Sarshar M, Behzadi P, Ambrosi C, Zagaglia C, Palamara AT, Scribano D. FimH and anti-adhesive therapeutics: A disarming strategy against uropathogens. Antibiotics. 2020; 9(7), 397. [DOI:10.3390/antibiotics9070397] [PMID] [PMCID]
10. Liu Y, Shapiro E, Lepor H, Sun TT, Wu XR. MP23-05 Development of novel knock-in mice provides direct evidence that Uroplakin IA is the urothelial receptor for type 1-piliated uropathogenic E. coli (UPEC). J Urol. 2018; 199(4S), e283. [DOI:10.1016/j.juro.2018.02.737]
11. Khandelwal P, Abraham SN, Apodaca G. Cell biology and physiology of the uroepithelium. Am J Physiol-Renal Physiol. 2009; 297(6), F1477-501. [DOI:10.1152/ajprenal.00327.2009] [PMID] [PMCID]
12. Terlizzi ME, Gribaudo G, Maffei ME. UroPathogenic Escherichia coli (UPEC) infections: virulence factors, bladder responses, antibiotic, and non-antibiotic antimicrobial strategies. Front Microbiol. 2017; 8, 1566. [DOI:10.3389/fmicb.2017.01566] [PMID] [PMCID]
13. Hughes FM, Hill HM, Wood CM, Edmondson AT, Dumas A, Foo WC, et al. The NLRP3 inflammasome mediates inflammation produced by bladder outlet obstruction. J Urol. 2016; 195(5), 1598-605. [DOI:10.1016/j.juro.2015.12.068] [PMID] [PMCID]
14. Nagamatsu K, Hannan TJ, Guest RL, Kostakioti M, Hadjifrangiskou M, Binkley J, et al. Dysregulation of Escherichia coli α-hemolysin expression alters the course of acute and persistent urinary tract infection. Proc Natl Acad Sci. 2015; 112(8), E871-80. [DOI:10.1073/pnas.1500374112] [PMID] [PMCID]
15. Hunstad DA, Justice SS. Intracellular lifestyles and immune evasion strategies of uropathogenic Escherichia coli. Ann Rev Microbiol. 2010; 64:203-21. [DOI:10.1146/annurev.micro.112408.134258] [PMID]
16. Schwab S, Jobin K, Kurts C. Urinary tract infection: recent insight into the evolutionary arms race between uropathogenic Escherichia coli and our immune system. Nephro Dial Transplant. 2017; 32(12), 1977-83. [DOI:10.1093/ndt/gfx022] [PMID]
17. Ching CB, Gupta S, Li B, Cortado H, Mayne N, Jackson AR, et al. Interleukin-6/Stat3 signaling has an essential role in the host antimicrobial response to urinary tract infection. Kidney Int. 2018; 93(6), 1320-9. [DOI:10.1016/j.kint.2017.12.006] [PMID] [PMCID]
18. Sun J, Deering RW, Peng Z, Najia L, Khoo C, Cohen PS, et al. Pectic Oligosaccharides from Cranberry Prevent Quiescence and Persistence in the Uropathogenic Escherichia coli CFT073. Sci Rep. 2019; 9(1), 1-9. [DOI:10.1038/s41598-019-56005-w] [PMID] [PMCID]
19. Davis JM, Rasmussen SB, O'Brien AD. Cytotoxic necrotizing factor type 1 production by uropathogenic Escherichia coli modulates polymorphonuclear leukocyte function. Infect Immun. 2005; 73(9), 5301-10. [DOI:10.1128/IAI.73.9.5301-5310.2005] [PMID] [PMCID]
20. Goller CC, Seed PC. Revisiting the Escherichia coli polysaccharide capsule as a virulence factor during urinary tract infection: contribution to intracellular biofilm development. Virulence. 2010; 1(4), 333-7. [DOI:10.4161/viru.1.4.12388] [PMID]
21. Lee JH, Subhadra B, Son YJ, Kim DH, Park HS, Kim JM, et al. Phylogenetic group distributions, virulence factors and antimicrobial resistance properties of uropathogenic Escherichia coli strains isolated from patients with urinary tract infections in South Korea. Lett Appl Microbiol. 2016; 62(1), 84-90. [DOI:10.1111/lam.12517] [PMID]
22. Maltby R, Leatham-Jensen MP, Gibson T, Cohen PS, Conway T. Nutritional basis for colonization resistance by human commensal Escherichia coli strains HS and Nissle 1917 against E. coli O157: H7 in the mouse intestine. PloS One. 2013; 8(1), e53957. [DOI:10.1371/journal.pone.0053957] [PMID] [PMCID]
23. Schiwon M, Weisheit C, Franken L, Gutweiler S, Dixit A, Meyer-Schwesinger C, et al. Crosstalk between sentinel and helper macrophages permits neutrophil migration into infected uroepithelium. Cell. 2014; 156(3), 456-68. [DOI:10.1016/j.cell.2014.01.006] [PMID] [PMCID]
24. Hurst RE, Dozmorov M, Kyker KD, Saban R, Shankar N, Dozmorov I, Centola MB. A Distinct Program of Gene Expression by Urothelial Cells Follows Infection by Enterococcus. J Urol. 2006; 175(4S), 21. [DOI:10.1016/S0022-5347(18)32328-0]
25. Abraham SN, Miao Y. The nature of immune responses to urinary tract infections. Nat Rev Immun 2015; 15(10), 655. [DOI:10.1038/nri3887] [PMID] [PMCID]
26. Justice SS, Hunstad DA, Seed PC, Hultgren SJ. Filamentation by Escherichia coli subverts innate defenses during urinary tract infection. Proc Natl Acad Sci. 2006; 103(52), 19884-9. [DOI:10.1073/pnas.0606329104] [PMID] [PMCID]
27. Godaly G, Proudfoot AE, Offord RE, Svanborg C, Agace WW. Role of epithelial interleukin-8 (IL-8) and neutrophil IL-8 receptor A in Escherichia coli-induced transuroepithelial neutrophil migration. Infect Immun. 1997; 65(8), 3451-6. [DOI:10.1128/iai.65.8.3451-3456.1997] [PMID] [PMCID]
28. Mysorekar IU, Hultgren SJ. Mechanisms of uropathogenic Escherichia coli persistence and eradication from the urinary tract. Proc Natl Acad Sci USA. 2006;103(38):14170-5. [DOI:10.1073/pnas.0602136103] [PMID] [PMCID]
29. Little P, Turner S, Rumsby K, Warner G, Moore M, Lowes JA. Urinary tract infection: development and validation, randomised trial, economic analysis, observational cohort and qualitative study. Health Technol Assess. 2009;13:19. [DOI:10.3310/hta13190] [PMID]
30. Bennett JE, Dolin R, Blaser MJ: Mandell, douglas, and bennett's principles and practice of infectious diseases: 2-volume set. Amsterdam: Elsevier Health Sciences; 2014.
31. Schmiemann G, Kniehl E, Gebhardt K, Matejczyk MM, Hummers-Pradier E. The diagnosis of urinary tract infection: a systematic review. Deutsch Ärztebl Int. 2010;107(21):361-7. [DOI:10.3238/arztebl.2010.0361] [PMID]
32. Masters BR. (2016). Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, (2015) Eds: John E. Bennett, Raphael Dolin, Martin J. Blaser. ISBN: 13-978-1-4557-4801-3, Elsevier Saunders. [DOI:10.1007/s00417-015-2950-1]
33. Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010; 50(5), 625-63. [DOI:10.1086/650482] [PMID]
34. Pontin AR, Barnes RD. Current management of emphysematous pyelonephritis. Nat Rev Urol. 2009; 6(5), 272-9. [DOI:10.1038/nrurol.2009.51] [PMID]
35. Fünfstück R, Nicolle LE, Hanefeld M, Naber KG. Urinary tract infection in patients with diabetes mellitus. Clin Nephrol. 2012; 77(1), 40. [DOI:10.5414/CN107216] [PMID]
36. Misgar RA, Mubarik I, Wani AI, Bashir MI, Ramzan M, Laway BA. Emphysematous pyelonephritis: a 10-year experience with 26 cases. Indian J endocrinol Metab. 2016; 20(4), 475. [DOI:10.4103/2230-8210.183475] [PMID] [PMCID]
37. Wiesel S, Gutman A, Abraham JE, Kiroycheva M. Foley Follies: Emphysematous Pyelitis from Instrumentation in Obstructive Uropathy. Cureus. 2017; 9(8). [DOI:10.7759/cureus.1612]
38. Ajmera P, Krishnamurthy S, Joshi M, Ajmera L. CT as a Diagnostic Tool for Emphysematous Pyelitis: A Case Report. Cureus. 2021; 13(2). [DOI:10.7759/cureus.13513]
39. Chiang CC, Jong YS, Wang WJ. Emphysematous pyelitis. Cmaj. 2010; 182(7), 698-698. [DOI:10.1503/cmaj.091055] [PMID] [PMCID]
40. Kua CH, Aziz YA. Air in the kidney: between emphysematous pyelitis and pyelonephritis. Biomed Imaging Interv J. 2008; 4(4). [DOI:10.2349/biij.4.4.e24] [PMID] [PMCID]
41. Thomas AA, Lane BR, Thomas AZ, Remer EM, Campbell SC, Shoskes DA. Emphysematous cystitis: a review of 135 cases. BJU Int. 2007; 100(1), 17-20. [DOI:10.1111/j.1464-410X.2007.06930.x] [PMID]
42. Kundu R, Baliyan A, Dhingra H, Bhalla V, Punia RS. Clinicopathological spectrum of xanthogranulomatous pyelonephritis. Indian J Nephrol. 2019; 29(2), 111. [DOI:10.4103/ijn.IJN_50_18] [PMID] [PMCID]
43. Ichaoui H, Saadi A, Chakroun M, Ayed H, Bouzouita A, Cherif M, et al. Xanthogranulomatous pyelonephritis in adults: clinical, biological, radiological and therapeutic main findings in diffuse and focal forms. About 42 cases. Tunis Med 2018; 96(8-9), 495-500.
44. Xie L, Tapiero S, Flores AR, Armas-Phan M, Limfueco L, Karani R, et al. Long-term antibiotic treatment prior to laparoscopic nephrectomy for Xanthogranulomatous pyelonephritis improves postoperative outcomes: results from a multicenter study. J Urol. 2021; 205(3), 820-5. [DOI:10.1097/JU.0000000000001429] [PMID]
45. Korkes F, Favoretto RL, Bróglio M, Silva CA, Castro MG, Perez MD. Xanthogranulomatous pyelonephritis: clinical experience with 41 cases. Urol 2008; 71(2), 178-180. [DOI:10.1016/j.urology.2007.09.026] [PMID]
46. Li L, Parwani AV. Xanthogranulomatous pyelonephritis. Arch Pathol Lab Med. 2011; 135(5), 671-4. [DOI:10.5858/2009-0769-RSR.1] [PMID]
47. Okafor CN, Onyeaso EE. Perinephric abscess. StatPearls 2020.
48. Kawaguchi Y, Mori H, Izumi Y, Ito M. Renal papillary necrosis with diabetes and urinary tract infection. Internal Med. 2018; 57(22), 3343. [DOI:10.2169/internalmedicine.0858-18] [PMID] [PMCID]
49. Aguilar-García CR, Naranjo-Tadeo I. Emphysematous Pyelonephritis. Medicina Interna de Méx 2014; 30(2), 215-22.
50. Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011; 52(5), e103-20. [DOI:10.1093/cid/ciq257] [PMID]
51. Olson RP, Harrell LJ, Kaye KS. Antibiotic resistance in urinary isolates of Escherichia coli from college women with urinary tract infections. Antimicrob Agents Chemother. 2009; 53(3), 1285-6. [DOI:10.1128/AAC.01188-08] [PMID] [PMCID]
52. Vahlensieck W, Perepanova T, Johansen TEB, Tenke P, Naber KG, Wagenlehner FM. Management of uncomplicated recurrent urinary tract infections. Eur Urol Suppl. 2016; 15(4), 95-101. [DOI:10.1016/j.eursup.2016.04.007]
53. Talan DA, Krishnadasan A, Abrahamian FM, Stamm WE, Moran GJ, Emergency ID NET Study Group. Prevalence and risk factor analysis of trimethoprim-sulfamethoxazole-and fluoroquinolone-resistant Escherichia coli infection among emergency department patients with pyelonephritis. Clin Infect Dis. 2008; 47(9), 1150-8. [DOI:10.1086/592250] [PMID]
54. Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005; 643-54. [DOI:10.1086/427507] [PMID]
55. Kallen AJ, Welch HG, Sirovich BE. Current antibiotic therapy for isolated urinary tract infections in women. Arch Internal Med. 2006; 166(6), 635-9. [DOI:10.1001/archinte.166.6.635] [PMID]
56. Knottnerus BJ, Grigoryan L, Geerlings SE, Moll van Charante EP, Verheij TJ, Kessels AG, et al. Comparative effectiveness of antibiotics for uncomplicated urinary tract infections: network meta-analysis of randomized trials. Fam Pract. 2012; 29(6), 659-70. [DOI:10.1093/fampra/cms029] [PMID]
57. Kahlmeter G. An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO SENS Project. J antimicrob Chemother. 2003; 51(1), 69-76. [DOI:10.1093/jac/dkg028] [PMID]
58. Lichtenberger P, Hooton TM. Antimicrobial prophylaxis in women with recurrent urinary tract infections. Int J antimicrob Agents. 2011; 38, 36-41. [DOI:10.1016/j.ijantimicag.2011.09.005] [PMID]
59. Cai T, Verze P, Brugnolli A, Tiscione D, Luciani LG, Eccher C, et al. Adherence to European Association of Urology guidelines on prophylactic antibiotics: an important step in antimicrobial stewardship. Eur Urol. 2016; 69(2), 276-83. [DOI:10.1016/j.eururo.2015.05.010] [PMID]
60. Edelsberg J, Weycker D, Barron R, Li X, Wu H, Oster G, et al. Prevalence of antibiotic resistance in US hospitals. Diagn Microbiol Infect Dis. 2014; 78(3), 255-62. [DOI:10.1016/j.diagmicrobio.2013.11.011] [PMID]
61. Neslihan İDİL, Candan ED, Rad AY. A Retrospective Study on Urinary Tract Infection Agents Isolated from Children and Their Antibiotic Susceptibility. Hacettepe J Bio Chem, 48(3), 265-74.
62. Huntington JA, Sakoulas G, Umeh O, Cloutier DJ, Steenbergen JN, Bliss C, et al. Efficacy of ceftolozane/tazobactam versus levofloxacin in the treatment of complicated urinary tract infections (cUTIs) caused by levofloxacin-resistant pathogens: results from the ASPECT-cUTI trial. J Antimicrob Chemother. 2016; 71(7), 2014-21. [DOI:10.1093/jac/dkw053] [PMID]
63. Zacchè MM, Giarenis I. Therapies in early development for the treatment of urinary tract inflammation. Expert Opin Inv Drug. 2016; 25(5), 531-40. [DOI:10.1517/13543784.2016.1161024] [PMID]
64. Brumbaugh AR, Mobley HL. Preventing urinary tract infection: progress toward an effective Escherichia coli vaccine. Expert Rev Vaccines. 2012; 11(6), 663-76. [DOI:10.1586/erv.12.36] [PMID] [PMCID]
65. Mobley HL, Alteri CJ. Development of a vaccine against Escherichia coli urinary tract infections. Pathogens. 2016; 5(1), 1. [DOI:10.3390/pathogens5010001] [PMID] [PMCID]

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