Prevalence, antimicrobial susceptibility patterns of bacterial uropathogens and evaluation of urine dipstick parameter accuracy among individuals with diabetes in Ayder Comprehensive Specialized Hospital and Mekelle General Hospital, Tigray, Ethiopia.

backgroundUrinary tract infections represent the primary cause of morbidity in individuals with diabetes due to various factors, including high glycosuria, low bladder emptying and weak immunity. However, there is a paucity of scientific studies in the region dealing with bacterial Urinary tract infections, antimicrobial resistance and assessment of urine dipstick parameters. Therefore, the primary aim of this research endeavour was to determine the prevalence, antimicrobial susceptibility profile of bacterial uropathogens, and the reliability of urine dipstick values among patients with diabetes undergoing treatment in public health facilities in the study area.

methodsA hospital-based cross-sectional study involving 422 individuals with diabetes was conducted at Mekelle General Hospital and Ayder Comprehensive Specialized Hospital between June 1, 2020 and September 20, 2020, using a consecutive sampling method. The data was collected using a structured questionnaire for socio-demographic and clinical details, and mid-stream urine samples were collected for laboratory investigation (dipstick tests, culture and antimicrobial susceptibility testing). The urine dipstick tests, including leukocyte esterase, blood, and nitrite tests, were evaluated as predictive parameters for urinary tract infections using a Laboquick urine reagent strip 10-test parameter following the manufacturer’s directions. In culture, bacterial counts exceeding [Formula: see text]105 Colony-forming units (CFU)/ml in midstream urine for asymptomatic UTI and [Formula: see text]103 CFU/ml for symptomatic UTI were regarded as indicative of significant bacteriuria. Additionally, after a successful characterization, antimicrobial susceptibility testing of pure isolates was performed aseptically on a Muller-Hinton agar plate following the Kirby-Bauer disc-diffusion method. To explore the association of independent variables and an outcome variable (bacterial uropathogen), the bivariate and multivariate logistic regression analysis were performed using SPSS version 26. Statistically significant relationships were considered at p < 0.05 and respective 95% confidence interval, and the direction of the association was interpreted based on the adjusted odds ratios generated from the multivariate analysis. Performance metrics for each dipstick parameter were calculated, including specificity, sensitivity, likelihood ratios, and predictive values.

resultsThe overall prevalence of bacterial uropathogens in this study was 13.3% (56/422). The most prevalent bacterial uropathogen was Escherichia coli (24, 42.8), followed by Coagulase-negative Staphylococci (21.9%), and Klebsiella pneumoniae (17%). The odds of having positive bacterial uropathogens were higher among females (Adjusted odds ratio = 3.21 (95% CI: 1.43–7.17) and individuals with diabetes mellitus for five or more years (Adjusted odds ratio = 2.27 (95% CI: 1.06–4.63). Additionally, those having current symptoms of urinary tract infection (Adjusted odds ratio = 17.80 (95% CI: 7.38–42.93), a history of antibiotic use before two weeks (Adjusted odds ratio = 4.45 (95%CI: 2.11–9.39), and those 56 years of age or older (Adjusted odds ratio = 4.3 (95% CI: 1.01–18.48) were significantly more likely to have positive culture for bacterial uropathogens. Most of the gram-negative bacteria (52, 94.5%) were sensitive to amikacin, followed by ciprofloxacin (42, 76.3%). A significant prevalence of resistance to Tetracycline and Trimethoprim-sulfamethoxazole was noted in Escherichia coli (79.1% and 66%, respectively) and Klebsiella pneumoniae (80% for both) among the tested gram-negative organisms. Overall, 24 of 56 bacterial isolates (42.8%) were multidrug-resistant. Specifically, 50% of Escherichia coli (12/24), Klebsiella pneumoniae (5/10), and Enterobacter species (1/2), 25% of Pseudomonas aeruginosa (1/4) and Coagulase-negative Staphylococci (3/12), and 33.3% of Staphylococcus aureus isolates were found to be multidrug-resistant. Leukocyte Esterase was the most sensitive of the dipstick parameters (94.4%), whereas the nitrite test was the most specific (99.7%). The test with the least sensitivity (51.8%) and specificity (85.8%) was the blood test.

conclusionIn conclusion, Escherichia coli was the primary bacterial uropathogen found in individuals with diabetes, with a notable prevalence of multidrug resistance among uropathogens. Among diagnostic tests, the nitrite test demonstrated superior potential compared to the leukocyte esterase and blood tests. Both the leukocyte esterase and nitrite tests are significant for confirming bacterial urinary tract infections. Nonetheless, in diabetic patients, the diagnosis and management of bacterial urinary tract infections must advance to include the identification of multidrug-resistant pathogens, tailored treatment strategies, and effective glycemic control.