The Management of Post-Catheterization Urinary Tract Infection in Patients with Uncontrolled Diabetes
Published: 2024-04-17
Page: 28-34
Issue: 2024 - Volume 7 [Issue 1]
Anwar Rashed Ahmed Ahmed *
Specialized Medical Care Hospital, UAE.
*Author to whom correspondence should be addressed.
Abstract
Urinary tract infections (UTI) are a frequent complication that follows course after hospitalization in patients. The reason for this lies in the fact that the majority of the patients get catheterized during their stay at the hospital, which adds to the risk of infections ultimately. It was seen that the majority of patients who got infected with UTIs were hospitalized patients with diabetes being the most common ones. In such circumstances, the control of situations in which a patient has an advanced case of diabetes and there are significant obstacles due to the combined effects of the immune weakening features of the disease and catheter-related risks. Patient with uncontrolled diabetes are disposed to UTIs because of their immune status being compromised, neuropathy affecting bladder emptying and high levels of sugar in urine providing a great and conducive environment for bacterial growth. Catheterization provides extra risks as it forms a port for micro-organisms to get to the bladder through where the infection gets a higher chance of infection. For patients with uncontrolled diabetes, the diagnosis of UTI can be different as the body could mask or present atypical symptoms in the off-shoot. In the context of non-traditional signs being less severe (for instance, dysuria and urgency) the diagnosis time will likely be delayed and the treatment deferred. Thus, urine culture and sensitivity are essential as they dictate indecent treatment as a method of management. Optimizing glycemic control is essential in managing post-catheterization UTIs in patients with diabetes. Hyperglycemia compromises immune function and promotes bacterial proliferation, thus exacerbating the risk of infection. Therefore, aggressive management of blood glucose levels through lifestyle modifications, oral hypoglycemic agents, or insulin therapy is crucial in reducing UTI recurrence rates. This review will explore all the reasons that people with diabetes suffer from the atrocities of UTIs, while at the same time, working to reflect upon the current management strategies to deal with this condition as per the current guidelines and recommendations.
Keywords: Urinary tract infections, UTI, diabetes mellitus, immunocompromised, hospitalized patients
How to Cite
References
Azeem S, Khan U, Liaquat A. The increasing rate of diabetes in Pakistan: A silent killer. Ann Med Surg. 2022;79. Available:https://journals.lww.com/annals-of-medicine-and surgery/fulltext/2022/07000/the_increasing_rate_of_diabetes_in_pakistan__a.13.aspx [Accessed on: 2024 Mar 18]
Sapra A, Bhandari P. Diabetes. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Available:http://www.ncbi.nlm.nih.gov/books/NBK551501 [Accessed on: 2024 Apr 6].
Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2010;33(Suppl 1):S62–9.
Genuth SM, Palmer JP, Nathan DM. Classification and Diagnosis of Diabetes. In: Cowie CC, Casagrande SS, Menke A, Cissell MA, Eberhardt MS, Meigs JB, et al., editors. Diabetes in America [Internet]. 3rd ed. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases (US); 2018 Available:http://www.ncbi.nlm.nih.gov/books/NBK568014 [cited 2024 Apr 6].
Goyal R, Singhal M, Jialal I. Type 2 Diabetes. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available:http://www.ncbi.nlm.nih.gov/books/NBK513253 [cited 2024 Mar 19].
Banday MZ, Sameer AS, Nissar S. Pathophysiology of diabetes: An overview. Avicenna J Med. 2020;10(4):174–88.
Ahmed AE, Abdelkarim S, Zenida M, Baiti MAH, Alhazmi AAY, Alfaifi BAH, et al. Prevalence and Associated Risk Factors of Urinary Tract Infection among Diabetic Patients: A Cross-Sectional Study. Healthcare. 2023;11(6):861.
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: 129–36.
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: 129–36.
Al Qurabiy HE, Abbas IM, Hammadi ATA, Mohsen FK, Salman RI, Dilfy SH. Urinary tract infection in patients with diabetes mellitus and the role of parental genetics in the emergence of the disease. J Med Life. 2022;15(8):955–62.
Ahmad S, Hussain A, Khan MSA, Shakireen N, Ali I. Diabetes mellitus and urinary tract infection: Causative uropathogens, their antibiotic susceptibility pattern and the effects of glycemic status. Pak J Med Sci. 2020;36(7):1550–7.
Hirji I, Guo Z, Andersson SW, Hammar N, Gomez-Caminero A. Incidence of urinary tract infection among patients with type 2 diabetes in the UK General Practice Research Database GPRD. J Diabetes Complications. 2012;26(6):513–6.
Hammar N, Farahmand B, Gran M, Joelson S, Andersson SW. Incidence of urinary tract infection in patients with type 2 diabetes. Experience from adverse event reporting in clinical trials. Pharmacoepidemiol Drug Saf. 2010 Dec;19(12):1287–92.
Yu S, Fu AZ, Qiu Y, Engel SS, Shankar R, Brodovicz KG, et al. Disease burden of urinary tract infections among type 2 diabetes mellitus patients in the U.S. J Diabetes Complications. 2014;28(5):621–6.
Fu AZ, Iglay K, Qiu Y, Engel S, Shankar R, Brodovicz K. Risk characterization for urinary tract infections in subjects with newly diagnosed type 2 diabetes. J Diabetes Complications. 2014;28(6):805–10.
Colgan R, Nicolle LE, McGlone A, Hooton TM. Asymptomatic bacteriuria in adults. Am Fam Physician. 2006;74(6): 985–90.
Nicolle LE. Asymptomatic bacteriuria. Curr Opin Infect Dis. 2014;27(1):90–6.
Papazafiropoulou A, Daniil I, Sotiropoulos A, Balampani E, Kokolaki A, Bousboulas S, et al. Prevalence of asymptomatic bacteriuria in type 2 diabetic subjects with and without microalbuminuria. BMC Res Notes. 2010;3:169.
Renko M, Tapanainen P, Tossavainen P, Pokka T, Uhari M. Meta-analysis of the significance of asymptomatic bacteriuria in diabetes. Diabetes Care. 2011;34(1):230–5.
Chávez-Reyes J, Escárcega-González CE, Chavira-Suárez E, León-Buitimea A, Vázquez-León P, Morones-Ramírez JR, et al. Susceptibility for Some Infectious Diseases in Patients With Diabetes: The Key Role of Glycemia. Front Public Health. 2021;9:559595.
Wen SC, Juan YS, Wang CJ, Chang K, Shih MCP, Shen JT, et al. Emphysematous prostatic abscess: case series study and review. Int J Infect Dis IJID Off Publ Int Soc Infect Dis. 2012; 16(5):e344-349.
Kofteridis DP, Papadimitraki E, Mantadakis E, Maraki S, Papadakis JA, Tzifa G, et al. Effect of diabetes mellitus on the clinical and microbiological features of hospitalized elderly patients with acute pyelonephritis. J Am Geriatr Soc. 2009;57(11):2125–8.
Sobel JD, Fisher JF, Kauffman CA, Newman CA. Candida urinary tract infections--epidemiology. Clin Infect Dis Off Publ Infect Dis Soc Am. 2011;52 Suppl 6:S433-436.
Lim JH, Cho JH, Lee JH, Park YJ, Jin S, Park GY, et al. Risk factors for recurrent urinary tract infection in kidney transplant recipients. Transplant Proc. 2013;45(4): 1584–9.
Inns T, Millership S, Teare L, Rice W, Reacher M. Service evaluation of selected risk factors for extended-spectrum beta-lactamase Escherichia coli urinary tract infections: a case-control study. J Hosp Infect. 2014;88(2):116–9.
Venmans LM a. J, Hak E, Gorter KJ, Rutten GEHM. Incidence and antibiotic prescription rates for common infections in patients with diabetes in primary care over the years 1995 to 2003. Int J Infect Dis IJID off Publ Int Soc Infect Dis. 2009;13(6):e344-351.
Yu S, Fu AZ, Qiu Y, Engel SS, Shankar R, Brodovicz KG, et al. Disease burden of urinary tract infections among type 2 diabetes mellitus patients in the U.S. J Diabetes Complications. 2014;28(5):621–6.
Fünfstück R, Nicolle LE, Hanefeld M, Naber KG. Urinary tract infection in patients with diabetes mellitus. Clin Nephrol. 2012;77(1):40–8.
Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis Off Publ Infect Dis Soc Am. 2005;40(5):643–54.
Nicolle LE, Zhanel GG, Harding GKM. Microbiological outcomes in women with diabetes and untreated asymptomatic bacteriuria. World J Urol. 2006;24(1): 61–5.
Wazait HD, van der Meullen J, Patel HRH, Brown CT, Gadgil S, Miller RA, et al. Antibiotics on urethral catheter withdrawal: a hit and miss affair. J Hosp Infect. 2004; 58(4):297–302.
Wazait HD, Patel HR, van der Meulen JHP, Ghei M, Al-Buheissi S, Kelsey M, et al. A pilot randomized double-blind placebo-controlled trial on the use of antibiotics on urinary catheter removal to reduce the rate of urinary tract infection: The pitfalls of ciprofloxacin. BJU Int. 2004;94(7):1048–50.
Harding GK, Nicolle LE, Ronald AR, Preiksaitis JK, Forward KR, Low DE, et al. How long should catheter-acquired urinary tract infection in women be treated? A randomized controlled study. Ann Intern Med. 1991;114(9):713–9.
Dow G, Rao P, Harding G, Brunka J, Kennedy J, Alfa M, et al. A prospective, randomized trial of 3 or 14 days of ciprofloxacin treatment for acute urinary tract infection in patients with spinal cord injury. Clin Infect Dis Off Publ Infect Dis Soc Am. 2004 39(5):658–64.