Abstract

Objective: Diabetes mellitus (DM) and antibiotic resistance is an emerging public health problem in Ethiopia. Urinary tract infections (UTIs) are common and occasionally life- threatening condition among diabetic patients. Despite, all these problems, antibiotics are prescribed empirically which may adversely affect antibiotic resistance so far. Therefore the aim of this study was to identify the etiologic agents of UTI and their antibiotic resistance pattern among diabetic patients attending diabetic clinic of Hawassa University Referral Hospital.

Material and methods: A cross-sectional study was conducted in a total of 240 diabetic patients from June to October, 2014. After obtaining an informed written consent, socio-demographic and clinical data were collected using pre-structured questionnaire. Clean catch mid-stream urine samples were collected and processed for identification of uropathogen through culture using standard microbiologic procedure. Antibiotic susceptibility test was carried out using Kirby-Bauer disc diffusion method.

Results: The overall prevalence of diabetic UTI was 13.8%. Out of the total number of patients, 11.2% and 23.1% had asymptomatic and symptomatic bacteriuria respectively. DM patients with no previous history of UTI [AOR=3.55; 95% CI=1.186-10.611] and illiterate [AOR=2.5; 95% CI=1.052-5.989] had higher odds of UTI compared with their counterparts. E. coli was the commonest isolated uropathogen followed by coagulase- negative Staphylococci. All the isolated bacteria were resistant to ampicillin but sensitive to nitrofurantoin. Gram- negative isolates demonstrated high level of resistance to trimethoprim-sulphamethoxazole in 9 (81.8%), gentamicin in 8 (72.7%) and ceftriaxone in 7 (63.6%) patients. Gram- positive bacteria showed resistance to penicillin in 14 (87.5%), norfloxacin in 10 (62.5%) and ciprofloxacin in 8 (50.0%) patients. Multidrug resistance was observed in 93.9% of the isolated uropathogens.

Conclusion: Illiterate DM patients with no previous history of UTI were significantly associated with UTI. Nitrofurantoin can be used as a drug of choice for empiric treatment of UTI in the study area. Multidrug resistance to commonly used antibiotics is an alarming phenomenon. Therefore, performing of urine cultures and periodic surveillance of UTI among DM patients is necessary.