A Study on Clinical and Bacteriological Profile of Urinary Tract Infections (UTI) in North Karnataka

Introduction

The bacterial infection of urothelium causes urinary tract infection (UTI) leading to bacteriuria and pyuria. It affects both the genders. Women aged 15-44 years are more commonly affected. As the age advances, the prevalence of infection of urinary tract increases. In elderly women, the rate of infection doubles.

In women, 90% of the bladder infections are due to sexual activity. When the infection occurs during the initial days after marriage, it is called ‘honeymoon cystitis’. Indwelling urinary catheter, compromised immune system, usage of birth control devices, contaminated public toilets, improper toilet habits, post-menopause, incontinence, obesity, diabetes, and family history are the other factors contributing to UTIs. The frequent symptoms include high fever, nausea, vomiting, shaking chills, and pain in the back or one side of the waist. The elderly people with UTI most commonly present with fatigue. It can present with different clinical manifestations such as, asymptomatic bacteriuria, cystitis, prostatitis, and pyelonephritis. Serious complications like emphysematous cystitis, pyelonephritis, renal abscesses, and renal papillary necrosis are more frequently seen in diabetics than non-diabetics. About 80-90% of UTIs are caused by a single type of bacteria. Escherichia coli accounts for 85% of community-acquired and 50% of hospital-acquired infections followed by Proteus, Klebsiella, Pseudomonas, Staphylococcus saprophyticus, Acinet-obacter and Staphylococcus epidermidis. Infections caused by Klebsiella and Group B Streptococcus occur 2-3 times more frequently in diabetics than non-diabetics. This study was undertaken to evaluate the prevalence, clinical and bacteriological profile of UTIs, as well as drug sensitivity of uropathogens in North Karnataka.

Materials and Methods

This was a prospective study conducted in the General Medicine department at KBN Teaching and General Hospital in North Karnataka. The study was carried out from June 2022 to November 2022. A total of 100 patients were recruited in the study, of which 54 were diabetics and 46 were non-diabetics.

The urine was tested for pH, turbidity, odour and microbiological components using urine-analyzer with ten para-strips. For culture and sensitivity, early morning mid-stream urine was collected in a sterile, dry, wide necked and leak proof container. Urine culture was done using Kirby Bauer disc diffusion method on blood agar and MacConkey’s agar and sensitivity was done using Mueller Hinton agar with different antibiotics.

Aim of the study

1.  To analyze the clinical profile and bacteriological profile of patients with UTI in both individuals with diabetes and those without diabetes.

2.   To understand the drug sensitivity of bacteria causing UTI in North Karnataka.

Results

Of the hundred patients studied, 54 were diabetics and 46 were non-diabetics (Table 1).

Most common age group affected was 60-70 years in both males and females, females being more commonly affected (Table 2).

Out of 100 patients, 74% were symptomatic and 26% were asymptomatic. About 41% presented with fever and 39% with burning micturition (Table 3).

The commonly encountered complication was cystitis. Out of 54 diabetic patients, 15% had cystitis and 4% had prostatitis. Out of 46 non-diabetics, 10% had cystitis infection (Table 4).

Out of 54 diabetics patients, 22% had Klebsiella pneumoniae infection, 16% had E. coli infection and only two patients had Candida albicans infection. Out of 46 non-diabetics, 16% had K. pneumoniae infection, followed by E. coli infection (14%) (Table 5).

The organisms Klebsiella, E. coli and Acinetobacter baumannii were sensitive to cephalosporins and carbapenem group of drugs. Pseudomonas was sensitive to aminoglycosides and cephalosporins (Table 6).

Discussion

The infection of urinary system which can involve both upper and lower urinary tracts is called urinary tract infection (UTI). Symptomatic UTI is defined as the presence of bacteria in urine with >105 colony forming units per milliliter (CFU/mL) in one urine specimen.¹ Asymptomatic bacteriuria is defined as the absence of clinical features of UTI with the presence of bacteria in urine.¹

UTI is the second most commonly diagnosed nosocomial infection next to respiratory tract infections among community dwelling elderly individuals above 65 years.² The incidence of UTI is higher in women than in men across all age groups. The young sexually active women are more prone to develop UTI with an incidence rate ranging from 0.5-0.7 per person year, while in young males between the age group of 18-24 years, the reported incidence is 0.01 per person year.^3,4 The number of cases increase as the age advances and over the age of 85 years, it is almost 30%.⁵ The post-menopausal women with diabetes have higher incidence of UTI. In a study conducted by Sonam Ramrakhia et al., the mean age group in diabetics was 46±11 years, while it was 51±13 years in non-diabetics. Females were more commonly affected both in diabetics and non-diabetics.⁶ In our study, most common age group affected was 60-70 years. In both diabetics (34 patients) and non-diabetics (20 patients), females were the most commonly affected, especially those in post-menopausal phase. The diabetic female patients experienced recurrent UTIs.

Individuals with long-standing diabetes are more likely to develop autonomic neuropathy, leading to incomplete bladder emptying and a nearly 1.9-fold increase in bacteriuria for every decade of diabetes.⁷ In our study, out of 54 diabetic patients, 25 patients were diabetics for more than 10 years and had recurrent history of UTIs.

In a study conducted by Vinod CSS et al., the prime symptoms of UTI were fever and dysuria in all the individuals. Thus, whenever an individual presents with fever without any other symptoms, especially in the elderly age group, it is imperative to suspect the possibility of UTI.⁸ Even in our study, fever was the prime symptom (41%), followed by burning micturition (39%). Cystitis was the frequently occuring complication noted in our study participants. Out of the 54 diabetic patients, 15% had cystitis and 4% had prostatitis. Out of 46 non-diabetics, 10% had cystitis infection.

E. coli was identified as the predominant organism linked to UTIs across all individuals. In research undertaken by Bonadio M et al. in 2006, E. coli was isolated in 32.5% of diabetic males and 54.1% diabetic females. E. coli was commonly found even in non-diabetic males and females (31.4% and 58.2%, respectively).⁹ About 78.6 percent diabetics had ESBL (Extended-spectrum beta-lactamases) E. coli infection compared to 45.2% non-diabetics. In our study, K. pneumoniae was the most prevalent pathogen isolated and among 54 diabetes patients, 22% had K. pneumoniae infection, while 16% had E. coli infection. Among the 46 non-diabetic patients, 16% had K. pneumoniae infection while 14% had E. coli infection.

Fungal UTI is seen in diabetic patients with extended hospital stays due to inadvertent use of steroids and antibiotics. In our study, only two diabetic patients had UTI caused by Candida albicans.

In terms of antimicrobial susceptibility, in a study conducted by Kaleem Ullah Zubair et al., K. pneumoniae was found to be most sensitive to Imipenem and Piperacillin/Tazobactam followed by Ceftriaxone, Cefixime, Norfloxacin and Ofloxacin. E. coli showed higher sensitivity to Imipenem and Piperacillin/ Tazobactam followed by Cefixime, Ciprofloxacin, Nitrofurantoin and Ofloxacin.¹⁰ In our study, the organisms Klebsiella, E. coli and Acinetobacter baumannii were sensitive to Carbapenem group of drugs followed by Piperacillin/Tazobactam, Cephalosporins and Fluoroquinolones. Pseudomonas was sensitive to Aminoglycosides and Cephalosporins.

Conclusion

The UTI is significantly highly prevalent among the diabetics. The incidence increases as age advances in both diabetics and non-diabetics, with females being the most susceptible. Asymptomatic bacteriuria is common in elderly patients, necessitating heightened clinical vigilance for UTIs in these patients. Klebsiella pneumoniae is the most prevalent bacteria accountable for UTIs and recurrent UTIs in north Karnataka region, followed by E. coli and Pseudomonas. Early diagnosis and treatment are essential to prevent progression to renal complications. Effective blood sugar management combined with proper hygiene practices plays a significant role in controlling UTI infections.

Conflicts of Interests

Nil