The burden of urinary tract infections among children and adolescents with type 1 diabetes mellitus: bacterial profile and antimicrobial susceptibility

Abstract

Background: Among the many comorbidities seen in patients with Type 1 Diabetes Mellitus (T1DM), urinary tract infections (UTIs) is currently a major cause of morbidity and increases the risk of decompensation to DKA and end-stage renal disease. A comorbidity with such a significant cause of morbidity and burden would require available in-country information on the burden of UTI among the T1DM pediatric age group to allow a logical approach to patient care. However, the available information reported so far does not indicate the burden of UTI in the T1DM pediatric age group. It is therefore necessary to understand the burden of UTI, factors associated and antimicrobial patterns of microbes amongst type 1 diabetes mellitus patients, which will ultimately enable prompt and effective management of UTIs in T1DM patients. Methods: A cross-sectional study among children aged 1 to 18 years was conducted between January and March 2023 at the Paediatric Diabetes clinic of Mulago NRRH. A structured questionnaire was administered upon obtaining informed consent from the primary caretaker of children less than 8 years; together with assent from children 8 years and older who attended the clinic during the study period and met the eligibility criteria. Using aseptic procedures, a urine sample was obtained and analyzed using dipstick, microscopy, and culture. All culture-positive urine samples were subjected to antimicrobial drug susceptibility testing. The data collected was entered in Epidata V3.1 and exported to STATA version 14.0 for analysis. Univariate analysis was used to summarize categorical and continuous variables into proportions, median (Inter quartile range) and frequencies. Bivariate and multivariate analysis using generalized linear model was utilized to assess the strength of associations between the independent and outcome variable, and a p-value < 0.05 was considered as statistically significant. Socio-demographic and clinical variables were summarized using descriptive statistics (frequency, median IQR) to see their distribution. The culture results were used to calculate prevalence of UTI, characterize the type of microbial growth and to test for antimicrobial susceptibility. Administrative clearance was obtained from the respective hospital Institutional Review Board (IRB) and approval by School of Medicine Research and Ethics Committee (SOMREC). Results: A total of 118 type 1 diabetes mellitus children aged 1-18 years and meeting the inclusion criteria were enrolled into the study. About 64 (54%) were females, the median age (IQR) was 10 (6-15years). The prevalence of urinary tract infections was 17% (20/118). Poorly controlled xv sugar levels (HBA1C >7.5%), poor compliance to diabetes mellitus treatment and having lived with type 1 diabetes mellitus for > 5years were significantly associated with urinary tract infections. Eschericia coli was the predominant isolate causing UTIs, bacterial isolates displayed high susceptibility to imipenem, nitrofurantoin, chloramphenicol, PISA and linezolid, while resistance patterns were to ceftriaxone, erythromycin, penicillin-G and ampicillin. Conclusion and recommendations: Prevalence of UTI infection was high among T1DM children aged 1-18 years, and T1DM with poorly controlled glucose levels were more prone to getting urinary tract infections. Overall, Gram-positive and Gram-negative isolates displayed resistance patterns to commonly prescribed antibiotics ceftriaxone, ciprofloxacin and penicillin antibiotics. These results call for proper control of blood sugar levels, regular screening for infections especially urinary tract infections, and clinicians should be educated about the appropriate antibiotic use based on culture results.