Asymptomatic Bacteriuria in Diabetic patients attending Mulago Hospital

Abstract

Introduction There are about 285 million people currently living with Diabetes Mellitus (DM) and the number is expected to reach 438 million in 2030. Intensive management of DM reduces microvascular complications by about 50%; however, despite management, 40% of individuals do develop these complications. Asymptomatic Bacteriuria (ASB) is one of the common complications among patients with DM. Objective: To determine the prevalence, culture, sensitivity patterns and factors associated with ASB in diabetics attending Mulago Hospital.

Methods Between January and March 2008, a cross sectional study to assess the prevalence, the culture and sensitivity patterns, and the factors associated with ASB was conducted among diabetic patients attending Mulago Hospital diabetic clinic. Using an interviewer administered questionnaire socio-demographic and clinical data were collected. In addition each respondent provided a blood sample and urine sample for laboratory investigations including culture and sensitivity tests among others. Data were entered into Epi-data version 3.1 statistical software and analyzed using SPSS 12.0. The prevalence of ASB with a 95% confidence interval (CI) significance was computed. Univariate and multivariate logistic analyses were performed to assess factors associated with ASB. An alpha (α) level of less than 0.05 was considered as significant for any associations. Results The overall prevalence of ASB in 412 DM patients attending Mulago hospital was found to be 101/412 (24.5%, 95% CI 23.7-25.3) and in these Klebsiella species were the most frequently identified isolated organisms with a percentage of 24.3%. There was a high sensitivity rate to newer drugs like the cephalosporins which had 100% sensitivity in several isolates like E. coli, Klebsiella and very low sensitivity in the older drugs like cotrimoxazole which had 100% resistance to the isolates in this study. Factors found to be significantly associated with ASB in Diabetics after controlling for all other extraneous factors were female sex, older age, low or no physical activity and HIV negative status.

Conclusions The study showed a high prevalence of ASB in our setting with almost one person in every four diabetics having it. ASB complicates the management of DM leading to increased morbidity in diabetics and therefore higher costs of care. The commonest isolated organisms have changed from those that the older findings showed, i.e. the newer organisms are Klebsiella and Staphylococcus away from the older Escherichia coli species. The sensitivity to the cheaper, older and more common first line drugs is relatively low but notably high in the newer drugs. These species and drug sensitivity patterns do have an implication on management because they do not match the current patterns used in common clinical practice. The risk of having ASB increased with the older age group, the female sex, and HIV negative status, but decreased with one being physically active pointing towards high risk groups of diabetics that would require further attention and more targeting when formulating education material, giving health education and when running DM clinics.

Recommendations It is recommended that clinicians routinely assess for ASB (and UTIs) especially in female and older patients, and in those that are less physically active. There should be less blind treatment and more advocacy for culture and sensitivity tests where facilities are available. There is also a need to establish the current culture and sensitivity patterns for UTIs for the utility of these in places where a culture and sensitivity test is not possible. There is also need for increased awareness about ASB as a complication of DM to the patients and especially the groups identified as at higher risk. Larger microbiology studies to redefine the culture and sensitivity patterns for UTIs in our setting and therefore the first line drugs to be used in a resource limited setting like ours, may be necessary.