BACTERIAL AND FUNGAL UROPATHOGENS IN DIABETIC PATIENTS AND THEIR SUSCEPTIBILITY PATTERNS: CASE STUDY OF TWO HOSPITALS IN DOUALA

Background: Diabetic patients are more prone to develop urinary tract infections (UTI), than non-diabetic patients. These infections are responsible for considerable morbidity, particularly if they are unrecognised or untreated. The successful management of UTI in diabetic patients depends on the proper identification of the pathogens responsible and the selection of efficient antibiotics/antifungals against them.

Methods: A cross-sectional study was carried out in the Endocrinology/Diabetic units of the General Hospital and the Laquintinie Hospital in Douala (Cameroon). Midstream urine samples were collected from the patients and analysed macroscopically and microscopically. Samples containing up to five leukocytes/mm3 were inoculated onto culture media for bacterial isolation and microbial load. Bacteriuria counts ≥10/mL was considered significant. Biochemical identification and susceptibility testing to antibiotics were carried out in positive cultures, using the VitekTM 2automated system. The susceptibility testing to antifungals was done by the disc diffusion method. Urine dipstick analysis was done using CombiScreenTM 11SYS PLUS.

Results: Three hundred and fifteen patients comprising of 192 (60.95%) females, were enrolled. The overall UTI frequency was 20%, with rates of symptomatic bacteriuria and asymptomatic bacteriuria being 6.37% and 13.63% respectively. A total of 75 uropathogens were isolated, 3fungi (4%) and 72 bacteria (96%) strains. The most isolated bacteria were Escherichia coli (45.33%). Gram-positive cocci included Staphylococcus aureus, and coagulase negative Staphylococci were also found. The only fungus isolated was Candida albicans.

The susceptibility rate for Gram-negative bacilli was 100% for Imipenem, 93.30% for Amikacin, and Piperacillin+Tazobactam. The lowest rates were observed for Amoxicillin and Cotrimoxazole. Gram-positive cocci were 100% susceptible to Moxifloxacin, Nitrofurantoin, Quinupristin/ Dalfopristin, Linezolid, Tetracycline, Tigecycline, and Rifampicin. The susceptibility rate for Vancomycin and Oxacillin were 66.70% and 55.50% respectively. All the isolated strains of C. albicans were susceptible to Econazole, Ketoconazole, Fluconazole and Flucytosine; and all were resistant to Nystatine.

Conclusion: Many uropathogens were isolated from diabetic patients, and low susceptibilities to "first-line" drugs were observed. Dipstick urinalysis has a great contribution in urine culture examination.