In this study, 33 out of 124 type-2 diabetics (26.6%) had AB. This is comparable to previous reports from Africa (22.5%), Netherlands (26%), and Turkey (25.5%); although these studies were carried out on a larger population of diabetics. In some parts of Nigeria, the prevalence of AB in two different studies was 6.3% and 20%. Other centers worldwide have reported much lower values varying from 5.8%, 7.9%, 10%, 11.1, 17%, to 19%. The lower figures recorded in these studies could be explained in that the studies based the diagnosis of AB on two urine cultures, as against single urine culture in the present study; the later may increase the observed prevalence of AB.
Many workers have demonstrated the pres ence of AB in different groups such as school age girls, sexually active young women, pregnant women, institutionalized elderly and catheterized patients. This shows that AB is quite common. In this study, AB was more common among diabetic women. This is comparable to previous reports in many countries including Italy, Scandinavia, Netherlands, South Africa, etc. is study, most of the diabetic women with AB were between 40 and 59 years of age, while most of the diabetic men were above 60 years. Only two patients in the study population below 40 years had AB. This supports other studies where UTI was found more commonly in the elderly. Apcalis Oral Jelly
K. pneumonia was the most common isolate from the urine samples. This is in contrast to other studies where E. coli was the most common organism isolated. This suggests a changing pattern in organisms causing infection in the population. At the University College Hospital in Ibadan, Nigeria, Klebsiella species were reported to occur more commonly than E. coli as the causative agent of bacteraemia amongst diabetics. Klebsiella species also was identified as the predominant organism causing UTI in the general population in the same environment This observation is, however, not surprising since Klebsiella species were known to be an important cause of both nosocomial and community acquired UTI
In this study, the presence of AB was related to the duration of diabetes and the age of the patient, but not related to the degree of control. This is comparable to previous reports worldwide. A statistically significant longer diabetes duration has been documented for diabetic subjects with bacteriuria than without (9.9vs5.4); while bacteriuria prevalence increased 1.9-fold with each 10-year increase in diabetes duration.
There was a high prevalence of multidrug resistant organisms in this study. A large number of the isolates were resistant to ampicillin, cotri-moxazole and tetracycline, which are very common and often purchased without prescription. The isolates were, however, susceptible to quinolones, gentamicin.
Eleven (78.6%) of the Klebsiella isolates were sensitive to nitrofurantoin, thus, indicating that the drug is still a useful urinary antiseptic in our environment. This finding is comparable to reports on antimicrobial sensitivity pattern of isolates from various centers in the country. It is quite expensive and, therefore, not likely to be purchased without prescription. Gentamicin is cheap and effective but requires parenteral administration and, therefore, will not be suitable for treating outpatients.
There are conflicting views as to the rationale of screening diabetics routinely for significant bacteriuria. In the mid-1950s, at a time when urinary infection was considered to be an important contributor to chronic renal failure, hypertension, toxaemia of pregnancy, routine screening for bacteriuria was advocated in diverse groups of patients. Thereafter, it was observed that schoolgirls and women with AB were no more likely to have progression to renal failure than those without. Interest in AB later shifted to pregnant women, men or women undergoing invasive genitourinary procedures, renal transplant recipients, post transplantation period, and diabetics. Studies in all these groups have consistently confirmed that patients with AB also are at increased risk for symptomatic urinary infection. This suggests that the diabetic patients with AB in this study also are at risk. It is, therefore, necessary to study the pattern and the prevalence of symptomatic bacteriuria among type 2 diabetic patients in Sagamu, Nigeria.
In conclusion, AB is more prevalent among female type 2 diabetics in Sagamu, Nigeria, than in non-diabetics. Diabetologists should emphasize the importance of urine microscopy and culture in the clinical care protocols of patients. It appears that there is a changing pattern in the organisms causing infection among diabetics. This may be a result of antibiotic abuse, which is prevalent in the population. This is reflected in various hospitals nationwide. There is a need for continuous surveillance of organisms causing infections in the hospital and the community.
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