NAME : BERNASHA SEPTIANITA

NIM : 151810113037

A retrospective cross-sectional study of urinary tract infections and prevalence of

antibiotic resistant pathogens in patients with diabetes mellitus from a public hospital in
Surabaya, Indonesia

In their paper “A retrospective cross-sectional study of urinary tract infections and

prevalence of antibiotic resistant pathogens in patients with diabetes mellitus from a public
hospital in Surabaya, Indonesia” Norafika et al., (2020) state that there is no association
between the duration of DM with the prevalence of UTI in DM patients and also patients with
type 2 DM are susceptible to multidrug resistant pathogens.
Diabetes mellitus (DM) is a chronic disorder that can lead to morbidity. DM Type 2 is
a condition that the body doesn’t produce enough insulin or it resists insulin, it is can caused
by genetic, lifestyle, and environmental. DM patients might have secondary effects in the
urogenital system that causes urinary tract infection. This infection often occurs because
of high blood sugar levels, poor circulation of leucosyte in the body and bladder emptying
process abnormality due to the autonomic neuropathy that can makes urine remain in
the bladder for a long time so it can make a breeding field for bacteria. UTI composes various
clinical syndromes including asymptomatic bacteriuria, acute cystitis, pyelonephritis, and
malignant urosepsis.
This paper was a study of 161 DM patients with UTI from Haji Hospital in Surabaya
from January 2017 to December 2018. The patients with UTI assist to 3.93% of the total
patients with DM and the majority were above 60 years old. The isolates that were found are
Gram negative bacteria, Gram positive bacteria, and Candida spp.. There is different pattern of
antimicrobial susceptibility between Gram-positive bacteria and Gram-negative bacteria.
According to this study and former study, there was no relation between the risk of UTI and
DM based on age, gender, DM duration, and glycaemic status. But Mama et al, 2018 reported
that gender represent a significant result in the prevalence of UTI. The apparent gender
preference was affected by several factors including body mass index (BMI), waist size,
clustering of metabolic syndrome, and no leisure time physical activity (Mulvey et al., 2002).
Furthermore, the difference prevalence was affected by impaired fasting glucose (more in men)
and impaired glucose tolerance (usually in women). Imbalance of sex hormones also affected
gender preference like higher testosterone, low sex hormone-binding globulin (SHBG; women
usually have higher levels), polycystic ovary syndrome which might be found in females only
with hyperinsulinemia and androgen excess related to obesity, psychosocial behaviors, and
unhealthy lifestyles also contributed to the progress of UTI (Mulvey et al., 2002).
The predominant microorganism found in UTI were Escherichia coli (24.6%),
Enterococcus faecalis (9.8%), and Acinetobacter baumannii (6.6%). The possible reason E.
coli was a causative agent of UTI is it can occupy and reproduce within uroepithelial cells that
supply a survival advantage to escape recognition and apoptosis by both innate and adaptive
immune defense mechanisms (Mulvey et al., 2002). However, Enterococcus faecalis is an
endogenous flora of the GI tract and can cause infection when it is in the other site of body
meanwhile Acinetobacter baumannii is an important nosocomial pathogen.
Based on this paper, the durations of DM didn’t have refference with the prevalence of
UTI in DM patients and prevalence of resistant pathogen found in UTI. It was found that all
DM patients with antibiotic resistant pathogens had been hospitalized so it was suggesting that
all infections would have been nosocomial. The result was consistent with the previous studies
showing that patients with type 2 DM are prone to multidrug resistant pathogens.