Multidrug-Resistant Escherichia coli Causing Urinary Tract Infections among Controlled and Uncontrolled Type 2 Diabetic Patients at Laquintinie Hospital in Douala, Cameroon

Abstract

Urinary tract infections (UTIs) in patients with diabetes are a major public health problem worldwide, particularly in developing countries. This study assessed the resistance profile of Escherichia coli and biochemical abnormalities in controlled and uncontrolled type 2 diabetic patients. A cross-sectional study was conducted at the Douala Laquintinie Hospital from January, 2020, to July, 2021, on the diabetic and nondiabetic participants. The clinical symptoms and biochemical parameters of patient having UTIs were measured using standard methods. E. coli was isolated from urine and an antibiotic susceptibility test was performed using the Kirby-Bauer Agar diffusion method. A total of 851 participants were included with a mean age of 48.54 years. Three hundred and forty-six (40.67%) were nondiabetic, 226 (26.56%) were diabetic patients with balanced blood sugar levels (i.e., glycosylated haemoglobin (HbA1c) is normal), and 279 (32.78%) were diabetic patients with unbalanced blood sugar levels (i.e., patients having an abnormal HbA1c). The prevalence of UTI caused by E. coli was significantly ( $p<0.001$ ) higher in diabetics with unbalanced blood sugar levels (15.41%) and diabetics with balanced blood sugar levels (9.73%) compared to nondiabetics (0.87%). Significant ( $p<0.001$ ) high frequencies of polyuria (48.39%), proteinuria (29.75%), leukocyturia (27.96%), and polyphagia (8.24%) were observed in diabetic participants with unbalanced blood sugar levels. Significantly ( $p<0.001$ ) high average values of aspartate transaminase (25.34; 27.07; 29.93), alanine transaminase (26.08; 27.38; 28.20), creatininemia (8.15; 9.67; 11.31), total cholesterol (1.57; 1.83; 2.63), and atherogenic index (3.81; 6.56; 11.73) were noted in nondiabetics, balanced, and unbalanced blood glucose diabetics, respectively. E. coli showed a high level of resistance to ciprofloxacin (30%), amoxicillin (10.8%), and ofloxacin (9.3%) in diabetic participants with unbalanced blood sugar levels. The antibiotic resistance patterns of the E. coli to triple, quadruple, and quintuple antibiotics were higher when participants had diabetes and even more when diabetes was not controlled. The present findings underline an increased susceptibility of diabetic patients with unbalanced blood sugar levels to multidrug resistant E. coli. Further studies should be conducted to determine the causal association between uncontrolled diabetes and bacterial multidrug resistance.