This document discusses a study on urinary tract infections (UTIs) in diabetic patients in Libya. The key points are: 1) UTIs are more common in women with diabetes than in non-diabetic women, due to factors like impaired immune response and presence of glucose in the urine. Escherichia coli is the primary cause of UTIs. 2) The study isolated bacteria from the urine of 135 diabetic and 164 non-diabetic patients with UTIs. The most common bacteria were E. coli, Klebsiella species, and Staphylococcus aureus. 3) Resistance to common antibiotics like trimethoprim-sulfamethoxazole and cipro

1. URINARY TRACT INFECTIONS IN
DIABETIC PATIENTS IN LIBYA
Prof. Khalifa Sifaw Ghenghesh

2. Introduction
• Common and rare infections are reported more
frequently among patients with diabetes mellitus (DM)
than in the general population
– not universally accepted
• Bacteriuria and urinary tract infections (UTIs) are more
common in women with DM than in non-DM women.
• Implicated factors:
– Differences in host responses between DM and non-DM
patients,
– A difference in the infecting bacterium itself,
– The presence of glucosuria and
– Impairment of granulocyte function.
• Others found no differences in such factors between
the two groups.

3. Introduction
• Escherichia coli is the major cause of UTIs.
• Other bacteria.
• Colonization of UT by uropathogenic E. coli (UPEC)
is medicated by a variety of virulence factor (VF) that
include:
– Fimbrial (P, S/F1C and type 1 fimbriae) and non-fimbrial
adhesins >> adherence to epithelia cells,
– Siderophores >> iron-acquisition systems,
– Toxins (haemolysin and cytotoxic necrotizing factor 1) and
– Capsule forming polysaccharides >> immune evasion

4. Introduction
• Treatment of UTIs
– Resistance rates to trimethoprim-sulphamethoxa-zole
exceeding 10% >> Ciprofloxacin and other
fluoroquinolones.
– Recently, high rates of antibiotic resistance among E. coli
from UTIs including new drugs (i.e. ciprofloxacin) have
been reported.

5. Uropathogens isolated from DM and non-DM patients with UTIs
Organism
DM patients
(n=135)
E. coli
Klebsiella sp
Proteus sp
Enterobacter sp
Citrobacter sp
Serratia sp
Pseudomonas sp
Streptococcus sp
S. aureus
S. saprophyticus
Candida albicans
Total
No organism
18 (13)
18 (13)
2 (1.5)
7 (5)
2 (1.5)
0 (0.0)
6 (4)
1 (1)
12 (9)
1 (1)
10 (7)
77 (57)
58 (43)
No. (%) positive in:
Non-DM patients
(n=164)
29 (18)
23 (14)
9 (5.5)
7 (4)
4 (2)
3 (2)
7 (4)
5 (3)
12 (7)
2 (1)
9 (5.5)
110 (67)
54 (33)
Total
(n=299)
47 (16)
41 (14)
11 (4)
14 (5)
6 (2)
3 (1)
13 (4)
6 (2)
24 (8)
3 (1)
19 (6)
187 (62.5)
112 (37.5)

6. • Age, gender, education level and marital status had
no statistically significant influence (P > 0.05) on the
isolation of E. coli, Klebsiella sp. or S. aureus from
DM and non-DM patients with UTIs.
• No significant differences were found in the isolation
rates of uropathogens from DM patients using oral
medications when compared with those taking
insulin (P > 0.05).

7. Antimicrobial sensitivity patterns of E. coli, Klebsiella sp. and
S. aureus isolated from DM and non-DM patients with UTIs

8. Ghenghesh KS., Elkateb E., Berbash N., Abdel
Nada R, Ahmed SF., Rahouma A, Seif-Enasser
N., Elkhabroun M-A., Belresh T., and Klena JD.
2009. Uropathogens from diabetic patients in
Libya: virulence factors and phylogenetic
groups of isolated Escherichia coli. Journal of
Medical Microbiology; 58: 1006-1014.
ghenghesh_micro@yahoo.com
ghenghesh@yahoo.com