From the Guidelines
For managing urinary tract infections (UTIs) in diabetic patients, I recommend empiric treatment with an intravenous third-generation cephalosporin as empirical treatment for complicated UTI with systemic symptoms, as suggested by the European Association of Urology guidelines 1. This approach is crucial due to the high risk of complications in diabetic patients.
- The treatment should be guided by urine culture and susceptibility results.
- For yeast infections in diabetic patients, topical antifungals like clotrimazole or miconazole cream for 7-14 days are first-line treatments, as per the Infectious Diseases Society of America guidelines 1.
- Blood glucose control is crucial for both conditions, as hyperglycemia promotes bacterial and fungal growth, and targeting HbA1c below 7% can reduce infection risk.
- Increased fluid intake, proper genital hygiene, and avoiding irritating products are important preventive measures.
- Diabetic patients are more susceptible to these infections due to glycosuria providing a growth medium for pathogens and impaired neutrophil function, making prompt and thorough treatment essential.
- It is also important to manage any urological abnormality and/or underlying complicating factors, as recommended by the European Association of Urology guidelines 1.
- For complicated UTIs or pyelonephritis, consider a combination of antibiotics, such as amoxicillin plus an aminoglycoside or a second-generation cephalosporin plus an aminoglycoside, as suggested by the European Association of Urology guidelines 1.
- The treatment plan should take into account interactions with other drugs and possible side effects, especially in older individuals who are frail and have multiple medical conditions, as recommended by the European Urology guidelines 1.
From the Research
Management of Urinary Tract Infections (UTI) in Patients with Diabetes Mellitus (DM)
- The treatment of UTI in DM patients is not different from that in non-DM patients, and asymptomatic bacteriuria should not be screened or treated 2.
- Early diagnosis and prompt intervention is recommended to limit morbidity of symptomatic infection 3.
- A 5-day treatment with nitrofurantoin should be considered to reduce cumulative nitrofurantoin exposure in DM patients 4.
- Previous UTI and previous hospital admission are independent risk factors for resistance, but DM is not 5.
Management of Candidal (Yeast) Infections in Patients with Diabetes Mellitus (DM)
- Candida spp. was isolated in 6% of the culture-positive patients with UTI 6.
- There is no specific information available on the management of candidal infections in patients with DM in the provided studies.
Antibiotic Sensitivity and Resistance
- The bacteria grown were most sensitive to Piperacillin-tazobactam, Cefoperazone-sulbactam, and Meropenem, whereas Fluoroquinolone and Co-Amoxyclav showed least sensitivity 6.
- The prevalence of Extended-spectrum betalactamases (ESBLs) in gram-negative bacilli was 36.84% 6.
- Resistance to common antibiotics, particularly to oral formulations, is increasing due to indiscriminate use of antibiotics 6.