Bacteriological Spectrum of UTI in Patients of Chronic Kidney Disease with Diabetes Mellitus in Bangladesh

Background: Urinary tract infections (UTIs) are a significant concern in chronic kidney disease (CKD) patients, particularly those with diabetes mellitus (DM), due to immune dysfunction and glycosuria. The increasing burden of antimicrobial resistance (AMR) in this population necessitates a detailed understanding of bacterial pathogens and susceptibility patterns. Objective: To determine the prevalence of UTIs in diabetic CKD patients, compare bacterial isolates between diabetic and non-diabetic CKD patients, and assess antimicrobial susceptibility patterns. Methods and Materials: This cross-sectional study included 997 CKD patients (499 with DM, 498 without DM) at a tertiary hospital in Bangladesh. Urine samples were collected and analyzed for bacterial growth. Antibiotic susceptibility was determined using the Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute (CLSI) guidelines. Statistical analysis was performed using STATA 17, with p<0.05 considered significant. Results: UTI prevalence was 66.33% in diabetic CKD patients and 57.83% in non-diabetic CKD patients (p=0.000). Escherichia coli (E. coli) was the predominant pathogen (62.15% in diabetic vs. 66.36% in non-diabetic CKD patients), followed by Klebsiella (18.75% vs. 17.88%). High resistance was observed for amoxicillin (95.28%), cefixime (81.65%), and ciprofloxacin (58.76%), whereas carbapenems (meropenem: 87.94%) and colistin (68.85%) were more effective. Conclusion: Diabetic CKD patients had a higher UTI prevalence and were more prone to multidrug-resistant infections. The findings highlight the urgent need for antibiotic stewardship, routine screening, and infection control measures to improve clinical outcomes.