Causative Uropathogenic Bacteria and Their Antimicrobial Susceptibility Patterns in Diabetic Patients with Urinary Tract Infection in Ilam, Western of Iran

Introduction: In fact, individuals with diabetes mellitus (DM) are highly susceptible to developing urinary tract infections (UTIs). This study aimed to evaluate the etiologic agents of UTIs and their patterns of antimicrobial resistance among diabetic patients with UTIs in Ilam, western Iran. Materials & Methods: A cross-sectional study was conducted from June 2020 to December 2023 in Ilam, in western Iran. A total of 3,362 patients with DM and UTI were evaluated for common uropathogens. Bacterial identification was performed using colony morphology, Gram staining, and standard biochemical tests. The antibiotic susceptibility pattern was determined using the Kirby-Bauer disk diffusion method on Muller-Hinton agar. Data analysis was performed using SPSS software version 16.0. Fisher's exact test and Pearson's chi-square test were used to assess the association between the variables (p-value <0.05 as significant). Results: Among the diabetic samples, 0.8% (27/3,362) were positive for uropathogens, with a higher prevalence in females (77.8%) than in males (22.2%) (p-value = 0.03). All positive cases were older than 44 years (p-value = 0.02). Gram-negative bacteria (GNB) were more common (70.3%) than gram-positive bacteria (GPB) (29.7%) (p-value = 0.001). Escherichia coli was the predominant pathogen (63%), followed by coagulase-negative staphylococci (25.9%), Citrobacter spp. (3.7%), Klebsiella spp. (3.7%), and coagulase-positive staphylococci (3.7%). Cefazolin and cephalexin showed the highest efficacy against GNB (both 10.5% resistance), whereas norfloxacin (63.2%), ampicillin (57.9%), and nalidixic acid (52.6%) exhibited higher resistance rates. Among GPB, co-trimoxazole, gentamycin, cefazolin, and amoxicillin/clavulanic acid were more effective (100% sensitive), whereas oxacillin (37.5%) showed poor efficacy. Conclusion: This study highlights the prevalence and resistance patterns of uropathogens in diabetic patients with UTIs, emphasizing the need for targeted antibiotic therapy and continuous monitoring.