Multi-drug resistance and multiple antibiotic resistance index of uropathogens in diabetic and non-diabetic patients with urinary tract infections

This study aimed to determine the multidrug resistance (MDR) rate and multiple antibiotic resistance index (MARI) of uropathogens among diabetic and non-diabetic patients with urinary tract infections (UTIs), highlighting the global concern for empirical treatment decisions. A prospective study was conducted from August 2021 to January 2024 in Gujarat, India, involving 2,408 patients with UTI symptoms, of whom 954 tested positives for UTIs. Among these, 280 (27%) were diabetic, and 674 (73%) were non-diabetic. In diabetic patients, Pseudomonas aeruginosa ( P. aeruginosa) was more common in males, while Escherichia coli ( E. coli) was more frequent in younger (18–40) females causing bacteriuria. Candida non-albicans which causes Candiduria was also found to be a prevalent pathogen in patients aged 61–95 and tended to recur. In non-diabetic patients, younger females were predominantly infected with E. coli , whereas males had higher rates of infections with P. aeruginosa and Klebsiella spp. Recurrence was strongly associated with E. coli in non-diabetics. Diabetic patients exhibited higher rates of antibiotic-resistant uropathogens compared to non-diabetics. Among the isolates, 61.84% were MDR, 19.49% were extreme drug-resistant (XDR), and 12.99% were pan drug-resistant (PDR). P. aeruginosa showed 92.10% MDR in diabetics, while E. coli showed 70.99% MDR in non-diabetics. XDR was more common in P. aeruginosa , while PDR was higher in Klebsiella spp. and P. aeruginosa . MARI greater than 0.2 was observed in 87.01% (201/231) of gram-negative uropathogens in diabetics and 71.03% (412/580) in non-diabetics. The study highlights significant differences in uropathogen prevalence and antibiotic resistance pattern between diabetic and non-diabetic UTI patients, emphasizing the need for targeted management and enhanced surveillance.