Antimicrobial resistance patterns and difficult-to-treat resistance in uropathogens among diabetic and non-diabetic patients: a cross-sectional study

While antimicrobial resistance (AMR) is a global challenge, data comparing Difficult-to-Treat Resistance (DTR) in diabetic versus non-diabetic urinary tract infection (UTI) patients is scarce. This study uniquely evaluates DTR and first-line resistance patterns to inform targeted empirical treatment strategies for these distinct patient cohorts. A prospective observational cross-sectional study was conducted from August 2021 to January 2024, at a tertiary care teaching hospital in Vadodara, Gujarat, India. During the period, 2408 patients with symptoms of UTI were screened for urine culture and sensitivity, of which 954 individuals tested positive for UTIs. Of the 2,408 symptomatic patients screened, 954 (39.61%) tested positive. The within-group UTI positivity rate was 27.4% (280/1,023) among diabetic patients and 48.7% (674/1,385) among non-diabetic patients. Among the isolated uropathogens, Escherichia coli (E. coli) (56.78%, 62.90%) was the predominant organism followed by Pseudomonas aeruginosa (P. aeruginosa) (13.57%, 5.78%) and Klebsiella spp. (13.21%, 17.35%) in diabetic and non-diabetic respectively. Among all the isolated uropathogen tetracycline (81.25%) and penicillin (71.86%) groups of antibiotics showed high resistance in diabetic patients, whereas fluoroquinolones had highest resistance in non-diabetic with 67.59%. However, the carbapenem, phosphonic and nitrofuran group of antibiotics showed least resistance in both diabetic and non-diabetic populations. Among all the antimicrobial drugs tested in our study, the first line of drugs was further analyzed, and P. aeruginosa had the highest DTR in both diabetic and non-diabetic individuals. Despite lower culture positivity rates among diabetic patients, diabetic UTI cases demonstrated substantially higher AMR burden and DTR compared to non-diabetics. P. aeruginosa showed highest DTR prevalence. Penicillin and tetracycline resistance were markedly elevated in diabetic UTIs, while nitrofurantoin and fosfomycin maintained high effectiveness in both groups. These findings emphasize that diabetes is strongly associated with greater therapeutic complexity and multidrug resistance burden, necessitating resistance-guided empirical therapy and regional antibiogram surveillance for optimal UTI management.