Analysis of pathogens and antimicrobial resistance of sodium-glucose cotransporter 2 inhibitors in treatment of urinary tract infection in patients with type 2 diabetes
ZHANG Chun1, YU Li2, CUI Long2, WEI Wang3, WANG Xiaohong4
1. Department of Emergency Medicine, 2. Department of Endocrinology, 3. Department of Clinical Pharmacology, 4. Department of Hand and Foot Surgery, Chongqing Municipal Corps Hospital of Chinese People's Armed Police Force, Chongqing 400061, China
Abstract：Objective To investigate the distribution and drug resistance of pathogens associated with urinary tract infections (UTIs) in the treatment of type 2 diabetes with sodium-glucose cotransporter 2 (SGLT-2) inhibitors. Methods A retrospective analysis was conducted on 231 patients with type 2 diabetes who were treated with SGLT-2 inhibitors and developed UTIs from January 2020 to December 2023 in Chongqing Municipal Corps Hospital of Chinese People's Armed Police Force. The distribution of pathogens and the resistance of the main isolates were analyzed using routine urine analysis, urine microbial culture and antimicrobial susceptibility testing. Results A total of 231 strains of pathogens were isolated, of which 37 were Gram-positive bacteria (16.02%), 182 were Gram-negative bacteria (78.79%), and 12 were fungi (5.19%). Among the Gram-positive bacteria, 18 strains were Enterococcus faecium (48.65%, 18/37) and 9 strains were Enterococcus faecalis (24.32%, 9/37); 14 strains were multidrug-resistant bacteria (37.84%, 14/37), including 7 strains each of enterococcus faecium and enterococcus faecalis. Among the Gram-negative bacteria, there were 156 strains of Escherichia coli (85.71%, 156/182) and 13 strains of Klebsiella pneumoniae (7.14%, 13/182); 84 strains were multidrug-resistant (46.15%, 84/182), of which 81 strains of Escherichia coli and 3 strains of Klebsiella pneumoniae produced extended-spectrum beta-lactamases (ESBLs).Antimicrobial susceptibility test showed that Escherichia coli had the highest resistance rate to ampicillin and ciprofloxacin (81.94% and 79.35%, respectively), but was more sensitive to carbapenems, tigecycline, and nitrofurantoin. Klebsiella pneumoniae demonstrated a resistance rate of 76.92% to quinolone antibiotics, but was completely sensitive to carbapenems, tigecycline, and cefepime/sulbactam. Both Enterococcus faecium and Enterococcus faecalis exhibited high resistance to a variety of antibiotics, yet showed high sensitivity to vancomycin, teicoplanin, and linezolid. Conclusions The main pathogenic bacteria in the treatment of type 2 diabetes patients with urinary tract infection by SGLT-2 inhibitors are Gram-negative bacteria such as Escherichia coli, with some infections also involving Gram-positive bacteria and a small amount of fungi. Due to the pharmacological mechanism of SGLT-2 inhibitors, there is a higher proportion of multidrug-resistant bacteria, and it is clinically essential to use medication rationally based on antibiogram results.
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ZHANG Chun, YU Li, CUI Long, WEI Wang, WANG Xiaohong. Analysis of pathogens and antimicrobial resistance of sodium-glucose cotransporter 2 inhibitors in treatment of urinary tract infection in patients with type 2 diabetes. Med. J. Chin. Peop. Armed Poli. Forc., 2024, 35(9): 754-757.
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2024, Vol. 35 
