Diversity and Complexity of Urinary Tract Infection in Diabetes Mellitus

Lukman M. Hakeem, Diptendu N. Bhattacharyya, Cyril Lafong, Khalid S. Janjua, Jonathan T. Serhan and Ian W. Campbell


British Journal of Diabetes and Vascular Disease. 2009;9(3):119-125. 

In This Article

Microbiological Spectrum of Infection

UTIs in patients with diabetes are due to the same urinary pathogens as those found in the general population, with the majority of ascending infections being caused by E.coli. Other uropathogens found in patients with diabetes include Proteus spp., Enterobacter spp. and Enterococcus faecalis. Klebsiella pneumoniae and group B streptococci are also more common in patients with diabetes.[35,36]Staphylococcus aureus accounts for infections caused by haematogenous spread. About 50–75% of emphysematous pyelonephritis cases are caused by E.coli[19,37] and most of the rest are caused by other Gram-negative organisms.[3]

Diabetes is a common predisposing factor for UTIs caused by fungi, particularly Candida species (C. albicans, C. glabrata, C. tropicalis). Around 5% of patients with candiduria will have two or more species simultaneously. The extent of involvement ranges from inconsequential lower urinary tract colonisation to clinical cystitis, emphysematous cystitis, pyelonephritis, and renal and perinephric abscess.[38,39,40] Upper urinary tract fungal infection only rarely becomes involved as ascending infection and even in these cases the presence of urinary tract obstruction, instrumentation, urethral stents, nephrostomy tubes and reflux may contribute. The majority of cases of renal candidiasis occur as a consequence of haematogenous seeding of renal parenchyma and not as a result of ascending spread.