Clinical Microbiology and Antimicrobial Chemotherapy. 2008; 10(3):235-244
Urinary tract infections (UTI) in patients with diabetes mellitus are considered complicated UTI. The specific characteristics of UTI in diabetic patients are the following: high prevalence of asymptomatic bacteriuria, involvement of upper urinary tract, and high risk of recurrence and complications. The main predisposing factors are diabetic nephropathy and autonomous (bladder) neuropathy. The most common pathogens of UTI in diabetics are Gram-negative aerobes, primarily E. coli (75%), followed by other Enterobacteriaceae and nonfermenting bacteria (~15–20% of pyelonephritis cases). Appropriate antimicrobial therapy and good control of the underlying disease are the most important measures in the treatment of UTI in diabetic patients. Antimicrobial therapy should be based on culture results, local data on antimicrobial susceptibility, severity of the disease, and renal function.