{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,8]],"date-time":"2026-11-08T00:30:06Z","timestamp":1794097806870,"version":"4.8.0"},"reference-count":59,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T00:00:00Z","timestamp":1695945600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"L\u2019OR\u00c9AL-UNESCO","award":["732\/12.06.2017"],"award-info":[{"award-number":["732\/12.06.2017"]}]},{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy in Iasi, Romania","award":["732\/12.06.2017"],"award-info":[{"award-number":["732\/12.06.2017"]}],"id":[{"id":"https:\/\/ror.org\/03hd30t45","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Diabetes mellitus is a chronic disease that, untreated or poorly controlled, can lead to serious complications, reducing life expectancy and quality. Diabetic patients are more likely to develop infections, including many common infections, but also pathognomonic ones such as emphysematous pyelonephritis, malignant otitis externa, mucormycosis and Fournier\u2019s gangrene. Considering the fact that diabetic patients experience more frequently urinary tract infections (UTIs) with a worse prognosis than non-diabetic people, we conducted a review study based on data in the literature, following the particularities of UTIs in this group of patients, the risk factors, the mechanisms involved and the challenges in their management. The findings highlight that UTI in diabetic patients have some particularities, including a more frequent evolution to bacteremia, increased hospitalizations, and elevated rates of recurrence and mortality than non-diabetic patients. The possible risk factors identified seem to be female gender, pregnancy, older age, UTI in the previous six months, poor glycemic control and duration of diabetes. The mechanisms involved are related to glucosuria and bladder dysfunction, factors related to bacterial strains and host response. The bacterial strains involved in UTIs in diabetic patients and their antibiotic susceptibility profile are, with some exceptions, similar to those in non-diabetic people; however, the antimicrobial agents should be carefully chosen and the duration of the treatment should be as those required for a complicated UTI. The data related to the risk of developing UTIs in patients treated with SGLT-2 inhibitors, a new class of oral hypoglycaemic agents with cardiovascular and renal benefits, are controversial; overall, it was evidenced that UTIs occurred at the initiation of the treatment, recurrent infection was uncommon and the majority of UTIs responded to treatment with standard antibiotics. Moreover, interruption or discontinuation of SGLT-2 inhibitor as a result of UTI was rare and SGLT-2 inhibitors did not increase the risk of severe infections such as urosepsis and pyelonephritis.<\/jats:p>","DOI":"10.3390\/medicina59101747","type":"journal-article","created":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T05:48:13Z","timestamp":1695966493000},"page":"1747","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Particularities of Urinary Tract Infections in Diabetic Patients: A Concise Review"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2687-2715","authenticated-orcid":false,"given":"Luminita-Georgeta","family":"Confederat","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaela-Iustina","family":"Condurache","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raluca-Elena","family":"Alexa","sequence":"additional","affiliation":[{"name":"\u201cSf\u00e2ntul Spiridon\u201d County Emergency Clinical Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana-Maria","family":"Dragostin","sequence":"additional","affiliation":[{"name":"Research Centre in the Medical-Pharmaceutical Field, Faculty of Medicine and Pharmacy, \u201cDunarea de Jos\u201d University of Galati, 800008 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1097\/XCE.0000000000000210","article-title":"Estimating life years lost to diabetes: Outcomes from analysis of National Diabetes Audit and Office of National Statistics data","volume":"9","author":"Healda","year":"2020","journal-title":"Cardiovasc. Endocrinol. Metab."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"International Diabetis Federation (2021). Diabetes is \u2018\u2018a pandemic of unprecedented magnitude\u2019\u2019 now affecting one in 10 adults worldwide. Diabetes Res. Clin. Pract., 181, 109133.","DOI":"10.1016\/j.diabres.2021.109133"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"109119","DOI":"10.1016\/j.diabres.2021.109119","article-title":"IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045","volume":"183","author":"Sun","year":"2022","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_4","unstructured":"GBD 2021 Diabetes Collaborators (2023). Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: A systematic analysis for the Global Burden of Disease Study 2021. Articles, 402, 203\u2013234."},{"key":"ref_5","first-page":"632","article-title":"Orthorexia Nervosa: The unhealthy obssesion for healthy food","volume":"119","author":"Arhire","year":"2015","journal-title":"Rev. Med. Chir."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1001\/jama.2020.0734","article-title":"US Health Care Spending by Payer and Health Condition, 1996\u20132016","volume":"323","author":"Dieleman","year":"2020","journal-title":"JAMA"},{"key":"ref_7","first-page":"1","article-title":"Variability of risk factors and diabetes complications","volume":"20","author":"Ceriello","year":"2021","journal-title":"Ceriello Prattichizzo Cardiovasc. Diabetol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2359","DOI":"10.2337\/dc14-0199","article-title":"Impact of Visit-to-Visit Glycemic Variability on the Risks of Macrovascular and Microvascular Events and All-Cause Mortality in Type 2 Diabetes: The ADVANCE Trial","volume":"37","author":"Hirakawa","year":"2014","journal-title":"Diabetes Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2187","DOI":"10.2337\/dc18-0548","article-title":"Glycemic Variation and Cardiovascular Risk in the Veterans Affairs Diabetes Trial","volume":"41","author":"Zhou","year":"2018","journal-title":"Diabetes Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.2337\/dc19-2589","article-title":"Prognostic Significance of Long term HbA1c Variability for All Cause Mortality in the accord trial","volume":"43","author":"Sheng","year":"2020","journal-title":"Diabetes Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1186\/s12933-020-01147-9","article-title":"Empaglifozin reduced long-term HbA1c variability and cardiovascular death: Insights from the EMPA-REG OUTCOME trial","volume":"19","author":"Ceriello","year":"2020","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_12","first-page":"41","article-title":"Diabetic neuropathy","volume":"5","author":"Feldman","year":"2019","journal-title":"Nat. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.1001\/jamaneurol.2015.2347","article-title":"Peripheral neuropathy: The importance of rare subtypes","volume":"72","author":"Callaghan","year":"2015","journal-title":"JAMA Neurol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"136","DOI":"10.2337\/dc16-2042","article-title":"Diabetic Neuropathy: A Position Statement by the American Diabetes Association","volume":"40","author":"Boulton","year":"2017","journal-title":"Diabetes Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1016\/j.ophtha.2021.04.027","article-title":"Global Prevalence of Diabetic Retinopathy and Projection of Burden through 2045. Systematic Review and Meta-analysis","volume":"128","author":"Teo","year":"2021","journal-title":"Ophthalmology"},{"key":"ref_16","unstructured":"GBD 2019 Blindness and Vision Impairment Collaborators* and Vision Loss Expert Group of the Global Burden of Disease Study (2021). Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: The Right to Sight: An analysis for the Global Burden of Disease Study. Lancet Glob. Health, 9, e144\u2013e160."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/dom.14007","article-title":"An updated overview of diabetic nephropathy: Diagnosis, prognosis, treatment goals and latest guidelines","volume":"22","author":"Selby","year":"2020","journal-title":"Diabetes Obes. Metab."},{"key":"ref_18","first-page":"188","article-title":"The cardiovascular complications of diabetes: A striking link through protein glycation","volume":"58","author":"Ahmad","year":"2020","journal-title":"Rom. J. Int. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"101","DOI":"10.2174\/157016111802200101155519","article-title":"Pharmacological Management of Type 2 Diabetes Complications","volume":"18","author":"Doumas","year":"2020","journal-title":"Curr. Vasc. Pharmacol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.2337\/dci22-0014","article-title":"Heart Failure: An Underappreciated Complication of Diabetes. A Consensus Report of the American Diabetes Association","volume":"45","author":"Januzzi","year":"2022","journal-title":"Diabetes Care"},{"key":"ref_21","first-page":"1829","article-title":"Biomarkers of Inflammation in Patients with Type 2 Diabets Mellitus and Hepatic Steatosis","volume":"9","author":"Gavril","year":"2016","journal-title":"Rev. Chim."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.jcot.2021.01.017","article-title":"The current burden of diabetic foot disease","volume":"17","author":"Edmonds","year":"2021","journal-title":"J. Clin. Orthop. Trauma."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"513","DOI":"10.2337\/dc17-2131","article-title":"Risk of Infection in Type 1 and Type 2 Diabetes Compared With the General Population: A Matched Cohort Study","volume":"41","author":"Carey","year":"2018","journal-title":"Diabetes Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/S2213-8587(15)00379-4","article-title":"Diabetes and infection: Assessing the association with glycaemic control in population-based studies","volume":"4","author":"Blundell","year":"2016","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Suaya, J.A., Eisenberg, D.F., Fang, C., and Miller, L.G. (2013). Skin and Soft Tissue Infections and Associated Complications among Commercially Insured Patients Aged 0\u201364 Years with and without Diabetes in the U.S. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0060057"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.jdiacomp.2014.11.005","article-title":"Diabetes Mellitus and Infection: An Evaluation of Hospital Utilization and Management Costs in the United States","volume":"29","author":"Korbel","year":"2015","journal-title":"J. Diabetes Complicat."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.dsx.2006.11.005","article-title":"Pattern of infections in patients with diabetes mellitus-Data from a tertiary care medical centre in Indian sub-continent","volume":"1","author":"Masoodi","year":"2007","journal-title":"Diabetes Metab. Syndr. Clin. Res. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.mpmed.2018.11.002","article-title":"Infections in people with diabetes","volume":"47","author":"Cooke","year":"2019","journal-title":"Medicine"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/j.jdiacomp.2014.06.009","article-title":"Risk characterization for urinary tract infections in subjects with newly diagnosed type 2 diabetes","volume":"28","author":"Fu","year":"2014","journal-title":"J. Diabetes Its Complicat."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.ijantimicag.2007.07.042","article-title":"Urinary tract infections in patients with diabetes mellitus: Epidemiology, pathogenesis and treatment","volume":"31","author":"Geerlings","year":"2008","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"230","DOI":"10.2337\/dc10-0421","article-title":"Meta-Analysis of the Significance of Asymptomatic Bacteriuria in Diabetes","volume":"34","author":"Renko","year":"2011","journal-title":"Diabetes Care"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/j.jdiacomp.2012.06.008","article-title":"Incidence of urinary tract infection among patients with type 2 diabetes in the UK General Practice Research Database (GPRD)","volume":"26","author":"Hirji","year":"2012","journal-title":"J. Diabetes Its Complicat."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"107","DOI":"10.4103\/0971-4065.57107","article-title":"Prevalence of lower urinary tract infection in South Indian type 2 diabetic subjects","volume":"19","author":"Janifer","year":"2009","journal-title":"Indian. J. Nephrol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Miftode, I.L., Pasare, M.A., Miftode, R.S., Nastase, E., Plesca, C.E., Lunca, C., Miftode, E.G., Timpau, A.S., Iancu, L.S., and Dorneanu, O.S. (2022). What doesn\u2019t kill them makes them stronger: The impact of the resistance patterns of urinary Enterobacterales isoaltes in patients from a tertiary hospital in Eastern Europe. Antibiotics, 11.","DOI":"10.3390\/antibiotics11050548"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.diabres.2013.12.052","article-title":"Genital and urinary tract infections in diabetes: Impact of pharmacologically-induced glucosuria","volume":"103","author":"Geerlings","year":"2014","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"236","DOI":"10.7883\/yoken.JJID.2008.236","article-title":"Frequency, risk factors, and responsible pathogenic microorganisms of asymptomatic bacteriuria in patients with type 2 diabetes mellitus","volume":"61","author":"Turan","year":"2008","journal-title":"Jpn. J. Infect. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"744","DOI":"10.2337\/diacare.23.6.744","article-title":"Asymptomatic Bacteriuria May Be Considered a Complication in Women With Diabetes","volume":"23","author":"Geerlings","year":"2000","journal-title":"Diabetes Care"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.2337\/diacare.25.8.1405","article-title":"Adherence of Type 1\u2013Fimbriated Escherichia coli to Uroepithelial Cells","volume":"25","author":"Geerlings","year":"2002","journal-title":"Diabetes Care"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/S0924-8579(03)00234-6","article-title":"Pathogenesis and management of bacterial urinary tract infections in adult patients with diabetes mellitus","volume":"22","author":"Hoepelman","year":"2003","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12941-015-0082-4","article-title":"Urinary tract infections and antimicrobial sensitivity among diabetic patients at Khartoum, Sudan","volume":"14","author":"Hamdan","year":"2015","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"ref_41","first-page":"945","article-title":"Antimicrobial resistance pattern in Escherichia coli causing urinary tract infection among inpatients","volume":"139","author":"Niranjan","year":"2014","journal-title":"Indian. J. Med. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1016\/j.jdiacomp.2016.01.005","article-title":"Bacterial resistance in urinary tract infections in patients with diabetes matched with patients without diabetes","volume":"30","author":"Malmartel","year":"2016","journal-title":"J. Diabetes Its Complicat."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1099\/jmm.0.007146-0","article-title":"Uropathogens from diabetic patients in Libya: Virulence factors and phylogenetic groups of Escherichia coli isolates","volume":"58","author":"Ghenghesh","year":"2009","journal-title":"J. Med. Microbiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.jmii.2011.12.024","article-title":"Bacterial characteristics and glycemic control in diabetic patients with Escherichia coli urinary tract infection","volume":"46","author":"Wang","year":"2013","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Bonadio, M., Costarelli, S., Morelli, G., and Tartaglia, T. (2006). The influence of diabetes mellitus on the spectrum of uropathogens and the antimicrobial resistance in elderly adult patients with urinary tract infection. BMC Infect. Dis., 6.","DOI":"10.1186\/1471-2334-6-54"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Owusu, E., Adjei, H., and Afutu, E. (2022). Similarities in Bacterial Uropathogens and Their Antimicrobial Susceptibility Profile in Diabetics and Their Non-Diabetic Caregivers at a National Diabetes Management and Research Centre, Accra-Ghana. Diseases, 10.","DOI":"10.3390\/diseases10040124"},{"key":"ref_47","first-page":"e13562","article-title":"Characteristics of Asymptomatic Bacteriuria in Diabetes Mellitus Patients: A Retrospective Observational Study","volume":"13","author":"Asghar","year":"2021","journal-title":"Cureus"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"3588297","DOI":"10.1155\/2022\/3588297","article-title":"Systematic Review of Literature Examining Bacterial Urinary Tract Infections in Diabetes","volume":"2022","author":"Paudel","year":"2022","journal-title":"J. Diabetes Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1017\/ice.2016.225","article-title":"Clinical and Molecular Characterization of Community-Onset Urinary Tract Infections Due to Extended-Spectrum Cephalosporin-Resistant Enterobacteriaceae","volume":"37","author":"Anesi","year":"2016","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1111\/j.1742-1241.2012.02991.x","article-title":"Epidemiology, risk factors and comorbidity for urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing enterobacteria","volume":"66","year":"2012","journal-title":"Int. J. Clin. Pr."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1146\/annurev-med-051013-110046","article-title":"The Mechanisms and Therapeutic Potential of SGLT2 Inhibitors in Diabetes Mellitus","volume":"66","author":"Vallon","year":"2015","journal-title":"Annu. Rev. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1056\/NEJMoa1611925","article-title":"Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes","volume":"377","author":"Neal","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"k119","DOI":"10.1136\/bmj.k119","article-title":"Cardiovascular outcomes associated with canagliflozin versus other non-gliflozin antidiabetic drugs: Population based cohort study","volume":"360","author":"Patorno","year":"2018","journal-title":"BMJ."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"262","DOI":"10.7326\/0003-4819-159-4-201308200-00007","article-title":"Sodium-glucose cotransporter 2 inhibitors for type 2 diabetes: A systematic review and meta-analysis","volume":"159","author":"Vasilakou","year":"2013","journal-title":"Ann. Intern. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1111\/dom.12825","article-title":"Urinary tract and genital infections in patients with type 2 diabetes treated with sodium-glucose co-transporter 2 inhibitors: A meta-analysis of randomized controlled trials","volume":"19","author":"Li","year":"2017","journal-title":"Diabetes Obes. Metab."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1007\/s00592-018-1116-0","article-title":"SGLT-2 inhibitors and the risk of infections: A systematic review and meta-analysis of randomized controlled trials","volume":"55","author":"Puckrin","year":"2018","journal-title":"Acta Diabetol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1016\/j.jiac.2021.05.012","article-title":"Complicated urinary tract infections with diabetes mellitus","volume":"27","author":"Kamei","year":"2021","journal-title":"J. Infect. Chemother."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"248","DOI":"10.7326\/M18-3136","article-title":"Sodium-glucose cotransporter 2 inhibitors and the risk of severe urinary tract infections","volume":"17","author":"Dave","year":"2019","journal-title":"Ann. Intern. Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.jcjd.2021.12.005","article-title":"Sodium-Glucose Cotransporter-2 Inhibitors and Urinary Tract Infections: A Propensity Scoreematched Population-based Cohort Study","volume":"46","author":"Alkabbani","year":"2022","journal-title":"Can. J. 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