Bacterial Spectrum, Antimicrobial Resistance, and Inflammatory Biomarker Profiles of Urinary Tract Infections in Patients with Type 2 Diabetes Mellitus
Author(s):
1Mohammed Khudhaier Abbas, 2Hayder Khudhair Abbas, 3Idriss Saleh Jalil
Date: 09/10/2026
doi: https://doi.org/10.5281/zenodo.8425890
Abstract
Background: Urinary tract infections are frequent in type 2 diabetes and are complicated by diverse
uropathogens, antimicrobial resistance, and heightened inflammation. Aims of the study: This study
aimed to identify the bacterial spectrum of urinary tract infections in patients with type 2 diabetes mellitus,
determine antimicrobial resistance, multidrug-resistance, and ESBL patterns, and assess their associations
with glycemic control and systemic inflammatory biomarkers. Methodology: An analytical case–control
study enrolled 150 adults with T2DM at Al-Habbobi Teaching Hospital, Dhi Qar, Iraq, from September
2025 to April 2026: 100 had culture-confirmed UTI and 50 were controls. Midstream urine was cultured,
isolates identified, and antimicrobial susceptibility, MDR, and ESBL phenotypes determined using CLSI
methods. Blood samples were analyzed for HbA1c, WBC, neutrophils, CRP, and procalcitonin, while IL
6 and TNF-α were measured by ELISA. Written consent and standardized quality-control procedures were
applied throughout specimen collection and laboratory testing. Result: Patients with UTI had poorer
glycemic control, more previous UTIs, and greater recent antibiotic exposure than controls. Gram
negative bacteria predominated, particularly Escherichia coli and Klebsiella pneumoniae. Ciprofloxacin
showed the highest resistance, whereas meropenem and amikacin retained the greatest activity. MDR and
ESBL phenotypes occurred in 35.0% and 27.5% of isolates, respectively. UTI patients had significantly
elevated CRP, procalcitonin, IL-6, TNF-α, WBC, and neutrophils. MDR infections were additionally
associated with higher HbA1c and inflammatory biomarker concentrations compared with non-MDR
infections. Conclusions: Urinary tract infections in patients with T2DM were predominantly caused by
Gram-negative bacteria and frequently exhibited MDR and ESBL phenotypes. Poor glycemic control,
previous infection, and antibiotic exposure were associated with UTI, while inflammatory biomarkers
increased particularly during MDR infections.
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