Epidemiology of Diabetes Mellitus and Molecular Characterization of Bacterial Isolates Recovered from Cases with Asymptomatic Bacteriauria in Trinidad and Tobago

Aims: To highlight the observed features including socio-demographic, economic and biochemical characteristics seen among uncontrolled diabetic adults that should be areas of concern or focus by healthcare providers during the management of diabetes in the country. Also to perform molecular characterization of bacterial organisms prevalent among a cross section of diabetic patients with asymptomatic bacteriauria.
Study Design: This was a cross sectional prospective and descriptive study.
Place and Duration of Study: Study was carried out among patients attending two non-communicable chronic diseases health centers in Trinidad & Tobago over a 6 months period in 2012.
Methodology: Following informed consent, diabetic volunteers were recruited to participate in the study. Participants fulfilled study criteria that included absence of urinary symptoms, not catheterized, no history of UTI or any form of uropathy. Blood samples were screened for Hb1Ac, serum electrolytes and urea values; urine for microscopy, culture and sensitivity. Enterobacteriaceae isolates from urine culture were subjected to screening for CTX-M, TEM, and SHV by amplification of gene fragments by conventional PCR and for KPC, and NDM and OXA48 targets by real-time PCR using Sybergreen melting curve analysis.
Results: Four hundred and fourteen diabetics were surveyed. Significant (15.7%; 65/414) bacteriauria was noted in sixty five subjects. Majority, 81.5% (53/65) with positive urine cultures had high HBA1c values. Escherichia coli 48.57% (34/70) and Klebsiella pneumonia 25.7% (18/70) were the most recovered organisms, with 87.1% (61/70) from urine samples and 75.4% (49/65) from female subjects. Urine samples from males 24.6% (16/65) yielded mostly Staphylococcus epidermidis 14.3% (10/7) and Staphylococcus aureus 5.7% (4/70) respectively. All Enterobacteriaceae isolates were negative for KPC, NDM and OXA-48. Although the blaTEM and bla SHV were detected in both the E. coli and K. pneumoniae isolates as expected.
Conclusion: Escherichia coli was the prevalent Enterobacteriaceae among the patients with asymptomatic bacteriauria. Poor diabetic control is significantly and strongly associated with bacteriauria that was more prevalent among female diabetics. Although none of the antimicrobial resistant targets were encountered among the Enterobacteriaceae, there is still the need to keep an eye on these targets and diabetic subjects in the country.