**1. Introduction**

Diabetes is a global threat that affects the quality of life, and it is estimated that it will affect 220 million people by the year 2020 worldwide. Morbidity and mortality in diabetic patients are caused by infections. Evidence suggests that, urinary tract infection (UTI) is the most common bacterial infections among diabetic patients. According to American Diabetes Association (ADA) report, patients suffering from type 2 diabetes are more likely to have a urinary tract infection (UTI) and repeat UTI than patients without diabetes. Symptomatic bacteriuria in patients with diabetes is serious and warrants proper clinical attention for diagnosis and treatment. High glucose concentration in the urine can provide a rich source of nutrients for

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

bacteria. Therefore, bacteria can multiply and make foundation for infection also. High glucose concentration in the urine can allow urinary colonization by microorganisms. Moreover, multiple mechanisms were involved in UTI patients with diabetes. Diabetic female, diabetic overweight, and diabetic obese patients are having the highest risk of UTI. In general diabetic population, other risk factors associated with urinary tract infection were found to be diabetic nephropathy, diabetes with hypertension, and insulin therapy. Emphysematous pyelonephritis, emphysematous cystitis, renal and perinephric abscesses, urosepsis, and bacteremia are the complications of diabetes-associated UTI. Longer hospitalization, recurrence of UTI, relapse and re-infection, bacteremia, azotemia, and septic shock are the outcomes of diabetes-associated UTI [1].

diseases associated with exocrine pancreas (such as cystic fibrosis), and drug- or chemicalinduced diabetes (such as use of glucocorticoid, in the treatment of HIV/AIDS or after

Urinary Tract Infection in Diabetics

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http://dx.doi.org/10.5772/intechopen.79575

Type 1 diabetes occurs in childhood, mainly due to destruction of pancreatic β-cell islets through autoimmune-mediated, causing complete insulin deficiency. Type 2 is more associated with adults and elderly people, which are mainly due to insulin resistance or abnormal insulin production. The exact reason of pancreatic failure and insulin resistance is unknown, but they are associated with disease condition, food habit, and environmental impact. Diabetic patients are more susceptible to various type of infection such as skin diseases and carbuncles [4].

Gestational diabetes is other type of diabetes, which is mainly associated with pregnancy. It occurs in the 4% of pregnancies in US, usually during the third trimester. It causes increased perinatal morbidity and mortality unless properly diagnosed or managed. Genetic defects of β-cell function or insulin action is also a type of diabetes mellitus commonly called maturity onset diabetes. Neonatal diabetes mellitus is also a type of diabetes, in which first 3 months of life insulin is required for the maintenance of blood glucose level in. It may be caused by intrauterine growth retardation and defects of chromosome. The heart, blood vessels, eyes, kidneys, and nerves can be damaged by diabetes, leading to disability and

Infections are frequent causes of morbidity and mortality in diabetic patients. Evidence suggesting that urinary tract infection (UTI) is the most common bacterial infections among diabetic patients. High glucose concentration in the urine can provide a rich source of nutrients for bacteria [5, 6]. Therefore, bacteria can multiply and make foundation for infection; also, high glucose concentration in the urine can allow urinary colonization by microorganisms. Moreover, some of the immunological defects like impaired neutrophil function, reduced T cell-mediated immune response, low levels of prostaglandin E, thromboxane B2, and leukotriene B4 may contribute to the increased risk for infection. Other conditions such as bladder dysfunction (incomplete bladder emptying) caused by autonomic neuropathy also may contribute to the increased risk for infection [7, 8]. UTI in diabetes can lead to severe complications including bacteremia, renal abscess, and renal papillary necrosis. In some cases, diabetes modifies the genitourinary system and may cause damage to the organ, which leads to pyelonephritis. This type of UTI occurs 15 times more frequently in diabetic patients. Therefore, early diagnosis and correct treatment are very important for diabetes patients with UTI [9, 10]. Molecular reasons for an increased frequency of UTI in diabetic patients include depression in the function of polymorphonuclear leucocytes especially during acidosis, dysfunction of chemotaxis, and phagocytosis [10]. High blood glucose levels may cause nerve damage, affecting the ability of the bladder to sense the presence of urine and thus allowing urine to

stay for a long time in the bladder and increasing probability of infection [11].

organ transplantation).

premature death.

**4. Urinary tract infection in diabetics**