CROSS-SECTIONAL AI SURVEILLANCE OF MULTIDRUG RESISTANCE IN URINARY PATHOGENS FROM DIABETIC OUTPATIENTS

Authors

DOI:

https://doi.org/10.71000/wzka1182

Keywords:

Anti-Bacterial Agents, Artificial Intelligence, Diabetes Mellitus, Drug Resistance, Microbial, Multidrug Resistance, Outpatients, Pakistan, Urinary Tract Infections, Uropathogenic Escherichia coli

Abstract

Background: Diabetic patients are at an increased risk of urinary tract infections (UTIs), which are frequently caused by multidrug-resistant (MDR) pathogens. Rising antimicrobial resistance complicates treatment decisions, especially in outpatient settings where empirical therapy is common. Enhanced surveillance using artificial intelligence (AI) may offer a novel solution for real-time monitoring of resistance patterns.

Objective: To determine the prevalence and resistance patterns of urinary pathogens in diabetic outpatients using AI-supported data analysis tools for enhanced microbial surveillance and informed public health response.

Methods: A cross-sectional study was conducted from October 2024 to June 2025 at outpatient clinics and laboratories in Lahore, Pakistan. A total of 350 diabetic outpatients with symptomatic UTIs were enrolled. Midstream urine samples were collected for culture and susceptibility testing using CLSI guidelines. MDR was defined as resistance to one agent in three or more antimicrobial classes. Data were analyzed using AI-supported tools to identify resistance trends and clustering. Statistical analysis included descriptive statistics, chi-square, t-tests, and logistic regression using SPSS v26.0.

Results: Escherichia coli was the most common pathogen (55.7%), followed by Klebsiella pneumoniae (17.4%) and Enterococcus spp. (11.1%). High resistance rates were observed for ciprofloxacin (64.8%) and ceftriaxone (59.4%). MDR pathogens were identified in 42.3% of isolates, with significant associations to poor glycemic control and prior antibiotic use. AI tools facilitated clustering of resistance patterns and highlighted emerging resistance trends.

Conclusion: The high burden of MDR uropathogens in diabetic outpatients necessitates routine culture-based diagnostics and antimicrobial stewardship. AI-supported surveillance proved effective in enhancing resistance detection and can guide more precise empirical therapy in resource-limited settings.

Author Biographies

  • Zahra Hayat , Health Services Academy, Islamabad, Pakistan.

     MSPH, Health Services Academy, Islamabad, Pakistan.

  • Ammar Khalil, University of Kotli, AJ&K, Pakistan.

     Lecturer, Department of Data Science, University of Kotli, AJ&K, Pakistan.

  • Ayesha Siddiqua , Hamdard University, Karachi, Pakistan.

     Doctor of Pharmacy, Hamdard University, Karachi, Pakistan.

  • Syeda Nazish Sohaib , Riphah International University, Islamabad, Pakistan.

     Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan.

  • Malik Naubakht Ali Saggu, Provincial TB Control Program, Lahore, Pakistan.

     Medical Lab Technologist, Provincial TB Control Program, Lahore, Pakistan.

  • Amna Noor , Rawalpindi Medical University, Rawalpindi, Pakistan.

     Additional Director ORIC, Coordinator PhD Microbiology and Molecular Biology, Rawalpindi Medical University, Rawalpindi, Pakistan.

References

Wong JWH, Xu RH, Ramm O, Tucker LY, Zaritsky EF. Urinary Tract Infections Among Gender Diverse People Assigned Female at Birth on Testosterone. Urogynecology (Phila). 2023;29(2):295-301.

Al Qurabiy HE, Abbas IM, Hammadi AA, Mohsen FK, Salman RI, Dilfy SH. Urinary tract infection in patients with diabetes mellitus and the role of parental genetics in the emergence of the disease. J Med Life. 2022;15(8):955-62.

Paudel S, John PP, Poorbaghi SL, Randis TM, Kulkarni R. Systematic Review of Literature Examining Bacterial Urinary Tract Infections in Diabetes. J Diabetes Res. 2022;2022:3588297.

Rondanelli M, Mansueto F, Gasparri C, Solerte SB, Misiano P, Perna S. Supplementation with Highly Standardized Cranberry Extract Phytosome Achieved the Modulation of Urinary Tract Infection Episodes in Diabetic Postmenopausal Women Taking SGLT-2 Inhibitors: A RCT Study. Nutrients. 2024;16(13).

Nikitha N, Satpathy PK. Study of Infections in Type 2 Diabetes Mellitus. J Assoc Physicians India. 2022;70(4):11-2.

Wiegley N, So PN. Sodium-Glucose Cotransporter 2 Inhibitors and Urinary Tract Infection: Is There Room for Real Concern? Kidney360. 2022;3(11):1991-3.

Qiu M, Ding LL, Zhang M, Zhou HR. Safety of four SGLT2 inhibitors in three chronic diseases: A meta-analysis of large randomized trials of SGLT2 inhibitors. Diab Vasc Dis Res. 2021;18(2):14791641211011016.

Zheng Z, He D, Chen J, Xie X, Lu Y, Wu B, et al. Risk of Urinary Tract Infection in Patients with Type 2 Diabetes Mellitus Treated with Dapagliflozin: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clin Drug Investig. 2023;43(4):209-25.

Yang H, Choi E, Park E, Na E, Chung SY, Kim B, et al. Risk of genital and urinary tract infections associated with SGLT-2 inhibitors as an add-on therapy to metformin in patients with type 2 diabetes mellitus: A retrospective cohort study in Korea. Pharmacol Res Perspect. 2022;10(1):e00910.

Salari N, Karami MM, Bokaee S, Chaleshgar M, Shohaimi S, Akbari H, et al. The prevalence of urinary tract infections in type 2 diabetic patients: a systematic review and meta-analysis. Eur J Med Res. 2022;27(1):20.

Tegegne KD, Wagaw GB, Gebeyehu NA, Yirdaw LT, Shewangashaw NE, Kassaw MW. Prevalence of urinary tract infections and risk factors among diabetic patients in Ethiopia, a systematic review and meta-analysis. PLoS One. 2023;18(1):e0278028.

Nelson V, Downey A, Summers S, Shropshire S. Prevalence of signs of lower urinary tract disease and positive urine culture in dogs with diabetes mellitus: A retrospective study. J Vet Intern Med. 2023;37(2):550-5.

Lai H, Kolanko M, Li LM, Parkinson ME, Bourke NJ, Graham NSN, et al. Population incidence and associated mortality of urinary tract infection in people living with dementia. J Infect. 2024;88(6):106167.

Confederat LG, Condurache MI, Alexa RE, Dragostin OM. Particularities of Urinary Tract Infections in Diabetic Patients: A Concise Review. Medicina (Kaunas). 2023;59(10).

Hill JB, Fixen C, Wright G, Saseen JJ. Medications Associated with Occurrence of Urinary Tract Infections in Patients with Diabetes, Heart Failure or Both. Curr Drug Saf. 2023;18(3):368-73.

Unnikrishnan R, Misra A. Infections and diabetes: Risks and mitigation with reference to India. Diabetes Metab Syndr. 2020;14(6):1889-94.

Kittipibul V, Cox ZL, Chesdachai S, Fiuzat M, Lindenfeld J, Mentz RJ. Genitourinary Tract Infections in Patients Taking SGLT2 Inhibitors: JACC Review Topic of the Week. J Am Coll Cardiol. 2024;83(16):1568-78.

Arshad M, Hoda F, Siddiqui NA, Najmi AK, Ahmad M. Genito Urinary Infection and Urinary Tract Infection in Patients with Type 2 Diabetes Mellitus Receiving SGLT2 Inhibitors: Evidence from a Systematic Literature Review of Landmark Randomized Clinical Trial. Drug Res (Stuttg). 2024;74(7):307-13.

Tan-Kim J, Shah NM, Do D, Menefee SA. Efficacy of vaginal estrogen for recurrent urinary tract infection prevention in hypoestrogenic women. Am J Obstet Gynecol. 2023;229(2):143.e1-.e9.

Pishdad R, Auwaerter PG, Kalyani RR. Diabetes, SGLT-2 Inhibitors, and Urinary Tract Infection: a Review. Curr Diab Rep. 2024;24(5):108-17.

Kamei J, Yamamoto S. Complicated urinary tract infections with diabetes mellitus. J Infect Chemother. 2021;27(8):1131-6.

Wang M, Zhang X, Ni T, Wang Y, Wang X, Wu Y, et al. Comparison of New Oral Hypoglycemic Agents on Risk of Urinary Tract and Genital Infections in Type 2 Diabetes: A Network Meta-analysis. Adv Ther. 2021;38(6):2840-53.

Tang YH, Lu PL, Huang HY, Lin YC. Clinical effectiveness of beta-lactams versus fluoroquinolones as empirical therapy in patients with diabetes mellitus hospitalized for urinary tract infections: A retrospective cohort study. PLoS One. 2022;17(3):e0266416.

Halsey-Nichols M, McCoin N. Abdominal Pain in the Emergency Department: Missed Diagnoses. Emerg Med Clin North Am. 2021;39(4):703-17.

Downloads

Published

2025-07-19