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Background <p>Urinary tract infections (UTIs) are prevalent among patients with diabetes mellitus (DM), with <i>E. coli</i> being the most common uropathogen. Understanding its antimicrobial resistance profile is crucial for empirical treatment, especially in resource-limited settings like Ethiopia. The study aimed to determine the prevalence of <i>E. coli</i> in UTIs among diabetic patients in Ethiopia and to assess its antimicrobial resistance patterns.</p> Methods <p>A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study protocol was registered in PROSPERO (CRD42023445772). A comprehensive search of PubMed, Google Scholar, Hinari, SCOPUS, and EMBASE was performed for studies published between January 1, 2014, and January 19, 2024. Inclusion criteria encompassed observational studies on microbiological investigations in UTI patients with DM conducted in Ethiopia. Data extraction and quality assessment were performed using the Joanna Briggs Institute (JBI) checklist.</p> Results <p>Eleven cross-sectional studies involving 2,830 diabetic patients were included. Among these, 492 bacterial isolates were identified, with 171 being <i>E. coli.</i> The pooled prevalence of UTIs caused by <i>E. coli</i> in diabetic patients was 52% (95% CI 36–74%, I² = 68.7%). Subgroup analysis revealed higher odds ratios in the Southern Nation Nationalities and People Region (SNNPR) and studies conducted after 2019. Nitrofurantoin exhibited the highest efficacy (0% resistance), while Ampicillin showed the highest resistance (98%). Significant heterogeneity was noted (I² = 68.7%, <i>p</i> &lt; 0.001). No publication bias was detected, and sensitivity analysis confirmed the robustness of the findings.</p> Conclusions <p><i>E. coli</i> is a significant uropathogen in diabetic patients with UTIs in Ethiopia, exhibiting high resistance to commonly used antimicrobials like Ampicillin. These findings underscore the need for routine antimicrobial susceptibility testing to guide empirical treatment and curb resistance.</p>

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E. coli as a uropathogen in patients with diabetes mellitus, its prevalence and antimicrobial resistance profile in Ethiopia: A systematic review and meta-analysis

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  • 发表日期：

    2025年10月10日

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  • Nuhamin Alemayehu Tesfaye,
  • Mulat Belete Demessie,
  • Minimize Hassen,
  • Tewodros Solomon,
  • Abel Andualem,
  • Tesfalem Lukas Gebreegziabher,
  • Mengistie Yirsaw Gobezie

摘要

Background

Urinary tract infections (UTIs) are prevalent among patients with diabetes mellitus (DM), with E. coli being the most common uropathogen. Understanding its antimicrobial resistance profile is crucial for empirical treatment, especially in resource-limited settings like Ethiopia. The study aimed to determine the prevalence of E. coli in UTIs among diabetic patients in Ethiopia and to assess its antimicrobial resistance patterns.

Methods

A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study protocol was registered in PROSPERO (CRD42023445772). A comprehensive search of PubMed, Google Scholar, Hinari, SCOPUS, and EMBASE was performed for studies published between January 1, 2014, and January 19, 2024. Inclusion criteria encompassed observational studies on microbiological investigations in UTI patients with DM conducted in Ethiopia. Data extraction and quality assessment were performed using the Joanna Briggs Institute (JBI) checklist.

Results

Eleven cross-sectional studies involving 2,830 diabetic patients were included. Among these, 492 bacterial isolates were identified, with 171 being E. coli. The pooled prevalence of UTIs caused by E. coli in diabetic patients was 52% (95% CI 36–74%, I² = 68.7%). Subgroup analysis revealed higher odds ratios in the Southern Nation Nationalities and People Region (SNNPR) and studies conducted after 2019. Nitrofurantoin exhibited the highest efficacy (0% resistance), while Ampicillin showed the highest resistance (98%). Significant heterogeneity was noted (I² = 68.7%, p < 0.001). No publication bias was detected, and sensitivity analysis confirmed the robustness of the findings.

Conclusions

E. coli is a significant uropathogen in diabetic patients with UTIs in Ethiopia, exhibiting high resistance to commonly used antimicrobials like Ampicillin. These findings underscore the need for routine antimicrobial susceptibility testing to guide empirical treatment and curb resistance.