Analysis of clinical characteristics and risk factors for diabetes mellitus complicated with urinary tract infection in children

doi:10.11958/20240181

Abstract

Abstract:

Objective To investigate clinical features and risk factors of childhood diabetes mellitus (DM) complicated with urinary tract infection (UTI). Methods The data of 160 children with DM in our hospital in the past 2 years were collected as the research object, and they were divided into the UTI group and the non-UTI group UTI, with 80 cases in each group. The clinical data of children with DM and UTI were collected and analyzed, including DM type, sex, age, body mass index (BMI), living environment, duration of disease, length of hospital stay, indwelling catheter, ketoacidosis, antibiotic and insulin use, the types of bacteria isolated from urine samples and various laboratory indicators on admission. Results Pathogen bacteria mainly included Escherichia coli (n=37, 46.2%), Enterococci (n=21, 26.2%) and Klebsiella pneumoniae (n=9, 11.2%) in the UTI group. Univariate analysis showed that there were significant differences in obesity, duration of disease, length of hospital stay, indwelling catheter, ketoacidosis, antibiotic use, glycosylated hemoglobin (HbA1c), albumin (ALB) and serum creatinine (Cr) between the two groups (P<0.05). Multivariate regression analysis showed that risk factors for DM complicating UTI included prolonged hospitalization (OR=2.087, 95%CI: 1.562-2.789), indwelling urinary catheter (OR=15.886, 95%CI: 2.336-108.007), ketoacidosis (OR=9.300, 95%CI: 1.169-73.992), duration of disease ≥36 months (OR=20.548, 95%CI: 2.425-174.119), increased HbA1c (OR=16.686, 95%CI: 3.666-75.955) and serum Cr (OR=1.010, 95%CI: 1.002-1.019), while the increased serum ALB (OR=0.799, 95%CI: 0.702-0.910) was its protective factor. Conclusion Pathogenic bacteria in the UTI group are mainly Escherichia coli. Children with DM and UTI are closely related to the length of hospitalization, indwelling catheter, ketoacidosis, duration of disease, HbA1c, serum Cr and ALB levels.

Key words: diabetes mellitus, risk factors, urinary tract infection, clinical characteristics, child

CLC Number:

R725.871

Figures/Tables 2

References 33

[1]	SUN H, SAEEDI P, KARURANGA S, et al. IDF diabetes atlas:Global,regional and country-level diabetes prevalence estimates for 2021 and projections for 2045[J]. Diabetes Res Clin Pract, 2022, 183:109119. doi:10.1016/j.diabres.2021.109119.
[2]	HOU L, LI X, LIU L, et al. A multicenter survey of type I diabetes mellitus in chinese children[J]. Front Endocrinol (Lausanne), 2021, 12:583114. doi:10.3389/fendo.2021.583114.
[3]	KALLINIKOU D, SOLDATOU A, TSENTIDIS C, et al. Diabetic neuropathy in children and adolescents with type 1 diabetes mellitus:Diagnosis,pathogenesis,and associated genetic markers[J]. Diabetes Metab Res Rev, 2019, 35(7):e3178. doi:10.1002/dmrr.3178.
[4]	ANTIKAINEN L, JÄÄSKELÄINEN J, NORDMAN H, et al. Boys but not girls exposed to maternal gestational diabetes mellitus have unfavorable fat distribution[J]. Horm Res Paediatr, 2021, 94(5/6):194-200. doi:10.1159/000518739.
[5]	VON SCHOLTEN B J, KREINER F F, GOUGH S, et al. Current and future therapies for type 1 diabetes[J]. Diabetologia, 2021, 64(5):1037-1048. doi:10.1007/s00125-021-05398-3.
[6]	KAMEI J, YAMAMOTO S. Complicated urinary tract infections with diabetes mellitus[J]. J Infect Chemother, 2021, 27(8):1131-1136. doi:10.1016/j.jiac.2021.05.012.
[7]	COUTO S, MACHADO D I, CONDE C, et al. Physical training is a potential modifier of risk for contrast-induced acute kidney injury in diabetes mellitus[J]. Biomed Res Int, 2020, 2020:1830934. doi:10.1155/2020/1830934.
[8]	KORBEL L, EASTERLING R S, PUNJA N, et al. The burden of common infections in children and adolescents with diabetes mellitus:a Pediatric Health Information System study[J]. Pediatr Diabetes, 2018, 19(3):512-519. doi:10.1111/pedi.12594.
[9]	中华医学会糖尿病学分会, 中国医师协会内分泌代谢科医师分会, 中华医学会内分泌学分会, 等. 中国1型糖尿病诊治指南(2021版)[J]. 中华糖尿病杂志, 2022, 14(11):1143-1250.
	Chinese Diabetes Society, Chinese Endocrinologist Association of Chinese Medical Doctor Association, Chinese Society of Endocrinology, et al. Guidelines for the diagnosis and treatment of type 1 diabetes mellitus in China (2021)[J]. Chin J Diabetes Mellitus, 2022, 14(11):1143-1250. doi:10.3760/cma.j.cn-11579120220916-00474.
[10]	中华医学会儿科学分会内分泌遗传代谢学组, 中华儿科杂志编辑委员会. 中国儿童1型糖尿病标准化诊断与治疗专家共识(2020版)[J]. 中华儿科杂志, 2020, 58(6):447-454.
	Chinese Society of Pediatric Endocrinology and Metabolism,Editorial board of Chinese Journal of Pediatrics. Expert consensus on the standardized diagnosis and management of type 1 diabetes mellitus in Chinese children(2020)[J]. Chin J Pediatr, 2020, 58(6):447-454. doi:10.3760/cma.j.cn112140-20200221-00124.
[11]	中华医学会儿科学分会肾脏学组. 泌尿道感染诊治循证指南(2016)[J]. 中华儿科杂志, 2017, 55(12):898-901.
	Nephrology Group,Paediatrics Society,Chinese Medical Association. Evidence-based guideline on diagnosis and treatment of urinary tract infection(2016)[J]. Chin J Pediatr, 2017, 55(12):898-901. doi:10.3760/cma.j.issn.0578-1310.2017.12.005.
[12]	JEBEILE H, KELLY A S, O'MALLEY G, et al. Obesity in children and adolescents:epidemiology,causes,assessment,and management[J]. Lancet Diabetes Endocrinol, 2022, 10(5):351-365. doi:10.1016/S2213-8587(22)00047-X.
[13]	KHADILKAR V, SHAH N. Evaluation of children and adolescents with obesity[J]. Indian J Pediatr, 2021, 88(12):1214-1221. doi:10.1007/s12098-021-03893-4.
[14]	OOI E, NASH K, RENGARAJAN L, et al. Clinical and biochemical profile of 786 sequential episodes of diabetic ketoacidosis in adults with type 1 and type 2 diabetes mellitus[J]. BMJ Open Diabetes Res Care, 2021, 9(2):e002451. doi:10.1136/bmjdrc-2021-002451.
[15]	NAGIB A M, ELSAYED M Y, GHEITH O A, et al. Diabetic nephropathy following posttransplant diabetes mellitus[J]. Exp Clin Transplant, 2019, 17(2):138-146. doi:10.6002/ect.2018.0157.
[16]	RUSSO S, KWIATKOWSKI M, GOVORUKHINA N, et al. Meta-inflammation and metabolic reprogramming of macrophages in diabetes and obesity:the importance of metabolites[J]. Front Immunol, 2021, 12:746151. doi:10.3389/fimmu.2021.746151.
[17]	GOLBIDI S, LAHER I. Bladder dysfunction in diabetes mellitus[J]. Front Pharmacol, 2010, 1:136. doi:10.3389/fphar.2-010.00136.
[18]	HARDING J L, BENOIT S R, GREGG E W, et al. Trends in rates of infections requiring hospitalization among adults with versus without diabetes in the U.S.,2000-2015[J]. Diabetes Care, 2020, 43(1):106-116. doi:10.2337/dc19-0653.
[19]	TANG Y H, LU P L, HUANG H Y, et al. Clinical effectiveness of beta-lactams versus fluoroquinolones as empirical therapy in patients with diabetes mellitus hospitalized for urinary tract infections:a retrospective cohort study[J]. PLoS One, 2022, 17(3):e0266416. doi:10.1371/journal.pone.0266416.
[20]	NADIMPALLI M L, CHAN C W, DORON S, et al. Antibiotic resistance:a call to action to prevent the next epidemic of inequality[J]. Nat Med, 2021, 27(2):187-188. doi:10.1038/s41591-020-01201-9.
[21]	GONZÁLEZ P, LOZANO P, ROS G, et al. Hyperglycemia and oxidative stress:an integral,updated and critical overview of their metabolic interconnections[J]. Int J Mol Sci, 2023, 24(11):9352. doi:10.3390/ijms24119352.
[22]	LEBLANC P O, BOURGOIN S G, POUBELLE P E, et al. Metabolic regulation of neutrophil functions in homeostasis and diseases[J]. J Leukoc Biol, 2024:qiae025. doi:10.1093/jleuko/qiae025.
[23]	ØSTERGAARD L, MOGENSEN U M, BUNDGAARD J S, et al. Duration and complications of diabetes mellitus and the associated risk of infective endocarditis[J]. Int J Cardiol, 2019, 278:280-284. doi:10.1016/j.ijcard.2018.09.106.
[24]	ZHAO T, DU G, ZHOU X, et al. Inappropriate urinary catheterisation:a review of the prevalence,risk factors and measures to reduce incidence[J]. Br J Nurs, 2022, 31(9):S4-S13. doi:10.12968/bjon.2022.31.9.S4.
[25]	WAKEFIELD A. Use of indwelling catheters and preventing catheter-associated urinary tract infections[J]. Nurs Stand, 2021, 36(5):77-82. doi:10.7748/ns.2021.e11594.
[26]	BARSKI L, GOLBETS E, JOTKOWITZ A, et al. Management of diabetic ketoacidosis[J]. Eur J Intern Med, 2023, 117:38-44. doi:10.1016/j.ejim.2023.07.005.
[27]	COLCERIU M C, ALDEA P L, RĂCHIșAN A L, et al. Vesicoureteral reflux and innate immune system:physiology,physiopathology,and clinical aspects[J]. J Clin Med, 2023, 12(6):2380. doi:10.3390/jcm12062380.
[28]	AL QURABIY H E, ABBAS I M, HAMMADI A A, et al. Urinary tract infection in patients with diabetes mellitus and the role of parental genetics in the emergence of the disease[J]. J Med Life, 2022, 15(8):955-962. doi:10.25122/jml-2021-0331.
[29]	AKIBOYE F, ADDERLEY N J, MARTIN J, et al. Impact of the diabetes inpatient care and education (DICE) project on length of stay and mortality[J]. Diabet Med, 2020, 37(2):277-285. doi:10.1111/dme.14062.
[30]	SHEAHAN K H, ATHERLY A, DAYMAN C, et al. The impact of diabetology consultations on length of stay in hospitalized patients with diabetes[J]. Endocrinol Diabetes Metab, 2021, 4(1):e00199. doi:10.1002/edm2.199.
[31]	GRIER W R, KRATIMENOS P, SINGH S, et al. Obesity as a risk factor for urinary tract infection in children[J]. Clin Pediatr (Phila), 2016, 55(10):952-956. doi:10.1177/0009922815617974.
[32]	CARULLO N, ZICARELLI M, MICHAEL A, et al. Childhood obesity:insight into kidney involvement[J]. Int J Mol Sci, 2023, 24(24):17400. doi:10.3390/ijms242417400.
[33]	SALIBA W, BARNETT-GRINESS O, RENNERT G, et al. The association between obesity and urinary tract infection[J]. Eur J Intern Med, 2013, 24(2):127-131. doi:10.1016/j.ejim.2012.11.006.

组别		性别（男/女）				年龄/岁				BMI分组
组别		性别（男/女）				年龄/岁				非超重/肥胖				超重				肥胖
非UTI组		34/46				8.3（6.2，11.0）				44（55.0）				32（40.0）				4（5.0）
UTI组		32/48				9.2（6.8，12.0）				34（42.5）				28（35.0）				18（22.5）
χ²或Z		0.103				0.901				10.458^＊＊
组别	DM类型（T1DM/T2DM）							住院时间/d			留置导尿管					酮症酸中毒			抗生素
非UTI组	66/14							9（8，12）			9（11.3）					5（6.3）			28（35.0）
UTI组	71/9							16（15，19）			22（27.5）					26（32.5）			9（11.3）
χ²或Z	1.269							93.040^＊＊			6.762^＊					17.644^＊＊			12.692^＊＊
组别			胰岛素				病程/月
组别			胰岛素				<6			6~<12			12~<36				≥36
非UTI组			72（90.0）				39（48.8）			17（21.3）			12（15.0）				12（15.0）
UTI组			68（85.0）				27（33.8）			13（16.3）			19（23.8）				21（26.3）
χ²			0.914				6.750^＊＊
组别				FBG/（mmol/L）					HbA1c/%						ALB/（g/L）
非UTI组				11.6（10.3，13.1）					7.2（6.7，7.7）						47.9（33.0，47.5）
UTI组				12.3（10.9，20.0）					8.1（7.7，8.7）						34.8（30.2，47.4）
Z				2.644^＊＊					29.192^＊＊						4.951^＊
组别					血Cr/（μmol/L）							住院费用/元
非UTI组					58.9（34.6，86.8）							2 433（2 080，3 087）
UTI组					77.2（41.9，124.2）							4 484（4 124，5 498）
Z					7.226^＊							90.000^＊＊

组别		性别（男/女）				年龄/岁				BMI分组
组别		性别（男/女）				年龄/岁				非超重/肥胖				超重				肥胖
非UTI组		34/46				8.3（6.2，11.0）				44（55.0）				32（40.0）				4（5.0）
UTI组		32/48				9.2（6.8，12.0）				34（42.5）				28（35.0）				18（22.5）
χ²或Z		0.103				0.901				10.458^＊＊
组别	DM类型（T1DM/T2DM）							住院时间/d			留置导尿管					酮症酸中毒			抗生素
非UTI组	66/14							9（8，12）			9（11.3）					5（6.3）			28（35.0）
UTI组	71/9							16（15，19）			22（27.5）					26（32.5）			9（11.3）
χ²或Z	1.269							93.040^＊＊			6.762^＊					17.644^＊＊			12.692^＊＊
组别			胰岛素				病程/月
组别			胰岛素				<6			6~<12			12~<36				≥36
非UTI组			72（90.0）				39（48.8）			17（21.3）			12（15.0）				12（15.0）
UTI组			68（85.0）				27（33.8）			13（16.3）			19（23.8）				21（26.3）
χ²			0.914				6.750^＊＊
组别				FBG/（mmol/L）					HbA1c/%						ALB/（g/L）
非UTI组				11.6（10.3，13.1）					7.2（6.7，7.7）						47.9（33.0，47.5）
UTI组				12.3（10.9，20.0）					8.1（7.7，8.7）						34.8（30.2，47.4）
Z				2.644^＊＊					29.192^＊＊						4.951^＊
组别					血Cr/（μmol/L）							住院费用/元
非UTI组					58.9（34.6，86.8）							2 433（2 080，3 087）
UTI组					77.2（41.9，124.2）							4 484（4 124，5 498）
Z					7.226^＊							90.000^＊＊

临床因素	β	SE	Wald χ²	P	OR（95% CI）
住院时间	0.736	0.148	24.760	<0.001	2.087（1.562~2.789）
留置导尿管	2.765	0.978	7.996	0.005	15.886（2.336~108.007）
酮症酸中毒	2.230	1.058	4.442	0.035	9.300（1.169~73.992）
HbA1c	2.815	0.773	13.248	<0.001	16.686（3.666~75.955）
病程			8.813	0.032
6~<12个月	-0.882	1.025	0.740	0.390	0.414（0.056~3.086）
12~<36个月	0.918	0.984	0.872	0.350	2.505（0.364~17.223）
≥36个月	3.023	1.090	7.686	0.006	20.548（2.425~174.119）
ALB	-0.224	0.066	11.489	0.001	0.799（0.702~0.910）
血Cr	0.010	0.004	5.725	0.017	1.010（1.002~1.019）
常数项	-22.143	5.635	15.444	<0.001	<0.001

临床因素	β	SE	Wald χ²	P	OR（95% CI）
住院时间	0.736	0.148	24.760	<0.001	2.087（1.562~2.789）
留置导尿管	2.765	0.978	7.996	0.005	15.886（2.336~108.007）
酮症酸中毒	2.230	1.058	4.442	0.035	9.300（1.169~73.992）
HbA1c	2.815	0.773	13.248	<0.001	16.686（3.666~75.955）
病程			8.813	0.032
6~<12个月	-0.882	1.025	0.740	0.390	0.414（0.056~3.086）
12~<36个月	0.918	0.984	0.872	0.350	2.505（0.364~17.223）
≥36个月	3.023	1.090	7.686	0.006	20.548（2.425~174.119）
ALB	-0.224	0.066	11.489	0.001	0.799（0.702~0.910）
血Cr	0.010	0.004	5.725	0.017	1.010（1.002~1.019）
常数项	-22.143	5.635	15.444	<0.001	<0.001