Antimicrobial treatment pattern and Medications Adherence among Iraqi T2DM patients with recurrent urinary tract infection in Wasit province
DOI:
https://doi.org/10.32947/ajps.v26i2.1377Keywords:
Antimicrobial treatment, Medication adherence, Recurrent urinary tract infection, Type 2 diabetes mellitusAbstract
Background: Recurrent urinary tract infections (rUTIs) are common in type 2 diabetes mellitus (T2DM) patients due to impaired immunity, glycosuria, and chronic comorbidities. Antimicrobial resistance complicates therapy, and inappropriate use further worsens recurrence.
Objective: To evaluate antimicrobial treatment patterns, among T2DM Iraqi patients with rUTIs.
Methods: A prospective, open-label study was conducted at Al-Zahraa Teaching Hospital and private internal medicine clinics in Wasit, Iraq, from October 2024 to June 2025. Ninety-nine patients with rUTIs were enrolled, including 58 of them with T2DM. Patients underwent structured three follow-up visits from day1 to days 7-14. Laboratory testing, urine cultures, antibiotics sensitivity test, antimicrobial prescriptions, and medication adherence (MARS) were assessed.
Results: E. coli was the most frequent uropathogen in this study. Fluoroquinolones—including levofloxacin, ciprofloxacin, and norfloxacin beside to Aminoglycoside as amikacin consistently showed the highest activity against most pathogens, particularly E. coli, Enterobacter spp., and Pseudomonas spp., with sensitivity rates frequently exceeding 90%. On the contrary, a wide variety of β-lactam antibiotics, including drugs such as cefixime, Augmentin and amoxicillin, show high degrees of resistance among nearly all strains of bacteria, with the percent of resistance often exceeding 90–100%. Although there was generally moderate adherence to medication regimens reported by participants in the MARS surveys,
Conclusion: Fluoroquinolones and aminoglycosides were the most commonly used antimicrobial treatments in Iraqi T2DM patients with rUTIs. Findings were significantly impacted by adherence and glucose levels.
References
1- Wajid H, Manzoor H, Manzoor M, Mirza S, Khan HS, Hassan S, et al. Recurrent urinary tract infection in diabetics: A retrospective analysis. Cureus. 2025;17(7): e87816.
2- Casqueiro J, Casqueiro J, Alves C. Infections in patients with diabetes mellitus: A review of pathogenesis. Indian J Endocrinol Metab. 2012;16(Suppl1): S27–36.
3- Yahya A, Muhammed A, Muhammed G, Ramadan N, Mihe S, Yousif Y. Antimicrobial Resistance Profile of Staphylococcus aureus Uro-Pathogens Among the General Population in Duhok City, Iraq. 2024.
4- Raza A, Pervaiz N, Ali I, Bint Shafqat M, Zubair M, Memon MS, et al. Hospital Admissions and Antimicrobial Resistance Patterns in Diabetic Patients with Urinary Tract Infections: A Cross-Sectional Study from a Tertiary Care Center in Pakistan. Cureus. 2025;17(8).
5- Tahir B, Tayib N, Ahmed AH, Tolossa D, Mekuria S, Barsenga S, et al. Prevalence, bacterial profile, antimicrobial susceptibility patterns and associated risk factors of bacterial UTI among diabetic patients at Jigjiga University Sheik Hasan Yabare Comprehensive Specialized Hospital, Jigjiga, Eastern Ethiopia. BMC Infect Dis. 2025;25(1):777.
6- Al-Jumaili AA, Ahmed KK. A review of antibiotic misuse and bacterial resistance in Iraq. Eastern Mediterranean Health Journal. 2024;30(10):663–70.
7- Gorter KJ, Hak E, Zuithoff NPA, Hoepelman AIM, Rutten GEHM. Risk of recurrent acute lower urinary tract infections and prescription pattern of antibiotics in women with and without diabetes in primary care. Fam Pract. 2010;27(4):379–85.
8- Chapman SCE, Chan AHY. Medication nonadherence-definition, measurement, prevalence, and causes: reflecting on the past 20 years and looking forwards. Front Pharmacol. 2025; 16:1465059.
9- Chauke GD, Nakwafila O, Chibi B, Sartorius B, Mashamba-Thompson T. Factors influencing poor medication adherence amongst patients with chronic disease in low-and-middle-income countries: A systematic scoping review. Heliyon. 2022;8(6).
10- Polonsky WH, Henry RR. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Patient Prefer Adherence. 2016;1299–307.
11- Excellence NI for H and C. Type 2 diabetes: prevention in people at high risk. NICE guideline (PH38). 2012.
12- Hussein NS. Clinical, etiological and antibiotic susceptibility profiles of community- acquired urinary tract infection in a Western Hemisphere of Baghdad. Bangladesh Journal of Medical Science. 2015 Oct 1;14(4):352–8. doi:10.3329/bjms. v14i4.19071
13- Thompson K, Kulkarni J, Sergejew AA. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses k. Schizophrenia Research [Internet]. 2000. Report. Available from: www.elsevier.com/locate/schres
14- Prabahar K, Albalawi MA, Almani L, Alenizy S. Assessment of medication adherence in patients with chronic diseases in Tabuk, Kingdom of Saudi Arabia. J Res Pharm Pract. 2020;9(4):196–201.
15- Taru MY, Bamidele LI, Faith AO, Philip TF, Allagoa EL, Izevbokun OH. Medication Non-Adherence and Disability among Outpatients with Schizophrenia in North-Central Nigeria. J Biosci Med (Irvine). 2022;10(09):86–117. doi:10.4236/jbm.2022.109008
16- MA B, S S, MJ H. Etiology, Risk Factors, and Treatment Outcomes of Recurrent Urinary Tract Infections. SAS Journal of Medicine. 2025 Mar 17;11(03):206–10. doi:10.36347/sasjm. 2025.v11i03.013
17- Taher TMJ, Sarray FTR, Shwekh AS, Mareedh TK, Ghazi HF. Bacterial causes of urinary tract infection among diabetic and non-diabetic patients in Al-Kut City, Iraq. Borneo Epidemiology Journal. 2021;2(1).
18- Hasan D, Mero W, Khalid H. The Prevalence of Enterobacteriaceae among Outpatients with Urinary Tract Infections in Zakho City, Kurdistan Region-Iraq. Journal of Life and Bio Sciences Research. 2025;6(01):1–5.
19- Burekovic A, Haskovic E, Ceric F, Halilovic D. Correlation Between Inflammatory and Biochemical Parameters in Patients with Diabetes and Urinary Tract Infection. Mater Sociomed. 2021;33(4):240.
20- Mancuso G, Midiri A, Gerace E, Marra M, Zummo S, Biondo C. Urinary Tract Infections: The Current Scenario and Future Prospects. Pathogens. MDPI; 2023. doi:10.3390/pathogens12040623
21- Ahmed SK, Karim Diab AA, Mansour Kanauf S, Ali AM, Maryoush HS, Dawah RN, et al. INVESTIGATION OF ASYMPTOMATIC BACTERIURIA IN A GROUP OF IRAQI PATIENTS WITH DIABETES MELLITUS TYPE 2 IN BAGHDAD CITY, IRAQ. Journal Port Science Research. 2022 Sep 26;5(1):29–33. doi:10.36371/port.2022.1.4
22- Sonkoue Lambou JC, Noubom M, Djoumsie Gomseu BE, Takougoum Marbou WJ, Tamokou JDD, Gatsing D. Multidrug-Resistant Escherichia coli Causing Urinary Tract Infections among Controlled and Uncontrolled Type 2 Diabetic Patients at Laquintinie Hospital in Douala, Cameroon. Genet Res (Camb). 2022;2022. doi:10.1155/2022/1250264
23- Khan HR, Awan UA, Qamar N, Ahmed N, Afghan TS, Gul B, et al. Evaluating the Risk Factors and Bidirectional Association of Urinary Tract Infections in Diabetes Mellitus. BioScientific Review. 2025 Jan 29;6(4):148–63. doi:10.32350/bsr.64.10
24- Hadi P, Rampal S, Neela VK, Cheema MS, Sarawan Singh SS, Kee Tan E, et al. Distribution of Causative Microorganisms in Diabetic Foot Infections: A Ten-Year Retrospective Study in a Tertiary Care Hospital in Central Malaysia. Antibiotics. 2023 Apr 1;12(4). doi:10.3390/antibiotics12040687
25- Gardiner BJ, Stewardson AJ, Abbott IJ, Peleg AY. Nitrofurantoin and fosfomycin for resistant urinary tract infections: Old drugs for emerging problems. Aust Prescr. 2019 Feb 1;42(1):14–9. doi:10.18773/austprescr.2019.002
26- Boyko EJ, Fihn SD, Scholes D, Chen CL, Normand EH, Yarbro P. Diabetes and the risk of acute urinary tract infection among postmenopausal women. Diabetes Care. 2002;25(10):1778–83.
27- Moore H, Yeoh D, Hughes C, Raby E, Sandaradura I. Aminoglycosides: an update on indications, dosing and monitoring. Aust Prescr. 2025 Aug 1;48(4):133–8. doi:10.18773/austprescr.2025.038
28- Mohammad EJ, Mohammed WK, Jaffal WN. Urinary tract infections and antimicrobial resistance: Across sectional study. International Journal of Surgery Science. 2024 Jan 1;8(1):44–8. doi: 10.33545/surgery.2024.v8.i1a.1048
29- Yadav A, Patel AK, Karna A, Jha P. Bacterial Uropathogens causing Urinary Tract Infection at Hetauda Hospital. Nepal Journal of Health Sciences. 2023;3(1):65–74.
30- Mohammed Amhimmid. Assessment of Antibiotic Resistance in Escherichia coli. Libyan Medical Journal. 2025 Sep 30;496–8. doi:10.69667/lmj.2517325
31- Topa AE, Ionescu C, Pinzaru A, Mocanu E, Iancu AM, Dumea E, et al. Challenges in the Treatment of Urinary Tract Infections: Antibiotic Resistance Profiles of Escherichia coli Strains Isolated from Young and Elderly Patients in a Southeastern Romanian Hospital. Biomedicines. 2025;13(5):1066.
32- Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical Infectious Diseases. 2011 Mar 1;52(5). doi:10.1093/cid/ciq257 PubMed PMID: 21292654.
33- Mohammed LR, Soor TAH. High Resistance to β-Lactams but Sustained Susceptibility to Colistin and Carbapenems in Escherichia coli Isolated from Urinary Tract Infections. Kurdistan Journal of Applied Research. 2025;10(1):190–9.
34- Moran C, Then S, Callisaya M, Beare R, Srikanth V. New Horizons - Cognitive Dysfunction Associated with Type 2 Diabetes. Journal of Clinical Endocrinology and Metabolism. Endocrine Society; 2022. p. 929–42. doi:10.1210/clinem/dgab797 PubMed PMID: 34788847.
35- Tominaga Y, Morisky DE, Mochizuki M. A cross-sectional study clarifying profiles of patients with diabetes who discontinued pharmacotherapy: reasons and consequences. BMC Endocr Disord. 2021 Dec 1;21(1). doi:10.1186/s12902-021-00778-7 PubMed PMID: 34120602.
36- Borek AJ, Edwards G, Santillo M, Wanat M, Glogowska M, Butler CC, et al. Re-examining advice to complete antibiotic courses: a qualitative study with clinicians and patients. BJGP Open. 2023;7(2). doi:10.3399/BJGPO.2022.0170
37- Valentine-King MA, Trautner BW, Zoorob RJ, Germanos G, Hansen M, Salemi JL, et al. Analysis of recurrent urinary tract infection management in women seen in outpatient settings reveals opportunities for antibiotic stewardship interventions. Antimicrobial Stewardship and Healthcare Epidemiology. 2022 Jan 17;2(1). doi:10.1017/ash.2021.224
38- Almomani BA, Hijazi BM, Al-Husein BA, Oqal M, Al-Natour LM. Adherence and utilization of short-term antibiotics: Randomized controlled study. PLoS One. 2023 Sep 1;18(9 September). doi: 10.1371/journal.pone.0291050 PubMed PMID: 37669277.
39- Yadav A, Patel AK, Karna A, Jha P. Bacterial Uropathogens causing Urinary Tract Infection at Hetauda Hospital. Nepal Journal of Health Sciences. 2023;3(1):65–74.
40- Kim T, Choi SH. Diabetes mellitus and infectious diseases: current evidence and clinical implications. Diabetes Metab J. 2025;49(5):915–33.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Maher Kadhum Abed, Manal Khalid Abdulridha, Hussein Adnan
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
