Prevalence of Urinary tract infections, associated factors, and Antimicrobial susceptibility patterns of the Uropathogens isolated from heart failure patients on sodium-glucose transporter 2 inhibitors at Jakaya Kikwete cardiac institute.

Abstract

ABSTRACT Background: Urinary tract infections (UTIs) are among the most encountered infectious diseases, with a global incidence of at least 150 million annually. UTI can occur because of a variety of risk factors, including the administration of certain drugs. Sodium-glucose transporter 2 inhibitors (SGLT2i) have recently emerged as a standard therapy for heart failure patients, and evidence has shown the drug to confer mortality benefits and reduce hospital readmission. Despite its undeniable benefits, previous studies have reported an association between SGLT2 inhibitors and a high risk of UTI. The management of UTI can be complicated due to the resistance of the uropathogens towards the commonly used antibiotics. Therefore, urgent information is required on the prevalence of UTIs among patients using SGLT2 inhibitors and the antibiotic susceptibility pattern of the isolated uropathogens. Broad objective: This study aimed to investigate the prevalence of UTI, associated factors and evaluate the antimicrobial susceptibility patterns of the isolated uropathogens among heart failure patients using SGLT2 inhibitors at Jakaya Kikwete Cardiac Institute (JKCI). Methodology: This cross-sectional study was conducted among heart failure patients using SGLT2 inhibitors at JKCI. A structured questionnaire was used to collect participant socio-demographic characteristics, and a case report form was used to record medical and medication history, together with laboratory result data. UTI was defined by positive cultures with significant bacteriuria of ≥105 CFU/ml as a gold standard, and urinalysis parameters including pyuria, and positive or negative nitrites. Antimicrobial susceptibility test (AST) was performed for the isolated uropathogens using the Kirby Bauer disc diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) guidelines and susceptibility patterns were recorded based on tested antibiotics, Statistical data analysis was performed by Statistical Product and Service Solution (SPSS) software version 26 (IBM SPSS Statistics, IBM Corp, Armonk, NY, USA). For analytical statistics, univariable and multivariable as well as Poisson robust regression models were used to assess the association between positive UTI and the risk factors such as age, sex, comorbidities, previous history of UTI, type of SGLT2 inhibitor, and duration of use of SGLT2 inhibitors. Moreover, the Pearson Chi-square test was also used to establish an association. The 95% confidence intervals were obtained, and p values <0.05 were considered statistically significant. Results: Out of 141 patients, more than half were males (55.3%) and individuals aged ≤60 years (53.9%). Empagliflozin (53.2%) and dapagliflozin (46.8%) were the main SGLT2 inhibitors used, with most patients using them for less than 4 months (87.0%). The prevalence of UTI among study participants was 15.6%. Compared to the culture and sensitivity test used for diagnosis, urinalysis showed a high sensitivity (100%) and lower positive predictive value (46.8%). Advanced age (>60 years) significantly increased UTI risk (aPR 3.77, 95% CI: 1.42-10.01), also the female sex (aPR 2.92, 95% CI: 1.19-7.15) was a risk for UTI. Moreover, a longer duration of SGLT2 inhibitor use (≥4 months) was also associated with a higher likelihood of UTI (aPR 3.19, 95% CI: 1.70-5.96). Uropathogens isolated included Escherichia coli (50%), Klebsiella pneumoniae (13.6%), Klebsiella oxytoca (9.1%), Pseudomonas aeruginosa (9.1%), Candida spp (9.1%), Staphylococcus aureus (4.5%), Staphylococcus saprophyticus (4.5%). High resistance of the uropathogens was noted for Ampicillin (99.9%), Tetracycline (69.2%), Ceftazidime (53.8%), Ceftriaxone (46.2%), and Gentamicin (46.2%). In contrast, the uropathogens were more susceptible to Nitrofurantoin (84.6%) and Meropenem (100%). Conclusion: This study has shown UTIs are prevalent by 15.6% among heart failure patients who were on SGLT2 inhibitors This study highlights significant socio-demographic and clinical factors associated with UTIs among heart failure patients using SGLT2 inhibitors. Advanced age, female sex, prolonged medication use, and post-menopausal status are key risk factors. Commonly isolated uropathogens included Escherichia coli, Klebsiella spp, Pseudomonas aeruginosa, Staphylococcus spp, and Candida spp. The bacterial uropathogens were highly resistant to Ampicillin, Tetracycline, Ceftazidime, Ceftriaxone, and gentamicin. While more susceptible to Nitrofurantoin and Meropenem. These study's findings therefore inform clinical practice and show the importance of targeted monitoring and preventive strategies to mitigate UTI risk in this vulnerable population. Continued research and clinical vigilance are essential to optimize heart failure patient management on SGLT2 inhibitors and reduce the burden of UTIs.