Original Articles

Inflammatory Parameters in UTIs Infection Caused by E. coli in Diabetic Patients

Abstract

Background:   Urinary tract infections (UTIs) are a public health concern, mainly for diabetic infections, who are more susceptible due to weakened immunity and high blood sugar. Understanding the role of immune parameters can help improved diagnose and attendant more effective treatment for diabetic mellitus patients with UTIs. This study aims to estimate the serum levels of AGEs, SAA, PCT, CD23 and CD25 in UTIs caused by E. coli in Diabetic Patients.

Methods:   This study had been included 300 samples (blood for Inflammatory parameters and urine for bacterial diagnosis) obtained from Diabetic patients found in Al-Betool Teaching Hospital. And Baquba Teaching Hospital between June 2023 and August 2024. Urine and blood samples were collected from 300 individuals with diabetes mellitus with both type who were suspected of having UTIs. Serum was isolated from the blood, blood glucose and HBA1c test was completed to check the presence of the diabetic illnesses. The serum samples were then stored for used in measuring immunological parameters that includes AGEs, SSA, PCT, CD23 and CD25 that done later by ELISA. Urine samples were culture on the blood agar and MacConkey agar, and then Bacteria diagnoses was done by using an automatic VITEK 2 system.

Results:   The current study showed that 220 samples urinary tract infections, 180 of which were bacterial. Of the 180 samples, 116 have E. coli bacterial isolates and 46 have other bacterial species. The study also shown an increase in the concentration of AGEs, SAA, PCT, CD23 and CD25 in the serum of Diabetic Mellitus patients have UTIs compared with the healthy.

Conclusion:   These inflammatory markers not only serve as diagnostic tools but also help in understanding the complex immune dysfunction present in diabetic patients with UTIs caused by E. coli.

1. Foxman B. The epidemiology of urinary tract infection. Nat Rev Urology 2014; 11(12):643-54.
2. Tiwari A, Dey A, Yadav A, et al. Diabetes and urinary tract infections: A review. J Diabetes Metabol Dis 2019; 18(1):1-9.
3. Petrak M, Simm R, Koessler M, et al. Risk factors for urinary tract infections in diabetic patients: A comprehensive review. J Diabetes Res 2021; 2021:9562184.
4. González GM, Gonzalez MJ, Uribe R, et al. Inflammatory markers in urinary tract infections: Role in diagnosis and management. Int J Urology 2020; 27(9):751-9.
5. Feldman S, Regev D, Kramer M, et al. Role of inflammatory markers in urinary tract infections: A focus on C-reactive protein and interleukins. J Infect 2021; 83(5):416-26.
6. Gaucher N, Aymard J, Guillemin F, et al. Hyperglycemia exacerbates the inflammatory response in urinary tract infections in diabetic patients. Diabetes Res Clin Prac 2017; 123:113-21.
7. Martin-Gallan P, Sanchez-Gonzalez J, Garcia-Medina J, et al. The impact of hyperglycemia on urinary tract infection outcomes in patients with diabetes mellitus. Infec Drug Res 2019; 12:335-43.
8. Monnier V, Sell DR, et al. Contribution of the Maillard reaction to the pathogenesis of diabetic complications. Diabetes Metabol Res Rev 2005; 21(1):3-12.
9. Semba RD, Nicklett EJ, Ferrucci L, et al. Does advanced glycation end-product accumulation contribute to the aging phenotype. J Gerontol A Biol Sci Med Sci 2011; 66(6):493-508.
10. Koyama H, Koyama Y, Koga T, et al. AGEs and diabetic nephropathy: their interaction and therapeutic implications. Diabetes Res Clin Prac 2010; 89(2):132-42.
11. Sánchez J, Serna A, Gomez A, et al. Serum amyloid A as a marker of inflammation in urinary tract infections. Clin Exp Immunol 2017; 187(3):378-87.
12. Li X, Zhou Y, Zhang H, et al. Serum amyloid A as a prognostic marker in urinary tract infections in patients with diabetes. J Diabetes Complicat 2019; 33(6):617-23.
13. Jessen KL, Jensen JS, Nielsen J, et al. Procalcitonin as a diagnostic marker in urinary tract infections. J Clin Microbiol 2018; 56(4):e01945-17.
14. Ducatelle R, Haesebrouck F, Van Immerseel F, et al. CD23 and immune responses in urinary tract infections. J Infec Dis 2015; 211(7):1100-6.
15. Kuhn KA, Stappenbeck TS, Clark-Lewis I, et al. Regulatory T cells and CD25 in urinary tract infections: Implications for immune regulation. J Immunol 2016; 196(6):2472-80.
16. Pires D, Marques D, Oliveira C, et al. Urinary tract infections in diabetic patients: Pathophysiology and clinical management. Diabetes Met J 2018; 42(1):24-30.
17. Santos CX, Anjos EI, Augusto O, et al. The role of advanced glycation end products in immune system dysfunction. Vas Pharmacol 2006; 44(3):102-10.
18. Ott C, Jacobs K, Haucke E, et al. Advanced glycation end products and their role in immune dysfunction and inflammation. Free Rad Bio Med 2014; 75:22-35.
19. Liu R, Nikolajczyk BS, Shi Y, et al. Advanced glycation end products impair the function of immune cells: The role of RAGE. Nat Rev Immunol 2014; 14(3):101-7.
20. Zhang L, Wang L, Li H, et al. Advanced glycation end products in the pathogenesis of diabetic complications: The role of the receptor for AGEs. Diabetes Res Clin Prac 2016; 115:97-108.
21. Gur C, Rachmilewitz D, Baniyash M, et al. Advanced glycation end products and their role in immune system dysfunction in diabetes. J Diabetes Res 2014; 2014:105627.
22. Touzé A, Soulas C, Bidault E, et al. Serum amyloid A (SAA) in urinary tract infections. J Clin Immunol 2005; 25(4):440-4.
23. Chung SW, Park KH, Kim MJ, et al. Serum amyloid A as a predictive marker of recurrent urinary tract infections in diabetic patients. J Clin Microbiol 2013; 51(5):1415-9.
24. Schuetz P, Christ-Crain M, Thomann R, et al. Procalcitonin as a diagnostic marker in bacterial infections: A systematic review and meta-analysis. Clin Infec Dis 2012; 55(6):1-12.
25. Jevon GM, Smith RJ, Patel K, et al. Procalcitonin and its role in assessing severity of infections in diabetic patients with UTIs. J Diabetes Complicat 2016; 30(5):1019-25.
26. Lippi G, Franchini M, Montagnana M, et al. Procalcitonin as a marker of bacterial infections in patients with urinary tract infections. Clin Biochem 2010; 43(7):575-8.
27. Liu Y, Wang J, Chen H, et al. Role of CD23 in the immune response to bacterial infections. J Leukocyte Biology 2013; 94(5):947-56.
28. Zhu J, Li Q, Wang Y, et al. CD23 expression and inflammation in chronic diseases: Implications for diabetic patients. Diabetes Met Res Rev 2014; 30(5):387-95.
29. Sanchez M, Ortega A, Fernandez P, et al. Immunological dysfunction and the role of CD23 in diabetic patients. J Diabetes Res 2015; 2015:346432.
30. Kwon J, Lee S, Kim H, et al. Role of CD23 in the recurrence of urinary tract infections in diabetic patients. J Urology 2017; 198(4):920-6.
31. Lee S, Kim H, Park J, et al. Expression of CD23 and immune regulation in recurrent urinary tract infections in diabetic patients. Clin Immunol 2018; 193:34-42.
32. Chen Y, Zhang L, Li X, et al. CD25 regulation in inflammatory responses in diabetic patients. Diabetes Met Res Rev 2013; 29(3):211-8.
33. Xu H, Wang Y, Li J, et al. Immune dysregulation and the role of CD25 in diabetic infections. Immunol Cell Bio 2014; 92(7):485-92.
34. Ghosh S, Patel R, Singh A, et al. CD25 as a predictor of infection prognosis in diabetic patients with UTIs. Infec Immun 2017; 85(11):e00456.
IssueVol 13 No 3 (2025) QRcode
SectionOriginal Articles
Keywords
E. coli ELISA Inflammatory Markers UTIs VITEK system.

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Khalaf S. Inflammatory Parameters in UTIs Infection Caused by E. coli in Diabetic Patients. J Med Bacteriol. 2025;13(3):18-27.