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Patients with T2DM are more likely to experience resistant infections, mainly of the respiratory and urinary tracts, than healthy individuals, according to a recent meta-review.

Type 2 diabetes mellitus (T2DM) is a global health burden associated with increased economic costs, mortality, morbidity, and disability. While T2DM is significantly related to the development of non-communicable diseases, it is considered an essential prognostic factor in communicable or infectious diseases. However, a limited number of studies thoroughly assess the association of bacterial-resistant infections with T2DM. A systematic review and meta-analysis, published in the Journal of Epidemiology and Community Health, assessed whether T2DM patients were at greater risk of suffering from antibiotic-resistant infections than healthy individuals without T2DM.
The review included 61 studies with 449,247 subjects in review and meta-analyses. Most of the studies were case-control and cross-sectional studies, investigating several infection sites, including respiratory and urinary tract infections at large. According to the random-effects meta-analysis, patients with T2DM were at a twofold higher risk of developing antibiotic-resistant urinary tract and respiratory infections. While the evidence provided in the studies was heterogeneous for infection sites other than respiratory and urinary tracts, the studies supported the association of T2DM with antibiotic-resistant infections. Other infection sites included intra-abdominal, surgical, ophthalmic, and skin or soft tissue infections.
The association of T2DM with antibiotic-resistant infections is supported by the negative interactions between T2DM and the immune system of the affected individual, which makes the individual susceptible to contracting antibiotic-resistant bacteria. In addition, the pharmacokinetics of antibiotics among obese individuals may manifest as suboptimal antibiotic levels, increasing the risk of developing antibiotic resistance.
In summary, patients with T2DM are more susceptible to resistant infections of the respiratory and urinary tracts. Effective decision-making and comprehensive clinical knowledge can be effective in formulating empirical treatments for T2DM and antibiotic-resistant infections.
Carrillo-Larco, R. M., Anza-Ramírez, C., Saal-Zapata, G., Villarreal-Zegarra, D., Zafra-Tanaka, J. H., Ugarte-Gil, C., & Bernabé-Ortiz, A. (2022). Type 2 diabetes mellitus and antibiotic-resistant infections: a systematic review and meta-analysis. J Epidemiol Community Health, 76(1), 75-84. https://doi.org/10.1136/jech-2020-216029

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