Urinary tract infection samples collected from patients in Gujarat, India, reveal a stark divide in antibiotic resistance between people with diabetes and people without it. In a prospective study running from August 2021 to January 2024, researchers tested 2,408 patients with symptoms of urinary tract infection, of whom 954 tested positive. Among those positive cases, 280, or 27 percent, were diabetic and 674, or 73 percent, were non-diabetic. The isolates recovered from these patients showed that 61.84 percent were multidrug resistant, 19.49 percent were extremely drug resistant, and 12.99 percent were pan drug resistant, figures that underline how difficult routine urinary infections have become to treat in this region.
The study, published in the Annals of Clinical Microbiology and Antimicrobials, set out to determine the multidrug resistance rate and the multiple antibiotic resistance index of uropathogens in the two patient groups. The multiple antibiotic resistance index, or MARI, serves as a quantitative indicator of antimicrobial exposure and resistance risk across patient groups, allowing a more objective assessment of the environmental and clinical factors behind high resistance patterns. A MARI value above 0.2 is treated as a warning signal of heavy antimicrobial pressure. In this cohort, such elevated values appeared in 87.01 percent of gram-negative uropathogens from diabetic patients, 201 out of 231 isolates, and in 71.03 percent of those from non-diabetic patients, 412 out of 580 isolates.
Resistance rates differed sharply by species and by patient group. Pseudomonas aeruginosa showed a multidrug resistance rate of 92.10 percent in diabetic patients, the highest single figure reported in the study. In non-diabetic patients, Escherichia coli carried a multidrug resistance rate of 70.99 percent. Extreme drug resistance was more common in P. aeruginosa, while pan drug resistance was higher in Klebsiella species and P. aeruginosa. Diabetic patients overall exhibited higher rates of antibiotic-resistant uropathogens than non-diabetic patients, a difference the authors link to the distinct bacterial landscape found in each group.
The distribution of infecting organisms also followed distinct demographic patterns. Among diabetic patients, P. aeruginosa was more common in males, while E. coli was more frequent in younger females aged 18 to 40, causing bacteriuria. Candida non-albicans, which causes candiduria, emerged as a prevalent pathogen in diabetic patients aged 61 to 95 and tended to recur. In non-diabetic patients, younger females were predominantly infected with E. coli, whereas males had higher rates of infection with P. aeruginosa and Klebsiella species. Recurrence showed different associations in the two groups: it was strongly linked with E. coli in non-diabetic patients, while Candida non-albicans infections tended to recur in older diabetic patients.
These findings arrive at a moment when empirical treatment of urinary infections, meaning treatment started before laboratory susceptibility results are available, faces growing difficulty worldwide. The authors frame their results as highlighting a global concern for such empirical decisions, since the choice of an initial antibiotic increasingly depends on local knowledge of which organisms resist which drugs. Region-specific data of this kind, gathered from a single Indian state over two and a half years, offers clinicians a picture of the resistance burden they are likely to encounter in their own patient population rather than relying on figures drawn from distant settings.
The use of the multiple antibiotic resistance index is presented as a key innovative aspect of the work. Rather than reporting resistance species by species and drug by drug alone, the index condenses the resistance burden of each isolate into a single number that can be compared across patient groups. Because a value above 0.2 signals substantial antimicrobial exposure, the high proportion of gram-negative isolates exceeding that threshold in both groups, and especially in diabetic patients, points to considerable cumulative pressure from antibiotic use in these populations. The authors suggest this approach enables more objective assessment of the environmental and clinical factors contributing to high resistance patterns, particularly in diabetic individuals.
The study also exposes what the authors describe as a critical gap in region-specific antimicrobial stewardship programs. Such programs coordinate how antibiotics are prescribed, dispensed and monitored within health systems, and the authors advocate for tailored interventions focused on high-risk groups. Their data suggest that diabetic patients with urinary infections may warrant particular attention, given the higher resistance rates observed in that group, while the differing species distributions between men and women and between age groups in both diabetic and non-diabetic patients complicate any one-size-fits-all prescribing rule.
The conclusion drawn by the researchers emphasizes notable differences in uropathogen prevalence and antibiotic resistance patterns between diabetic and non-diabetic patients, and the need for targeted management and enhanced surveillance. The species-specific figures carry practical weight: a clinician facing a diabetic male with a urinary infection in this region confronts a pathogen pool in which P. aeruginosa is both more prevalent and almost universally multidrug resistant, whereas in non-diabetic patients E. coli dominates among younger women but still resists multiple drugs in roughly seven out of ten cases. Recurrence patterns add a further layer, with E. coli strongly associated with repeat infections in non-diabetic patients and Candida non-albicans recurring in older diabetic patients.
As a prospective study with a defined enrollment period and nearly a thousand positive cases, the work provides a structured snapshot of resistance in one Indian setting rather than a global estimate. Its value lies in the granularity of the comparison: the same infections, the same laboratory methods and the same resistance definitions applied to diabetic and non-diabetic patients side by side. The reported proportions, 61.84 percent multidrug resistant, 19.49 percent extremely drug resistant and 12.99 percent pan drug resistant across all isolates, together with the MARI figures of 87.01 percent in diabetics and 71.03 percent in non-diabetics, give stewardship programs concrete benchmarks against which future local surveillance can be measured.
Subject of Research: Multidrug resistance and multiple antibiotic resistance index of urinary pathogens in diabetic versus non-diabetic patients in Gujarat, India
Article Title: Multi-drug resistance and multiple antibiotic resistance index of uropathogens in diabetic and non-diabetic patients with urinary tract infections
Article References: Kalola, P., Patadia, H., & Priyadarshini, A. (2026). Multi-drug resistance and multiple antibiotic resistance index of uropathogens in diabetic and non-diabetic patients with urinary tract infections. Annals of Clinical Microbiology and Antimicrobials, 25(1), Article 43. https://doi.org/10.1186/s12941-026-00866-3
Image Credits: AI Generated
DOI: 10.1186/s12941-026-00866-3
Keywords: urinary tract infection, uropathogens, multidrug resistance, diabetes, antimicrobial resistance, multiple antibiotic resistance index, Pseudomonas aeruginosa, Escherichia coli, Klebsiella, Candida non-albicans, antimicrobial stewardship, India
News Source: Kristina Jarvis. (October 30, 2026). Uropathogens from diabetic patients show higher multidrug resistance than those from non-diabetics. Scienmag.
