Background: Diabetic patients are more prone to severe UTIs, thereby posing challenges in their management. Locally there is paucity of data on the patterns of uropathogens implicated in UTIs. Antibiotics are frequently prescribed empirically which results in excessive prescription of antibiotics with precedent complications including but not limited to resistant microbial agents in the population. This study investigated the antibiotic susceptibility patterns of bacterial pathogens causing UTI in diabetic patients in Thika level 5 hospital, Kiambu County, Kenya. Methods: A cross-sectional descriptive study was carried out with one hundred and seventy-eight type IIdiabetic patients attending the diabetic clinic with a positive urinalysis being enrolled into the study. The urine was cultured on cysteine lactose-electrolyte deficient (CLED) agar and blood agar media as per standard urine culture. Antibiotic sensitivity was done on Mueller-Hinton agar using Kirby-Bauer disk diffusion methods according to ClSI guidelines. Appropriate biochemical tests were done to identify the isolated bacteria. Consecutive sampling was used until the sample size was attained. Chi square test of significance was used to determine relationship between the categorical outcome variables with level of significance set at P < 0.05. Multivariate Logistics regression models was used to identify relationships between independent and dependent variables. Results: A total of 229 participants were included in this study of which 63.8% were females. The mean age of the participants was 52.52 and the most frequently observed symptom suggestive of UTI was frequent urination (67.2%).Among the culture-positive bacterial isolates, prevalence of gram negative bacteria was 88.89% while prevalence of gram positive bacteria was 11.11%. The major microorganisms isolated were Escherichia coli (56.7%), Klebsiella pneumoniae (16.7%), Candida albicans (10%), and Staphylococcus aureus (6.7%).E. coli showed higher sensitivity to Imipenem/meropenem (78.6%), gentamicin (73.3%), piperacillin/tazobactam (75.0%), nitrofurantoin (100%), ertapenem (100%), and amikacin (100%) but resistant to amoxiclav (100%), ampicillin (100%), cefuroxime and ciprofloxacin (70.6% each). S. aureus was sensitive to gentamicin, ampicillin, and nitrofurantoin (100% each) while resistant to clindamycin and erythromycin (100% each). Conclusion: The predominant pathogens causing UTI were gram negative bacilli, the Enterobacteriaceae, particularly E. coli. UTI development had a significant association with the sex of participants, and specific positive urinalysis results (leucocyte esterase, nitrites, pus cells, and appearance of urine). These factors were individually and statistically significant (p < 0.05) from the initial binomial regression but with nitrite results as the only factor showing statistical significance following multivariate regression. Based on the antimicrobial susceptibility test results, it may be inferred that amikacin is among the drugs of choice for UTI treatment in this study area. The isolated gram negative micro-organisms also demonstrated high resistance (100%) to commonly used antibiotics; ampicillin, and amoxiclav. Therefore, management should be supported by culture and sensitivity testing and clinicians may need to revise their prescription habits based on the sensitivity findings.
