Type 2 diabetes mellitus and antibiotic-resistant infections: a systematic review and meta-analysis

BACKGROUND: Type 2 diabetes mellitus (T2DM) has been associated with infectious diseases; however, whether T2DM is associated with bacterial-resistant infections has not been thoroughly studied. We ascertained whether people with T2DM were more likely to experience resistant infections in comparison to T2DM-free individuals. METHODS: Systematic review and random-effects meta-analysis. The search was conducted in Medline, Embase and Global Health. We selected observational studies in which the outcome was resistant infections (any site), and the exposure was T2DM. We studied adult subjects who could have been selected from population-based or hospital-based studies. I(2) was the metric of heterogeneity. We used the Newcastle-Ottawa risk of bias scale. RESULTS: The search retrieved 3370 reports, 97 were studied in detail and 61 (449 247 subjects) were selected. Studies were mostly cross-sectional or case–control; several infection sites were studied, but mostly urinary tract and respiratory infections. The random-effects meta-analysis revealed that people with T2DM were twofold more likely to have urinary tract (OR=2.42; 95% CI 1.83 to 3.20; I(2) 19.1%) or respiratory (OR=2.35; 95% CI 1.49 to 3.69; I(2) 58.1%) resistant infections. Although evidence for other infection sites was heterogeneous, they consistently suggested that T2DM was associated with resistant infections. CONCLUSIONS: Compelling evidence suggests that people with T2DM are more likely to experience antibiotic-resistant urinary tract and respiratory infections. The evidence for other infection sites was less conclusive but pointed to the same overall conclusion. These results could guide empirical treatment for patients with T2DM and infections.