Recurrent urinary tract infection: Effect of glycemic status, disease severity and antimicrobial response in wasit, Iraq a prospective comparative cohort study

Type 2 diabetes mellitus (T2DM) is a known risk factor for recurrent urinary tract infections (rUTIs), which impacts the response to antimicrobial therapy due to glycemic variability. This study aimed to evaluate the association between glycemic control and antimicrobial treatment response in T2DM patients with rUTIs. A prospective observational comparative cohort study was conducted in the Wasit province of Iraq at Al-Zahraa Teaching Hospital and private internal medicine clinics from October 2024 to June 2025. Patients with rUTIs were enrolled, including patients with T2DM. Patients underwent structured follow-up at Days 1, 3, 7, and 30. Laboratory testing, urine cultures, antibiotic sensitivity tests, and antimicrobial prescriptions were assessed. Outcomes included clinical cure (Day 14) and recurrence (Day 30). Among the 99 patients who participated, 58 (58.6%) had diabetes, while the remaining 41 (41.4%) were non-diabetic. The most frequently identified bacteria in this study were Escherichia coli (32%), Staphylococcus aureus (20%), Enterococcus species (15%), Pseudomonas aeruginosa (17%), and Proteus spp. (7%). The study results demonstrate a significant association between diabetes status and the age of patients (p-values of <0.001). Furthermore, there was a significant association between UTI recurrence and RBS, the HbA1c variable (p-value=0.001). Patients with poor glycemic control demonstrated substantially higher recurrence rates within 30 days following treatment (65%) compared with patients with good glycemic control (22.2%), whereas no recurrence was observed among non-diabetic patients. Resistance patterns were more prominent in the uncontrolled group. Poor glycemic control was associated with increased UTI recurrence despite adequate initial antimicrobial response, underscoring the importance of glycemic optimization for sustained treatment success.