Diagnostic and therapeutic challenges of urinary tract infections in type 2 diabetes mellitus: A clinical case

This report presents a clinical case of asymptomatic chronic pyelonephritis in a patient with decompensated type 2 diabetes mellitus (T2DM). The patient initially sought medical care due to clinical manifestations of T2DM, without reporting any symptoms suggestive of pyelonephritis. Signs of renal inflammation were identified only during hospitalization through laboratory testing. In this multimorbid condition, hyperglycemia served as a substrate for the accelerated growth of Escherichia coli, triggering an exacerbation of chronic urinary tract infection. Additionally, T2DM contributed to the increased virulence and multidrug resistance of the microflora. The complexity of pyelonephritis management in this case required continuous monitoring and adjustment of antibacterial therapy. The initially prescribed antibiotic, ceftriaxone, was replaced with cefoperazone–sulbactam. Given the patient’s severe multimorbid condition and the high variability of the glycemic profile, glucose-lowering therapy was adjusted along with antibiotic treatment. Glycemic control facilitated the immune system recovery and reduced renal inflammation, ultimately leading to the resolution of the active phase of chronic pyelonephritis. Consequently, glycemic control contributed to the immune system recovery, alleviation of renal inflammation, and subsequent resolution of the active phase of chronic pyelonephritis.