Article Text

Download PDFPDF

Type 2 diabetes mellitus and antibiotic-resistant infections: a systematic review and meta-analysis
  1. Rodrigo M Carrillo-Larco1,2,
  2. Cecilia Anza-Ramírez2,
  3. Giancarlo Saal-Zapata3,
  4. David Villarreal-Zegarra2,
  5. Jessica Hanae Zafra-Tanaka2,
  6. Cesar Ugarte-Gil4,5,6,
  7. Antonio Bernabé-Ortiz2,7
  1. 1 Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London, UK
  2. 2 CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
  3. 3 Hospital Nacional Guillermo Almenara Irigoyen – EsSalud, Lima, Peru
  4. 4 Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
  5. 5 Universidad Peruana Cayetano Heredia Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru
  6. 6 Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
  7. 7 Universidad Cientifica del Sur, Lima, Peru
  1. Correspondence to Dr Rodrigo M Carrillo-Larco, Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London W2 1PG, UK; rcarrill{at}


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. I2 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; I2 19.1%) or respiratory (OR=2.35; 95% CI 1.49 to 3.69; I2 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.

  • nutritional sciences
  • infections
  • public health

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.


  • Twitter @cecianza

  • Contributors RMC-L and AB-O conceived the idea. RMC-L and AB-O conducted the search, the screening and the final study selection. CA-R, GS-Z, DV-Z and JHZ-T extracted the information from the selected reports. RMC-L wrote the manuscript with support from CA-R, AB-O and CU-G. All author approved the submitted version. RMC-L, AB-O, CA-R, GS-Z, DV-Z and JHZ-T are collectively responsible for the accuracy of the information.

  • Funding RMC-L has been supported by a Strategic Award, Wellcome Trust-Imperial College Centre for Global Health Research (100693/Z/12/Z) and Imperial College London Wellcome Trust Institutional Strategic Support Fund (Global Health Clinical Research Training Fellowship) (294834/Z/16/Z ISSF ICL). RMC-L is supported by a Wellcome Trust International Training Fellowship (214185/Z/18/Z).

  • Disclaimer The funder had no role in this work and decision to submit for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.