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Bittersweet: infective complications of drug-induced glycosuria in patients with diabetes mellitus on SGLT2-inhibitors: two case reports

Bartolo, Caroline, Hall, V, Friedman, ND, Lanyon, C, Fuller, A, Morrissey, CO and Athan, Eugene 2021, Bittersweet: infective complications of drug-induced glycosuria in patients with diabetes mellitus on SGLT2-inhibitors: two case reports, BMC Infectious Diseases, vol. 21, no. 1, doi: 10.1186/s12879-021-05982-3.

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Title Bittersweet: infective complications of drug-induced glycosuria in patients with diabetes mellitus on SGLT2-inhibitors: two case reports
Author(s) Bartolo, Caroline
Hall, V
Friedman, ND
Lanyon, C
Fuller, A
Morrissey, CO
Athan, EugeneORCID iD for Athan, Eugene orcid.org/0000-0001-9838-6471
Journal name BMC Infectious Diseases
Volume number 21
Issue number 1
Article ID ARTN 284
Total pages 4
Publisher BMC
Place of publication England
Publication date 2021-12-01
ISSN 1471-2334
1471-2334
Keyword(s) Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
Candidemia
SGLT2 inhibitor
Glycosuria
Case report
Genital mycotic infection
Prostatic abscess
Summary Abstract Background Sodium-glucose co-transporter 2 (SGLT2) inhibitors are novel hypoglycemic agents which reduce reabsorption of glucose at the renal proximal tubule, resulting in significant glycosuria and increased risk of genital mycotic infections (GMI). These infections are typically not severe as reported in large systematic reviews and meta-analyses of the medications. These reviews have also demonstrated significant cardiovascular benefits through other mechanisms of action, making them attractive options for the management of Type 2 diabetes mellitus (T2DM). We present two cases with underlying abnormalities of the urogenital tract in which the GMI were complicated and necessitated cessation of the SGLT2 inhibitor. Case presentations Both cases are patients with T2DM on empagliflozin, an SGLT2 inhibitor. The first case is a 64 year old man with Candida albicans balanitis and candidemia who was found to have an obstructing renal calculus and prostatic abscess requiring operative management. The second case describes a 72 year old man with Candida glabrata candidemia who was found to have prostatomegaly, balanitis xerotica obliterans with significant urethral stricture and bladder diverticulae. His treatment was more complex due to fluconazole resistance and concerns about urinary tract penetration of other antifungals. Both patients recovered following prolonged courses of antifungal therapy and in both cases the SGLT2 inhibitor was ceased. Conclusions Despite their cardiovascular benefits, SGLT2 inhibitors can be associated with complicated fungal infections including candidemia and patients with anatomical abnormalities of the urogenital tract may be more susceptible to these infections as demonstrated in these cases. Clinicians should be aware of their mechanism of action and associated risk of infection and prior to prescription, assessment of urogenital anatomical abnormalities should be performed to identify patients who may be at risk of complicated infection.
Language eng
DOI 10.1186/s12879-021-05982-3
Indigenous content off
Field of Research 0605 Microbiology
1103 Clinical Sciences
1108 Medical Microbiology
HERDC Research category C2 Other contribution to refereed journal
Free to Read? Yes
Persistent URL http://hdl.handle.net/10536/DRO/DU:30149552

Document type: Journal Article
Collections: Faculty of Health
Open Access Collection
Rural Clinical Schools
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.