BackgroundThe role of Diabetes mellitus (DM) in the etiology and in the antimicrobial resistance of uropathogens in patients with urinary tract infection has not been well clarified. For this reason we have evaluated the spectrum of uropathogens and the profile of antibiotic resistance in both diabetic and non diabetic patients with asymptomatic urinary tract infection (UTI).MethodsUrinary isolates and their patterns of susceptibility to the antimicrobials were evaluated in 346 diabetics (229 females and 117 males) and 975 non diabetics (679 females and 296 males) who were screened for significant bacteriuria (≥105 CFU/mL urine). The mean age of diabetic and non diabetic patients was respectively 73.7 yrs ± 15 S.D. and 72.7 ± 24 (p = NS).ResultsMost of our patients had asymptomatic UTI. The most frequent causative organisms of bacteriuria in females with and without DM were respectively : E. coli 54.1% vs 58.2% (p = NS), Enterococcus spp 8.3% vs 6.5% (p = NS), Pseudomonas spp 3.9 vs 4.7% (p = NS). The most frequent organisms in diabetic and non diabetic males were respectively E. coli 32.5% vs 31.4% (p = NS), Enterococcus spp 9.4% vs 14.5% (p = NS), Pseudomonas spp 8.5% vs 17.2% (p = <0.02). A similar isolation rate of E. coli, Enterococcus spp and Pseudomonas spp was also observed in patients with indwelling bladder catheter with and without DM. No significant differences in resistance rates to ampicillin, nitrofurantoin, cotrimoxazole and ciprofloxacin of E. coli and Enteroccus spp were observed between diabetic and non diabetic patients.ConclusionIn our series of patients with asymptomatic UTI (mostly hospital acquired), diabetes mellitus per se does not seem to influence the isolation rate of different uropathogens and their susceptibility patterns to antimicrobials.

No abstract

We screened 228 women with diabetes for bacteriuria during the period of January 1997 through December 2000 at Pisa General Hospital (Pisa, Italy). A control group of 146 women without diabetes was also evaluated. The frequency of significant bacteriuria was 17.5% (40 of 228) among women with diabetes and 18.5% (27 of 146) among women in the control group. Seven (13.5%) of 52 and 33 (18.8%) of 176 women with type 1 and in type 2 diabetes, respectively, had significant bacteriuria. The presence of higher glycated hemoglobin levels was the only significant risk factor for significant bacteriuria in women with type 2 diabetes. A similar frequency of bacteriuria in women with and women without diabetes was found. Severe impairment of metabolic control of type 2 diabetes increases the risk of acquiring asymptomatic bacteriuria.

Aim: The aim of the study was to compare the epidemiological, microbiological and clinical features of diabetic patients with urinary tract infection (UTI) to those of nondiabetic ones. Methods: A prospective study was performed on 490 consecutive patients with proven UTI. The patients were studied on the basis of a specific questionnaire and hospital records. Results: Of 490 enrolled patients, 89 (18.1%) had diabetes mellitus. The mean age of diabetics and nondiabetics was respectively 64.9 ± 13.2 (SD) and 54.4 ± 23.3 years. Most diabetics had asymptomatic bacteriuria and had undergone bladder catheterization more frequently than the nondiabetics. The most frequent causative agents of UTI in diabetics and nondiabetics were: E. coli (respectively, 56.1 vs. 56.8%), Proteus sp. (7.9% vs. 7.2%), Pseudomonas sp. (6.7 vs. 8.2%), Enterococcus sp. (6.7 vs. 7.2%). More than 50% of the isolated Pseudonomas sp. strains in both groups were resistant to gentamicin, piperacillin and norfloxacin. Both diabetics (52.8%) and nondiabetics (42.2%) had recurrent UTI during the follow-up period; the difference in the incidences did not reach statistical significance. Conclusion: No significant differences in epidemiological, clinical and microbiological evaluated features of diabetics and nondiabetics were pointed out, except for the higher frequency of bladder catheterization of diabetics than nondiabetics. However, the eradication of UTI seemed to be more difficult in diabetics than in nondiabetics.

The aim of this study was the evaluation of the mechanism of renal excretion of DTPA-^99mTc in man. For this purpose the renal clearances of DTPA-^99mTc and diatrizoate-¹³¹I were simultaneously determined in 21 patients by means of vesical catheterization and of continuous venous infusion of the tracers. The mean ratio between the clearances of DTPA-^99mTc and diatrizoate-¹³¹I was 0.92 ± (SD) 0.06 (p < 0.001). In order to demonstrate a possible tubular reabsorption of the studied tracer, its clearance was determined simultaneously with those of diatrizoate-¹³¹I and urea in 10 patients at different urine flow rates, i. e., under basal conditions and at high urine flow induced by hydration. In contrast to the urea clearance, changes in urine flow rate did not significantly affect the clearances of either tracer. In 12 patients the clearance of DTPA-^99mTc was also determined by means of external counting over the bladder. The mean ratio between the clearances obtained by external counting and by vesical catheterization was 1.03 ± (SD) 0.05. These results demonstrate that the renal clearance of DTPA-^99mTc is slightly lower than the glomerular filtration rate as measured by diatrizoate-¹³¹I. Since its clearance may be easily measured by means of the noninvasive method of external counting over the bladder, DTPA-^99mTc represents a valuable tool in the determination of glomerular filtration rate in man.

A retrospective review of all episodes of bloodstream infection (BSI) in HIV-positive patients admitted to the Infectious Diseases Unit at the Pisa General Hospital from 1991 to 1994 was performed. Sixty-eight episodes of BSI were recorded in 61 patients (5.8% of all patients admitted for HIV infection). BSI was community-acquired in 64.7% of cases. The patients were mainly male and i.v. drug abusers with a mean age of 33.8 yrs +/- 5.6 S.D. Sixty-four episodes occurred in AIDS patients (CDC criteria). CD4 count was less than 100 in 49 patients. The most frequent isolates were coagulase-negative staphylococci 33, S. aureus 7, Pseudomonas spp 7, fungi 1, non-typhoidal Salmonella 4. The most common sources of BSI were the skin or subcutaneous tissue infections and intravascular catheters. The overall mortality associated with BSI was 27.3%. Vancomycin and teicoplanin were active in vitro against all but one of the staphylococcal isolates.

No abstract

No abstract