Asymptomatic Bacteriuria in Women with Diabetes: Influence of Metabolic Control

Bonadio, M.; Boldrini, E; Forotti, G; Matteucci, Elena; Vigna, Armando; Mori, Stefano; Giampietro, Ottavio

doi:10.1086/381755

Cited by 48 publications

(54 citation statements)

References 28 publications

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“…For diabetes-specific variables, most [1][2][3] but not all [8] studies have found no relationship between glycaemic control and ASB. Chronic complications such as nephropathy and neuropathy have been associated with ASB in type 1 but not type 2 diabetic patients [1,7], a pattern that also holds for longer diabetes duration [7].…”

Section: Discussionmentioning

confidence: 95%

Asymptomatic bacteriuria as a predictor of subsequent hospitalisation with urinary tract infection in diabetic adults: The Fremantle Diabetes Study

et al. 2005

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Aims/hypothesis: We examined the prognosis of well-characterised community-based diabetic patients with asymptomatic bacteriuria (ASB). Methods: We studied 496 adults with type 1 or 2 diabetes participating in a prospective observational study. In addition to detailed clinical and laboratory data, a single mid-stream urine sample was taken for aerobic culture and antibiotic-sensitivity testing. ASB was defined as ≥10 5 colony-forming units/ml of one or two organisms without symptoms of urinary infection. Patients were followed for 2.9±0.6 years for hospital admission for/with urosepsis or death. Results: Thirty-six patients (7.3%) had ASB, comprising 33 females (14.4% of all females) and three males (1.1% of all males). Only female sex predicted ASB amongst a range of variables including indices of metabolic control. Twentynine patients (5.8%) were subsequently hospitalised with urosepsis. Of these, urosepsis was the principal diagnosis in 12 (41%). In a Cox proportional hazards model, ASB was associated with an increased risk of hospitalisation for urosepsis as principal diagnosis (hazard ratio [95% CI] 4.4 [1.2-16.5]; p=0.004). ASB did not predict the combined endpoint of hospitalisation with urosepsis as principal or secondary diagnosis (2.3 [0.8-6.7]; p=0.12), or of non-urinary sepsis as principal (n=12) or principal/secondary (n=28) diagnosis (p>0.3). Conclusions/interpretation: ASB identifies diabetic patients who are at significantly increased risk of subsequent urosepsis requiring hospitalisation. Further large-scale studies are needed to establish the cost-effectiveness of screening for, and pre-emptive treatment of ASB, especially in females.

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Section: Discussionmentioning

confidence: 95%

Asymptomatic bacteriuria as a predictor of subsequent hospitalisation with urinary tract infection in diabetic adults: The Fremantle Diabetes Study

et al. 2005

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“…Escherichia coli adhesion to uroepithelial cells is increased in diabetic patients [25], and elevated urinary glucose levels support the growth of bacteria [26]. Lack of metabolic control, as measured by glycated haemoglobin, is a risk factor for bacteriuria [27]. In concordance, control of hyperglycaemia reduced the short-term risk of infectious complications among a population of surgical critically ill patients [28].…”

Section: Discussionmentioning

confidence: 99%

Influence of diabetes and hyperglycaemia on infectious disease hospitalisation and outcome

2006

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Aims/hypothesis Diabetes mellitus is believed to increase susceptibility to infectious diseases. The effects of hyperglycaemia per se on infectious disease risk are unknown and the influence of diabetes on infectious disease outcome is controversial. Materials and methods We studied 10,063 individuals from the Danish general population, who were participants in The Copenhagen City Heart Study, over a follow-up period of 7 years. Risk of hospitalisation caused by any infectious disease, and subsequent risk of disease progression to death were estimated by Cox proportional hazards regression analysis. Results At baseline, 353 individuals reported having diabetes. During 71,509 person-years of follow-up, a total of 1,194 individuals were hospitalised because of an infection. The risk of pneumonia (adjusted hazard ratio [aHR] 1.75, 95% CI 1.23-2.48), urinary tract infection (aHR 3.03, 95% CI 2.04-4.49) and skin infection (aHR 2.43, 95% CI 1.49-3.95) was increased in subjects with diabetes compared with subjects without. Each 1 mmol/l increase in plasma glucose at baseline was associated with a 6-10% increased relative risk of pneumonia, urinary tract infection and skin infection after adjustment for other possible confounders. Among patients hospitalised for urinary tract infection, diabetic patients were at an increased risk of death at 28 days after admission compared with nondiabetic subjects (HR 3.90,. Conclusions/interpretation In the Danish general population, diabetes and hyperglycaemia are strong and independent risk factors for hospitalisation as a result of pneumonia, urinary tract infection and skin infection. Further, diabetes has a negative impact on the prognosis of urinary tract infection.

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“…Despite this, the decline in renal function in diabetic patients with ASB followed for up to 2 years did not differ from a group with diabetes alone [107]. Diabetic women with ASB are at greater risk of UTI [100] and subsequent hospitalisation with urosepsis [103]. However, there is no evidence that presumptive antibiotic therapy for ASB is beneficial [101,108].…”

Section: Urinary Tract Infectionsmentioning

confidence: 96%

“…A number of predisposing factors for ASB have been reported. In most [99][100][101][102] but not all [103] studies, there is no relationship between glycaemic control and ASB. Chronic complications such as nephropathy and neuropathy have been associated with ASB in type 1 but not type 2 diabetes [99,104], a pattern that holds for longer diabetes duration [104].…”

Section: Urinary Tract Infectionsmentioning

confidence: 97%

Common infections in diabetes: pathogenesis, management and relationship to glycaemic control

Peleg

Weerarathna

McCarthy

et al. 2006

Diabetes Metabolism Res

498

406

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SummarySpecific defects in innate and adaptive immune function have been identified in diabetic patients in a range of in vitro studies. However, the relevance of these findings to the integrated response to infection in vivo remains unclear, especially in patients with good glycaemic control. Vaccine efficacy seems adequate in most diabetic patients, but those with type 1 diabetes and high glycosylated haemoglobin levels are most likely to exhibit hyporesponsiveness. While particular infections are closely associated with diabetes, this is usually in the context of extreme metabolic disturbances such as ketoacidosis. The link between glycaemic control and the risk of common community-acquired infections is less well established but could be clarified if infection data from large community-based observational or intervention studies were available. The relationship between hospital-acquired infections and diabetes is well recognized, particularly among post-operative cardiac and critically ill surgical patients in whom intensive insulin therapy improves clinical outcome independent of glycaemia. Nevertheless, further research is needed to improve our understanding of the role of diabetes and glycaemic control in the pathogenesis and management of community-and hospitalacquired infections.

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Asymptomatic Bacteriuria in Women with Diabetes: Influence of Metabolic Control

Cited by 48 publications

References 28 publications

Asymptomatic bacteriuria as a predictor of subsequent hospitalisation with urinary tract infection in diabetic adults: The Fremantle Diabetes Study

Asymptomatic bacteriuria as a predictor of subsequent hospitalisation with urinary tract infection in diabetic adults: The Fremantle Diabetes Study

Influence of diabetes and hyperglycaemia on infectious disease hospitalisation and outcome

Common infections in diabetes: pathogenesis, management and relationship to glycaemic control

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