Published in:
01-07-2005 | Short Communication
Asymptomatic bacteriuria as a predictor of subsequent hospitalisation with urinary tract infection in diabetic adults: The Fremantle Diabetes Study
Published in: Diabetologia | Issue 7/2005
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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 ≥105 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. Twenty-nine 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.