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

Karunajeewa H, McGechie D, Stuccio G, Stingemore N, Davis WA, Davis TM

School of Medicine and Pharmacology, Fremantle Hospital, University of Western Australia, P.O. Box 480, Fremantle, WA, 6959, Australia.

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. 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.

Published 20 July 2005 in Diabetologia, 48(7): 1288-91.
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