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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ObjectiveTo describe antibiotic resistance patterns in Helicobacter pylori. DesignCulture and antibiotic sensitivity testing of antral and gastric body biopsy samples from patients having gastroscopy. ParticipantsConsecutive consenting patients aged 18 years or more presenting for gastroscopy from 1 July 1998 to 30 June 1999. SettingAn open‐access gastroscopy service at an urban university tertiary hospital. Main outcome measuresNumber of H. pylori isolates showing resistance to antibiotics; correlates of such resistance with demographic and clinical information. ResultsOf 1580 patients undergoing endoscopy, 434 agreed to participate in the study. 108 (24.9%) had positive cultures for H. pylori, and 88 of these isolates (81%) were available for further testing. Resistance to metronidazole and clarithromycin was detected in 36% and 11%, respectively. No resistance was found to tetracycline or amoxycillin. Metronidazole resistance was commoner in younger patients (P = 0.0004) and macrolide resistance was commoner in those born outside Australia or New Zealand (P = 0.03). ConclusionsWe found substantial resistance to metronidazole, and emerging clarithromycin resistance, but complete susceptibility to amoxycillin, tetracycline, gentamicin and cefaclor. These factors may influence the effectiveness of presently recommended eradication regimens.

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