Asymptomatic Bacteriuria in Patients with Type 2 Diabetes Mellitus

Abstract

Objectives: Asymptomatic bacteriuria (ASB) is a common finding in patients with diabetes. Moreover, patients with diabetes and ASB have a greater risk for symptomatic urinary tract infections and associated severe complications. The aim of this study was to estimate the prevalence of ASB, as well as to identify independent risk factors and related pathogens associated with ASB in female and male patients with type 2 diabetes mellitus (T2D). Methods: This prospective case-control study was performed at the University hospital, and the Venezeleion General Hospital, Heraklion, Greece between 2012 and 2019. All patients with T2D attending the diabetes and hypertension outpatient clinics at both hospitals were enrolled, and data regarding their medical history and clinical and laboratory profiles were recorded. Asymptomatic patients with positive urine cultures were assigned as cases while those with negative urine cultures were designated as controls. Results: A total of 437 adult patients of which 61% were female and 39% were male patients with a mean age of 70.5 ± 9.6 years, were enrolled. The prevalence of ASB was 20.1%, in total. ASB was noted in 27% of female participants and 9.4% of male participants. Higher glycated hemoglobin (OR = 3.921, 95%CI: 1.521–10.109, p < 0.001) and urinary tract infection within the previous year (OR = 13.254, 95%CI: 2.245–78.241, p < 0.001) were independently positively associated with ASB, while higher levels of vitamin B12 were independently negatively associated with ASB (OR = 0.994 per ng/mL, 95%CI: 0.989–0.999, p < 0.001). Conclusions: Development of ASB was associated with specific factors, some of which may be modifiable. Interestingly, high B12 was found to be negatively associated with ASB.

Asymptomatic bacteriuria in patients with type 2 diabetes mellitus in rural southwestern Nigeria: a cross-sectional study

“…The mean age (54.5 AE 11.4 years) of the participants was comparable to the mean age of the participants in the study by Banerjee et al, probably because of similar sociodemographic factors and study design. 25 However, it was lower than that of the participants in the studies by Asghar et al, 26 Odetoyin et al, 10 and Matthiopoulou et al, 6 and higher than that of the participants in the studies by Venketesen et al 7 and Bissong et al 12 These differences may be results of differences in sample size, study location, or the age group of the participants.…”

“…4 People with T2DM are at a four-fold higher risk of ASB than those without, 4,5 and the majority of previous studies have shown that untreated ASB progresses to symptomatic urinary tract infection (UTI), which is an important cause of morbidity in patients with diabetes mellitus. [5][6][7] There is a close association between the retention of urine, owing to poor bladder function, and greater bacterial growth. 4 This rapid bacterial growth occurs in patients with T2DM in the presence of poor glycemic control, which results in poor blood supply and abnormal cell-mediated immunity.…”

“…8,13,14 Furthermore, comorbidities such as human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), obesity, chronic renal disease, urinary tract defects, and a history of UTI have been reported previously. 6,8,15 Previous studies performed in SSA have shown that Escherichia coli (E.coli), Staphylococcus aureus (S. aureus), and Klebsiella species are the most common bacterial isolates from urine samples in patients with T2DM. [6][7][8] However, with the exception of those for pregnant women and for patients about to undergo urological procedures, there are no standard guidelines in Nigeria for the management of ASB in patients with T2DM.…”

“…6,8,15 Previous studies performed in SSA have shown that Escherichia coli (E.coli), Staphylococcus aureus (S. aureus), and Klebsiella species are the most common bacterial isolates from urine samples in patients with T2DM. [6][7][8] However, with the exception of those for pregnant women and for patients about to undergo urological procedures, there are no standard guidelines in Nigeria for the management of ASB in patients with T2DM. 6,16 Therefore, early diagnosis, the identification of the etiological agent, and appropriate treatment could help to reduce the incidence of the complications associated with ASB in such patients.…”

“…[6][7][8] However, with the exception of those for pregnant women and for patients about to undergo urological procedures, there are no standard guidelines in Nigeria for the management of ASB in patients with T2DM. 6,16 Therefore, early diagnosis, the identification of the etiological agent, and appropriate treatment could help to reduce the incidence of the complications associated with ASB in such patients. Even though an association between poor glycemic control and the development of ASB in patients with T2DM has been shown in several previous studies, 4,8,13,14 the relationship between glycated hemoglobin (HbA1c) level and ASB has not been thoroughly studied in rural southwestern Nigeria.…”