Outcomes of Asymptomatic Bacteriuria in Patients With Diabetes Mellitus in a Year-Long Follow Up Study

Abstract

BACKGROUNDDiabetes mellitus is a major public health problem worldwide today. It affects the genitourinary system. It predisposes patients to a variety of urinary tract infections and has long term effects on patient health. Asymptomatic bacteriuria (ASB) in diabetic patients, its effects on renal function, microalbuminuria, hypertension are not clearly defined. This study was carried out to determine the prevalence of asymptomatic bacteriuria, its clinical and microbiological outcomes in Indian diabetic patients. METHODSTwo hundred and fifty type -2 diabetics (100 males and 150 females) without genitourinary symptoms or abnormalities were included in the study. Midstream urine samples were collected from the study participants after getting informed consent. Urine samples were examined and processed for the culture using the standard microbiological procedures. The spectrum of uropathogens causing asymptomatic bacteriuria was noted. Follow up after one year was done to evaluate clinical and microbiological outcomes. RESULTSAmong the 250 diabetic patients, 43 (17.2%) had asymptomatic bacteriuria of which 31 (72.1%) were females and 12 (27.9%) were males. Escherichia coli (37.2%) was the most prevalent organism followed by Klebsiella (13.9%), Enterococcus faecalis (9.3%), Pseudomonas aeruginosa (6.9%), Staphylococcus aureus (6.9%), Candida species (6.9%), Proteus species (4.7%) and Coagulase Negative Staphylococcus (4.7%). On follow up it was found that incidence of symptomatic UTI in the study duration was 10 (23.26%) in the group with ASB and 39 (18.84%) in patients not having ASB at baseline. Prevalence of hypertension was also similar at the end of one year in both the groups. eGFR, prevalence of microalbuminuria and macroalbuminuria was also similar in both the groups at one year of follow up. CONCLUSIONSThe overall prevalence of ASB in the diabetic patients was 17.2%. It was more common in females. Post-menopausal females have higher prevalence of ASB. E. coli was the most prevalent organism. Risk of symptomatic UTI appears to be comparable to general diabetic population. Hypertension, renal function and microalbuminuria do not appear to be affected by presence of ASB.

A study of asymptomatic bacteriuria in patients with diabetes mellitus

“…Diabetes mellitus has a range of effects on various organ systems [3] a 1940 autopsy study showed that 18% of the subjects with diabetes had a urinary tract infection (UTI) [2] . Also diabetic patients are prone to asymptomatic UTI [4] . The spectrum of UTI in these patients ranges from asymptomatic bacteriuria (ASB) to lower UTI (cystitis), pyelonephritis, and severe urosepsis.…”