|
1
|
Pishdad R, Auwaerter PG, Kalyani RR. Diabetes, SGLT-2 Inhibitors, and Urinary Tract Infection: a Review. Curr Diab Rep 2024; 24:108-117. [PMID: 38427314 DOI: 10.1007/s11892-024-01537-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE OF REVIEW The aim of this review is to focus on epidemiology, pathogenesis, risk factors, management, and complications of UTI in people with diabetes as well as reviewing the association of SGLT-2 inhibitors with genitourinary infections. RECENT FINDINGS Individuals diagnosed with T2DM are more prone to experiencing UTIs and recurrent UTIs compared to individuals without T2DM. T2DM is associated with an increased risk of any genitourinary infections (GUI), urinary tract infections (UTIs), and genital infections (GIs) across all age categories. SGLT2 inhibitors are a relatively new class of anti-hyperglycemic agents, and studies suggest that they are associated with an increased risk of genitourinary infections. The management of diabetes and lifestyle modifications with a patient-centric approach are the most recognized methods for preventing critical long-term complications including genitourinary manifestations of diabetes. The available data regarding the association of SGLT-2 inhibitors with genitourinary infections is more comprehensive compared to that with UTIs. Further research is needed to better understand the mechanisms underlining the association between SGLT-2 inhibitors and genital infections and UTIs.
Collapse
Affiliation(s)
- Reza Pishdad
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Division of Endocrinology, Diabetes, and Metabolism, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Paul G Auwaerter
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rita R Kalyani
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
|
2
|
Darraj MA. The Appropriateness of Empirical Antimicrobial Treatment of Uncomplicated Urinary Tract Infection in Adult Female Patients in Jazan Region, Saudi Arabia. Clin Pract 2023; 13:743-752. [PMID: 37489416 PMCID: PMC10366825 DOI: 10.3390/clinpract13040067] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Uncomplicated urinary tract infection (uUTI) is one of the most prevalent bacterial infections in clinical practice. Empirical treatment is used commonly; thus, knowledge of the local antimicrobial susceptibility pattern is crucial to avoid the growing antibiotic resistance. PURPOSE The aim of this study is to evaluate the effectiveness of the empirical treatment of uUTI and determine the susceptibility pattern for common uUTI causative microorganisms at outpatient clinics in hospitals in the Jazan region. METHOD This is a prospective observational study of 120 patients with uncomplicated urinary tract infections attending internal medicine outpatient clinics in Al-Hayat Jazan hospital, Saudi Arabia, from September 2021 to January 2023. RESULTS In total, 120 patients were included in the study. The mean age of the participants was 48.53 ± 9.29. Risk factors for UTI were found in 57.5%, and type 2 diabetes mellitus (DM) was the major risk factor (27.5%). The most common causative microorganism was Escherichia coli (E. coli) (87.5%), followed by Klebsiella pneumoniae (5%), Staphylococcus aureus, Enterobacter spp., and Enterococcus spp. (2.5%). Nitrofurantoin was the most effective antimicrobial agent (sensitivity rate of 91.7%) against all microorganisms, followed by Ciprofloxacin (75%). CONCLUSIONS This study concluded that nitrofurantoin and Ciprofloxacin are suitable empirical treatments for uncomplicated urinary tract infection in the Jazan region, and increased resistance against trimethoprim/sulphamethoxazole (TMPSMX) and cefaclor was observed; thus, empirical therapy with these agents should be reconsidered in local guidelines. Wide surveillance research is necessary to monitor effective empirical therapies and to evaluate the regional antimicrobial susceptibility pattern.
Collapse
Affiliation(s)
- Majid A Darraj
- The Department of Internal Medicine, The Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| |
Collapse
|
|
3
|
Asymptomatic Bacteriuria: a Contemporary Review. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00675-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
|
4
|
Ganguly A, Ebrahimzadeh T, Komarovsky J, Zimmern PE, De Nisco NJ, Prasad S. DigEST
: Digital plug‐n‐probe disease Endotyping Sensor Technology. Bioeng Transl Med 2022. [DOI: 10.1002/btm2.10437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Antra Ganguly
- Department of Bioengineering University of Texas at Dallas Richardson Texas USA
| | - Tahmineh Ebrahimzadeh
- Department of Biological Sciences University of Texas at Dallas Richardson Texas USA
| | - Jessica Komarovsky
- Department of Biological Sciences University of Texas at Dallas Richardson Texas USA
| | - Philippe E. Zimmern
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas USA
| | - Nicole J. De Nisco
- Department of Biological Sciences University of Texas at Dallas Richardson Texas USA
| | - Shalini Prasad
- Department of Bioengineering University of Texas at Dallas Richardson Texas USA
| |
Collapse
|
|
5
|
Nabi T. Asymptomatic and symptomatic bacteriuria in patients with type 2 diabetes. INTERNATIONAL ARCHIVES OF HEALTH SCIENCES 2022. [DOI: 10.4103/iahs.iahs_98_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
|
6
|
Alhabeeb H, Baradwan S, Kord-Varkaneh H, Tan SC, Low TY, Alomar O, Salem H, Al-Badawi IA, Abu-Zaid A. Association between body mass index and urinary tract infection: a systematic review and meta-analysis of observational cohort studies. Eat Weight Disord 2021; 26:2117-2125. [PMID: 33423153 DOI: 10.1007/s40519-020-01101-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/19/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Very few studies have investigated the relationship between body mass index (BMI) and risk of urinary tract infection (UTI), and conclusions from these available studies have been inconsistent. To resolve this inconsistency, we performed a systematic review and meta-analysis to precisely examine the association between BMI and UTI. METHODS This meta-analysis was performed based on the PRISMA recommendations. PubMed, Web of Science, Scopus, Embase, and Google Scholar databases were searched for all published observational studies that reported the risk of UTI based on BMI categories up to March 2020. RESULTS Fourteen (n = 14) articles comprising 19 studies in different populations met our inclusion criteria. The overall analysis showed a significant increased risk of UTI in subjects affected by obesity vs. individuals without obesity (RR = 1.45; 95% CI: 1.28 - 1.63; I2 = 94%), and a non-significant increased risk of UTI in subjects who were overweight (RR = 1.03; 95% CI: 0.98 - 1.10; I2 = 49.6%) and underweight (RR = 0.99; 95% CI: 0.81 - 21; I2 = 0.0%) when compared to subjects who had normal weight. In the stratified analysis, we showed that obesity increased the risk of UTI in females (RR = 1.63; 95% CI: 1.38 - 1.93) and in subjects below 60 years old (RR = 1.53; 95% CI: 1.33 - 1.75). CONCLUSION This systematic review and meta-analysis recognized a significant relationship between BMI and incidence of UTI in obese vs. non-obese subjects, as well as in females and in individuals below 60 years old.
Collapse
Affiliation(s)
- Habeeb Alhabeeb
- Clinical Research, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Saeed Baradwan
- Department of Obstetrics and Gynecology, HealthPlus Fertility and Women's Health Center, Jeddah, Saudi Arabia
| | - Hamed Kord-Varkaneh
- Department of Clinical Nutrition and Dietetics, Student Research Committee, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shing Cheng Tan
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Teck Yew Low
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Osama Alomar
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hany Salem
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ismail Abdulrahman Al-Badawi
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ahmed Abu-Zaid
- Department of Pharmacology, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA. .,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| |
Collapse
|
|
7
|
Tauseef A, Zafar M, Syyed E, Thirumalareddy J, Sood A, Mirza M. Asymptomatic Bacteriuria (ASB) in diabetic patients: Treat or not to treat: A prospective, observational study conducted at a tertiary care hospital. J Family Med Prim Care 2021; 10:1963-1969. [PMID: 34195132 PMCID: PMC8208176 DOI: 10.4103/jfmpc.jfmpc_1894_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/24/2020] [Accepted: 12/16/2020] [Indexed: 12/02/2022] Open
Abstract
Background: The term asymptomatic bacteriuria (ASB) refers to the isolation of bacteria in a urine specimen of individuals who denied symptoms of urinary tract infection. Diabetes mellitus (DM) is a disease involving multiple organ systems, hallmarked for its chronicity and thus-forth endless complications including asymptomatic bacteriuria. Objectives: This study aimed to determine the characteristics of asymptomatic bacteriuria and antibiotic susceptibility pattern amongst patients with diabetes. Settings and Design: A prospective observational study was conducted at a tertiary care hospital in Karachi, Pakistan. Methods and Material: The study included all those patients with a diagnosis of diabetes with no signs and symptoms of urinary tract infection but showing the growth of an organism in urine culture. Pregnant females and subjects who used antibiotics in last two weeks were excluded. A total of 222 urine cultures were observed prospectively who met the inclusion criteria through non-probability consecutive sampling. Results: Out of 222 urine cultures observed, mean age of subjects were 62.89 ± 13.77 out of which 76% were females, and 61% had a family history of diabetes. The most frequent organisms isolated were Escherichia. Coli (E. Coli), Enterococcus, Klebsiella, Pseudomonas, and Enterobacter species. A total of 20 subjects got dual bacterial growth in their cultures among which 17 subjects had a growth of Enterococcus with any other pathogen causing UTI. Gender, family history of diabetes, levels of HBA1c, and older age groups all were found significantly associated with ASB. Conclusions: Our study is the first to analyze and study the associated risk factors amongst ASB in DM patients, and to identify the pathogens involved along with assessing their antibiotic resistance profiles. Also, due to the increase resistance to antibiotics we would recommend to use antibiotics in ASB patients only if they have any two or more comorbidities.
Collapse
Affiliation(s)
- Abubakar Tauseef
- Resident Physician, Department of Internal Medicine, Creighton University Hospital Program, Omaha, NE, USA
| | - Maryam Zafar
- Resident Physician in Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Erum Syyed
- Medical Student at Dow University of Health Sciences, Karachi, Pakistan
| | - Joseph Thirumalareddy
- Hospitalist, Department of Internal Medicine, Creighton University Hospital Program, Omaha, NE, USA
| | - Akshat Sood
- Hospitalist, Department of Internal Medicine, Creighton University Hospital Program, Omaha, NE, USA
| | - Mohsin Mirza
- Associate Program Director, Department of Internal Medicine, Creighton University Hospital Program, Omaha, NE, USA
| |
Collapse
|
|
8
|
Abstract
Urinary tract infection (UTI) is one of the most common infections afflicting women. UTI often accompanies vaginal infections and is frequently caused by pathogens originating in the digestive tract. The paper discusses the prevalence of UTI in various patient populations, including postmenopausal, pregnant, diabetic, epileptic, and perioperative female patients. Current UTI treatment and prevention guidelines both for primary and recurring UTIs were reviewed. Antibiotic treatment duration should be minimized, with the exact dosage and time schedule depending on the type of infection. Asymptomatic bacteriuria does not always require antibiotic treatment, because their excessive use may lead to the emergence of antibiotic resistant strains. The role of non-antibiotic prophylaxis of recurrent infections involving immunomodulants (OM-89), probiotics, and behavioural interventions was underlined.
Collapse
|
|
9
|
Asghar MS, Akram M, Singh M, Yasmin F, Yaseen R, Ahmed N, Siddiqui M, Hassan M, Rasheed U, Ali A. Characteristics of Asymptomatic Bacteriuria in Diabetes Mellitus Patients: A Retrospective Observational Study. Cureus 2021; 13:e13562. [PMID: 33791179 PMCID: PMC8004580 DOI: 10.7759/cureus.13562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and objective The term asymptomatic bacteriuria (ASB) refers to the isolation of bacteria in a urine specimen of individuals without any symptoms of urinary tract infection (UTI). Diabetes mellitus (DM) is a disease involving multiple organ systems, characterized by its chronicity and hence endless complications including ASB. This study aimed to determine the characteristics of ASB and antibiotic susceptibility patterns among patients with diabetes. Materials and methods This was a retrospective observational study conducted in a tertiary care hospital. The study included patients with a diagnosis of diabetes with no signs and symptoms of UTI but who still showed the growth of an organism in urine culture. A total of 222 urine cultures were analyzed retrospectively, ensuring that they met the inclusion criteria through non-probability consecutive sampling. Results The mean age of the study participants was 62.89 ± 13.77 years; 76% of them were females, and 61% had a family history of diabetes. The most frequent organisms isolated were Escherichia coli (E. coli), Enterococcus, Klebsiella pneumonia, Pseudomonas aeruginosa, and Enterobacter species. A total of 20 subjects had dual bacterial growth in their cultures, with Enterococcus species (n=17) being the most common organism. Gender, family history of diabetes, levels of hemoglobin A1c (HbA1c), and advanced age were all found significantly associated with ASB. Conclusion Our study is the first of its kind to analyze and examine the risk factors associated with ASB in DM patients, and to identify the pathogens involved, along with assessing their antibiotic resistance profiles.
Collapse
Affiliation(s)
| | - Mohammed Akram
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Manjeet Singh
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Farah Yasmin
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Rabail Yaseen
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Nisar Ahmed
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Mariam Siddiqui
- Internal Medicine, Dow International Medical College, Karachi, PAK
| | - Maira Hassan
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Uzma Rasheed
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Abraish Ali
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| |
Collapse
|
|
10
|
Laway BA, Nabi T, Bhat MH, Fomda BA. Prevalence, clinical profile and follow up of asymptomatic bacteriuria in patients with type 2 diabetes-prospective case control study in Srinagar, India. Diabetes Metab Syndr 2021; 15:455-459. [PMID: 33601179 DOI: 10.1016/j.dsx.2020.12.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/30/2020] [Accepted: 12/31/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Asymptomatic bacteriuria (ASB) is more prevalent in diabetes mellitus (DM) patients than non diabetics, but its significance is not fully known. This study was done to estimate the prevalence, clinical profile, risk factors and follow up of ASB in type 2 diabetes (T2D) patients compared with matching healthy controls. METHODS Prospective, case-control study involving 400 T2D patients without symptoms of urinary tract infection (UTI) and 200 age and sex matched healthy controls. Apart from clinical and biochemical parameters, samples for urine examination and culture were taken from all the subjects. ASB was defined as ≥105 colony-forming units/ml of one or two organisms in the absence of symptoms of UTI. RESULTS The prevalence of ASB was significantly higher in T2D (17.5%) as compared to controls (10%). E. coli was the most common organism. On multivariate analysis, postmenopausal state, prior history of UTI, uncontrolled diabetes and longer duration of disease were associated with increased risk of ASB. Presence of ASB was significantly associated with symptomatic UTI at the 6-month follow up without deterioration of renal parameters. CONCLUSIONS Asymptomatic bacteriuria was more prevalent in people with diabetes than those without diabetes. The presence of ASB may be considered a risk factor for subsequent symptomatic UTI on follow up but has no adverse effect on kidney function.
Collapse
Affiliation(s)
- Bashir A Laway
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
| | - Tauseef Nabi
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Moomin H Bhat
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Bashir A Fomda
- Department of Endocrinology and Microbiology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| |
Collapse
|
|
11
|
Kuo IC, Lee JJ, Hwang DY, Lim LM, Lin HYH, Hwang SJ, Chen HC, Hung CC. Pyuria, urinary tract infection and renal outcome in patients with chronic kidney disease stage 3-5. Sci Rep 2020; 10:19460. [PMID: 33173137 PMCID: PMC7655801 DOI: 10.1038/s41598-020-76520-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/14/2020] [Indexed: 01/24/2023] Open
Abstract
Pyuria is common in chronic kidney disease (CKD), which could be due to either urinary tract infection (UTI) or renal parenchymal inflammation. Only little is known regarding the association of pyuria or UTI with renal outcomes. We investigated 3226 patients with stage 3–5 CKD. Pyuria was defined as ≥ 50 WBC per high-power field (hpf) and was correlated to old age, female, diabetes, hypoalbuminemia, lower eGFR, and higher inflammation status. In Cox regression, patients with more than one episode of pyuria in the first year (11.8%) had increased risks for end-stage renal disease (ESRD) [hazard ratio (95% CI): 1.90 (1.58–2.28); p < 0.001], rapid renal function progression [odds ratio (95% CI): 1.49 (1.13–1.95); p = 0.001], and all-cause mortality [hazard ratio: 1.63 (1.29–2.05); p < 0.001], compared to those without pyuria. In a subgroup analysis, the risk of pyuria for ESRD was modified by CKD stages. We investigated the effects of UTI (urinary symptoms and treated by antibiotics) and pyuria without UTI (urine WBC < 50 to ≥ 10/hpf without any episodes of ≥ 50 WBC/hpf or UTI), while both groups were associated with clinical outcomes. In conclusion, CKD stage 3–5 patients with frequent pyuria or UTI episodes have increased risks of renal outcomes.
Collapse
Affiliation(s)
- I-Ching Kuo
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou First Road, Kaohsiung, 807, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jia-Jung Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou First Road, Kaohsiung, 807, Taiwan
| | - Daw-Yang Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou First Road, Kaohsiung, 807, Taiwan.,National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan
| | - Lee-Moay Lim
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou First Road, Kaohsiung, 807, Taiwan
| | - Hugo You-Hsien Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou First Road, Kaohsiung, 807, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou First Road, Kaohsiung, 807, Taiwan.,Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Institute of Population Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Hung-Chun Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou First Road, Kaohsiung, 807, Taiwan.,Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Chih Hung
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou First Road, Kaohsiung, 807, Taiwan.
| |
Collapse
|
|
12
|
Nicolle LE, Gupta K, Bradley SF, Colgan R, DeMuri GP, Drekonja D, Eckert LO, Geerlings SE, Köves B, Hooton TM, Juthani-Mehta M, Knight SL, Saint S, Schaeffer AJ, Trautner B, Wullt B, Siemieniuk R. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis 2020; 68:e83-e110. [PMID: 30895288 DOI: 10.1093/cid/ciy1121] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/27/2018] [Indexed: 12/22/2022] Open
Abstract
Asymptomatic bacteriuria (ASB) is a common finding in many populations, including healthy women and persons with underlying urologic abnormalities. The 2005 guideline from the Infectious Diseases Society of America recommended that ASB should be screened for and treated only in pregnant women or in an individual prior to undergoing invasive urologic procedures. Treatment was not recommended for healthy women; older women or men; or persons with diabetes, indwelling catheters, or spinal cord injury. The guideline did not address children and some adult populations, including patients with neutropenia, solid organ transplants, and nonurologic surgery. In the years since the publication of the guideline, further information relevant to ASB has become available. In addition, antimicrobial treatment of ASB has been recognized as an important contributor to inappropriate antimicrobial use, which promotes emergence of antimicrobial resistance. The current guideline updates the recommendations of the 2005 guideline, includes new recommendations for populations not previously addressed, and, where relevant, addresses the interpretation of nonlocalizing clinical symptoms in populations with a high prevalence of ASB.
Collapse
Affiliation(s)
- Lindsay E Nicolle
- Department of Internal Medicine, School of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Kalpana Gupta
- Division of Infectious Diseases, Veterans Affairs Boston Healthcare System and Boston University School of Medicine, West Roxbury, Massachusetts
| | | | - Richard Colgan
- Department of Family and Community Medicine, University of Maryland, Baltimore
| | - Gregory P DeMuri
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Dimitri Drekonja
- Division of Infectious Diseases, University of Minnesota, Minneapolis
| | - Linda O Eckert
- Department of Obstetrics and Gynecology and Department of Global Health, University of Washington, Seattle
| | - Suzanne E Geerlings
- Department of Internal Medicine, Amsterdam University Medical Center, The Netherlands
| | - Béla Köves
- Department of Urology, South Pest Teaching Hospital, Budapest, Hungary
| | - Thomas M Hooton
- Division of Infectious Diseases, University of Miami, Florida
| | | | - Shandra L Knight
- Library and Knowledge Services, National Jewish Health, Denver, Colorado
| | - Sanjay Saint
- Department of Internal Medicine, Veterans Affairs Ann Arbor and University of Michigan, Ann Arbor
| | | | - Barbara Trautner
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Bjorn Wullt
- Division of Microbiology, Immunology and Glycobiology, Lund, Sweden
| | - Reed Siemieniuk
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
|
13
|
Kiranmala K, Johnson R, Savio J, Idiculla J. Microbiologic profile and clinical practices in urinary tract infections in a tertiary care center in Southern India. J Family Med Prim Care 2019; 8:2888-2892. [PMID: 31681661 PMCID: PMC6820372 DOI: 10.4103/jfmpc.jfmpc_346_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 04/29/2019] [Accepted: 06/10/2019] [Indexed: 01/04/2023] Open
Abstract
Context: Studies reported differences in clinical profiles of urinary tract infections (UTIs) in patients with and without type 2 diabetes mellitus (T2DM). Studies on the impact of the pattern of antibiotic resistance of organisms causing UTI on actual clinical practice are lacking. Objectives: 1. To study the clinical and microbiologic profiles of UTIs. 2. To compare treatment given with the prevailing antimicrobial sensitivity. Settings and Design: This is a cross-sectional study conducted in a tertiary care hospital. Methods and Materials: Retrospective chart review of inpatients with UTI (N = 200, 100 each of patients with and without T2DM), aged >18 years with a positive urine culture. Statistical Analysis: We used the statistical package SPSS version 17. The categorical variables were analyzed by the Chi-square test. Data were considered significant if P value was less than 0.05. Results: Similar to previous Indian studies, T2DM patients with UTI had significantly more asymptomatic bacteriuria, asymptomatic bacteriuria (32% vs. 6%), previous history of UTI (25% vs. 2%), and prior catheterization (16% vs. 1%). Escherichia coli (E. coli) was the most common organism isolated and showed sensitivity pattern of meropenem > netilmicin > amikacin > nitrofurantoin. Ceftriaxone was the most common empirical therapy given in spite the prevailing low sensitivity of E. coli to it. All ASB cases were treated unlike recommendations. Conclusions: Ceftriaxone is the most common empirical therapy given in spite the prevailing low sensitivity of E. coli to it. Cases of ASB were treated unlike recommendations.
Collapse
Affiliation(s)
| | - Reuben Johnson
- Department of Orhopedics, St. John's Medical College, Bengaluru, Karnataka, India
| | - Jayanthi Savio
- Department of Microbiology, St. John's Medical College, Bengaluru, Karnataka, India
| | - Jyothi Idiculla
- Department of General Medicine, St. John's Medical College, Bengaluru, Karnataka, India
| |
Collapse
|
|
14
|
Ramos-Ramirez MJ, Surani S. Asymptomatic bacteriuria among hospitalized diabetic patients: Should they be treated? World J Meta-Anal 2019; 7:339-342. [DOI: 10.13105/wjma.v7.i7.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 02/06/2023] Open
Abstract
Diabetes Mellitus is a significant health care challenge in the United States. The Center for Disease Control and Prevention estimates approximately 9.4% of patients in the United States are afflicted by diabetes. The Infectious Disease Society of America asymptomatic bacteriuria in women as two consecutive clean-catch voided urine specimens with isolation of the same bacterial strain in counts ≥ 105 cfu/mL It is understood that diabetic patients tend to be at higher risk for infections than non-diabetics. Urinary tract infections (UTIs) tend to be the most common infection contracted by this population. UTIs are not only a significant cause of morbidity and mortality, they are also a significant financial burden. The data are conflicting, in regard to treating asymptomatic bacteriuria in diabetic patients to avoid hospital complications and ultimately decrease healthcare costs associated with these complications. However, clinicians continue to prescribe antibiotics empirically. Further randomized controlled study looking into the specific population as immunocompromised diabetic patients, patient with diabetic ketoacidosis and patient in intensive care unit needs to be undertaken.
Collapse
Affiliation(s)
| | - Salim Surani
- Medical Critical Care Services, Christus Spohn Hospitals-Corpus Christi, Corpus Christi, TX 78413, United States
| |
Collapse
|
|
15
|
López-Simarro F, Redondo Margüello E, Mediavilla Bravo JJ, Soriano Llora T, Iturralde Iriso J, Hormigo Pozo A. [Prevention and treatment of infectious diseases in diabetic patients]. Semergen 2018; 45:117-127. [PMID: 30580897 DOI: 10.1016/j.semerg.2018.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/04/2018] [Accepted: 07/06/2018] [Indexed: 01/13/2023]
Abstract
The bidirectional relationship between infectious diseases and diabetes is well-known. On the one hand, diabetes patients are at a higher risk of presenting with infectious diseases, possibly with more severity, and on the other hand, infectious diseases impair metabolic control in patients with diabetes. Population ageing arises partly due to an increased survival rate in chronic diseases, of which diabetes is amongst them. Improving infectious disease prevention could reduce complications arising from the former diseases, consequences of decompensated diabetes condition (morbidity, incapacity, hospital admissions, healthcare costs, and mortality rates) and result in improved quality of life in patients with diabetes. The current review presents the treatment of infectious diseases in patients with diabetes and the dealing with immuno-preventable diseases with the currently advised vaccinations.
Collapse
Affiliation(s)
- F López-Simarro
- Área Básica de Salud Martorell Urbano, Institut Català de la Salut, Martorell, Barcelona, España; Grupo de Trabajo Diabetes de SEMERGEN, España.
| | - E Redondo Margüello
- Centro de Salud Internacional Madrid Salud, Ayuntamiento de Madrid, Madrid, España; Grupo de Actividades Preventivas y Salud Pública de SEMERGEN, España
| | - J J Mediavilla Bravo
- Grupo de Trabajo Diabetes de SEMERGEN, España; Centro de Salud Burgos Rural, Burgos, España
| | - T Soriano Llora
- Grupo de Trabajo Diabetes de SEMERGEN, España; Centro de Salud Canal de Panamá, Madrid, España
| | - J Iturralde Iriso
- Grupo de Trabajo Diabetes de SEMERGEN, España; Centro de Salud La Habana, Vitoria-Gasteiz, España
| | - A Hormigo Pozo
- Grupo de Trabajo Diabetes de SEMERGEN, España; Unidad de Gestión Clínica Puerta Blanca, Málaga, España
| |
Collapse
|
|
16
|
Teichmann-Knorrn S, Reese S, Wolf G, Hartmann K, Dorsch R. Prevalence of feline urinary tract pathogens and antimicrobial resistance over five years. Vet Rec 2018; 183:21. [PMID: 29622684 DOI: 10.1136/vr.104440] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 01/17/2018] [Accepted: 03/26/2018] [Indexed: 11/04/2022]
Abstract
The aim of this retrospective study was to document the prevalence of bacterial species in cats with significant bacteriuria and to compare their antimicrobial susceptibilities over five years. One hundred sixty-nine positive urine cultures from 150 cats were included. Fifty-five per cent showed clinical signs, while 40 per cent had subclinical bacteriuria. Escherichia coli, Staphylococcus species, Enterococcus species, Streptococcus species and Proteus mirabilis accounted for 50.5 per cent, 22.9 per cent, 15,1 per cent, 3.6 per cent and 2.6 per cent, respectively. Enterococcus species was significantly more common in cats with subclinical bacteriuria. Enterococcus species and Proteus mirabilis isolates were resistant to a significantly higher number of antimicrobials than other isolates. Applying the formula to select rational antimicrobial therapy, bacterial isolates were most likely to be susceptible to imipenem, nitrofurantoin, gentamicin and amoxicillin clavulanic acid. Over the study period, only minor differences were noted for the antimicrobial impact factors (IFs) between years and between cats with and without clinical signs. The cumulative IF increased significantly compared with the previous 10 years. Empirical treatment of bacterial cystitis should be avoided whenever possible and, if needed, based on the locally determined bacterial spectrum and antibiotic susceptibility.
Collapse
Affiliation(s)
| | - Sven Reese
- Institute of Veterinary Anatomy, Histology and Embryology, LMU Munich, Munich, Germany
| | - Georg Wolf
- Institute for Infectious Diseases and Zoonoses, LMU Munich, Munich, Germany
| | - Katrin Hartmann
- Clinic of Small Animal Medicine, LMU Munich, Munich, Germany
| | - Roswitha Dorsch
- Clinic of Small Animal Medicine, LMU Munich, Munich, Germany
| |
Collapse
|
|
17
|
White JD, Cave NJ, Grinberg A, Thomas DG, Heuer C. Subclinical Bacteriuria in Older Cats and its Association with Survival. J Vet Intern Med 2018; 30:1824-1829. [PMID: 27859751 PMCID: PMC5115191 DOI: 10.1111/jvim.14598] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 07/29/2016] [Accepted: 09/19/2016] [Indexed: 12/01/2022] Open
Abstract
Background Bacterial urinary tract infections are uncommon in cats in general but the prevalence increases to 29% in older cats with comorbidities (Veterinary Clinical Pathology 2008, 37, 317; Journal of Feline Medicine & Surgery 2007, 9, 124; Veterinary Microbiology 2009, 136, 130). Frequently, the infections are subclinical. The clinical relevance of subclinical bacteriuria (SB) is uncertain, and the optimal treatment requires clarification. Objective Prospective, observational study to: (i) identify the prevalence and incidence count of SB in older (≥7 years), nonazotemic cats, (ii) evaluate specific risk factors for SB, and (iii) investigate the potential relationship between untreated SB and survival. Animals Sixty‐seven, nonazotemic cats were tested on 5 occasions over 3 years. Methods Urine samples were obtained by cystocentesis for quantitative urine culture and blood samples for measurement of serum creatinine concentration. Episodes of SB were not treated. Serum creatinine concentration, body weight, urine specific gravity, sex, and age were evaluated as potential risk factors for a positive urine culture. The association between urine culture results and survival was evaluated with Cox's proportional hazard model. Results A total of 256 urine samples was obtained. The prevalence of SB varied between 10 and 13%, and incident infections were uncommon. Female cats were 21 times more likely to have a positive urine culture than were male cats (odds ratio [OR], 21.2; confidence interval [CI], 4.1–110; P = .00028). Subclinical bacteriuria was not significantly associated with survival. Conclusion and clinical importance Subclinical bacteriuria is common in nonazotemic, older cats. Although antimicrobial treatment was withheld, the presence of SB was not adversely associated with survival.
Collapse
Affiliation(s)
- J D White
- Massey University Veterinary Teaching Hospital, Palmerston North, New Zealand
| | - N J Cave
- Institute of Veterinary, Animal & Biomedical Sciences, Palmerston North, New Zealand
| | - A Grinberg
- Institute of Veterinary, Animal & Biomedical Sciences, Palmerston North, New Zealand
| | - D G Thomas
- Institute of Veterinary, Animal & Biomedical Sciences, Palmerston North, New Zealand
| | - C Heuer
- EpiCentre, Massey University, Palmerston North, New Zealand
| |
Collapse
|
|
18
|
Abstract
Urinary tract infection (UTI) is one of the most common bacterial infections, and the incidence in women is much higher than in men. The diagnosis of a UTI can be made based on a combination of symptoms and a positive urine analysis or culture. Most UTIs are uncomplicated UTIs, defined as cystitis in a woman who is not pregnant, is not immunocompromised, has no anatomical and functional abnormalities of the urogenital tract, and does not exhibit signs of tissue invasion and systemic infection. All UTIs that are not uncomplicated are considered to be complicated UTIs. Differentiation between uncomplicated and complicated UTIs has implications for therapy because the risks of complications or treatment failure are increased for patients with a complicated UTI. Asymptomatic bacteriuria (ASB) is defined as the presence of a positive urine culture collected from a patient without symptoms of a UTI. Concerning the complicated UTI, it is possible to make a differentiation between UTI with systemic symptoms (febrile UTI) and UTI in a host, which carries an increased risk to develop complications of this UTI. Febrile UTIs are urosepsis, pyelonephritis, and prostatitis. A complicated host is defined as one that has an increased risk for complications, to which the following groups belong: men, pregnant women, immunocompromised patients, or those who have an anatomical or functional abnormality of the urogenital tract (e.g., spinal cord-injury patients, renal stones, urinary catheter).
Collapse
|
|
19
|
Rizzi M, Trevisan R. Genitourinary infections in diabetic patients in the new era of diabetes therapy with sodium-glucose cotransporter-2 inhibitors. Nutr Metab Cardiovasc Dis 2016; 26:963-970. [PMID: 27514605 DOI: 10.1016/j.numecd.2016.07.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/06/2016] [Accepted: 07/07/2016] [Indexed: 12/11/2022]
Abstract
AIMS To review prevalence and significance of urinary tract (UTI) and genital infections (GI) in diabetes and the effects of sodium glucose cotransporter 2 (SGLT-2) inhibitors on these complications. DATA SYNTHESIS The prevalence of asymptomatic bacteriuria (ASB) is 2-3 times higher in diabetic than in non-diabetic women. The treatment of ASB has no impact on the development of UTIs and/or a decline in renal function. Therefore, there is no indication for screening for and/or treatment of ASB. The incidence of UTI is higher and frequently complicated in diabetic patients, particularly in those with longer duration of disease and of older age. There is no consistent evidence of an association between A1c levels, glycosuria and the risk of ASB and/or UTIs. Diabetes is a known risk factor for Candida colonization and GI, and a poor glycemic control is associated with a higher risk. While patients treated with SGLT-2 inhibitors may have a non-significant increased risk of UTI, they have a clearly increased risk of GI; most of these infections are mild, easy to treat, and the rate of recurrence is low. CONCLUSION Diabetic patients are at high risk of UTIs and of GI. Only GI are associated with poor glycemic control. Although patients treated with SGLT-2 inhibitors have an increased 3-5 fold risk of GI, proper medical education can reduce this risk.
Collapse
Affiliation(s)
- M Rizzi
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - R Trevisan
- Endocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.
| |
Collapse
|
|
20
|
Tandogdu Z, Cai T, Koves B, Wagenlehner F, Bjerklund-Johansen TE. Urinary Tract Infections in Immunocompromised Patients with Diabetes, Chronic Kidney Disease, and Kidney Transplant. Eur Urol Focus 2016; 2:394-399. [PMID: 28723471 DOI: 10.1016/j.euf.2016.08.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 01/28/2023]
Abstract
CONTEXT This paper provides a brief overview of urinary tract infections (UTIs) in immunocompromised patients from the perspective of a practicing urologist. OBJECTIVE The primary objective was to provide an update on UTIs in immunocompromised patients. Diabetes mellitus (DM), chronic kidney disease, and kidney transplant (KT) are the most common clinical cases encountered by urologists. Diagnosis, management, and future research needs are summarised. EVIDENCE ACQUISITION We conducted a nonsystematic review of the literature. A comprehensive search of the PubMed database between 1996 and 2016 was performed. EVIDENCE SYNTHESIS Clinical diagnosis of UTIs in immunocompromised patients is challenging. Causative pathogens in DM are slightly different to those in the general population, but without any difference in resistance profiles. Keeping serum glucose under control is the most important preventive measure. The prevalence of UTIs in patients with autosomal dominant polycystic kidney disease (ADPKD) is 21-75%. Lipophilic antibiotics are effective in the treatment of infected cysts, albeit with a trend for lower effectiveness due to increasing resistance rates. UTIs are the most common infections in KT recipients, with a reported rate of 45-72%. Diagnostic challenges exist for both ADPKD and KT patients who develop UTIs. Treatment of UTIs should be tailored according to individual patient characteristics and the severity classification framework suggested by the European Society of Infections in Urology. CONCLUSIONS The underlying pathophysiology of UTIs in immunocompromised patients is not well known, which limits UTI management, including early diagnosis, treatment, and prevention. Future research to identify patients at higher risk of UTIs is necessary. PATIENT SUMMARY In this report we looked at patients with a weakened immune system who are more likely to develop a urine infection. We focused on the patient groups most commonly encountered in a urology setting. We found that these patients have a higher risk of urinary infection, but the signs of infection may be different to those in the general population. Early diagnosis is imperative in this group. Further research on early diagnosis and better individualised management strategies are necessary.
Collapse
Affiliation(s)
- Zafer Tandogdu
- Northern Institute for Cancer Research & Institute of Health and Society, Newcastle University, Newcastle-Upon-Tyne, UK.
| | - Tommaso Cai
- Department of Urology, Santa Chiara Hospital Regional Hospital, Trento, Italy
| | - Bela Koves
- Jahn Ferenc South Pest Teaching Hospital, Budapest, Hungary
| | - Florian Wagenlehner
- Department of Urology, Paediatric Urology and Andrology, Justus-Liebig University, Giessen, Germany
| | | |
Collapse
|
|
21
|
Abstract
Asymptomatic bacteriuria is very common. In healthy women, asymptomatic bacteriuria increases with age, from <1% in newborns to 10% to 20% of women age 80 years, but is uncommon in men until after age 50 years. Individuals with underlying genitourinary abnormalities, including indwelling devices, may also have a high frequency of asymptomatic bacteriuria, irrespective of age or gender. The prevalence is very high in residents of long-term-care facilities, from 25% to 50% of women and 15% to 40% of men. Escherichia coli is the most frequent organism isolated, but a wide variety of other organisms may occur. Bacteriuria may be transient or persist for a prolonged period. Pregnant women with asymptomatic bacteriuria identified in early pregnancy and who are untreated have a risk of pyelonephritis later in pregnancy of 20% to 30%. Bacteremia is frequent in bacteriuric subjects following mucosal trauma with bleeding, with 5% to 10% of patients developing severe sepsis or septic shock. These two groups with clear evidence of negative outcomes should be screened for bacteriuria and appropriately treated. Asymptomatic bacteriuria in other populations is benign and screening and treatment are not indicated. Antimicrobial treatment has no benefits but is associated with negative outcomes including reinfection with antimicrobial resistant organisms and a short-term increased frequency of symptomatic infection post-treatment. The observation of increased symptomatic infection post-treatment, however, has led to active investigation of bacterial interference as a strategy to prevent symptomatic episodes in selected high risk patients.
Collapse
|
|
22
|
Nicolle LE. The Paradigm Shift to Non-Treatment of Asymptomatic Bacteriuria. Pathogens 2016; 5:E38. [PMID: 27104571 PMCID: PMC4931389 DOI: 10.3390/pathogens5020038] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 03/21/2016] [Accepted: 04/18/2016] [Indexed: 11/17/2022] Open
Abstract
Asymptomatic bacteriuria, also called asymptomatic urinary infection, is a common finding in healthy women, and in women and men with abnormalities of the genitourinary tract. The characterization and introduction of the quantitative urine culture in the 1950s first allowed the reliable recognition of asymptomatic bacteriuria. The observations that a substantial proportion of patients with chronic pyelonephritis at autopsy had no history of symptomatic urinary infection, and the high frequency of pyelonephritis observed in pregnant women with untreated asymptomatic bacteriuria, supported a conclusion that asymptomatic bacteriuria was harmful. Subsequent screening and long term follow-up programs for asymptomatic bacteriuria in schoolgirls and women reported an increased frequency of symptomatic urinary tract infection for subjects with asymptomatic bacteriuria, but no increased morbidity from renal failure or hypertension, or increased mortality. Treatment of asymptomatic bacteriuria did not decrease the frequency of symptomatic infection. Prospective, randomized, comparative trials enrolling premenopausal women, children, elderly populations, patients with long term catheters, and diabetic patients consistently report no benefits with antimicrobial treatment of asymptomatic bacteriuria, and some evidence of harm. Several studies have also reported that antimicrobial treatment of asymptomatic bacteriuria increases the short term risk of pyelonephritis. Current investigations are exploring the potential therapeutic intervention of establishing asymptomatic bacteriuria with an avirulent Escherichia coli strain to prevent symptomatic urinary tract infection for selected patients.
Collapse
Affiliation(s)
- Lindsay E Nicolle
- Department of Internal Medicine and Medical Microbiology, University of Manitoba, Health Sciences Centre, Room GG443-820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada.
| |
Collapse
|
|
23
|
Capon G, Caremel R, de Sèze M, Even A, Fontaine S, Loche CM, Bart S, Castel-Lacanal E, Duchêne F, Karsenty G, Mouracade P, Perrouin-Verbe MA, Phé V, Rey D, Scheiber-Nogueira MC, Gamé X. [The impact of mellitus diabetes on the lower urinary tract: A review of Neuro-urology Committee of the French Association of Urology]. Prog Urol 2015; 26:245-53. [PMID: 26452712 DOI: 10.1016/j.purol.2015.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/06/2015] [Accepted: 09/07/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Specify urinary functional impairment associated with diabetic pathology. Propose guidance for screening, monitoring of clinical signs of lower urinary tract (LUTS) and describe the specifics of the urological treatment of patients. METHODS A review of literature using PubMed library was performed using the following keywords alone or in combination: "diabetes mellitus", "diabetic cystopathy", "overactive bladder", "bladder dysfunction", "urodynamics", "nocturia". RESULTS LUTS are more common in the diabetic population with an estimated prevalence between 37 and 70 %, and are probably underevaluated in routine practice. They are heterogeneous and are frequently associated with other diabetic complications. Both storage and voiding symptoms can coexist. Despite a major evaluation in the literature, no recommendation supervises the assessment and management of LUTS in this specific population. An annual screening including medical history, bladder and kidney ultrasound and post-void residual measurement is required in the follow-up of diabetic patients. Specific urologial referral and urodynamic investigations will be performed according to the findings of first-line investigations. The type of bladder dysfunction, the risk of urinary tract infections and dysautonomia should be considered in the specific urological management of these patients. CONCLUSION Diabetes mellitus significantly impacts on the lower urinary tract function. A screening of LUTS is required as well as other complications of diabetes. The management of LUTS must take into consideration the specific risks of the diabetic patient regarding the loss of bladder contractility, the possibility of dysautonomia and infectious complications.
Collapse
Affiliation(s)
- G Capon
- Service d'urologie, hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France.
| | - R Caremel
- Service d'urologie, hôpital Charles-Nicolle, 76000 Rouen, France
| | - M de Sèze
- Cabinet de neuro-urologie, urodynamique et pelvipérinéologie, clinique Saint-Augustin, 33000 Bordeaux, France
| | - A Even
- Service de médecine physique et réadaptation, hôpital Raymond-Poincaré, AP-HP, 92340 Garches, France
| | - S Fontaine
- Service de médecine interne, endocrinologie, diabète, nutrition, hôpital Joseph-Ducuing, 31300 Toulouse, France
| | - C-M Loche
- Service de rééducation neurolocomotrice, CHU Henri-Mondor, AP-HP, 94010 Créteil, France
| | - S Bart
- Service d'urologie, centre hospitalier René-Dubos, 95300 Cergy-Pontoise, France
| | - E Castel-Lacanal
- Service de médecine physique et réadaptation, CHU Rangueil, 31400 Toulouse, France
| | - F Duchêne
- Service d'urologie, clinique de l'Alliance, 37540 Saint-Cyr-sur-Loire, France
| | - G Karsenty
- Service d'urologie et de transplantation rénale, hôpital de la Conception, AP-HM, Aix-Marseille université, 13005 Marseille, France
| | - P Mouracade
- Service d'urologie, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France
| | - M-A Perrouin-Verbe
- Service d'urologie, hôpital de la Cavale-Blanche, CHU de Brest, 29609 Brest, France
| | - V Phé
- Service d'urologie, hôpital de la Pitié-Salpêtrière, AP-HP, université Paris VI, 75013 Paris, France
| | - D Rey
- Clinique Saint-Augustin, 33000 Bordeaux, France
| | - M-C Scheiber-Nogueira
- Services d'urologie et d'explorations neurologiques, CHU Lyon Sud, 69495 Pierre-Bénite, France
| | - X Gamé
- Service d'urologie, CHU Rangueil, 31400 Toulouse, France
| |
Collapse
|
|
24
|
Abstract
Asymptomatic bacteriuria (ASB) is a common finding and frequently detected in premenopausal nonpregnant women, institutionalized patients, patients with diabetes mellitus, and the ambulatory elderly population. Despite clear recommendations regarding diagnosis and management of ASB in these populations from the Infectious Diseases Society of America (IDSA), there remains an alarming rate of antimicrobial overuse. This article reviews definitions of ASB, epidemiology of ASB, literature surrounding ASB in diabetic patients, risk factors of ASB, microbiologic data regarding bacterial virulence, use of ASB strains for treatment of symptomatic urinary tract infection, and approaches to addressing translational barriers to implementing IDSA recommendations regarding diagnosis and management of ASB.
Collapse
Affiliation(s)
- Matthew Ferroni
- Department of Urology, University of Pittsburgh Medical Center, 300 Halket Street, Suite 4710, Pittsburgh, PA 15213, USA
| | - Aisha Khalali Taylor
- Department of Urology, University of Pittsburgh Medical Center, 300 Halket Street, Suite 4710, Pittsburgh, PA 15213, USA.
| |
Collapse
|
|
25
|
Nitzan O, Elias M, Chazan B, Saliba W. Urinary tract infections in patients with type 2 diabetes mellitus: review of prevalence, diagnosis, and management. Diabetes Metab Syndr Obes 2015; 8:129-36. [PMID: 25759592 PMCID: PMC4346284 DOI: 10.2147/dmso.s51792] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Urinary tract infections are more common, more severe, and carry worse outcomes in patients with type 2 diabetes mellitus. They are also more often caused by resistant pathogens. Various impairments in the immune system, poor metabolic control, and incomplete bladder emptying due to autonomic neuropathy may all contribute to the enhanced risk of urinary tract infections in these patients. The new anti-diabetic sodium glucose cotransporter 2 inhibitors have not been found to significantly increase the risk of symptomatic urinary tract infections. Symptoms of urinary tract infection are similar to patients without diabetes, though some patients with diabetic neuropathy may have altered clinical signs. Treatment depends on several factors, including: presence of symptoms, severity of systemic symptoms, if infection is localized in the bladder or also involves the kidney, presence of urologic abnormalities, accompanying metabolic alterations, and renal function. There is no indication to treat diabetic patients with asymptomatic bacteriuria. Further studies are needed to improve the treatment of patients with type 2 diabetes and urinary tract infections.
Collapse
Affiliation(s)
- Orna Nitzan
- Infectious Disease Unit, Ha’emek Medical Center, Afula, Israel
- Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
- Infectious Disease Unit, Padeh-Poriya Medical Center, Afula, Israel
| | - Mazen Elias
- Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
- Department of Internal Medicine C, Ha’emek Medical Center, Afula, Israel
| | - Bibiana Chazan
- Infectious Disease Unit, Ha’emek Medical Center, Afula, Israel
- Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Walid Saliba
- Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
- Department of Internal Medicine C, Ha’emek Medical Center, Afula, Israel
- Correspondence: Walid Saliba, Department of Internal Medicine C, Ha’emek Medical Center, Afula 18101, Israel, Tel +972 4 649 5132, Fax +972 4 649 5134, Email
| |
Collapse
|
|
26
|
Vasudevan R. Urinary Tract Infection: An Overview of the Infection and the Associated Risk Factors. ACTA ACUST UNITED AC 2014. [DOI: 10.15406/jmen.2014.01.00008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
|
27
|
Geerlings S, Fonseca V, Castro-Diaz D, List J, Parikh S. Genital and urinary tract infections in diabetes: impact of pharmacologically-induced glucosuria. Diabetes Res Clin Pract 2014; 103:373-81. [PMID: 24529566 DOI: 10.1016/j.diabres.2013.12.052] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 07/31/2013] [Accepted: 12/28/2013] [Indexed: 01/01/2023]
Abstract
Predisposition to genital infections and urinary tract infections (UTIs) in type 2 diabetes mellitus (T2DM) results from several factors such as glucosuria, adherence of bacteria to the uroepithelium and immune dysfunction. The tendency to develop these infections could be even higher in patients with T2DM treated with the emerging class of sodium-glucose cotransporter-2 (SGLT2) inhibitors. Studies have shown that pharmacologically-induced glucosuria with SGLT2 inhibitors raises the risk of developing genital infections and, to a relatively lesser extent, UTIs. However, a definitive dose relationship of the incidence of these infections with the SGLT2 doses is not evident in the existing data. Therefore, the precise role of glucosuria as a causative factor for these infections is yet to be fully elucidated.
Collapse
Affiliation(s)
- Suzanne Geerlings
- Academic Medical Centre, Centre for Infection and Immunity, Amsterdam CINIMA, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Vivian Fonseca
- Section of Endocrinology, Tulane University Health Sciences Centre, 1430 Tulane Avenue-SL 53, New Orleans, LA 70112, USA
| | - David Castro-Diaz
- University Hospital of the Canary Islands, Carretera Cuesta Taco, S/N, 38320 San Cristobal de la Laguna, Tenerife, Spain
| | - James List
- Bristol-Myers Squibb, Global Development, Research and Development, Princeton, NJ, USA
| | - Shamik Parikh
- AstraZeneca, Global Medical Affairs, Diabetes and Metabolism, Wilmington, DE, USA
| |
Collapse
|
|
28
|
de Lastours V, Foxman B. Urinary tract infection in diabetes: epidemiologic considerations. Curr Infect Dis Rep 2014; 16:389. [PMID: 24407547 DOI: 10.1007/s11908-013-0389-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The epidemiology of urnary tract infections (UTIs) among men and women with diabetes is similar to the epidemiology of those without: Women have greater risk than men, and frequency of sexual activity is a risk factor. The bacteriology and antibiotic susceptibility patterns also do not, in general, differ from those without diabetes. Although persons with diabetes are more likely to have asymptomatic bacteriuria, asymptomatic bacteriuria does not lead to increased risk of symptomatic infection, except during pregnancy or prior to genital-urinary or gastrointestinal surgery, and should not be treated otherwise. However, diabetes doubles the risk of UTI. The source of this increase is not well understood, although bladder dysfunction, which increases with duration of diabetes, and glycosuria are hypothesized mechanisms. As treatment using sodium glucose cotransporter 2 inhibitors-which lead to glycosuria-increases, there is a potential for the frequency of UTI to increase among those with diabetes.
Collapse
Affiliation(s)
- Victoire de Lastours
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, USA
| | | |
Collapse
|
|
29
|
Abstract
Diabetic nephropathy can impact on quality of life, morbidity and mortality of affected patients. The prognosis can be improved by early diagnosis and therapy. The association between renal insufficiency, cardiovascular morbidity and mortality is of importance. Annual nephropathy screening should involve the analyses of albuminuria and glomerular filtration rate (GFR). After having detected albuminuria or reduced GFR, renal ultrasound imaging and microscopic examination of the urine sediment is necessary. Patients with abnormal or ambiguous findings should be referred to a nephrologist and may require a renal biopsy. Patients with renal complications can benefit from a goal-orientated intervention involving an antidiabetic, antihypertensive and lipid-modifying therapy. The avoidance of potentially nephrotoxic prescriptions and a renal function dependent dose-adjustment of medications are of importance in patients with declining renal function.
Collapse
Affiliation(s)
- A Sämann
- Nephrologische Gemeinschaftspraxis, Rainweg 68, 07318, Saalfeld, Deutschland.
| | | |
Collapse
|
|
30
|
Al-Rubeaan KA, Moharram O, Al-Naqeb D, Hassan A, Rafiullah MRM. Prevalence of urinary tract infection and risk factors among Saudi patients with diabetes. World J Urol 2012; 31:573-8. [DOI: 10.1007/s00345-012-0934-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 08/17/2012] [Indexed: 01/20/2023] Open
|
|
31
|
Casqueiro J, Casqueiro J, Alves C. Infections in patients with diabetes mellitus: A review of pathogenesis. Indian J Endocrinol Metab 2012; 16 Suppl 1:S27-36. [PMID: 22701840 PMCID: PMC3354930 DOI: 10.4103/2230-8210.94253] [Citation(s) in RCA: 510] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In general, infectious diseases are more frequent and/or serious in patients with diabetes mellitus, which potentially increases their morbimortality. The greater frequency of infections in diabetic patients is caused by the hyperglycemic environment that favors immune dysfunction (e.g., damage to the neutrophil function, depression of the antioxidant system, and humoral immunity), micro- and macro-angiopathies, neuropathy, decrease in the antibacterial activity of urine, gastrointestinal and urinary dysmotility, and greater number of medical interventions in these patients. The infections affect all organs and systems. Some of these problems are seen mostly in diabetic people, such as foot infections, malignant external otitis, rhinocerebral mucormycosis, and gangrenous cholecystitis. In addition to the increased morbidity, infectious processes may be the first manifestation of diabetes mellitus or the precipitating factors for complications inherent to the disease, such as diabetic ketoacidosis and hypoglycemia. Immunization with anti-pneumococcal and influenza vaccines is recommended to reduce hospitalizations, deaths, and medical expenses.
Collapse
Affiliation(s)
- Juliana Casqueiro
- Department of Pediatrics, Pediatric Endocrinology Unit, Hospital Universitario Prof. Edgard Santos, Faculty of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Janine Casqueiro
- Department of Pediatrics, Pediatric Endocrinology Unit, Hospital Universitario Prof. Edgard Santos, Faculty of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Cresio Alves
- Department of Pediatrics, Pediatric Endocrinology Unit, Hospital Universitario Prof. Edgard Santos, Faculty of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil
| |
Collapse
|
|
32
|
Renko M, Tapanainen P, Tossavainen P, Pokka T, Uhari M. Meta-analysis of the significance of asymptomatic bacteriuria in diabetes. Diabetes Care 2011; 34:230-5. [PMID: 20937688 PMCID: PMC3005460 DOI: 10.2337/dc10-0421] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate whether asymptomatic bacteriuria (ASB) is more common in patients with diabetes than among control subjects. In addition, we wanted to clarify the clinical significance of ASB in patients with diabetes. RESEARCH DESIGN AND METHODS We conducted a systematic review and meta-analysis of published data since 1966. Twenty-two studies fulfilled the inclusion criteria of the meta-analysis. RESULTS ASB was present in 439 of 3,579 (12.2%) patients with diabetes and in 121 of 2,702 (4.5%) healthy control subjects. ASB was more common both in patients with type 1 diabetes (odds ratio 3.0 [95% CI 1.1-8.0]) and type 2 diabetes (3.2 [2.0-5.2]) than in control subjects. The point prevalence of ASB was higher in both women (14.2 vs. 5.1%; 2.6 [1.6-4.1]) and men (2.3 vs. 0.8%; 3.7 [1.3-10.2]) as well as in children and adolescents (12.9 vs. 2.7%; 5.4 [2.7-11.0]) with diabetes than in healthy control subjects. Albuminuria was more common in patients with diabetes and ASB than those without ASB (2.9 [1.7-4.8]). History of urinary tract infections was associated with ASB (1.6 [1.1-2.3]). CONCLUSIONS We were able to show that the prevalence of ASB is higher in all patients with diabetes compared with control subjects. We also found that diabetic subjects with ASB more often had albuminuria and symptomatic urinary tract infections.
Collapse
Affiliation(s)
- Marjo Renko
- Department of Pediatrics, University of Oulu, Oulu, Finland.
| | | | | | | | | |
Collapse
|
|
33
|
Clinical Guideline for the Diagnosis and Treatment of Urinary Tract Infections: Asymptomatic Bacteriuria, Uncomplicated & Complicated Urinary Tract Infections, Bacterial Prostatitis. Infect Chemother 2011. [DOI: 10.3947/ic.2011.43.1.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
|
34
|
Schmiemann G, Kniehl E, Gebhardt K, Matejczyk MM, Hummers-Pradier E. The diagnosis of urinary tract infection: a systematic review. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:361-7. [PMID: 20539810 DOI: 10.3238/arztebl.2010.0361] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 08/26/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Urinary tract infections (UTI) are among the leading reasons for treatment in adult primary care medicine, accounting for a considerable percentage of antibiotic prescriptions. Because this problem is so common and so significant in routine clinical practice, a high level of diagnostic accuracy is essential. Antibiotics should not be prescribed excessively, particularly in view of the increasing prevalence of antibiotic resistance. METHOD Systematic review of relevant articles that were retrieved by a search of the Medline, Embase, and Cochrane Library databases. The recommendations of selected international guidelines were also taken into account, as were the German national quality standards for microbiological diagnosis. RESULTS The diagnosis of UTI by clinical criteria alone has an error rate of approximately 33%. The use of refined diagnostic algorithms does not completely eliminate uncertainty. CONCLUSION With the aid of a small number of additional diagnostic criteria, antibiotic treatment for UTI can be provided more specifically and thus more effectively. Differentiating UTI from asymptomatic bacteriuria, which usually requires no treatment, can lower the frequency of unnecessary antibiotic prescriptions.
Collapse
Affiliation(s)
- Guido Schmiemann
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Germany.
| | | | | | | | | |
Collapse
|
|
35
|
Dalal S, Nicolle L, Marrs CF, Zhang L, Harding G, Foxman B. Long-term Escherichia coli asymptomatic bacteriuria among women with diabetes mellitus. Clin Infect Dis 2009; 49:491-7. [PMID: 19583518 PMCID: PMC2833278 DOI: 10.1086/600883] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Persistent Escherichia coli asymptomatic bacteriuria (ASB) is common among persons with diabetes mellitus, but the duration of colonization and the rates of recolonization are unknown. We estimated the duration of colonization and the rate of recolonization among successively isolated E. coli from diabetic women with ASB and compared the virulence profiles with uropathogenic and commensal E. coli. METHODS A total of 105 women with diabetes were enrolled in a randomized, controlled clinical trial for treatment of ASB in Manitoba, Canada, and were observed at least every 3 months for up to 3 years. We analyzed 517 isolates from 70 women with repeated E. coli ASB for genetic similarity using enterobacterial repetitive intergenic consensus polymerase chain reaction. Unique strains were screened for uropathogenic virulence characteristics using dot blot hybridization and compared with different collections of E. coli isolates. RESULTS On average, differences were found among women assigned to treatment for ASB, those treated only for symptomatic infections, and untreated women in (1) follow-up time with bacteriuria (29%, 31%, and 66%, respectively; P<.001), (2) duration of bacteriuria (2.2, 2.5, and 3.7 months, respectively; P=.04), and (3) carriage of unique isolates (2.4, 2.8, and 4 months, respectively; P=.03). Women assigned to antibiotic treatment usually had recurrent infection (76%), 64% of the time with a genetically new E. coli strain. Virulence characteristics of these isolates were comparable to those of fecal isolates from healthy women. CONCLUSIONS Treatment may reduce the overall proportion of time infected in the long term and carriage of a unique strain, but most treatment regimens were followed by subsequent recolonization. Infecting strains did not have virulence factors characteristic of uropathogenic E. coli.
Collapse
Affiliation(s)
- Shona Dalal
- Department of Epidemiology, School of Public Health, University of Michigan, 109 Observatory St., Ann Arbor, MI 48109
| | - Lindsay Nicolle
- Departments of Internal Medicine and Medical Microbiology, University of Manitoba, Manitoba, Canada
| | - Carl F. Marrs
- Department of Epidemiology, School of Public Health, University of Michigan, 109 Observatory St., Ann Arbor, MI 48109
| | - Lixin Zhang
- Department of Epidemiology, School of Public Health, University of Michigan, 109 Observatory St., Ann Arbor, MI 48109
| | - Godfrey Harding
- Departments of Internal Medicine and Medical Microbiology, University of Manitoba, Manitoba, Canada
| | - Betsy Foxman
- Department of Epidemiology, School of Public Health, University of Michigan, 109 Observatory St., Ann Arbor, MI 48109
| |
Collapse
|
|
36
|
Igari Y, Oba K, Yamamoto Y, Yasuoka H, Ouchi M, Watanabe K, Matsumura N, Suzuki T, Nakano H. Asymptomatic leukocyturia and the autonomic nervous system in women. Geriatr Gerontol Int 2009; 9:190-6. [DOI: 10.1111/j.1447-0594.2009.00520.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
|
37
|
Kramer CK, Camargo J, Ricardo ED, Almeida FK, Canani LH, Gross JL, Azevedo MJ. Does bacteriuria interfere with albuminuria measurements of patients with diabetes? Nephrol Dial Transplant 2008; 24:1193-6. [PMID: 19015170 DOI: 10.1093/ndt/gfn629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Urinary albumin is the main parameter employed to diagnose diabetic nephropathy (DN). The exclusion of bacteriuria has been recommended at the time of DN diagnosis. This approach has been debated and information on this suggestion in patients with diabetes is scarce. The present case-control study was conducted to investigate the interference of bacteriuria in the interpretation of urinary albumin measurements in random urine samples of diabetic patients. METHODS Urinary albumin concentration (UAC) was measured in random urine samples twice in diabetic patients with and without bacteriuria (> or =10(5) colony-forming units/mL). Cases (n = 81) were defined as patients who had baseline UAC measurement in the presence of bacteriuria and had the second UAC measured in a sterile urine sample. Controls (n = 80) had the two UAC measured in sterile urine specimens. RESULTS Baseline UAC was not different between case [15.4 (1.5-2148) mg/L] and control groups [14.2 (1.5-1292) mg/L; P = 0.24], nor was the proportion of patients with normo-, micro- and macroalbuminuria. In cases, UAC measurements in the presence of bacteriuria and in sterile urine specimens were not different [15.4 (1.5-2148) versus 13.7 (1.5-2968) mg/L; P = 0.14)], nor was the proportion of normo- (51.9% versus 61.5%), micro- (40.7% versus 32.1%) and macroalbuminuria (7.4% versus 6.4%; P = 0.46). In the control group, UAC values were also not different in the two urine samples: [14.2 (1.5-1292) versus 9.7 (1.5-1049) mg/L, P = 0.22]. CONCLUSIONS The presence of bacteriuria does not interfere significantly with urinary albumin measurements and its exclusion is not necessary to diagnose DN.
Collapse
Affiliation(s)
- Caroline K Kramer
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil.
| | | | | | | | | | | | | |
Collapse
|
|
38
|
Putative role of asymmetric dimethylarginine in microvascular disease of kidney and heart in hypertensive patients. Am J Hypertens 2008; 21:650-6. [PMID: 18443575 DOI: 10.1038/ajh.2008.29] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Despite the frequent simultaneous presentation of cardiac and renal dysfunction, the relationship between these pathophysiological processes remains unclear. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide (NO) synthase, which has been linked to endothelial dysfunction and atherosclerosis. This study elucidates the relationship between ADMA and intrarenal and coronary microvascular diseases. METHODS In this study, we included 66 consecutive hypertensive patients with normal renal function or mild renal insufficiency (creatinine <or= 1.2 mg/dl). On the basis of their estimated glomerular filtration rate (eGFR), the patients were divided into two groups (normal group, eGFR >or=90 ml/min; renal insufficiency group, eGFR <90 ml/min). Coronary flow velocity reserve (CFVR) was measured using adenosine-triphosphate stress transthoracic Doppler echocardiography. In addition, a plasma ADMA assay, echocardiography, carotid ultrasound, and brachial-ankle pulse wave velocity measurement were performed. RESULTS The plasma ADMA level was the highest in patients with both renal insufficiency and reduced CFVR. ADMA was significantly associated with eGFR (r = -0.342, P = 0.006) and CFVR (r = -0.459, P < 0.001), and eGFR and CFVR were significantly associated with each other (r = 0.337, P = 0.006). Multiple regression analysis revealed that ADMA was an independent clinical parameter associated with both eGFR and CFVR. CONCLUSIONS Plasma ADMA is suggested to be an incipient biochemical marker of microvascular disease in both kidney and heart in hypertensive patients. ADMA might play an important role in the pathogenesis of organ damage in the kidney and heart in essential hypertension.
Collapse
|
|
39
|
Geerlings SE. Urinary tract infections in patients with diabetes mellitus: epidemiology, pathogenesis and treatment. Int J Antimicrob Agents 2007; 31 Suppl 1:S54-7. [PMID: 18054467 DOI: 10.1016/j.ijantimicag.2007.07.042] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Accepted: 07/30/2007] [Indexed: 10/22/2022]
Abstract
Patients with diabetes mellitus (DM) have a higher prevalence of asymptomatic bacteriuria (ASB) and incidence of urinary tract infections (UTIs) compared with patients without DM. They also more often have bacteraemia, with the urinary tract as the most common focus for these infections, as well as a higher mortality outside the hospital compared with patients without DM. It appears that the increased prevalence of ASB in diabetic women is not the result of a difference in causative bacteria, as the same virulence factors and resistance to antimicrobials were found in Escherichia coli isolated from the urine of diabetic women with ASB compared with non-diabetic controls. Bacterial growth in vitro is increased after the addition of glucose, however glucosuria is not a risk factor for ASB or for the development of UTIs in vivo. No differences in granulocyte function tests were demonstrated among diabetic women with ASB, non-bacteriuric women and healthy control subjects, but women with both ASB and DM had lower urinary cytokine and leukocyte concentrations than women with ASB without DM. Finally, it was found that E. coli expressing type 1 fimbriae adhere better to uroepithelial cells of women with DM compared with those isolated from women without DM. There are no randomised trials that answer the question as to the optimal duration of treatment for UTIs in diabetic patients. It has been recommended to consider these patients as having a complicated UTI and therefore to treat them for a period of 7-14 days.
Collapse
Affiliation(s)
- Suzanne E Geerlings
- Academic Medical Center, F4-217, Center for Infection and Immunity Amsterdam (CINIMA), Meibergdreef 9, Amsterdam, The Netherlands.
| |
Collapse
|
|
40
|
Abstract
AIMS The prevalence of significant bacteriuria (SB) in diabetes mellitus has not been clearly established. Having previously investigated SB frequency in inpatient diabetic women, we now screened for SB (both asymptomatic and symptomatic forms) in outpatients. METHODS We examined 511 consecutive outpatients with Type 1 (T1D) or Type 2 diabetes (T2D), and 98 non-diabetic subjects. At least one uncontaminated midstream urine sample was available from 602 subjects: 64 T1D (37 female, age 49 +/- 13 years, diabetes duration 23 +/- 15 years), 441 T2D (212 female, 66 +/- 10 years, 12 +/- 10 years), and 97 healthy control subjects (39 female, 57 +/- 12 years). On the same day, we determined: blood cell count, fasting plasma glucose (FPG), glycated haemoglobin (HbA(1c)), plasma creatinine, urinary creatinine, and urinary albumin excretion (UAE; microg/mg urinary creatinine). RESULTS The rate of SB was 14.1% in T1D, 9.3% in T2D and 6.2% in control subjects (P = NS). The 50 diabetic patients with SB differed from the 455 diabetic patients without SB in gender (43 male vs. 206 female, P < 0.001), FPG (10.2 +/- 3.6 vs. 9.2 +/- 2.9 mmol/l, P < 0.05), HbA(1c) (7.8 +/- 1.1 vs. 7.5 +/- 1.3%, P < 0.05), and UAE (median 15.6 vs. 7.6 microg/mg, P < 0.01). Eleven diabetic patients with SB had symptoms (vs. 48 without SB, P < 0.05); UAE levels were higher in the 39 asymptomatic diabetic patients with SB than in the 11 symptomatic patients. CONCLUSIONS The prevalence of SB is similar in outpatient diabetic individuals and in non-diabetic subjects. The main risk factors for SB in diabetic patients were female gender and UAE. The likelihood of asymptomatic SB increased with UAE levels, i.e. with the presence of established microangiopathy. Poor glycaemic control is associated with bacteriuria, either as a cause or consequence of bacteriuria.
Collapse
Affiliation(s)
- E Matteucci
- Department of Internal Medicine, Pisa University, Pisa, Italy.
| | | | | | | |
Collapse
|
|
41
|
Gross PA, Patel B. Reducing Antibiotic Overuse: A Call for a National Performance Measure for Not Treating Asymptomatic Bacteriuria. Clin Infect Dis 2007; 45:1335-7. [DOI: 10.1086/522183] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2007] [Accepted: 07/11/2007] [Indexed: 11/03/2022] Open
|
|
42
|
Gupta S, Koirala J, Khardori R, Khardori N. Infections in Diabetes Mellitus and Hyperglycemia. Infect Dis Clin North Am 2007; 21:617-38, vii. [PMID: 17826615 DOI: 10.1016/j.idc.2007.07.003] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Infections in diabetes mellitus are relatively more common and serious. Diabetic patients run the risk of acute metabolic decompensation during infections, and conversely patients with metabolic decompensation are at higher risk of certain invasive infections. Tight glycemic control is of paramount importance during acute infected or high stress state. Infections in diabetic patients result in extended hospital stays and additional financial burden. Given the risks of not alleviating the metabolic dysregulation and the benefits of decent glycemic control, it is necessary that besides antimicrobial therapy, equal emphasis be placed on intensified glycemic control.
Collapse
Affiliation(s)
- Smita Gupta
- Division of Endocrinology, Metabolism and Molecular Medicine, Southern Illinois University School of Medicine, 701 North First Street, D-405B, PO Box 19636, Springfield, IL 62794-9636, USA.
| | | | | | | |
Collapse
|