L E Nicolle1, G G Zhanel, G K M Harding. 1. Section of Infectious Diseases, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada. lnicolle@hsc.mb.ca
Abstract
BACKGROUND:Asymptomatic bacteriuria is common in diabetic women. Treatment of asymptomatic bacteriuria is not beneficial, but the natural history of the microbiology of asymptomatic bacteriuria has not been well described. OBJECTIVE: To describe the microbiological outcomes of bacteriuria in diabetic women with untreated asymptomatic bacteriuria. METHODS:Study subjects were initially identified through ambulatory endocrinology clinics. They were enrolled if they had two positive urine cultures > or = 10(8) cfu/l with the same organism within 2 weeks and no symptoms referable to urinary tract infection. Women initially received a 2-week course of placebo with follow-up cultures obtained at the end of treatment and 4 weeks post-treatment. Subsequently, the prevalence of bacteriuria was determined with urine cultures obtained every 3 months to a maximum of 36 months. Outcomes at yearly intervals were designated as one of: persistent bacteriuria; spontaneous resolution; resolution with antibiotics for symptomatic urinary infection; or resolution with antibiotics given for other indications. Women with and without persistent or frequent bacteriuria were compared to identify variables associated with bacteriuria. RESULTS: The prevalence of bacteriuria in the study cohort declined to about 50% by 9 months, and subsequently remained stable throughout 3 years follow-up. Almost 20% of subjects remained bacteriuric with the original infecting organism throughout the period of observation. With evaluation at 12-month intervals, approximately one-quarter of subjects had each of the four potential outcomes of: resolution following antibiotic therapy for symptomatic urinary infection, following antibiotic therapy for other indications, spontaneous resolution without antibiotics, and persistent bacteriuria with the same organism. Women infected with gram-negative organisms were more likely to have persistent bacteriuria. Many women with resolution of initial bacteriuria, with or without antibiotics, became bacteriuric again during follow-up. CONCLUSIONS:Women with asymptomatic bacteriuria and diabetes tend to have persistent or recurrent asymptomatic bacteriuria. Bacteriuria is benign, and seldom permanently eradicable.
RCT Entities:
BACKGROUND: Asymptomatic bacteriuria is common in diabeticwomen. Treatment of asymptomatic bacteriuria is not beneficial, but the natural history of the microbiology of asymptomatic bacteriuria has not been well described. OBJECTIVE: To describe the microbiological outcomes of bacteriuria in diabeticwomen with untreated asymptomatic bacteriuria. METHODS: Study subjects were initially identified through ambulatory endocrinology clinics. They were enrolled if they had two positive urine cultures > or = 10(8) cfu/l with the same organism within 2 weeks and no symptoms referable to urinary tract infection. Women initially received a 2-week course of placebo with follow-up cultures obtained at the end of treatment and 4 weeks post-treatment. Subsequently, the prevalence of bacteriuria was determined with urine cultures obtained every 3 months to a maximum of 36 months. Outcomes at yearly intervals were designated as one of: persistent bacteriuria; spontaneous resolution; resolution with antibiotics for symptomatic urinary infection; or resolution with antibiotics given for other indications. Women with and without persistent or frequent bacteriuria were compared to identify variables associated with bacteriuria. RESULTS: The prevalence of bacteriuria in the study cohort declined to about 50% by 9 months, and subsequently remained stable throughout 3 years follow-up. Almost 20% of subjects remained bacteriuric with the original infecting organism throughout the period of observation. With evaluation at 12-month intervals, approximately one-quarter of subjects had each of the four potential outcomes of: resolution following antibiotic therapy for symptomatic urinary infection, following antibiotic therapy for other indications, spontaneous resolution without antibiotics, and persistent bacteriuria with the same organism. Women infected with gram-negative organisms were more likely to have persistent bacteriuria. Many women with resolution of initial bacteriuria, with or without antibiotics, became bacteriuric again during follow-up. CONCLUSIONS:Women with asymptomatic bacteriuria and diabetes tend to have persistent or recurrent asymptomatic bacteriuria. Bacteriuria is benign, and seldom permanently eradicable.
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