|
|
 | |||||||||||||||||||||||||||||||||||||||||||||||||||
 | |||||||||||||||||||||||||||||||||||||||||||||||||||
| |||||||||||||||||||||||||||||||||||||||||||||||||||
Background Asymptomatic bacteriuria is common among women with diabetes, and the treatment of such infections has been recommended to prevent complications related to symptomatic urinary tract infection.
Methods We enrolled women (>16 years of age) with diabetes, bacteriuria (
Results Four weeks after the end of the initial course of therapy, 78 percent of placebo recipients had bacteriuria, as compared with 20 percent of women who received antimicrobial agents (P<0.001). During a mean follow-up of 27 months, 20 of 50 women in the placebo group (40 percent) and 23 of 55 women in the antimicrobial-therapy group (42 percent) had at least one episode of symptomatic urinary tract infection. The time to a first symptomatic episode was similar in the placebo group and the antimicrobial-therapy group (P=0.67 by the log-rank test), as were the (±SD) rates of any symptomatic urinary tract infection (1.10±0.17 and 0.93±0.14 per 1000 days of follow-up, respectively; relative risk, 1.19; 95 percent confidence interval, 0.28 to 1.81), pyelonephritis (0.28±0.08 and 0.13±0.05 per 1000 days of follow-up; relative risk, 2.13; 95 percent confidence interval, 0.81 to 5.62), and hospitalization for urinary tract infection (0.10±0.36 and 0.06±0.22 per 1000 days of follow-up; relative risk, 1.93; 95 percent confidence interval, 0.47 to 7.89). The women in the antimicrobial-therapy group had almost five times as many days of antibiotic use for urinary tract infection as did the women in the placebo group (158.2±1.7 vs. 33.7±0.91 per 1000 days of follow-up; relative risk, 0.21; 95 percent confidence interval, 0.20 to 0.22).
Conclusions Treatment of asymptomatic bacteriuria in women with diabetes does not appear to reduce complications. Diabetes itself should not be an indication for screening for or treatment of asymptomatic bacteriuria. .
105 colony-forming units of an organism per milliliter in cultures of two consecutive urine specimens), and no urinary symptoms; 50 were randomly assigned to receive placebo and 55 to receive antimicrobial therapy. For the first six weeks, which included the initial course of treatment, the study was placebo-controlled and double-blind. Subsequently, the women were screened for bacteriuria every three months for up to three years; antimicrobial therapy was provided to women in the antimicrobial-therapy group who had asymptomatic bacteriuria.
Source Information
From the Departments of Internal Medicine (G.K.M.H., L.E.N.), Medical Microbiology (G.K.M.H., G.G.Z., L.E.N.), and Community Health Sciences (M.C.), University of Manitoba; Health Sciences Centre (L.E.N.); and St. Boniface General Hospital (G.K.M.H.) — all in Winnipeg, Man., Canada.
Address reprint requests to Dr. Nicolle at the Health Sciences Centre, Department of Internal Medicine, GG443–820 Sherbrook St., Winnipeg, MB R3A 1R9, Canada, or at lnicolle{at}hsc.mb.ca.
Related Letters:
Treatment of Asymptomatic Bacteriuria in Diabetic Women
Geerlings S. E., Meiland R., Hoepelman A. I.M., Nicolle L. E., Harding G. K.M., Zhanel G. G.
Extract |
Full Text |
PDF
N Engl J Med 2003;
348:957-958, Mar 6, 2003.
Correspondence
This article has been cited by other articles:
HOME | SUBSCRIBE | SEARCH | CURRENT ISSUE | PAST ISSUES | COLLECTIONS | PRIVACY | TERMS OF USE | HELP | beta.nejm.org Comments and questions? Please contact us. The New England Journal of Medicine is owned, published, and copyrighted © 2009 Massachusetts Medical Society. All rights reserved. |
Previous
