The importance of asymptomatic bacteriuria in women with diabetes mellitus

Introduction: Patients with diabetes have an increased risk of urinary tract infections compared with normal population. Even though UTI’s are asymptomatic and does not affect life quality, it may cause serious complications like pyelonephritis, emphysematous cystitis, renal abcesses and bacteriemia.
Matherial and methods: A total of 261 patients with diabetes who had no complaints of urinary tract visiting diabetes outpatient clinic were included in the study in order to determine to determine the prevalance of asymptomatic bacteriuria (ASB) in diabetic women. The mean age of the patients was 46,5 (18-70). Exculision criteria were pregnancy, pathological findings of urinary tract in sonography and vaginal infections. All patients had urinanalysis and urine cultures. ASB was defined as the presence of at least 10 CFG per mililiter in at least two clean voided midstream urine samples.
Results: Seventy four patients (28,6%) had type I DM and 187 patients (71,4%) at type 2 DM. The mean age was 52 and mean duration of DM was 18 years in the patients having ASB, while the mean age was 47 and mean duration of DM was 13 years in patients without ASB. We found the prevalance of ASB in diabetic women as 29%, the ratio of ASB in type 1 DM 22% and the ratio of ASB in type 2 DM women was 31%. The most isolated microorganism was E.Coli. in the follow-up period 78 patients (30%) had cystitis. Altough given apropriate antibiotherapy 20 patients developed 2 UTI’s and 10 patients 3 or more UTI’s. 2 patients had pyelonephritis and I patient had pyonehrosis.
Conclusions: The prevalance of ASB is higher in diabetic women. This situation clinically may be a serious risk factor that can cause renal function loss in diabetic women.

Diyabetik kadýn hastalarda asemptomatik bakteriüri

Giriþ: Diyabetik kadýn hastalarda üriner sistem enfeksiyon riski normal populasyona yöre daha yüksektir. Asemptomatik seyretmesi nedeni ile yaþam kalitesini etkilemese de pyelonefrit, renal abse, amfizömatöz sistit, perinefritik apse ve hakteriyemi gibi ciddi komplikasyonlara neden olabilmektedir.
Gereç ve yöntem: Diyabetik kadýn hastalarda asemptomatik bakteriiiri (ASB) prevalansýný saptamak amacýyla hastanemiz diyabet polikliniðine baþvuran, iiriner sistem þikateti bulun¬mayan 261 hasta çalýþmaya alýndý. Hastalarýn ortalama yaþlan 46,5 (18-70) idi. Vajinal akýntýsý olanlar, 111trasonagrafide üriner sistem patolojisi saptananlar ve gebe olanlar çalýþma dýþý býrakýldý. Hastalarýn hepsine tam idrar tahlili ve idrar kültürü yapýldý. Üriner sistem semptomlarý olmayan diyabetik kadýn hastalarýn orta akýný idrar örneðinden en az iki kez alýnan idrar kültüründe 105 koloni üremesi asemptomatik bakteriüri olarak tanýmlandý.
Bulgular: Çalýþmaya alman 261 hastanýn 74’ii (28,6) tipi DM, /87’si tip 2 DM idi. ASB saptanan grubun yaþ ortalamasý 52 ve diyabetli yaþam süresi ortalama 18 yýl olarak tespit edilirken ASB saptanmayan grubun yaþ ortalamasý 47 ve diyabetli yaþam süresi ise 13 yýl okýrak bulunmuþtur. Çalýþmamýzda hastalarda asemptomatik bakteriiiri prevalansýný %29 olarak bulduk. Tip 1 DM olan ASB‘li kadýnlarda hu oran %22, Tip 2 DM olan ASB’li kadýnlarda %31 idi. Býý hastalarda en sýk izole edilen üropatojen E.Coli idi. Hastalarýn takibinde 78 hasta (%30) sistizm þikayetleri ile polikliniðimize baþvurdu. Bunlarýn tümüne uygun antibiyoterapi yapýlmasýna raðmen 20 hastada 2 kez, 10 hastada ise üç veya daha fazla semptomatik üriner sistem enfeksiyonu, iki hastada pyelonefrit, bir hastada pyoýýefroz saptandý.
Sonuç: Diyabetli kadýn hastalarda asemptomatik bakteriüri normal topluma göre daha sýk görülmektedir Klinik olarak bu durum, diyabetik kadýnlarda renal fonksiyon kaybýna kadar götüren ciddi bir risk faktörü olarak karþýmýza çýkabilmektedir.