title: Asymptomatic bacteriuria as a predictor of subsequent hospitalisation with urinary tract infection in diabetic adults: The Fremantle Diabetes Study.
abstract: OBJECTIVE
  We examined the prognosis of well-characterised community-based diabetic patients with asymptomatic bacteriuria (ASB).
  
  
  METHODS
  We studied 496 adults with type 1 or 2 diabetes participating in a prospective observational study. In addition to detailed clinical and laboratory data, a single mid-stream urine sample was taken for aerobic culture and antibiotic-sensitivity testing. ASB was defined as >/=10(5) colony-forming units/ml of one or two organisms without symptoms of urinary infection. Patients were followed for 2.9+/-0.6 years for hospital admission for/with urosepsis or death.
  
  
  RESULTS
  Thirty-six patients (7.3%) had ASB, comprising 33 females (14.4% of all females) and three males (1.1% of all males). Only female sex predicted ASB amongst a range of variables including indices of metabolic control. Twenty-nine patients (5.8%) were subsequently hospitalised with urosepsis. Of these, urosepsis was the principal diagnosis in 12 (41%). In a Cox proportional hazards model, ASB was associated with an increased risk of hospitalisation for urosepsis as principal diagnosis (hazard ratio [95% CI] 4.4 [1.2-16.5]; p=0.004). ASB did not predict the combined endpoint of hospitalisation with urosepsis as principal or secondary diagnosis (2.3 [0.8-6.7]; p=0.12), or of non-urinary sepsis as principal (n=12) or principal/secondary (n=28) diagnosis (p>0.3).
  
  
  CONCLUSIONS
  ASB identifies diabetic patients who are at significantly increased risk of subsequent urosepsis requiring hospitalisation. Further large-scale studies are needed to establish the cost-effectiveness of screening for, and pre-emptive treatment of ASB, especially in females.
authors.affiliation: School of Medicine and Pharmacology, Fremantle Hospital, University of Western Australia, P.O. Box 480, Fremantle, WA, 6959, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Karunajeewa
authors.forename: D
authors.initials: D
authors.lastname: McGechie
authors.forename: G
authors.initials: G
authors.lastname: Stuccio
authors.forename: N
authors.initials: N
authors.lastname: Stingemore
authors.forename: W A
authors.initials: WA
authors.lastname: Davis
authors.forename: T M E
authors.initials: TM
authors.lastname: Davis
mesh_terms: D000368:Aged; D001437:Bacteriuria; D003928:Diabetic Nephropathies / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology*