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Abstract
Results of various epidemiologic studies suggest that bacteriuria and urinary tract
infection (UTI) occur more commonly in women with diabetes than in women without this
disease. Similar findings have been demonstrated for asymptomatic bacteriuria (ASB),
with ASB being a risk factor for pyelonephritis and subsequent decline in renal function.
Although ASB is not associated with serious health outcomes in healthy patients, further
research needs to be undertaken regarding the impact of ASB in patients with diabetes.
Patients with diabetes often have increased complications of UTI, including such rare
complications as emphysematous cystitis and pyelonephritis, fungal infections (particularly
Candida species), and increased severity and unusual manifestations (e.g., gram-negative
pathogens other than Escherichia coli). Anatomic and functional abnormalities of the
urinary tract are also associated with diabetes. Such abnormalities result in greater
instrumentation of the urinary tract, thereby increasing the risk of secondary UTI.
In addition, these abnormalities complicate UTI and require specialized treatment
strategies. There is a greater likelihood of UTI affected by antimicrobial resistance
or atypical uropathogens, and the risk of upper tract involvement is increased. Pre-
and posttherapy urine cultures are therefore indicated. The initial choice of empiric
antimicrobial therapy should be based on Gram stain and urine culture. Choice of antibiotic
therapy should integrate local sensitivity patterns of the infecting organism. Fluoroquinolones
are a reasonable empiric choice for many patients with diabetes. For seriously ill
patients, including patients infected with Pseudomonas spp., such agents as imipenem,
ticarcillin-clavulanate, and piperacillin-tazobactam may also be considered. Treatment
of ASB in patients with diabetes is often recommended to prevent the risk of symptomatic
UTI. However, the management of ASB in patients with diabetes is complex, with no
single preferred approach.