Antimicrobial Treatment in Diabetic Women With Asymptomatic Bacteriuria
Year: 2002
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: ABSTRACT 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 in fection. Methods We enrolled women (>16 years of age) with diabetes, bacteriuria (»105 colony-forming units of an organism per milliliter in cultures of two consec utive 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. Sub sequently, 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. Results Four weeks after the end of the initial course of therapy, 78 percent of placebo recipients had bac teriuria, 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 infec tion. The time to a first symptomatic episode was sim ilar in the placebo group and the antimicrobial-ther apy 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 bacteri uria in women with diabetes does not appear to re duce complications. Diabetes itself should not be an indication for screening for or treatment of asympto matic bacteriuria. (N Engl J Med 2002;347:1576-83). Copyright © 2002 Massachusetts Medical Society.
DOI: 10.7302/26765
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4414591447