Antimicrobial treatment in diabetic women with asymptomatic bacteriuria - PubMed (original) (raw)
Clinical Trial
. 2002 Nov 14;347(20):1576-83.
doi: 10.1056/NEJMoa021042.
Affiliations
- PMID: 12432044
- DOI: 10.1056/NEJMoa021042
Free article
Clinical Trial
Antimicrobial treatment in diabetic women with asymptomatic bacteriuria
Godfrey K M Harding et al. N Engl J Med. 2002.
Free article
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 infection.
Methods: We enrolled women (>16 years of age) with diabetes, bacteriuria (> or =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.
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.
Copyright 2002 Massachusetts Medical Society
Comment in
- Asymptomatic bacteriuria in patients with diabetes--enemy or innocent visitor?
Andriole VT. Andriole VT. N Engl J Med. 2002 Nov 14;347(20):1617-8. doi: 10.1056/NEJMe020120. N Engl J Med. 2002. PMID: 12432051 No abstract available. - Screening for and treating asymptomiatic bacteriuria not useful in women with diabetes.
DeYoung GR, Ashmead S. DeYoung GR, et al. J Fam Pract. 2003 Feb;52(2):98-9. J Fam Pract. 2003. PMID: 12585982 - Treatment of asymptomatic bacteriuria in diabetic women.
Geerlings SE, Meiland R, Hoepelman AI. Geerlings SE, et al. N Engl J Med. 2003 Mar 6;348(10):957-8; author reply 957-8. doi: 10.1056/NEJM200303063481018. N Engl J Med. 2003. PMID: 12621142 No abstract available.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical