Karunajeewa H, McGechie D, Stuccio G, Stingemore N, Davis W A, Davis T M E
School of Medicine and Pharmacology, Fremantle Hospital, University of Western Australia, P.O. Box 480, Fremantle, WA, 6959, Australia.
Diabetologia. 2005 Jul;48(7):1288-91. doi: 10.1007/s00125-005-1794-3. Epub 2005 May 26.
AIMS/HYPOTHESIS: We examined the prognosis of well-characterised community-based diabetic patients with asymptomatic bacteriuria (ASB).
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.
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/INTERPRETATION: 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.
目的/假设：我们研究了特征明确的社区糖尿病无症状菌尿（ASB）患者的预后情况。
我们对496例1型或2型糖尿病成人患者进行了一项前瞻性观察研究。除详细的临床和实验室数据外，采集一份中段尿样本进行需氧培养和抗生素敏感性测试。ASB定义为每毫升尿液中一种或两种微生物的菌落形成单位≥10⁵且无泌尿系统感染症状。对患者进行了2.9±0.6年的随访，观察其因尿脓毒症住院或死亡情况。
36例患者（7.3%）患有ASB，其中女性33例（占所有女性的14.4%），男性3例（占所有男性的1.1%）。在包括代谢控制指标在内的一系列变量中，只有女性性别可预测ASB。随后有29例患者（5.8%）因尿脓毒症住院。其中，尿脓毒症是12例（41%）患者的主要诊断。在Cox比例风险模型中，ASB与以尿脓毒症为主要诊断的住院风险增加相关（风险比[95%置信区间]4.4[1.2 - 16.5]；p = 0.004）。ASB不能预测以尿脓毒症为主要或次要诊断的住院联合终点（2.3[0.8 - 6.7]；p = 0.12），也不能预测以非泌尿系统脓毒症为主要（n = 12）或主要/次要（n = 28）诊断的情况（p>0.3）。
结论/解读：ASB可识别出随后发生需住院治疗的尿脓毒症风险显著增加的糖尿病患者。需要进一步开展大规模研究以确定ASB筛查和预防性治疗的成本效益，尤其是在女性患者中。
