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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The traditional criterion of 10(5) colony-forming units (CFU) per milliliter of urine to diagnose urinary tract infection was based on studies of pregnant and nonpregnant women with asymptomatic bacteriuria or acute pyelonephritis. Recent studies of symptomatic women revealed that urine cultures in approximately one third of those with confirmed urinary tract infections grew only 10(2) to 10(4) CFU/mL. The major causes of acute dysuria among such women are urinary tract infection, sexually transmitted disease, and vaginitis. In most instances, it is possible to make the diagnosis based on clinical features. The major features of urinary tract infection are internal dysuria; frequency, urgency, and voiding of small volumes; abrupt onset; suprapubic pain; presence of pyuria. Presence of hematuria which occurs in about 50 percent of patients strongly suggests bacterial cystitis. Three to seven days of empiric antimicrobial therapy is indicated for these patients, with selection of a first-line antimicrobial agent that offers efficacy against Escherichia coli or Staphylococcus saprophyticus; reasonable cost; few side effects. Ampicillin is not recommended. Indications for culture include uncertain clinical features; history of previous infection within the past three weeks; duration of symptoms of more than seven days; recent hospitalization or catheterization; pregnancy; diabetes. To maximize the sensitivity and specificity of the urine culture in acutely symptomatic women, it is necessary to request the laboratory to report 10(2) to 10(4) CFU/mL.
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PMID:Protocol for diagnosis of urinary tract infection: reconsidering the criterion for significant bacteriuria. 304 81

Antimicrobial prophylaxis is recommended in all clean-contaminated surgery where the critical threshold of number and virulence of the contaminating organisms with respect to host resistance is reached. Obstetric and gynaecological surgery is clean-contaminated and risk of infection due to aerobic and anaerobic bacteria without prophylaxis can be quantified at 30-40% for vaginal hysterectomy, 10-35% for abdominal hysterectomy and 10-34% for caesarean section. To assess the role of two different cephalosporins as short term prophylaxis, we carried out a multicentre randomised study involving a single 2 g i.v. dose of cefotetan in comparison with two doses of cefazolin (2 g i.v. before surgery and after 8 hours). Criteria for exclusion were: exposure to antibiotics within 7 days, preoperative infection, hypersensitivity to beta-lactams. Four hundred and sixty patients entered the study, of which 229 received cefotetan and 231 cefazolin. No significant differences in mean age, obesity, preoperative weight loss, diabetes, type of disease, type of surgery (vaginal or abdominal hysterectomies and caesarean sections) and number of pregnancies and abortions existed between the two groups of patients. The total rate of infected patients undergoing hysterectomy was 8.6% (13/151) in the cefotetan group and 17.4% (29/167) in the cefazolin group (p less than 0.05). This difference was due to cases of symptomatic bacteriuria and antibiotic retreatment, while wound infections were not significantly different (2.6% and 1.8% respectively). Among patients undergoing caesarean section, 9 of 78 (11.5%) and 7 of 64 (10.9%) were infected following cefotetan and cefazolin, respectively (not significant). Cefotetan mean tissue concentrations in gynaecological organs were higher than those of cefazolin (25.5-44.8 vs. 7.4-9.5 mg/kg).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prophylaxis in gynaecological and obstetric surgery: a comparative randomised multicentre study of single-dose cefotetan versus two doses of cefazolin. 305 93

This study examined whether non-insulin-dependent diabetic (NIDDM) subjects have an increased prevalence of asymptomatic bacteriuria compared with subjects with normal glucose tolerance. Diabetic (n = 206) and normal (n = 418) subjects were identified from a defined geographic area in the San Luis Valley of southern Colorado. Presence of asymptomatic bacteriuria was determined by testing the subjects' urine with a reagent-strip test for nitrite and leukocyte esterase (Chemstrip LN). The ability of the Chemstrip LN to detect bacteriuria was evaluated by comparing its results with those from urine culture on a subsample of subjects. There were 7 control and 12 diabetic subjects with bacteriuria as measured by the Chemstrip LN. The prevalence of urinary tract colonization among diabetic compared with control subjects was increased 3.5-fold (95% confidence interval 1.4-8.6). Adjustment for confounding by age, sex, ethnicity, and county of residence resulted in an adjusted prevalence ratio of 4.4 (95% confidence interval 1.1-17.4). Among diabetic subjects, prevalence of bacteriuria increased with longer disease duration but was not affected by measures of glucose control. We conclude that NIDDM increases the prevalence of bacterial colonization of the urine and, therefore, probably also increases the risk of symptomatic urinary tract infection.
Diabetes Care 1988 Oct
PMID:Prevalence of asymptomatic bacteriuria in subjects with NIDDM in San Luis Valley of Colorado. 322 41

Significant bacteriuria (viable count greater than or equal to 10(5)/ml) was found on single testing in 10% of 400 consecutive diabetic women aged 15-65 yr routinely attending a diabetic clinic. Twenty patients with and 21 without significant bacteriuria were then randomly selected for measurement of cardiovascular autonomic reflexes, bladder ultrasound, and mictiography. There were no significant differences between these two groups in age, duration and type of diabetes, glycosylated hemoglobin, blood urea, and creatinine. Abnormalities of cardiovascular autonomic function were more common in the bacteriuric group (P less than .01). Although the bacteriuric group voided a smaller volume of urine, none had evidence of increased residual bladder volume of urine on ultrasound. Diabetic women with cardiovascular autonomic neuropathy appear to be at increased risk of developing bacteriuria. However, age is probably the most important factor influencing the prevalence of bacteriuria in diabetic and in nondiabetic women.
Diabetes Care
PMID:Bacteriuria and autonomic nerve function in diabetic women. 353 74

The presence of bacteriuria and pyuria on urinalysis immediately before renal transplantation has resulted in cancellation of surgery because of concern about post-transplant wound infection. Of 113 renal transplant recipients reviewed 41 (36 per cent) had 5 or more white blood cells per high power field with bacteria in either a voided urine or bladder washout specimen obtained just before grafting. Of those 41 patients 2 suffered postoperative wound infections. Of 72 patients (64 per cent) with less than 5 white blood cells or no bacteria on a preoperative specimen 1 suffered a wound infection (p not significant by Fisher's exact test). Preoperative urine cultures and operative bladder cultures of all 3 patients failed to yield the organisms found later in the wound infections. The factors of sex, insulin-dependent diabetes, delayed graft function, living related versus cadaver donor and pre-transplant splenectomy had no significant relationship to wound infection rates. Renal transplantation can be performed safely in patients who have pyuria and bacteriuria but no signs or symptoms of infection.
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PMID:Significance of immediate preoperative bacteriuria with pyuria in renal transplant recipients. 355 Jan 45

We measured hemoglobin A1 (HbA1) and performed clean-catch urine cultures in 752 patients (411 men and 341 women) with non-insulin-dependent diabetes mellitus (NIDDM) attending an outpatient diabetes clinic. Prevalence of bacteriuria was significantly greater in diabetic women than in controls (9.1 vs. 5.0%, P less than .001) but not in diabetic men. Risk of bacteriuria was not related to level of HbA1 at the time of urine culture. However, mean duration of diabetes mellitus was significantly greater in diabetic women with bacteriuria than in those without infection (9.9 +/- 1.5 vs. 5.4 +/- 0.4 yr, P less than .025), and the prevalence of bacteriuria was significantly greater in patients with complications of long-standing diabetes mellitus than in those without complications (P less than .005).
Diabetes Care
PMID:Asymptomatic bacteriuria and hemoglobin A1. 376 20

In an effort to ascertain important epidemiologic and prognostic risk factors, we analyzed 33 cases of Staphylococcus aureus meningitis occurring over an 8-year period (1976 to 1984). Staphylococcus aureus caused 6% of all bacterial meningitis at our University Hospital. Fifty percent of cases were pediatric and included 7 newborn infants, of whom 71% were either premature or had low birth weight. Major underlying diseases were: central nervous system (CNS) disorders (55%), endocarditis (21%, predominantly intravenous drug abusers), other sites of infection (27%), and prematurity (24%). Fifty-seven percent of patients were bacteremic and 41% of those had concomitant bacteriuria. Hypoglycorrhachia was present in 27% of cases, positive cerebrospinal fluid (CSF) Gram stain in 20%, disseminated intravascular coagulation (DIC) in 19%, and methicillin-resistant organisms in 18%. Cerebrospinal fluid cultures remained positive for a protracted period (mean, 6.7 days) regardless of the presence or absence of a CNS shunt. Overall mortality was 21%. Favorable outcomes were associated with the eventual presence of sterile CSF (15.4% vs. 100% mortality) and the removal of foreign bodies (10% vs. 67% mortality). Mortality was also associated (p less than 0.5) with the presence of diabetes mellitus, age greater than 60, obtundation or coma on presentation, bacteremia, or DIC. Cure correlated (p less than .05) with CNS shunt-associated infections, age less than 1, normal neurologic examinations on presentation, or the absence of DIC or bacteremia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Staphylococcus aureus meningitis: a broad-based epidemiologic study. 382 85

Our current knowledge of the long-term outcome of uncomplicated urinary tract infections in women is based on several things: a reevaluation of the criteria for defining pyelonephritis at autopsy, careful description of the causes of renal disease among patients entering dialysis and transplant programs, long-term observation of patients, and epidemiologic studies attempting to determine the association of bacteriuria with mortality. The weight of the evidence favors the conclusion that, although urinary tract infections can severely impair renal function, this is rare in the absence of a major predisposing factor such as obstruction, calculus, reflux, abnormalities of the voiding mechanism, or diabetes. The predisposing lesions, however, may go undetected until heralded by episodes of acute pyelonephritis or by renal failure. Unfortunately, urinary tract infections are so common that it is difficult to distinguish the population at greatest risk. The possible role of renal damage produced by autoimmune mechanisms following infection needs continued study.
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PMID:Does kidney infection cause renal failure? 388 49

Most physicians believe that the diabetic patient is predisposed to infections and that infections complicate the control of the diabetes. Despite the lack of scientific proof, certain infections (such as tuberculosis, bacteriuria in females, malignant external otitis, rhinocerebral mucormycosis, emphysematous cholecystitis, emphysematous pyelonephritis, acute papillary necrosis etc) are widely regarded to be associated with the diabetic. Foot infections, infections of the respiratory tract and the urinary tract are very important in the diabetic. The reasons why diabetics are susceptible to infections are unclear: although the production of humoral antibody appear intact, defective function of the polymorphonuclear leucocytes has been demonstrated. Successful treatment of infections in the diabetic requires early and exact diagnosis, the exhibition of the correct antimicrobials, the treatment of the diabetic state and associated disorders and prompt surgical intervention where required. Good control of blood glucose in diabetic patients is a desirable goal in the prevention of certain infections and to ensure maintenance of normal host defense mechanisms that determine resistance and response to infection.
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PMID:Infections in diabetes with special reference to diabetics in Singapore. 389 79

From 1980 to 1983, 69 patients (36 male) with end-stage renal disease underwent kidney transplantation (11 from cadaveric donors). Twenty-six out of 69 (17 male) with a mean age of 37 years (range 16-50 years) developed 69 UTI episodes. The standard immunosuppressive regimen consisted of prednisolone and azathioprine and, in selected cases, antilymphocyte globulin or cyclosporin A were given for a short period of time. Thirty-five episodes (50%) occurred within two months of the operation. The most commonly isolated bacteria were E. coli (28 cases), Ps. aeruginosa (16) and Proteus mirabilis (9). Kidney graft dysfunction, diabetes mellitus, urological complications and antirejection treatment were the main predisposal factors. Recurrence or reinfections were finally diagnosed in 19/26 patients (73%). Thirteen patients presented with asymptomatic bacteriuria (55% of episodes). Aminoglycosides, ureidopenicillins and third-generation cephalosporins were found to be very effective for treating severely ill, febrile patients. In addition, trimethoprim/sulphamethoxazole and mecillinam were useful for patients on long-term chemotherapy. There were no deaths or impairment of the renal graft function directly attributable to the urinary infection. In conclusion, UTIs are a very common cause of morbidity in kidney graft recipients, with the highest incidence in the early post-transplant period. Recurrences or reinfections occur often and asymptomatic bacteriuria is a common finding which needs not be treated aggressively in the absence of symptoms or obstructive uropathy. Patient and graft survival in the long term remain unaffected by the presence of the urinary infection.
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PMID:Urinary tract infections after renal transplantation. 391 78


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