CLINICAL RELEVANCE AND COURSE OF ASYMPTOMATIC BACTERIURIA :- A RETROSPECTIVE OBSERVATIONAL STUDY OF CLINICAL CHARACTERISTICS AND TREATMENT OUTCOMES AMONG DIABETIC AND NON DIABETICS

Introduction:

Asymptomatic bacteriuria is a common finding in patients with structural abnormalities of urinary tract, pregnant women, elderly, patients with impaired voiding and spinal cord abnormalities.Treatment of asymptomatic bacteriuria is usually not indicated. It’s treatment is clinically significant in pregnant female and in patients with prior urological procedures.It is important in day to day clinical practice, to know clinical course of asymptomatic bacteriuria, significance of its treatment and its impact on renal function. 

Methods:

This is Retrospective observational study, included 110 patients who satisfied criteria of asymptomatic bacteriuria, with no or single prior admission  with normal renal function, with at least 6 months of follow up between January 2018- December 2022. They were categorised into diabetic and non diabetic group. Symptomatic patients with negative urine culture, known anatomical abnormalities, Cerebrovascular accident, spinal cord involvement, prolonged catheterisation, on immuno suppressive medication, recent instrumentation of urinary tract were excluded.In subsequent follow up few Diabetic patients were treated in absence of symptoms (treated) and few did’t receive treatment(untreated). Clinical characteristics of patients were noted,Frequency of urine culture positive with Urinary tract infection in subsequent visits without AKI, with AKI, and organism isolated, any further worsening of renal function were noted.

Results:

Among patients included, 72% were diabetic and 28% were non diabetics with female preponderance in both groups. On retrospective analysis Mean duration of follow up was 2years+/-6 months. Elderly population was more affected in both groups, mean age group in diabetic patients was 69+/-6years and in non diabetic patients was 62+/-6years. Patients in diabetic group had prolonged duration of diabetes (mean 20+/-6years) with uncontrolled blood sugar (mean Hba1c 9+/-1.3). No specific risk factors were noted among non diabetic group.In follow up positive urine culture with symptoms was seen among 24% of total diabetic (6% from treated and 18% from untreated),in whom symptoms resolved with treatment and asymptomatic bacteriuria persisted in further follow up, these patients had no acute kidney injury.In total diabetic group 12% (4% from treated and 8% from untreated) developed symptomatic urinary tract infection with acute kidney injury and 6%(untreated) progressed to CKD in subsequent follow up(mean serum creatinine of 2+/-0.5). In non diabetic group only 5% developed positive urine cultures in subsequent visit with symptoms which resolved with treatment and none had acute kidney injury and had no risk of CKD. E.coli was found to be the most common organisms isolated followed by klebsiella.

Conclusions:

Asymptomatic bacteriuria in diabetic patients with uncontrolled blood sugars have increased risk of symptomatic urinary tract infection, AKI and risk of progression to CKD, requiring regular follow up, strict glycemic control and treatment which is clinically significant.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.