Issue 131 Item 8 Routine Urine Tests Not Advised for Diabetic Women

Treating asymptomatic bacteriuria in diabetic women was of no benefit and should not be standard practice, according to the results of a new study in the New England Journal of Medicine. "Treatment of asymptomatic bacteriuria in women with diabetes does not appear to reduce complications," write Godfrey K. M. Harding, MD, and colleagues for the Manitoba Diabetes Urinary Tract Infection Study Group. "Diabetes itself should not be an indication for screening for or treatment of asymptomatic bacteriuria."

For six weeks, 105 diabetic women aged more than 16 years with asymptomatic bacteriuria received placebo or antibiotics in double-blind fashion. Every three months for up to three years thereafter, women in the antibiotic group who had asymptomatic bacteriuria at follow-up received additional antibiotics.

Four weeks after completion of initial treatment, bacteriuria was present in 78% of the placebo group and in 20% of the antibiotic group (P<.001). During a mean follow-up of 27 months, 20 (40%) of 50 women in the placebo group and 23 (42%) of 55 women in the antibiotic group had at least one episode of symptomatic urinary tract infection.

The two groups were also similar in time to a first symptomatic episode, rate of any symptomatic urinary tract infection, rate of pyelonephritis, and hospitalization for urinary tract infection. Women in the antibiotic group had almost five times as many days of antibiotic use for urinary tract infection per 1,000 days of follow-up as did women in the placebo group (relative risk, 0.21; 95% confidence interval, 0.20-0.22).

"Resources now spent on screening and treatment in [women with diabetes mellitus] should instead be spent to identify the precursors that do lead to symptomatic urinary tract infections in patients with diabetes," Vincent T. Andriole, MD, from Yale University in New Haven, Connecticut, writes in an accompanying editorial. "Asymptomatic bacteriuria in women with diabetes mellitus may be just an innocent visitor; even if it is an enemy, a few weeks of antimicrobial therapy for asymptomatic infection is not beneficial. But we must fight back promptly and effectively when the enemy reveals itself and threatens the well-being of women with diabetes." N Engl J Med. 2002;347(20):1549-1556, 1613-1615