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Randomized Controlled Trial
. 2009 Aug 15;49(4):491-7.
doi: 10.1086/600883.

Long-term Escherichia coli asymptomatic bacteriuria among women with diabetes mellitus

Shona Dalal  1 , Lindsay Nicolle, Carl F Marrs, Lixin Zhang, Godfrey Harding, Betsy Foxman
Affiliations
Randomized Controlled Trial

Long-term Escherichia coli asymptomatic bacteriuria among women with diabetes mellitus

Shona Dalal et al. Clin Infect Dis. .

Abstract

Background: Persistent Escherichia coli asymptomatic bacteriuria (ASB) is common among persons with diabetes mellitus, but the duration of colonization and the rates of recolonization are unknown. We estimated the duration of colonization and the rate of recolonization among successively isolated E. coli from diabetic women with ASB and compared the virulence profiles with uropathogenic and commensal E. coli.

Methods: A total of 105 women with diabetes were enrolled in a randomized, controlled clinical trial for treatment of ASB in Manitoba, Canada, and were observed at least every 3 months for up to 3 years. We analyzed 517 isolates from 70 women with repeated E. coli ASB for genetic similarity using enterobacterial repetitive intergenic consensus polymerase chain reaction. Unique strains were screened for uropathogenic virulence characteristics using dot blot hybridization and compared with different collections of E. coli isolates.

Results: On average, differences were found among women assigned to treatment for ASB, those treated only for symptomatic infections, and untreated women in (1) follow-up time with bacteriuria (29%, 31%, and 66%, respectively; P<.001), (2) duration of bacteriuria (2.2, 2.5, and 3.7 months, respectively; P=.04), and (3) carriage of unique isolates (2.4, 2.8, and 4 months, respectively; P=.03). Women assigned to antibiotic treatment usually had recurrent infection (76%), 64% of the time with a genetically new E. coli strain. Virulence characteristics of these isolates were comparable to those of fecal isolates from healthy women.

Conclusions: Treatment may reduce the overall proportion of time infected in the long term and carriage of a unique strain, but most treatment regimens were followed by subsequent recolonization. Infecting strains did not have virulence factors characteristic of uropathogenic E. coli.

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Figures

Figure 1
Figure 1
Agarose gel of ERIC-PCR patterns from E. coli. Lanes marked M contain a molecular weight marker. Lanes 1-9 are isolates from one individual. Lanes 10–12 are from a different woman.
Figure 2
Figure 2
Dendogram showing grouping of isolates according to similarity in banding pattern of samples from 5 women using the unweighted pair group method with arithmetic averages (UPGMA) of BioNumerics software. Lanes 1–3 are samples from person 1, lane 4 from person 2, lane 5 from person 3, lanes 6, 7, 8 from person 4 and lanes 9–12 from the fifth person. ERIC: enterobacterial repetitive intergenic consensus sequence.
See this image and copyright information in PMC

References

    1. Stapleton A. Urinary tract infections in patients with diabetes. Am J Med. 2002;113 Suppl 1A:80S–84S. - PubMed
    1. Zhanel GG, Nicolle LE, Harding GK. Prevalence of asymptomatic bacteriuria and associated host factors in women with diabetes mellitus. The Manitoba Diabetic Urinary Infection Study Group. Clin Infect Dis. 1995;21(2):316–322. - PubMed
    1. Harding GK, Zhanel GG, Nicolle LE, Cheang M. Antimicrobial treatment in diabetic women with asymptomatic bacteriuria. N Engl J Med. 2002;347(20):1576–1583. - PubMed
    1. Geerlings SE, Stolk RP, Camps MJ, et al. Consequences of asymptomatic bacteriuria in women with diabetes mellitus. Arch Intern Med. 2001 Jun 11;161(11):1421–1427. - PubMed
    1. Ribera MC, Pascual R, Orozco D, Perez Barba C, Pedrera V, Gil V. Incidence and risk factors associated with urinary tract infection in diabetic patients with and without asymptomatic bacteriuria. Eur J Clin Microbiol Infect Dis. 2006 Jun;25(6):389–393. - PubMed

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