Urinary tract infection in diabetes

Abstract

The aim of this article is to review recent publications relevant to understanding the interaction of urinary tract infection and diabetes mellitus, including epidemiology, pathogenesis, microbiology, and treatment. The largest number of identified reports described aspects of epidemiology, including defining the incidence and outcomes of urinary infection in patients with diabetes. In several reports, mortality and risk of hospitalization for urinary infection were not increased with diabetes, although length of hospitalization may be prolonged. Other reports quantify the increased incidence of cystitis or pyelonephritis in persons with diabetes, but remain subject to potential biases which could overestimate the occurrence in diabetic relative to non-diabetic populations. Several reports suggest that resistant bacteria are more frequently isolated from diabetic outpatients with urinary infection, but it is not clear how this is directly attributable to diabetes. There are no recent clinical trials which enhance our understanding of optimal treatment of symptomatic urinary infection, although several review articles acknowledge the appropriateness of the non-treatment of asymptomatic bacteriuria in diabetic women. Recent reports exploring diabetes and urinary tract infection provide some insights, particularly for risks of infection and outcomes, but there are no recent large advances in the knowledge base. Questions related to incidence, optimal treatment, and role of metabolic control still need to be addressed to expand the knowledge base and enhance management of this common problem.