Tip 2 Diyabet hastalığı ve bozulmuş glikoz toleransı olan kadınlarda asemptomatik bakteriüri ve üriner sistem enfeksiyonları

Öz

Amaç: Çalışmamızda; tip 2 diabetes mellitusu DM olan ve bozulmuş glikoz toleransı BGT olan iki kadın hasta grubunun üriner sistem infeksiyonu ÜSİ ve asemptomatik bakteriüri ASB varlığı ve ilişkili risk faktörleri açısından karşılaştırılması amaçlandı. Risk faktörleri olarak; yaş, vücut kitle indeksi VKİ , serum HbA1c ve kreatinin seviyeleri, glomerüler filtrasyon oranı GFR , idrardaki lökosit sayısı, glikoz miktarı ve mikroalbumin düzeyi seçildi. Yöntem: Diyabetli 208 kadın hasta ve BGT’si olan 208 kadın hasta çalışmaya dahil edildi. Serum HbA1c ve kreatinin seviyeleri ve idrardaki lökosit sayısı, glikoz miktarı ve mikroalbumin düzeyi biyokimya laboratuvarında ölçüldü. GFR, Cockcroft-Gault formula kullanılarak hesaplandı. Hastalardan alınan orta akım idrarı mikrobiyoloji laboratuvarında kanlı agar ve EMB agara ekildi. Bulgular: Diyabetli hasta grubunda beş %2 hastada, BGT hasta grubunda 15 %7 hastada ASB saptandı. ÜSİ; diyabetik grupta dokuz %4 hastada , BGT hasta grubunda yedi %3 hastada belirlendi p>0.05 . Piyüri; her iki hasta grubunda ASB ile ilişkili risk faktörü idi p

Anahtar Kelimeler

• Diabetes mellitus, bozulmuş glikoz toleransı, üriner sistem infeksiyonu, asemptomatik bakteriüri

Asymptomatic bacteriuria, urinary tract infection and risk factors in women with type 2 diabetes mellitus and impaired glucose tolerance

Öz

Objective: We aimed to compare a type 2 diabetic women groups with a women group with impaired glucose tolerance IGT for the presence of urinary tract infection UTI and/or asymptomatic bacteriuria ASB and related risk factors [age, body mass index BMI , serum HbA1c and creatinine levels, glomerular filtration rate GFR , and urine microalbumin, urine leukocyte and glucose levels] associated therewith. Methods: The study population consisted of 416 female patients and divided into two groups as the type 2 diabetes mellitus DM, n=208 and the IGT n=208 group. Serum HbA1c and creatinine levels and leukocyte counts, glucose level and microalbumin level in the urine, were measured in the biochemistry laboratory. GFR was calculated using the Cockcroft-Gault formula. Urine samples were inoculated on blood agar and EosinMethylene Blue agar medium and incubated for 24-48 hour at 37°C. Results: ASB was determined in 5 patients 2% in the DM group and in 15 patients 7% in the IGT group. UTI was detected in 9 patients 4% in the diabetic group and in 7 patients 3% in the IGT group p>0.05 . Pyuria was found as an ASB-related risk factor in both groups p

Anahtar Kelimeler

• diabetes mellitus, impaired glucose tolerance, urinary tact infection, asymptomatic bacteriuria

Kaynakça

1. Galkina E, Ley K. Leukocyte recruitment and vascular injury in diabetic nephropathy. J Am Soc Nephrol, 2006; 17: 368-77.
2. Van Oostrom AJ, Van Wijk JP, Sijmonsma TP, Rabelink TJ, Castro Cabezas M. Increased expression of activation markers on monocytes and neutrophils in type 2 diabetes. Neth J Med, 2004; 62(9): 320-5.
3. Boyko EJ, Fihn SD, Scholes D, Abraham L, Monsey B. Risk of urinary tract infection and asymptomatic bacteriuria among diabetic and nondiabetic postmenopausal women. Am J Epidemiol, 2005; 161(6): 557-64.
4. American Diabetes Association, et al. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010; 33(suppl 1): S62-S69.
5. Siu AL, Screening for abnormal blood glucose and type 2 diabetes mellitus: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med, 2015; 163: 861-8.
6. Renko M, Tapanainen P, Tossavainen P, Pokka T, Uhari M. Meta-analysis of the significance of asymptomatic bacteriuria in diabetes. Diabetes Care, 2011; 34(1): 230-5.
7. Baron EJ, Miller JM, Weinstein MP, Richter SS, Gilligan PH, Thomson RB, et al. A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2013 recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis, 2013; 57 (4): e22-e121.
8. McCarter YS, Burd EM, Hall GS, Zervos M (eds). Cumitech 2C: Laboratory diagnosis of urinary tract infections. Washington, DC: ASM Press, 2009. Botev R, Mallié JP, Couchoud C, Schück O, Fauvel JP, Wetzels JF, et al. Estimating glomerular filtration rate: Cockcroft-Gault and modification of diet in renal disease formulas compared to renal inulin clearance. Clin J Am Soc Nephrol, 2009; 4: 899-906.

9. 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; 25: 389-93.
10. Nitzan O, Elias M, Chazan B, Saliba W. Urinary tract infections in patients with type 2 diabetes mellitus: review of prevalence, diagnosis, and management. Diabetes Metab Syndr Obes, 2015; 26(8): 129-36.
11. Muller LMAJ, Gorter KJ, Hak E, Goudzwaard WL, Schellevis FG, Hoepelman AIM, et al. Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clin Infect Dis, 2005; 41:281–8.
12. Hoepelman AI, Meiland R, Geerlings SE. Pathogenesis and management of bacterial urinary tract infections in adult patients with diabetes mellitus. Int J Antimicrob Agents, 2003; 22 (Suppl 2):35-43.
13. Turan H, Serefhanoglu K, Torun AN, Kulaksizoglu S, Kulaksızoglu M, Pamuk B, et al. Frequency, risk factors, and responsible pathogenic microorganism of asymptomatic bacteriuria in patients with type 2 diabetes mellitus. Jpn J Infect Dis, 2008; 61: 236-8.
14. Boroumand MA, Sam L, Abbasi SH, Salarifar M, Kassaian E, Forghani S. Asymptomatic bacteriuria in type 2 Iranian diabetic women: a cross sectional study. BMC Womens Health, 2006; 6:4 doi:10.1186/1472-6874-6-4.
15. Burd EM, Kehl KS. A critical appraisal of the role of the clinical microbiology laboratory in the diagnosis of urinary tract infections. J Clin Microbiol, 2011; 49 (suppl 9): S34–8.
16. National Guideline Clearinghouse 2008. Guideline synthesis: uncomplicated urinary tract infection. http:// www.guideline.gov Accessed November 2010. management of
17. Raz R. Asymptomatic bacteriuria. Clinical significance and management. Int J Antimicrob Agents, 2003; 22(suppl 2): 45–7.
18. Fünfstück R, Nicolle LE, Hanefeld M, Naber KG. Urinary tract infection in patients with diabetes mellitus. Clin Nephrol, 2012; 77(1):40-8.
19. Al-Rubeaan KA, Moharram O, Al-Naqeb D, Hassan A, Rafiullah MR. Prevalence of urinary tract infection and risk factors among Saudi patients with diabetes. World J Urol, 2013; 31(3): 573-8.
20. Wilke T, Boettger B, Berg B, Groth A, Mueller S, Botteman M, et al. Epidemiology of urinary tract infections in type 2 diabetes mellitus patients: An analysis based on a large sample of 456,586 German T2D patients. J Diabetes Complications, 2015; 29(8):1015-23
21. Bonadio M, Boldrini E, Forotti G, Matteucci E, Vigna A, Mori S, et al. Asymptomatic bacteriuria in women with diabetes: influence of metabolic control. Clin Infect Dis, 2004; 38(6): e41-5.
22. Hiamanshu D, Singhal S, Vaish AK, Singh M, Rana H, Agrawal A. A study of asymptomatic bacteriuria in North Indian type 2 diabetic patients. Int J Dev Ctries, 2015; 6(11): 620. doi:10.4172/2155- 6156.1000620.
23. Ishay A, Lavi I, Luboshitzky R.Prevelance and risk factors for asymptomatic bacteriuria in women with type 2 diabetes mellitus. Diabet Med, 2006; 23(2): 185-8.
24. Rawat V, Singhai M, Kumar A, Jha PK, Goyal R. Bacteriological resistance profile in isolate from diabetic patients. N Am J Med Sci, 2012; 4(11): 563-8.
25. Dalal S, Nicolle L, Marss CF, Zahnag L, Harding G, Foxman B. Long-term Escherichia coli asymptomatic bacteriuria among woman with diabetes mellitus. Clin Infect Dis, 2009; 49: 491-7. Stoeckle M, Kaec C, Trampuz A, Zimmerli W. The role of diabetes mellitus in patientswith bloodstream infections. Swiss Med Wkly 2008; 138(35–36): 512–9.
26. Harding GK, Zhanel GG, Nicolle LE, Cheang M. Manitoba Diabetes Urinary Tract Infection Study Group. Antimicrobial treatment in diabetic women with asymptomatic bacteriuria. N Engl J Med, 2002; 347(20):1576–83.