ABSTRACT
Andy I.M. Hoepelman Department of Medicine, Division Acute Medicine & Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
INTRODUCTION
Urinary tract infections (UTIs) are among the most common bacterial infections [1]. Up to 50 percent of women report having had at least one UTI in their lifetimes.[2] Uncomplicated UTIs occur most often in young healthy adult women and are easy to treat. However, in other patient groups, UTIs can have a complicated course, are more difficult to treat, and often recur. Complicated UTIs occur most commonly in patients with abnormalities of the genitourinary tract. However, also other subtle conditions such as age over 65 years, treatment with immunosuppressive drugs, the presence of Human Immunodeficiency Virus (HIV)-infection and last but not least diabetes mellitus (DM) predispose to an enhanced susceptibility for the development of a UTI with a complicated course.[3,4]
DM is the most common endocrine disease. Besides organ complications as retinopathy, nephropathy and neuropathy, diabetic patients also suffer more frequently from (complicated) infections compared to nondiabetic patients. In a large study of bacteremic patients, it was demonstrated that two thirds of the patients had DM; the urinary tract was the most prevalent infection site.[5]
In this chapter we focus on UTIs, although we are aware that infections elsewhere are also very important, particularly in men with DM. Furthermore it is important to realize that most of the research described here, has been performed in female patients, who have a higher prevalence of UTIs than men. First, this article describes shortly the specific aspects on the epidemiology, pathogenesis, clinical presentation and consequences of asymptomatic and symptomatic UTIs in adult patients with DM, followed by a more extensive description of the management of bacteriuria in these patients. Because of the specialized character, the treatment of the complications of UTIs will not be described.
