Consequences Of Asymptomatic Bacteria

Recently, a large study among 796 sexually active, non-pregnant women without DM (age 18-40 years old), identified ASB as a strong predictor of a subsequent symptomatic UTI [34] In (other) studies of non-diabetic patients, it was suggested that ASB can lead to recurrent UTIs, progressive renal impairment, hypertension, and an increased mortality [35], although most authors agree that ASB per se in a healthy individual causes no harm [36,37]. However, despite the high prevalence of ASB among women with DM, little is known about the consequences in this specific population [12,7]. In the study mentioned earlier, we have shown that women with DM type 2 with ASB at baseline had an increased risk of developing a UTI during the 18-month follow-up, compared to women with DM type 2 without ASB at baseline (17% without ASB versus 27% with ASB, p=0.02). In contrast, we did not find a difference in the incidence of asymptomatic UTI between DM type 1 women with and without ASB. However, a more interesting finding was that women with DM type 1 and ASB had tendency to a faster decline in renal function than those without ASB (relative increase in creatinin 4.6% versus 1.5%, p=0.2) [28]. If longer follow-up studies, as ongoing in our center, show that ASB contributes to the development of diabetic nephropathy, this would have important consequences. Diabetes now accounts for 35% of all new cases of end-stage renal disease in the United States, and persons with DM make up the fastest growing group of renal dialysis and transplant recipients [38,39].

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