Abstract
The prevalence of asymptomatic bacteriuria (ASB) in women with diabetes mellitus (DM) is increased. In this thesis different aspects of ASB in this patient group are described, focusing on the pathogenesis, the different methods of diagnosis, and the consequences on the long term. In the first part, it is described
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that the adherence of type 1-fimbriated E. coli to uroepithelial cells of women with DM is increased, compared to the adherence to uroepithelial cell of women without DM. This may play a role in the increased prevalence. It is shown that the fimH sequence, which encodes the adhesive part of type 1-fimbriae, of E. coli strains isolated from women with DM is highly homologous to the known fimH sequence of E. coli from nondiabetic patients. The resistance rates of E. coli strains isolated from the urine of diabetic women with ASB are found to be comparable to those of routine isolates from the female population in the same area. In the second part, two alternative ways to diagnose ASB are described. First, a scoring system that is based on two variables routinely obtained in daily clinical practice (duration of DM and glycosylated hemoglobin for women with DM type 1, and age and the number of symptomatic urinary tract infections in the previous year for women with DM type 2), that in combination with a urinary leukocyte count accurately predicts the presence of ASB in women with DM. Secondly, the development and validation of a real-time Polymerase Chain Reaction (PCR)-based assay to diagnose E. coli bacteriuria are described. Despite the high prevalence of ASB, little is known about the possible consequences on the long term. It was investigated whether Escherichia coli bacteriuria was associated with a decline in renal function, the development of end-stage renal failure, or with hypertension in a healthy female population and in women with DM after a long-term follow-up. E. coli bacteriuria was not associated with a decline in renal function or with the development of end-stage renal failure in a population of generally healthy adult women during 12 to 14 years of follow-up. However, a strong association was found between E. coli bacteriuria and hypertension in the same population. Finally, the results of a prospective multicenter study are described that show that ASB does not lead to a faster decline in renal function or to the development of hypertension in women with DM type 1 or type 2 after six years of follow-up. Therefore, we conclude that screening of and subsequent treatment for ASB are not indicated in women with DM type 1 or type 2.
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