[Asymptomatic bacteriuria: which management in patients with diabetes mellitus?]

Most of the research about asymptomatic bacteriuria (ASB) in patients with diabetes mellitus has been performed in female patients, with a prevalence of approximately 7-13 %, about 3 to 4 times higher than that reported for nondiabetic women. Poor metabolic control, as assessed by haemoglobin A1c or glucosuria, is not associated with increased ASB. The latter is associated with an increased risk of symptomatic urinary tract infection among patients with type 2 diabetes, but not type 1 diabetes. These infections tend to be more complicated and caused by more resistant organisms than reported for nondiabetic patients. Despite this, systematic screening for and treating ASB have not been shown to reduce long-term complications, such as accelerated progression to arterial hypertension or renal failure, or symptomatic urinary tract infections (including pyelonephritis) or hospitalization for these infections. Thus, available evidence does not support systematic screening and antimicrobial treatment of ASB among patients with diabetes mellitus.