1074. Diabetes Mellitus Is Not Associated with Adverse Outcome of Febrile Urinary Tract Infection
Session: Poster Abstract Session: Infection in Immunocompromised Patients
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Diabetes mellitus (DM) is considered a risk factor for febrile urinary tract infection (UTI), but the association of DM with the subsequent course of disease and outcome is unclear.

Methods: A prospective observational multicenter cohort study included consecutive adult patients with febrile UTI presenting at emergency departments of 7 hospitals and 35 primary care units. The effect of pre-existing DM on microbiological etiology, bacteremia and ICU admission, duration of fever and hospital admission, clinical and microbiological failure within 1 month, and 30-day mortality was assessed by multivariable logistic regression to establish whether DM is an independent risk factor for adverse outcomes. Factors included in the model were age, sex, DM, comorbidities, and presence of SIRS-criteria at presentation.

Results: Of 858 consecutive patients, 140 had DM (94% type II DM). Patients with DM were older (median 73 [IQR 60-80] vs 64 [IQR 61-81] yr), predominantly male (48% vs 35%, p 0.006), had more comorbidity (74% vs 52%, p <0.001), and were more frequently admitted to hospital (81% vs 64%, p<0.001) compared to 718 patients without DM.  Escherichia coli (52-58%) was the most common causal uropathogen in both groups, whereas Klebsiella spp (9.0% vs 4.9%, p 0.03) and Enterococcus spp (10.5% vs 4.1%, p<0.001) were more frequently found in DM. DM was not associated with longer fever duration (all median 2. 0 [IQR 1.0-3.0] d), prolonged hospital admission (overall median 6.0 [IQR 4.0-11.5] d) or clinical failure (OR 1.10, 95%-CI: 0.72-1.69), compared to those without DM. Patients with DM more often had bacteremia (OR 1.55, 95% CI 1.03-2.34), ICU admission (2.08, 95% CI 0.94-4.59), microbiological failure (OR 3.03, 95% CI 1.69-5.47) and mortality within 30 days (3.29, 95% CI 1.34-8.09). However, when adjusted for possible confounders and comorbidity, DM was not an independent risk factor for any of these adverse outcomes.

Conclusion: Although it is widely held that patients with DM have a more complicated course of infections, our data show that DM is not associated with adverse outcomes in an unselected population of patients with febrile UTI.


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Willize E. van der Starre, MD1, Hanneke Borgdorff1, Albert M. Vollaard, MD, PhD1, Cees van Nieuwkoop, MD, PhD1,2, Jan W. van 't Wout, MD, PhD1,3, Ida C. Spelt, MD4, Jeanet W. Blom, MD, PhD5, Eliane M.S. Leyten, MD, PhD6, Ted Koster, MD, PhD7, Nathalie M. Delfos, MD8, Hans C. Ablij, MD9 and Jaap T. van Dissel, MD, PhD1, (1)Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands, (2)Haga Hospital, The Hague, Netherlands, (3)Bronovo Hospital, The Hague, Netherlands, (4)Primary Health Care Center, Wassenaar, Netherlands, (5)Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands, (6)Medical Center Haaglanden, The Hague, Netherlands, (7)Groene Hart Hospital, Gouda, Netherlands, (8)Rijnland Hospital, Leiderdorp, Netherlands, (9)Diaconessenhuis Leiden, Leiden, Netherlands

Disclosures:

W. E. van der Starre, None

H. Borgdorff, None

A. M. Vollaard, None

C. van Nieuwkoop, None

J. W. van 't Wout, None

I. C. Spelt, None

J. W. Blom, None

E. M. S. Leyten, None

T. Koster, None

N. M. Delfos, None

H. C. Ablij, None

J. T. van Dissel, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.