In the Journals

Asymptomatic bacteriuria no more prevalent in female ARD patients than healthy controls

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December 31, 2014

Asymptomatic bacteriuria appeared to be prevalent among immunocompromised women with autoimmune rheumatic disease, but it was no more common in this population than in healthy women, according to recent study data.

In a case-controlled, prospective study, researchers evaluated 260 consecutive women who presented with autoimmune rheumatic disease (ARD) to the outpatient rheumatology clinic of a tertiary care hospital in Athens, Greece. Eligible patients were seen between February 2010 and April 2012, were aged older than 14 years and had no baseline symptoms of urinary tract infection (UTI). The researchers also enrolled age-matched women (n=238) attending the hospital’s ambulatory endocrinology clinic for comparison.

All patients and controls were screened at baseline for asymptomatic bacteriuria through two urine cultures within 1 week. Baseline data also were collected, including demographic characteristics, type and duration of ARD, diabetes mellitus history and history of UTI.

The researchers found that 93.5% of ARD patients were undergoing treatment with immunosuppressive agents. Asymptomatic bacteriuria was identified in 24 of the ARD patients (9.2%) and in 22 of the control patients (9.2%; P=1). Escherichia coli was the most prevalent pathogen detected (66%) in the ARD patients. Among the independent predictors of asymptomatic bacteriuria were diabetes (adjusted OR=6.597; 95% CI, 1.633-26.649) and ARD duration longer than 84 months (aOR=4.428; 95% CI, 1.287-15.232). Nine patients with baseline asymptomatic bacteriuria remained bacteriuric for the 1-year study period, while 11 were sporadically bacteriuric. Four of the 24 patients (16.7%) with asymptomatic bacteriuria at baseline developed symptomatic UTI, while 29 of the 236 patients (12.3%) without baseline asymptomatic bacteriuria developed symptomatic UTI (P=.522).

According to the researchers, these findings suggest screening for asymptomatic bacteriuria in women with ARD may not be warranted.

“The occurrence of [asymptomatic bacteriuria] was detected in a substantial proportion of immunocompromised women with ARD studied; however, its prevalence was not significantly higher than that of age-matched women without ARD,” they wrote. “At 12 months of follow-up, baseline [asymptomatic bacteriuria] was persisting in the majority of the patients, but it was not associated with higher risk for symptomatic or severe UTI. Thus, screening for or treatment of [asymptomatic bacteriuria] in women with ARD does not appear justified.”

Disclosure: The researchers report no relevant financial disclosures.

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