Community-acquired febrile urinary tract infection in diabetics could deserve a different management: a case-control study

Abstract. Horcajada JP, Moreno I, Velasco M,Marti´nez JA, Moreno-Marti´nez A, Barranco M,Vila J, Mensa J (Hospital Cli´nic Universitari-IDIBAPS, Barcelona, Spain) Community-acquiredfebrile urinary tract infection in diabetics coulddeserve a different management: a case–controlstudy. J Intern Med 2003; 254: 280–286.Objective. To investigate if there are relevantdifferences in clinical, microbiological and outcomecharacteristics of community-acquired febrileurinary tract infection (UTI) between diabetic andnondiabetic patients.Design. A prospectively matched case–control study.Setting. An 800-bed tertiary care university-affiliated hospital.Subjects. A total of 108 patients (54 diabetic and 54nondiabetic patients matched by age and gender)admitted between January 1996 and September1999 with febrile UTI.Methods. Clinical, analytical, microbiological andoutcome variables were analysed by means ofMcNemar test (categorical) or Wilcoxon matchedpairs signed rank test (continuous).Results. Mean age (SD) in both groups was 67.9(14.4) years. In comparison with controls, diabeticpatients were more likely to have fever withoutlocalizing symptoms (27% vs. 9%, P £ 0.0001),diminished consciousness level at admission (25%vs. 10%, P ¼ 0.03), aetiological microorganismdifferent from Escherichia coli (17% vs. 0,P ¼ 0.0004), and quinolone-resistant bacteria(17% vs. 3.7%, P ¼ 0.07). Duration of fever afterthe onset of treatment was 1.75 (1) days in diabeticsand 1.5 (1.1) days in nondiabetics (P ¼ 0.17).However, diabetic patients had a longerhospitalization [5.2 (3.3) days] than nondiabetics[3.9 (2.6) days, P ¼ 0.006].Conclusions. In diabetic patients, febrile UTIs haveclinical and microbiological peculiarities that mayhave diagnostic and therapeutic implications.Keywords: case–control study, diabetes, febrileurinary tract infection.