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Prediction of complicated urinary tract infections in patients with type 2 diabetes: a questionnaire study in primary care

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Abstract

Background

Relatively few data are available to predict a complicated course of community-acquired complicated urinary tract infections (UTIs) in patients with diabetes type 2 (DM2). The aim of this study was to assess predictors for a complicated course of UTIs in DM2 patients in primary care.

Method

We conducted a cross-sectional questionnaire study among DM2 patients aged over 45 years as part of an educational trial. The combined outcome measure was a complicated course of UTI, defined as a self-reported episode of acute pyelonephritis, prostatitis or recurrent cystitis in the 12 months before the trial. Patients with an outcome were all verified by review of medical records. A prediction model was derived with multivariable logistic regression analysis.

Results

Of the 1151 trial participants, 94 (8%) had a self-reported community-acquired complicated course of UTIs and 62 (66%) of these were medically-attended. Independent predictors for a complicated course were age above 60 years (adjusted odds ratio (OR): 1.74; 95% confidence interval (CI): 0.99–3.03), chronic use of antibiotics (adjusted OR: 5.50; 95% CI: 2.31–13.08), more than 6 physician contacts in previous year (adjusted OR: 3.60; 95% CI: 2.00–6.49), hospitalization in previous year (adjusted OR: 1.36; 95% CI: 1.00–1.85), renal disease (adjusted OR: 4.92; 95% CI: 1.59–15.18) and incontinence of urine (adjusted OR: 3.78; 95% CI: 1.93–7.38). Area under the receiver-operating curve was 0.72 (95% CI: 0.66–0.78). Analysis according to medically attended complicated UTIs did not change our findings.

Conclusion

Easily obtainable predictors from medical history can be used to accurately predict a complicated course of UTIs in DM2 patients.

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Abbreviations

AUC:

Area under the curve

CI:

Confidence interval

DM2:

Type 2 diabetes mellitus

GP:

General practitioner

OR:

Odds ratio

SD:

Standard deviation

UTI:

Urinary tract infection

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Acknowledgements

We thank the general practitioners and diabetic patients who participated in this study and we acknowledge Mrs. M. Smit for her administrative assistance.

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Authors and Affiliations

  1. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. 85500, 3508 6A, Utrecht, The Netherlands

    Leonie M. A. J. Venmans, Marian Sloof, Eelko Hak, Kees J. Gorter & Guy E. H. M. Rutten

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  1. Leonie M. A. J. Venmans
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  2. Marian Sloof
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  3. Eelko Hak
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  4. Kees J. Gorter
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  5. Guy E. H. M. Rutten
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Correspondence to Leonie M. A. J. Venmans.

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Venmans, L.M.A.J., Sloof, M., Hak, E. et al. Prediction of complicated urinary tract infections in patients with type 2 diabetes: a questionnaire study in primary care. Eur J Epidemiol 22, 49–54 (2007). https://doi.org/10.1007/s10654-006-9077-y

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  • DOI: https://doi.org/10.1007/s10654-006-9077-y

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