1. Introduction

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Asymptomatic bacteriuria (ABU) is frequently observed in women and is defined as intense bacterial excretion in the urine without any complaint.In the current European guideline, if at least 2 urine cultures of more than 24 hours in a woman without a complaint, the same bacteria is produced above 105 cfu, this is defined as asymptomatic bacteriuria. The only difference between women in men is to show bacterial load in a single culture is sufficient for the definition of asymptomatic bacteriuria [1,2].The prevalence of ABU in women with diabetes mellitus (DM) is approximately three times higher than non-diabetic women [3-6].In patients with DM, ABU may occur due to inadequate control of blood glucose levels, neurogenic bladder, chronic urinary retention, leukocyte dysfunction, recurrent vaginitis, diabetic microangiopathy [3,7].In addition, poor perineal hygiene contributes to urinary tract infection especially in immunocompromised diabetic women.

2. Materials And Methods

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A total of 138 patients with type 2 diabetes, 88 women and 50 men, who were admitted to the internal medicine clinic of Antalya Kepez State Hospital between October 2018 and December 2018 were included in the study. HBA1c levels, urine microscopic examinations and urine cultures were retrospectively evaluated from the patient records.

3. Results

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Of 138 patients, 88 were female (63.8%) and 50 male (36.2%). Of the patients, 13 (81.2%)were females and 3 (18.8%) were males. In 16 patients, urine cultures showed growth in 105cfu \ ml. Three female patients had dysuria and the other patients had no symptoms. The mean age of patients with urine growth was 60.1 and mean HBA1c was 8.7%. In the urine analysis, 4 patients were found to have pyuria. Risk factors for urinary tract infection due to diabetes were given in Table 1. Active distribution of reproduction; In 10 patients (62.5%) Eschrichia coli, in 2 patients (12.5%) Streptococcus agalactiae, in 2 patients (12.5%) Klebsiella spp., In 1 patient (6%) Candida spp. and coagulase negative staphylococci in 1 patient.

The demographic distribution and distribution of factors are shown in Table 2. 13 of the patients had contamination in the urine culture. All of these patients were female (100%) and the mean age was 52.8 years.When diabetic patients were examined according to blood HbA1c level; Themean HbA1c value of the 13 female patients who had contamination in the urine culture was 9.4%.The mean HbA1c value of 16 patients with urine culture was found to be 8.7%.

Table1    Table2

4. Discussion

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Of the 138 patients who were screened in our study, 3 had symptomatic urinary tract infection and 13 patients had ABU, and all of the symptomatic patients were female (100%). Three of the female patients were symptomatic (3.4%).The rate of ABU was 26% in diabetic women and 6% in non-diabetic women [9,10]. In our study, ABU was found in 14.7% of female diabetic patients. The mean age was 60.2 and 81% of the cases were female.In postmenopausal women, vaginal Ph drops due to the lack of estrogen, the colonization of lactobacilli decreases.Thus, it facilitates colonization of the vagina with the possible uropathogens originating from the gastrointestinal tract. This may be explained by the high prevalence of ABU in males and females compared with males [8].The mean HbA1C level was 8.7% in patients with symptomatic urinary tract infection and ABU. This shows poor glycemic control. Diabetes regulation can be thought to reduce the rate of morbidity. Keleştimur and colleagues were reported to have ABU in 32% of diabetic patients with high HbA1C levels and in 7% of patients with normal HbA1c levels [11].

The most common cause of ABU is aeropo-gram-negative bacteria. Escherichia coli is isolated from 70-75% of samples. Klebsiella pneumoniae and Enterebacter spp.saptanir in 12-23% of cases. It is not uncommon for group B streptococci and Pseudomonas species to become ABU agents [3,12,13]. In our study, 10 (62.5%) of 16 reproduction were E.coli. The diagnosis of symptomatic urinary tract infection may be difficult in the elderly. Patients with dysuria, urinary frequency, new onset urinary incontinence, side pain, and fever may not have symptoms such as urinary incontinence. In patients, ABU is caused by its own gastrointestinal flora and the use of antibiotics leads to the development of resistant strains.All 13 cases with contamination were female. Naturally, anatomical reasons, vaginal flora, short urethra, lactobacilli and hygiene factor affect this condition [14].It is a known fact that treatment of ABU in many cases is unnecessary due to antibiotic cost and side effects.In the presence of ABU, the recommended treatment groups consist of pregnant women, surgical interventions, renal transplant recipients and children [15].

5. Conclusion

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The risk of urinary tract infection increases in diabetic postmenopausal patients with poor glycemic control. Genital region hygiene and prevention of urinary tract infections should be explained in patients undergoing diabetes education.