Management of bacterial urinary tract infections in adult patients with diabetes mellitus.

Urinary tract infections (UTIs) are more common and tend to have a more complicated course in patients with diabetes mellitus than in the general population. The mechanisms that potentially contribute to the increased prevalence of both asymptomatic and symptomatic bacteriuria in these patients are defects in the local urinary cytokine secretions and an increased adherence of the microorganisms to the uroepithelial cells. The need for treatment of asymptomatic bacteriuria remains controversial. No evidence is available on the optimal treatment of acute cystitis and pyelonephritis in patients with diabetes. Because of the frequent (asymptomatic) upper tract involvement and the possible serious complications, many experts recommend a 7- to 14-day oral antibacterial regimen for bacterial cystitis in these patients, with an antibacterial agent that achieves high concentrations both in the urine and in urinary tract tissues. The recommended treatment of acute pyelonephritis does not differ from that in patients without diabetes. Clinical trials specifically dealing with the treatment of UTIs in patients with diabetes, comparing the optimal duration and choice of antibacterial agent, are needed. In addition, new approaches to preventive strategies must prove their value in this specific patient group.