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

Objective. To investigate if there are relevant differences in clinical, microbiological and outcome characteristics of community-acquired febrile urinary tract infection (UTI) between diabetic and nondiabetic 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 54 nondiabetic patients matched by age and gender) admitted between January 1996 and September 1999 with febrile UTI. Methods. Clinical, analytical, microbiological and outcome variables were analysed by means of McNemar test ( categorical) or Wilcoxon matched pairs signed rank test (continuous). Results. Mean age (SD) in both groups was 67.9 (14.4) years. In comparison with controls, diabetic patients were more likely to have fever without localizing symptoms (27% vs. 9%, P less than or equal to 0.0001), diminished consciousness level at admission (25% vs. 10%, P = 0.03), aetiological microorganism different from Escherichia coli (17% vs. 0, P = 0.0004), and quinolone-resistant bacteria (17% vs. 3.7%, P = 0.07). Duration of fever after the onset of treatment was 1.75 (1) days in diabetics and 1.5 (1.1) days in nondiabetics (P = 0.17). However, diabetic patients had a longer hospitalization [5.2 (3.3) days] than nondiabetics [3.9 (2.6) days, P = 0.006]. Conclusions. In diabetic patients, febrile UTIs have clinical and microbiological peculiarities that may have diagnostic and therapeutic implications.