Résumé :
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[BDSP. Notice produite par INIST-CNRS R0xV2JcX. Diffusion soumise à autorisation]. 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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