Diabetes and Risk of Community-Acquired Respiratory Tract Infections, Urinary Tract Infections, and Bacteremia

The risk of asymptomatic bacteriuria and cystitis is 1.5 to 2 times increased in diabetes patients, while their risk of pyelonephritis may be 2 to 4 times increased. Treatment of asymptomatic bacteriuria in diabetes is generally not recommended. Diabetes duration and chronic complications including cystopathy appear to be more important risk factors than current glycemic control, but further evidence is needed. Modifiable risk factors for urinary tract infection are the same as in persons without diabetes.

The risk of bacteremia due to pneumococci is approximately 1.5 times increased in diabetes, similar to the increased risk for pneumonia. In comparison, diabetes is associated with 2.5 to 3 times increased risk for bacteremia due to E. coli and other enterobacteria, often due to a urinary tract focus. Diabetes is also associated with a 2 times increased risk for hemolytic streptococcal bacteremia, and 3 times increased risk for invasive group B streptococcal infection. Limited data is available for staphylococcal bacteremia.

Increased infection surveillance and unmeasured confounding factors among diabetic patients may contribute to the observed increased infection risk, yet outcomes following infection are similar or worse in diabetes patients. In conclusion, there is epidemiological evidence that individuals with diabetes have a substantially increased risk of a number of important infections. Clinicians should remain vigilant for infections in this increasing group of patients.