Complications
Serious and well known consequences in patients
with diabetes mellitus involve pyelonephritis,
including emphysematous pyelonephritis, bacteraemia
and urosepsis. Tsu et al. [7&] confirmed in a
retrospective study that most (66.7%) patients with
emphysematous pyelonephritis suffered from diabetes.
High tissue glucose levels, creating a favourable
environment for the growth and multiplication
of microorganisms, might be one of the aspects in
the pathogenesis of this severe kind of pyelonephritis.
A case report described bilateral emphysematous
pyelonephritis caused by Escherichia coli in
combination with a splenic abscess in a 66-yearold
woman with untreated diabetes [8].
A number of recently published studies focused
on the association between UTI and bladder or
kidney function. Chiu et al. [9&&] showed that UTI
in diabetic patients with late-stage chronic kidney
disease was associated with reversible superimposed
acute kidney injury. In addition, recurrent UTI was
found to be associated with impaired voiding function
and diabetic bladder dysfunction in women
with type 2 diabetes mellitus [10&]. Diabetes mellitus
with complications was an independent predictor of
major abnormalities (for instance hydronephrosis
or urolithiasis) on ultrasonography or computed
tomography (CT) scan in adult patients with community-
acquired urosepsis [11]. In addition, a study
of 271 E. coli random urine and bloodstream isolates
performed in Taiwan by Wang et al. [12&] demonstrated
that poorer glycaemic control and more
virulent E. coli isolates were more often associated
with the presence of urosepsis in diabetic patients
(80% women) than the presence of only ASB or UTI
in this patient group.