What is the appropriate management for this woman with diabetes who has been found to have asymptomatic bacteriuria?
Jean, a 57-year-old woman with type 2 diabetes, has come in today to discuss her routine blood test results, which were organised last week by your registrar. Jean is taking metformin and an ACE inhibitor. Her blood pressure is well controlled at 126/78 mmHg. Jean’s HbA1c is within target range and her eGFR has been stable (50 to 55 mL/min/1.73m2) for the past two years. A renal ultrasound past year showed no obstruction or other abnormality. Jean’s urinary albumin–creatinine ratio was normal when checked three months ago.
Last week, your registrar found nitrites and leucocytes in Jean’s urine on dipstick testing and sent a mid-stream urine sample for culture. The pathology report showed a pure culture of Escherichia coli with accompanying pyuria. Jean feels well, with no urgency, frequency, dysuria or nocturia.
How should Jean’s results be interpreted and what is appropriate management?