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Eshwarappa M, Rao MY, KC G, MS G, Swaroop A, Suryadevara S. Clinico-microbiological Profile and Outcomes of Asymptomatic Bacteriuria in Pregnancy. Indian J Nephrol 2024; 34:134-138. [PMID: 38681000 PMCID: PMC11044665 DOI: 10.4103/ijn.ijn_305_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 05/10/2022] [Indexed: 05/01/2024] Open
Abstract
Background Asymptomatic bacteriuria (ASB) during pregnancy can lead to symptomatic urinary tract infection (UTI), with increased fetal and maternal morbidity and mortality. We evaluated the incidence, clinical and microbiological profile, and outcome of ASB in pregnant women attending our antenatal clinic. Materials and Methods This prospective study was conducted on 3769 pregnant women in a routine antenatal clinic at a tertiary care center. Participants were divided into two groups, ASB and non-bacteriuria. Data were collected in a standard proforma and analyzed using the software Statistical Package for the Social Sciences (SPSS) v. 20. Results The incidence of ASB was 3.29% (124/3769). Majority of the women were in the age group of 21-30 years (78.76%, n = 89). Escherichia coli (61.06%) was the most common organism isolated. Maternal anemia (30.08% and 2.93% in the ASB and non-bacteriuria groups, respectively), low birth weight (LBW; 42.5% and 27.98% in the ASB and non-bacteriuria groups, respectively), intrauterine death (4.4% and 1.4% in the ASB and non-bacteriuria groups, respectively), and preterm delivery (37.2% and 22.31% in the ASB and non-bacteriuria groups, respectively) were were associated with ASB (P = 0.001). Conclusion ASB was associated with maternal anemia, preterm delivery, intrauterine death, and LBW. Early detection and treatment of ASB may result in favorable maternal outcome.
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Affiliation(s)
- Mahesh Eshwarappa
- Department of Nephrology, M S Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka, India
| | - Medha Y. Rao
- Department of General Medicine, M S Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka, India
| | - Gurudev KC
- Department of Nephrology, M S Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka, India
| | - Gireesh MS
- Department of Nephrology, M S Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka, India
| | - Asha Swaroop
- Department of Obstetrics and Gynecology, M S Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka, India
| | - Saritha Suryadevara
- Department of Nephrology, M S Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka, India
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Sheppard M, Ibiebele I, Nippita T, Morris J. Asymptomatic bacteriuria in pregnancy. Aust N Z J Obstet Gynaecol 2023; 63:696-701. [PMID: 37157162 DOI: 10.1111/ajo.13693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 04/11/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Asymptomatic bacteriuria (ASB) is associated with adverse maternal and neonatal outcomes and is routinely screened for and treated in the first trimester. Prevalence of ASB in the second and third trimesters of pregnancy is unknown. AIMS The aim is to determine the prevalence of ASB in the second and third trimesters of pregnancy. METHODS Prospective cohort study of 150 pregnant women. Mid-stream urine samples were tested for ASB in the second (24-28+6 ) and third (32-36+6 ) trimesters. Women were assigned to one of two groups: (i) ASB in any trimester of pregnancy and (ii) no evidence of ASB in pregnancy. Maternal and neonatal outcomes were compared between groups. RESULTS Among 143 women included in the study, the rate of ASB was 4.9% (2.1, 2.1 and 3.2% in the first, second and third trimesters, respectively). Of those with ASB, 14% had it in every trimester, whereas 43% had it on two or more samples. Of those with ASB in pregnancy, 43% were detected for the first time in the third trimester. Rates of maternal and neonatal outcomes were not statistically significantly different between the two groups. No women with ASB were induced for chorioamnionitis or growth restriction. CONCLUSION The rate of ASB was highest in the third trimester of pregnancy, with rates of 2.1, 2.1 and 3.2% in the first, second and third trimesters, respectively. This study was underpowered to assess maternal and fetal outcomes. Although numbers were small, the absence of ASB in the first trimester was a poor predictor of ASB in the third trimester.
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Affiliation(s)
- Madeleine Sheppard
- Faculty of Medicine and Health, Reproduction and Perinatal Centre, The University of Sydney, New South Wales, Sydney, Australia
- Kolling Institute, Northern Sydney Local Health District, New South Wales, St Leonards, Australia
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, New South Wales, St Leonards, Australia
| | - Ibinabo Ibiebele
- Faculty of Medicine and Health, Reproduction and Perinatal Centre, The University of Sydney, New South Wales, Sydney, Australia
- Kolling Institute, Northern Sydney Local Health District, New South Wales, St Leonards, Australia
| | - Tanya Nippita
- Faculty of Medicine and Health, Reproduction and Perinatal Centre, The University of Sydney, New South Wales, Sydney, Australia
- Kolling Institute, Northern Sydney Local Health District, New South Wales, St Leonards, Australia
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, New South Wales, St Leonards, Australia
| | - Jonathan Morris
- Kolling Institute, Northern Sydney Local Health District, New South Wales, St Leonards, Australia
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, New South Wales, St Leonards, Australia
- Clinical Excellence Commission, New South Wales Ministry of Health, New South Wales, Sydney, Australia
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Agarwal A, Pandey S, Maheshwari U, Singh MP, Srivastava J, Bose S. Prevalence of Asymptomatic Bacteriuria and Antimicrobial Resistance Profile among Pregnant Females in a Tertiary Care Hospital. Indian J Community Med 2021; 46:469-473. [PMID: 34759490 PMCID: PMC8575230 DOI: 10.4103/ijcm.ijcm_792_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 04/16/2021] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives: Urinary tract infection (UTI) is the most common clinical finding during pregnancy, and if it is asymptomatic bacteriuria (ASB), it can progress to pyelonephritis, leading to further complications. The present study aims to know the prevalence of ASB in pregnant females and the antimicrobial resistance pattern in our hospital setup. Materials and Methods: A total of 552 urine samples were collected from pregnant females (with no symptoms of UTI) both attending outpatient department and admitted in the wards of obstetrics and gynecology department. Urine culture was performed on blood agar, MacConkey agar, and UTI chromogenic agar. Antibiotic sensitivity test was done using Kirby-Bauer disc diffusion method, and the results were interpreted. Results: The prevalence rate of ASB in pregnant females was 17.4%. It was common in the age group of 25–33 years (60.4%). The infection rate was higher in the second trimester (43.7%) compared to the third (29.2%) and first (27.1%) trimester. Multiparity (60.4%) was a common finding in ASB during pregnancy. There was a significant finding of previous history of UTI (22.9%) and anemia (58.3%) associated with ASB in pregnant females. Escherichia coli (39.2%) was the most common microorganism isolated followed by Staphylococcus aureus (34.3%), Enterococcus faecalis (14.7%), Klebsiella (4.9%), coagulase-negative Staphylococcus spp. (2.9%), and Citrobacter and Acinetobacter (1.9%). Most sensitive drugs to be given in ASB during pregnancy were nitrofurantoin and fosfomycin. Conclusion: It was emphasized that urine culture should be done in early antenatal visit as routine screening to identify ASB in pregnant females as it can prevent fetal and maternal complications.
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Affiliation(s)
- Anjali Agarwal
- Department of Microbiology, Hind Institute of Medical Sciences, Barabanki, UP, India
| | - Shreya Pandey
- Department of MBBS Student, Hind Institute of Medical Sciences, Barabanki, UP, India
| | - Ujjwal Maheshwari
- Department of Cardiology, Vivekanand Polyclinic and Institute of Medical Sciences, Lucknow, India
| | - M P Singh
- Department of Community Medicine, Hind Institute of Medical Sciences, Barabanki, UP, India
| | - Jyoti Srivastava
- Department of Microbiology, Hind Institute of Medical Sciences, Barabanki, UP, India
| | - Seema Bose
- Department of Microbiology, Hind Institute of Medical Sciences, Barabanki, UP, India
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A systematic review and meta-analysis on the prevalence of Escherichia coli and extended-spectrum β-lactamase-producing Escherichia coli in pregnant women. Arch Gynecol Obstet 2021; 303:363-379. [PMID: 33386957 DOI: 10.1007/s00404-020-05903-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/17/2020] [Indexed: 01/05/2023]
Abstract
PROPOSE The aim of the present study was to determine the prevalence of E. coli and extended-spectrum β-lactamase-producing (ESBL) E. coli in pregnant women in a systematic review and meta-analysis study. METHODS We searched important databases, including Medline (PubMed), Embase, Scopus, Web of sciences, Cochrane library, Ovid, and CINHAL to retrieve all articles reporting the prevalence of ESBL E. coli in pregnant women that published from January 1990 to June 2020. RESULTS The pooled prevalence of E. coli in pregnant women with and without symptoms of UTI after combining 82 studies with a sample size of 33,118 was 29% (29%; %95 CI 23, 36%). The prevalence based on urine, Feacal, and vagina samples was 26% (% 95 CI 19-34%), 77% (% 95 CI 22-98%), and 32% (% 95 CI 17-48%), respectively. Also, 19 studies with a sample size of 9,200 reported ESBL E. coli prevalence in pregnant women. After combining the results of these studies, the pooled prevalence of ESBL E. coli in pregnant women was 34% (34%; %95 CI 24, 43%). The pooled prevalence of E. coli in pregnant women with HIV was 9%(9%; %95 CI 7, 11%). CONCLUSION According to the results of this study, the prevalence of E. coli and ESBL E. coli is high in pregnant women. Also, the overuse of antibiotics was higher in European and Asian pregnant women than other continents.
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Omidifar N, Taghi E, Mohebi S, Motamedifar M. Distribution and antimicrobial susceptibility pattern of bacterial pathogens causing urinary tract infection in pregnant women in Shiraz, Southwest Iran. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Belete MA. Bacterial Profile and ESBL Screening of Urinary Tract Infection Among Asymptomatic and Symptomatic Pregnant Women Attending Antenatal Care of Northeastern Ethiopia Region. Infect Drug Resist 2020; 13:2579-2592. [PMID: 32801795 PMCID: PMC7395684 DOI: 10.2147/idr.s258379] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/05/2020] [Indexed: 12/20/2022] Open
Abstract
Background Urinary tract infection is a common cause of morbidity in pregnant women. Emergence of antimicrobial resistance particularly ESBL production among bacterial uropathogens is increasing and becoming principal cause of treatment failure. The aim of this study was to determine the bacterial profile, their antimicrobial susceptibility patterns, risk factors and identify ESBL-producing bacterial uropathogens. Patients and Methods A hospital-based cross-sectional study was conducted in the Northeastern Ethiopia region. A total of 323 pregnant women were included and structured questionnaire was used to collect sociodemographic and risk factor-related data. About 10mL freshly voided midstream urine specimen was collected, transported and processed according to standard operating procedures. The data obtained were entered into SPSS version 22 and descriptive statistics, chi-square, bivariate and multivariate logistic regression analyses were performed. P-value ≤0.05 with corresponding 95% confidence interval were considered for statistical significance. Results The overall prevalence of UTI was 15.5% (50/323). The predominant bacterial isolates were Escherichia coli 17 (33.3%) followed by coagulase-negative staphylococci 15 (30.0%) and Staphylococcus aureus 14 (27.5%). Previous history of UTI (AOR=8.824, 95% CI: 3.769,20.654, P<0.001) and history of catheterization (AOR=3.270, 95% CI: 1.316,8.122, P=0.011) were significantly associated with the occurrence of bacterial UTI. Gram-negative isolates showed high level of resistance to ampicillin 12 (60.0%) and relatively low level of resistance to nitrofurantoin 5(25.0%), norfloxacin 5 (25.0%) and ceftazidime 3 (15.0%). Gram-positive uropathogens showed higher resistance for penicillin 29 (93.5%) and trimethoprim-sulfamethoxazole 23 (79.3%) whereas all isolates were sensitive 29 (100.0%) to nitrofurantoin. Moreover, multidrug resistance was observed among 41 (80.4%) of the isolates, and 3 (15.8%) of isolated gram-negative bacteria were ESBL producers. Conclusion High prevalence of bacterial UTI and MDR for commonly prescribed drugs were observed with significant number of ESBL producers. Therefore, instant UTI culture assessment of pregnant women, especially those having possible risk factors such as previous histories of UTI and catheterization; moreover, appropriate prescription and use of antibiotics are necessary.
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Affiliation(s)
- Melaku Ashagrie Belete
- Department of Medical Laboratory Science, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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Perlitz Y, Saffoury E, Shabso N, Labai A, Namatiyof JF, Nitzan O, Ben-Shlomo I, Azrad M, Ben-Ami M, Peretz A. Maternal and neonatal outcome of asymptomatic bacteriuria at term pregnancy. Pathog Dis 2020; 77:5565048. [PMID: 31549172 DOI: 10.1093/femspd/ftz046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/05/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Guidelines recommend antibiotic treatment for every episode of asymptomatic bacteriuria throughout pregnancy in order to reduce maternal and fetal complications. We evaluated intra- and post-partum, as well as puerperal maternal and neonatal outcomes of an untreated group of pregnant women with asymptomatic bacteriuria at term. METHODS This was a single center prospective cohort study. We enrolled women who came for labor or checkups, 37-42 weeks gestation, with singleton, vertex presentation. On admission, women gave a urine sample; we compared maternal, obstetric and neonatal data from the positive culture group to the negative culture. RESULTS Among 248 pregnant women recruited, 205 negative and 32 positive urine cultures were collected. None of the women that participated in this study developed pyelonephritis during hospitalization or during the puerperium. No significant differences were detected between the two groups in terms of age, nulliparity, gestational age at delivery, length of hospitalization, birth type, intra- or post-partum fever, antibiotic treatment during labor or post-partum. CONCLUSIONS No increased maternal or neonatal adverse effects were observed in women with untreated ASB detected at term.
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Affiliation(s)
- Yuri Perlitz
- Department of Obstetrics & Gynecology, The Baruch Padeh Medical Center Poriya, Poriya hilly region, 768 road, Poriya 15208, Israel.,The Faculty of Medicine in the Galilee, Bar Ilan University, Henrietta Szold 8, Safed 1311502, Israel
| | - Enas Saffoury
- Department of Obstetrics & Gynecology, The Baruch Padeh Medical Center Poriya, Poriya hilly region, 768 road, Poriya 15208, Israel
| | - Nora Shabso
- Department of Obstetrics & Gynecology, The Baruch Padeh Medical Center Poriya, Poriya hilly region, 768 road, Poriya 15208, Israel
| | - Aminat Labai
- Department of Obstetrics & Gynecology, The Baruch Padeh Medical Center Poriya, Poriya hilly region, 768 road, Poriya 15208, Israel
| | - Jennifer Fathy Namatiyof
- Department of Obstetrics & Gynecology, The Baruch Padeh Medical Center Poriya, Poriya hilly region, 768 road, Poriya 15208, Israel
| | - Orna Nitzan
- The Faculty of Medicine in the Galilee, Bar Ilan University, Henrietta Szold 8, Safed 1311502, Israel.,Infectious Disease Unit, The Baruch Padeh Medical Center Poriya, Poriya hilly region, 768 road, Poriya 15208, Israel
| | - Izhar Ben-Shlomo
- Department of Obstetrics & Gynecology, The Baruch Padeh Medical Center Poriya, Poriya hilly region, 768 road, Poriya 15208, Israel.,The Faculty of Medicine in the Galilee, Bar Ilan University, Henrietta Szold 8, Safed 1311502, Israel
| | - Maya Azrad
- Clinical Microbiology Laboratory, The Baruch Padeh Medical Center Poriya, Poriya hilly region, 768 road, Poriya 15208, Israel
| | - Moshe Ben-Ami
- Department of Obstetrics & Gynecology, The Baruch Padeh Medical Center Poriya, Poriya hilly region, 768 road, Poriya 15208, Israel.,The Faculty of Medicine in the Galilee, Bar Ilan University, Henrietta Szold 8, Safed 1311502, Israel
| | - Avi Peretz
- The Faculty of Medicine in the Galilee, Bar Ilan University, Henrietta Szold 8, Safed 1311502, Israel.,Clinical Microbiology Laboratory, The Baruch Padeh Medical Center Poriya, Poriya hilly region, 768 road, Poriya 15208, Israel
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Nteziyaremye J, Iramiot SJ, Nekaka R, Musaba MW, Wandabwa J, Kisegerwa E, Kiondo P. Asymptomatic bacteriuria among pregnant women attending antenatal care at Mbale Hospital, Eastern Uganda. PLoS One 2020; 15:e0230523. [PMID: 32191758 PMCID: PMC7082119 DOI: 10.1371/journal.pone.0230523] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/02/2020] [Indexed: 11/18/2022] Open
Abstract
Background Asymptomatic bacteriuria in pregnancy (ASBP) is associated with adverse pregnancy outcomes such as pyelonephritis, preterm or low birth weight delivery if untreated. The aim of this study was to determine the prevalence of asymptomatic bacteriuria, the isolated bacterial agents, and their antibiotic sensitivity patterns in pregnant women attending antenatal care at Mbale Hospital. Methods This was a cross sectional study in which 587 pregnant women with no symptoms and signs of urinary tract infection were recruited from January to March 2019. Mid-stream clean catch urine samples were collected from the women using sterile containers. The urine samples were cultured using standard laboratory methods. The bacterial colonies were identified and antibiotic sensitivity was done using disc diffusion method. Chi squared tests and logistic regression were done to identify factors associated with asymptomatic bacteriuria. A p value < 0.05 was considered statistically significant. Results Out of the 587 pregnant women, 22 (3.75%) tested positive for asymptomatic bacteriuria. Women aged 20–24 years were less likely to have ASBP when compared to women aged less than 20 years (AOR = 0.14, 95%CI 0.02–0.95, P = 0.004). The most common isolates in descending order were E. coli (n = 13, 46.4%) and S.aureus (n = 9, 32.1%). Among the gram negative isolates, the highest sensitivity was to gentamycin (82.4%) and imipenem (82.4%). The gram positive isolates were sensitive to gentamycin (90.9%) followed by imipenem (81.8%). All the isolates were resistant to sulphamethoxazole with trimethoprim (100%). Multidrug resistance was 82.4% among gram negative isolates and 72.4% among the gram positive isolates. Conclusion There was high resistance to the most commonly used antibiotics. There is need to do urine culture and sensitivity from women with ASBP so as to reduce the associated complications.
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Affiliation(s)
- Julius Nteziyaremye
- Department of Obstetrics and Gynecology, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Stanley Jacob Iramiot
- Department of Microbiology and Immunology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Rebecca Nekaka
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Milton W. Musaba
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Julius Wandabwa
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Enoch Kisegerwa
- Department of Obstetrics and Gynecology, Mulago Hospital, Kampala, Uganda
| | - Paul Kiondo
- Department of Obstetrics and Gynecology, College of Health Sciences, Makerere University, Kampala, Uganda
- * E-mail:
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Abstract
BACKGROUND Asymptomatic bacteriuria is a bacterial infection of the urine without any of the typical symptoms that are associated with a urinary infection, and occurs in 2% to 15% of pregnancies. If left untreated, up to 30% of mothers will develop acute pyelonephritis. Asymptomatic bacteriuria has been associated with low birthweight and preterm birth. This is an update of a review last published in 2015. OBJECTIVES To assess the effect of antibiotic treatment for asymptomatic bacteriuria on the development of pyelonephritis and the risk of low birthweight and preterm birth. SEARCH METHODS For this update, we searched the Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) on 4 November 2018, and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCT) comparing antibiotic treatment with placebo or no treatment in pregnant women with asymptomatic bacteriuria found on antenatal screening. Trials using a cluster-RCT design and quasi-RCTs were eligible for inclusion, as were trials published in abstract or letter form, but cross-over studies were not. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked for accuracy. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS We included 15 studies, involving over 2000 women. Antibiotic treatment compared with placebo or no treatment may reduce the incidence of pyelonephritis (average risk ratio (RR) 0.24, 95% confidence interval (CI) 0.13 to 0.41; 12 studies, 2017 women; low-certainty evidence). Antibiotic treatment may be associated with a reduction in the incidence of preterm birth (RR 0.34, 95% CI 0.13 to 0.88; 3 studies, 327 women; low-certainty evidence), and low birthweight babies (average RR 0.64, 95% CI 0.45 to 0.93; 6 studies, 1437 babies; low-certainty evidence). There may be a reduction in persistent bacteriuria at the time of delivery (average RR 0.30, 95% CI 0.18 to 0.53; 4 studies; 596 women), but the results were inconclusive for serious adverse neonatal outcomes (average RR 0.64, 95% CI 0.23 to 1.79, 3 studies; 549 babies). There were very limited data on which to estimate the effect of antibiotics on other infant outcomes, and maternal adverse effects were rarely described. Overall, we judged only one trial at low risk of bias across all domains; the other 14 studies were assessed as high or unclear risk of bias. Many studies lacked an adequate description of methods, and we could only judge the risk of bias as unclear, but in most studies, we assessed at least one domain at high risk of bias. We assessed the quality of the evidence for the three primary outcomes with GRADE software, and found low-certainty evidence for pyelonephritis, preterm birth, and birthweight less than 2500 g. AUTHORS' CONCLUSIONS Antibiotic treatment may be effective in reducing the risk of pyelonephritis in pregnancy, but our confidence in the effect estimate is limited given the low certainty of the evidence. There may be a reduction in preterm birth and low birthweight with antibiotic treatment, consistent with theories about the role of infection in adverse pregnancy outcomes, but again, the confidence in the effect is limited given the low certainty of the evidence. Research implications identified in this review include the need for an up-to-date cost-effectiveness evaluation of diagnostic algorithms, and more evidence to learn whether there is a low-risk group of women who are unlikely to benefit from treatment of asymptomatic bacteriuria.
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Affiliation(s)
- Fiona M Smaill
- McMaster UniversityDepartment of Pathology and Molecular Medicine, Faculty of Health Sciences1200 Main Street WestRoom 2N29HamiltonONCanadaL8N 3Z5
| | - Juan C Vazquez
- Instituto Nacional de Endocrinologia (INEN)Departamento de Salud ReproductivaZapata y DVedadoHabanaCuba10 400
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Ndamason LM, Marbou WJ, Kuete V. Urinary tract infections, bacterial resistance and immunological status: a cross sectional study in pregnant and non-pregnant women at Mbouda Ad-Lucem Hospital. Afr Health Sci 2019; 19:1525-1535. [PMID: 31148980 PMCID: PMC6531958 DOI: 10.4314/ahs.v19i1.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Urinary tract infections (UTI) are frequently encountered medical complications of pregnancy. Objective This study was aimed at analyzing the bacterial resistance in urogenital tract as well as the immunological profile amongst pregnant and non-pregnant women at Mbouda Ad-Lucem Hospital, Western Region of Cameroon. Methods A cross-sectional study was carried out from December 2015 to May 2016 at Mbouda Ad-Lucem hospital on 104 pregnant women and 24 non-pregnant women. The midstream urine from participants was analysed for the presence, isolation and identification of the uro-pathogens, using selective and specific bacterial culture media. An antibiotic susceptibility tests was carried out using disk diffusion method. Blood samples were collected for C-reactive protein (CRP) dosage, CD4 and CD8 lymphocytes count. Results Out of 128 participants in this study, a high prevalence of uro-pathogens and resistance strains was observed. The most prevalent urinary tract pathogens were Staphylococcus sp. with 45% and 38.89% respectively in pregnant and non-pregnant women. Staphylococcus sp. showed resistance to Amoxicillin (AMO; 55.56%) and Chloramphenicol (CHL; 100%) respectively in pregnant and non-pregnant women. Pregnant women had a significantly high average of granulocytes (p=0.009), monocytes (P=0.001), high ratio of CD4/CD8 (p< 0.0001) and significantly low CD8 lymphocytes (p< 0.0001) average compared to non-pregnant women. Conclusion This study outlines high prevalence of Staphylococcus sp as the main urinary tract infectious pathogen in women at Mbouda Ad-Lucem hospital. It prevalence was accompanied with resistance to the routine antibiotics treatment, and a pronounced lymphocytosis and monocytosis.
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Affiliation(s)
- Loveline M Ndamason
- Department of Biochemistry, Faculty of Science, University of Dschang, Cameroon
| | - Wiliane Jt Marbou
- Department of Biochemistry, Faculty of Science, University of Dschang, Cameroon
| | - Victor Kuete
- Department of Biochemistry, Faculty of Science, University of Dschang, Cameroon
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Kalinderi K, Delkos D, Kalinderis M, Athanasiadis A, Kalogiannidis I. Urinary tract infection during pregnancy: current concepts on a common multifaceted problem. J OBSTET GYNAECOL 2018; 38:448-453. [DOI: 10.1080/01443615.2017.1370579] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Kallirhoe Kalinderi
- 3rd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Delkos
- 3rd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michail Kalinderis
- Department of Obstetrics and Gynaecology, King’s College Hospital NHS Foundation Trust, Princess Royal University Hospital, Orpington, UK
| | - Apostolos Athanasiadis
- 3rd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kalogiannidis
- 3rd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Garnizov TM. Asymptomatic bacteriuria in pregnancy from the perspective of public health and maternal health care: review and case report. BIOTECHNOL BIOTEC EQ 2015. [DOI: 10.1080/13102818.2015.1114429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Teodor Markov Garnizov
- Department of Obstetrics and Gynecology, Postpartum Unit, Medical University of Sofia, University Obstetrics and Gynecology Hospital “Maichin Dom”, Sofia, Bulgaria
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Labi AK, Yawson AE, Ganyaglo GY, Newman MJ. Prevalence and Associated Risk Factors of Asymptomatic Bacteriuria in Ante-Natal Clients in a Large Teaching Hospital in Ghana. Ghana Med J 2015; 49:154-8. [PMID: 26693190 PMCID: PMC4676592 DOI: 10.4314/gmj.v49i3.5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Asymptomatic bacteriuria, the presence of bacteria in urine without symptoms of acute urinary tract infection, predisposes pregnant women to the development of urinary tract infections and pyelonephritis, with an attendant pregnancy related complications. OBJECTIVE To measure the prevalence of asymptomatic bacteriuria among ante-natal clients at the Korle-Bu Teaching Hospital in Ghana and its' associated risk factors. METHODS A cross-sectional study involving 274 antenatal clients was conducted over a period of 4 weeks. A face to face questionnaire was completed and midstream urine collected for culture and antimicrobial susceptibility testing. RESULTS The prevalence of asymptomatic bacteriuria was 5.5%. It was associated with sexual activity during pregnancy (Fisher's Exact 5.871, p-value 0.0135), but not with sexual frequency. There were no significant associations with educational status, parity, gestational age, marital status and the number of foetuses carried. The commonest organism isolated was Enterococcus spp (26.7%) although the enterobacteriaceae formed the majority of isolated organisms (46.7%). Nitrofurantoin was the antibiotic with the highest sensitivity to all the isolated organisms. CONCLUSIONS The prevalence of asymptomatic bacteriuria among ante-natal clients at this large teaching hospital in Ghana is 5.5%, which is lower than what has been found in other African settings. Enterococcus spp was the commonest causative organism. However, due to the complications associated with asymptomatic bacteriuria, a policy to screen and treat- all pregnant women attending the hospital, is worth considering.
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Affiliation(s)
- A-K Labi
- Department of Microbiology Korle-Bu Teaching Hospital, Korle-Bu
| | - A E Yawson
- Department of Community Health, University of Ghana Medical School, College of Health Science, Korle-Bu
| | - G Y Ganyaglo
- Department of Obstetrics and Gynaecology, Korle-Bu Teaching Hospital, Korle-Bu
| | - M J Newman
- Department of Microbiology, University of Ghana Medical School, College of Health Sciences, Korle-Bu
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Abstract
BACKGROUND Asymptomatic bacteriuria occurs in 2% to 10% of pregnancies and, if not treated, up to 30% of mothers will develop acute pyelonephritis. Asymptomatic bacteriuria has been associated with low birthweight and preterm birth. OBJECTIVES To assess the effect of antibiotic treatment for asymptomatic bacteriuria on the development of pyelonephritis and the risk of low birthweight and preterm birth. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (19 March 2015) and reference lists of retrieved studies. SELECTION CRITERIA Randomized trials comparing antibiotic treatment with placebo or no treatment in pregnant women with asymptomatic bacteriuria found on antenatal screening. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. MAIN RESULTS Fourteen studies, involving almost 2000 women, were included. Antibiotic treatment compared with placebo or no treatment reduced the incidence of pyelonephritis (average risk ratio (RR) 0.23, 95% confidence interval (CI) 0.13 to 0.41; 11 studies, 1932 women; very low quality evidence). Antibiotic treatment was also associated with a reduction in the incidence of low birthweight babies (average RR 0.64, 95% CI 0.45 to 0.93; six studies, 1437 babies; low quality evidence) and preterm birth (RR 0.27, 95% CI 0.11 to 0.62; two studies, 242 women; low quality evidence). A reduction in persistent bacteriuria at the time of delivery was seen (average RR 0.30, 95% CI 0.18 to 0.53; four studies; 596 women). There were very limited data on which to estimate the effect of antibiotics on other infant outcomes and maternal adverse effects were rarely described.Overall, all 14 studies were assessed as being at high or unclear risk of bias. While many studies lacked an adequate description of methods and the risk of bias could only be assessed as unclear, in almost all studies there was at least one domain where the risk of bias was judged as high. The three primary outcomes were assessed with GRADE software and given a quality rating. Evidence for pyelonephritis, preterm birth and birthweight less than 2500 g was assessed as of low or very low quality. AUTHORS' CONCLUSIONS While antibiotic treatment is effective in reducing the risk of pyelonephritis in pregnancy, the estimate of the effect is very uncertain because of the very low quality of the evidence. The reduction in low birthweight and preterm birth with antibiotic treatment is consistent with theories about the role of infection in adverse pregnancy outcomes, but this association should be interpreted with caution given the very poor quality of the included studies.
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Affiliation(s)
- Fiona M Smaill
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, 1200 Main Street West, Room 2N29, Hamilton, ON, Canada, L8N 3Z5
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Sujatha R, Nawani M. Prevalence of asymptomatic bacteriuria and its antibacterial susceptibility pattern among pregnant women attending the antenatal clinic at kanpur, India. J Clin Diagn Res 2014; 8:DC01-3. [PMID: 24959438 DOI: 10.7860/jcdr/2014/6599.4205] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 02/15/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Symptomatic and asymptomatic bacteriuria (ASB) is common in pregnant women. Pregnancy enhances the progression from ASB to symptomatic bacteriuria, which if left untreated, could lead to acute pyelonephritis and other adverse outcomes such as prematurity, postpartum, hypertensive disease, anaemia, UTIs and higher foetal mortality rates. AIM To identify the prevalence of ASB, the most common causative microorganisms and the antibacterial susceptibilities of the isolated microorganisms at a tertiary care centre at Kanpur, India. MATERIALS AND METHODS A total number of 300 asymptomatic pregnant women were screened for ASB by urine culture by using a semi quantitative culture method. RESULTS In this study, significant bacteriuria was found in only 22 cases (7.3%). Growth of contaminants was seen in 40 cases (13.3%). Among cases which showed positive cultures, 48.9% were primigravidae and 51.1% were multigravidae. Highest incidence was reported in age group of 21-30 years. The predominant organisms which were isolated were Escherichia coli, followed by Klebsiella pneumoniae, Enterococcus faecalis, Staphylococcus aureus and Proteus mirabilis. Escherichia coli, the most common isolate, was found to be only 61% and 70% sensitive to ampicillin and amoxicillin + clavulanate, respectively. Sensitivity to ceftriaxone and ciprofloxacin was 95%, and sensitivity to amikacin was 99%. Hundred percent sensitivity was found for the broad spectrum pencillins, imipenem, and meropenem. Klebsiella pneumoniae, the second most frequent organism which was grown on culture, was only 11% sensitive to ampicillin, while sensitivity to amoxicillin + clavulanate and cefuroxime was 86%. 100% sensitivity was found for cefepime, ceftriaxone, ciprofloxacin, imipenem and meropenem. CONCLUSION Routine urine culture test should be carried out for all antenatal women, to detect asymptomatic bacteriuria, and every positive case should be treated with appropriate antibiotic therapy, to prevent any obstetric complication which is associated with pregnancy.
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Affiliation(s)
- R Sujatha
- Associate Professor, Department of Microbiology, Rama Medical College Hospital and Research Centre , Kanpur, India
| | - Manju Nawani
- Professor and H.O.D, Department of Obstretics and Gynaecology, Rama Medical College Hospital and Research Centre , Kanpur, India
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Gilbert NM, O'Brien VP, Hultgren S, Macones G, Lewis WG, Lewis AL. Urinary tract infection as a preventable cause of pregnancy complications: opportunities, challenges, and a global call to action. Glob Adv Health Med 2014; 2:59-69. [PMID: 24416696 PMCID: PMC3833562 DOI: 10.7453/gahmj.2013.061] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The urinary tract is a common site of infection in humans. During pregnancy, urinary tract infection (UTI) is associated with increased risks of maternal and neonatal morbidity and mortality, even when the infection is asymptomatic. By mapping available rates of UTI in pregnancy across different populations, we emphasize this as a problem of global significance. Many countries with high rates of preterm birth and neonatal mortality also have rates of UTI in pregnancy that exceed rates seen in more developed countries. A global analysis of the etiologies of UTI revealed familiar culprits as well as emerging threats. Screening and treatment of UTI have improved birth outcomes in several more developed countries and would likely improve maternal and neonatal health worldwide. However, challenges of implementation in resource-poor settings must be overcome. We review the nature of the barriers occurring at each step of the screening and treatment pipeline and highlight steps necessary to overcome these obstacles. It is our hope that the information compiled here will increase awareness of the global significance of UTI in maternal and neonatal health and embolden governments, nongovernmental organizations, and researchers to do their part to make urine screening and UTI treatment a reality for all pregnant women.
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Affiliation(s)
- Nicole M Gilbert
- Department of Molecular Microbiology, Center for Women's Infectious Disease Research, Washington University School of Medicine, St Louis, Missouri, United States
| | - Valerie P O'Brien
- Department of Molecular Microbiology, Center for Women's Infectious Disease Research, Washington University School of Medicine, St Louis, Missouri, United States
| | - Scott Hultgren
- Department of Molecular Microbiology, Center for Women's Infectious Disease Research, Washington University School of Medicine, St Louis, Missouri, United States
| | - George Macones
- Department of Obstetrics and Gynecology, Center for Women's Infectious Disease Research, Washington University School of Medicine, St Louis, Missouri, United States
| | - Warren G Lewis
- Department of Medicine, Center for Women's Infectious Disease Research, Washington University School of Medicine, St Louis, Missouri, United States
| | - Amanda L Lewis
- Departments of Molecular Microbiology, Obstetrics and Gynecology, Center for Women's Infectious Disease Research, Washington University School of Medicine, St Louis, Missouri, United States
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Mokube MN, Atashili J, Halle-Ekane GE, Ikomey GM, Ndumbe PM. Bacteriuria amongst pregnant women in the Buea Health District, Cameroon: prevalence, predictors, antibiotic susceptibility patterns and diagnosis. PLoS One 2013; 8:e71086. [PMID: 23976983 PMCID: PMC3745459 DOI: 10.1371/journal.pone.0071086] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 06/30/2013] [Indexed: 11/23/2022] Open
Abstract
Background Bacteriuria is associated with significant maternal and foetal risks. However, its prevalence is not known in our community. Objectives This study was carried out to determine the prevalence and predictors of bacteriuria in pregnant women of the Buea Health District (BHD) as well as the antibiotic sensitivity patterns of bacterial isolates. It also sought to determine the diagnostic performance of the nitrite and leucocyte esterase tests in detecting bacteriuria in these women. Methods An observational analytic cross-sectional study was carried out amongst pregnant women attending selected antenatal care centres in Buea. We recruited 102 consenting pregnant women for the study. Demographic and clinical data were collected using structured questionnaires. Clean catch midstream urine was collected from each participant in sterile leak proof containers. Samples were examined biochemically, microscopically and by culture. Significant bacteriuria was defined as the presence of ≥108 bacteria/L of cultured urine. Identification and susceptibility of isolates was performed using API 20E and ATB UR EU (08) (BioMerieux, Marcy l'Etoile, France). Results Significant bacteriuria was found in the urine of 24 of the 102 women tested giving a bacteriuria prevalence of 23.5% in pregnant women of the BHD. Asymptomatic bacteriuria was detected in 8(7.8%) of the women. There was no statistically significant predictor of bacteriuria. Escherichia coli were the most isolated (33%) uropathogens and were 100% sensitive to cefixime, cefoxitin and cephalothin. The nitrite and leucocyte esterase tests for determining bacteriuria had sensitivities of 8%, 20.8% and specificities of 98.7% and 80.8% respectively. Conclusion Bacteriuria is frequent in pregnant women in the BHD suggesting the need for routine screening by urine culture. Empiric treatment with cefixime should be instituted until results of urine culture and sensitivity are available. Nitrite and leucocyte esterase tests were not sensitive enough to replace urine culture as screening tests.
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Affiliation(s)
- Morike Ngoe Mokube
- Faculty of Health Sciences, University of Buea, Buea, South-West Region, Cameroon
| | - Julius Atashili
- Faculty of Health Sciences, University of Buea, Buea, South-West Region, Cameroon
- * E-mail:
| | | | - George M. Ikomey
- Faculty of Health Sciences, University of Buea, Buea, South-West Region, Cameroon
| | - Peter M. Ndumbe
- Faculty of Health Sciences, University of Buea, Buea, South-West Region, Cameroon
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Jain V, Das V, Agarwal A, Pandey A. Asymptomatic bacteriuria & obstetric outcome following treatment in early versus late pregnancy in north Indian women. Indian J Med Res 2013; 137:753-8. [PMID: 23703344 PMCID: PMC3724257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND & OBJECTIVES Asymptomatic bacteriuria during pregnancy if left untreated, may lead to acute pyelonephritis, preterm labour, low birth weight foetus, etc. Adequate and early treatment reduces the incidence of these obstetric complications. The present study was done to determine presence of asymptomatic bacteriuria (ASB) and obstetric outcome following treatment in early versus late pregnancy. METHODS A prospective cohort study was conducted at a tertiary care teaching hospital of north India. Pregnant women till 20 wk (n=371) and between 32 to 34 wk gestation (n=274) having no urinary complaints were included. Their mid stream urine sample was sent for culture and sensitivity. Women having > 10 [5] colony forming units/ml of single organism were diagnosed positive for ASB and treated. They were followed till delivery for obstetric outcome. Relative risk with 95% confidence interval was used to describe association between ASB and outcome of interest. RESULTS ASB was found in 17 per cent pregnant women till 20 wk and in 16 per cent between 32 to 34 wk gestation. Increased incidence of preeclamptic toxaemia (PET) [RR 3.79, 95% CI 1.80-7.97], preterm premature rupture of membrane (PPROM)[RR 3.63, 45% CI 1.63-8.07], preterm labour (PTL) [RR 3.27, 95% CI 1.38-7.72], intrauterine growth restriction (IUGR)[RR 3.79, 95% CI 1.80-79], low birth weight (LBW) [RR1.37, 95% CI 0.71-2.61] was seen in late detected women (32-34 wk) as compared to ASB negative women, whereas no significant difference was seen in early detected women (till 20 wk) as compared to ASB negative women. INTERPRETATION & CONCLUSIONS Early detection and treatment of ASB during pregnancy prevents complications like PET, IUGR, PTL, PPROM and LBW. Therefore, screening and treatment of ASB may be incorporated as routine antenatal care for safe motherhood and healthy newborn.
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Affiliation(s)
- Vaishali Jain
- Vivekanand Polyclinic & Institute of Medical Sciences, Lucknow, India.
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Hannan TJ, Totsika M, Mansfield KJ, Moore KH, Schembri MA, Hultgren SJ. Host-pathogen checkpoints and population bottlenecks in persistent and intracellular uropathogenic Escherichia coli bladder infection. FEMS Microbiol Rev 2012; 36:616-48. [PMID: 22404313 DOI: 10.1111/j.1574-6976.2012.00339.x] [Citation(s) in RCA: 223] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Bladder infections affect millions of people yearly, and recurrent symptomatic infections (cystitis) are very common. The rapid increase in infections caused by multidrug-resistant uropathogens threatens to make recurrent cystitis an increasingly troubling public health concern. Uropathogenic Escherichia coli (UPEC) cause the vast majority of bladder infections. Upon entry into the lower urinary tract, UPEC face obstacles to colonization that constitute population bottlenecks, reducing diversity, and selecting for fit clones. A critical mucosal barrier to bladder infection is the epithelium (urothelium). UPEC bypass this barrier when they invade urothelial cells and form intracellular bacterial communities (IBCs), a process which requires type 1 pili. IBCs are transient in nature, occurring primarily during acute infection. Chronic bladder infection is common and can be either latent, in the form of the quiescent intracellular reservoir (QIR), or active, in the form of asymptomatic bacteriuria (ASB/ABU) or chronic cystitis. In mice, the fate of bladder infection, QIR, ASB, or chronic cystitis, is determined within the first 24 h of infection and constitutes a putative host-pathogen mucosal checkpoint that contributes to susceptibility to recurrent cystitis. Knowledge of these checkpoints and bottlenecks is critical for our understanding of bladder infection and efforts to devise novel therapeutic strategies.
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Affiliation(s)
- Thomas J Hannan
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
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