Lower Urinary Pathogens: Do More Pathogenic Bacteria Increase the Risk of Pyelonephritis?

2020 ◽  
Author(s):  
Heather A. Rosett ◽  
Madison K. Krischak ◽  
Sarika Sachdeva ◽  
Kristin E. Weaver ◽  
Robert Phillips Heine ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Pathogenic Bacteria ◽  
Low Birthweight ◽  
Asymptomatic Bacteriuria ◽  
Chronic Hypertension ◽  
Acute Cystitis ◽  
E Coli ◽  
Tertiary Center ◽  
History Of ◽  
Lower Urinary

Objective Outside of pregnancy, urinary pathogens such as Proteus and Klebsiella are considered more pathogenic than E. coli. During pregnancy, the implications of lower urinary tract infection (LUTI) with more pathogenic bacteria are unclear. Thus, we sought to compare the risk of progression from LUTI to pyelonephritis among women infected with these more pathogenic urinary bacteria to those infected with E. coli. Study Design Retrospective cohort of pregnant women with LUTI at single tertiary center from July 2013 to May 2019. Pathogenic infections (PI) were defined as asymptomatic bacteriuria or acute cystitis urinary cultures positive for Proteus, Klebsiella, Enterobacter, Citrobacter, Acinetobacter, Staphylococcus, or Raoultella species. Demographic, infectious, antepartum, and postpartum data abstracted. Pregnant women with PI compared with those with E. coli. Primary outcome was progression to pyelonephritis. Secondary outcomes included pyelonephritis length of stay (LOS) >6 days, preterm birth (PTB), low birthweight (LBW), and measures of pyelonephritis-related morbidity. Results Of 686 pregnant women with LUTIs, 313 had urine culture growing out either PI or E. coli, with 59 (12%) growing PI and 254 (54%) growing E. coli. Women with PI were more likely to be African American, have chronic hypertension, and have history of preeclampsia. The primary species causing PI were Klebsiella (n = 29) and Proteus (n = 11). PI were not more likely to progress to pyelonephritis than E. coli LUTIs (10.9 vs. 14.5%; p = 0.67). Median LOS for pyelonephritis and other measures of pyelonephritis-related morbidity did not differ nor did PTB or LBW rates. After controlling for race, body mass index, history of preeclampsia, and history of pyelonephritis, PI were not associated with increased odds of progression to pyelonephritis (adjusted odds ratio: 0.69, 95% confidence interval: 0.27–1.80). Conclusion Bacteria traditionally considered to be more pathogenic outside of pregnancy do not progress to pyelonephritis at higher rates than E. coli in pregnancy, and are associated with similar pyelonephritis-related morbidity. Larger studies are needed to confirm these findings. Key Points

scholarly journals THE CURRENT STATE OF ANTIBIOTIC RESISTANCE AND THE COMPOSITION OF PATHOGENS OF URINARY TRACT INFECTIONS IN PREGNANT WOMEN

2018 ◽  
Vol 6 (2) ◽  
pp. 13-20 ◽  
Author(s):  
K. L. Lokshin ◽  
V. N. Shirshov ◽  
A. S. Popko ◽  
Yu. L. Demidko ◽  
N. D. Luchenkova
Keyword(s):  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Antibiotic Therapy ◽  
Pregnant Women ◽  
Urinary Tract Infections ◽  
Asymptomatic Bacteriuria ◽  
Resistance Rate ◽  
Acute Cystitis ◽  
E Coli ◽  
Tract Infections

Introduction.The main treatment component of asymptomatic bacteriuria, acute cystitis and pyelonephritis in pregnant women is antibiotic therapy, which in many patients is prescribed empirically. For successful selection of the drug, it is necessary to know both the structure of pathogens and the current profile of their antibiotic resistance.Purpose of research.The study of species composition and resistance to antibiotics of bacteria that cause urinary tract infections (UTIs) in pregnant women in the Moscow RegionMaterials and methods.The study included 104 pregnant women with uncomplicated UTIs who were observed and treated at the Lapino Clinical Hospital between 2016 and 2017. The material for bacteriological studies was the midstream portion of urine or urine collected by a catheter.Results.90 patients had asymptomatic bacteriuria, 10 had acute cystitis, and 4 had acute gestational pyelonephritis. The structure of the pathogens of UTI is presented: E. coli, Enterococcus faecalis, Klebsiella pneumoniae, Proteus spp., Staphylococcus spp., Streptococcus spp., Enterobacter cloacae. The most frequently detected pathogens were E. coli (67.3%) and E. faecalis (50%). Resistance rate of E.coli strains more than 20% was detected to ampicillin (36.4%), amoxicillin / clavulanate (23.2%), trimethoprim / sulfamethoxazole (27.4%), nalidixic acid (20.7%), cephalosporins 2 and 3 generation (respectively, 25.7% and 24.3%). Resistance rate more than 20% in Enterobacteriaceae family strains was detected to trimethoprim/sulfamethoxazole (24.4%), nalidixic acid (20.7%), cephalosporins 2 generations (21.7%). Antibiotic resistance of E.coli and other Enterobacteriaceae family taxons less than 10% was noted only with respect to carbapenems (0%) and fosfomycin (1.5% and 3.5%, respectively).Conclusions.It is expedient to use the obtained data on the composition and sensitivity profile of uropathogens in UTIs in pregnant women when choosing starting empirical antibiotic therapy. Disclosure: The study did not have sponsorship. The authors have declared no conflicts of interest.

scholarly journals Bacterial Etiology, Antibiotic Sensitivity Pattern and Risk Factors for Asymptomatic Bacteriuria during Pregnancy: Experience in a Tertiary Care Hospital

2017 ◽  
Vol 6 (2) ◽  
pp. 79-83
Author(s):  
Shakila Khanum ◽  
Jamal Uddin Ahmed ◽  
Khaleda Khanam
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Past History ◽  
Asymptomatic Bacteriuria ◽  
Antibiotic Sensitivity ◽  
Urine Samples ◽  
Successful Outcome ◽  
E Coli ◽  
History Of ◽  
Tract Infections

Background: Urinary tract infections (UTIs) are common during pregnancy. Untreated asymptomatic bacteriuria (ASB) during pregnancy may cause serious complications including pyelonephritis and delivery of premature or low-birth-weight infants. This study aimed to assess the risk factors for asymptomatic bacteriuria, bacterial agents and their antibiotic susceptibility pattern in pregnant women attending in Combined Military Hospital (CMH), Dhaka.Methods: This cross-sectional study was conducted in a total of 1540 pregnant women with no signs and symptoms of UTI from October 2013 to March 2015. Clean catch mid-stream urine samples were collected from all study participants using sterile containers. Urine samples were cultured using standard bacteriological methods. Identification of suspected colonies and antibiotic sensitivity testing were done. Patients having ASB were further evaluated to find out associated risk factors.Results: Out of 1540 pregnant women, 254 (16.5%) had asymptomatic bacteriuria (Colony forming unit >105/mL).The most frequently isolated bacteria were Escherichia coli (E. coli) (50.4%), followed by Klebsiella (24.0%). The antibiotic sensitivity rate of bacterial isolates were highest for imipenem and amikacin. Among different associated conditions, anemia (16.5%), gestational diabetes mellitus (GDM) (10%) and past history of UTI (5.1%) were found to be the most frequent factors associated with increased prevalence of ASB.Conclusion: In this study, the prevalence of ASB was high among pregnant women with anemia, GDM and past history of UTI. E. coli was the most common organism causing ASB, which is less susceptible to conventional oral antibiotics but more susceptible to imipenem and amikacin. So, careful drug selection is required for successful outcome in ASB.Birdem Med J 2016; 6(2): 79-83

scholarly journals Asymptomatic Bacteriuria among Pregnant Women Attending Tertiary Care Hospital in Lucknow, India

2021 ◽  
pp. 1-8
Author(s):  
Naimshree Sonkar ◽  
Malay Banerjee ◽  
Suman Gupta ◽  
Absar Ahmad
Keyword(s):  
Haemoglobin Level ◽  
Pregnant Women ◽  
Antimicrobial Susceptibility ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Asymptomatic Bacteriuria ◽  
Care Hospital ◽  
Gram Positive ◽  
Gram Negative ◽  
E Coli

Introduction: Asymptomatic bacteriuria (ASB) is the presence of actively multiplying bacteria within the urinary tract with absence of any symptoms, resulting in adverse pregnancy outcomes. This research study was done in order to review prevalence, antimicrobial susceptibility profile, and factors associated with ASB occurring in female patients who are pregnant and being treated at a tertiary care hospital in Lucknow, India. Method and Materials: This is a cross-sectional study done among 216 pregnant women attending a hospital for antenatal check-ups. Clean catch midstream urine samples were collected and examined microscopically, and semi-quantitative culture was done on blood agar and MacConkey agar. Isolates were identified by colony morphology and biochemical tests, and antimicrobial susceptibility testing was done by using the Kirby-Bauer method. Results: Of the 216 pregnant women, 36 (16.7%) tested positive for ASB. The female gestational period, haemoglobin level, and BMI were significantly associated with ASB. Logistic regression also showed that higher haemoglobin level was less likely to ASB (AOR = 0.42, 95% confidence interval: 0.202–0.88, p = 0.021). The predominant and usual isolates were E. coli (n = 22, 61.1%), followed by Cons (n = 6, 16.7%), and S. aureus (3, 8.3%). All Gram-negative isolates were mostly sensitive to most of the drugs like piperacillin-tazobactam, cefepime, nitrofurantoin, and meropenem but were 100% resistant to ampicillin. Similarly, Gram-positive isolates were sensitive to ampicillin, vancomycin, linezolid, and nitrofurantoin but 100% resistant to co-trimoxazole. Conclusion: The present study shows the existence of ASB was 16.7% among women who are pregnant. Pregnancy duration, haemoglobin level, and BMI were significantly associated with ASB. The isolates identified more frequently were E. coli (61.16%), Cons (16.7%), and S. aureus (8.3%). All isolates which were Gram-negative were mostly sensitive to most of the drugs but were 100% resistant to ampicillin. Similarly, Gram-positive isolates were sensitive to most of the drugs but 100% resistant to co-trimoxazole.

scholarly journals Relationship Parity and Contraception with Mild Preeclampsia at Puskesmas Jagir

2016 ◽  
Vol 4 (1) ◽  
pp. 100
Author(s):  
Rizky Pradana Setiawan
Keyword(s):  
Diabetes Mellitus ◽  
Body Weight ◽  
Family History ◽  
Pregnant Women ◽  
Calcium Supplementation ◽  
Chronic Hypertension ◽  
Family History Of Diabetes ◽  
Maternal Characteristics ◽  
History Of ◽  
Mild Preeclampsia

Mild preeclampsia is the frequent disease experienced by pregnant women in Puskesmas Jagir in 2011-2014. The number of mild preeclampsia in Puskesmas Jagir keep increase significantly. The purpose of this study is to analyze the association between the characteristics, family history and calcium supplementation in pregnant women with mild preeclampsia at Puskesmas Jagir Surabaya. The type of research is non-reactive research with case control design. Subjects was taken from the population using simple random sampling. The variables studied were age, body weight changes, parity, family history of preeclampsia, contraception, family history of diabetes mellitus, family history of chronic hypertension, and calcium supplementation. The statistical test was Chi-square test with α = 0.05, odds Ratio is calculated by value with 95% confidence interval (CI 95%). Variables associated with mild preeclampsia is a maternal characteristics such as parity (p = 0.001, OR 0.17) and contraception (p = 0.019, OR = 5.636). Variables that are not associated with mild preeclampsia is a maternal characteristics such as the form of changes in body weight during pregnancy, age, and family history of diabetes mellitus in the form of family history and family history of hypertension and calcium supplementation. There is a association between parity and contraception with mild preeclampsia.Keywords: mild preeclampsia, parity, contraception 

scholarly journals Prevention and treatment of non-complicated infections of the lower urinary tract in pregnant women

2021 ◽  
Vol 4 (2) ◽  
pp. 119-123
Author(s):  
N.A. Nashivochnikova ◽  
◽  
V.N. Krupin ◽  
V.E. Leanovich ◽  
◽  
...  
Keyword(s):  
Urinary Tract ◽  
Pregnant Women ◽  
Treatment Efficacy ◽  
Asymptomatic Bacteriuria ◽  
Control Group ◽  
Chronic Cystitis ◽  
Acute Cystitis ◽  
Total Treatment ◽  
Group 2 ◽  
Group 1

Aim: to assess the efficacy of biologically active additive Cystenium II as a component of combined antimicrobial treatment of acute cystitis or exacerbation of chronic cystitis and asymptomatic bacteriuria (ASB) in pregnant women. Patients and Methods: 65 pregnant women with urinary tract infections were enrolled. Group 1 included 22 women with acute cystitis or exacerbation of chronic cystitis and group 2 included 20 women with ASB. These women received standard antimicrobial therapy (fosfomycin trometamol 3 g) and Cystenium II (1 tablet twice daily with food for 14 days). The control group included 23 women with acute cystitis or exacerbation of chronic cystitis or ASB who received standard antimicrobial therapy only. Treatment results were evaluated after 14 days and 2 months. Results: complete resolution of cystitis occurred on days 2 and 3 in group 1 and days 4 and 5 in group 2. Eradication of causative agent as demonstrated by inoculation of urine samples after 14 days was reported in 77.3% of women in group 1, 70% of women in group 2, and 61% of women in group 3. Total treatment efficacy in group 1 was 81.9%, i.e., exacerbations of chronic cystitis were diagnosed in 3 women (13.6%), acute pyelonephritis in 1 woman (4.5%). Total treatment efficacy in group 2 was 90%, i.e., recurrence of ASB was diagnosed in 2 women (10%). Meanwhile, treatment efficacy in the control group was 56.5%, i.e., clinical exacerbation of chronic cystitis was diagnosed in 6 women (26%). Moreover, in 4 women (17.4%), the disease was complicated by acute pyelonephritis. Conclusions: Cystenium II for acute cystitis or exacerbation of chronic cystitis and ASB in pregnant women improves treatment success and also maintains the effect. KEYWORDS: cystitis, asymptomatic bacteriuria, pregnancy, treatment, cranberry, prevention of recurrences. FOR CITATION: Nashivochnikova N.A., Krupin V.N., Leanovich V.E. Prevention and treatment of non-complicated infections of the lower urinary tract in pregnant women. Russian Journal of Woman and Child Health. 2021;4(2):119–123. DOI: 10.32364/2618-8430- 2021-4-2-119-123.

scholarly journals Association between insulin resistance and preeclampsia in obese non-diabetic women receiving metformin

2017 ◽  
Vol 10 (4) ◽  
pp. 170-173 ◽  
Author(s):  
Jyoti Balani ◽  
Steve Hyer ◽  
Argyro Syngelaki ◽  
Ranjit Akolekar ◽  
Kypros H Nicolaides ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Pregnant Women ◽  
Significant Contribution ◽  
Randomised Trial ◽  
Secondary Analysis ◽  
Chronic Hypertension ◽  
Model Assessment ◽  
Gestational Weight ◽  
Metformin Group ◽  
History Of

Objectives To examine whether the reduced incidence of preeclampsia in non-diabetic obese pregnant women treated with metformin is mediated by changes in insulin resistance. Methods This was a secondary analysis of obese pregnant women in a randomised trial (MOP trial). Fasting plasma glucose and insulin were measured in 384 of the 400 women who participated in the MOP trial. Homeostasis model assessment of insulin resistance (HOMA-IR) was compared in the metformin and placebo groups and in those that developed preeclampsia versus those that did not develop preeclampsia. Results At 28 weeks, median HOMA-IR was significantly lower in the metformin group. Logistic regression analysis demonstrated that there was a significant contribution in the prediction of preeclampsia from maternal history of chronic hypertension and gestational weight gain, but not HOMA-IR either at randomisation ( p = 0.514) or at 28 weeks ( p = 0.643). Conclusions Reduced incidence of preeclampsia in non-diabetic obese pregnant women treated with metformin is unlikely to be due to changes in insulin resistance.

Assessment of Prevalence of Hypertension in pregnant women with its Complications: A Cross Sectional Study

2021 ◽  
pp. 3805-3808
Author(s):  
Hemalatha S. ◽  
S. M. Shaheedha ◽  
Ramakrishna Borra
Keyword(s):  
Pregnant Women ◽  
Cross Sectional Study ◽  
World Health ◽  
Chronic Hypertension ◽  
Pregnancy Induced Hypertension ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Gynecology And Obstetrics ◽  
Induced Hypertension ◽  
History Of

Introduction: World Health Organization has reported that pregnancy induced hypertension is one of the main causes for mortality and morbidity in maternal and fetal deaths. About 60% of deaths accounted of eclampsia. Aims and Objectives: To diagnose for hypertension in pregnant women. To evaluate the knowledge of pregnancy induced hypertension among the pregnant women. To investigate the complications reported in Pregnancy induced hypertension (PIH) women, during and after labor. Study area and period: The present study was conducted in Chittoor government hospital, Chittoor, during the period of Jan 2016 and Dec 2017. The information and materials required for the study have been collected from the gynecology and obstetrics departments of the respective hospital. Results: During the study period of Jan 2016 and Dec 2017, about 2234 number of pregnant women have visited the obstetrics and gynecology department. All the 2234 pregnant women were tested for blood pressure. Among which 198 women were found to have hypertension, which may be of early onset PIH or chronic hypertension (HTN). Different variables of the study population like period of gestation [<20 weeks, ≥20 weeks], previous cesarean section if present, previous preterm delivery if present, hypertension in previous pregnancy, history of paternal hypertension, history of abortions if have been, history of any still births, family history of PIH have been noted and reported in table 2. More than 8% of women were found to been falling in <20 weeks of gestational age (GA). Conclusion: The study included 2234 pregnant women, in which 198 women were diagnosed with hypertension. Thus, prior investigation and identification hypertension in pregnant women helps in better management of PIH and to overcome the complications that are reported due to PIH during and after labor. Better knowledge and treatment is required for managing hypertension in maternal women in gynecology and obstetrics department for maternal and fetal care.

scholarly journals Asymptomatic Bacteriuria and Antibacterial Susceptibility Patterns in an Obstetric Population

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Şevki Çelen ◽  
Ayla Sargin Oruç ◽  
Rana Karayalçin ◽  
Sibel Saygan ◽  
Serpil Ünlü ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Urine Analysis ◽  
Asymptomatic Bacteriuria ◽  
High Sensitivity ◽  
Klebsiella Pneumonia ◽  
Low Birth Weight Infants ◽  
E Coli ◽  
Antibacterial Susceptibility ◽  
Obstetric Population ◽  
Associated Risk Factors

Introduction. Asymptomatic bacteriuria (ASB), occurring in 2–11% of pregnancies, is a major predisposition to the development of pyelonephritis, which is associated with obstetrical complications, such as preterm labor and low birth weight infants. The aim of this study was to determine the prevalence of ASB, the antibacterial susceptibilities of the isolated microorganisms and the associated risk factors in an outpatient clinical setting in Zekai Tahir Burak Women's Health Education and Research Hospital in Ankara, Turkey. Material and Methods. Between December 2009 and May 2010, pregnant women admitted to the antenatal outpatient clinic were included in this study. The results of a complete urine analysis, midstream urine culture and antibacterial susceptibility were evaluated. Results. Of the 2011 pregnant women included, 171 had ASB (8.5%). E. coli was the most frequently isolated microorganism (76.6%), followed by Klebsiella pneumonia (14.6%). Both microorganisms were highly sensitive to fosfomycin, sensivity being 99.2% for E. coli and 88% for Klebsiella pneumonia. Conclusions. In this certain geographical region, we found E. coli as the most common causative agent of ASB in the obstetric population and it is very sensitive to fosfomycin. We recommend fosfomycin for ASB in pregnant women due to its high sensitivity, ease of administration and safety for use in pregnancy.

scholarly journals PROPHILAXIS ANEMIA IN PREGNANCY

2010 ◽  
Vol 1 (3) ◽  
pp. 76-83
Author(s):  
S A Levakov ◽  
E V Kozhurina ◽  
A G Kedrova ◽  
N I Stuklov ◽  
S F Torubarov
Keyword(s):  
Folic Acid ◽  
Pregnant Women ◽  
Respiratory Diseases ◽  
Chronic Hypertension ◽  
Important Public Health ◽  
Nutritional Anemia ◽  
Fetal Complications ◽  
History Of ◽  
Iron And Folic Acid ◽  
Tobacco Usage

Pregnancy anemia is one of the important public health problems not only in Russian but also in another countries. Indeed, it is a known risk factor for many maternal and fetal complications. Anemia put to the worse many risk factors: young age, obstetrical factors (history of previous preterm or small- for gestational-age deliveries, plurality of pregnancy multiple or singleton); behavioral factors (smoking or tobacco usage, alcohol usage); medical conditions (diabetes, renal or cardio-respiratory diseases, chronic hypertension). If all pregnant women receive routine iron and folic acid, it is possible to prevent nutritional anemia. Therefore, 50 -100milligrams elemental iron and 500-1000 micrograms of folic acid daily for 100 days must be taken into national nutritional anaemia prophylaxis program to all pregnant women.

scholarly journals Phylogenetic background of E. coli isolated from asymptomatic pregnant women from Kolkata, India

2015 ◽  
Vol 9 (07) ◽  
pp. 720-724 ◽  
Author(s):  
Mandira Mukherjee ◽  
Snehashis Koley ◽  
Sandip Kumar Mukherjee ◽  
Shreya Basu ◽  
Biplab Ghosh ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Pregnant Women ◽  
Statistical Significance ◽  
Asymptomatic Bacteriuria ◽  
Antibiotic Sensitivity ◽  
Etiologic Agent ◽  
Esbl Production ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Resistance Patterns

Introduction: Asymptomatic bacteriuria (ABU) in pregnancy generates medical complications. E. coli is the common etiologic agent responsible for ABU-associated infections. This study aimed to identify the phylogenetic background and drug resistance in asymptomatic E. coli from a pregnant population. Methodology: E. coli was confirmed biochemically from culture-positive urine samples collected from asymptomatic pregnant women. Phylogenetic typing was done by polymerase chain reaction (PCR). The isolates were subjected to antibiotic susceptibility testing and extended-spectrum beta-lactamase (ESBL) production. Statistical significance was determined using SPSS 17.0 software. Results: Bacteriuria was observed in 113 (22.6%) of 500 asymptomatic pregnant females. E. coli was reported in 44 (38.9%) of 113 isolates. The mean age-wise distribution was 25.14 ± 4.63. Although pathogenic phylogroup B2 was predominant (54.5%), incidence of non-pathogenic phylogroup B1 (27.3%) was found to be statistically significant (p ≤ 0.001), and B1 and B2 were correlated with respect to total ABU population. Antibiotic sensitivity against ampicillin (34.1%), ceftazidime (50%), cefotaxime (47.7%), ciprofloxacin (47.7%), amikacin (86.4%), nitrofurantion (79.5%), and co-trimoxazole (36.4%) was observed. Multidrug resistance (MDR) and ESBL production was reported in 26 (59.1%) of 44 and 18 (69.2%) of the 26 MDR isolates, respectively. A significant distribution of phylogroup B1 (p = 0.03) with drug resistance was also observed. Conclusions: This is the first study that reported significant incidence of non-pathogenic phylogroup B1 in asymptomatic E. coli with high incidence of MDR isolated from pregnant women in Kolkata, India.  These varied resistance patterns present major therapeutic and infection control challenges during pregnancy.

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