Abstract
Both asymptomatic (ASB) and symptomatic bacteriuria during pregnancy increase the risk of adverse fetal or maternal outcomes. Our study aims to determine the prevalence of bacteriuria, the etiological agents with their susceptibility to antimicrobials, and the risk factors for therapeutic failure among pregnant women for antenatal care in the primary health care of Macau, China. Methods: This is a cross-sectional survey involving 5101 antenatal care pregnant women from 1st Jan to 31st Dec., 2017. The mid-stream clean-catch urine specimens were routinely examined microscopically and cultured following the first consultation. Other data were collected from the computerized medical records. Results: The mean age of the pregnant women was 31.4 ± 5.04 years. We followed 130 women with positive cultures on first consultation, of whom 35 (26.9%) were found to have contaminated cultures. 95 pregnant women were confirmed to have UTI. The prevalence of bacteriuria was 1.86% (n = 95), of which 83 (87.4%) were asymptomatic. ASB was mainly in the younger age-group (20 - 30 years) and the primipara. Of 196 positive cultures, the commonest bacterium was Escherichia coli (n = 111 or 56.6%, 98.2% susceptible to nitrofurantoin), followed by Klebsiella pneumonia (n = 20 or 10.2%, 90% susceptible to 2nd generation cephalosporin), and Streptococcus agalactiae (n = 16 or 8.2%, 100% susceptible to nitrofurantoin). After treatment, there were 80 (84.2%) therapeutic successes and 15 (15.8%) failures. Symptomatic infection and later trimester were significantly associated with therapeutic failure (P ≤ 0.05). Conclusions: ASB is common in the young age group and primipara. Nitrofuranton and 2nd generation cephalosporin are effective antibiotics against UTI in pregnancy. Symptomatic infection and occurrence in later trimester were significantly associated with treatment failure.
Highlights
Pregnant women are more susceptible to urinary tract infections (UTI) due to several anatomical and hormonal changes
Our study aims to determine the prevalence of bacteriuria, the etiological agents with their susceptibility to antimicrobials, and the risk factors for therapeutic failure among pregnant women for antenatal care in the primary health care of Macau, China
The prevalence of asymptomatic bacteriuria (ASB) in pregnant women was about 2% - 7% [2]. Both ASB and symptomatic bacteriuria (SB) during pregnancy increase the risk of pyelonephritis and have been associated with adverse pregnancy outcomes, such as preterm births, low birth weight infants, preeclampsia, and perinatal mortality [3] [4]
Summary
Pregnant women are more susceptible to urinary tract infections (UTI) due to several anatomical and hormonal changes. UTI is defined as two consecutive aseptically collected midstream urine specimens with the isolation of the same bacterial strain in quantitative counts of ≥105 colony-forming units (CFU)/ml [1]. Most of these UTI present as asymptomatic bacteriuria (ASB). The prevalence of ASB in pregnant women was about 2% - 7% [2] Both ASB and symptomatic bacteriuria (SB) during pregnancy increase the risk of pyelonephritis and have been associated with adverse pregnancy outcomes, such as preterm births, low birth weight infants, preeclampsia, and perinatal mortality [3] [4]. Other factors that are associated with failure to treat bacteriuria are not known in recent studies
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