Bacteriuria In Pregnant Women Research Articles

Office diagnosis of asymptomatic bacteriuria in pregnant women

Diagnosis and treatment of asymptomatic bacteriuria in pregnant patients can virtually eliminate pyelonephritis, the most common medical cause for antepartum hospitalization. However, the ever-increasing cost of the urine culture has led most clinicians away from routine urine screening. Uricult dip-slide paddles provide an inexpensive, efficient way to screen urine. Clean-catch urine specimens were obtained from 544 consecutive asymptomatic pregnant patients seen in the outpatient obstetric clinic at the Medical University of South Carolina. Specimens were analyzed by both traditional culture techniques and the Uricult dip-slide paddles. By comparison, the Uricult test detected 55 of the 56 significant gram-negative urinary pathogens found by culture. Detection of potential gram-positive pathogens is more difficult. A scheme is proposed that allows reliable, inexpensive surveillance in all pregnant patients. Hopefully, this algorithm will rekindle the obstetrician's interest in urine screening.

Serum estriol level during treatment with pivmecillinam.

Asymptomatic bacteriuria in pregnant women shall always be treated, because of the risk of development of acute pyelonephritis. Some antibiotics reduce the level of serum estriol and therefore are less suitable in the treatment of cystitis in the last trimester of pregnancy. Mecillinam is found effective against the most frequent urinary pathogen in cystitis in pregnancy (escherichia coli), and as it is found not to reduce the level of serum estriol it is concluded that pivmecillinam/mecillinam is an alternative in the treatment of symptomatic and asymptomatic urinary tract infections in the last trimester of pregnancy.

Anaerobic and other fastidious microorganisms in asymptomatic bacteriuria in pregnant women.

Urine from 44 pregnant women with known or suspected renal disease (group 1) and from 50 healthy pregnant women (group 2) with negative routine cultures of midstream urine was obtained by suprapubic aspiration. Aerobic and anaerobic cultures showed bacteriuria in 70% of the women in group 1 and in 26% of those in group 2. Gardnerella vaginalis was the most frequently isolated organism. Ureaplasma urealyticum was isolated from 14(48%) of 29 women in group 1 and from two (12.5%) of 16 women in group 2. Radiologic studies showed a high incidence of underlying renal disease in asymptomatic women with bacteriuria. Localization testing indicated kidney infection in six of 14 women in group 1 and in one of four women in group 2. These findings suggest that there is an increased susceptibility to colonization of the bladder with these microorganisms during pregnancy and that persistence of infection and renal involvement are associated with underlying renal disease.

Cost Effectiveness of Renal Disease Screening

Diseases of the kidney and their complications represent a major cause of disability and death. Search for evidence that the prognosis for a substantial portion of patients with chronic renal disease might be effectively influenced by early screening has been largely unrewarding. There is limited evidence that the progressive course of many chronic renal diseases can be arrested by presently available therapeutic methods. Thus, except for detection of bacteriuria in pregnant women, it would seem unreasonable to seek early identification. In addition, screening of asymptomatic individuals may create unnecessary, serious, economic and psychosocial problems for the many patients with benign or transient urinary abnormalities.