Urinary tract infections (UTIs) are among the most common infectious diseases in women, and are the most frequent cause of infectious complications of pregnancy. This paper reviews current scientific and methodical literature on UTIs in obstetrics and gynecology. Aspects of clinical importance of UTIs (epidemiology, clinical manifestations, complications), their etiology, antimicrobial resistance of UTIs agents were discussed, and current recommendations on diagnostics and treatment of UTIs were summarized. Special attention was paid to UTIs in pregnancy.
Introduction. Urinary tract infections are the most common infections in obstetrics and gynecology. Bacteriological method to investigate urine is laborious and time-consuming, therefore development of accurate and rapid methods for the detection of significant bacteriuria is important. Objective. Evaluation of quantitative real-time PCR based approach for the detection of significant bacteriuria in pregnant women. Material and methods. A retrospective investigation of mid-stream urine samples obtained from pregnant women was performed. Urine culture was performed using quantitative method, and a case was considered as significant bacteriuria if ≥ 105 CFU/ml were detected. Urine samples were analyzed for main uropathogens / groups of uropathogens using quantitative multiplex real-time PCR. Diagnostic characteristics of PCR were computed relative to the results of urine culture. Results. In total, 896 urine samples were tested. Of them, significant bacteriuria was found in 28 cases (3%). The frequency of detection of Escherichia coli was 50%, Enterococcus spp. — 25%, Klebsiella spp. — 7%, Proteus spp. and S. saprophyticus 4% each, Streptococcus spp. — 14%. Sensitivity and specificity of the detection of significant bacteriuria using quantitative real-time PCR for the majority of bacterial species / groups were 99% to 100%. Sensitivity and specificity of the quantitative real-time PCR based method were 96% and 98%, respectively. Conclusions. Prevalence of significant bacteriuria among pregnant women is 3%. Half of the uropathogens isolated from pregnant women with bacteriuria are E. coli. Sensitivity and specificity of quantitative PCR for the detection of significant bacteriuria are 96% and 98%, respectively.
Urinary tract infections are among the most common infectious diseases in women and often complicate the course of pregnancy. This article reviews current scientific and methodical literature on the management of pregnant women with urinary tract infection. Aspects of clinical importance of urinary tract infections during pregnancy (epidemiology, clinical manifestations, and complications) are discussed, with current recommendations for diagnosis and management of urinary tract infections summarized. Special attention is paid to the problem of antibiotic resistance of urinary tract infection pathogens.
Introduction. Bacterial vaginosis (BV) is associated with a number of reproductive health disorders, therefore timely and accurate diagnosis of this condition is exceedingly important. Objective.Comparison of effectiveness of clinical and laboratory diagnostics of BV in women with vaginal discharge. Material and methods. In total, 318 patients addressing gynecological clinics with complaints about vaginal discharge participated in the study. Clinical diagnostics of BV was performed in the clinics participating in patient enrollment in accordance with their clinical practice. For laboratory diagnostics, microscopy of Gram stained smears according to the Nugent method and quantitative real-time PCR were used. Sensitivity and specificity of clinical diagnostics of BV and the molecular method were evaluated using the Nugent method as reference standard. Results. With the Nugent method, BV was diagnosed in 27% of women, with real-time PCR — in 37% of women. Using clinical signs of BV, the condition was diagnosed in 91% women. Sensitivity and specificity of the real-time PCR were 97% and 87%, respectively. Sensitivity of clinical diagnostics was 100%, but specificity was only 17%. Conclusions. Diagnostics of BV based only on the presence of vaginal discharge leads to false positive results and requires laboratory confirmation. The molecular method has a high sensitivity and satisfactory specificity for BV diagnosis and can be used as an alternative to the Nugent method.
BACKGROUND: Despite numerous studies of the vaginal microbiota, there is still a lack of knowledge regarding its restoring dynamics in the early postpartum period. The condition of the vaginal microflora during pregnancy plays a key role in maintaining the physiological microbiocenosis of the birth canal and creating conditions for the normal course of pregnancy, the establishment of an infants intestinal microbiota, and the further development of the child. AIM: The aim of this study was to estimate the role of certain types of lactobacilli in restoring the vaginal microbiota in women in the early postpartum period, depending on the method of delivery. MATERIALS AND METHODS: We examined 150 women at 38-41 weeks of gestation. The clinical material for the study was vaginal discharge before and after delivery. To determine the species of lactobacilli and other microorganisms in the clinical material, we used quantitative real-time PCR. RESULTS: Before delivery, lactobacilli were found in vaginal discharge in 144 out of 150 women (96.0%), their number in the majority being more than 106 GE. In the postpartum period, lactobacilli were found in 66/128 (51.5%) cases, while prevailing in women after vaginal delivery in 50/65 (76.9%) cases (4.61.6, p = 0.000000). Among the dominant species of lactobacilli was L. crispatus, found in vaginal discharge before delivery, which most often affects the recovery of the vaginal microbiota in the postpartum period (29 out of 61 women, 47.5%). L. iners detected in the lochia predisposes to the violation of uterine involution in the early postpartum period (p = 0.03). CONCLUSIONS: Normal vaginal microbiota in the postpartum period is restored more quickly in women after vaginal delivery. Our study confirms that L. crispatus and L. iners play a major role in restoring the vaginal microbiota in the postpartum period.
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