Bacteriuria and Pyelonephritis of Pregnancy

Abstract

The interpretation of bacterial cultures of the urine has been greatly aided by the use of quantitative methods. Analysis of the bacterial colony counts of urines obtained from large numbers of patients has indicated that, except for certain defined clinical circumstances,1 a colony count greater than 100,000 per milliliter of freshly obtained urine generally indicates the presence of true bacteriuria, that is, of actual multiplication of bacteria within the urinary tract. Conversely, bacterial colony counts less than 100,000 usually represent contamination attendant upon the collection of the specimen.2,3The validity of this approach has been amply confirmed,4-6 despite some earlier and relatively minor disagreements that have since been largely resolved.7 The quantitative approach has been of value not only in defining the presence or absence of infection of the urinary tract in the usual clinical setting, but also it has provided a means for determining the presence of asymptomatic infection of the urinary tract.2,3 Per¬ haps equally important, it has provided a dimension which must be taken into account in the study of the natural history and pathogenesis of pyelonephritis.Asymptomatic bacteriuria is found with particular frequency in those population groups that are particularly likely to de¬ velop pyelonephritis (i.e., patients with diabetes mellitus, pregnancy, obstructive uropathy, past histories of instrumentation, etc.). At autopsy, active pyelonephritis is almost always accompanied by bacteriuria, although there are many instances of bac¬ teriuria without morphologic evidence of bacterial invasion of the kidneys or blad¬ der.8The available evidence, therefore, indi¬ cates a strong relationship between bac¬ teriuria and pyelonephritis. It does not, however, offer any clear view of the role of bacteriuria in the pathogenesis of pye¬ lonephritis.It is the purpose of the present report to show that asymptomatic bacteriuria during pregnancy predisposes to the development of pyelonephritis and that, when asympto¬ matic bacteriuria is eliminated by appropri¬ ate treatment, symptomatic infection of the urinary tract is averted. It will be shown further that when persistent bacteriuria is induced in the experimental animal, active pyelonephritis due to ascending infection can be produced regularly in the absence of demonstrable obstruction.The study of asymptomatic bacteriuria in pregnancy was undertaken for several rea¬ sons.Pyelonephritis occurs particularly often in women of childbearing age and is the commonest complication of pregnancy.9Chronic renal failure and hypertension are commoner in women than in men, and ob¬ servant students of the problem have point¬ ed out for years that patients with renal

Prevalence of Asymptomatic Bacteriuria and its Antibacterial Susceptibility Pattern Among Pregnant Women Attending the Antenatal Clinic at Kanpur, India

“…Those women who show positive cultures should be treated as per antimicrobial sensitivity patterns of the bacteria which are isolated from their samples, to prevent maternal and foetal morbidities. In this study, the prevalence of asymptomatic bacteriuria was 7.3%, which was similar to those seen in various other studies [2,[9][10][11][12][13][14]. Neupane et al, (26%) and Imade et al, (45.3%) reported a higher prevalence [15,16].…”

“…The higher incidence in first trimester could be caused by hormonal changes occurring prior to occurrence of anatomical changes. Moreover, earliest study done by Kass explains that there is rare acquisition of bacteriuria after the second month of pregnancy [9].…”

Prevalance of Pregnancy Associated Asymptomatic Bacteriuria: A Study Done in a Tertiary Care Hospital

“…Subsequently asymptomatic bacteriuria should be treated as per antimicrobial sensitivity pattern of the isolate to prevent maternal and perinatal morbidity. The pioneer in reporting incidence of asymptomatic bacteriuria was Kass, who reported it to be 6-7% [6]. Overall the incidence in various Indian studies was found to be between 5 and 12% and in western studies the incidence ranges from 2 to 7% [3].In the present study the incidence of asymptomatic bacteriuria came out to be 7.34% which is concordant with many foreign and Indian studies.…”

“…The higher incidence in first trimester could be because of hormonal changes occurring prior to anatomical changes. Moreover, earliest study by Kass explains that there is rare acquisition of bacteriuria after the second month of pregnancy [6]. The bacteria responsible for asymptomatic bacteriuria are of fecal origin which colonize the periuretheral area.…”

Prevalence of Asymptomatic Bacteriuria in Pregnant Women, Westren Region, Taif, Sudia Arabia

“…The pioneer in reporting incidence of asymptomaticbacteriuria was Kass, who reported it to be 6-7% [33].Overall the incidence in various Indian studies was foundto be between 5 and 12% and in western studies the incidenceranges from 2 to 7% [34].…”