Diagnostic and Treatment Difficulties of Pyelonephritis in Pregnancy in Resource-Limited Settings

Abstract

Limited microbiology services impede adequate diagnosis and treatment of common infections such as pyelonephritis in resource-limited settings. Febrile pregnant women attending antenatal clinics at Shoklo Malaria Research Unit were offered urine dipstick, sediment microscopy, urine culture, and a 5-mL blood culture. The incidence of pyelonephritis was 11/1,000 deliveries (N = 53 in 4,819 pregnancies) between January 7, 2004 and May 17, 2006. Pyelonephritis accounted for 20.2% (41/203) of fever cases in pregnancy. Escherichia coli was the most commonly isolated pathogen: 87.5% (28/32) of organisms cultured. Susceptibility of E. coli to ampicillin (14%), cotrimoxazole (21%), and amoxicillin-clavulanic acid (48%) was very low. E. coli was susceptible to ceftriaxone and ciprofloxacin. The rate of extended spectrum β-lactamase (4.2%; 95% confidence interval = 0.7–19.5) was low. The rate and causes of pyelonephritis in pregnant refugee and migrant women were comparable with those described in developed countries. Diagnostic innovation in microbiology that permits affordable access is a high priority for resource-poor settings.

Extended‐spectrum beta‐lactamase (ESBL)‐producingEnterobacteriaceaeand urinary tract infections in pregnant/postpartum women: A systematic review and meta‐analysis

“…America, 32 12 studies in Asia, [33][34][35][36][37][38][39][40][41][42][43][44] and 2 studies in Europe. 45,46 We contacted authors of 20 studies for more clarifications about their reports.…”

“…For studies that lasted for more than 12 months, the midyear of the study period that actual sampling and laboratory evaluation was done was determined as the date of the study. Nine studies reported data on patients with symptomatic UTI, 24,27,29,[31][32][33]43,44,46 nine reported AB, 25,26,[34][35][36][37][40][41][42] and infection type in five studies 28,30,38,39,45 were indeterminate. Two studies included postpartum women.…”

The Aetiologies and Impact of Fever in Pregnant Inpatients in Vientiane, Laos

“…vivax infection [ 20 – 22 ]. Dengue, leptospirosis, typhoid fever and rickettsioses are common causes of fever in tropical areas [ 23 , 24 ] but whether the risk and severity of these diseases are higher in pregnancy is unclear [ 17 , 25 – 36 ].…”

The role of point‐of‐care tests in antibiotic stewardship for urinary tract infections in a resource‐limited setting on the Thailand–Myanmar border

“…High levels of resistant organisms were cultured (20.9% of E. coli produced ESBL) although this is comparatively lower than the 37% reported from 97 samples (2009-2010) from two Thai hospital (Sirriraj Hospital in Bangkok and Songklanakarin Hospital, Songkhla, Southern Thailand) described in the Study for Monitoring Antimicrobial Resistance Trends (SMART) [34]. It is, however, five times higher than described in the same setting in adult febrile pregnant women just 8 years earlier (2004)(2005)(2006) [22]. In addition, rates of antibiotic resistance against cephalosporins, ampicillin, cotrimoxazole and gentamicin were comparable to E. coli susceptibilities of community-acquired infections in Asia [35].…”