Urinary tract infections in pregnancy in a rural population of Bangladesh: population-based prevalence, risk factors, etiology, and antibiotic resistance

Abstract

BackgroundUrinary tract infection (UTI) in pregnancy, including asymptomatic bacteriuria, is associated with maternal morbidity and adverse pregnancy outcomes, including preterm birth and low birthweight. In low-middle income countries (LMICs), the capacity for screening and treatment of UTIs is limited. The objective of this study was to describe the population-based prevalence, risk factors, etiology and antimicrobial resistance patterns of UTIs in pregnancy in Bangladesh.MethodsIn a community-based cohort in Sylhet district, Bangladesh, urine specimens were collected at the household level in 4242 pregnant women (< 20 weeks gestation) for culture and antibiotic susceptibility testing. Basic descriptive analysis was performed, as well as logistic regression to calculate adjusted odds ratios (aOR) for UTI risk factors.ResultsThe prevalence of UTI was 8.9% (4.4% symptomatic UTI, 4.5% asymptomatic bacteriuria). Risk factors for UTI in this population included maternal undernutrition (mid-upper arm circumference <23 cm: aOR= 1.29, 95% CI: 1.03–1.61), primiparity (aOR= 1.45, 95% CI: 1.15–1.84), and low paternal education (no education: aOR= 1.56, 95% CI: 1.09–2.22). The predominant uro-pathogens were E. coli (38% of isolates), Klebsiella (12%), and staphyloccocal species (23%). Group B streptococcus accounted for 5.3% of uro-pathogens. Rates of antibiotic resistance were high, with only two-thirds of E. coli susceptible to 3rd generation cephalosporins.ConclusionsIn Sylhet, Bangladesh, one in 11 women had a UTI in pregnancy, and approximately half of cases were asymptomatic. There is a need for low-cost and accurate methods for UTI screening in pregnancy and efforts to address increasing rates of antibiotic resistance in LMIC.

Prevalence and Bacteriology of Symptomatic Urinary Tract Infection among Pregnant women at Mbarara Regional Referral Hospital, South-western Uganda

“…E.coli and Pseudomonas aeruginosa were 100% resistant to both Ampicillin and Amoxicillin. This has been demonstrated in other studies in Ethiopia, Kenya, Tanzania and Uganda at Mulago National Referral Hospital though the level of resistance was much higher than reported in most of the mentioned studies (8,10,13,16,17). The high resistance could be attributed to the over-the counter availability of these drugs particularly Ampicillin and Amoxicillin.…”

Rising prevalence of multidrug-resistant uropathogenic bacteria from urinary tract infections in pregnant women

“…They also reported bacteriuria due to staphylococcal (23% of isolates) and Group B streptococcus species (5.3% of isolates). 35 Similarly, Majumder et al. 44 and Haque et al.…”

“…Recently, a study conducted in Bangladesh on UTI in pregnant women reported high-burden bacteriuria (5.7%) in both symptomatic and asymptomatic cases. 35 Similarly, Dashtizade et al. 36 also reported the prevalence of UTI in Iranian pregnant women.…”

Prevalence and associated risk factors of urinary tract infection in pregnancy at the Douala General Hospital, Cameroon: a case–control study

“…Introduction / Введение Urinary tract infection (UTI) is a common clinical problem and is an infection caused by the presence and growth of microorganisms in the urinary tract. It affects all age groups but women are more susceptible than men due to their short urethra, absence of prostatic secretion, pregnancy and easy contamination of the urinary tract with faecal flora [1]. UTI is the second common infection occurring during pregnancy [2].…”

“…Several microorganisms have been associated with UTI although Escherichia coli is the most frequent accounting for 80 % to 90 % of UTI's in pregnancy [1,[9][10][11].…”