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Prevalence of asymptomatic bacteriuria among pregnant women in Kashmir
Abstract and Figures
Objective: To determine the prevalence of asymptomatic bacteriuria in pregnant women and antimicrobial susceptibility pattern of pathogens isolated and also to determine the relationship between asymptomatic bacteriuria and pyuria. Methods: A total of 392 urine specimens were collected from 392 pregnant women with asymptomatic bacteriuria attending different antenatal care clinics for regular perinatal care between April, 2007 and July, 2008. All specimens were processed using standard microbiological procedures. All the subjects were evaluated for bacteriuria. Results: The prevalence of asymptomatic bacteriuria was 6.1% among the pregnant women in Srinagar. From 92 (23.5%) patients who had ≥5 pus cells per high power field, only 15 (16.3%) had positive urine culture. E.coli (~71%) was the commonest causative agent of asymptomatic bacteriuria followed by Klebsiella pneumoniae (~17%), group B Beta haemolytic Streptococcus (8.3%) and Proteus mirabilis (4.2%). Ciprofloxacin was found to be highly sensitive against all isolates.
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... The prevalence of ASB 6.1%, 7.5%, 9.8%, among antenatal women was reported by Ahmad and colleagues 21 Pregnant patients in Yemen, the United Arab Emirates (UAE), Qatar, and Iran were indicated to have an ASB incidence of 30, 4.8, 9.9, and 3.3e6.1%, correspondingly Moghadas and Irajian. ...
... Data gathered from several locations revealed that E. coli is still the most commonly infection in ASB like our study Marahatta and colleagues, 23 Chitralekha and colleagues, 24 Ahmad and colleagues 21 and Rizvi and colleagues. 30 Lactoses and amino acid levels increased during pregnancy, which favorably promotes the development of E. coli. ...
... Asymptomatic bacteriuria (ASB) has been defined as common cause of adverse maternal and pregnancy outcomes precisely pyelonephritis, low birth weight, preterm premature rupture of membranes and preterm labour, only around 10% of pregnant women will develop symptoms of a UTI, while others have asymptomatic bacteriuria, which may lead to serious infections complication, if not diagnosed and treated. (Ahmad et al., 2011), but Asymptomatic bacteriuria in pregnant women complications risk will be reduced by quick early routine screen and treat policy in pregnant women (Wingert et al., 2019). Worldwide about 30-40 untreated pregnant women with ASB will develop acute pyelonephritis in late pregnancy which is associated with significant morbidity for the mother and fetus and thus exact screening and treatment of bacteriuria in order to avoid further complications (Mwei et al., 2018). ...
Asymptomatic bacteriuria (ASB) is known as significant presence of pathogenic bacteria more as 105 CFU/ml in urine culture of pregnant women without any symptoms indicate of urinary tract infections. Which is may lead to serious complications on health of a pregnant woman, and the fetus if left untreated. The purpose of this study was designed to find the prevalence of asymptomatic urinary tract infection (AUTI) among pregnant women, and also to determine the antibacterial susceptibility of the isolates to various antibiotics to reduce risk factors in pregnancy. However, little is known about asymptomatic bacteriuria in pregnancy in Libya, namely in Sirte city. A total of 265 samples were collected in 7 months study involving women attending antenatal clinics in Sirte City-Libya, mid-stream urine samples were collected for microscopically examination. A colony culture growth were identified by biochemical tests and conventional antibiotic susceptibility tested in microbiology laboratory. Isolates were identified and tested against commonly used antimicrobial drugs using Kirby Bauer disc diffusion method. The prevalence of 265 pregnant women in different age groups were enrolled in this study, only 76 (28.7%) pregnant women had bacteriuria. The organism isolated from the urine sample according to the frequency of occurrence was Escherichia coli 32(42.1%), Coagulase negative Staphylococcus 11 (14.4%), Staphylococcus aureus 9(11.8%), Klebsiella Pneumoniae 9(11.8%), Streptococcus agalactiae 8 (10.5%), Enterococcus spp 5(6.6%), Proteus mirabilis 2(2.6%), respectively. The overall prevalence of asymptomatic bacteriuria among pregnant women in the study area was not high, but need to be taken on consider reducing risk of infections. The presence of asymptomatic bacteriuria and their antibiotic susceptibility test results should be taken into consideration during the management of pregnant women who are visiting antenatal care clinic; because there was high resistance to the most commonly used antibiotics. Routine urine culture and antimicrobial sensitivity for antenatal women should be carried out to detect asymptomatic bacteriuria to treat early infections, to prevent any serious complication associated with pregnancy.
... Our finding is in line with studies done in Dessie, Northeast Ethiopia [25], Baghdad, Iraq [26], and Kanpur, India [27]. However, contrary to studies done in Kashmir [28], and Adigrat, Northern Ethiopia [29]. The easy accessibility of the commonly prescribed antimicrobials over-the-counter combined with the misuse of the antibiotics by both the patients and clinicians, lack of trained personnel for urine culture, and frequent use of common antimicrobial agents without prescription might be responsible for the observed high prevalence of antimicrobial resistance to commonly used antibiotics. ...
Background
Asymptomatic bacteriuria is a common problem in pregnant women and about 40% of women with untreated asymptomatic bacteriuria during pregnancy develop pyelonephritis, which might lead to low birth weight, premature rupture of membranes, and preterm labour. Therefore, this study aimed to assess the prevalence of asymptomatic bacteriuria, antimicrobial susceptibility pattern of the isolates among pregnant women attending the antenatal care of Assosa general hospital, western Ethiopia.
Methods
A facility-based cross-sectional study was conducted from January to February 2019. Two hundred and eighty-three pregnant women with no symptoms of urinary tract infections participated in the study. Bacterial isolates were identified as per the standard bacteriological procedure using colony characteristics, Gram-staining, and series of biochemical tests. Antimicrobial susceptibility test was carried out by Kirby- Bauer disk diffusion technique on Muller-Hinton agar medium and the diameter of zone of inhibition was interpreted according to Clinical Laboratory Standard Institute guidelines.
Results
The overall prevalence of asymptomatic bacteriuria among pregnant women in this study was 13.78% (i.e. 39 out of 283 urine samples were positive for bacterial isolates). E. coli was the most predominant isolate (53.8%) followed by K. pneumoniae (17.95%), S. aureus (15.4%), and coagulase-negative staphylococci (12.8%). Gram-negative bacteria were highly resistant to tetracycline (96.4%), and ampicillin (90.5%).
Conclusion
Significant bacteriuria was observed in asymptomatic pregnant women. A large number of the bacterial isolates were resistant to the commonly used antimicrobial drugs.
... Which show that most of the Gram-negative isolates were sensitive to ceftazidime, ceftriaxone, cefotaxime, amikacin, tobramycin, cipro oxacin and resistant to tetracycline and amoxicillin. Our nding are contrary to studies done in Kashmir [27], and Adigrat Northern Ethiopia [28]. Which show that most of the Gram-negative isolates were sensitive trimethoprim-sulfamethoxazole augmentin, nalidixic acid and gentamycin. ...
Background: ASB is a common problem in pregnant women. About 40% of women with untreated asymptomatic bacteriuria during pregnancy develop pyelonephritis, this has the possibility of leading to low birth weight, preterm, premature rupture of membranes and preterm labour. This study is aimed to assess the prevalence of asymptomatic bacteriuria and antimicrobial susceptibility pattern isolating among pregnant women attending the antenatal clinical care of Assosa General Hospital in western Ethiopia.
Methods: A facility-based cross-sectional study was conducted from January to February 2019. Well-mixed and uncentrifuged urine specimens obtained from the pregnant women were directly inoculated on cystine lactose electrolyte deficient agar (CLED) (Oxoid, Ltd, England) media by streak plate method. Bacterial isolates were identified as per the standard bacteriological procedure using colony characteristics, gram-staining, and series of biochemical tests. Antimicrobial susceptibility test was carried out by Kirby- Bauer disk diffusion technique on Muller-Hinton agar medium and the diameter of zone of inhibition was interpreted according to Clinical Laboratory Standard Institute (CLSI) guidelines
Result: The overall prevalence of ASB among pregnant women in this study was 14.85%. E-coli was the most predominant isolate (50 %,) followed by K. pneumoniae (16.7%,), S. aureus (14.3%), coagulase-negative staphylococci (CONS) (11.9%), and group B streptococci (GBS) (7.1%). Gram-negative bacteria were highly resistant for tetracycline (96.4%), ampicillin. Gram-positive bacteria were 100% sensitive for ceftazidime.
Conclusion: Significant bacteriuria was observed in asymptomatic pregnant women. Therefore, routine laboratory diagnosis of ASB in pregnant women in addition to providing appropriate treatment should be needed to reduce its complications.
... Gebeler arasında ASB'den sorumlu en yaygın bakteriler E. coli, Proteus spp., Klebsiella spp., Pseudomonas spp., Enterococcus spp., S. aureus ve koagülaz negatif stafilokoklardır [6] . E. coli, gebeler arasında ASB'ye neden olan en baskın bakteridir [7,8] . Streptococcus agalactiae (grup B Streptococcus) kaynaklı ASB, kötü obstetrik sonuçlarla ilişkilendirilmiştir. S. agalactiae'nın kadın genitoüriner sistemde kolonize olduğu ve doğumdan önce, doğum sırasında veya sonrasında yenidoğana geçtiği bilinmektedir [9] . ...
Giriş: Asemptomatik bakteriüri (ASB) idrar yolu infeksiyonlarının belirgin belirtileri olmadan idrarda bakteri varlığı olarak tanımlanmaktadır. Asemptomatik bakteriüri hamilelik sırasında ortaya çıkmakta olup hamilelik sırasında tedavi edilmediğinde olumsuz maternal ve perinatal sonuçlarla ilişkilendirilmektedir. Bu çalışmadaki amacımız bölgemizde kadın hastalıkları ve doğum kliniğine başvuran gebelerdeki ASB görülme sıklığını, ilişkili risk faktörlerini, bakteriüriye sebep olan mikroorganizmaları ve antibiyotik duyarlılıklarını belirlemektir.
Materyal ve Metod: Üniversite hastanemizin kadın hastalıkları ve doğum kliniklerine 1 Ocak 2017-1 Ocak 2019 tarihleri arasında başvuran 18 yaş ve üstü tüm gebeler dahil edildi. Hastalara ait demografik özellikler, risk faktörleri, laboratuvar bulguları, hastaların klinik kayıtlarından elde edildi. İdrar örnekleri aseptik koşullarda toplandı. Elde edilen örnekler rutin makroskopi, mikroskopi incelemesi ve uygun besiyerlerine ekilerek kültüre edildi. Kültürde anlamlı üreme olan plaklardaki mikrobiyal izolatlar konvensiyonel metotlar ile tanımlandı. Tüm bakteriyel izolatların antimikrobiyal duyarlılıklarının belirlenmesi için Kirby Bauer disk difüzyon yöntemi kullanıldı. Veriler SPSS versiyon 24 yazılımı ile analiz edildi ve tüm durumlarda, 0.05’in altındaki p değerleri istatistiksel olarak anlamlı kabul edildi.
Bulgular: Çalışmaya toplam 410 gebe dahil edildi. Kültürde üreme olan 32 hasta vaka grubuna, kültürde üreme olmayan 378 hasta ise kontrol grubuna dahil edildi. Ortalama yaş 30.29 ± 5.61 (18-45 yaş) olarak bulundu. ASB görülme sıklığı %7.8 idi. Doğum sayısı ile ASB arasında istatistiksel anlamlı bir fark saptandı. İstatistiksel analiz sonucuna göre; 2 doğum yapan gebelerin, 1 doğum yapanlara göre ASB’ye yakalanma riski 0.056 kat, 3 doğum yapan gebelerin, 2 doğum yapanlara göre ASB’ye yakalanma riskinin ise 0.045 kat
arttığı belirlendi (Doğum sayısı; 1; OR: 0,148; % 95 GA: (0.023-0.957), 2; OR: 0,056; % 95 GA: (0.006-0.580), 3; OR: 0.045 % 95 GA: (0.002-0.870); P< .005). İzole edilen mikroorganizmalar içerisinde en baskın tür Escherichia coli (%59.4) olup bunu Enterobacter aerogenes (%15.7), Staphylococcus aureus (%9.4) izledi. İzolatlar, nitrofurantoin (%93.75), amikasin (%93.75), tetrasiklin (%93.10) ve trimetoprim-sülfametoksazol (%87.5) antibiyotiklere duyarlı idi.
Sonuç: ASB gebelerde önemli oranda yüksektir. Düşük ve erken doğum için bir risk faktörü olan ASB varlığının gebelik sırasında taranması ve tedavi edilmesi önemlidir. Gebelerin ASB açısından taranması ve tedavi edilmesi, gebelik komplikasyonları ve ilişkili advers
doğum sonuçlarının önlenmesini de sağlayacaktır. Gebelerin tedavisinde antibiyotik duyarlılık testi sonuçları mutlaka dikkate alınmalıdır.
Anahtar Kelimeler: Asemptomatik bakteriüri; Antimikrobiyal duyarlılık; Gebelik; Risk faktörleri
... Which show that most of the Gram-negative isolates were sensitive to ceftazidm, ceftriaxone, cefotaxime, amikacin, tobramycin and cipro oxacin and resistant to tetracycline and amoxicillin. However, our nding is in contrary to studies done in Kashmir [27], and Adigrat Northern Ethiopia [28]. Which show that most of the Gram-negative isolates were sensitive trimethoprim-sulfamethoxazole augmentin, nalidixic acid and gentamycin. ...
Background: ASB is a common problem in pregnant women and about 40% of women with untreated asymptomatic bacteriuria during pregnancy develop pyelonephritis, which might lead to low birth weight, preterm, premature rupture of membranes and preterm labour. Therefore, this study aimed to assess the prevalence of asymptomatic bacteriuria, antimicrobial susceptibility pattern of the isolates among pregnant women attending antenatal care clinic of Assosa General Hospital, western Ethiopia.
Methods: A facility-based cross sectional study was conducted from January to February 2019. Well-mixed and uncentrifuged urine specimens obtained from the pregnant women was directly inoculated on cystine lactose electrolyte deficient agar (CLED) (Oxoid, Ltd, England) media by streak plate method. Bacterial isolates were identified as per the standard bacteriological procedure using colony characteristics, gram-staining, and series of biochemical tests. Antimicrobial susceptibility test was carried out by Kirby- Bauer disk diffusion technique on Muller-Hinton agar medium and the diameter of zone of inhibition was interpreted according toClinical Laboratory Standard Institute (CLSI) guidelines
Result: The overall prevalence of ASB among pregnant women in this study was 14.85%.E. coli was the most predominant isolate (50 %,) followed by K. pneumoniae (16.7%,), S. aureus (14.3%), coagulase negative staphylococci (CONS) (11.9%), and group B streptococci (GBS) (7.1%).Gram-negative bacteria were highly resistant for tetracycline (96.4%), ampicillin .Gram-positive bacteria were 100% sensitive for ceftazidime.
Conclusion: Significant bacteriuria was observed in asymptomatic pregnant women. Therefore, routine laboratory diagnosis of ASB in pregnant women and providing appropriate treatment should be needed to reduce its complications.
... [39] However, our result of E. coli predominance rate was lower to that reported for UK and USA. [40] Previous studies reported that E. coli was the predominant pathogen as the cause of infection in pregnant women [1,7,18,19,[41][42][43][44][45] , however, the studies conducted in Arab countries and Africa revealed that E. coli form <50% as a cause of UTI. [22] Okonko et al [46] reported that studies revealed that > 40% of UTI aetiology was due to E. coli as compared to other bacteria and was higher to that found in the present study. ...
... The predominant organism isolated was Escherichia coli as reported by several studies. [23][24][25][26][27] Antibiogram of Gram negative organisms showed highest sensitivity to Carbapenams followed by beta lactam and beta lactam inhibitor combination, Nitrofurantoin, third generation cephalosporins, Aminoglycosides and fluoroquinolones. Antibiogram of Gram positive organisms showed highest sensitivity to Vancomycin, Linezolid, Teicoplanin and moderate resistance to aminoglycosides and fluoroquinolones. ...
... 10 % of pregnant women with asymptomatic bacteriuria develop symptomatic bacteriuria during pregnancy .The challenge with asymptomatic bacteriuria is that, it is difficult to diagnose, as there are no specific symptoms. 30 -40% of the cases of untreated asymptomatic bacteriuria develop acute pyelonephritis in later part of pregnancy (Ahmad, 2011). The other complications that are associated with untreated asymptomatic bacteriuria are: chronic renal failure, IUGR, hypertensive disease of pregnancy, anemia, preterm labour, low birth weight infants, and infants with mental retardation or developmental delay (Girishbabu et al., 2011;Jaylakshmi, 2008;Tincello, 1998). ...
Asymptomatic bacteriuria in antenatal women is associated with adverse maternal and fetal outcomes. The gold standard for the diagnosis of bacteriuria is urine culture. This is expensive and time consuming. Hence, it is better to resort to a screening test which is user friendly and economical, with good sensitivity and specificity. We undertook this study, to note the occurrence ofasymptomatic bacteriuria and pyuria in antenatal women, the microbiological profile of the etiological agents, to evaluate the various screening tests, to note down the associated risk factors and complications. 250 antenatal womenwere screened. The midstream clean catch urine samples were subjected to Gram's stain, pus cell count, leucocyte esterase test, nitrite test, combined nitrite and leucocyte esterase , catalase test and to culture and sensitivity. Percentage description of data was given .Culture was taken as the gold standard against which the screening tests were compared. Significant bacteriuria was noted in 30 patients (12%). Asymptomatic bacteriuria was seen in 25-29 years age group (46.66%), in the third trimester (56.66%) and in multiparous women (53.33%), in low socioeconomic group (73.33%).The most common organism isolated in the present study was Escherichia coli (43.33%).The isolated organisms were sensitive to nitrofurantoin and gentamicin. Gram's stain of uncentrifuged urine was found to be the single, most useful test with good sensitivity (86.6%), specificity (98.6%) and NPV (98.1%). Pre-eclamptic toxaemia was observed in 3.33% of antenatal women, while 6.66% had low birth weight babies. Therefore, all antenatal women should be screened for asymptomatic bacteriuria and started on prompt treatment to prevent adverse maternal and fetal outcomes.
Resumen
Objetivo estimar la prevalencia y etiología de las infecciones urinarias en gestantes del Eje Cafetero, así como describir los factores asociados e identificar la sensibilidad a los antibióticos.
Métodos estudio de corte transversal, en gestantes que consultaron, por primera vez, a consulta prenatal, y que tuvieron un resultado positivo en el urocultivo, en tres centros de atención en el Eje Cafetero, entre 2018 y 2019. Se reclutaron 1131 mujeres. Se evaluaron los factores de riesgo asociados, el aislamiento e identificación de los gérmenes involucrados, así como la prevalencia de enterobacterias productoras de β-lactamasas de espectro extendido (BLEE).
Resultados La edad de las mujeres osciló entre 18 y 42 años, promedio de 29,46 ± 5,82 años. La prevalencia global de infección urinaria fue de un 14,94% (IC95%: 11,78-21,46). La etiología más frecuente caracterizó la Escherichia Coli (80,47%), seguida por Klebsiella spp. (9,46%) y Proteus mirabilis (5,91%). La prevalencia de gérmenes BLEE (+) alcanzó el 11,24% (IC95%: 9,47-11,75). Las mujeres con depilación íntima tuvieron mayor riesgo de presentar infección urinaria (OR = 4,62; IC95%: 1,08-8,64) seguida por el tabaquismo (OR = 4,56; IC95%: 2,58-9,81) y la diabetes mellitus (OR = 3,96; IC95%: 1,05-6,54). El uso de protectores íntimos fue mayor en las mujeres con infección urinaria (OR = 2,88; IC95%: 1,02-3,99).
Conclusiones se identificó la infección urinaria en el 14,94% de las gestantes. Se detectó la Escherichia Coli como la etiología más frecuente. La depilación íntima fue el principal factor de riesgo.
Editorial Urinary tract infections (UTIs) are a frequent problem worldwide which are caused by microbial invasion to different tissues of the urinary tract. Urine is normally sterile, that is, free of bacteria, viruses, and fungi. A urinary tract infection is a condition in which one or more parts of the urinary system (the kidneys, ureters, bladder, and urethra) become infected. UTIs are one of the most common bacterial infections in the general population, with an estimated overall incidence rate of 18 per 1000 person per year. It is the most frequent bacterial infection recorded in older people [1]. In addition, UTIs are a major cause of hospital admissions and are associated with significant morbidity and mortality as well as a high economic burden [2]. In a study performed by Sammon et al. 10.8 million patients in the United States visited an Emergency Department (ED) for the treatment of a UTI between 2006 and 2009. The economic burden of utilizing the ED for the treatment of UTIs is estimated to be $2 billion US dollars annually [3]. UTIs can manifest in a wide clinical range from bacteriuria with limited clinical symptoms to sepsis [4]. 1. Depending on the factors that trigger the infections UTIs are classified as: 2. Uncomplicated or complicated, 3. Depending on whether the infection is occurring they are classified as: 4. Primary or recurrent, 5. Depending on sing and symptoms they are classified as: 6. Symptomatic or asymptomatic A complicated urinary tract infection (cUTI) is an infection associated with a condition, such as a structural or functional abnormality of the genitourinary tract, or the presence of an underlying disease that interferes with host defense mechanisms, which increase the risks of acquiring infection or of failing therapy [1-8]. The primary risk factors for the development of UTI include: age, presence of catheter, chronic comorbidities, neurogenic bladder, diminished mental status, urinary incontinence, diabetes, being female, gynecological disorders, male prostatic hypertrophy ect. Secondary risk factors include dehydration, immobility, other infection, colonization with resistant organisms, and poor personal hygiene. Older adults, especially women, are at increased risk of a secondary infection after the development of a urinary tract infection [2]. The prevalence of UTIs increases in the female population. Pregnancy is one of the factors which increase the risk of UTI partly due to the pressure of gravid uterus on the ureters causing stasis of urine flow and is also attributed to the humoral and immunological changes during normal pregnancy [4]. Estrogen deficiency has been recognized as a risk factor for recurrent UTIs in postmenopausal women because of ensuing vaginal flora changes: protective lactobacilli are replaced by E.coli and other uropathogens [2]. People with indwelling catheters can also be more prone to infections of the bloodstream and they are more generally at risk of urinary infections. [3-5]. The patients are affected by microorganisms capable of inducing inflammation within the urinary and male genital tract. Nearly 95% of cases of UTIs are caused by bacteria that typically multiply at the opening of the urethra and travel up to the bladder. Organisms causing UTI are derived primarily from the aerobic members of the fecal flora. An overwhelming majority of uncomplicated urinary tract infections [95%] are caused by a single organism. In contrast, infections among hospitalized patients, patients with urinary catheters, or individuals with structural abnormalities of the urinary tract may be polymicrobial. In uncomplicated UTIs Escherichia coli is the leading organism, whereas in complicated UTIs the bacterial spectrum is much broader including Gram-negative and Gram-positive and often multiresistant organisms. The primary goal of managing UTIs is optimal administration of appropriate antimicrobial agent and correction of any underlying genitourinary abnormalities. A rapid diagnosis is critical to meet the requirements of early goal directed therapy [4]. The diagnosis of UTI is particularly difficult in elderly patients, who are more likely to have asymptomatic bacteriuria as they get older. Urinalysis usually provides enough information to start or not treatment. A urine culture can help identify the specific bacteria causing the infection, and determine which type of antibiotics to use.
Urine specimen from 300 suspected cases of urinary tract infection (UTI) were cultured to see the significant growth of bacteria, to identify the species and to determine antimicrobial sensitivity pattern in positive cases. The result showed that out of 300 cases, 160 (53.33%) (F-111, M-49) had significant growth of bacteria (≥105/ml of urine). Out of these isolates, E. coli constituted highest number 94(59%), followed by Klebsiella sp. 20 (12.5%), staph. saphrophyticus 11 (6.87%) Pseudomonas sp. 9 (5.62%), proteus sp. 8(5%), staph, pyogenes 6(3.75%), strept. beta haemolyticus, strept. fecalis, strept. viridans each 4 (2.5%). Drug sensitivity pattern of organisms revealed aft isolates were sensitive to ciprofloxacin, ceftriaxone and gentamycin at very high percentage ranging 75 to 100% except pseudomonas to ciprofloxacin (55.5%). Organisms showed higher resistance to amoxycillin, nalidixic acid, co-trimoxazole, doxacycline and cephradine at varying percentage. Cephalexin and erythromycin were sensitive to percentage of 60 to 100% with the exception of proteus and pseudomonas. It is concluded that antibiotics should not be used indiscriminately without antibiogram in suspected cases of UTI. It is also of note that there is increasing trend of organisms resistant to different antibiotics.
Urinary tract infections (UTIs) are one of the most common infectious diseases encountered in clinical practice today. UTIs are not only common but the range of clinical effect varies from asymptomatic bacteriuria to acute pyelonephritis with sepsis. This review will highlight the recent advances how to define significant bacteriuria in different clinical settings, the classification of UTIs, the types of recurrent infections and their treatment. Pathogenesis of UTIs are also discussed in details including E. coli virulence factor influencing infection. The clinical features including urethral syndrome and the graded approach to treat them, are also described. Finally, diagnostic approach in patients of UTIs and the single dose, short term, conventional prolonged and low dose prophylactic treatment including some of the side effects of drugs are also mentioned.
Screening for asymptomatic bacteriuria is a standard of obstetrical care and is included in most antenatal guidelines. There is good evidence that treatment of asymptomatic bacteriuria will decrease the incidence of pyelonephritis. All pregnant women should be screened for asymptomatic bacteriuria, and there are no new data that would indicate otherwise. Antibiotic treatment of asymptomatic bacteriuria is associated with a decrease in the incidence of preterm delivery or low birth weight, but the methodological quality of the studies means any conclusion about the strength of this association needs to be drawn cautiously. A better understanding of the mechanism by which treatment of asymptomatic bacteriuria could prevent preterm delivery is needed. While several rapid screening tests have been evaluated, none perform adequately to replace urine culture for detecting asymptomatic bacteriuria. Until there are data from well-designed trials that establish the optimal duration of therapy for asymptomatic bacteriuria, standard treatment courses are recommended.
Urinary tract infection results in significant morbidity and mortality while consuming large amounts of national resources. The prevention, diagnosis, and treatment of urinary tract infection produce both costs and benefits, and economic analysis provides a rational framework for looking at these effects. The goals and methods of economic analysis in medicine are summarized, and strategies to address uncomplicated cystitis, nosocomial urinary tract infection, and pyelonephritis are reviewed, with an emphasis on the economic trade-offs faced by decision makers.