Risk factors of asymptomatic bacteriuria and fetomaternal outcome following treatment in early versus late gestation
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20220159Keywords:
Asymptomatic bacteriuria, Feto-maternal outcome, Early detection, Late detectionAbstract
Background: Asymptomatic bacteriuria (ASB) has higher incidence in pregnant than in non-pregnant women and is difficult to diagnose. It is associated with fetomaternal complications like prelabour rupture of membranes, preterm labour, low birth weight and increased perinatal mortality. The aim of this study is to analyse various risk factors and the maternal and fetal outcome following treatment of asymptomatic bacteriuria in early versus late gestation.
Methods: This prospective study was conducted in Thanjavur Medical college and Hospital in 2019. The study population comprises all pregnant women attending antenatal clinic for their 1st antenatal visit.
Results: Total of 800 antenatal women were enrolled in 2 groups based on gestational age <20 weeks (n=394) and between 28 to 32 weeks (n=406) at the time of their 1st antenatal visit. Incidence of asymptomatic bacteriuria was 13.6% and 84.4% were in the age group of 21-30 years. High prevalence was noted in primigravidae (47.7%) and in lower socioeconomic class (70.9%). Commonest organism isolated was E. coli (42.2%) and most of the organisms were sensitive to gentamycin (89.9%) and cefotaxime (84.4%). Despite treatment of asymptomatic bacteriuria, complications like anaemia, gestational hypertension & preterm labour were higher in late detection group than in early detection group.
Conclusions: This study shows high prevalence of asymptomatic bacteriuria in pregnant women. The chances of developing maternal complications were significantly reduced after antibiotic therapy of asymptomatic bacteriuria. Hence, early screening and treatment of asymptomatic bacteriuria needs to be incorporated in routine antenatal care.
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References
Stamm WE, Norrby SR. Urinary tract infections: disease panorama and challenges. J Infect Dis. 2001;183:1-4.
Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: mechanisms of infection and treatment options. Nat Rev Microbiol. 2015;13(5):269-84.
Prevention of Group B Streptococcal Early Onset Disease in Newborns. ACOG committee opinion summary, Number 782. Obstet Gynecol. 2019;134(1):1.
Nicolle LE, Gupta K, Bradley SF, Colgan R, DeMuri GP, Drekonja D, et al. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2019;68(10):83-110.
Dwyer PL, O’ Reilly M. Recurrent urinary tract infection in the female. Curr Opin Obstet Gynecol. 2002;14(5):537-43.
Henderson J, Webber E, Bean S. Screening for asymptomatic bacteriuria in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2019:322(12):1195-205.
Garingalo–Molina FD. Asymptomatic bacteriuria among pregnant women: Overview of diagnostic approaches. Phil J Microbiol Infect Dis. 2000;29:177-86.
Mittendorf R, Williams MA, Kass EH. Prevention of preterm delivery and low birth weight associated with asymptomatic bacteriuria. Clin Infect Dis. 1992;14(4):927-32.
Kass EH. Pyelonephritis and bacteriuria. A major problem in preventive medicine. Ann Intern Med. 1962;56:46-53.
Lavanya SV, Jogalakshmi D. Asymptomatic bacteriuria in antenatal women. Indian J Med Microbiol. 2002;20(2):105-6.
Fatima N, Ishrat S. Frequency and risk factors of asymptomatic bacteriuria during pregnancy. J Coll Physicians Surg Pak. 2006;16(4):273-5.
Ghafari M, Baigi V, Cheragi Z, Doc Irani A. The prevalence of Asymptomatic Bacteriuria in Iranian Pregnant Women: A Systematic Review and Meta-Analysis. PLoS One. 201;11(6):e0158031.
Radha S, Nambisan B, Prabakaran NK, Jamal S. Prevalence and outcome of asymptomatic bacteriuria in early pregnancy. Int J Reprod Contracept Obstet Gynecol. 2017;6:223-7.
Imade PE, Izekor PE, Eghafona NO, Enabulele OI, Ophori E. Asymptomatic bacteriuria among pregnant women. N Am J Med Sci. 2010;2(6):263-6.
Amadi ES, Enemuo OB, Uneke CJ, Nwosu OK, Onyeagba RA, Ugbogu OC. Asymptomatic Bacteriuria among Pregnant Women in Abakaliki, Ebonyi State Nigeria. J Med Sci. 2007;7:698-700.
Hazhir S. Asymptomatic bacteriuria in pregnant women. Urol J. 2007;4(1):24-7.
Abdel-Aziz Elzayat M, Barnett-Vanes A, Dabour MF, Cheng F. Prevalence of undiagnosed asymptomatic bacteriuria and associated risk factors during pregnancy: a cross-sectional study at two tertiary centres in Cairo, Egypt. BMJ Open. 2017;7(3):e013198.
Schnarr J, Smaill F. Asymptomatic bacteriuria and symptomatic urinary tract infections in pregnancy. Eur J Clin Invest. 2008;38(2):50-7.
Jayalakshmi J, Jayaram VS. Evaluation of various screening tests to detect asymptomatic bacteriuria in pregnant women. Indian J Pathol Microbiol. 2008;51:379-81.
Jain V, Das V, Agarwal A, Pandey A. Asymptomatic bacteriuria & obstetric outcome following treatment in early versus late pregnancy in north Indian women. Indian J Med Res. 2013;137(4):753-8.
Svanborg C, Godaly G. Bacterial virulence in urinary tract infection. Infect Dis Clin North Am. 1997;11(3):513-29.
Uncu Y, Uncu G, Esmer A, Bilgel N. Should asymptomatic bacteriuria be screened in pregnancy? Clin Exp Obstet Gynecol. 2002;29(4):281-5.
Smaill FM, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev. 2015;(8):CD000490.
Moore A, Doull M, Grad R, Groulx S, Pottie K, Tonelli M, Courage S, Garcia AJ, Thombs BD; Canadian Task Force on Preventive Health Care. Recommendations on screening for asymptomatic bacteriuria in pregnancy. CMAJ. 2018;190(27):823-30.
Romero R, Oyarzun E, Mazor M, Sirtori M, Hobbins JC, Bracken M. Meta-analysis of the relationship between asymptomatic bacteriuria and preterm delivery/low birth weight. Obstet Gynecol. 1989;73(4):576-82.
Sheiner E, Mazor-Drey E, Levy A. Asymptomatic bacteriuria during pregnancy. J Matern Fetal Neonatal Med. 2009;22(5):423-7.
Gilstrap LC, Ramin SM. Urinary tract infections during pregnancy. Obstet Gynecol Clin North Am. 2001;28(3):581-91.
Meis PJ, Michielutte R, Peters TJ, Wells HB, Sands RE, Coles EC, Johns KA. Factors associated with preterm birth in Cardiff, Wales. II. Indicated and spontaneous preterm birth. Am J Obstet Gynecol. 1995;173(2):597-602.
Kazemier BM, Koningstein FN, Schneeberger C, Ott A, Bossuyt PM, de Miranda E, et al. Maternal and neonatal consequences of treated and untreated asymptomatic bacteriuria in pregnancy: A prospective cohort study with an embedded randomised controlled trial. Lancet Infect Dis. 2015;15(11):1324-33.
Yan L, Jin Y, Hang H, Yan B. The association between urinary tract infection during pregnancy and preeclampsia: A meta-analysis. Medicine (Baltimore). 2018;97(36):e12192.
Easter SR, Cantonwine DE, Zera CA, Lim KH, Parry SI, McElrath TF. Urinary tract infection during pregnancy, angiogenic factor profiles, and risk of preeclampsia. Am J Obstet Gynecol. 2016;214(3):387.
Hill JB, Sheffield JS, McIntire DD, Wendel GD. Acute pyelonephritis in pregnancy. Obstet Gynecol. 2005;105(1):18-23.
Enayat K, Fariba F, Bahram N. Asymptomatic bacteriuria among pregnant women reffered to outpatient clinics in Sanandaj, Iran. Int Barz J Urol. 2007;34:699-707.
Nicolle LE, Gupta K, Bradley SF, Colgan R, DeMuri PG, Drekonja D, et al. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria:2019 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2019;68:83-110.