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

作者：Anne CC Lee, Luke C. Mullany, Alain K. Koffi, Iftekhar Rafiqullah, Rasheda Khanam, Lian V. Folger, Mahmoodur Rahman, Dipak Kumar Mitra, Alain Bernard Labrique, Parul S. Christian, Jamal Uddin, Parvez Ahmed, Salahuddin Ahmed, Arif Mahmud, Sushil Kanta Dasgupta, Nazma Begum, Mohammad Abdul Quaiyum, Samir Kumar Saha, Abdullah Hel Baqui · 发表于：BMC Pregnancy and Childbirth · 年份：2019 · DOI：10.1186/s12884-019-2665-0 · 被引用次数：342 · 研究领域：Urinary Tract Infections Management、Pelvic floor disorders treatments、Pediatric Urology and Nephrology Studies

Abstract Background Urinary 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. Methods In 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. Results The 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. Conclusions...