Bacteriuria asintomática en el embarazo. Serie de casos en una clínica privada de Uruapan, Michoacán / Asymptomatic bacteriuria in pregnancy. Cases series in a private clinic in Uruapan Michoacán

Resumen OBJETIVO: Determinar la prevalencia de bacteriuria asintomática, su adecuado tratamiento con base en el reporte del antibiograma de pacientes embarazadas que acudieron a control prenatal en una clínica privada. MATERIALES Y MÉTODOS: Estudio retrospectivo de una serie de casos, descriptivo y transversal efectuado en mujeres embarazadas que acudieron a control prenatal en la consulta externa del Hospital Fray Juan de San Miguel de Uruapan, Michoacán, entre el 1 de enero de 2019 y el 31 de diciembre de 2021. Variables de estudio: edad de las madres, semanas de embarazo, embarazos, bacteriuria, agente causal, antibiótico indicado y respuesta al tratamiento. Para interpretar los resultados obtenidos se aplicaron estadística descriptiva, medidas de tendencia central y de frecuencias simples. RESULTADOS: Se estudiaron 227 embarazadas; de ellas, 49 tuvieron un urocultivo positivo. La prevalencia de bacteriuria asintomática fue de 21.59. Escherichia coli fue el agente causal más reportado. De los urocultivos de control 36 de 37 resultaron negativos y solo 1 de 37 fue positivo. CONCLUSIÓN: La prevalencia de bacteriuria asintomática de este estudio fue de 21.59% y el principal agente etiológico asilado E. coli en la mayoría de los casos, con sensibilidad a nitrofurantoína en la mayoría de los casos.

Abstract OBJECTIVE: To determine the prevalence of asymptomatic bacteriuria, its adequate treatment based on the antibiogram report of pregnant patients who attended prenatal control in a private clinic. MATERIALS AND METHODS: Retrospective study of a case series, descriptive and cross-sectional carried out in pregnant women who attended prenatal control in the outpatient clinic of the Hospital Fray Juan de San Miguel de Uruapan, Michoacán, between January 1, 2019 and December 31, 2021. Study variables: mothers' age, weeks of pregnancy, pregnancies, bacteriuria, causative agent, indicated antibiotic and response to treatment. Descriptive statistics, measures of central tendency and simple frequencies were used to interpret the results obtained. RESULTS: A total of 227 pregnant women were studied; 49 of them had a positive urine culture. The prevalence of asymptomatic bacteriuria was 21.59. Escherichia coli was the most reported causative agent. Of the control urine cultures 36 of 37 were negative and only 1 of 37 was positive. CONCLUSION: The prevalence of asymptomatic bacteriuria in this study was 21.59% and the main etiologic agent was E. coli in most cases, with sensitivity to nitrofurantoin in most cases.

Profile of uropathogens in pregnancy over 5 years from a large tertiary center in South India

Objectives: Urinary tract infections (UTIs) are a common medical problem in both antenatal and postnatal women. Data from India on the demography of these women, microbiology and antimicrobial susceptibility of the causative bacteria, need elucidation. Material and Methods: We performed an observation study that collected data on UTI in antenatal and postnatal women between 2013 and 2017 at our tertiary care center in South India. Antenatally, urine dipstick-positive patients, high-risk, and symptomatic patients submitted urine cultures. Postnatally, all symptomatic patients had urine cultures. This was 20% of all antenatal and postnatal women resulting in 20,203 cultures. Results: Of 20,203 cultures, significant bacteriuria was seen in 9.48% of antenatal and 13.28% of postnatal women. A higher mean age was seen among those with UTI, antenatal 27 (SD 3.5) and postnatal 26.4 (SD 4.7) years versus 23.9 (SD 3.6) with no growth in culture. The mean BMI among antenatal was 28.2 (SD 3.5) and postnatal was 28 (SD 7.4). Most (60%) were primigravida. At delivery, 37% required cesarean sections while 21.2% required instrumental delivery. Recurrent UTI was seen in 25% antenatally and 10% in the postnatal period. Escherichia coli accounted for 66 and 60% of infections among antenatal and postnatal women, respectively. Enterococcus species accounted for 13% in both while Klebsiella species was 4.9 and 7.3%, respectively. Among E. coli, 68.3 and 59.2% of isolates in antenatal and postnatal period were cefpodoxime susceptible. Nearly 75% of ante- and postnatal isolates were susceptible to amoxicillin-clavulanate while 90.2% and 92.5% were susceptible to nitrofurantoin. Enterococci spp. up to 84.4 and 97.1% in ante- and postnatal isolates were susceptible to ampicillin, 64.4 and 77.4% susceptible to high-level gentamicin, and 84 and 95.5% susceptible to nitrofurantoin. Asymptomatic bacteriuria in pregnancy was documented in 2.1% of antenatal outpatients and E. coli was isolated in 74% of these cultures. Conclusion: Importance of microbiological evidence prior to administration of antimicrobials is evidenced by 79% negative cultures in this 5-year cohort. Escherichia coli accounted for 60-66% of significant bacteriuria followed by Enterococcus and Klebsiella species with 30-40% E.coli probable ESBL producers. Nitrofurantoin followed by amoxicillin-clavulanate were found to be the best oral antimicrobial options.

Effect of Antibiotic Prophylaxis on Infectious Complications in Patients with Asymptomatic Bacteriuria Undergoing Urologic Surgery / Efecto de la profilaxis antibiótica sobre las complicaciones infecciosas en pacientes con bacteriuria asintomática programados a cirugía urológica

Objectives To identify the effect of duration of surgical antibiotic prophylaxis (SAP) and other variables on infectious postsurgical complications in patients with asymptomatic bacteriuria (ASB) undergoing urological surgery. Methods We conducted an observational study of a cohort of patients with ASB scheduled for urologic surgery at three health service providers in Colombia. The study population comprised all patients with planned urologic surgery who had ASB prior to surgery from April 2018 to January 2019. The intervention evaluated was the duration of preoperative SAP, and the outcome variable was the development of any postoperative infectious complications for up to 30 days after the procedure. Results The present study included 184 patients with ASB scheduled for urologic surgery. The median duration of preoperative SAP (p = 0.49) or of 1 dose SAP (risk ratio [RR] = 1.24; 95% confidence interval [CI]: 0.45­3.39) were not statistically different in patients with postsurgical infectious complications. Infectious complications were more frequent among patients with benign prostatic hyperplasia (RR = 6.57; 95%CI: 1.98­21.76) and hospitalization in the preceding 3 months (RR = 8.32; 95%CI: 2.69­25.71). Conclusion One dose of antimicrobial therapy is sufficient to avoid infectious complications in patients with ASB. There were other factors associated with postsurgical infectious complications, such as benign prostatic hyperplasia and hospitalization in the preceding 3 months.

Objetivos Identificar el efecto de la duración de la profilaxis antibiótica quirúrgica (PAQ) y otras variables sobre las complicaciones infecciosas posquirúrgicas en pacientes con bacteriuria asintomática (BA) sometidos a cirugía urológica. Métodos Se realizó un estudio observacional de una cohorte de pacientes con BA programados para cirugía urológica en tres instituciones de salud en Colombia. La población de estudio comprendió a todos los pacientes programados para cirugía urológica y con BA en el periodo de Abril del 2018 a Enero 2019. La intervención evaluada fue la duración de la PAQ preoperatoria, y la variable de resultado fue el desarrollo de cualquier complicación infecciosa posoperatoria hasta 30 días después del procedimiento. Resultados El estudio incluyó a 184 pacientes con BA programados para cirugía urológica. La mediana de duración de la PAQ preoperatoria (p = 0,49) o 1 dosis de PAQ (razón de riesgo [RR]: 1,24; intervalo de confianza [IC] del 95%: 0,45 a 3,39) no fueron estadísticamente diferentes en pacientes con complicaciones infecciosas posquirúrgicas. Las complicaciones infecciosas fueron más frecuentes entre los pacientes con hiperplasia prostática benigna (RR: 6,57; IC del 95%: 1,98 a 21,76) y hospitalización en los 3 meses anteriores (RR: 8,32; IC del 95%: 2,69 a 25,71). Conclusión Una dosis de terapia antimicrobiana es suficiente para evitar complicaciones infecciosas en pacientes con BA. Hubo otros factores asociados con complicaciones infecciosas posquirúrgicas, como hiperplasia prostática benigna y hospitalización en los tres meses anteriores.

Parámetros diagnósticos en los lactantes con sospecha de infección del tracto urinario

Introducción: La sintomatología de la infección del tracto urinario es variable en la edad pediátrica, por ende, se presentan cuadros clínicos típicos y atípicos diversos debido a múltiples factores estudiados y definidos, que ofrecen dificultad para la confirmación diagnóstica. Objetivo: Identificar la utilidad de los parámetros diagnósticos de la infección urinaria. Métodos: Estudio observacional, analítico, de caso y controles, en lactantes ingresados con sospecha de infección urinaria en el Hospital Pediátrico Universitario "Octavio de la Concepción y de la Pedraja" admitidos en el servicio de clínicas pediátricas. El universo fueron los lactantes con sospecha de infección del tracto urinario y la muestra fue de 191 pacientes que cumplieron con los criterios de inclusión. Las variables utilizadas fueron la edad, el sexo, signos y síntomas, factores clínicos, formas clínicas, parámetros microbiológicos, parámetros clínicos según presencia de criterios de Rochester y escalas de evaluación para infección bacteriana y los parámetros de laboratorio. Resultados: Las variables clínicas más importantes asociadas a una infección urinaria fueron la edad menor de tres meses, la fiebre y el no disfrute de la lactancia materna, mientras que las de laboratorio fueron anemia, leucocitosis, neutrofilia y eritrosedimentación elevada. Conclusiones: Se identifica un conjunto de parámetros clínicos y estudios de laboratorio útiles en la atención médica del niño con infección urinaria. La forma de presentación febril es la característica especial de la enfermedad y las investigaciones hematológicas y del sedimento urinario son fuentes de apoyo diagnóstico.

Introduction: The symptomatology of urinary tract infection is variable in pediatric ages, therefore, there are typical and atypical clinical pictures due to multiple factors studied and defined but that offer difficulty for diagnostic confirmation. Objective: Identify the usefulness of the diagnostic parameters of urinary tract infection. Methods: Observational, analytical, case-control study in infants admitted with suspected urinary tract infection at "Octavio de la Concepción y de la Pedraja" University Pediatric Hospital and admitted to the pediatric clinic service. The total sample were infants with suspected urinary tract infection and the sample was 191 patients who met the inclusion criteria. The variables used were age, sex, signs and symptoms, clinical factors, clinical forms, microbiological parameters, clinical parameters according to the presence of Rochester criteria and evaluation scales for bacterial infection and laboratory parameters. Results: The most important clinical variables associated with a urinary tract infection were: age less than three months, fever and non-enjoyment of breastfeeding; while laboratory variables were: anemia, leukocytosis, neutrophilia and elevated erythrosedimentation. Conclusions: A set of clinical parameters and laboratory studies useful in the medical care of children with urinary tract infection are identified. The form of febrile presentation is the specific characteristic of the disease and hematological and urinary sediment investigations are sources of diagnostic support.

Prevalence of asymptomatic bacteriuria in hospitalized patients / Эрүүл мэндийн лаборатори

Description@#Asymptomatic bacteriuria is defined as the presence of 1x105 or more bacteria per milliliter of urine, although there are no signs of UTI [1]. Asymptomatic bacteriuria is quite common and occurs in 1-5% of healthy women before menopause. The incidence of asymptomatic bacteriuria increases in the elderly (men and women) to 4-19%. Asymptomatic bacteriuria is observed in 0.7% -27% of patients with diabetes mellitus, in 2-10% of pregnant women and in 23-89% of patients with spinal cord injury. Asymptomatic bacteriuria is rarely observed in young men and always requires differential diagnosis with chronic bacterial prostatitis[2]. </br> Among the elderly, those in institutionalized settings such as long-term care facilities and hospitals have a higher prevalence of asymptomatic bacteriuria than those living in the community. Therefore, interest in asymptomatic bacteriuria has shifted from the general population to these groups of individuals. The prevalence varies from 2% to 10% in pregnancy and from 15% to 50% in the elderly in long-term care facilities.[3,4]</br> This study was undertaken to determine the prevalence of people asymptomatic bacteriuria in among hospitalized people.@*Purpose@#Investigate cases of asymptomatic bacteriuria among hospitalized individuals and determine antibiotic susceptibility by type of pathogen detected in urine.@*Materials and methods@#This cross-sectional study in the “I” Hospital of UB city, Mongolia. We conducted into the study 133 patients. After obtaining informed consent, a midstream clean-catch urine sample was collected in the same 24 hour time window and was evaluated for urinalysis using a dipstick test and routine culture. A positive urine culture was defined as a single urine sample with microbal growth of >10⁵ colony- forming units of a single organism. We use 5-10% Blood agar, UTI agar, Mackkong agar and Chroma agar for a bacterial growth. Then we did antibiotic susceptibility of the determined pathogen.@*Result@#The average age of the respondents was 55.9±14.6, the youngest was 17 years old and the oldest was 91 years old (CI 95% 53.4-58.5). By age group, 4.5% (n = 6) of people aged 20-30, 21.1% (n = 28) of people aged 31-45, 37.5% (n = 50) of people aged 46-60, and people over 61 years of age 36.8% (n = 49) respectively.Of the respondents, more than 56 or 54.9% (n = 73) were elderly, of which 63.9% (n = 85) were women and 36.1% (n = 48) were men. </br> A total of 36 (27.1%) leukocytes were detected, and 25 (34.2%) more (P-0.05) were detected in people over 56 years of age. The protein detected in 24 (18.0%) people, all over 56 years of age and more defined in men (P-0.01).</br> 80.5% (n = 107) of those surveyed were diagnosed with the pathogens, and 54.9% were elderly (P-0.031). 82.4% of women and 77.1% of men were diagnosed with urinary pathogens. </br> Streptococcus 26%, E.coli 19%, Saprophyticus 13%, Enterococcus 11% and Staphylococcus 11% were detected in the analysis, and Streptococcus and E.coli (19%) accounted for a slightly higher rate of infection.</br> A total of 13 types of pathogens were identified, of which 53.4% were susceptible, 21.7% were moderately sensitive, and 24.9% were non-susceptible.@*Discussion@#According to a study conducted by researchers at the University of Taiwan, the prevalence of asymptomatic UTI-s in the general population is 57.8%. E.Coli was also the most common bacterium in the urine [6]. </br> In our study, there are many cases of E. coli. </br> Study in the United States found that the prevalence of asymptomatic bacteriuria among inpatients was 8.5%, all of them women. The most common pathogens in this study are Enterococcus bacteria. This study found that 1 in 10 people admitted to the hospital may have asymptomatic bacteriuria. [1] @*Conclusion@#</br> 1. Asymptomatic bacteriuria in 80.5% of those surveyed 54.9% were detected in people over 56 years of age. </br> 2. Antibiotic susceptibility of the tested pathogens was determined as 53.4% sensitive, 21.7% moderately sensitive and 24.9% insensitive.

Asymptomatic bacteriuria in pregnancy: what is the validity of urine sediment microscopy as a screening tool in a low resource setting?

Background: Asymptomatic bacteriuria in pregnancy should be screened and treated to reduce the risk of morbidity and mortality. Urine culture is the recommended test. In low resource setting with large patient load urine culture in all pregnant patients is not feasible. In this study authors have assessed the validity of urine microscopy in the screening of asymptomatic bacteriuria in pregnancy.Methods: Midstream clean catch urine specimen collected from 675 pregnant women was subjected to urine sediment microscopy and culture. It was considered screen positive if pus cells were >5/HPF. Asymptomatic bacteriuria was diagnosed if there were >/=100000 CFU of a single uropathogen per ml. Results obtained were statistically analysed for the prevalence of asymptomatic bacteriuria, sociodemographic and medical risk factors, causative organisms, antibiotic sensitivity and validity of urine sediment microscopy in detecting asymptomatic bacteriuria.Results: The incidence of asymptomatic bacteriuria in our study was 10.2%. The incidence was higher in the age group between 20-30 years, in gravida 3 and above, in upper lower and lower socioeconomic status, in women with hyperglycemia in pregnancy and anaemia. E. coli was the commonest bacterial isolate in culture positive cases. Bacterial isolates had poor sensitivity for Ampicillin, amoxicillin and nitrofurantoin and good sensitivity for cephalosporins and aminoglycosides. The sensitivity, specificity, positive and negative predictive values for urine microscopy was 43%, 85%, 25% and 93% respectively.Conclusions: This study shows poor sensitivity and positive predictive value and good specificity and negative predictive value.

Impacto de la bacteriuria asintomática en trasplante renal. cohorte retrospectiva / Impact of asymptomatic bacteriuria on renal transplantation. retrospective cohort study

RESUMEN Introducción: La bacteriuria asintomática (BA), en el primer año postrasplante renal,tiene una incidencia mayor al 50%. La infección urinaria (ITU) es la complicación infecciosa más común en trasplante renal, su incidencia oscila entre el 30 y el 70% en el primer año.Objetivo:Analizar la incidencia de ITU y BA en el primer año postrasplante renal y su impacto en la función renal. Material y métodos: Estudio retrospectivo, de pacientes trasplantados renales, mayores de 18 años, en el período comprendido entre enero de 2006 y diciembre de 2017, en nuestro centro. Fueron excluidos pacientes con trasplantes renales combinados, pérdida del injerto renal durante el primer año por complicaciones quirúrgicas (trombosis, rotura renal) o médicas (rechazo, recidiva de enfermedad de base).Resultados: Fueron analizados 161 pacientes adultos trasplantados renales. La incidencia en el primer año postrasplante de ITU y BA fue del 32% y del 25%, respectivamente. La función renal promedio al año del trasplante fue: de los pacientes con ITU(n=53) Cr 1,36(±0,44), de los pacientes con BA no tratada(n=30) Cr 1.36(±0,41), de los pacientes con BA tratada(n=11)Cr 1,39(±0,42), y de los pacientes sin ITU ni BA(n=90) Cr 1,31(±0,43) p=0,95. El riesgo de ITU en las BA no tratadas fue del 55% y en las tratadas del 57%, con un RR 0,96 (IC 95% 0,52-1,8). Conclusión: No hubo diferencias significativas en la función renal al año del trasplante en los pacientes que tuvieron ITU y BA en relación a los pacientes que no tuvieron. El tratamiento de las BA no redujo el riesgo de padecer ITU.

ABSTRACT Introduction:Asymptomatic bacteriuria (AB) during the first year post-renal transplantation has an incidence higher than 50%. Urinary tract infection (UTI) is the most frequent complication of renal transplantation; its incidence is between 30 and 70 % during the first year. Objective: To analyze the incidence of UTI and AB during the first year post-renal transplantation and their impact on renal function. Methods: Retrospective study in renal transplantation patients older than 18 between January 2006 and December 2017 in our center. Patients who had received combined renal transplantation, lost renal graft during the first year due to surgical complications (thrombosis, allograft rupture) or medical complications (rejection, underlying disease recurrence) were excluded. Results: A study was performed with 161 adult patients who had undergone kidney transplantation. The incidence of UTI and AB during the first year after receiving transplantation was 32% and 25%, respectively. The mean renal function one year after transplantation was as follows: (n=53) Cr 1.36(±0.44) for UTI patients; (n=30) Cr 1.36(±0.41) for AB non-treated patients; (n=11) Cr 1.39(±0.42) for AB treated patients, and (n=90) Cr 1.31(±0.43) p=0.95 for patients not suffering from UTI or AB. The risk of UTI was 55 % for non-treated AB and 57% for treated AB, with RR 0.96 (95% CI: 0.52-1.8).Conclusion: No significant differences in renal function were found in UTI and AB patients one year after transplantation as compared to patients not suffering from these conditions. AB treatment did not reduce UTI risk.

Asymptomatic bacteriuria among pregnant women attending antenatal clinic at a tertiary care centre

Background: The term asymptomatic bacteriuria is defined as the presence of > 100,000 colonies of a single bacterial species per millilitre of urine (105 cfu /mL), cultured from clean catch midstream sample in the absence of declared symptoms. The aim of this study was to know the incidence of asymptomatic bacteriuria in pregnancy and the various factors influencing it, to identify the pathogens and their antibiotic susceptibility patterns.Methods: Clean catch mid-stream urine samples were collected from 3000 pregnant women (all trimesters) aged between 18-35 years of age attending the antenatal OPD in GMCH, Guwahati for a period of one year (July 2018-June2019).  Identification of organisms and antibiotic sensitivity tests were performed as per standard methods.Results: In our study, incidence of asymptomatic bacteriuria was found to be 12.1%. Most women (52.89%) were in the age group of (20-30) years, mostly in second trimester (47.1%). Gram negative organisms were the commonest organisms isolated; among which Escherichia coli (56.75%) was the principal urinary pathogen followed by Klebsiella sp (14.33%) and Staphylococcus saprophyticus (12.67%). The isolates were most sensitive to Nitrofurantoin (87.88%).Conclusions: Asymptomatic bacteriuria is common in pregnancy. Once ASB is recognized during pregnancy, it should be appropriately treated with antibiotics and promptly followed up.

A study of prevalence of asymptomatic bacteriuria in pregnant women from rural areas attending to Obstetric Department in Akash Hospital, Karnataka, India

Background: Asymptomatic bacteriuria (ASB) in pregnancy is a significant risk factor for developing upper urinary tract infection and pyelonephritis which is associated with significant maternal and fetal risks. The aim of this study was to know the prevalence of asymptomatic bacteriuria in pregnancy, to identify the organisms and their antibiotic susceptibility patterns and to formulate a single or combined rapid screening method as an acceptable alternative to urine culture.Methods: A total of 375 pregnant women aged between 18 to 45 years were included in this study. Clean catch mid-stream urine samples were collected. Screening tests done were gram staining of uncentrifuged urine, pus cell count, nitrite test and leukocyte esterase test. Identification of pathogens and antibiotic sensitivity tests were performed as per standard urine culture and sensitivity methods.Results: Out of the 375 pregnant women, 31 (8.4%) had significant bacteriuria. High percentage of women with ASB were primigravidas (51.38%) and in 2nd trimester (43.86%). The most common organism isolated was E.coli (56.14%). In screening tests, gram staining of uncentrifuged urine had a sensitivity of 85.71%. Sensitivity of 71.42% was found in Nitrite and leucocyte esterase tests. However, the combination of these two tests, with either test positive, showed sensitivity and negative predictive value of 90.47% and 99.09% respectively.Conclusions: Early detection and treatment of ASB in pregnancy can prevent complications. ASB can be identified by simple and combined rapid screening methods and urine culture along with antibiogram. Therefore, screening and treatment of ASB may be incorporated as routine antenatal care for safe motherhood and healthy newborn.

Comparison between the Outcomes of Short Term Versus Long Term Catheterisation after Anterior Colporraphy with or without Other Vaginal Procedures: A Hospital based Prospective, Comparative, Randomised Study

Introduction: Defects in the pelvic supporting structuresresult in a variety of clinically evident pelvic relaxationabnormalities. The present study was aimed to assess whetherremoval of an in-dwelling catheter 24 hours after surgery affectthe rate of re-catheterization, symptomatic or asymptomaticurinary tract infections and hospital stay in comparison to 72hours of catheterization.Material and methods: Interventional, Prospective, hospitalbased study was done in Department of Obstetrics andGynaecology of R.G. Kar Medical College and Hospitalduring July 2016- June 2017. All women under gone anteriorcolporrhaphy with or without other vaginal procedure wereincluded and divided into two groups randomly. Group Aincluded 195 patients with Foley catheter kept in situ for 24hours following surgery and Group B included 195 patientswith Foley catheter placed in situ for 72 hours followingcompletion of surgery.Results: Mean duration of catheter removal to voidingduration in group A (2.3077±1.2301 hours) and in groupB (2.2308±1.1090 hours) was statistically insignificant(p=0.5170). Difference between post-void residual urine ineach group was insignificant (p=0.1021). Need and attempts ofre-catheterisation in either group was statistically insignificant(p=0.1184). Presence of UTI and Asymptomatic Bacteriuriawere statistically significant (p=0.0002 for UTI and p=0.0115for asymptomatic bacteriuria) in two groups and found less ingroup A compared to group B. Mean hospital stay in group A(2.533±0.8572 days) was less than Group B (3.7487±1.0762days) and was statistically significant (p<0.0001).Conclusion: Early removal of catheter is associated with lesshospital-stay, less complication like UTI or asymptomaticbacteriuria but has no effect on post void residual volume,voiding duration, attempts and need of re-catheterisation.

Asymptomatic Bacteriuria and Candida Colonization among Pregnant Women in a District Hospital in Eastern Uganda

Background: Urinary tract infection (UTI) is the most common reason for which antimicrobials are prescribed in pregnancy Worldwide. This study aimed to determine the prevalence of asymptomatic bacteriuria, Candida colonization and antimicrobial susceptibility patterns among pregnant women attending antenatal in a District Hospital in Eastern Uganda.Materials and Methods: A descriptive cross sectional study was conducted in which pregnant mothers who had come for routine antenatal care were counseled and their consents obtained before taking off urine samples for laboratory diagnosis. For those samples found to have pus cells, culture and sensitivity test was done to identify the organisms and determine susceptibility to particular antibiotics and antifungal agents.Results: Gram negative isolates were more sensitive to meropenem (100%), and ciprofloxacin (93.8%) but less sensitive to trimethoprim/sulphurmethoxazole (20%), Ceftazidime (7%), and Cefepime (6%). Gram positive isolates were more sensitive to vancomycin (100%), meropenem (87%) and linezolid (88.1%) but less sensitive to Cefotaxime (31%) and Trimethoprim/sulphurmethoxazole (14%). All bacteria isolated in this study were multi-drug resistant (MDR). All Candidaisolates were susceptible to Econazole and Nystatin whereasall isolates were resistant to Griseofulvin. Conclusion: The prevalence of asymptomatic bacteriuria among pregnant women in Butaleja district is high with many of the bacteria isolated exhibiting resistance to the commonly used antibiotics. Antifungal resistance was common in this study

Study of asymptomatic bacteriuria in pregnant women: prevalence, isolates and their antibiotic sensitivity pattern

Background: Asymptomatic bacteriuria (ASB) is common in pregnant women due to morphological and physiological changes in the genitor-urinary tract, which untreated may lead to complications like pyelonephritis and may also effect the fetus. The objective of our study was to determine the prevalence of ASB in pregnant women, to identify the organisms responsible and their antibiotic sensitivity pattern.Methods: A clean catch midstream urine was collected from 250 pregnant women in different trimesters attending antenatal OPD in a tertiary care hospital. Isolates and their antibiogram were obtained by conventional methods.Results: Among 250 pregnant women, 23(9.2%) had shown significant bacteriuria, and majority (52.1%) were in 3rd trimester. Escherichia coli (56.5%) was the commonest isolate followed by Klebsiella pneumoniae (17.4%). Most of the isolates showed sensitivity to imipenam, nitrofurantoin and cefepime.Conclusions: Asymptomatic bacteriuria is common during pregnancy which requires a routine examination of urine for culture and sensitivity and the positive cases should be treated with appropriate antibiotics to prevent any further complication.

Asymptomatic bacteriuria in antenatal cases and its effects on obstetrical outcome

Background: Urinary tract infection is the second most common bacterial infection seen during pregnancy and is due to the morphological and physiological changes that take place in the genitourinary tract. The pregnant women are two times more commonly affected than age matched non pregnant females and it may lead to less favorable pregnancy outcomes and complications such as premature birth, low birth weight, pyelonephritis, preeclampsia and anemia.Methods: This hospital based cross sectional study was conducted on 350 pregnant women, falling into the inclusion criteria of the study, who attended the antenatal clinic in the Department of Obstetrics and Gynecology at PCMS and RC, Bhopal, irrespective of the gestational age of the cases. The cases found to have asymptomatic bacteriuria were followed till delivery and any adverse antenatal or perinatal outcome was noted.Results: The study was conducted with the aim to know the prevalence of asymptomatic bacteriuria and the obstetrical outcome in pregnant women. The prevalence of asymptomatic bacteriuria was 13% and it was common in the age group of 21-25 years, in primigravidas and with period of gestation less than 12 weeks. E. coli was found to be the commonest causative organism. Asymptomatic bacteriuria was found significantly associated with the presence of anemia. Maternal morbidity in terms of pre term labour was higher in cases with asymptomatic bacteriuria.Conclusions: Urine culture and sensitivity should be done as a routine investigation to screen the patients for asymptomatic bacteriuria and to prevent adverse maternal and fetal outcomes.

Correlation between Asymptomatic Bacteriuria and Surgical Site Infection in Middle-aged and Elderly Patients Undergoing Open Hysterectomy / 中国医学科学院学报

Objective To explore the correlation between asymptomatic bacteriuria(AB)and surgical site infection(SSI)in middle-aged and elderly women undergoing open hysterectomy.Methods The clinical data of 1469 middle-aged and elderly women undergoing open hysterectomy in the Third Affiliated Hospital of Guizhou Medical University from June 2011 to August 2018 were retrospectively analyzed.Factors associated with SSI after operation were analyzed by univariate and multivariate regression models to identify the relationship of AB with SSI after open hysterectomy.Results Of these 1469 patients,101(6.88%)had SSI and 124 had AB[including 14 patients(11.29%)with infections].In addition,1345 patients had no AB,among whom 87(6.47%)had infections.Thus,the infection rate in patients with AB was significantly higher than that in patients without AB(=4.123,=0.042).Univariate analysis showed AB,history of diabetes mellitus,surgical procedure,length of stay(>15 d),season(summer and autumn),body mass index(≥25 kg/m ),nature of lesions(malignant tumors),ASA grade(>grade Ⅱ),incision length(≥10 cm),and operative time(≥3 h),bleeding volume(≥1000 ml),serum albumin concentration(grade Ⅱ)were risk factors for SSI in these patients(all <0.05). Conclusions AB is one of the risk factors for SSI in middle-aged and elderly women undergoing open hysterectomy.Screening and treatment of AB before surgery can reduce the risk of SSI.ASA grading shall be performed before surgery before corresponding preparation was offered.Effective control of blood glucose,improved surgical skills,and shorter operative time are helpful for lowering postoperative SSI.

A Patient with End-stage Bladder Cancer Who Developed Hyperammonemia and Impaired Consciousness and Who Was Found to Have Asymptomatic Bacteriuria and Alkaline Urine

Introduction: The current author encountered a patient with end-stage bladder cancer who developed hyperammonemia and impaired consciousness. Case: A 90-year-old man had repeated bleeding from a bladder tumor, so a urethral catheter was placed. During admission to the Palliative Care Unit, impaired consciousness and hyperammonemia were noted. Liver metastasis was not noted. Urinalysis revealed alkaluria and ammonium magnesium phosphate crystals, so production of ammonia by bacteria with the ability to hydrolyze urea was suspected. Levofloxacin was inefficacious. As a result of administration of metronidazole, however, consciousness improved, blood ammonia levels returned to normal, urine was acidic, and ammonium magnesium phosphate crystals disappeared. The bacterium with the ability to hydrolyze urea could not be identified. Discussion: In patients with advanced or end-stage bladder cancer like the current patient, ammonia produced by bacteria with the ability to hydrolyze urea can cause hyperammonemia and impaired consciousness even if the urinary tract is unobstructed.

Manejo de las infecciones urinarias en la consulta ambulatoria: de las guías a la práctica clínica / Management of urinary tract infections in the outpatient clinic: from the guides to clinical practice

La infección del tracto urinario constituye el segundo proceso infeccioso más frecuente en el ser humano. Existen controversias respecto a la conducta en casos de bacteriuria asintomática, cistitis aguda no complicada, pielonefritis aguda y manejo de pacientes cateterizados. Objetivo: Con este estudio descriptivo basado en la realización de una encuesta pretendemos comparar el manejo de las infecciones urinarias en la consulta ambulatoria con respecto a las recomendaciones de las guías internacionales. Materiales y Métodos: Se realizó un estudio descriptivo basado en una encuesta compuesta de 15 preguntas de selección múltiple basadas en las guías internacionales dirigida a médicos de familia y de atención primaria de la salud (APS). El análisis estadístico de los datos fue realizado con el programa Microsoft Excel 2003®. Las frecuencias fueron expresadas como porcentajes y los datos cuantitativos como media, mediana y moda. Discusión y Resultados: Existe discordancia en el manejo ambulatorio de las infecciones urinarias de los profesionales encuestados en relación a lo establecido en las guías internacionales. El 48,4% de los médicos utiliza la ciprofloxacina como antibiótico de primera línea para la cistitis aguda no complicada; el 50,8% indica el tratamiento antibiótico durante 6 a 10 días. Con respecto a la resistencia de los uropatógenos, solo el 10% conoce como se encuentra la misma en sus centros hospitalarios. En cuanto al tratamiento de la pielonefritis aguda, el 57% considera necesario el tratamiento parenteral en todos los casos.

The infection of the urinary tract constitutes the second most frequent infectious process in the human being. Controversies exist regarding behavior in cases of asymptomatic bacteriuria, uncomplicated acute cystitis, acute pyelonephritis and management of catheterized patients. Objective: With this descriptive study based on the conduct of a survey, we intend to compare the management of urinary tract infections in the outpatient clinic with respect to the recommendations of international guidelines. Material and method: A descriptive study was conducted based on a survey composed of 15 multiple-choice questions based on international guidelines for family doctors and primary health care (PHC). The statistical analysis of the data was performed with the Microsoft Excel 2003® program. The frequencies were expressed as percentages and the quantitative data such as mean, median and fashion. Discussion and Results: There is disagreement in the ambulatory management of urinary tract infections of the professionals surveyed in relation to what is established in the international guidelines.48.4% of doctors use ciprofloxacin as a first-line antibiotic for uncomplicated acute cystitis; 50.8% indicate antibiotic treatment for 6 to 10 days. With respect to the resistance of uropathogens, only 10% know how it is in their hospital centers. Regarding the treatment of acute pyelonephritis, 57% considered parenteral treatment necessary in all cases.

Complicaciones infecciosas después de prostatectomía abierta y resección transuretral de próstata en pacientes con hiperplasia prostática benigna / Postoperative infectious complications after open prostatectomy and transurethral resection of the prostate in patients with benign prostatic hyperplasia

RESUMEN La hiperplasia prostática benigna (HPB) es la neoplasia más común en hombres y puede requerir tratamiento quirúrgico cuando hay retención urinaria, uropatía obstructiva, hematuria a repetición, cistolitiasis o falta de mejoría de los síntomas con las terapias farmacológicas. Las opciones quirúrgicas más frecuentes son la prostatectomía abierta y la resección transuretral de próstata, entre cuyas complicaciones están las infecciones del tracto urinario (ITU) hasta en 12,9 % de los pacientes. Sin embargo, este porcentaje es variable porque no siempre se especifica la diferencia entre ITU y bacteriuria. Los siguientes son factores de riesgo: bacteriuria preoperatoria, tiempo quirúrgico mayor de 60 minutos y manipulación posoperatoria de la sonda vesical. Es importante que los profesionales de la salud que participan en la atención de pacientes con HPB conozcan e intervengan estas complicaciones infecciosas y sus factores de riesgo.

SUMMARY Benign prostatic hyperplasia (BPH) is the most common tumor in men and may require surgical treatment when there is urinary retention, obstructive uropathy, recurrent hematuria, cystolithiasis or lack of improvement of symptoms with drug therapies. The most common surgical options are open prostatectomy and transurethral resection of the prostate. Urinary tract infections (UTI) are among the complications of these procedures, and may occur in up to 12.9 % of patients. However, this percentage is variable because the difference between UTI and bacteriuria is not always specified. Risk factors are: preoperative bacteriuria, operating time longer than 60 minutes and handling of postoperative bladder catheter. It is important that health professionals involved in the care of patients with BPH know these infectious complications and their risk factors.

Prevalence of urinary tract infection and antibiotic sensitivity among pregnant women having prenatal check-up at a tertiary hospital in Manila / Philippine Journal of Obstetrics and Gynecology

Objective@#The objective of this study is to determine the prevalence and the most common causative agent of urinary tract infection (UTI) in pregnant women having prenatal check-up at a tertiary hospital, as well as the antibiotic sensitivity of these organisms to selected antimicrobials that are currently recommended for use in the treatment of UTI in pregnancy (specifically Nitrofurantoin, Amoxicillin, Cephalexin, Cefuroxime, Amoxicillin with Clavulanic acid). The results of this study will not only update the hospital’s biogram, it will also aid the physicians in prescribing patients with the most cost-effective regimen. @*Methodology@#Patients seen at the outpatient department were included in the study starting May 2017 up to September 2017. Patients with previous antibiotic intake during the current pregnancy were excluded. A questionnaire containing demographic data, prenatal history, checklist for symptoms, and consent were provided for each patient. As per guidelines, urine gram stain and culture studies were requested during their prenatal visit. All urine specimen were sent to the same laboratory for microscopy and culture. Results were analyzed using SPSS v 23.0 @*Result@#The prevalence of urinary tract infection in pregnant patients having prenatal care at a tertiary hospital in Manila was 15.6%. The most common isolates were still E. coli and Staphylococcus. Symptoms were not reflective of the presence of UTI and previous prenatal care did not affect the presence UTI. Analysis of sensitivity and resistance patterns of the isolated organisms showed increasing resistance to the commonly used antibiotics given to pregnant patients, especially Co-Amoxiclav. Cephalosporins, on the other hand, remain to have good sensitivity.@*Conclusion@#Urinary tract infection is prevalent among pregnant women having prenatal check up at a tertiary hospital. It is recommended that guidelines on the diagnosis of UTI in pregnancy be strictly followed so that management will be culture-guided, thus preventing the development of antibiotic resistance.

Incidence of Significant Bacteriuria among Pregnant Women in a Teaching Hospital of Rural Setup

Aim This study was carried out to determine the prevalence of asymptomatic bacteriuria in pregnant women attending a teaching hospital in rural setup. Materials and Methods A total of 600 women were recruited for this study. A total of 200 antenatal women were clinically identified to have no signs and symptoms of UTI, 200 antenatal women were having signs and symptoms of UTI, and 200 were non-pregnant women that were studied as controls. Clean catch midstream urine samples were collected from each patient into a sterile universal container from Gynecology and obstetrics department and general medicine department. The urine samples were examined microscopically and by the cultural method. Identification of isolates was carried out by a standard microbiological technique. Result A total of 272 (45.3%) were positive for significant bacteriuria. There was a significant difference in the prevalence of asymptomatic bacteriuria with respect to age (P< 0.0001). Trimester did not show any significant difference (P = 0.2006) in the prevalence of asymptomatic bacteriuria. Escherichia coli was the most predominant organism followed closely by Klebsiella species. Nitrofurantoin, ampicillin, and levofloxacin were mostly used antibiotics. Conclusion Asymptomatic bacteriuria is not uncommon among antenatal patients in the population studied. Routine urine cultural test should be carried out on all antenatal patients in order to identify any unsuspecting infection. This measure will go a long way in reducing maternal and obstetric complications associated with pregnancy.

Infección del tracto urinario en receptores de trasplante renal / Urinary tract infection in renal transplant recipients

Introducción. La infección del tracto urinario (ITU) es común en receptores de trasplante renal (TR). La frecuencia de ITU depende de factores previos y posteriores al trasplante. Objetivos. Determinar la cronología de aparición de ITU sintomática, los microorganismos causantes y la incidencia de ITU resistente a antibióticos en receptores de TR. Diseño. Estudio retrospectivo. Lugar. Unidad de Trasplante Renal, Hospital Edgardo Rebagliati Martins, EsSalud, Lima, Perú. Participantes. Pacientes sometidos a TR. Intervenciones. Se revisó la historia clínica de 304 pacientes sometidos a TR en el período 2002-2011, con seguimiento de hasta cuatro años por paciente. Se constató 215 episodios de ITU sintomática confirmada mediante urocultivo en 84 receptores. Principales medidas de resultados. Incidencia, cronología, determinación microbiológica/susceptibilidad, resistencia bacteriana, factores de riesgo, estrategias diagnósticas, presencia o no de bacteriemia y manejo terapéutico. Resultados. En 50% de los 84 receptores el episodio inicial ocurrió durante los primeros tres meses, y en 39% se constató más de un episodio de ITU. Las bacterias representaron la etiología más frecuente (94%), siendo la Escherichia coli (77%) el uropatógeno prevalente, con tasa productora betalactamasa espectro extendido (BLEE) en 38%, seguida de Klebsiella pneumonie (11%) con BLEE 65%. En 12% de los 215 episodios de ITU el hemocultivo fue positivo. Entre los factores de riesgo se detectó luego del trasplante 19% receptores con anormalidades anatómicas del tracto urinario. Conclusiones. La ITU ocurrió tempranamente luego del trasplante y la Escherichia coli fue el microorganismo etiológico más frecuente. La resistencia antibiótica estuvo presente en 37% de los 215 episodios de ITU, representando un desafío contínuo a resolver en la práctica clínica.

Introduction. Urinary tract infections (UTI) are common among renal transplant recipients (RTR) and their frequency depends on pre- and post-transplant factors. Objectives. To determine the time of appearance of symptomatic UTI among renal transplant recipients, microorganisms causing the infection, and incidence of UTI resistant to antibiotics. Design. Retrospective study. Setting. Renal Transplant Unit, Hospital Edgardo Rebagliati Martins, EsSalud, Lima, Peru. Participants. Patients who have undergone renal transplantation. Interventions. The clinical records of 304 patients subject to kidney transplantation performed between 2002 and 2011 and followed for up to four years were reviewed. There were 215 urine culture-confirmed UTI episodes in 84 transplant recipients. Main outcome measures. Incidence, chronology, microbiological determination/ susceptibility, bacterial resistance, risk factors, diagnostic strategies, presence or absence of bacteremia, and therapeutic management. Results. In 42 of the 84 recipients, the initial episode occurred during the first three months, and 33 (39%) had more than one UTI episode. Bacteria represented the most common etiology (94%), and Escherichia coli was the most prevalent uropathogen, with an extended-spectrum beta-lactamase (ESBL) production rate of 38%, followed by Klebsiella pneumoniae (11%) with an ESBL of 65%. Blood culture was positive in 25 (12%) of the 215 UTI episodes. In 17 recipients (19%), anatomic anomalies of the urinary tract were detected following the transplant. Conclusions. UTI occurred early following kidney transplantation, and Escherichia coli was the most common microorganism found. Antibiotic resistance was present in 79 (37%) of the 215 UTI episodes, representing a continuous challenge in clinical practice.