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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2020

01-12-2020 | Antibiotic | Research article

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

Authors: Anne CC Lee, Luke C. Mullany, Alain K. Koffi, Iftekhar Rafiqullah, Rasheda Khanam, Lian V. Folger, Mahmoodur Rahman, Dipak K. Mitra, Alain Labrique, Parul Christian, Jamal Uddin, Parvez Ahmed, Salahuddin Ahmed, Arif Mahmud, Sushil K. DasGupta, Nazma Begum, Mohammad A. Quaiyum, Samir K. Saha, Abdullah H. Baqui

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

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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

In 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.
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Metadata
Title
Urinary tract infections in pregnancy in a rural population of Bangladesh: population-based prevalence, risk factors, etiology, and antibiotic resistance
Authors
Anne CC Lee
Luke C. Mullany
Alain K. Koffi
Iftekhar Rafiqullah
Rasheda Khanam
Lian V. Folger
Mahmoodur Rahman
Dipak K. Mitra
Alain Labrique
Parul Christian
Jamal Uddin
Parvez Ahmed
Salahuddin Ahmed
Arif Mahmud
Sushil K. DasGupta
Nazma Begum
Mohammad A. Quaiyum
Samir K. Saha
Abdullah H. Baqui
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-019-2665-0

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