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

Anne Lee, Luke C. Mullany, Alain K. Koffi, Iftekhar Rafiqullah, Rasheda Khanam, Lian V. Folger, Mahmoodur Rahman, Dipak Kumar 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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Article number1
JournalBMC pregnancy and childbirth
Volume20
Issue number1
DOIs
StatePublished - Dec 31 2019

Keywords

  • Antimicrobial resistance
  • Asymptomatic bacteriuria
  • Bangladesh
  • Maternal morbidity
  • Pregnancy
  • Risk factors
  • Urinary tract infection

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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