TITLE:
Antimicrobial Susceptibility Pattern of Bacteriuria and Risks of Therapeutic Failure among Pregnant Women in Primary Health Care of Macau, China
AUTHORS:
Mei-Fong Chou, Chau-Sha Kwok, Chon-Kit Ieong, Sai-Meng Pang
KEYWORDS:
Pregnancy, Asymptomatic Bacteriuria (ASB), Symptomatic Bacteriuria (SB), Primary Health Care, Antenatal Care
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.9 No.10,
October
14,
2019
ABSTRACT: Both
asymptomatic (ASB) and symptomatic bacteriuria during pregnancy increase the
risk of adverse fetal or maternal outcomes. Our study aims to determine the
prevalence of bacteriuria, the etiological agents with their susceptibility to
antimicrobials, and the risk factors for therapeutic failure among pregnant
women for antenatal care in the primary health care of Macau, China. Methods: This is a cross-sectional survey involving 5101 antenatal care pregnant women from 1st Jan to 31st Dec., 2017. The
mid-stream clean-catch urine specimens were routinely examined
microscopically and cultured following the first consultation. Other data were
collected from the computerized medical records. Results: The mean age
of the pregnant women was 31.4 ± 5.04 years. We followed 130 women with
positive cultures on first consultation,
of whom 35 (26.9%) were found to have contaminated cultures. 95 pregnant women
were confirmed to have UTI. The prevalence of bacteriuria was 1.86% (n = 95), of which 83 (87.4%) were asymptomatic. ASB was mainly in the younger
age-group (20 - 30 years) and the
primipara. Of 196 positive cultures, the commonest bacterium was Escherichia coli (n = 111 or 56.6%, 98.2% susceptible to nitrofurantoin),
followed by Klebsiella pneumonia (n = 20 or 10.2%, 90% susceptible to 2nd generation cephalosporin), and Streptococcus agalactiae (n = 16 or 8.2%, 100%
susceptible to nitrofurantoin). After treatment, there were 80 (84.2%)
therapeutic successes and 15 (15.8%) failures. Symptomatic infection and later
trimester were significantly associated with therapeutic failure (P ≤ 0.05). Conclusions: ASB is common in the young age group and primipara. Nitrofuranton and 2nd generation
cephalosporin are effective antibiotics against UTI in pregnancy. Symptomatic
infection and occurrence in later trimester were significantly associated with
treatment failure.