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.

中文翻译：

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孟加拉国农村人口妊娠期尿路感染：人群患病率、危险因素、病因和抗生素耐药性。


背景妊娠期尿路感染（UTI），包括无症状菌尿，与孕产妇发病和不良妊娠结局相关，包括早产和低出生体重。在中低收入国家（LMIC），筛查和治疗尿路感染的能力有限。本研究的目的是描述孟加拉国妊娠期尿路感染的人群患病率、危险因素、病因和抗菌药物耐药性模式。方法 在孟加拉国锡尔赫特地区的一个社区队列中，收集了 4242 名孕妇（妊娠 < 20 周）的家庭尿液样本，用于培养和抗生素敏感性测试。进行了基本描述性分析以及逻辑回归来计算 UTI 风险因素的调整优势比 (aOR)。结果 UTI 患病率为 8.9%（有症状 UTI 为 4.4%，无症状菌尿为 4.5%）。该人群中尿路感染的危险因素包括孕产妇营养不良（中上臂周长<23 cm：aOR= 1.29，95% CI：1.03-1.61）、初产（aOR= 1.45，95% CI：1.15-1.84）和低生育率父亲受教育程度（无受教育程度：aOR= 1.56，95% CI：1.09-2.22）。主要的泌尿道病原体是大肠杆菌（占分离株的 38%）、克雷伯菌属（12%）和葡萄球菌属（23%）。 B族链球菌占尿路病原体的5.3%。抗生素耐药率很高，只有三分之二的大肠杆菌对第三代头孢菌素敏感。结论 在孟加拉国锡尔赫特，每 11 名女性中就有 1 人在怀孕期间患有尿路感染，并且大约一半的病例没有症状。需要低成本、准确的妊娠期尿路感染筛查方法，并努力解决中低收入国家抗生素耐药率上升的问题。