Diagnostic and treatment difficulties of pyelonephritis in pregnancy in resource-limited settings.
Limited microbiology services impede adequate diagnosis and treatment of common infections such as pyelonephritis in resource-limited settings. Febrile pregnant women attending antenatal clinics at Shoklo Malaria Research Unit were offered urine dipstick, sediment microscopy, urine culture, and a 5-mL blood culture. The incidence of pyelonephritis was 11/1,000 deliveries (N = 53 in 4,819 pregnancies) between January 7, 2004 and May 17, 2006. Pyelonephritis accounted for 20.2% (41/203) of fever cases in pregnancy. Escherichia coli was the most commonly isolated pathogen: 87.5% (28/32) of organisms cultured. Susceptibility of E. coli to ampicillin (14%), cotrimoxazole (21%), and amoxicillin-clavulanic acid (48%) was very low. E. coli was susceptible to ceftriaxone and ciprofloxacin. The rate of extended spectrum β-lactamase (4.2%; 95% confidence interval = 0.7-19.5) was low. The rate and causes of pyelonephritis in pregnant refugee and migrant women were comparable with those described in developed countries. Diagnostic innovation in microbiology that permits affordable access is a high priority for resource-poor settings.
Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand. SMRU@tropmedres.ac
Rose
R
McGready
Vanaporn
V
Wuthiekanun
Elizabeth A
EA
Ashley
Saw Oo
SO
Tan
Mupawjay
M
Pimanpanarak
Samuel Jacher
SJ
Viladpai-Nguen
Wilarat
W
Jesadapanpong
Stuart D
SD
Blacksell
Stephane
S
Proux
Nicholas P
NP
Day
Pratap
P
Singhasivanon
Nicholas J
NJ
White
François
F
Nosten
Sharon J
SJ
Peacock
D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001419:Bacteria / Q000145:classification / Q000187:drug effects; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000191:economics / Q000628:therapy* / Q000652:urine; D011704:Pyelonephritis / Q000175:diagnosis* / Q000191:economics / Q000628:therapy* / Q000652:urine; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology
D000900:Anti-Bacterial Agents