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Introduction: Urinary tract infections (UTIs) pose a significant health concern, particularly among pregnant women, for whom accurate diagnosis is essential. However, the use of Urine flow cytometry (UF) for detecting UTIs in this demographic often results in misdiagnosis. The objective of this study was to explore the reasons behind these diagnostic errors and to develop a strategy to minimize the rate of UTI misdiagnosis in pregnant women., Material and Methods: The study enrolled 1,200 women aged 18 to 40 years, categorized into pregnant and non-pregnant groups. UTIs were diagnosed using urine bacterial culture, microscopic examination, and UF, followed by statistical analysis to identify any discrepancies in diagnosis between the groups. Following the calibration of UF analyzer's parameters, the most effective CR(WBC)-CW-FSC-P Gain setting for diagnosing UTIs in pregnant women through UF was ascertained by applying the Youden index., Results: The clinical diagnosis rate of UTIs was significantly higher in pregnant women (40.91%) compared to non-pregnant women (20.26%). However, urine microscopy and bacterial culture showed no significant difference in the rates of UTIs between the two groups, suggesting a potential for misdiagnosis. The false-positive rate for WBCs detected by UF was 30.43%, and adjusting the CR(WBC)-CW-FSC-P Gain value of UF reduced the false-positive rate to 9.45%., Conclusion: The incidence of UTIs in pregnant women may be overestimated because of the limitations inherent to UF. Adjusting the parameters of the UF analyzer, particularly the CR(WBC)-CW-FSC-P Gain value, can significantly reduce the rate of UTI misdiagnosis in pregnant women., Competing Interests: The authors have declared that no competing interests exist, (Copyright: © 2024 Liu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: In utero Cytomegalovirus (CMV) vertical transmission occurs predominantly during primary maternal infection. There are no known non-invasive methods for diagnosis of fetal infection before delivery, however some risk factors have been suggested. We aimed to evaluate the association between maternal CMV urinary excretion and congenital CMV infection., Methods: A retrospective cohort study of all women who were diagnosed with primary CMV infection during pregnancy in a single university affiliated tertiary medical center, between 2012 and 2016. We examined congenital CMV infection and disease rates among infants born to women with and without CMV urinary excretion., Results: Overall, 126 women were included, 77 in the positive urinary excretion group, and 49 in the negative urinary excretion group. There was no difference in maternal symptoms between the groups. We found no difference in congenital CMV infection and disease rates between infants born to women with and without urinary excretion of CMV (congenital infection rate 37.1% vs. 24.4%, p = 0.209, congenital disease rate of 18.2% vs. 22.4%, p = 0.648). Women with positive urinary CMV excretion had lower IgG avidity values (36.7% vs 54.6%, p = 0.007), with no additional difference in serology pattern. Compared to asymptomatic women, those with CMV related symptoms did not have significantly higher rates of urinary excretion of CMV (70% vs. 60.5%, p = 0.38) or congenital infection rates (40.7% vs. 31.2%, p = 0.48)., Conclusion: Among infants of women with primary CMV infection in pregnancy, we did not find an association between urinary excretion of CMV and congenital CMV infection., (© 2021. The Author(s).)

In this study, we aimed to document adverse pregnancy outcomes and maternal complications among pregnant women who acquired asymptomatic bacteriuria in Addis Ababa, Ethiopia. We used hospital-based prospective cohort study design in which we followed 44 pregnant women with asymptomatic bacteriuria confirmed by urine culture result of ≥10 5 cfu/ml of urine. We documented adverse pregnancy outcomes and maternal complications in terms of frequency, percentage, mean, and standard deviation. Additionally, we used Pearson's correlation coefficient to investigate associations of selected variables with perinatal death as one of adverse pregnancy outcomes. Of the 44 pregnant women enrolled in the study, complete data was collected from 43 participants with one lost to follow-up. Six (14%) of women developed fever and were treated with antibiotic during pregnancy, 26 (60.5%) delivered with cesarean section, two (4.3%) perinatal deaths within seven days of delivery, one miscarriage, and 4 (9.3%) newborns were found underweight. The mean birth weight of the newborns was 3.1 kg ± 0.60. Almost half 21(48.8%) were born before 37 weeks of gestational age. Fourteen (32.6%) of newborns were born asphyxiated. Twenty-two (51.2%) of newborns developed early neonatal fever within 48 hours of delivery and treated with antibiotic. Correlation coefficient analysis revealed that weight and gestational age of newborns at birth, Apgar score at 1 st and 5 th minutes of birth and miscarriage were positively correlated and significantly associated with perinatal death. The occurrence of unsought pregnancy outcomes were frequent, and substantial number of pregnant women developed maternal complications. Therefore, screening pregnant women for asymptomatic bacteriuria and treating may reduce the possible maternal complications and adverse pregnancy outcomes., Competing Interests: All authors declared that they have no conflict of interest., (Copyright © 2021 Ketema Bizuwork Gebremedhin et al.)

Zika virus (ZIKV) has recently been confirmed as endemic in Indonesia, but no congenital anomalies (CA) related to ZIKV infection have been reported. We performed molecular and serological testing for ZIKV and other flaviviruses on cord serum and urine samples collected in October 2016 to April 2017 during a prospective, cross-sectional study of neonates in Jakarta, Indonesia. Of a total of 429 neonates, 53 had CA, including 14 with microcephaly. These 53, and 113 neonate controls without evidence of CA, were tested by ZIKV-specific real-time reverse transcription polymerase chain reaction (RT-PCR), pan-flavivirus RT-PCR, anti-ZIKV and anti-DENV IgM ELISA, and plaque reduction neutralization test. There was no evidence of ZIKV infection among neonates in either the CA or non-CA cohorts, except in three cases with low titers of anti-ZIKV neutralizing antibodies. Further routine evaluation throughout Indonesia of pregnant women and their newborns for exposure to ZIKV should be a high priority for determining risk.

Introduction: In pregnant women, bacteriuria with group B streptococci (GBS) may be associated with a high degree of recto-vaginal GBS colonisation and therefore an increased risk of early-onset GBS disease. The aim of this study was to assess the performance of routine use of dipstick urine analysis during pregnancy for prediction of recto-vaginal GBS colonisation at the time of labour., Methods: Among 902 unselected Danish pregnant women, we obtained results from 1) dipstick urine analysis, 2) urine culture carried out during pregnancy, if indicated, and 3) recto-vaginal culture at labour. The inclusion criteria were age > 18 years and gestational age ≥ 37 weeks., Results: Intrapartum recto-vaginal GBS colonisation was predicted by a positive urine dipstick with 5% sensitivity only., Conclusion: Dipstick urine analysis had a low sensitivity for predicting intrapartum recto-vaginal colonisation with GBS., Funding: none., Trial Registration: not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

Paired maternal and newborn urine and amniotic fluid from 138 subjects collected during a Zika virus (ZIKV) outbreak was analyzed for ZIKV by gene amplification (RT-qPCR), and the findings were correlated with clinical symptoms and neurological anomalies in the babies. ZIKV was detected in 1 of 9 symptomatic women (11.1%) and in 19 of 129 asymptomatic women (14.7%). Neurological manifestations were present in 19 babies (13.7%), 10 of 20 (50%) positive and 9 of 119 (7.6%) negative (p < 0.001) for ZIKV. Twelve (8.6%) urines collected during gestation were ZIKV-positive; only 2 remained positive for ZIKV postpartum. Six (4.1%) newborn urines collected within 1 day of delivery were ZIKV-positive cases. In 3 of these cases, ZIKV was detected in mother's urine pre- and postpartum and in both mother's urine and babies' urine. Four of the amniotic fluid samples (2.9%) were ZIKV-positive. Among ZIKV-negative babies with neurological sequel, 87.5% were female; in contrast, 72.7% ZIKV-positive babies with neurological abnormalities were male (p = 0.019). We conclude that during a ZIKV outbreak, clinical symptoms and ZIKV detection in biological fluids are poor predictors of infection and adverse neurologic sequel in newborns.

Raltegravir (RAL) is a HIV-integrase inhibitor recommended for treatment of HIV type 1 infection during pregnancy. The elimination of RAL to RAL glucuronide (RAL GLU) is mediated primarily by UDP glucuronosyltransferase 1A1 (UGT1A1). The present study shows the development and validation of 4 different methods for the analysis of RAL and RAL GLU in plasma and in urine samples. The methods were applied to evaluate the maternal-fetal pharmacokinetics of RAL and RAL GLU in a HIV-infected pregnant woman receiving RAL 400 mg twice daily. The sample preparation for RAL and RAL GLU analysis in 25 μL plasma and 100 μL diluted urine (10-fold with water containing 0.1% formic acid) were carried out by protein precipitation procedure. RAL and RAL GLU generate similar product mass fragments and require separation in the chromatographic system, so a suitable resolution was achieved for unchanged RAL and RAL GLU employing Ascentis Express C18 (75 × 4.6 mm, 2.7 μm) for both plasma and urine samples. The methods showed linearities at the ranges of 0.1-13.5 μg/mL RAL and 0.15-19.5 μg/mL RAL GLU in urine and 10-2000 ng/mL RAL and 2.5-800 RAL GLU in plasma. Precise and accurate evaluation showed coefficients of variation and relative errors ≤ 15%. The methods have been successfully applied in a maternal-fetal pharmacokinetic study., (Copyright © 2019. Published by Elsevier B.V.)

Background: Pregnant women with asymptomatic bacteriuria are at increased risk of developing symptomatic urinary tract infections. HIV infection may modify the acquisition of bacteriuria in pregnancy., Objective: To identify the determinants of asymptomatic bacteriuria in HIV-positive and HIV-negative pregnant women in Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria., Methods: A cross-sectional study involving 211 HIV-positive pregnant women and 422 HIV-negative pregnant women attending their first antenatal clinic between October 2017 and March 2018. Information on socio-demographic characteristics and risk factors for asymptomatic bacteriuria in study participants was recorded. Microbial culture was carried out on aseptically collected urine samples., Results: Asymptomatic bacteriuria was found in 66(31.3%) and 118(28.0%) in HIV-positive and negative women respectively. Advanced maternal age, gestational age above 20 weeks, low socioeconomic status, history of urinary tract infections in previous pregnancies and low CD4 cell count had statistically significant association with increased prevalence of asymptomatic bacteriuria among HIV positive women. Binary logistic regression analysis showed that low socioeconomic status and history of urinary tract infections in previous pregnancies were strong determinants of asymptomatic bacteriuria among HIV positive women (AOR 4.1, CI 1.9-8.7, P < 0.001; AOR 5.8, CI 2.5-13.6, P < 0.001 respectively). In HIV negative women, gestational age above 20 weeks had statistically significant association with increased prevalence of asymptomatic bacteriuria (AOR= 2.34, CI 1.3-4.1, P= 0.002)., Conclusion: Low socioeconomic status and previous history of urinary tract infections are determinants of asymptomatic bacteriuria in HIV positive women while gestational age above 20 weeks is a determinant in HIV negative women. These determinants could be used to identify women at high risk of asymptomatic bacteriuria for targeted screening.

Objective: To investigate an association between Group B streptococci (GBS) in urine culture during pregnancy and preterm delivery. Methods: A population-based cohort consisted of all the pregnant women ( n  = 36,097) from the catchment area of Lillebaelt Hospital, Denmark, during the period January 2002 -December 2012. The cohort of 34,285 singleton pregnancies used in this study was divided into three groups. Group I ( N  = 249) included women whose urine culture was positive for GBS; group II ( N  = 5765) included women whose urine culture was negative for GBS; and group III ( N  = 28 271) included women whose urine had not been cultured during pregnancy. Primary outcome was preterm delivery before 37 weeks' gestation (PTD). Results: We did not find an association between PTD and GBS bacteriuria in the cultured groups (odds ratios (OR) = 0.89; 95% CI: 0.5-1.4) ( Table 1 ). After controlling for potential confounders, the PTD remained not associated with GBS bacteriuria (adjusted OR = 0.99; 95% CI: 0.6-1.6). Combined, the cultured groups (I and II) were associated with a statistically significant higher risk for PTD, when compared with the group with no urine specimens taken for culture (OR = 1.96; 95% CI: 1.8-2.2 and adjusted or 1.80; 95% CI 1.6-2.0). The cultured group of women differed considerably from the group of women with no urine specimens taken for culture on the vast majority of variables examined. Conclusions: No association between asymptomatic GBS bacteriuria and preterm delivery among women with singleton pregnancy and urine specimens cultured during pregnancy was found. Previous suggestions of such association may have been compromised by a selection problem for testing due to a high-risk profile of pregnancy complications in pregnant women selected for urine culture.

Objective: Treatment of uncomplicated urinary tract infections in primary care is generally empirical without requesting urine culture and based on biased resistance data collected from selected patients, most of them having risk factors for the isolation of resistant microorganisms. In order to overcome the lack of information on the real resistance rates in uncomplicated UTI, we compared antimicrobial phenotype and genotype of Escherichia coli isolated from pregnant women with asymptomatic bacteriuria (culture always performed) with those from women with uncomplicated acute cystitis (culture rarely performed) of different age groups., Methods: Between September 2017 and March 2018, 103 urines were randomly collected from pregnant women aged between 16 and 47 with asymptomatic bacteriuria (AB) (n=42), not hospitalized women in the same age range with uncomplicated acute cystitis (UAC) (n=31) and women older than 47 not hospitalized with UAC (n=30). Bacteria identification was performed using mass spectrometry and the antibiogram by broth microdilution. Genetic typification was carried out by pulsed-field gel electrophoresis., Results: There are no significant differences between the groups of patients in the antibiotic susceptibility. Likewise, as expected, a wide genetic diversity is observed among the strains of E. coli studied without significant differences between the three groups., Conclusions: We propose a simple model that could provide better guidance for selection of empirical antimicrobial therapy for non-pregnant women with UAC than do generic hospital antibiogram data based on reliably extrapolating the susceptibility data of strains isolated from pregnant women with AB as representation of women with community-acquired UAC., (©The Author 2019. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).)

A 27-year-old pregnant woman who was positive for anti-cytomegalovirus (CMV) antibodies gave birth to a congenitally CMV-infected neonate at 40 weeks of gestation. According to strain-specific serological analysis, which is able to determine the two types of CMV glycoprotein H (gH), the mother possessed anti-gH(To) antibodies only, but the neonate possessed anti-gH(AD) and anti-gH(To) antibodies at 4 weeks after birth. As the anti-gH(To) IgG was decreased in the neonate at 8 months post-delivery, these antibodies are thought to have been transferred from the mother as maternal antibodies. The anti-gH(AD) IgG level was maintained in the child even after 8 months post-delivery. Congenital infection with a CMV gH(AD) type strain was confirmed by strain-specific real-time PCR using a urine specimen from the child. On the other hand, anti-gH(AD) IgG was not detected even after 8 months post-delivery in a maternal specimen. The mother only produced antibodies against the CMV strain identified as the primary infection, which is characteristic of original antigenic sin., (Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: In pregnant women, the rectovaginal colonization by Streptococcus agalactiae (GBS) is related with geographic area of origin (6.5% to 36%). It was analysed GBS carriage in pregnant women in 2012-2014 in our hospital., Methods: Observational retrospective study about GBS isolates from rectovaginal samples (RVS) and urine cultures of Spanish and immigrant pregnant women in 2012-2014. It was considered only a single isolation for patient. There were excluded women with GBS in urine samples of RVS study., Results: A total of 4,648 Spanish and 1,405 immigrant women were analysed. GBS was detected in urine samples in 231 Spanish (5%) and 106 immigrant (7.6%). A total of 5,716 RVS were analysed, GBS was detected in 10.5% of Spanish women and in 18.9% of immigrant women., Conclusions: The overall colonization in immigrant women is higher than in Spanish with the exception of Asian women. Cases of GBS detected in urine samples might serve as a possible explanation for the high rate of GBS carriage., (©The Author 2018. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).)

Objective: To compare the prevalence of asymptomatic bacteriuria (ASB) and the incidence of urinary tract infection (UTI) in pregnant women with and without diabetes mellitus (DM) or gestational DM (GDM)., Study Design: We performed a cohort study in five hospitals and two midwifery clinics in the Netherlands. Pregnant women with and without DM or GDM were screened for the presence of ASB around 12 and 32 weeks' gestation. Characteristics of participants as well as outcome data were collected from questionnaires and medical records. ASB was defined as the growth of at least 10e5 cfu/ml isolated from the urine of a woman without UTI complaints. UTI was considered to be present when a treating physician had diagnosed UTI and prescribed antibiotics., Results: We studied 202 women with and 272 women without DM or GDM. Of all women 31.7% with and 94.9% without DM or GDM provided a week 12 sample. The prevalence of ASB was comparable in women with and without DM or GDM (12 weeks' n = 322; 4.7% and 2.3%; relative risk (RR) 2.02; 95% confidence interval (CI) 0.52-7.84; 32 weeks' n = 422; 3.2% and 3.0%; RR 1.06; 95% CI 0.36-3.09), as was the incidence of UTI (16.8% and 12.9%; RR 1.31; 95% CI 0.85-2.02). Neither ASB nor UTI were associated with preterm birth or babies being small for gestational age., Conclusion: In pregnant women with and women without DM or GDM, the overall prevalence of ASB was low. Neither ASB nor UTI did differ significantly between the groups. Our data discourage a routine ASB screen and treat policy in pregnant women with DM or GDM., (Copyright © 2017. Published by Elsevier B.V.)

Group B streptococcus (GBS) is one of the severe pathogenic bacteria during the perinatal period, both on pregnant women and newborns. GBS infection may lead to pneumonia, septicemia, meningitis or other severe disease, even death in neonates. Although only 1%-2% infections will develop into GBS disease among the neonates, the etiological mechanism of which is worth researching. This review summarizes the possible factors related to GBS infection or occurrence of the disease, including the risk in gestation period (for example, colonization of GBS on vagina of pregnant women, preterm birth or premature rupture of fetal membranes and so on), related pathogens (bacteria strains, loads or virulence), immune level (inflammatory factor or neutralizing anticytokine auto-Abs), gene defect or primary immunodeficiencies of the hosts.

Background: Urinary tract infection is common in pregnancy. Urine is sampled from by mid-stream collection (MSU). If epithelial cells are detected, contamination by vulvo-vagial skin and skin bacteria is assumed. Outside pregnancy, catheter specimen urine (CSU) is considered less susceptible to contamination. We compared MSU and CSU methods in term pregnancy to test these assumptions., Methods: Healthy pregnant women at term gestation (n = 32, median gestation 38 + 6 weeks, IQR 37 + 6-39 + 2) undergoing elective caesarean section provided a MSU and CSU for paired comparison that were each analysed for bacterial growth and bladder distress by fresh microscopy, sediment culture and immunofluorescent staining. Participants completed a detailed questionnaire on lower urinary tract symptoms. Epithelial cells found in urine were tested for urothelial origin by immunofluorescent staining of Uroplakin III (UP3), a urothelial cell surface glycoprotein. Urothelial cells with closely associated bacteria, or "clue cells", were also counted. Wilcoxons signed rank test was used for paired analysis., Results: Women reported multiple lower urinary tract symptoms (median 3, IQR 0-8). MSU had higher white blood cell counts (median 67 vs 46, z = 2.75, p = 0.005) and epithelial cell counts (median 41 vs 22, z = 2.57, p = 0.009) on fresh microscopy. The proportion of UP3+ cells was not different (0.920 vs 0.935, z = 0.08, p = 0.95), however MSU had a higher proportion of clue cells (0.978 vs 0.772, z = 3.17, p = 0.001). MSU had more bacterial growth on sediment culture compared to CSU specimens (median 8088 total cfu/ml vs 0, z = 4.86, p = 0.001). Despite this, routine laboratory cultures reported a negative screening culture for 40.6% of MSU specimens., Conclusion: Our findings have implications for the correct interpretation of MSU findings in term pregnancy. We observed that MSU samples had greater bacterial growth and variety when compared to CSU samples. The majority of epithelial cells in both MSU and CSU samples were urothelial in origin, implying no difference in contamination. MSU samples had a higher proportion of clue cells to UP3+ cells, indicating a greater sensitivity to bacterial invasion. Urinary epithelial cells should not be disregarded as contamination, instead alerting us to underlying bacterial activity.

Background: Cytomegalovirus (CMV) urinary shedding in pregnant women infected with human immunodeficiency virus (HIV) was evaluated to determine whether it poses an increased risk for congenital CMV infection (cCMV)., Methods: A subset of mother-infant pairs enrolled in the perinatal NICHD HPTN 040 study (distinguished by no antiretroviral use before labor) was evaluated. Maternal and infant urines were tested by qualitative real-time polymerase chain reaction (RT-PCR) for CMV DNA with quantitative RT-PCR performed on positive specimens., Results: Urine specimens were available for 260 women with 85.4% from the Americas and 14.6% from South Africa. Twenty-four women (9.2%) had detectable CMV viruria by qualitative PCR. Maternal CMV viruria was not associated with mean CD4 cell counts or HIV viral load but was associated with younger maternal age (P = .02). Overall, 10 of 260 infants (3.8%) had cCMV. Women with detectable peripartum CMV viruria were more likely to have infants with cCMV than those without: 20.8% (5/24) versus 2.1% (5/236), (P = .0001). Women with CMV viruria had significantly higher rates of HIV perinatal transmission (29.2% vs. 8.1%, P = .002). They were 5 times (adjusted odds ratio [aOR] = 5.6, 95% confidence interval [CI] 1.9-16.8) and nearly 30 times (aOR, 29.7; 95% CI, 5.4-164.2) more likely to transmit HIV and CMV to their infants, respectively. Maternal gonorrhea (aOR, 19.5; 95% CI, 2.5-151.3) and higher maternal HIV log10 viral load (OR, 2.8; 95% CI, 1.3-6.3) were also significant risk factors for cCMV., Conclusion: In this cohort of HIV-infected pregnant women not on antiretrovirals, urinary CMV shedding was a significant risk factor for CMV and HIV transmission to infants., Clinical Trials Registration Number: NCT00099359., (© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com)

Competing Interests: Competing interests: We have read and understood the BMJ policy on declaration of interests and declare the following interests: None.

Given the consensus that there is a causal relationship between Zika virus (ZIKV) infection in pregnancy and congenital Zika syndrome (CZS), clinicians must be prepared to manage affected patients despite the numerous gaps in current knowledge. The clinical course in pregnancy appears similar to that in non-pregnant women, although viraemia may be prolonged. ZIKV infection can be diagnosed by serum and urine reverse transcription-polymerase chain reaction, but commercially available serological tests are currently unreliable in dengue-endemic regions. Although vertical transmission can occur at any time during gestation, first- and second-trimester infections have the highest risk of developing central nervous system anomalies. Aberrant fetal growth and pregnancy loss may also occur. Serial ultrasonography should be conducted for infected cases. Without a vaccine, pregnant women should be advised to minimise mosquito bites and reduce sexual transmission risk. Overall, the absolute risk of CZS arising amid a ZIKV outbreak appears relatively low., (Copyright: © Singapore Medical Association.)

An estimated 40 million women of childbearing age suffer from schistosomiasis. Animal models indicate a deleterious effect of maternal schistosomiasis on pregnancy outcomes. To date there is a lack of epidemiological evidence evaluating schistosomiasis-related morbidity in pregnancy. This study was designed to describe the impact of urogenital schistosomiasis on pregnancy outcomes in a highly endemic region of central Africa. Pregnant women attending antenatal clinics in Fougamou and Lambaréné, Gabon, were consecutively screened for the presence of Schistosoma haematobium eggs in diurnal urine samples. Maternal and newborn characteristics assessed at delivery were compared between infected and uninfected mothers. The impact of maternal schistosomiasis on low birth weight and preterm delivery was assessed using logistic regression analysis. Urogenital schistosomiasis was diagnosed in 103 (9%) of 1115 pregnant women. Maternal age was inversely associated with the prevalence of urogenital schistosomiasis, with a higher burden amongst nulliparous women. Low birth weight was more common amongst infants of S. haematobium-infected mothers. This association was unaffected by controlling for demographic characteristics, gestational age and Plasmodium infection status (adjusted Odds Ratio 1.93; 95% confidence interval: 1.08-3.42). Other risk factors associated with low birth weight delivery were underweight mothers (adjusted Odds Ratio 2.34; 95% confidence interval: 1.12-4.92), peripheral or placental Plasmodium falciparum infection (adjusted Odds Ratio 2.04; 95% confidence interval: 1.18-3.53) and preterm birth (adjusted Odds Ratio 3.12; 95% confidence interval: 1.97-4.96). Preterm delivery was not associated with S. haematobium infection (adjusted Odds Ratio 1.07 95% confidence interval: 0.57-1.98). In conclusion, this study indicates that pregnant women with urogenital schistosomiasis are at an increased risk for low birth weight deliveries. Further studies evaluating targeted treatment and prevention programmes for urogenital schistosomiasis in pregnant women and their impact on delivery outcomes are warranted., (Copyright © 2016 Australian Society for Parasitology. Published by Elsevier Ltd. All rights reserved.)

Objectives: Pivmecillinam is a safe beta-lactam for use in pregnancy. It has been widely used for the treatment of lower urinary tract infections (UTIs) in the Nordic countries where its efficacy, minor impact on the microbiota, and low level of resistance among the Escherichia coli strains have been proven. However, susceptibility data related to E. coli involved in asymptomatic bacteriuria and lower UTIs in pregnant women is lacking. We aimed to support the 2015 recommendations issued by the French Infectious Diseases Society (SPILF) on gestational UTI, with a particular focus on pivmecillinam., Material and Methods: Antimicrobial susceptibility testing was performed by 12 hospitals with a maternity department on 235 E. coli strains isolated from the urine of pregnant women. Susceptibility to mecillinam was tested by disk diffusion method using the 2015 recommendations of the antibiogram committee of the French microbiology society (CA-SFM)., Results: Global susceptibility to mecillinam was 86.4%. Susceptibility to mecillinam was 96.5% for strains susceptible to amoxicillin-clavulanic acid and 38.7% for resistant strains. All six extended-spectrum beta-lactamase-producing E. coli strains were susceptible to mecillinam., Conclusion: Given the efficacy and safety of pivmecillinam during pregnancy, it may be used for the documented treatment of asymptomatic bacteriuria and acute cystitis in pregnant women. It also represents an alternative for the treatment of multidrug-resistant bacterial infections., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

This cross-sectional study was undertaken to determine the prevalence of asymptomatic bacteriuria (ASB), the commonest bacterial isolates and the antibiotic sensitivity pattern among 556 pregnant women in Lagos University Teaching Hospital (LUTH), Nigeria. Women with a bacterial count over 100,000 colony-forming units per millilitre of the same organisms in paired urine samples were considered to have ASB. The prevalence of ASB was 14.6%. Klebsiella was the commonest micro-organism (39.2%) isolated. ASB was significantly associated with marital status, body mass index and parity. There was a significant relationship between urinary nitrites and ASB. The isolated organisms showed remarkable resistance to commonly prescribed antibiotics such as amoxicillin, cloxacillin and trimethoprim but good sensitivity to ofloxacin, gentamycin and ceftazidime. These facts have implications for the management of ASB in pregnancy.

Objectives: Pregnancy results in physiological changes altering the pharmacokinetics of drugs metabolized by cytochrome P450 3A4 (CYP3A4). The urinary ratio of 6-β hydroxycortisol to cortisol (6βHF : F) is a marker of CYP3A4 induction. We sought to evaluate its change in antiretroviral (ARV)-treated HIV-1-infected women and to relate this change to ARV pharmacokinetics., Methods: Women receiving various ARVs had pharmacokinetic evaluations during the third trimester of pregnancy (>30 weeks) and postpartum with determination of 6βHF : F carried out on the same days. The Wilcoxon signed rank test was used to compare the ratio antepartum to postpartum. The relationship between the change in ratio and the change in pharmacokinetics was analysed using Kendall's tau., Results: 6βHF : F ratios were available for 107 women antepartum, with 54 having postpartum values. The ratio was higher antepartum (P=0.033) (median comparison 1.35; 95% confidence interval 1.01, 1.81). For 71 women taking a protease inhibitor (PI), the antepartum vs. postpartum 6βHF : F comparison was marginally significant (P=0.058). When the change in the 6βHF : F ratio was related to the change in the dose-adjusted ARV area under the plasma concentration vs. time curve (AUC) between antepartum and postpartum, the 35 subjects in the lopinavir/ritonavir (LPV/r) arms demonstrated an inverse relationship (P=0.125), albeit this correlation did not reach statistical significance., Conclusions: A 35% increase in the urinary 6βHF : F ratio was measured during late pregnancy compared with postpartum, indicating that CYP3A induction occurs during pregnancy. The trend towards an inverse relationship between the change in the 6βHF : F ratio and the change in the LPV AUC antepartum vs. postpartum suggests that CYP3A induction may be one mechanism behind altered LPV exposure during pregnancy., (© 2014 British HIV Association.)

Background: Urinary tract infections are among the most common bacterial infections of humans. Urine culture is the gold standard for asymptomatic bacteriuria and pyuria is not always present in bacteriuria, nor is it specific for bacteriuria., Objective: The aim of the present study was to determine neutrophil activation and the contributions of this activation in the differentiation of infection and contamination., Methods: The serum and urine myeloperoxidase (MPO) levels of 50 pregnant females with symptoms suggesting UTI and 25 healthy non-pregnant control subjects were measured using the enzyme-linked immunosorbent assay (ELISA) method and the obtained values were compared with the results of urine microscopy and urine culture., Results: The leukocyte count in urine was significantly higher in group 1 (infection) and group 2 (contamination) when compared with the control group (group 1 mean: 18.2; group 2 mean: 14.2; control mean: 4.8; ANOVA test, p ≤ 0.00). According to the obtained ELISA values, a statistical difference in the levels of urine MPO between the patient and control groups was seen (p ≤ 0.00). There was no statistical difference among the groups for serum MPO levels (p ≥ 0.451)., Conclusion: The study findings suggest that standardized measurement techniques such as dipstick screening assay for urine MPO level may be useful in differentiating infection and contamination, especially in pregnant patients., (© 2015 S. Karger AG, Basel.)

Objective: The objective of this study was to assess the frequency of urinary tract infection (UTI) with urine samples obtained via catheterization among women undergoing cesarean delivery at term pregnancy., Materials and Methods: A cross-sectional study involving 159 women in whom cesarean delivery was conducted at term pregnancy after a regular follow-up from first to third trimester. For screening and diagnosis of UTI during antenatal period, the authors used dipstick test and microscopic urinalysis, and urine culture was used in the presence of symptomatic UTI unresponsive to initial antibiotic therapy. A urine sample was obtained immediately after insertion of Foley catheter for urine dipstick test, microscopic urinalysis, and culture during cesarean delivery. Obstetric and UTI data were recorded., Results: Of 159 pregnant women, 95 (59.8%) did not develop UTI during antenatal care. There was no patient with symptomatic UTI at the admission for cesarean delivery. The authors found UTI with urine dipstick and microscopic urinalysis in 12 patients and of them, four patients had no history of UTI, and all the remaining eight patients had asymptomatic UTI during antenatal follow-up. UTI according to urine culture was encountered in three patients, two of them had one episode of UTI, and one had two episodes of UTI during antenatal follow-up., Conclusions: After regular antenatal follow-up screening with urine dipstick, microscopic urinalysis, and counseling of pregnant women regarding UTIs, the frequency of bacteriuria decreases considerably during cesarean delivery.

Background: Untreated asymptomatic bacteriuria (ASB) during pregnancy may cause serious complications including pyelonephritis and delivery of premature or low-birth-weight infants. However, little is known about asymptomatic bacteriuria in pregnancy in Ethiopia. This study aimed to assess the prevalence of asymptomatic bacteriuria, bacterial agents, and their antibiotic susceptibility pattern in pregnant women attending antenatal clinic of the Hawassa Teaching and Referral Hospital., Methods: A cross-sectional study was conducted in a total of 244 pregnant women with no sign and symptom of urinary tract infection from March 2012 to September 2012. Clean catch mid-stream urine samples were collected from all study participants using sterile containers. Urine samples were cultured using standard bacteriological methods. Identification of suspected colonies and antibiotic sensitivity testing were done., Result: Out of 244 pregnant women, 46(18.8%) were positive for asymptomatic bacteriuria (Colony Forming Unit ≥ 105/mL). There was no difference in prevalence of asymptomatic bacteriuria with respect to age (p = 0.07) and trimester (p = 0.27).The most frequently isolated bacteria were coagulase negative Staphylococcus (32.6%), followed by Escherichia coli (26.1%), and Staphylococcus auerus (13%). The susceptibility rate of bacterial isolate was highest for norfloxacin (64.7%) and lowest for ampicillin (17.6%)., Conclusion: The high prevalence of ASB in pregnant women warrant the need to screen all pregnant women and treat those infected with appropriate antimicrobial regimens in order to reduce its complications.

Purpose: Urinary tract infection (UTI) is one of the most common conditions during pregnancy. The aim of this study was to assess the prevalence of germs and the antimicrobial susceptibility profile in urine culture isolates from pregnant patients treated at a tertiary maternity hospital in Porto Alegre, Brazil., Methods: A cross-sectional, retrospective and descriptive study was carried out at Hospital Fêmina, a leading institution in prenatal, birth and postnatal healthcare in the city of Porto Alegre, Brazil. A total of 482 microbial community results were analyzed out of 1,558 positive urine cultures of pregnant women in all gestational ages treated at Fêmina Hospital between January 2007 and July 2013., Results: The susceptibility pattern presented in this research shows that the choice for UTI treatment during pregnancy should be nitrofurantoin (for uncomplicated infections) or second-generation cephalosporins such as cefuroxime (for uncomplicated and complicated infections), over ampicillin, first-generation cephalosporins and sulfamethoxazole/trimethoprim., Conclusion: Empirical treatment for UTI in pregnancy should be started according to the susceptibility patterns described in the literature and re-analyzed after the results of the urine culture.

Detection of asymptomatic bacteriuria (ASB) in pregnancy is important to avert the attendant morbidities. Therefore, we assessed the use of chlorhexidine reaction to detect ASB in pregnancy. This was a prospective study, which compared chlorhexidine reaction with dipstick tests and urine culture in 150 asymptomatic pregnant women. Urine cultures detected bacteriuria in seven women (4.7%). Chlorhexidine detected ASB in 72 women (48%) and had sensitivity, specificity and accuracy of 100%, 54% and 56%, respectively. Leucocyte esterase (LE) and nitrite detected bacteriuria in 31 (20.7%) women and 12 (8.0%) women, respectively. Singly, LE had a sensitivity and specificity of 14.3% and 79%, respectively, while nitrite's sensitivity and specificity was 42.9% and 93.7%, respectively. Combined, LE and nitrite had better sensitivity (97.9%) and accuracy (94%). Since the accuracy of chlorhexidine is low, other than urine culture, combined dipstick urinalysis of leucocyte esterase and nitrite tests is good to detect asymptomatic bacteriuria in pregnancy.

This study was performed with the objective to examine the diagnostic framework for urinary tract infection (UTI) in pregnancy and physician response to the clinical diagnosis and to correlate responses to the results of urine culture and sensitivity. Over a 6-month period, 81 consecutive patients attending the labor ward admission of a district general hospital with the diagnosis of UTI during pregnancy were analyzed. Relevant information on symptom complex, result of dipstick urinalysis and culture and sensitivity were recorded. Data were analyzed using descriptive statistics. Of the 78 patients analyzed, 79% had increased urinary frequency, 73.1% had suprapubic pains and 53.1% had dysuria. All the patients had urinalysis with dipsticks, 41 (52.6%) were positive for nitrites and 64 (82.1%) were positive for leukocyte esterase. All 78 patients had urine culture and sensitivity, 21 (26.8%) of who were positive, and coliforms were the most commonly isolated pathogens. The sensitivity for nitrite was 80.9%, specificity 57.9% and positive predictive value 41.4%. The corresponding figures for leukocyte esterase were sensitivity 100%, specificity 24.6% and positive predictive value 32.8%. Sixty-six (84.6%) patients had treatment started on the basis of the clinical diagnosis, mostly with co-amoxyclavullinic acid or amoxicillin alone. A high resistance rate to these empirically chosen antibiotics was seen in the sensitivity pattern of isolated pathogens. Current clinical diagnostic algorithms for the diagnosis of UTI when applied in the context of pregnancy have low specificity and positive predictive values; yet, empirical antibiotics are frequently employed on this basis. These are often not in keeping with the sensitivity pattern of isolated organisms. There is need for a continuing research for more specific bedside tests.

Background/objective: The objective was to establish the characteristics of antenatal attendees in Faith Medical Centre, a private health facility in Benin City who have asymptomatic bacteriuria (ASB) as well as to determine the relationship between ASB and socioeconomic status., Methods: It was a descriptive, cross-sectional study involving 240 pregnant women who presented in the course of antenatal care from January to April 2009. With the aid of a questionnaire patients who were recruited for the study had their socio-demographic data and relevant gynecological and drug history recorded. A physical examination was done to document temperature, height, weight and symphysiofundal height. A clean-catch midstream urine sample was collected for microscopy and culture. White blood cell count of≥5/hpf and/or bacteria count of≥1/hpf of urine was considered significant for urine microscopy and a single colony count of ≥105/ml from two consecutive urine samples was considered significant for urine culture., Results: The prevalence of ASB was 13.8% by urine culture and 43.8% by urine microscopy among antenatal attendees in Faith Medical Centre, Benin City. There was no relationship between ASB and socio-economic factor (P value=0.1267). There was also no significant specific trend between ASB and age (P value=0.0578). Using urine culture as gold standard, the sensitivity of urine microscopy was 90.9%, the specificity was 49.3%, the positive predictive value was 22.2% and the negative predictive value was 97.1%., Conclusion: ASB in pregnancy is common in Faith Mediplex and has no statistically significant relationship with socioeconomic status. The current practice of diagnosing and treating ASB based on urine microscopy needs to be reviewed since the specificity of urine microscopy is very low. Also the practice of screening pregnant women only at the time of booking can lead to under-diagnosis of ASB. This is so because most women who develop this condition later in the course of antenatal care will be missed."

Objectives: Damage of the fallopian tube after sexually transmitted diseases like Chlamydia trachomatis, is an important risk factor for ectopic pregnancy (EP). The study was designed to assess the prevalence of C. trachomatis infection in patients with EP in the southeastern part of Iran., Method: The polymerase chain reaction (PCR) on fallopian tube tissue was applied to detect Chlamydia DNA in 42 patients with EP (EP group) and 87 patients without EP (control group) who underwent tubal ligation. The same protocol was performed with urine samples taken from the husbands in both groups., Results: Out of all studied females, 5 patients in the EP group were PCR-positive for C. trachomatis and none of the control group subjects was PCR-positive for C. trachomatis infection (P<0.05). Among the husbands, the PCR result was positive in the urine of 19 males (9 in the EP group and 10 in the control group). All PCR-positive women had husbands with PCR positive urine samples. No significant difference was found between Chlamydia infection in the EP and the control groups regarding age, duration of marriage, contraceptive method and history of infertility surgery and pelvic pain. There was no significant difference between prevalence of EP in women based on the PCR outcome in the husbands. The Chlamydia infection in men did not show any relation to the number of marriages., Conclusion: Based on our findings, it can be concluded that Chlamydia is an important risk factor of the fallopian tube damage and EP in our society. Therefore, screening programs and treatment of Chlamydia infection are recommended in young women and high risk women and men.

Purpose: To identify the accuracy of urinalysis in the diagnosis of urinary tract infection in pregnant women at high risk., Methods: a prospective, cross-sectional study was conducted on 164 pregnant women admitted to the high-risk the ward of the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) during the period from January to June 2011. Patients who had been taking antibiotics in the last ten days were excluded. All patients were subjected to simple urine tests and urine culture at the beginning of their admission. The agreement between the results of the examinations was evaluated by Kappa indices (K), and accuracy, sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values were also determined., Results: When only the presence of pus cells in urinalysis was used as a diagnostic criterion suggesting bacteriuria, there was a poor agreement when compared to uroculture (K=0.16). Accuracy was 61%, sensitivity 62.5%, and specificity 60.6%. PPV was 27.78% and NPV was 87%., Conclusion: The presence of alteration of urinalysis does not necessarily indicate an ongoing urinary tract infection, with urine culture being necessary. However, when urinalysis data are normal, uroculture may be avoided.

Asymptomatic polyomaviruria of pregnancy has been documented in point prevalence studies, but little attention has been given to the dynamics of polyomavirus excretion during pregnancy because of its benign course. We tested the hypothesis that the frequency and/or magnitude of polyomavirus excretion would increase as pregnancy progresses. Urine specimens were obtained prospectively from 179 healthy women during uncomplicated pregnancies and 37 healthy non-pregnant women. Real-time polymerase chain reaction was used to determine BK virus (BKV) and JC virus (JCV) viral loads in urine, blood, and rectal and vaginal swabs collected during routine obstetric and gynecologic clinic visits. Asymptomatic urinary shedding of BKV and/or JCV was observed in 384 (48.0%) of 800 specimens from 100 (55.8%) pregnant women. BKV excretion was more common in pregnant than non-pregnant women (41.3% vs. 13.5%, P = 0.0026). The frequency of JCV excretion was no different in pregnant compared to non-pregnant women. The frequency and magnitude of polyomavirus shedding did not vary with gestational age. Post-partum shedding of BKV, but not JCV, rapidly decreased to undetectable levels. Pregnancy-associated BKV excretion begins early in pregnancy and terminates rapidly post-partum. Neither the frequency nor magnitude of BKV or JCV shedding increased with pregnancy progression. Further study into the host factors that regulate pregnancy-associated BKV excretion may allow identification of the host factors that predict susceptibility to BKV-associated diseases in immune compromised patients., (Copyright © 2012 Wiley Periodicals, Inc.)

Background: The Malawian government recently changed its prevention of mother-to-child transmission (PMTCT) regimen and plans to change its first-line antiretroviral therapy (ART) regimen to Tenofovir(TDF)/Lamivudine/Efavirenz as a fixed-dose combination tablet. Implementation could be challenging if baseline creatinine clearance (CrCl) screening were required to assess renal function prior to TDF therapy. Our goal is to determine predictors of CrCl<50 ml/min among HIV-infected, ART-naïve individuals., Methodology: Data on HIV-infected, ART-naïve adults screened for enrollment into 5 HIV clinical trials in Lilongwe, Malawi were combined for a pooled analysis of predictors for CrCl<50 ml/min. CrCl was derived from the Cockroft-Gault equation. Multivariable logistic regression modeled the association of age, body mass index (BMI), hemoglobin, CD4 cell count <350 cells/mm(3), gender, and pregnancy with CrCl<50 ml/min., Results: The analysis included 3508 patients with values for creatinine clearance. Most subjects were female (90.6%) with a median age of 26 years (IQR 22-29). The median CD4 cell count was 444 (IQR 298.0-561.0), and 85.2% percent of women in our study were pregnant. Few patients had CrCl<50 ml/min (n = 38, 1.1%). A BMI less than 18.5 in non-pregnant females (OR = 8.87, 95% CI = 2.45-32.09)) was associated with CrCl<50 ml/min. Hemoglobin level higher than 10 g/dL in males (OR = 0.69, 95% CI = 0.56-0.86) and non-pregnant females (OR = 0.21, 95% CI = 0.04-0.97) was protective against CrCl<50 ml/min., Discussion: Our findings indicate few patients would be excluded from a TDF-based antiretroviral regimen, suggesting baseline creatinine clearance assessment may not be necessary for implementation. However, in ART settings individuals with low BMI or anemia could potentially be at increased risk for lower CrCl.

Aim: The aim of this study was to evaluate urine microscopy, dipstick analysis and urinary symptoms in screening for urinary tract infection (UTI) in hyperemesis gravidarum (HG)., Materials and Methods:   A prospective cross-sectional study was performed on women at first hospitalization for HG. A clean-catch mid-stream urine sample from each recruit was sent for microscopy (for bacteria, leucocytes and erythrocytes), dipstick analysis (for leukocyte esterase, nitrites, protein and hemoglobin) and microbiological culture. The presence of current urinary symptoms was elicited by questionnaire. UTI is defined as at least 10(5) colony-forming units/mL of a single uropathogen on culture. Screening test parameters were analyzed against UTI., Results: UTI was diagnosed in 15/292 subjects (5.1%). Receiver-operator characteristic curve analysis of microscopic urine leucocytes revealed area under the curve=0.64, 95% confidence interval (CI) 0.5-0.79, P=0.063 and erythrocytes area under the curve=0.53, 95%CI 0.39-0.67, P=0.67 for UTI indicating the limited screening utility of these parameters. Microscopic bacteriuria (likelihood ratio [LR] 1.1, 95%CI 0.7-1.5) and urine dipstick leukocyte esterase (LR 1.4, 95%CI 1.1-1.8), nitrites (LR 2.3, 95%CI 0.3-17.2), protein (LR 1.0, 95%CI 0.7-1.6) and hemoglobin (LR 0.8, 95%CI 0.4-1.5) were not useful screening tests for UTI in HG. Elicited symptoms were also not predictive of UTI., Conclusion: Urine microscopy, dipstick analysis and urinary symptoms were not useful in screening for UTI in HG. UTI should be established by urine culture in HG before starting antibiotic treatment., (© 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.)

Background:   Pyelonephritis occurs in approximately two per cent of pregnancies and can cause significant maternal and fetal morbidity and mortality. Evidence-based guidelines recommend appropriate antibiotic therapy, urine culture for test of cure after treatment and monthly follow-up cultures until delivery., Aims:   To evaluate adherence to guidelines for the management of antepartum pyelonephritis within an Australian obstetric population and to assess associations with noncompliance., Methods:   A retrospective study was performed for the 103 pregnant women admitted with pyelonephritis between January 2001 and December 2009 at the Royal Brisbane and Women's Hospital, a tertiary referral obstetric hospital. We assessed baseline characteristics, the frequency of appropriate treatment and follow-up, and any associations among these., Results:   The guideline recommended antibiotic treatment was prescribed in 90.3% of women. Of the women with antibiotic-resistant organisms, 31.6% had their antibiotics changed appropriately. The test of cure urine culture was performed in only 35.0% of women after treatment completion. Inadequate long-term follow-up occurred in 60.2% of the cohort studied. Inappropriate follow-up was associated with low socioeconomic status (P=0.04), unemployment (P=0.04) and the absence of a test of cure urine culture (P=0.001)., Conclusion:   The empiric treatment of antepartum pyelonephritis is generally appropriate; however, antibiotic changes for bacterial resistance are inadequate. Test of cure and monthly follow-up urine cultures are infrequently performed despite their recommendation in published treatment guidelines., (© 2011 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology © 2011 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Objective: To compare the rates of Chlamydia trachomatis detection using urine and cervical secretions from pregnant women at our institution., Methods: A large cross-sectional sample of pregnant women (N=2,018) at 35-37 weeks of gestation were tested for C trachomatis with both endocervical and urine sampling using the Aptima Combo 2 Assay., Results: A prevalence of 4.3% and 4.1% were found for Chlamydia endocervical and urine samples, respectively. There was no difference between the two tests by McNemar's test (-0.02%, 0.32%; P=.083). There was excellent correlation between the tests found by the κ statistic (0.982 [0.961-1.000])., Conclusion: Urine sampling for C trachomatis is equivalent to endocervical sampling in pregnancy using the Aptima 2 Combo Assay., Level of Evidence: II.

The aim of the study was to determine the prevalence of vaginal group B streptococcus (GBS) colonization in pregnant women from Osijek area, the possible effect of GBS colonization on pregnancy outcome and neonatal complications and the role of intrapartum prophylaxis in this context. This retrospective case-control study took place at the Department of Gynecology and Obstetrics, Osijek University Hospital Center from December 2003 to June 2006. A total of 118 pregnant women was enrolled in study and divided into two groups: 59 women in 35th-37th week of gestation, free from risk factors for infection (control group); and 59 women in 25th-41st week of gestation with risk factors for infection. Low vaginal swab for GBS isolation and identification on selective and enriched medium was obtained from each woman. GBS colonization was recorded in 29 (24.6%) women: 12 (20.3%) control and 17 (28.8%) women at risk of infection, yielding a statistically non-significant difference (Chi2 = 1.480489; p < 0.48). Early neonatal infection was observed in six (20.7%) neonates born to 29 mothers with GBS colonization, pointing to a correlation between vaginal GBS colonization and early neonatal infection (r(s) = 0.99). Early perinatal infection was found in 22 (18.6%) neonates, including 17 (28.8%) pregnancies with risk factors, pointing to a significant correlation between vaginal GBS colonization, risk factors and early perinatal infection (Chi2 = 88.68; p < 0.001); however, gestational age and pregnancy outcome were not influenced by GBS colonization. In eight (36.4%) newborns, early neonatal infection developed in spite of intrapartum administration of antibiotics; three of these children were born to GBS positive mothers, and perinatal GBS infection was demonstrated in one (0.84%) child. Study results revealed a relatively high rate of GBS colonization in the population of pregnant women in Croatia, occasionally leading to early neonatal infection. Large studies are needed to develop national strategy for the prevention of GBS infection in Croatia.

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.

Background: urinary tract infection is a common problem during pregnancy. Asymptomatic bacteriuria can cause the development of serious complications affecting both the mother and foetus. Urine culture, the traditional screening test is relatively expensive, time consuming and requires a microbiology laboratory and trained staff. However simpler, less expensive tests which include urine multistix and urine gramstain better suited for developing countries are available., Objective: to determine the sensitivity, specificity and predictive values of multistix nitrite, leucocyte esterase (LE) and urine gram staining for asymptomatic bacteriuria in pregnancy., Methods: A cross-sectional study was carried out from 1st July to 31st October 2007, at the University of Ilorin Teaching Hospital (UITH) on 125 consenting asymptomatic pregnant women. A structured proforma was used to collect information from the women and a midstream urine specimen collected in two sterile bottles. One was tested with Multistix® for the presence of nitrite and leucocyte esterase and the other for bacteriological culture and urine gram stain., Results: using the gold standard of urine culture, the sensitivities of Multistix® nitrite and leucocyte esterase were each 14% and the specificity 100% and 96% respectively. Urine gram stain had a sensitivity of 98% and a specificity of 74.7%., Conclusion: multistix® nitrite and leucocyte esterase are not sufficiently sensitive to be used as a screening tool for asymptomatic bacteriuria. Urine gram stain can be used in areas where facilities are inadequate for culture but cannot replace it. More studies are required to determine the accuracy of urine gram-stain.

Purpose of Review: Asymptomatic bacteriuria (ASB) in pregnancy, if left undiagnosed and appropriately treated can lead to acute pyelonephritis in mothers and low birth weight in infants. Urine culture is the gold standard for diagnosing ASB. Unfortunately, urine culture is limitedly available. The present review aims at evaluating performance of various screening tests and effectiveness of antibiotic regimens for ASB., Recent Findings: Positive dipslide test is very likely to have a definitive diagnosis of ASB, whereas a negative result effectively rules out ASB. Available evidences regarding the performance of urine dipstick are still conflicting, it is currently not appropriate to recommend urine dipstick for screening ASB in pregnancy. Choice of antibiotics should be guided by antimicrobial susceptibility testing whenever possible. Nitrofurantoin seems to be antibiotic of choice for ASB in pregnancy. Seven-day regimen of antibiotics gives a better microbiological cure rate but no difference in important clinical outcomes compared with 1-day regimen., Summary: Dipslide culture is a promising screening test for ASB. Pregnant women with ASB should be treated with 7-day regimen of antibiotics, although 1-day regimen might be appropriate in some settings. More research is needed for identifying appropriate screening tests for ASB.

Background: Genital Chlamydia trachomatis infection is a worldwide public health burden. A screening program for C. trachomatis was therefore initiated by the public health insurers in Germany ("Gemeinsamer Bundesausschuss", GBA) in April 2008., Objectives: To estimate C. trachomatis prevalence from screening 115,766 asymptomatic females and 20,033 female patients with unspecific abdominal pain., Study Design: Urine samples (pooled by five for the asymptomatic screening subjects) and cervical swabs were analyzed using semi-automated real-time PCR. Infection prevalence was determined separately in four categories of women, defined by health status (asymptomatic screening vs. non-screening with unspecified symptoms) and test material used. Comparative analyses were stratified by age and pregnancy status., Results: Experimental evaluation of the assay used revealed a detection limit of 379 genome copies/ml urine. For pooled urine samples, the positive predictive value was 100% whereas the negative predictive value equaled 98.1%. The observed infection prevalence was higher for cervical swabs than for urine samples. Prevalence estimates also differed significantly between pregnant and non-pregnant adolescents (< or = 20 years), irrespective of the test material used (10.2% vs. 7.3% for cervical swabs, 10.9% vs. 6.1% for pooled urine samples)., Conclusions: Our retrospective study, based upon a very large number of females from all parts of Germany, revealed a high infection prevalence in adolescents, particularly in pregnant adolescents, thereby justifying the screening directive of the German GBA., (Copyright 2009 Elsevier B.V. All rights reserved.)

Objective: To evaluate the effectiveness of systematic investigation for Group B Streptococcus (GBS) in urine samples to detect colonization in pregnant women., Methods: This study included 1036 pregnant women whose urine samples were cultured in our laboratory during 2006. Any colony consistent with GBS was identified in urine or in rectovaginal samples submitted for screening of GBS colonization., Results: GBS was recovered in urine samples from 111 of the 1036 women (10.7%), and in 77 of them bacterial count was <10(4) colony forming units/mL. Screening for GBS in rectovaginal samples was performed in 841 of the 925 pregnant women who did not have GBS bacteriuria (10.1% positive results) and in 61 of the 111 with GBS bacteriuria (60.7% positive results; no significant differences were found when results were stratified by colony count). Estimated rectovaginal colonization was 15.4%, and colonization exclusively detected in urine was 4.2%. Only 30% of pregnant women with GBS bacteriuria, but negative antenatal screening cultures who were admitted to our hospital for delivery received intrapartum antibiotic prophylaxis., Conclusions: Systematic investigation of the presence of GBS in urine samples from pregnant women improves the detection of carriers who are candidates for receiving intrapartum prophylaxis to prevent perinatal GBS infection, when compared with rectovaginal screening culture in the last trimester of gestation alone.

Anatomic and physiological alterations during pregnancy predispose pregnant women to urinary tract infections (UTI). This study aimed to identify the accuracy of the simple urine test for UTI diagnosis in low-risk pregnant women. Diagnostic test performance was conducted in Botucatu, SP, involving 230 pregnant women, between 2006 and 2008. Results showed 10% UTI prevalence. Sensitivity, specificity and accuracy of the simple urine test were 95.6%, 63.3% and 66.5%, respectively, in relation to UTI diagnoses. The analysis of positive (PPV) and negative (NPV) predictive values showed that, when a regular simple urine test was performed, the chance of UTI occurrence was small (NPV 99.2%). In view of an altered result for such a test, the possibility of UTI existence was small (PPV 22.4%). It was concluded that the accuracy of the simple urine test as a diagnostic means for UTI was low, and that performing a urine culture is essential for appropriate diagnosis.

Objective: The present study was aimed to test the association between asymptomatic bacteriuria during pregnancy, among patients in whom antibiotic treatment was recommended, and perinatal outcome. Our study was also designed to characterize common bacteria and risk factors associated with asymptomatic bacteriuria during pregnancy., Methods: A retrospective population-based study comparing all singleton pregnancies of women with and asymptomatic bacteriuria was conducted. Patients with urinary tract infection were excluded from the analysis. Multiple logistic regression model was used to control for confounders., Results: Out of 199,093 deliveries, 2.5% (n = 4890) were in patients with asymptomatic bacteriuria. E. coli was the most common pathogen associated with asymptomatic bacteriuria, representing 78.6% of the cultures with specified growth. Patients with asymptomatic bacteriuria were more likely to deliver preterm (PTD, 13.3%vs. 7.6%, odd ratio (OR) = 1.9, 95% confidence interval CI 1.7-2.0; P < 0.001) and deliver low birth-weight neonates (<2500 g, 13.3%vs. 7.9%, OR = 1.8; 95% CI 1.6-2.0; P < 0.001). Asymptomatic bacteriuria was independently associated with PTD (adjusted OR = 1.6; 95% CI 1.5-1.7; P < 0.001), fertility treatments, hypertensive disorders, recurrent abortions, diabetes mellitus, intrauterine growth restriction, polyhydramnion and oligohydramnion, premature rupture of membranes and labour induction, in a multivariable analysis with backwards elimination. Perinatal mortality rates (1.5%vs. 1.4%; P = 0.707) as well as low 5 min Apgar scores (0.8%vs. 0.6%; P = 0.065) were comparable between the groups., Conclusion: Asymptomatic bacteriuria is an independent risk factor for preterm delivery.

Background: Pregnancies in spinal cord-injured (SCI) patients present unique clinical challenges. Because of the neurogenic bladder and the use of intermittent catheterization, chronic bacteriuria and recurrent urinary tract infection (UTI) is common. During pregnancy the prevalence of UTI increases dramatically. Recurrent UTI requires multiple courses of antibiotics and increases the risks of abortion, prematurity, and low birth weight. A weekly oral cyclic antibiotic (WOCA) program was recently described for the prevention of UTI in SCI patients., Objective: To test the impact of WOCA in six SCI pregnant women (four paraplegic, two tetraplegic)., Design: This was a prospective observational study. WOCA consists of the alternate administration of one of two antibiotics once per week., Results: We observed a significant reduction of UTI (6 UTI/patient/year before pregnancy to 0.4 during pregnancy and under WOCA; p<0.001) and no obstetric complications. Infant outcomes were good., Conclusion: The WOCA regimen could be useful for UTI prophylaxis in SCI pregnant women.