Department of Microbiology, Tumor and Cell Biology, Division of Clinical Microbiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda.
Clin Infect Dis. 2017 Aug 15;65(4):544-550. doi: 10.1093/cid/cix356.
Urinary tract infections (UTIs) are one of the most common bacterial infections in women. During pregnancy physiological changes, like frequency, mimic UTI symptoms, and therefore bacteriological cultures are needed to confirm the diagnosis. However, in developing countries antibiotic therapy is commonly initiated without culture confirmation.
We investigated the prevalence of bacteriuria among pregnant women with and without UTI symptoms in Uganda. In total 2 562 urine samples were evaluated with nitrite and leukocyte esterase tests, using urine culture and/or dipslide with species identification as reference.
The prevalence of culture-proven UTI among pregnant women with UTI symptoms was 4%. Since treatment is initiated based only on the presence of symptoms, 96% were erroneously given antibiotics. Further, there is a high prevalence of resistance to commonly used antibiotics, with 18 % ESBL and 36 % multidrug resistant Escherichia coli strains. Nitrite, leukocyte esterase tests, and urine microscopy alone were of poor diagnostic value. Using dipslide, gynecologists and nurses, not trained in microbiology, were mostly able to identify E. coli and negative cultures. Mixed Gram-negative flora, suggesting fecal contamination was, however, in the majority of cases interpreted as a single pathogenic bacterium and would have resulted in antibiotic treatment.
To prevent excessive use of antibiotics, dipslide possibly supported by a combination of nitrite and leukocyte esterase tests can be used. Trained frontline health care professionals correctly diagnosed E. coli UTI and negative urine cultures, which would help preventing antibiotic misuse. In addition, regular screening for antibiotic resistance would improve correct treatment.
尿路感染（UTI）是女性最常见的细菌感染之一。在怀孕期间，生理变化如尿频会模拟 UTI 症状，因此需要进行细菌培养来确诊。然而，在发展中国家，抗生素治疗通常在没有培养确认的情况下开始。
我们在乌干达调查了有和无症状孕妇的菌尿患病率。共评估了 2562 份尿液样本，使用硝酸盐和白细胞酯酶试验，以尿液培养和/或带有种属鉴定的浸片作为参考。
有 UTI 症状孕妇中经培养证实的 UTI 患病率为 4%。由于治疗仅基于症状的存在而开始，因此 96%的患者被错误地给予了抗生素。此外，常见抗生素的耐药率很高，产 ESBL 和多重耐药的大肠杆菌分别为 18%和 36%。单独使用硝酸盐、白细胞酯酶试验和尿液显微镜检查的诊断价值较低。使用浸片，未经微生物学培训的妇科医生和护士大多能够识别大肠杆菌和阴性培养物。然而，大多数情况下，混合革兰氏阴性菌群提示粪便污染被解释为单一病原体，这将导致抗生素治疗。
为了防止抗生素的过度使用，可以使用浸片，可能还需要结合硝酸盐和白细胞酯酶试验。经过培训的一线医护人员能够正确诊断大肠杆菌 UTI 和阴性尿液培养物，这有助于防止抗生素滥用。此外，定期筛查抗生素耐药性将有助于正确治疗。
