妊娠无症状菌尿筛查的最佳时机：第一孕期与第二孕期。

Optimal timing to screen for asymptomatic bacteriuria during pregnancy: first vs. second trimester.

机构信息

University Hospital of Brussels, Brussels, Belgium.

Interfaculty Center Data Processing and Statistics, University of Brussels, Brussels, Belgium.

出版信息

J Perinat Med. 2021 Jan 13;49(5):539-545. doi: 10.1515/jpm-2020-0322. Print 2021 Jun 25.

DOI:10.1515/jpm-2020-0322

PMID:33554579

Abstract

OBJECTIVES

Although current guidelines advice to screen for asymptomatic bacteriuria during pregnancy, little is known about the best moment of testing. The goal of this study is to analyze the optimal timing (first vs. second trimester) to screen for asymptomatic bacteriuria during pregnancy.

METHODS

A retrospective cohort analysis, comparing patients that were screened for asymptomatic bacteriuria in the first vs. second trimester was performed. The main question was to compare the rate of positive urinary culture in both trimesters. Study included patients all followed a prenatal consultation at the University Hospital of Brussels between 2012 and 2017. Other outcomes considered were the nature of identified germs, treatments, possible risk and confounding factors (age, BMI, gravidity-parity-abortus [GPA], type of conception, ethnicity, education, prior urinary tract infection (UTI), diabetes, hypertension, prior preterm delivery and sickle cell disease) and complications (UTI, preterm delivery, preterm rupture of the membranes and chorio-amnionitis).

RESULTS

A total of 2,005 consecutive files were reviewed, 655 concerned patients screened during the first trimester group and 1,350 in the second trimester group. Asymptomatic bacteriuria was present in only 71 cases (3.54%), 23 in the first trimester group (3.50%) and 48 in the second trimester group (3.55%). was the most frequently identified germ (37 cases (1.8%), 14 in the first trimester group and 23 in the second trimester group). Our logistic regression analysis shows no statistical difference according to the moment the urinary culture was done for the presence of asymptomatic bacteriuria ( or others), for its association with hospitalization for pyelonephritis, preterm contractions, preterm pre-labor rupture of the membranes (PPROM) and/or preterm delivery.

CONCLUSIONS

If recommendations remain to screen for asymptomatic bacteriuria at least once during pregnancy, this study indicates that the moment of testing (first vs. second trimester) has no clinical impact on obstetrical outcomes.

摘要

目的

尽管目前的指南建议在怀孕期间筛查无症状菌尿症，但对于最佳检测时机知之甚少。本研究旨在分析怀孕期间筛查无症状菌尿症的最佳时机（第一孕期与第二孕期）。

方法

进行了一项回顾性队列分析，比较了在第一孕期和第二孕期筛查无症状菌尿症的患者。主要问题是比较两个孕期的尿培养阳性率。研究纳入了 2012 年至 2017 年期间在布鲁塞尔大学医院进行产前咨询的所有患者。其他考虑的结局包括鉴定出的细菌的性质、治疗、可能的风险和混杂因素（年龄、BMI、孕产次数、受孕类型、种族、教育程度、既往尿路感染史、糖尿病、高血压、早产史和镰状细胞病）以及并发症（尿路感染、早产、胎膜早破和绒毛膜羊膜炎）。

结果

共回顾了 2005 份连续病历，其中 655 例患者在第一孕期组接受筛查，1350 例患者在第二孕期组接受筛查。仅 71 例（3.54%）患者存在无症状菌尿症，其中 23 例（3.50%）在第一孕期组，48 例（3.55%）在第二孕期组。大肠埃希菌是最常鉴定出的细菌（37 例（1.8%），14 例在第一孕期组，23 例在第二孕期组）。我们的逻辑回归分析显示，根据尿培养检测无症状菌尿症的时间（第一孕期与第二孕期），其存在与因肾盂肾炎住院、早产宫缩、早产胎膜早破（PPROM）和/或早产之间无统计学差异。