Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
PLoS One. 2024 Oct 3;19(10):e0303772. doi: 10.1371/journal.pone.0303772. eCollection 2024.
Asymptomatic bacteriuria (ASB) affects 23.9% of pregnant women globally and, if left untreated, can lead to adverse fetomaternal outcomes. In Tanzania, ASB prevalence has ranged from 13% to 17% over the past decade. Yet, its impact on fetomaternal outcomes remains unexplored, hindering the development of screening strategies, antimicrobial therapies, and preventive measures for this vulnerable population.
A cross-sectional analytical study was conducted on 1,093 pregnant women admitted for delivery at Bugando Medical Center (BMC) in Mwanza, Tanzania, from July to December 2022. Socio-demographic, obstetric, and clinical data were collected from the women, along with mid-stream urine samples for analysis. Fetomaternal outcomes were assessed within 72 hours after delivery.
The median age of participants was 29 years (range: 15-45 years). ASB prevalence among pregnant women was 16.9% (185/1093), with a 95% CI of 14.6-19.3%. Risk factors for ASB included anemia (OR: 5.3; 95% CI = 3.7-8.2, p-value <0.001) and a history of antenatal care admission (OR 4.2; 95% CI = 2.9-6.1, p-value <0.001). Among all participants, 82 (7.5%), 65 (5.9%), 49 (4.5%), and 79 (7.2%) experienced pre-term labor (PTL), premature rupture of membrane (PROM), preeclampsia, and delivered newborns with low birthweight (LBW), respectively. Among the 185 patients with ASB, the respective proportions of PTL, PROM, preeclampsia, and LBW were 25.4%, 17.3%, 9.2%, and 12.4%. Multivariable logistic regression analysis revealed significant associations between ASB and PTL [OR (95% CI): 8.8 (5.5-14.5); p-value <0.001], PROM [OR (95% CI): 4.5 (2.5-8.0); p-value <0.001], and LBW [OR (95% CI): 2.0 (1.2-3.5); p-value = 0.011]. Escherichia coli (50.8%) and Klebsiella pneumoniae (14.05%) were the most common pathogens, with low resistance rates to nitrofurantoin, amoxicillin-clavulanate, and cephalosporins-antibiotics considered safe during pregnancy-ranging from 8.2% to 31.0%.
The prevalence of ASB among pregnant women in Tanzania remains high and is associated with adverse fetomaternal outcomes. Integrating routine urine culture screening for all pregnant women, irrespective of symptoms, and providing specific antimicrobial therapies during antenatal care can help prevent adverse pregnancy outcomes.
无症状菌尿症（ASB）影响全球 23.9%的孕妇，如果不治疗，可能导致母婴不良结局。在坦桑尼亚，过去十年 ASB 的患病率在 13%至 17%之间波动。然而，它对母婴结局的影响仍未得到探索，这阻碍了为这一脆弱人群制定筛查策略、抗菌治疗和预防措施。
对 2022 年 7 月至 12 月在坦桑尼亚姆万扎布甘多医疗中心（BMC）分娩的 1093 名孕妇进行了一项横断面分析性研究。从孕妇那里收集了社会人口统计学、产科和临床数据，并采集了中段尿液样本进行分析。在分娩后 72 小时内评估母婴结局。
参与者的中位年龄为 29 岁（范围：15-45 岁）。孕妇中 ASB 的患病率为 16.9%（185/1093），95%CI 为 14.6-19.3%。ASB 的危险因素包括贫血（OR：5.3；95%CI=3.7-8.2，p 值<0.001）和产前保健入院史（OR 4.2；95%CI=2.9-6.1，p 值<0.001）。在所有参与者中，分别有 82 人（7.5%）、65 人（5.9%）、49 人（4.5%）和 79 人（7.2%）经历了早产（PTL）、胎膜早破（PROM）、子痫前期和新生儿低出生体重（LBW）。在 185 名 ASB 患者中，PTL、PROM、子痫前期和 LBW 的比例分别为 25.4%、17.3%、9.2%和 12.4%。多变量逻辑回归分析显示，ASB 与 PTL [OR（95%CI）：8.8（5.5-14.5）；p 值<0.001]、PROM [OR（95%CI）：4.5（2.5-8.0）；p 值<0.001]和 LBW [OR（95%CI）：2.0（1.2-3.5）；p 值=0.011]之间存在显著关联。大肠埃希菌（50.8%）和肺炎克雷伯菌（14.05%）是最常见的病原体，对硝基呋喃妥因、阿莫西林克拉维酸和头孢菌素类抗生素的耐药率较低，这些抗生素在怀孕期间被认为是安全的，耐药率在 8.2%至 31.0%之间。
坦桑尼亚孕妇中 ASB 的患病率仍然很高，与母婴不良结局有关。对所有孕妇进行常规尿液培养筛查，无论症状如何，并在产前保健期间提供特定的抗菌治疗，可以帮助预防不良的妊娠结局。
