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Pregnancy outcome following bacteriuria in pregnancy and the significance of nitrites in urinalysis – a retrospective cohort study

Eviatar Naamany , Irit Ayalon-Dangur , Eran Hadar ORCID logo , Iftach Sagy , Dafna Yahav and Shachaf Shiber ORCID logo EMAIL logo

Abstract

Background

The association between bacteriuria and adverse pregnancy outcomes has been extensively described. The current practice of screening all pregnant women for bacteriuria is challenged by recent studies. We aimed to evaluate pregnancy outcomes among women with a positive urine culture, to assess the significance of positive urinary nitrites in this setting.

Methods

This was a retrospective cohort study at the emergency department (ED) of the Helen Schneider Hospital for Women, Israel, during 2014–2018. This included all gravida women >18 years old within the 20th week of pregnancy or above, admitted to the ED with diverse complains, who had urinalysis collected and subsequently had a positive urine culture. Clinical and obstetric characteristics were stratified by positive vs. negative nitrites in urinalysis. The primary outcome was premature delivery, and the secondary outcomes were a composite outcome of all recorded pregnancy complications and the significance of urinalysis in predicting urinary tract infection (UTI).

Results

Overall, 874 pregnant women with a positive urine culture were included. Of them, 721 (79%) patients had a negative nitrite in their urine exam (NNU-group) and 153 (21%) had a positive nitrite in their urine exam (PNU-group). Escherichia coli was the most common pathogen, with significantly higher rates of growth in the PNU-group vs. NNU-group [129 (84.3%) vs. 227 (38.4%), P < 0.001]. Premature delivery was recorded with no association of symptomaticity or nitrite status. Among symptomatic women with classic symptoms of UTI, PNU was significantly associated with decreased risk for major peripartum complications [odds ratio (OR) with 95% confidence interval (CI) of 0.22 (0.05–0.94)].

Conclusion

Our findings support that PNU among symptomatic pregnant women with UTI-related symptoms was associated with lower risk of developing major adverse obstetrical outcomes.


Corresponding author: Shachaf Shiber, MD, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and Department of Emergency Medicine, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St., Petah Tikva 49100, Israel, Tel.: +972-54-7860068
aEviatar Naamany and Irit Ayalon-Dangur contributed equally to this work.
  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005;40:1556.10.1086/427507Search in Google Scholar

2. Smaill F. Asymptomatic bacteriuria in pregnancy. Best Pract Res Clin Obstet Gynaecol 2007;2:439–50.10.1016/j.bpobgyn.2007.01.004Search in Google Scholar

3. Naeye RL. The duration of maternal cigarette smoking, fetal and placental disorders. Early Hum Dev 1979;3:229–37.10.1016/0378-3782(79)90031-8Search in Google Scholar

4. Millar LK, Cox SM. Urinary tract infections complicating pregnancy. Infect Dis Clin North Am 1997;11:13–26.10.1016/S0891-5520(05)70339-1Search in Google Scholar

5. Millar LK, DeBuque L, Wing DA. Uterine contraction frequency during treatment of pyelonephritis in pregnancy and subsequent risk of preterm birth. J Perinat Med 2003;31:41–6.10.1515/JPM.2003.006Search in Google Scholar

6. Romero R, Oyarzun E, Mazor M, Sirtori M, Hobbins JC, Bracken M. Meta-analysis of the relationship between asymptomatic bacteriuria and preterm delivery/low birth weight. Obstet Gynecol 1989;73:576–82.Search in Google Scholar

7. Smaill FM, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev 2015;8:CD000490.10.1002/14651858.CD000490.pub3Search in Google Scholar

8. Kazemier BM, Koningstein FN, Schneeberger C, Ott A, Bossuyt PM, de Miranda E, et al. Maternal and neonatal consequences of treated and untreated asymptomatic bacteriuria in pregnancy: a prospective cohort study with an embedded randomised controlled trial. Lancet Infect Dis 2015;15:1324–33.10.1016/S1473-3099(15)00070-5Search in Google Scholar

9. Angelescu K, Nussbaumer-Streit B, Sieben W, Scheibler F, Gartlehner G. Benefits and harms of screening for and treatment of asymptomatic bacteriuria in pregnancy: a systematic review. BMC Pregnancy Childbirth 2016;16:336.10.1186/s12884-016-1128-0Search in Google Scholar PubMed PubMed Central

10. Lin K, Fajardo K. Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2008;149:W20–4.10.7326/0003-4819-149-1-200807010-00009-w1Search in Google Scholar PubMed

11. Chu CM, Lowder JL. Diagnosis and treatment of urinary tract infections across age groups. Am J Obstet Gynecol 2018;219: 40–51.10.1016/j.ajog.2017.12.231Search in Google Scholar PubMed

12. Demilie T, Beyene G, Melaku S, Tsegaye W. Diagnostic accuracy of rapid urine dipstick test to predict urinary tract infection among pregnant women in Felege Hiwot Referral Hospital, Bahir Dar, North West Ethiopia. BMC Res Notes 2014;7:481.10.1186/1756-0500-7-481Search in Google Scholar PubMed PubMed Central

13. Guerra GV, de Souza AS, da Costa BF, do Nascimento FR, Amaral Mde A, Serafim AC. Urine test to diagnose urinary tract infection in high-risk pregnant women. Rev Bras Ginecol Obstet 2012;34:488–93.10.1590/S0100-72032012001100002Search in Google Scholar

14. Awonuga DO, Dada-Adegbola HO, Fawole AO, Olala FA, Onimisi-Smith HO. Asymptomatic bacteriuria among an obstetric population in Ibadan. West Afr J Med 2011;30:89–93.10.4314/njm.v19i2.56517Search in Google Scholar PubMed

15. Ajayi AB, Nwabuisi C, Aboyeji PO, Fowotade A, Fakeye OO. Reliability of urine multistix and Gram stain in the detection of asymptomatic bacteriuria in pregnancy. West Afr J Med 2010;29:339–43.Search in Google Scholar

16. Eigbefoh JO, Isabu P, Okpere E, Abebe J. The diagnostic accuracy of the rapid dipstick test to predict asymptomatic urinary tract infection of pregnancy. J Obstet Gynaecol 2008;28:490–5.10.1080/01443610802196914Search in Google Scholar PubMed

17. Schnarr J, Smaill F. Asymptomatic bacteriuria and symptomatic urinary tract infections in pregnancy. Eur J Clin Invest 2008;38(Suppl 2):50–7.10.1111/j.1365-2362.2008.02009.xSearch in Google Scholar PubMed

18. Mambatta A, Rashme V, Menon S, Jayarajan J, Harini S, Kuppusamy J. Reliability of dipstick assay in predicting urinary tract infection. J Family Med Prim Care 2015;4:265–8.10.4103/2249-4863.154672Search in Google Scholar PubMed PubMed Central

19. Devillé WL, Yzermans JC, van Duijn NP, Bezemer PD, van der Windt DA, Bouter LM. The urine dipstick test useful to rule out infections. A meta-analysis of the accuracy. BMC Urol 2004;4:4.10.1186/1471-2490-4-4Search in Google Scholar PubMed PubMed Central

20. Demilie T, Beyene G, Melaku S, Tsegaye W. Diagnostic accuracy of rapid urine dipstick test to predict urinary tract infection among pregnant women in Felege Hiwot Referral Hospital, Bahir Dar, North West Ethiopia. BMC Res Notes 2014;7:481.10.1186/1756-0500-7-481Search in Google Scholar

21. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–32.10.1016/j.ajic.2008.03.002Search in Google Scholar PubMed

22. Nitzan O, Elias M, Chazan B, Saliba W. Urinary tract infections in patients with type 2 diabetes mellitus: review of prevalence, diagnosis, and management. Diabetes Metab Syndr Obes 2015;8:129–36.10.2147/DMSO.S51792Search in Google Scholar PubMed PubMed Central

23. Schneeberger C, van den Heuvel ER, Erwich JJ, Stolk RP, VisserCE, Geerlings SE. Contamination rates of three urine-sampling methods to assess bacteriuria in pregnant women. Obstet Gynecol 2013;121(2 Pt 1):299–305.10.1097/AOG.0b013e31827e8cfeSearch in Google Scholar PubMed

24. Hooton TM, Roberts PL, Cox ME, Stapleton AE. Voided midstream urine culture and acute cystitis in premenopausal women. N Engl J Med 2013;369:1883–91.10.1056/NEJMoa1302186Search in Google Scholar PubMed PubMed Central

Received: 2018-12-23
Accepted: 2019-04-08
Published Online: 2019-05-29
Published in Print: 2019-08-27

©2019 Walter de Gruyter GmbH, Berlin/Boston

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