Urinary tract infections in pregnancy: Evaluation of diagnostic framework

Abstract

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.

Pregnancy associated Urinary Tract Infection: Prevalence and Screening

“…This is in contrast to our study. In our study urinary leucocyte detection has been an ideal screening method for detecting pregnancy associated UTI, which has already been quoted by Jido TA (18) in a similar study in Nigeria. The number of positive cases by the detection of leucocyte was 215 of 219, accounting for 98%.…”

Gram-Positive Uropathogens, Polymicrobial Urinary Tract Infection, and the Emerging Microbiota of the Urinary Tract

“…In some clinical settings such as with infants, leukocyte esterase (LE) and pyuria (by dipstick analysis) have a very high sensitivity and specificity for UTI (>90% as defined by the culture of a uropathogen from urine with >100,000 colony forming units (CFU) per ml) [2, 3]. However, in contexts such as pregnancy, dipstick analysis using LE, pyuria, or presence of nitrites is less reliable as an indication of UTI per the microbiological definition of 10 5 CFU/ml cutoff [4, 5]. While dipstick urinalysis that is positive for LE and/or nitrites in a clean-catch urine sample is consistent with a UTI diagnosis, these tests can miss UTIs that meet the gold standard of bacteriuria diagnosis in relation to adverse outcomes in pregnancy (e.g.…”

Diagnostic accuracy of dipsticks test among clinically suspected urinary tract infected patients at National Hospital, Tanzania

“…Children especially female and pregnant women contribute to about 80% of all urinary tract infections UTIs [3]. Early detection and treatment of UTIs is recommended and may help to reduce the incidences and its associated complications [4]. On other hand, inaccurate diagnosis of UTIs exposes patient to a wrong and unnecessary treatment [3,5].…”

“…http://dx.doi.org/10.17352/ojb.000009 high skilled/experienced personnel and may take up to 72 hours to establish the diagnosis [3]. In resource-limited settings the most practical and convenient method for diagnosis of UTIs is urine dipstick test, this method allows early detection of UTIs, inexpensive; require less time and expertise making it reliable and rapid diagnostic test in high-risk patients [3,4].…”