Antibiotic Overconsumption in Pregnant Women With Urinary Tract Symptoms in Uganda

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dc.contributor.authorSekikubo, Musa
dc.contributor.authorHedman, Karolina
dc.contributor.authorMirembe, Florence
dc.contributor.authorBrauner, Annelie
dc.date.accessioned2022-01-21T05:38:13Z
dc.date.available2022-01-21T05:38:13Z
dc.date.issued2017
dc.description.abstractUrinary 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. Methods. 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. Results. 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. Conclusions. 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.en_US
dc.identifier.citationSekikubo, M., Hedman, K., Mirembe, F., & Brauner, A. (2017). Antibiotic overconsumption in pregnant women with urinary tract symptoms in Uganda. Clinical Infectious Diseases, 65(4), 544-550. DOI: 10.1093/cid/cix356en_US
dc.identifier.other10.1093/cid/cix356
dc.identifier.urihttps://nru.uncst.go.ug/xmlui/handle/123456789/1378
dc.language.isoenen_US
dc.publisherClinical Infectious Diseasesen_US
dc.subjectUrinary tract infectionsen_US
dc.subjectE. colien_US
dc.subjectAntibioticsen_US
dc.subjectPregnant womenen_US
dc.subjectUgandaen_US
dc.titleAntibiotic Overconsumption in Pregnant Women With Urinary Tract Symptoms in Ugandaen_US
dc.typeArticleen_US
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