Abstract
Objective. The present study was aimed to test the association between asymptomatic bacteriuria during pregnancy, among
patients in whom antibiotic treatment was recommended, and perinatal outcome. Our study was also designed to
characterize common bacteria and risk factors associated with asymptomatic bacteriuria during pregnancy.
Methods. A retrospective population-based study comparing all singleton pregnancies of women with and asymptomatic
bacteriuria was conducted. Patients with urinary tract infection were excluded from the analysis. Multiple logistic regression
For personal use only.
Keywords: Asymptomatic bacteriuria, preterm delivery, low birth-weight, caesarean delivery, pregnancy
Correspondence: Eyal Sheiner, MD, PhD, Department of Obstetrics and Gynecology, Soroka University Medical Center, P.O Box 151, Beer-Sheva, Israel.
Tel: 972-8-6400774. Fax: 972-8-6275338. E-mail: sheiner@bgu.ac.il
ISSN 1476-7058 print/ISSN 1476-4954 online 2009 Informa Healthcare USA, Inc.
DOI: 10.1080/14767050802360783
424 E. Sheiner et al.
tory positive urine culture (based on the detection of deliver preterm (OR 1.9, 95% CI 1.72.0;
more than 100,000 bacteria/ml in a single voided P 5 0.001; Table II).
midstream urine), in the absence of specific symp- Obstetric risk factors complications and outcomes
toms of acute UTI [2,5,8]. National health services of patients with and without asymptomatic bacter-
in Israel provide comprehensive perinatal care for all iuria are presented in Table III. Patients with
women, and urine cultures are performed as part of asymptomatic bacteriuria had higher rates of fertility
the routine prenatal care, starting during the first treatments, hypertensive disorders, recurrent
appointment, basically around 12 weeks gestation. abortions, diabetes mellitus (either gestational or
These patients with positive urine culture were pre-gestational), IUGR, polyhydramnion and oligo-
prescribed antibiotic treatment. Data were collected hydramnion, PROM and labour induction as
from the computerised perinatal database that compared to patients without asymptomatic bacter-
consists of information recorded directly after iuria. Also, these patients had higher rates of CD,
delivery by an obstetrician. Only four skilled medical vacuum extractions and complications such as
secretaries examine the information routinely before chorioamnionitis, pyelonephritis, calculus of kidney
entering it into the database. Coding is done after
assessing the medical prenatal care records as well as
Table I. Bacterial growth in specimens of asymptomatic women
the routine hospital documents. These procedures (asymptomatic bacteriuria; n 4890).
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Perinatal mortality rate was comparable between (adjusted OR 1.6; 95% CI 1.51.7; P 5 0.001),
the groups. and accordingly with LBW (52500 g, OR 1.8;
Asymptomatic bacteriuria was independently as- 95% CI 1.62.0; P 5 0.001). Asymptomatic bacter-
sociated with PTD, fertility treatments, hypertensive iuria is linked to a wide variety of complications
disorders, recurrent abortions, diabetes mellitus, suggesting that it might be a marker for the intensity
IUGR, polyhydramnion and oligohydramnion, of prenatal care and the complications that influence
PROM and labour induction, in a multivariable that intensity.
analysis with backwards elimination (Table V). The Because asymptomatic bacteriuria, by definition,
model controlled for the year of delivery, to control is lacking any symptoms, compliance might be
for ascertainment bias. low. Unfortunately, we do not have information
Table III. Obstetric risk factors, complications and outcomes of patients with and without asymptomatic bacteriuria.
IUGR, intra-uterine growth restriction; PROM, premature rupture of membranes. Data are presented as percentages, odds ratios (OR),
95% confidence intervals (CI) and P-values for statistical significance.
Table IV. Neonatal outcome of patients with and without asymptomatic bacteriuria.
Gender
Male 51.3% 51.3%
Female 48.7% 48.7% 1.0 0.91.1 0.931
Apgar 1 min 5 7 5.1% 4.1% 1.0 0.91.1 50.001
Apgar 5 min 5 7 0.8% 0.6% 1.3 0.981.9 0.065
Birth weight (mean + SD) 3100 + 617 3190 + 544 50.001
LBW (weight 52.5 kg) 13.3% 7.9% 1.8 1.62.0 50.001
Perinatal mortality 1.5% 1.4% 1.0 0.81.3 0.707
Data are presented as percentages, odds ratios (OR), 95% confidence intervals (CI) and P-values for statistical significance.
426 E. Sheiner et al.
Table V. Multiple logistic regression model, with backward were noted between the groups regarding lower
elimination, of factors associated with asymptomatic bacteriuria. 5 min Apgar scores and perinatal mortality despite
Characteristics Odds ratio 95% CI P higher rates of PTD.
Similar to all other studies [2,5,8,14], the major
Diabetes mellitus 1.8 1.61.9 50.001 pathogen isolated from about 80% of the urine
Preterm delivery (537 week) 1.6 1.51.7 50.001
cultures was E. coli. In our study, it involved 78.6%
IUGR 1.6 1.31.5 50.001
Hypertensive disorders 1.3 1.11.6 50.001 of the cultures with specified growth. The E. coli is
Fertility treatments 1.3 2.83.1 50.001 considered uropathogenic due to a number of
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Labour induction 1.3 1.21.4 50.001 virulence factors specific for colonisation and inva-
Polyhydramnios 1.3 1.11.5 50.001 sion of the urinary epithelium, such as the P-fimbria
Oligohydramnios 1.2 1.11.4 0.023
and S-fimbria adhesions [5]. Likewise, the associa-
Recurrent abortions 1.1 1.011.3 0.046
PROM 1.1 1.011.2 0.031 tion between diabetes mellitus and asymptomatic
Year of delivery (years) 1.08 1.071.09 50.001 bacteriuria is well-established [4,15].
In conclusion, asymptomatic bacteriuria is an
IUGR, intrauterine growth restriction; PROM, premature rupture independent risk factor for preterm delivery,
of membranes; CI, confidence interval. Data are expressed as odds
ratio, 95% confidence interval and P-values for statistical
although treatment recommendation. Further pro-
significance. The initial model included placental abruption as spective studies should investigate compliance for
well. treatment of asymptomatic bacteriuria and compare
outcome of patients who were actually treated to
these with partial or no treatment. Patients should be
regarding actual treatment and compliance. Thus, consulted regarding the significance of asymptomatic
the high rates of PTD might be attributed to sub- bacteriuria to improve compliance for antimicrobial
optimal treatment. Treatment is basically given to treatment.
prevent UTI and other complications, such as
pyelonephritis [4]. Pyelonephritis is a serious Declaration of interest: The authors report no
For personal use only.
complication leading to severe morbidity, including conflicts of interest. The authors alone are respon-
multi-system derangement from endotoximia and sible for the content and writing of the paper.
sepsis [5,9,10]. A cost evaluation study reported
that screening for pyelonephritis is appropriate
when the prevalence of asymptomatic bacteriuria References
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