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Diagnostic and Treatment Difficulties of Pyelonephritis in Pregnancy in Resource-Limited Settings

Limited microbiology services impede adequate diagnosis and treatment of common infections such as pyelonephritis in resource-limited settings. Febrile pregnant women attending antenatal clinics at Shoklo Malaria Research Unit were offered urine dipstick, sediment microscopy, urine culture, and a 5-...

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Detalles Bibliográficos
Autores principales: McGready, Rose, Wuthiekanun, Vanaporn, Ashley, Elizabeth A., Tan, Saw Oo, Pimanpanarak, Mupawjay, Viladpai-nguen, Samuel Jacher, Jesadapanpong, Wilarat, Blacksell, Stuart D., Proux, Stephane, Day, Nicholas P., Singhasivanon, Pratap, White, Nicholas J., Nosten, François, Peacock, Sharon J.
Formato: Texto
Lenguaje:English
Publicado: The American Society of Tropical Medicine and Hygiene 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990053/
https://www.ncbi.nlm.nih.gov/pubmed/21118943
http://dx.doi.org/10.4269/ajtmh.2010.10-0332
Descripción
Sumario:Limited microbiology services impede adequate diagnosis and treatment of common infections such as pyelonephritis in resource-limited settings. Febrile pregnant women attending antenatal clinics at Shoklo Malaria Research Unit were offered urine dipstick, sediment microscopy, urine culture, and a 5-mL blood culture. The incidence of pyelonephritis was 11/1,000 deliveries (N = 53 in 4,819 pregnancies) between January 7, 2004 and May 17, 2006. Pyelonephritis accounted for 20.2% (41/203) of fever cases in pregnancy. Escherichia coli was the most commonly isolated pathogen: 87.5% (28/32) of organisms cultured. Susceptibility of E. coli to ampicillin (14%), cotrimoxazole (21%), and amoxicillin-clavulanic acid (48%) was very low. E. coli was susceptible to ceftriaxone and ciprofloxacin. The rate of extended spectrum β-lactamase (4.2%; 95% confidence interval = 0.7–19.5) was low. The rate and causes of pyelonephritis in pregnant refugee and migrant women were comparable with those described in developed countries. Diagnostic innovation in microbiology that permits affordable access is a high priority for resource-poor settings.