Volume 83, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



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 ( = 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. was the most commonly isolated pathogen: 87.5% (28/32) of organisms cultured. Susceptibility of to ampicillin (14%), cotrimoxazole (21%), and amoxicillin-clavulanic acid (48%) was very low. 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.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Sharma P, Thapa L, , 2007. Acute pyelonephritis in pregnancy: a retrospective study. Aust N Z J Obstet Gynaecol 47: 313315.[Crossref] [Google Scholar]
  2. Pazos Otero N, Fuentes Ricoy L, Ferrandez Perez B, Martinez Vazquez C, Martinez Poch M, Osuna Diaz JL, , 2007. Pyelonephritis and pregnancy. Our experience in a general hospital. Med Interna 24: 585587. [Google Scholar]
  3. Hill JB, Sheffield JS, McIntire DD, Wendel GD, Jr, 2005. Acute pyelonephritis in pregnancy. Obstet Gynecol 105: 1823.[Crossref] [Google Scholar]
  4. Steer P, , 2005. The epidemiology of preterm labor—a global perspective. J Perinat Med 33: 273276.[Crossref] [Google Scholar]
  5. Lawn JE, Cousens S, Zupan J, , 2005. 4 million neonatal deaths: When? Where? Why? Lancet 365: 891900.[Crossref] [Google Scholar]
  6. Smaill F, , 2007. Asymptomatic bacteriuria in pregnancy. Best Pract Res Clin Obstet Gynaecol 21: 439450.[Crossref] [Google Scholar]
  7. Calderon Jaimes E, Arredondo Garcia JL, Olvera Salinas J, Echaniz Aviles G, Conde Gonzalez C, Hernandez Nevarez P, , 1989. The prevention of urinary infection during pregnancy in patients with asymptomatic bacteriuria. Ginecol Obstet Mex 57: 9096. [Google Scholar]
  8. Grio R, Porpiglia M, Vetro E, Uligini R, Piacentino R, Mini D, Marchino GL, , 1994. Asymptomatic bacteriuria in pregnancy: a diagnostic and therapeutic approach. Panminerva Med 36: 195197. [Google Scholar]
  9. Uncu Y, Uncu G, Esmer A, Bilgel N, , 2002. Should asymptomatic bacteriuria be screened in pregnancy? Clin Exp Obstet Gynecol 29: 281285. [Google Scholar]
  10. Cheng AC, West TE, Limmathurotsakul D, Peacock SJ, , 2008. Strategies to reduce mortality from bacterial sepsis in adults in developing countries. PLoS Med 5: e175.[Crossref] [Google Scholar]
  11. Wagenlehner F, Hoyme U, Naber K, , 2006. Therapy of the acute uncomplicated urinary tract infection. Urologe 45: 429435.[Crossref] [Google Scholar]
  12. Wagenlehner FM, Naber KG, , 2003. Recurrent urinary tract infections should not be treated cavalierly. First verify the diagnosis! MMW Fortschr Med 145: 3739. [Google Scholar]
  13. Newton PN, Hampton CY, Alter-Hall K, Teerwarakulpana T, Prakongpan S, Ruangveerayuth R, White NJ, Day NP, Tudino MB, Mancuso N, Fernandez FM, , 2008. Characterization of “Yaa Chud” Medicine on the Thailand-Myanmar border: selecting for drug-resistant malaria and threatening public health. Am J Trop Med Hyg 79: 662669. [Google Scholar]
  14. Boucher M, Leduc L, Rinfret D, , 1989. The pertinence of microscopic analysis of the urine as a diagnostic test for asymptomatic bacteriuria in pregnancy. Union Med Can 118: 162166. [Google Scholar]
  15. Kutlay S, Kutlay B, Karaahmetoglu O, Ak C, Erkaya S, , 2003. Prevalence, detection and treatment of asymptomatic bacteriuria in a Turkish obstetric population. J Reprod Med 48: 627630. [Google Scholar]
  16. Bookallil M, Chalmers E, Andrew B, , 2005. Challenges in preventing pyelonephritis in pregnant women in Indigenous communities. Rural Remote Health 5: 395. [Google Scholar]
  17. Schnarr J, Smaill F, , 2008. Asymptomatic bacteriuria and symptomatic urinary tract infections in pregnancy. Eur J Clin Invest 38 (Suppl 2): 5057.[Crossref] [Google Scholar]
  18. van Nieuwkoop C, van't Wout JW, Assendelft WJ, Elzevier HW, Leyten EM, Koster T, Wattel-Louis GH, Delfos NM, Ablij HC, Kuijper EJ, Pander J, Blom JW, Spelt IC, van Dissel JT, , 2009. Treatment duration of febrile urinary tract infection (FUTIRST trial): a randomized placebo-controlled multicenter trial comparing short (7 days) antibiotic treatment with conventional treatment (14 days). BMC Infect Dis 9: 131.[Crossref] [Google Scholar]
  19. Chen LF, Chopra T, Kaye KS, , 2009. Pathogens resistant to antibacterial agents. Infect Dis Clin North Am 23: 817845.[Crossref] [Google Scholar]
  20. Angel JL, O'Brien WF, Finan MA, Morales WJ, Lake M, Knuppel RA, , 1990. Acute pyelonephritis in pregnancy: a prospective study of oral versus intravenous antibiotic therapy. Obstet Gynecol 76: 2832. [Google Scholar]
  21. Ovalle A, Martinez MA, Wolff M, Cona E, Valderrama O, Villablanca E, Lobos L, , 2000. Prospective, randomized, comparative study of the efficacy, safety and cost of cefuroxime versus cephradine in acute pyelonephritis during pregnancy. Rev Med Chil 128: 749757. [Google Scholar]
  22. Sanchez-Ramos L, McAlpine KJ, Adair CD, Kaunitz AM, Delke I, Briones DK, , 1995. Pyelonephritis in pregnancy: once-a-day ceftriaxone versus multiple doses of cefazolin. A randomized, double-blind trial. Am J Obstet Gynecol 172: 129133.[Crossref] [Google Scholar]
  23. Wing DA, Hendershott CM, Debuque L, Millar LK, , 1998. A randomized trial of three antibiotic regimens for the treatment of pyelonephritis in pregnancy. Obstet Gynecol 92: 249253. [Google Scholar]
  24. Warren JW, Abrutyn E, Hebel JR, Johnson JR, Schaeffer AJ, Stamm WE, , 1999. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA). Clin Infect Dis 29: 745758.[Crossref] [Google Scholar]
  25. Le J, Briggs GG, McKeown A, Bustillo G, , 2004. Urinary tract infections during pregnancy. Ann Pharmacother 38: 16921701.[Crossref] [Google Scholar]
  26. MacLean AB, , 2001. Urinary tract infection in pregnancy. Int J Antimicrob Agents 17: 273276.[Crossref] [Google Scholar]
  27. McGready R, Ashley EA, Wuthiekanun V, Oo Tan S, Pimanpanarak M, Jacher Viladpai-nguen S, Jesadapanpong W, Blacksell SD, Peacock SJ, Paris DH, Day NP, Singhasivanon P, White NJ, Nosten F, , 2010. Arthropod borne disease: the leading cause of fever in pregnancy on the Thai-Burmese border. PLoS Negl Trop Dis, in press. [Google Scholar]
  28. Nosten F, ter Kuile F, Maelankirri L, Decludt B, White NJ, , 1991. Malaria during pregnancy in an area of unstable endemicity. Trans R Soc Trop Med Hyg 85: 424429.[Crossref] [Google Scholar]
  29. Plewes K, Lee T, Kajeechewa L, Thwin MM, Lee SJ, Carrara VI, Nosten F, McGready R, , 2008. Low seroprevalence of HIV and syphilis in pregnant women in refugee camps on the Thai-Burma border. Int J STD AIDS 19: 833837.[Crossref] [Google Scholar]
  30. Jenkins RD, Fenn JP, Matsen JM, , 1986. Review of urine microscopy for bacteriuria. JAMA 255: 33973403.[Crossref] [Google Scholar]
  31. Clinical and Laboratory Standards Institute, 2004. Performance Standards for Antimicrobial Disk Susceptibility Tests: Approved Standard, 8th Ed. CLSI document M100-S14. Wayne, PA: Clinical and Laboratory Standards Institute. [Google Scholar]
  32. Dubowitz LM, Dubowitz V, Goldberg C, , 1970. Clinical assessment of gestational age in the newborn infant. J Pediatr 77: 110.[Crossref] [Google Scholar]
  33. Calderon Jaimes E, Arredondo Garcia JL, Olvera Salinas J, Echaniz Aviles G, Conde Gonzales C, Hernandez Nevarez P, , 1989. Acute cystourethritis during pregnancy. Ginecol Obstet Mex 57: 5763. [Google Scholar]
  34. Le Conte P, Simon N, Bourrier P, Merit JB, Lebrin P, Bonnieux J, Potel G, Baron D, , 2001. Acute pyelonephritis. Randomized multicenter double-blind study comparing ciprofloxacin with combined ciprofloxacin and tobramycin. Presse Med 30: 1115. [Google Scholar]
  35. Millar LK, Wing DA, Paul RH, Grimes DA, , 1995. Outpatient treatment of pyelonephritis in pregnancy: a randomized controlled trial. Obstet Gynecol 86: 560564.[Crossref] [Google Scholar]
  36. Wing DA, Hendershott CM, Debuque L, Millar LK, , 1999. Outpatient treatment of acute pyelonephritis in pregnancy after 24 weeks. Obstet Gynecol 94: 683688. [Google Scholar]
  37. Stelling JM, Travers K, Jones RN, Turner PJ, O'Brien TF, Levy SB, , 2005. Integrating Escherichia coli antimicrobial susceptibility data from multiple surveillance programs. Emerg Infect Dis 11: 873882.[Crossref] [Google Scholar]
  38. Kahlmeter G, , 2000. The ECO.SENS Project: a prospective, multinational, multicentre epidemiological survey of the prevalence and antimicrobial susceptibility of urinary tract pathogens—interim report. J Antimicrob Chemother 46 (Suppl 1): 1522.[Crossref] [Google Scholar]
  39. Kahlmeter G, Menday P, , 2003. Cross-resistance and associated resistance in 2478 Escherichia coli isolates from the Pan-European ECO.SENS Project surveying the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections. J Antimicrob Chemother 52: 128131.[Crossref] [Google Scholar]
  40. Farrell DJ, Morrissey I, De Rubeis D, Robbins M, Felmingham D, , 2003. A UK multicentre study of the antimicrobial susceptibility of bacterial pathogens causing urinary tract infection. J Infect 46: 94100.[Crossref] [Google Scholar]
  41. Sahm DF, Thornsberry C, Mayfield DC, Jones ME, Karlowsky JA, , 2001. Multidrug-resistant urinary tract isolates of Escherichia coli: prevalence and patient demographics in the United States in 2000. Antimicrob Agents Chemother 45: 14021406.[Crossref] [Google Scholar]
  42. Biedenbach DJ, Johnson DM, Jones RN, , 1999. In vitro evaluation of cefepime and other broad-spectrum beta-lactams in eight medical centers in Thailand. The Thailand Antimicrobial Resistance Study Group. Diagn Microbiol Infect Dis 35: 325331.[Crossref] [Google Scholar]
  43. Suankratay C, Jutivorakool K, Jirajariyavej S, , 2008. A prospective study of ceftriaxone treatment in acute pyelonephritis caused by extended-spectrum beta-lactamase-producing bacteria. J Med Assoc Thai 91: 11721181. [Google Scholar]
  44. Hawser SP, Bouchillon SK, Hoban DJ, Badal RE, Hsueh PR, Paterson DL, , 2009. Emergence of high levels of extended-spectrum-beta-lactamase-producing gram-negative bacilli in the Asia-Pacific region: data from the Study for Monitoring Antimicrobial Resistance Trends (SMART) program, 2007. Antimicrob Agents Chemother 53: 32803284.[Crossref] [Google Scholar]
  45. Shears P, , 2007. Poverty and infection in the developing world: healthcare-related infections and infection control in the tropics. J Hosp Infect 67: 217224.[Crossref] [Google Scholar]
  46. Ingsathit A, Thakkinstian A, Chaiprasert A, Sangthawan P, Gojaseni P, Kiattisunthorn K, Ongaiyooth L, Vanavanan S, Sirivongs D, Thirakhupt P, Mittal B, Singh AK, , Thai-SEEK Group, 2010. Prevalence and risk factors of chronic kidney disease in the Thai adult population: Thai SEEK study. Nephrol Dial Transplant 25: 15671575.[Crossref] [Google Scholar]
  47. Ellis RD, Fukuda MM, McDaniel P, Welch K, Nisalak A, Murray CK, Gray MR, Uthaimongkol N, Buathong N, Sriwichai S, Phasuk R, Yingyuen K, Mathavarat C, Miller RS, , 2006. Causes of fever in adults on the Thai-Myanmar border. Am J Trop Med Hyg 74: 108113. [Google Scholar]
  48. Wing DA, , 2001. Pyelonephritis in pregnancy: treatment options for optimal outcomes. Drugs 61: 20872096.[Crossref] [Google Scholar]
  49. Deville WL, Yzermans JC, van Duijn NP, Bezemer PD, van der Windt DA, Bouter LM, , 2004. The urine dipstick test useful to rule out infections. A meta-analysis of the accuracy. BMC Urol 4: 4.[Crossref] [Google Scholar]
  50. D'Souza Z, D'Souza D, , 2004. Urinary tract infection during pregnancy–dipstick urinalysis vs. culture and sensitivity. J Obstet Gynaecol 24: 2224.[Crossref] [Google Scholar]
  51. Pollock HM, , 1983. Laboratory techniques for detection of urinary tract infection and assessment of value. Am J Med 75: 7984.[Crossref] [Google Scholar]
  52. Lumbiganon P, Laopaiboon M, Thinkhamrop J, , 2010. Screening and treating asymptomatic bacteriuria in pregnancy. Curr Opin Obstet Gynecol 22: 9599.[Crossref] [Google Scholar]
  53. Bothamley G, , 2001. Drug treatment for tuberculosis during pregnancy: safety considerations. Drug Saf 24: 553565.[Crossref] [Google Scholar]
  54. Cassina M, Fabris L, Okolicsanyi L, Gervasi MT, Memmo A, Tiboni GM, Di Gianantonio E, Clementi M, , 2009. Therapy of inflammatory bowel diseases in pregnancy and lactation. Expert Opin Drug Saf 8: 695707.[Crossref] [Google Scholar]
  55. Lumbiganon P, Villar J, Laopaiboon M, Widmer M, Thinkhamrop J, Carroli G, Duc Vy N, Mignini L, Festin M, Prasertcharoensuk W, Limpongsanurak S, Liabsuetrakul T, Sirivatanapa P, , 2009. One-day compared with 7-day nitrofurantoin for asymptomatic bacteriuria in pregnancy: a randomized controlled trial. Obstet Gynecol 113: 339345.[Crossref] [Google Scholar]
  56. Whalley P, , 1967. Bacteriuria of pregnancy. Am J Obstet Gynecol 97: 723738.[Crossref] [Google Scholar]
  57. McGready R, Tan SO, Ashley EA, Pimanpanarak M, Viladpai-Nguen J, Phaiphun L, Wustefeld K, Barends M, Laochan N, Keereecharoen L, Lindegardh N, Singhasivanon P, White NJ, Nosten F, , 2008. A randomised controlled trial of artemether-lumefantrine versus artesunate for uncomplicated Plasmodium falciparum treatment in pregnancy. PLoS Med 5: e253.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 09 Jun 2010
  • Accepted : 01 Aug 2010
  • Published online : 06 Dec 2010

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error