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Diagnostic and Treatment Difficulties of Pyelonephritis in Pregnancy in Resource-Limited Settings
Rose McGready
Rose McGready
Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Vaccinology and Tropical Medicine, Churchill Hospital, Oxford; Department of Microbiology, Imperial College National Health Service (NHS) Trust, London, United Kingdom; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Addenbrooke's Hospital
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Vanaporn Wuthiekanun
Vanaporn Wuthiekanun
Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Vaccinology and Tropical Medicine, Churchill Hospital, Oxford; Department of Microbiology, Imperial College National Health Service (NHS) Trust, London, United Kingdom; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Addenbrooke's Hospital
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Elizabeth A. Ashley
Elizabeth A. Ashley
Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Vaccinology and Tropical Medicine, Churchill Hospital, Oxford; Department of Microbiology, Imperial College National Health Service (NHS) Trust, London, United Kingdom; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Addenbrooke's Hospital
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Saw Oo Tan
Saw Oo Tan
Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Vaccinology and Tropical Medicine, Churchill Hospital, Oxford; Department of Microbiology, Imperial College National Health Service (NHS) Trust, London, United Kingdom; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Addenbrooke's Hospital
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Mupawjay Pimanpanarak
Mupawjay Pimanpanarak
Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Vaccinology and Tropical Medicine, Churchill Hospital, Oxford; Department of Microbiology, Imperial College National Health Service (NHS) Trust, London, United Kingdom; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Addenbrooke's Hospital
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Samuel Jacher Viladpai-nguen
Samuel Jacher Viladpai-nguen
Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Vaccinology and Tropical Medicine, Churchill Hospital, Oxford; Department of Microbiology, Imperial College National Health Service (NHS) Trust, London, United Kingdom; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Addenbrooke's Hospital
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Wilarat Jesadapanpong
Wilarat Jesadapanpong
Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Vaccinology and Tropical Medicine, Churchill Hospital, Oxford; Department of Microbiology, Imperial College National Health Service (NHS) Trust, London, United Kingdom; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Addenbrooke's Hospital
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Stuart D. Blacksell
Stuart D. Blacksell
Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Vaccinology and Tropical Medicine, Churchill Hospital, Oxford; Department of Microbiology, Imperial College National Health Service (NHS) Trust, London, United Kingdom; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Addenbrooke's Hospital
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Stephane Proux
Stephane Proux
Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Vaccinology and Tropical Medicine, Churchill Hospital, Oxford; Department of Microbiology, Imperial College National Health Service (NHS) Trust, London, United Kingdom; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Addenbrooke's Hospital
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Nicholas P. Day
Nicholas P. Day
Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Vaccinology and Tropical Medicine, Churchill Hospital, Oxford; Department of Microbiology, Imperial College National Health Service (NHS) Trust, London, United Kingdom; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Addenbrooke's Hospital
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Pratap Singhasivanon
Pratap Singhasivanon
Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Vaccinology and Tropical Medicine, Churchill Hospital, Oxford; Department of Microbiology, Imperial College National Health Service (NHS) Trust, London, United Kingdom; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Addenbrooke's Hospital
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Nicholas J. White
Nicholas J. White
Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Vaccinology and Tropical Medicine, Churchill Hospital, Oxford; Department of Microbiology, Imperial College National Health Service (NHS) Trust, London, United Kingdom; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Addenbrooke's Hospital
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François Nosten
François Nosten
Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Vaccinology and Tropical Medicine, Churchill Hospital, Oxford; Department of Microbiology, Imperial College National Health Service (NHS) Trust, London, United Kingdom; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Addenbrooke's Hospital
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Sharon J. Peacock
Sharon J. Peacock
Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Vaccinology and Tropical Medicine, Churchill Hospital, Oxford; Department of Microbiology, Imperial College National Health Service (NHS) Trust, London, United Kingdom; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Addenbrooke's Hospital
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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.
Author Notes
Financial support: This study was funded by the Wellcome Trust, which is a United Kingdom-based medical research charity and is independent from all drug companies. It has no financial links with the manufacturers of either the diagnostic tests or the drugs used in this study.
Authors' addresses: Rose McGready, Saw Oo Tan, Mupawjay Pimanpanarak, Samuel Jacher Viladpai-nguen, Stephane Proux, and François Nosten, Shoklo Malaria Research Unit (SMRU), Tak, Thailand, E-mail: SMRU@tropmedres.ac. Vanaporn Wuthiekanun, Wilarat Jesadapanpong, Stuart D. Blacksell, Nicholas P. Day, Pratap Singhasivanon, and Nicholas J. White, Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. Elizabeth A. Ashley, Department of Microbiology, Imperial College NHS Trust, London, United Kingdom. Sharon J. Peacock, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Sharma P, Thapa L, 2007. Acute pyelonephritis in pregnancy: a retrospective study. Aust N Z J Obstet Gynaecol 47: 313–315.
-
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: 585–587.
-
3.
Hill JB, Sheffield JS, McIntire DD, Wendel GD Jr, 2005. Acute pyelonephritis in pregnancy. Obstet Gynecol 105: 18–23.
-
4.
Steer P, 2005. The epidemiology of preterm labor—a global perspective. J Perinat Med 33: 273–276.
-
5.
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6.
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7.
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-
8.
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-
9.
Uncu Y, Uncu G, Esmer A, Bilgel N, 2002. Should asymptomatic bacteriuria be screened in pregnancy? Clin Exp Obstet Gynecol 29: 281–285.
-
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.
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11.
Wagenlehner F, Hoyme U, Naber K, 2006. Therapy of the acute uncomplicated urinary tract infection. Urologe 45: 429–435.
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12.
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-
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: 662–669.
-
14.
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16.
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17.
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18.
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