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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.
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.