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Title: Diagnostic and treatment difficulties of pyelonephritis in pregnancy in resource-limited settings
Authors: Rose McGready
Vanaporn Wuthiekanun
Elizabeth A. Ashley
Saw Oo Tan
Mupawjay Pimanpanarak
Samuel Jacher Viladpai-nguen
Wilarat Jesadapanpong
Stuart D. Blacksell
Stephane Proux
Nicholas P. Day
Pratap Singhasivanon
Nicholas J. White
François Nosten
Sharon J. Peacock
Shoklo Malaria Research Unit
Mahidol University
Imperial College Healthcare NHS Trust
University of Cambridge
Keywords: Immunology and Microbiology;Medicine
Issue Date: 1-Dec-2010
Citation: American Journal of Tropical Medicine and Hygiene. Vol.83, No.6 (2010), 1322-1329
Abstract: 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. Copyright © 2010 by The American Society of Tropical Medicine and Hygiene.
ISSN: 00029637
Appears in Collections:Scopus 2006-2010

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