بررسی شیوع باکتریوری بدون علامت در زنان باردار مبتلا به دیابت حاملگی و سالم شهر اصفهان

نوع مقاله : Original Article(s)

نویسندگان

1 دانشیار، گروه زنان و زایمان، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 دانشیار، گروه باکتری شناسی و ویروس شناسی،دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 پزشک عمومی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

4 پزشک عمومی، معاونت درمان، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: باکتریوری بدون علامت یکی از مشکلات شایع بارداری است. هدف از این مطالعه، بررسی شیوع باکتریوری بدون علامت در زنان باردار سالم و مبتلا به دیابت حاملگی مراجعه کننده به مرکز پزشکی شهید بهشتی اصفهان بود.روش‌ها: این مطالعه‌ی موردی- شاهدی بر روی زنان باردار 40-16 ساله انجام گردید. زنان باردار در طی مراقبت‌های بارداری از نظر دیابت حاملگی بررسی و در دو گروه مبتلا به دیابت حاملگی و سالم از نظر باکتریوری بدون علامت مقایسه شدند. دیابت حاملگی با استفاده از آزمون تحمل گلوکز بررسی گردید. نمونه‌های ادرار صبحگاهی ناشتا به صورت نمونه‌ی میانه‌ی ادرار استریل تهیه و از لحاظ آزمایش‌های کامل ادرار و کشت بررسی شد.یافته‌ها: در طی این مطالعه، 172 زن باردار در هر گروه مورد بررسی قرار گرفتند. شیوع باکتریوری بدون علامت در زنان باردار سالم و مبتلا به دیابت حاملگی به ترتیب 4/24 و 3/27 درصد بود (05/0 < P). شیوع باکتریوری بدون علامت در زنان باردار سالم در گروه‌های سنی پایین‌تر، بیشتر بود ولی در زنان باردار مبتلا به دیابت حاملگی تفاوت معنی‌داری وجود نداشت. بین بروز باکتریوری بدون علامت و سابقه‌ی عفونت‌های ادراری رابطه‌ای وجود نداشت. اشرشیاکولی شایع‌ترین عامل ایجاد بیماری در 2/76 و 2/70 درصد در زنان باردار سالم و مبتلا به دیابت حاملگی بود.نتیجه‌گیری: باکتریوری بدون علامت، مشکل شایعی در جامعه‌ی ما تلقی می‌گردد و گر چه شیوع این بیماری در زنان باردار مبتلا به دیابت حاملگی تفاوتی با زنان باردار سالم نداشت ولی با توجه به شیوع بالای بیماری، جهت پیش‌گیری از عوارض آن، غربالگری زنان باردار با کشت ادرار پیشنهاد می‌گردد.

کلیدواژه‌ها

عنوان مقاله [English]

The Prevalence of Asymptomatic Bacteruria in Pregnant Women with and without Gestational Diabetes

نویسندگان [English]

  • Azar Danesh Shahraki 1
  • Ebtehaj Pishva 2
  • Sahar Mirbaha 3
  • Alireza Arabzadeh 4
1 Associate Professor, Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Associate Professor, Department of Bacteriology and Virology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3 General Practitioner, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
4 General Practitioner, Vice Chancellor of Treatment, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Asymptomatic bacteriuria is common in pregnant women. The aim of this study was to determine the prevalence of asymptomatic bacteruria in pregnant women with and without gestational diabetes.Methods: In this case-control study, pregnant women aged 16-40 years attended to Shahid Beheshti hospital in Isfahan were studied and the prevalence of asymptomatic bacteruria was compared in pregnant women with and without gestational diabetes. They were screened for gestational diabetes mellitus, using glucose challenge test. Asymptomatic bacteruria was determined using microscopic examination and culture of a clean midstream voided urine specimen.Finding: 172 pregnant women were enrolled in each group. The prevalence of asymptomatic bacteruria was 27.3% and 24.4% in pregnant women with and without gestational diabetes (P > 0.05). The rate of asymptomatic bacteruria was higher in lower age group in non diabetic patients, but it was not different significantly in pregnant women with gestational diabetes. There was not significant relationship between history of urinary tract infection and asymptomatic bacteruria (P > 0.05).The most common cause of asymptomatic bacteruria was E.Coli in both groups (76.2% in non diabetic and 70.2% in pregnant women with gestational diabetes).Conclusion: Asymptomatic bacteriuria considered as a major health problem in this region and though its prevalence was not higher in diabetic pregnant women than non diabetic ones but considering its high prevalence, screening for asymptomatic bacteruria during pregnancy seems to be essential.

کلیدواژه‌ها [English]

  • Asymptomatic bacteruria
  • Gestational diabetes
  • Pregnancy
  • Isfahan

مراجع

  1. Schnarr J, Smaill F. Asymptomatic bacteriuria and symptomatic urinary tract infections in pregnancy. Eur J Clin Invest 2008; 38(Suppl 2): 50-57.
  2. Saidi A, Delaporte V, Lechevallier E. [Urological problems encountered during pregnancy]. Prog Urol 2005; 15(1): 1-5.
  3. Tugrul S, Oral O, Kumru P, Kose D, Alkan A, Yildirim G. Evaluation and importance of asymptomatic bacteriuria in pregnancy. Clin Exp Obstet Gynecol 2005; 32(4): 237-40.
  4. Delzell JE, Jr., Lefevre ML. Urinary tract infections during pregnancy. Am Fam Physician 2000; 61(3): 713-21.
  5. McIsaac W, Carroll JC, Biringer A, Bernstein P, Lyons E, Low DE, et al. Screening for asymptomatic bacteriuria in pregnancy. J Obstet Gynaecol Can 2005; 27(1): 20-4.
  6. Gant NF, Leveno KJ, Gilstrop LC, Hauth GC, Wenstrom KD. Williams obstetrics. 21th ed. New York: McGraw-Hill; 2001. p. 1125-31.
  7. Haney AF, Key HH. Urinary tract infection. In: Danforth D, Scott J, Gibbs R, Karlan B, edi-tors. Danforth's obstetric and Gynocology. Philadelphia: Lippincott Williams & Wilkins; 2003. p. 335-65.
  8. Bodly L, Bailey Jr. Urinary tract infection. In: Tailor R, editor. Family medicine. New York; 2003. p. 807-813.
  9. Zhanel GG, Harding GK, Nicolle LE. Asymptomatic bacteriuria in patients with diabetes mellitus. Rev Infect Dis 1991; 13(1): 150-4.
  10. Patterson JE, Andriole VT. Bacterial urinary tract infections in diabetes. Infect Dis Clin North Am 1997; 11(3): 735-50.
  11. McMahon MJ, Ananth CV, Liston RM. Gesta-tional diabetes mellitus. Risk factors, obstetric complications and infant outcomes. J Reprod Med 1998; 43(4): 372-8.
  12. Cousins L. Pregnancy complications among diabetic women: review 1965-1985. Obstet Gynecol Surv 1987; 42(3): 140-9.
  13. MacLean AB. Urinary tract infection in pregnancy. Br J Urol 1997; 80 Suppl 1: 10-3.
  14. Pedler SJ, Bint AJ. Management of bacteriuria in pregnancy. Drugs 1987; 33(4): 413-21.
  15. Rizk DE, Mustafa N, Thomas L. The prevalence of urinary tract infections in patients with gestational diabetes mellitus. Int Urogynecol J Pelvic Floor Dysfunct 2001; 12(5): 317-21.
  16. Tadesse A, Negash M, Ketema LS. Asymtomatic bacteriuria in pregnancy: asses-ment of prevlence, microbial agents and ther antimicrobial sensitivty pattern in Gondar Teaching Hospital, north west Ethiopia. Ethiop Med J 2007; 45(2): 143-9.
  17. Akinloye O, Ogbolu DO, Akinloye OM, Terry Alli OA. Asymptomatic bacteriuria of pregnancy in Ibadan, Nigeria: a re-assessment. Br J Biomed Sci 2006; 63(3): 109-12.
  18. Alavi Naini R, Sharifi-Mood B, Metanat M. The prevalence of asymptomatic bacteriuria and drug resistance in pregnant women referred to Zahedan Ghods. Journal of Midwifery and Women's infertility in Iran 1994; 6(1): 58-63.
  19. Enayat K, Fariba F, Bahram N. Asymptomatic bacteriuria among pregnant women referred to outpatient clinics in Sanandaj, Iran. Int Braz J Urol 2008; 34(6): 699-707.
  20. Hazhir S. Asymptomatic bacteriuria in preg-nant women. Urol J 2007; 4(1): 24-7.
  21. Mobasheri L, Tabarae A, Ghaemi A, Moujerlu M, Vakili A, Dastforoshan M, et al. The preva-lence of asymptomatic bacteriuria in pregnant women referred to the Educational Center of Gorgan stream. Journal of Gorgan University of Medical Sciences 2003; 4(9): 42-6.
  22. Ghaffar Nejad M, Shams M. Study of asymptomatic bacteriuria in pregnant women attending prenatal care clinics small Mirza Khan in 1996. Tehran University Medical Journal 1999; 58(2): 76-9.
  23. Russell MA, Carpenter MW, Coustan DR. Screening and diagnosis of gestational di-abetes mellitus. Clin Obstet Gynecol 2007; 50(4):
  24. -58.
  25. Gunningham FG, Levono KJ, Bloom SL. Uri-nary tract disorder. In: Gunningham FG, GantNF, Williams JW, editors. William's obstetrics. New York: McGrow Hill; 2005. p. 1095-6.
  26. Clinical and Laboratory Standard Institute. Performance Standards for Antimicrobial Disk Susceptibility Tests. Int Braz J Urol 2005; 40: 634-54.
  27. Stanton SL, Dwyer PL. Urinary tract infection in female. 1st ed. London: Marlin Duntize; 2000. p. 340.
  28. Edwin GHB, Aarti JR. Effect of maternal UTI on the fetus and neonat. In: Cherry SH, Merkatz IR, editors. Complication of pregnancy: Medical, Surgical, Gnecologic, Psychosocial, and perinatal. Baltimore: Williams and Wilkins; 1991. p. 1182-4.
  29. Ellen AH. Renal disease UTI preconception care for women with medical disease. In: Cherry SH, Merkatz IR, editors. Complication of pregnancy: Medical, Surgical, Gnecologic, Psychosocial, and perinatal. Baltimore: Williams and Wilkins; 1991. p. 35-8.
  30. Kincaid-Smith P. Bacteriuria and urinary infection in pregnancy. Clin Obstet Gynecol 1968; 11(2): 533-49.
  31. Munzon OT. Bacteriuria during pregnancy. Am J Obstet and Genecology 1993; 85: 511-3.
  32. Nicolle LE. Asymptomatic bacteriuria: when to screen and when to treat. Infect Dis Clin North Am 2003; 17(2): 367-94.
  33. Kovavisarach E, Vichaipruck M, Kanjaraha-reutai S. Risk factors related to asymptomatic bacteriuria in pregnant women. J Med Assoc Thai 2009; 92(5): 606-10.
  34. Shirazi MH, Ranjbar R, Daneshyar A, Sadeghian S, Sadeghi N. Etiology and antimicrobial resistance of urinary tract infections in asymptomatic pregnant women attending health centers affiliated to the University of Medical Sciences. Journal of Tropical and Infectious Diseases 2007; 12(36): 53-8.
  35. Kasraeian M, Asadi N, Ghaffarpasand F. Prevalence of asymptomatic bacteriuria among pregnant women in Shiraz, Iran. Saudi Med J 2009; 30: 917-20.
  36. Turpin C, Minkah B, Danso K, Frimpong E. Asymptomatic bacteriuria in pregnant women attending antenatal clinic at komfo anokye teaching hospital, kumasi, ghana. Ghana Med J 2007; 41(1): 26-9.
  37. Schieve LA, Handler A, Hershow R, Persky V, Davis F. Urinary tract infection during pregnancy: its association with maternal morbidity and perinatal outcome. Am J Public Health 1994; 84(3): 405-10.
  38. Brauner A, Flodin U, Hylander B, Ostenson CG. Bacteriuria, bacterial virulence and host factors in diabetic patients. Diabet Med 1993; 10(6): 550-4.
  39. Lye WC, Chan RKT, Lee EJC, Kumarasinghe G. Urinary tract infection in patients with diabetes mellitus. Journal Infect 1992; 24(2): 169-74.
  40. O'sullivan DJ, Fitzgerald MG, Mey-Nell MJ, Malins JM. Urinary tract infection. A comparative study in the diabetic and general populations. Br Med J 1961; 1(5228): 786-8.
  41. Golan A, Wexler S, Amit A, Gordon D, David MP. Asymptomatic bacteriuria in normal and high-risk pregnancy. Eur J Obstet Gynecol Re-prod Biol 1989; 33(2): 101-8.
  42. Farajzadegan Z, Mirmoghtadaee P, Mehrabian F. Comparative study of the cost - effectiveness analysis of urine culture method for screening asymptomatic bacteriuria in pregnant women. Journal of Isfahan Medical School 2007; 89(26): 119-6.
مجله دانشکده پزشکی اصفهان
دوره 28، شماره 118 - شماره پیاپی 118
بهمن و اسفند 1389
صفحه 1214-1222

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سابقه مقاله

  • تاریخ دریافت: 17 بهمن 1389
  • تاریخ بازنگری: 08 اردیبهشت 1403
  • تاریخ پذیرش: 17 فروردین 1401

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