Asymptomatic bacteriuria during pregnancy with special reference to group B streptococci

Area of Science:

• Urology
• Obstetrics
• Microbiology

Background:

• Asymptomatic bacteriuria (AB) in pregnancy is linked to adverse outcomes.
• Significant bacteriuria (SB) is typically diagnosed via urine culture.

Purpose of the Study:

• To investigate the correlation between significant bacteriuria (SB) and actual bacterial presence in the urinary bladder of asymptomatic pregnant women.
• To evaluate the diagnostic accuracy of SB for true asymptomatic bacteriuria (AB).

Main Methods:

• Recruited asymptomatic pregnant women with significant bacteriuria (SB) (≥10^5 CFU/ml in two voided urine samples).
• Performed bladder puncture to directly detect bacteria in the urinary bladder.
• Identified bacterial species and serotypes from both urine and bladder aspirates.

Main Results:

• Bacteria were found in the bladder in 70% of women with SB.
• Escherichia coli, Klebsiella pneumoniae, and Staphylococcus saprophyticus SB accurately predicted bladder bacteriuria.
• Group B streptococci (GBS), Streptococcus faecalis, and Staphylococcus epidermidis SB had poor predictive value for bladder bacteriuria.
• Serotype III GBS was common in GBS-associated SB.
• One infant developed early-onset sepsis from a mother with GBS SB without detectable bladder bacteria.

Conclusions:

• The poor predictive value of SB for certain bacteria (GBS, S. faecalis, S. epidermidis) necessitates bladder puncture for accurate AB diagnosis in pregnant women.
• SB with GBS, even without confirmed bladder bacteriuria, poses a risk to the infant.
• Bladder puncture is essential for diagnosing true asymptomatic bacteriuria and guiding appropriate management during pregnancy.