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BMC Pregnancy Childbirth. 2019 Dec 31;20(1):1. doi: 10.1186/s12884-019-2665-0.

Urinary tract infections in pregnancy in a rural population of Bangladesh: population-based prevalence, risk factors, etiology, and antibiotic resistance.

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Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
Department of Microbiology and Immunology, University of Mississippi Medical Center (UMMC), 2500 N State St, Jackson, MS, 39216, USA.
Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
North South University, Plot #15, Block #B, Bashundhara R/A, Dhaka, 1229, Bangladesh.
Bill and Melinda Gates Foundation, 440 5th Avenue North, Seattle, WA, 98109, USA.
Save the Children Bangladesh, House No. CWN (A) 35, Road No. 43 Gulshan 2, Dhaka, 1212, Bangladesh.
Institute of Epidemiology Disease Control and Research, Mohakhali, Dhaka, 1212, Bangladesh.
Projahnmo Research Foundation, House: 37, Road:27, Block: A, Banani, Dhaka, 1213, Bangladesh.
School of Community Health and Policy, Morgan State University, Baltimore, MD, 21251, USA.
Department of Microbiology, Dhaka Shishu Hospital, Sher-E-Banglanagar, Child Health Research Foundation, Dhaka, 1207, Bangladesh.



Urinary tract infection (UTI) in pregnancy, including asymptomatic bacteriuria, is associated with maternal morbidity and adverse pregnancy outcomes, including preterm birth and low birthweight. In low-middle income countries (LMICs), the capacity for screening and treatment of UTIs is limited. The objective of this study was to describe the population-based prevalence, risk factors, etiology and antimicrobial resistance patterns of UTIs in pregnancy in Bangladesh.


In a community-based cohort in Sylhet district, Bangladesh, urine specimens were collected at the household level in 4242 pregnant women (< 20 weeks gestation) for culture and antibiotic susceptibility testing. Basic descriptive analysis was performed, as well as logistic regression to calculate adjusted odds ratios (aOR) for UTI risk factors.


The prevalence of UTI was 8.9% (4.4% symptomatic UTI, 4.5% asymptomatic bacteriuria). Risk factors for UTI in this population included maternal undernutrition (mid-upper arm circumference <23 cm: aOR= 1.29, 95% CI: 1.03-1.61), primiparity (aOR= 1.45, 95% CI: 1.15-1.84), and low paternal education (no education: aOR= 1.56, 95% CI: 1.09-2.22). The predominant uro-pathogens were E. coli (38% of isolates), Klebsiella (12%), and staphyloccocal species (23%). Group B streptococcus accounted for 5.3% of uro-pathogens. Rates of antibiotic resistance were high, with only two-thirds of E. coli susceptible to 3rd generation cephalosporins.


In Sylhet, Bangladesh, one in 11 women had a UTI in pregnancy, and approximately half of cases were asymptomatic. There is a need for low-cost and accurate methods for UTI screening in pregnancy and efforts to address increasing rates of antibiotic resistance in LMIC.


Antimicrobial resistance; Asymptomatic bacteriuria; Bangladesh; Maternal morbidity; Pregnancy; Risk factors; Urinary tract infection

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