





































CAJGH_Template


 

 

New articles in this journal are licensed under a Creative Commons Attribution 4.0 United States License. 

 

 

This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

 

 

 

 

 

 
 

 

 

 

Asymptomatic Bacteriuria in 

Pregnant Women in Outpatient 

Facilities 

 

Maral G. Nogayeva & Svetlana A. 

Tuleutayeva 

 

Asfendiyarov Kazakh National Medical 
University, Almaty, Kazakhstan 

 

 

 

Vol. 4, No. 1 (2015)   |   ISSN 2166-7403 (online)    

DOI 10.5195/cajgh.2015.53   |   http://cajgh.pitt.edu 

http://www.library.pitt.edu/
http://www.pitt.edu/
http://www.library.pitt.edu/articles/digpubtype/index.html
http://www.upress.pitt.edu/upressIndex.aspx
http://creativecommons.org/licenses/by/3.0/us/


 

 

NOGAYEVA 

 

 

This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 

This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 4, No. 1 (2015)  |  ISSN 2166-7403 (online)  |  DOI 10.5195/cajgh.2015.53  |  http://cajgh.pitt.edu 

 

 

Abstract 

Urinary tract morbidity has increased by 7% in Kazakhstan between 2007 to 2011. Pregnant women with extragenital pathologies 

or kidney diseases had the greatest prevalence of morbidity. Asymptomatic bacteriuria (AB) is one of the most important risk 

factors of pyelonephritis development in pregnant women, and it can affect the course and outcome of pregnancy, delivery, and 

postnatal period. AB prevention requires prevention of pregnancy complications including early diagnostic of urinary tract 

infections, timely optimization of therapy at outpatient facilities, and dynamic follow-up. 

Keywords: asymptomatic bacteriuria, pregnancy, antibiotic resistance, prevention 

 

Asymptomatic Bactreriuria in 

Pregnant Women at Outpatient 

Facility  
 

Maral G. Nogayeva & Svetlana A. 

Tuleutayeva  
 
Asfendiyarov Kazakh National Medical 
University, Almaty, Kazakhstan 

Short Report 

Extragenital pathology in pregnant women 

remains one of the most urgent issues in health care. 

Previous research has indicated that urinary system 

infections are identified only in 15 to 30 % of all cases.1 

One particular risk factor associated with an increase of 

urinary system infections and related complications is 

asymptomatic bacteriuria (AB). AB is an important risk 

factor in the development of pyelonephritis in pregnant 

women. AB means that a certain amount of bacteria is 

identified in properly collected urine samples taken from 

those who have no signs or symptoms of urinary system 

diseases in two consecutive tests taken within an interval 

of 1 to 2 weeks.2,3 Even when no clinically significant 

pyelonephritis is observed, AB may result in pre-term 

delivery, development of anemia in pregnant women, 

preeclampsia, low weight of newborn child, or fetal 

intrauterine retardation.2,4,5 

Although there are numerous complications 

associated with AB, little attention is paid to AB and 

latent pyelonephritis in pregnant women. Delayed 

diagnostics and inadequate treatment of pyelonephritis 

and AB can result in chronic kidney disease, and over 

time, in chronic renal insufficiency.6,7 The aim of this 

study was to examine the diagnosis and treatment of AB 

in pregnant women in city polyclinic no. 5 (CP 5). 

 

Methods 

Medical examination was performed on 140 

pregnant women between 19 and 42 years of age. These 

women were patients of the prenatal clinic of CP 5 in the 

Almaly District, Almaty, Kazakhstan. Informed consent 

was obtained from all participants. 

The following tests were performed for all 

pregnant women: general medical examination, full 

blood count, general urine test, urine test by 

Nechiporenko method, bacterioscopic and urine culture 

test, antibiotics sensitivity of urinary microflora 

(performed at INVIVO® Laboratory), biochemical blood 

assay for total protein, sugar, ALT, AST, cholesterol, 

creatinine, urea, blood coagulability, and ultrasound 

http://www.library.pitt.edu/
http://www.pitt.edu/
http://www.library.pitt.edu/articles/digpubtype/index.html
http://www.upress.pitt.edu/upressIndex.aspx


 

 

CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 

 

 

This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 

This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 4, No. 1 (2015)  |  ISSN 2166-7403 (online)  |  DOI 10.5195/cajgh.2015.53  |  http://cajgh.pitt.edu 

  

 

examination of kidneys using ALOKA 1400 unit.  

Urinary infection was treated to ensure both effective 

eradication of the causative agent of the specific diseases 

and safety of the fetus. AB was treated based on 

gestational period, causative agent, and antibiotic 

sensitivity. Safety of the treatment was evaluated 

according to side effects, allergic reactions, and 

individual intolerance. Fetal ultrasound was performed 

before and after treatment. Evaluation of the 

effectiveness of therapy was evaluated at the beginning 

of therapy, 10 days post-therapy, and 30 days post-

therapy. Bacteriological test results were evaluated 

during each visit on the following criteria: recovery 

(sterile urine culture or bacteria in the urine at a 

concentration of less than 10 ³ CFU / ml); persistence of 

infection (detection of the same pathogen in the urine at 

10 ³ CFU / ml or more); and reinfection (detection in the 

urine of a new species of bacteria at 10 ³ CFU / ml or 

more during any visit). 

 

Results 

The average age of the 140 participants was 33.2 

± 2.53 years. All participants with AB were classified by 

gestation periods: first trimester – 74 women (52.8%), 

second trimester – 62 (44.3%), and third trimester – 4 

(2.9%). 

During the reporting period, there was an 

overall slight decrease in the number of diagnosed 

urinary tract diseases among pregnant women at CP 5; 

however, in 2010, the proportion of women with the 

disease went up to 29.5% compared to 24% in 2008-

2009. These can be further seen in Figure 1. 

 

Figure 1: Number of diagnosed urinary tract diseases 

among pregnant women from the Urinary System 

Diseases at CP5 prenatal clinic of Almaty from 2008 to 

2011 

 

Bacteriuria (≥105 cfu/ml) was detected in 

38.5% of participants, and AB prevailed in the first 

trimester of pregnancy at a rate of 52.8%. Ultrasound 

examination of the kidneys identified a dilatation of the 

renal collecting system in 69 (49.3%) women and 

hydronephrotic transformation in 25 (17.9%) pregnant 

women with AB. 88% of participants with AB had 

asiderotic anemia of slight and medium degree. 2% had 

arterial hypertension, exhibited as general faintness, 

headaches, and dizziness, 27.8% had history of 

pyelonephritis, and 20.7% had previously diagnosed 

cystitis. 

Tests for various types of urinary microflora and 

antibiotic sensitivity of the isolated microflora revealed 

optionally anaerobic commensal flora with prevalence of 

Еscherichia coli and Streptococcus faecalis, which can 

be further explored in Figure 2. In all cases, the isolated 

microflora was resistant to more than one antibiotic, 

specifically Amoxiccillin; however, it was sensitive to 

Cephalosporins and Fluoroquinolones. 

 

Figure 2. Frequency of urinary bacterial microflora 

 

A complex therapy included antibacterial drugs 

(Cefuroxime, 750 mg, twice a day, 5 days), urinary 

antiseptics (Furazidin, 1 tablet, 4 times a day),  vitamin 

and mineral supplements (depending on gestation 

period), and antiplatelet medication (Dipiridamol, 25 mg, 

2 pills 4 times a day). Alternative therapy using third 

generation Cephalosporin was performed in 2 women 

against urinary pathology strains resistant to Cefuroxime. 

In women with AB, high resistance of microorganisms, 

and allergies, an alternative method of treatment was 

combined with herbal supplement Canefron N, (2 pills or 

50 droplets, three times a day during a month). 

As a result of the treatment, all pregnant women 

reported improvement of health, decrease of general 

weakness, and weight loss in 12 women (8.5%) for 14-

http://www.library.pitt.edu/
http://www.pitt.edu/
http://www.library.pitt.edu/articles/digpubtype/index.html
http://www.upress.pitt.edu/upressIndex.aspx


 

 

NOGAYEVA 

 

This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 

This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 4, No. 1 (2015)  |  ISSN 2166-7403 (online)  |  DOI 10.5195/cajgh.2015.53  |  http://cajgh.pitt.edu 

 

 

17 days at 2-3 kg, due to the reduction or disappearance 

of edema. Recurrence of the treated bacteriuria and 

preeclampsia in our study was not observed. 

 

Discussion  

According to annual reports of the Ministry of 

Health, overall urinary disease morbidity rate in 

population of Kazakhstan increased by 7 % from 2007 to 

2011,8 which indicates the need for awareness as the 

majority of the cases are asymptomatic.  

AB mainly prevails in the first trimester of 

pregnancy, which also confirmed the presence of chronic 

diseases in the urinary system before pregnancy. The 

main risk factors for the high prevalence of AB in the 

outpatient setting are cystitis and pyelonephritis in 

previous medical history,1,6 which should be also given 

special attention in family planning process. According 

to ultrasound examination of the kidneys, dilatation of 

the renal collecting system is a risk factor in renal 

inflammation, which means that the inflammatory 

process was prolonged. This can cause adverse events for 

the mother and fetus. Еscherichia coli was the primary 

cause in most cases which are resistant to Amoxiclav. 

According to medical scientific sources, Citobacterkoseri 

is sensitive to such antibacterial drugs as Nifuroxazid and 

Levofloxacin, which are contraindicated for pregnant 

women. In our study, pregnant women took 

Cefalosporins, which are hardly active against this 

microorganism; however, they were combined with 

Canefron, which gave such positive outcome as 

elimination of causative agent.  

Therapeutic tactics of treatment of pregnant 

women with AB includes timely complex treatment, 

control of sterility of urine at each visit to the doctor for 

the purpose of testing urine sterility in every trimester of 

pregnancy to prevent any complications in mothers and 

fetuses, and testing of the male partner for concealed 

bacteriospermia.  

 

References  

1. Delzell JE, Lefevre ML. Urinary tract infections during 

pregnancy. Am Fam Physician. 2000;61(3):713-720. 

2. Colgan R, Nicolle LE, McGlone A, Hooton TM. 

Asymptomatic bacteriuria in adults. Am Fam Physician. 

2006;74(6):985-990. 

3. Mires G, Williams F, Howie P. Randomised controlled trial 

of cardiotocography versus Doppler auscultation of fetal heart at 

admission in labour in low risk obstetric population. BMJ. 

2001;322(7300):1457-1460. 

4. Graham JC, Leathart JBS, Keegan SJ, Pearson J, Bint A, 

Gally DL. Analysis of Escherichia coli strains causing bacteriuria 

during pregnancy: Selection for strains that do not express Type 

1 Fimbriae. Infect Immun. 2001;69(2):794-799. 

5. Davison JM. Renal disorders in pregnancy. Curr Opin 

Obstet Gynecol. 2001;13(2):109-114. 

6. Wing DA, Fassett MJ, Getahun D. Acute pyelonephritis in 

pregnancy: An 18-year retrospective analysis. Am J Obstet 

Gynecol. 2014;210(3):e1-e6. 

7. Tomilina NA, Bikbov BT. Epidemiology of chronic renal 

failure. New approaches to classification and assessment of 

severity of chronic progressive renal diseases. Ter Arkh. 

2005;77(6):87-92. 

8. Republic of Kazakhstan Ministry of Health. Public health in 

the Republic of Kazakhstan, and activities of healthcare 

organizations in 2009, 2010. Astana: Republic of Kazakhstan 

Ministry of Health;2011. 

 

  

http://www.library.pitt.edu/
http://www.pitt.edu/
http://www.library.pitt.edu/articles/digpubtype/index.html
http://www.upress.pitt.edu/upressIndex.aspx


 

 

CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 

 

 

This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 

This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 4, No. 1 (2015)  |  ISSN 2166-7403 (online)  |  DOI 10.5195/cajgh.2015.53  |  http://cajgh.pitt.edu 

  

 

 

Figure 1: Number of diagnosed urinary tract diseases among pregnant women from the 

Urinary System Diseases at CP5 prenatal clinic of Almaty from 2008 to 2011 

 

  

1770 1718 1651 1578

426 413 487

345

0

500

1,000

1,500

2,000

2,500

2008 2009 2010 2011

Number of pregnant women with urinary tract diseases

Number of pregnant women observed during reporting period

http://www.library.pitt.edu/
http://www.pitt.edu/
http://www.library.pitt.edu/articles/digpubtype/index.html
http://www.upress.pitt.edu/upressIndex.aspx


 

 

NOGAYEVA 

 

This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 

This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 4, No. 1 (2015)  |  ISSN 2166-7403 (online)  |  DOI 10.5195/cajgh.2015.53  |  http://cajgh.pitt.edu 

 

 

Figure 2. Frequency of urinary bacterial microflora 

 

 

 

57%

23%

5%

6%
4% 5% Еscherichia coli

Streptococcus faecalis

Staphylococcus epidermidis

Citrobacterkoseri

Streptococcus haemolyticus

Enterococcus faecalis

http://www.library.pitt.edu/
http://www.pitt.edu/
http://www.library.pitt.edu/articles/digpubtype/index.html
http://www.upress.pitt.edu/upressIndex.aspx

