ETIOLOGICAL STRUCTURE AND PREVALENCE OF URINARY TRACT INFECTIONS IN PREGNANT WOMEN WITH TYPE 1 DIABETES MELLITUS

Aim. To study prevalence and etiological structure of urinary tract infections (UTIs) in pregnant women with type 1 diabetes mellitus, to assess sensitivity of various methods of UTIs detection.

Materials and methods. 192 pregnant women with type 1 diabetes mellitus (DM1) were examined. The presence of a urinary infection was assessed by detection of nitrites, leukocyte esterase in general urinalysis and by bacteriological culture with the use of the classical and "DipStrik" express method.

Results. UTI has been detected in 57.3%. The frequency is as follows: asymptomatic bacteriuria (> 105 cfu /ml) (ABU) – 35.9% (n=69), acute pyelonephritis – 19.8% (n=38), acute cystitis – 1.6% (n=3). The proportion of low ABU (102-104 cfu/ ml) is 16.1% (n=31). Escherichia coli prevailed in the structure of pathogens of UTI: in ABU – 66.7%, in pyelonephritis – 78.9%. Then goes Enterococcus faecalis: in ABU – 14.5%, in pyelonephritis – 13.2%; and then Klebsiella: in ABU – 7.2%, in pyelonephritis – 5.3%. Other pathogens (Streptococcus agalactiae, Staphylococcus aureus, Proteus) were less common. Sensitivity of the nitrite test to detect UTI was 30%; sensitivity of leukocyte esterase detection for low ABU was 22.6%, for ABU – 52.2%, for pyelonephritis –71%. Sensitivity of the express method "DipStrik" with reference to classical bacteriological culture was 98%.

Conclusion. The structure of UTI in DM1 differs from that of in pregnant women without DM. In DM1 a "significant" ABU dominates over a low ABU. The share of manifest forms of UTI in DM1 is much higher than in pregnant without DM. In the structure of UTI pathogens in pregnant women with DM1 gram-positive microbes (E. faecalis, S. agalactiae and S. aureus) have a greater proportion compared with pregnant women without DM, in which more than 80% of UTI pathogens are gram-negative (E. coli, K pneumoniae and Proteus). Cultural methods still remain the gold standard of UTI detection, and especially its asymptomatic forms. Moreover, the "DipStrik" express method of bacteriological culture has sensitivity comparable to the classical culture (in our study 98 %).

type 1 diabetes mellitus, pregnancy, urinary infection, prevalence, pathogens

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