Infecções do trato urinário e do trato genital inferior em gestantes de baixo risco do município de Botucatu/SP
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Data
2008-07-30
Autores
Feitosa, Danielle Cristina Alves [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Alterações anatômicas e fisiológicas da gravidez predispõem gestantes a infecções do trato urinário (ITU). O não tratamento ou o tratamento inadequado dessas infecções pode levar a complicações obstétricas e neonatais, como amniorexe prematura, trabalho de parto e parto prematuros. Considerando a relevância das complicações, a possibilidade de ocorrência de bacteriúria assintomática e a demora para obtenção do resultado da urocultura, padrão-ouro para diagnóstico de ITU, muitos profissionais optam por iniciar o tratamento de ITU em gestantes, caso o exame de urina simples mostre-se alterado, mesmo na ausência de sinais clínicos inequívocos. Identificar a acurácia do exame de urina simples para diagnóstico de infecção do trato urinário em gestantes de baixo risco. Material e Método: Foi realizado estudo analítico e transversal no município de Botucatu/SP. A propedêutica de atendimento incluiu a realização do exame de urina simples e urocultura, os dados foram colhidos de outubro de 2006 a março de 2008 nos serviços de atenção básica. Resultados: Foram incluídas no estudo 230 gestantes, com mediana de idade de 25,2 anos (14 - 43), 79,2% casadas ou em união estável. A prevalência de ITU foi de 10%, sendo o microrganismo de maior freqüência a Escherichia coli (47,8%). A sensibilidade foi 95,6% e a especificidade 63,3% do exame de urina simples em relação ao diagnóstico de ITU. A acurácia foi de 66,5%. A análise dos valores preditivos positivo e negativo (VPP e VPN) mostrou que na vigência de exame de urina simples normal, a chance de haver ITU foi pequena (VPN 99,2%), frente ao resultado alterado deste exame, a probabilidade de haver ITU foi baixa (VPP 22,4%). Conclui-se que a acurácia do exame de urina simples como meio diagnóstico de infecção urinária foi baixa; alterações no exame de urina simples, mesmo na presença...
Anatomic and physiological alterations during pregnancy predispose pregnant women to urinary tract infections (UTI). Poor treatment or no treatment at all of these infections may lead to neonatal and obstetric complications like premature amniorexis, premature labor and delivery. Considering complications relevance and the possibility of asymptomatic bacteriuria occurrence and the delay from uroculture results, gold standard for UTI diagnosis, many professionals choose to begin UTI treatment in the pregnant woman, if simple urine examination is altered even in the absence of clear clinical signals. Objective: Identify simple urine examination accuracy to diagnose urinary tract infection in low risk pregnant women. Material and Methods: An analytical and transversal study was performed in Botucatu/SP. The service began with simple urine examination and uroculture, data collected from October 2006 to March 2008 in the basic health service. Results: 230 pregnant women were included in the study with an average age of 25,2 years (14 - 43), 79,2% married or under stable relationship. UTI prevalence was 10%, Escherichia coli as a more frequent organism (47, 8%). Sensitiveness was 95,6% and specificity 63,3% of simple urine examination related to UTI diagnosis. Accuracy was 66,5%. The analysis of predictive positive and negative values (PPV e NPV) showed that during a normal and simple urine examination UTI occurrence was lower (NPV 99,2%), against the altered result of this examination the likely of UTI occurrence was low (PPV 22,4%). One conclude that simple urine examination accuracy as a way of urinary infection diagnosis was low; alterations in simple urine examination, even in the presence of clinical signals do not necessarily means UTI and uroculture is extremely necessary for a right diagnosis.
Anatomic and physiological alterations during pregnancy predispose pregnant women to urinary tract infections (UTI). Poor treatment or no treatment at all of these infections may lead to neonatal and obstetric complications like premature amniorexis, premature labor and delivery. Considering complications relevance and the possibility of asymptomatic bacteriuria occurrence and the delay from uroculture results, gold standard for UTI diagnosis, many professionals choose to begin UTI treatment in the pregnant woman, if simple urine examination is altered even in the absence of clear clinical signals. Objective: Identify simple urine examination accuracy to diagnose urinary tract infection in low risk pregnant women. Material and Methods: An analytical and transversal study was performed in Botucatu/SP. The service began with simple urine examination and uroculture, data collected from October 2006 to March 2008 in the basic health service. Results: 230 pregnant women were included in the study with an average age of 25,2 years (14 - 43), 79,2% married or under stable relationship. UTI prevalence was 10%, Escherichia coli as a more frequent organism (47, 8%). Sensitiveness was 95,6% and specificity 63,3% of simple urine examination related to UTI diagnosis. Accuracy was 66,5%. The analysis of predictive positive and negative values (PPV e NPV) showed that during a normal and simple urine examination UTI occurrence was lower (NPV 99,2%), against the altered result of this examination the likely of UTI occurrence was low (PPV 22,4%). One conclude that simple urine examination accuracy as a way of urinary infection diagnosis was low; alterations in simple urine examination, even in the presence of clinical signals do not necessarily means UTI and uroculture is extremely necessary for a right diagnosis.
Descrição
Palavras-chave
Gravidez - Complicações e seqüelas - Botucatu (SP), Infecção urinária - Gestantes, Urinary infections - Pregnant women
Como citar
FEITOSA, Danielle Cristina Alves. Infecções do trato urinário e do trato genital inferior em gestantes de baixo risco do município de Botucatu/SP. 2008. 105 f. Dissertação (mestrado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2008.