Screening for bacteriuria by culture of voided midstream urine was done in 6803 puerperal women; significant growth was found in 8.1%. The urine was recollected by suprapubic aspiration and bacteriuria was confirmed in 52%, corresponding to an incidence of bladder bacteriuria of 3.7%. A history of past urinary tract infection, bacteriuria in pregnancy, operative delivery, epidural anesthesia, and bladder catheterization increased the risk of postpartum urinary tract infection. Only 21% of the women complained of dysuria; this symptom occurred significantly more often after operative delivery and in patients with previous urinary tract infection. Two hundred fifty-one women with bladder bacteriuria were subjected to different treatments by randomized allocation: 153 patients with amoxicillin-susceptible bacterias were selected for amoxicillin treatment of 1, 3, and 10 days' duration. The cure rates were 84%, 94%, and 98%, respectively; the single-dose therapy was significantly less effective than 10 days' treatment (p less than 0.05). Forty-six women with amoxicillin-resistant bacterial infections received cephalexin or nitrofurantoin therapy of 7 days' duration; the cure rate was 91%. Fifty-two women served as control subjects and received no treatment. Ten weeks later 27% still had persistent bacteriuria in their suprapubic aspiration control specimens. All therapeutic regimens except the single-dose method showed a cure rate that was significantly higher than the spontaneous cure rate (p less than 0.05). Multiparity seemed to be a predisposing factor for persistence of bacteriuria. The study indicates that puerperal patients with positive midstream urine specimens should not be automatically treated, but more thoroughly examined. In cases of confirmed bladder bacteriuria, treatment should be recommended; 3 days' therapy appears to be sufficient.

译文

在6803名产褥期妇女中通过排尿中尿培养筛查细菌尿; 在8.1% 中发现显着生长。通过耻骨上抽吸重新收集尿液,并在52% 中确认了细菌尿,这与3.7% 的膀胱细菌尿的发生率相对应。既往尿路感染史,妊娠期细菌尿,手术分娩,硬膜外麻醉和膀胱导管插入术增加了产后尿路感染的风险。只有21% 的女性抱怨排尿困难; 这种症状在手术分娩后和先前患有尿路感染的患者中明显更频繁地发生。通过随机分配对101名患有膀胱菌尿的妇女进行了不同的治疗: 选择了153名对阿莫西林敏感的细菌的患者进行为期1、3和10天的阿莫西林治疗。治愈率分别为84% 、94% 和98%; 单剂量治疗的效果明显低于10天治疗 (p <0.05)。46名患有阿莫西林耐药细菌感染的妇女接受了7天的头孢氨苄或呋喃妥因治疗; 治愈率为91%。52名妇女作为对照受试者,未接受任何治疗。十周后,27% 的耻骨上抽吸对照标本中仍有持续的细菌尿。除单剂量方法外,所有治疗方案均显示治愈率显着高于自发治愈率 (p小于0.05)。多胎次似乎是细菌尿持续存在的诱因。研究表明,中段尿液标本阳性的产褥期患者不应自动接受治疗,而应进行更彻底的检查。对于确诊的膀胱菌尿,应推荐治疗; 3天的治疗似乎足够。

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