Bacteria Associated With Urinary Tract Infection in Pregnant Women and Their Antibiotic Susceptibility
Chapter One
OBJECTIVE OF STUDY
- The aim of this study was to determine bacterial etiology agent and evaluate their invitro susceptibility pattern to commonly used antimicrobial agents.
- To identify the bacteria Isolates
CHAPTER TWO
LITERATURE REVIEW
Urinary Tract Infection in Pregnancy causes numerous changes in the women’s body. Hormonal and mechanical Changes increase the risk of Urinary stasis and vesicoureteral reflux. These changes along with an already short urethra (approximately 3-4cm in females) and difficulty with hygiene due to a distended pregnant belly, increase the frequency of urinary tract infection (UTIS) in pregnant women (Hollowell, 2008). Indeed, Urinary Tract Infection UTIS are one of the most common bacterial infections during pregnancy.
In general, pregnant patients are considered immunocompromised UTIS hosts because of the Physiologic changes associated with pregnancy (Mazor-Dray, et al, 2009). These changes increases the risk of serious infections, complications from asymptomatic and symptomatic urinary infection even in healthy pregnant women (Whitehead, et al, 2009).
DEFINITION OF UTI
Urinary Tract Infection is defined as the presence of at least 100,000 organisms per milliliter of urine in an asymptomatic patient, or as more than 100 organisms/ml of urine with accompanying Pyuria (>7 WBCS/ml) in a symptomatic patients, a diagnosis of UTI should be supported by a positive culture for a uropathogen. UTIS are associated with risks to both the fetus and the mother, including Pyelonephritis, preterm birth, low birth weight, and increased perinatal mortality.
THE RISK FACTORS IN PREGNANT WOMEN.
ASYMPTOMATIC BACTERIA
Asymptomatic bacteriuria (ASB) is commonly defined as the presence of more than 100,000 organism/ml in 2 cosnecutive urine samples in the absence of declared symptoms. Untreated ASB is a risk factor for acute cystitis (40%) and pyelonephritis (25-30%) in pregnancy. These cases accounts for 70% of all cases of symptomatic UTI among unscreened pregnant women (Smail. 2007).
ACUTE CYSTITIS
Acute cystitis involves only the lower urinary tract. It is characterized by inflammation of the bladder due to bacterial or non bacterial causes (i.e radiation, viral). Acute cystitis develops in approximately 1% of pregnant patients, of whom 60% have a negative result on initial screening.
SIGNS AND SYMPTOMS INCLUDE:
- Hematuria
- Dysuria
- Suprapublic discomfort
- Frequency
- Urgency
These symptoms are often difficult to distinguish from those due to pregnancy itself. The acute cystitis is also complicated by upper urinary tract disease (i.e, Pyelonephritis) in 15-50% of cases (Millar and COX, 1997).
ACUTE PYLEONLENEPHRITIS
Pyelonephritis is the most common urinary tract complication in pregnant women, occurring in approximately 2% of all pregnancies.
Acute pyelonephritis is characterized by Fever, Flank pain, and tenderness in addition to significant bacteriura. Other symptoms may include:
- Vomiting
- Nausea
- Frequency
- Urgency
- Dysuria
Furthermore, women with additional risk factors (eg, Immunoosuppression, diabetes, sickle cell anaemia, neurogenic bladder, recurrent or persistent UTIS prior to pregnancy) are at an increased risk for a complicated UTI (Millar LK, et al, 1995).
VAGINAL INFECTIONS
Virginal infection can cause or mimic UTIS, which are common in women in their reproductive years, affecting 25-30% of women aged 20-45 years. Discriminating between 2, depending on the results of vaginal and urinary cultures.
MORBIDITY AND MORTALITY CONCERN.
The primary complication of bacteriuria during pregnancy is cystitis, although the primary morbidity is due to pyelonephritis, Septic shock and death have been reported. Although these outcomes are rare. Hypoxic fetal events can occur because of maternal complications of infection that lead to hypoperfusion of the placenta. (Versi, et al, 1997).
CHAPTER THREE
MATERIAL AND METHOD
SUBJECT COLLECTION
The patients is this study are pregnant women within the gestation age of first and second trimesters (1-3, 4-6 months) coming for antenatal clinic at New Era hospital, Ihunanya hospitals, Sivon medical laboratory and Simons Hospital Aba.
The population served by these hospital include a wide range of patients from all socio-economic status patients include middle income group such as school teacher, clerk, secretaries etc. as well as low income group such as petty trader, cleaners, farmers etc. over a period of 6 weeks, certain number (20) of patients were examined.
SAMPLE COLLECTION
Mid stream urine
Procedure: 20mls of mid stream urine were collected in a sterile containers and were labeled with number, Age and date immediately and transported to the laboratory for diagnosis.
CHAPTER FOUR
DISCUSSION
In this present study of the urine, proper investigation and prompt treatment are needed to prevent serious life threatening condition and morbidity due to UTI that can occur in pregnant women. The findings shows that only (10) urine specimens out of (20) pregnant women that come for antenatal clinic at Ihunanya hospital, New Era hospital Aba were tested for urinalysis, urine microscopy, etc. During the last 6 weeks from the result obtained, it was found out that in pregnant, women urinary tract infection were present in the gestation period of first second trimesters (1-3) (4-6 months). Staphaureus was the common in pregnant women Escherichia. Coli, Klebsiella. SPP. Screening of all pregnant women are very important for significant bacteriuria because (ASB) can be present in majority of pregnant women (Delzell et al 2000).
Moreover, previous clinical trails have shown that antibiotic treatment significantly reduces the risk of complications associated with UTI in pregnancy.
Furthermore, screening for treatment of asymptomatic bacteriuria during pregnancy has become a standard of care in other countries (Smaill, 2007). Also preventing the occurrence of adverse outcomes for mothers such as pyelonephritis, hypertension, premature labour as well as adverse outcome of the unborn child (Raz, 2003).
In this research, gram negative bacteria were more prevalent than gram positive bacteria (Bomberg etal,2005). Staphylococcus. aureus was the major pathogen isolated for (7) positive culture with significant bacteriuria. Staphylococcus aureus was considered uropthogenic due to a number of virulence factors specific for colonization and invasion of urinary epithelium (sheffied and Cunaingham, 2005). Escherichia. COLI, Coagulase positive and klebsiella. SPP. were the third most common bacterial isolated.
Although, the spectrum of agents causing UTI in pregnant women is relatively constant, because their antibiotic susceptibility patterns are different in different geographical locations. The current research shows high level of sensitive to first line antimicrobial drugs such as streptomycin. Most antimicrobials used to treat UTI including Ciprofloxacin can also achieve high urinary concentrations. This could imply that urinary isolates which were moderately resistant to gentamycin could be effectively treated with normal doses of antibiotics. However, some previous studies have reported that clinical cure rates may be lower among outpatient women with uncomplicated UTI treated with Gentamycin when the infected pathogen is resistant to gentamycin (Masterton and Bochsler, 1995).
CONCLUSION
The physiological changes of pregnancy predispose women to asymptomatic bacteriuria (ASB) and UTI. All pregnant women should be screened for ASB with a urine culture treated with antibiotics if the culture is positive, and then retested for cure. The goal of treatment of UTI in pregnancy is to prevent negative sequelae to the mother and fetus. For patients treated symptomatic bacteruiria (SB) UTI in pregnancy should be continued on daily prophylactic antibiotic for the duration of their pregnancy.
RECOMMENDATION
It is therefore, recommended that pregnant women should constantly attend antenatal clinic for screening and for prompt treatment of infection when detected.
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