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Title: Urinary Tract Infection in Pregnant Women Attending Antenatal Clinic of Tikur Anbessa Specialized Hospital
???metadata.dc.contributor.*???: Dr. Daniel Asrat
Dr. Yimtubezinash Wolde Amanuel
Assefa, Addisu
Keywords: Urinary Tract Infection;Pregnancy;Bacteriuria;Prevalence;Bacterial Uropathogens;Antimicrobial Susceptibility Pattern
Issue Date: Jun-2006
Publisher: Addis Ababa University
Abstract: Urinary tract infection (UTI) is a common complication of pregnancy. In the majority of the patients, infection appears to be confined to the lower urinary tract. It may be asymptomatic (asymptomatic bacteriuria), or symptomatic (acute cystitis). All pregnant women, therefore, should h ave t heir u rine cultured a11heir first v isit t o t he c linic. T he aim o f t his s tudy w as t o determine the prevalence of UTI in pregnant women attending antenatal clinic of TASH, Addis Ababa, Ethiopia, and to analyze the antimicrobial susceptibility pattern of bacterial uropathogens. A cross-sectional study was conducted on urine specimens collected from pregnant women attending antenatal clinic of TASH. Four hundred fourteen pregnant women comprising asymptomatic pregnant women (n=369) and symptomatic pregnant women (n=45) were investigated for urinary tract infection from January to March 2005. The age ranges of both groups were 18-44 years, with mean age of 27.1 and 25.1 years in asymptomatic group and in symptomatic group respectively. Bacteriological screening of mid-stream urine specimen revealed that 3 9/369 ( 10.6%) and 9 /45 ( 20%) had significant bacteriuria in asymptomatic and symptomatic group, respectively. The difference w as not statistically significant (p>0.05). The overall prevalence o f urinary tract i nfection w as 4 8/414 ( 11.6%). S ytnptoms d id not associate with the prevalence of symptomatic urinary tract infection. Prevalence of urinary tract infection was significantly associated with past history of urinary tract and maternal educational level (p <0.05). Maternal age, marital status, family monthly income, parity, duration of pregnancy, gestational diabetes mellitus and urologic disease or structural / functional abnormalities of urinary tract had no significant association with the prevalence of urinary tract infection during pregnancy. Using urine culture as gold standard, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of pyuria in detecting urinary tract infection were 70.8%, 87.2%, 42%, and 95.6% in overall subjects. The bacterial pathogens isolated were predominantly E. coli 22 (44%), followed by S. aureus 10 (20%), coagulase-negative staphylococci 8 (16%), and K. pneumoniae 4 (8%). Others found in small numbers included Erwinia spp., P. mirabilis, P. aeruginosa, A. baumannnii, Enterococcus spp., and non-Group A B-hemolytic s treptococcus a ccounting for ( 2%), e ach. T he r ates o f s usceptibility o f t he G ramnegatives to antibacterial agents tested ranged from 30-93.3%. Among the Gram-negative more than 65% of the isolates were sensitive to amoxicillin + clavulanic acid (70%), trimethoprim + sulphamethoxazole (73.3%), chloramphenicol (83.3%), nitrofurantoin (87.7%), gentamicin u(93.3%), and kanamycin (93.3%). Gram-negative bacteria showed a high rate of resistance to ampicillin, and cephalothin (70%), each. The rates of susceptibility of Gram-positives ranged from 20-100%. Among the Gram-positives, more than 55% of the isolates were sensitive to kanamycin (60%), trimethoprim + sulphamethoxazole (65%), chloramphenicol (70%), erythromycin (80%), gentamicin (85%), cephalothin (95%), amoxicillin + clavuianic acid (100%), and nitrofurantoin (100%). They, however, showed high rate of resistance to kanamycin (40%), penicillin (75%), and ampicillin (80%). Generally, chloramphenicol, trimethoprim + sulphamethoxazole, amoxicillin + clavuianic acid, gentamicin, kanamycin, and nitrofurantoin were the effective drags in at least 70% of the isolates. There was also high resistance of the isolates to ampicillin. About 37/50 ( 74%) o f the isolated pathogens or 1 8/30 ( 60%) of Gramnegatives and 19/20 (95%) of the Gram-positives showed resistance to two or more antimicrobial agents. In the present study, there was a relatively higher prevalence of UT1 during pregnancy than previous report in Ethiopia. According to the theoretically 20-40% progression of untreated asymptomatic bacteriuria to symptomatic urinary tract infection, the progression in this study could be 2.1%- 4.2%. For diagnosis of urinary tract infection during pregnancy especially in case where culture is unavailable, a combination of microscopic urinalysis of significant pyuria and bacteriuria, and other available tests should be practiced than using a single test. Continuous study on a larger scale is recommended in the future in order to monitor any changes in the sensitivity patterns of pathogens causing urinary tract infection in the pregnant women.
Description: A Thesis Submitted To Graduate Studies Program, Addis Ababa University In Partial Fulfillment Of The Requirement For The Degree Of Masters Of Science In Applied Microbiology
Appears in Collections:Thesis- Microbial, Cellular and Molecular Biology

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