Urinary Tract Infection in Pregnant Women Attending Antenatal Clinic of Tikur Anbessa Specialized Hospital
No Thumbnail Available
Date
2005-06
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Addis Ababa Universty
Abstract
Urinary tract infection (UTI) is a common complication of pregnancy. In the majority of the
patients, infection appears to be confined to thc lower urinary tract. It may be asymptomatic
(asymptomatic bacteriuria), or symptomatic (acute cystitis). All pregnant women, therefore,
should have their urine cultured at t heir first visit tot he clinic. T he aim 0 f this study w as to
detelmine the prevalence of UTI in pregnant women attending antenatal clinic of T ASH, Addis
Ababa, Ethiopia, and to analyze the antimicrobial susceptibility pattern of bacterial uropathogens.
A cross-sectional study was conducted on urine specimens collccted from pregnant women
attending antenatal clinic of T ASH. Four hundred fourteen pregnant women comprising
asymptomatic pregnant women (n=369) and symptomatic prcgnant women (n=4S) were
investigated for urinary tract infection from January to March 200S. The age ranges of both
groups were 18-44 years, with mean age of 27.1 and 2S.1 years in asymptomatic group and in
symptomatic group respectively. Bacteriological screening of mid-stream urine specimen
revealed that 3 91}69 (10.6%) and 9/45 (20%) had significant bacteriuria in asymptomatic and
symptomatic group, respectively. Thc difference was not statistically significant (p>0.05). The
overall prevalence 0 furinary tract infection was 4 8/414 (11.6%). Symptoms did 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 1 functional abnollllalities of
urinary tract had no significant association with the prevalence of urinary tract infection during
pregnancy. Using urinc 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 9S.6% in overall subjects. The bacterial pathogens isolated were
predominantly E. coli 22 (44%), followed by S. aurells 10 (20%), coagulase-negative
staphylococci 8 (16%), and K. plleulJlolliae 4 (8%). Others found in small numbers included
Envil1ia spp., P. lJIirabilis, P. aemgillosa, A. baulJlallllllii, Ellterococcus spp., and non-Group A
B-hemolytic streptococcus accounting for (2%), each. T he l' ates 0 f susceptibility 0 ft 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 (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, morc than 55% of the isolates were sensitive to
kanamycin (60%), trimethoprim + sulphamethoxazole (65%), chloramphenicol (70%),
erythromycin (80%), gentamicin (85%), cephalothin (95%), amoxicillin + clavulanic 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 + clavulanic acid, gentamicin, kanamycin, and nitrofurantoin
were the effective drugs in at least 70% of the isolates. There was also high resistance of the
isolates to a mpicillin. A bout 3 7/50 (74%) 0 f t hc isolated pathogens 0 r I 8/30 ( 60%) 0 f G ramnegatives
and 19120 (95%) of the Gram-positivcs showed resistance to two or more antimicrobial
agents. In the present study, there was a relatively higher prevalence of UTI 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 casc
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 pattems of pathogens causing urinary tract infection in the pregnant women.
Keywords: Urinary tract infection, pregnancy, bacteriuria, prevalence, b acterialu ropathogens,
antimicrobial sllsceptibility pattern
Description
Keywords
Urinary tract infection, Pregnancy, Bacteriuria, Prevalence, Bacterial Uropathogens, Antimicrobial sllsceptibility pattern