ABSTRACT

The aim of this study was to determine the The Bacteria Associated With Urinary Tract Infect In Pregnant Women In University Of Uyo Teaching Hospital Akwa Ibom State Nigeria. An institutional-based cross-sectional study was conducted from February 18, 2015 to March 25, 2015. Clean-catch midstream urine specimens were collected from 186 pregnant women using sterile containers.The prevalence of significant bacteriuria was 14%. Gram-negative bacteria were more prevalent (73%). Escherichia coli (34.6%), coagulase-negative staphylococci (19.2%), Pseudomonas aeruginosa (15.4%), and Klebsiella spp. (11.5%) were common bacterial isolates, where most of them were resistant against ampicillin, amoxicillin, tetracycline, trimethoprim– sulfamethoxazole, and chloramphenicol. Multidrug resistance (resistance in 2 drugs) was seen in 100% of the isolated bacteria. A majority of the bacterial isolates were sensitive to ciprofloxacin, ceftriaxone, erythromycin, and gentamicin. Therefore, the early routine detection of causative agents of UTI and determining their drug susceptibility pattern are important for pregnant women to avoid complications in mother and fetus. Ciprofloxacin, ceftriaxone, gentamicin, and erythromycin can be used with great care for the empirical treatment of UTI.

CHAPTER ONE

INTRODUCTION

Urinary Tract Infection (UTI) is a common health problem among pregnant women (Saidi et al ,2005). This usually begins in week 6 and peaks during week 22 to 24 of pregnancy due to a number of factors including ureteral dilatation, increased bladder Volume and decreased  bladder  tone.  Along with decreased  ureteral tone which contributes to increased urinary stasis and ureterovesical reflux (chaliha et al, 2002). Up to 70% of pregnant women develop glyucosuria, which encouraged bacteria growth in the urine (AI.  Issa, 2009). It may manifest as Asympromatic  bacteriuria (ASB) or symptomic Bacteriuria (SB).  The  prevalence of asymptomatic bacteriuria UTI has been previously reported to be 2% to 13% in pregnant women (Delzell et al, 2000).  Compared with that of symptomatic Bacteriuria in (UTI) which occur in 1-18% during pregnancy. Urinary tract infection (UTI) during pregnancy may cause complications such as Pyelonephritis, hypertensive disease of pregnancy, anaemia, chronic renal failure premature delivery and foetal mortality.

(Dwyer, et al 2002). The incidence of these complications can be decreased by treating promptly Asymptomatic Bacteriuria (ASB) and Symptomatic (SB) during pregnancy due to the potential adverse sequelea of Urinary tract infection in pregnancy. Most  clinic perform routine urinalysis of midstream urine specimen  during one or more antenatal clinic (ANC) visits (Smaill 2007). However, culture and antimicrobial drug susceptibility testing are needed for  surveillar purposes  to guide the clinician on the proper management and prevent empirical  treatment of pregnant women with (ASB) and  (SB).

 A limited spectrum of organisms cause UTI and these include Escherichia Coli, which accounts  for the majority of uncomplicated urinary tract infection Isolates.  (crupta, et al, 2001). Others are Staphylococcus Saprophyticus, Klebsiella  Spp, Proteus Spp, Enterococcus  Spp and Enterobacter  Spp (Massinde, , et al  2009).

Data  on the current distribution and antimicrobial Isolates from pregnant women in Tanania is limited .

Urinary tract infections refer to the presence of microbial pathogen within the urinary tract and it is  usually  classified by the infection site, bladder (Cystitis), kidney (Pyelonephritis or urine (Bacteria) and also can be a Asymptomatic or symptomatic  (UTI) that occur in a normal genitourinary tract with no prior instrumentation are considered as “Uncomplication” whereas “Complicated” Infections are diagnosed in genitourinary tracts  that have  structural or functional abnormalities Urethral catheters, and are  frequently asymptomatic  (3,4)  (kriptke, 2005).

It has been estimated    that globally symptomatic  (UTIS) result in as many as 7 millions  visits to out patient  clinic,  1 million visits to emergency departments, and 100,000 hospitalization annually (5) (chin et al 2011).

Many different microorganisms can cause  urinary  tract infection (UTIS),  though the most  common pathogens  causing the  simple ones in the community are Esherichia  Coli and other Enterobacteriacae,which accounts approximately 75% of the isolates (Kebira et al, 2009).

In complicated Urinary tract infections and hospitalized patients,  organisms  such as Enterococcuss Faecalis  and Highly resistant, gram-ve rods including Pseudomoinas Spp.  are comparatively more  common.  The relative frequency of the pathogens varies depending upon age, sex, catheterization and hospitalization.

Urinary tract infection cases is often started empirically an therapy is based on information determined from the antimicrobial resistance pattern of the urinary pathogen. However, a large proportion of uncontrolled antibiotic  usage has  contributed to the emergency of resistant bacterial Infections (7-10). As a result, the prevalence of antimicrobial resistance among urinary track has been increasing world wide. (Biadglegene. et al, 2009).

Associated resistance i.e, the fact that a bacterium resistant to one antibiotics is often much more likely to be   resistant to other antibiotics, drastically decreases the chances of getting a second empirical attempt right. Resistance rates to the most  common prescribe drugs used in the treatment of (UTI)  vary considerably  in different areas, world-wide. The estimation of local etiology and susceptibility profile could support the most effective empirical treatment. Therefore, investigating epidemiology of (UTIS), the prevalence risk factors, are bacterial isolates and antibiotics sensitivity is fundamental for care givers and health planner to guide the expected intervention.

OBJECTIVE OF STUDY

1.     The aim to determine the bacterial profile of urinary tract infection (UTI) and antimicrobial susceptibility pattern among pregnant women attending at antenatal

2.     To determine the prevalence of significant bacteriuria

3.     To determine the sensitive of  common bacterial isolates

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