Bacteria Associated With Urinary Tract Infection In Pregnant Women And Their Antibiotic Susceptibility

Project and Seminar Material for Microbiology

Abstract

Urinary tract infection is a major public health problem in terms of morbidity and financial cost and represents one of the most common diseases encountered in medical practice today with an estimated 150 million UTIs per annum worldwide. It remains a commonly diagnosed infection both in community as wells as in hospitalized pregnant mothers and Escherichia coli was found to be the most common pathogen of UTI both in community and hospital acquired infections. The main objective determines bacteria associated with urinary tract infection in pregnant women and their antibiotic susceptibility.

The study was a Cross-sectional descriptive study where systematic sampling was used to recruit the respondents that meet the inclusion criteria 80 pregnant women from trimester 1, 2 and 3 respectively participating in the study. Demographic and risk factors details were obtained through a structured Check List interviews. Data was analyzed using Microsoft Excel and presented in tables and graphs presentation. Coding and verification of the data was done before data analyzed. Analysis was done using SPSS version 15.

Chi-square test (2×2) or Fishers Exact Test was applicable at P-value derivation for socio-demographic and risk factors to identify variables associated with UTIs. Antimicrobial susceptibility pattern rate of gram negative bacteria ranged from 27% to 92% to be accurate Susceptibility was as Cefriaxozone 74 (92%), Ciprofloxacin 56 (70%), Gentamycin 56 (70%), co-Trimoxazole 55 (69%), Ampicillin 50 (63%), Chloraphenical 40 (50%), Streptomycin 32 (43%) and Tetracycline 22 (27%) respectively.

This study recommends that effective identification, isolation and sensitivity tests of uropathogens in pregnant mothers such as E. coli associated with UTI should be done as SOP and the government should expand the existing maternal health programs and put more emphasis on uti treatment components targeting mothers who were established to be at a higher risk. The study was a hospital based study and may not truly reflect findings in the rural areas and the entire state. The antibiotic sensitivity test against bacteria in the laboratory is an in vitro activity and may not exactly reflect the in vivo activity.

Table Of Contents

Preliminary Page(s)

• Title page
• Certification page
• Dedication
• Acknowledgement
• Abstract
• Table of content

Chapter One

1.0 Introduction

• 1.1 Background To The Study
• 1.2 Statement Of The Problem
• 1.3 Objective Of Study
• 1.4 Research Questions

Chapter Two

2.0 Literature Review

• 2.1 Conceptual Review
• 2.2 Urinary Tract Infection In Pregnant Women
• 2.3 Antimicrobial Susceptibility Of Escherichia Coli
• 2.4 Urinary Tract Pathogens
• 2.5 Isolation Of Escherichia Coli
• 2.6 Impact On Hospitalization

Chapter Three

3.0 Materials And Method

• 3.1 Study Design
• 3.2 Study Population
• 3.3 Sample Size Determination
• 3.3 Sampling Procedure
• 3.4 Sampling Procedure
• 3.5 Data Analysis

Chapter Four

4.0 Results And Discussion

• 4.1 Results And Findings
• 4.2 Discussion

Chapter Five

5.0 Conclusion And Recommendation

• 5.1 Conclusion
• 5.2 Recommendations
• References

Chapter One

1.0 Introduction

1.1 Background To The Study

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 million visits to outpatient 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.

1.2 Statement Of The Problem

The prevalence of UTI among pregnant women has been reported to be high regardless of the women’s age, parity and gestational age and E. coli is suspected to be the commonest isolated organism with multi resistance toward different antibiotics. Previously the prevalence of UTI among pregnant women in the neighbor countries has been indicated to be 14.6% and 11.6% in Tanzania and Ethiopia (Masinde, et al., 2009). It has been shown that anti-microbial resistance to one drug does not always correlate to the consumption of the same drug or closely related drugs (Kahlmeter, et al., 2003).

Inappropriate antimicrobial use can lead to inadequate therapy and contribute to further drug resistance (Fluit and Schmitz, 2001). The inappropriate use of antimicrobial in low income countries is perhaps due to the lack of adequate knowledge about drugs and non-availability or non-accessibility of guidelines for therapy (Mathai, et al.. 2004), or to the availability of antimicrobials without prescription and perhaps it was prescribed by non-skilled practitioners (Yilmaz, et al., 2009).

1.3 Objective Of Study

The aim of this study was to determine the bacteria associated with urinary tract infection in pregnant women and their antibiotic susceptibility.

1. To characterize UTI causing pathogens from urine samples in pregnant women.
2. To determine antimicrobial resistance of Escherichea coli isolates from urine samples in pregnant women.
3. To compare antimicrobials susceptibility pattern on Escherichia coli isolates in inpatient and out-pregnant mothers.

1.4 Research Questions

The following research questions guided the study;

1. What’s the criterion of characterizing Escherichea coli isolates from urine samples in pregnant women.
2. What’s the level of antimicrobial resistance of Escherichea coli isolates from urine samples in pregnant women.
3. Is there any significance in antimicrobials susceptibility pattern on Escherichia coli isolates in inpatient and out-pregnant mothers?

Chapter Five

5.0 Conclusion And Recommendation

5.1 Conclusion

In this study, cephalosporins had a remarkable antibiotic sensitivity pattern of 92% of ceftriaxone, constituted a significantly high proportion of bacterial isolates in this study. Quinolones and cephalosporins were the most sensitive drugs to all the micro organisms isolated from symptomatic cases in this study. Cephalosporins, like ceftriaxone, could be administered empirically because of their high sensitivity and wide spectrum of activity against micro organisms causing UTI in pregnancy seen in this study. Thereafter, the cheap and readily available antibiotics like nitrofurantoin could be used to replace the cephalosporins if the antibiotic sensitivity of the offending bacterial isolates shows susceptibility to these cheap readily available antibiotics.

However, considering the morbidity and mortality that may complicate UTI in pregnancy if not adequately managed, the cephalosporins, even though expensive, are cost effective and safe when appropriately used in pregnancy. However, the cost implication could be addressed by effective implementation of ministry of health. Through the government chemist and poisons board and national health insurance scheme, cephalosporins could be made available at no financial burden to these pregnant women with symptomatic UTI. However, in the interim, the government could subsidize the cost of this potent antibiotic to reduce perinatal and maternal morbidity and mortality. This research will be used for empirical therapies and improvement of appropriate infection control strategies.

We found significant differences in resistance patterns between outpatient and inpatient urinary isolates for several of the most commonly prescribed antibiotic agents. We also noted that uropathogens prevalence varies by patient visit setting. These findings substantiate the need for separate inpatient and outpatient based antibiogram to optimize empirical antibiotic selection for pregnant mothers with UTI treatment.

5.2 Recommendations

This study recommends that effective identification, isolation and sensitivity tests of uropathogens in pregnant mothers such as E. coli associated with UTI.

1. Pregnant mothers treatment and safe practices which reduce pathogen carriage such as pathogen clean water, increased hygiene hospital, health education efforts to protect public health and continued implementation of safe motherhood. This will minimize pregnant mothers’ auto infections and contamination with these pathogens that can occur.
2. Routine surveillance and timely reporting of antibiotic resistance patterns among uropathogens should become a high priority to establish possible sources of bacterial resistance and provide data that can be used to select appropriate treatment.
3. Establishing National Committee of Clinical Laboratory Standards on antibiotic sensitivity testing on uropathogens.
4. The government should expand the existing maternal health programs and put more emphasis on UTI treatment components targeting mothers who were established to be at a higher risk.
5. The government should support the private sector and NGOs that deals antibiotic regimes program through enhanced private partnerships.
6. Health policy makers should encourage unified and well-coordinated mechanisms with other relevant stakeholders such as Ministry of Public Health and Sanitation, Ministry of Housing, Local Government, Ministry of Finance and Planning to incorporate free maternal

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