Investigation Of UTI In Pregnancy

Investigation Of UTI In Pregnancy
Abstract
This study investigates the bacteriological aetiology and Urinary Tract Infections (UTIs) among pregnant women attending antenatal clinics at hospitals in Enugu metropolis.70 mid-stream urine samples were collected and cultured for the presence of bacterial pathogens, 38 of which showed significant bacterial growth while the remaining 32 showed no significant bacterial growth.
Bacterial agents were isolated from 38 pregnant women and were identified as: Escherichia coli; Klebsiellaspp., Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureusand Staphylococcus epidermidis. Escherichia coli 15(39.5%)was the commonest offending bacterial pathogen isolated. Other bacterial pathogens incriminated in this study were Klebsiellaspp. 9 (23.7%), Proteus mirabilis 6 (15.8%), Pseudomonas aeruginosa4(10.5%), Staphylococcus aureus2 (5.3%) and Staphylococcus epidermidis2 (5.3%). The study indicated a low incidence of Urinary tract infections(38.0%),though most of the pregnant women showed no clinical manifestation.
Chapter One
1.0 Introduction
1.1 Urinary Tract Infections
Urinary Tract Infections (UTIs) are associated with multiplication of organisms in the urinary tract. UTI defined as the microbial invasion of any of the tissues of the urinary tract extending from the renal cortex to the urethral meatus (DelzellandLefevre, 2000). The urinary tract includes the organs that collect and store urine and release it from the body which include: kidneys, ureters, bladder, urethra and accessory structures. Urine formed in the kidney is a sterile fluid that serves as a good culture medium for proliferation of bacteria (Omonigho et al., 2001). UTI is evident by the presence of 105 microorganisms or of a single strain of bacterium per ml in two consecutive midstream samples of urine (Davidson et al.,1989). UTI could be described based on the part of the tract affected, for upper tract it is called Pyelonephritis and the lower part, cystitis (Stamm, 1998).
Urinary tract infections are the second most common type of infection in the body and account for around 8.1 million visits to health care providers each year (Onyemelukwe et al., 2003). Over 50% of all women will experience at least one UTI during their lifetime, with 20-30% experiencing recurrent UTI (Brook et al., 2001). Women are more likely to develop UTIs than men, due to anatomical differences; the urethra is shorter in women than in men, and it is closer to the anus, making it more likely that bacteria are transferred to the bladder. With each UTI, the risk that a woman or man will have another UTI increases. Pregnant women are not more likely to develop a UTI than other women, but if one does occur in a pregnant woman then it is more likely to travel up to the kidneys due to anatomical changes affecting the urinary tract in pregnancy (Dimetry et al., 2007). As a UTI in pregnancy can prove dangerous for both maternal and infant health, most pregnant women are tested for bacteriuria, even if asymptomatic, and treated with prophylactic antibiotics. Most UTIs are not serious, but some can lead to serious problems, particularly with upper urinary tract infections. Recurrent or long-lasting kidney infections (chronic) can cause permanent damage, and some sudden kidney infections (acute) can be life-threatening, particularly if septicemia (bacteria entering the bloodstream) occurs.They can also increase the risk of women delivering low birth weight or premature infants (Dimetry et al., 2007).
UTI has been reported among 20% of the pregnant women and it is the most common cause of admission in obstetrical wards (Bacak et al., 2005).
Anatomically UTI can be classified into lower urinary tract infection involving the bladder and urethra and upper urinary tract infection involving the kidney, pelvis, and ureter. The majority of the UTI occur due to ascending infection (Orenstein and Wong, 1999; Delzell and Lefevre, 2000). Three common clinical manifestations of UTIs in pregnancy are: asymptomatic bacteriuria, acute cystitis and acute pyelonephritis (Loh and Silvalingam, 2007).
UTI 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 (>5 WBCs/mL) in a symptomatic patient. Particularly in asymptomatic patients, a diagnosis of UTI should be supported by a positive culture for auropathogen(Emilie et al., 2011). Untreated asymptomatic bacteriuria is a risk factor for acute cystitis (40%) and pyelonephritis (25-30%) in pregnancy. These cases account for 70% of all cases of symptomatic UTI among unscreened pregnant women (Emilie et al., 2011). Symptomatic and asymptomatic bacteriuria have been reported among 17.9% and 13.0% pregnant women, respectively (Masinde et al., 2009).
Pregnancy increases the risk of UTI. At around 6th week of pregnancy, due to the physiological changes of pregnancy the ureters begin to dilate. This is also known as “hydronephrosis of pregnancy”, which peaks at 22-26 weeks and continues to persist until delivery. Both progesterone and estrogens levels increase during pregnancy and these will lead to decreased ureteral and bladder tone. Increased plasma volume during pregnancy leads to decrease urine concentration and increased bladder volume. The combination of all these factors lead to urinary stasis and uretero-vesical reflux (Delzell and Lefevre, 2000).Additionally, theapparent reduction in immunity of pregnant women appears toencourage the growth of both commensal and non-commensalmicroorganisms (Scott et al., 1999). The physiological increase in plasmavolume during pregnancy decreases urine concentration and upto 70% pregnant women develop glucosurea, whichencourages bacterial growth in the urine (Patterson and Andrriole, 1987; Lucas and Cunningham, 1993).
Female gender itself is a risk factor because of short urethra, its proximity to vagina and anus and inability of women to empty their bladder completely. High incidence is seen in lower socioeconomic group (Wesley, 2002). Sexual activity and certain contraceptive methods are also said to increase the risk (Bandyopadhyay et al., 2005) The anatomical relationship of female’s urethra and the vagina makes it liable to trauma during sexual intercourse as well as bacteria been massaged up the urethra into the bladder during pregnancy/child birth (Arthur et al., 1975; Duerden et al., 1990). Abnormalities of urinary tract or stones, diabetes mellitus, immunosupression and past history of UTI tend to increase the risk (Patterson and Andriole, 1997).
Urinary tract infection during pregnancy contributes significantly to maternal and perinatal morbidity (Akerele et al., 2002). Abortion, small birth size, maternal anemia, hypertension, preterm labour, phlebitis, thrombosis and chronic pyelonephritis are related to urinary tract infection during pregnancy (Akerele et al., 2002; Onuh et al., 2006).
coli remains the predominant organism implicated in urinary tract infection in pregnancy, though recent reports show changes in pattern of the infection (Onuh et al., 2006). Recent studies in Nigeria show an increasing involvement of Klebsiella Spp. Staphylococcus aureus, Proteus spp., and Pseudomonas spp. in urinary tract infection in pregnancy (Abdul andOnile, 2001).
Studies have also shown that treatment of bacteriuria during pregnancy reduces the incidence of these complications (Patterson and Andriole, 1987) and lowers the long-term risk of sequelae following asymptomatic bacteriuria (Barr et al., 1985).
1.2 Objectives of the Research
This objectives of this research are to;
- Investigate the Urinary tract infections in pregnancy
- Investigate Urinary tract infections in relation to age distributions of pregnant women.
- Determine percentage of occurrence and distribution of bacterial pathogens in Urinary tract infections among pregnant women
1.3 Justification
Urinary tract infections typically occur when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder. Although the urinary system is designed to keep out such microscopic invaders, these defenses sometimes fail. When that happens, bacteria may take hold and grow into a full-blown infection in the urinary tract. Antibiotic sensitivity can be tested with urine culture, making it useful in the selection of antibiotic treatment.
1.5 Limitations
- Sampled population is limited to only pregnant women that visited Sabon-gari and Samaru Family Health Centres from February to April, 2011
- Only subjects with urine microbial levels > 105cfu/ml wereincluded in the study.
- Retrospective analysis of incidence of bacteriuria in pregnant women in the health centres could not be carried out due to lack of records on patients.
- Follow up study was not carried out due to cultural practices that hinder contact with subjects outside the health centres.
- Questionnaires were administered through the Nursing officials and interpreted to the un-educated Subjects. Some of the Subjects were uncooperative in giving their age and parity status
Chapter Six
Summary, Conclusion and Recommendations
6.1 Summary
This study was designed to determine the incidence of asymptomatic bacteriuria (ASB) among pregnant women attending ante-natal clinics in Sabon-Gari LGA–Zaria, Nigeria. An incidence rate of 58.4% was found. This level of incidence is in consonance with findings from other parts of the country. Higher incidence was recorded among 31- ≥40 years age group and also among those who were in their second trimester.
The most common organisms isolated from asymptomatic bacteriuric pregnant subjects were Gram-negative bacteria, notably Klebsiella, Proteus, E. coli and Pseudomonas constituting 74.1%. Among the Gram-positive bacteria, Staph. aureus and Staph. xylosuswere the most predominant. Further identification to specie level with API kits revealed the presence of E. coli (30.3%), Ent. cloacae (15.1%),Citro. freundii(6.1%),Citro. braakii(6.1%),and Kleb. pneumoniae (6.1%).Others are Staph. aureus (18%), Staph. xylosus(12.82%), Staph. lentus(7.7%), Staph. auriculous(5.1%), Staph. cohnii(2.56%)and Micrococcus (10.3%). Ps. aeruginosa (6.4%), Aeromonas aerohydrophila/caviae(2.4%), Ps. leutiola(0.8%),and Burkholpseudomallei(0.8%)
Antimicrobial susceptibility test revealed varying susceptibility profiles for the isolates. Most Staphylococcus spp were only susceptible to ciprofloxacin, ofloxacin, nitrofurantoin, gentamicin and cotrimoxazole but resistant to other agents tested.
Escherichia spp isolates were moderately susceptible to (F), (CIP), (OFX), (SXT) and erythromycin and were resistant to other agents. Isolates of Proteus spp showed good susceptibility to OFX and CIP, F, CN and streptomycin, they were resistant to other agents. Similarly, isolates of Klebsiella spp were susceptible to OFX, CN, CIP, F and SXT.
6.2 Multiplex PCR
Multiplex PCR showed that most of the test E.coli isolates harbour genes that encode for β-lactamase and ESBL as well as genes that code for resistance to β-lactam antibiotics. The detection of TEM, SHV, OXA-2 encoding genes (though they seem to be mutant strains) for resistance to ESBLs shows that these resistance determinants are found in our environment. These resistant traits call for surveillance in clinical settings because ESBLs gene is a world growing trait for resistance but its epidemiological effect and evaluation is still under estimated with low awareness.
6.3 Recommendations
- It has been reported that approximately 25-30% of asymptomatic bacteriuria in pregnancy will progress to symptomatic infection, which is 3-4 times as in non-pregnant women (Dominic, 2006), hence there is need for early routine screening of all antenatal patients presenting or not presenting with clinical symptoms of urinary tract infection in order to prevent adverse maternal and neonatal outcome.
- Proper routine bacterial culture test should be carried out by clinicians for their antenatal patients. The strip urinalysis method which is been utilized by most clinicians for assessing the urine of these pregnant women can not quantify the extent of infection as well as provide adequate antimicrobial therapy, so this should be discouraged in antenatal clinics. Asymptomatic bacteriuria occurs without the usual clinical symptoms of UTI, most of these pregnant women might be infected with some uropathogens without their knowledge; and this could lead to adverse maternal and neonatal outcome.
- Asymptomatic bacteriuria must be treated in pregnancy in order to prevent complications such as pyelonephritis, premature labour, still birth, hypertension, preeclampsia and septicemia. (Raz, 2003).
- Rational use of antibiotics should be encouraged in all antenatal clinics to help fight the war against the emergence and transmission of multiple antibiotic resistant strains.
- There is the need to improve patients record keeping in the Primary Health Care System. As at now, virtually no records of patients are being kept making it impossible for follow-up and monitoring of patients that may be placed on antibiotic therapy /management.


The Complete Material Will Be Sent to You in Just 2 Steps
Quick & Simple…
![]()
Make Payment (Through Transfer) of ₦5,000 to the Account Below
![]() | Acc No: 0811003731 |
| Samphina Academy | |
| Current Account |
Or CLICK HERE To Pay With Debit Card
| FOR STUDENTS OUTSIDE NIGERIA | |
| CLICK HERE To Pay With Card ($15) | |
| FOR GHANA STUDENTS (GHS 100) | |
![]() | MTN MoMo |
| 0553978005 | |
| Douglas Osabutey | |
![]()
Send the Following Details on WhatsApp ( 07062590260 ) After Payment
- Payment Details
- TOPIC: Investigation Of UTI In Pregnancy
The Complete Material Will Be Sent To You On WhatsApp After Receiving Your Details
T & C Apply
Students Review
List of Related Works
An Assessment Of Early Pregnancy On The Academic Performance Of Secondary School Female Students
Causes Of The Prevalence Of Teenage Pregnancy Among Secondary School Female Students
Malaria In Pregnancy Among The Pregnant Women Attending Antenatal Care
Knowledge, Attitudes And Perceptions Of Adolescent Girls Towards Prevention Of Unintended Pregnancy
Prevalence Of Pregnancy Related Illness Of Women Attending Antenatal Care
Pregnancy Duration And Choice Of Ante-Natal And Delivery Care
Maternal Health Care Seeking Behaviour And Pregnancy Outcome In Udi And Abia Communities Enugu State
Sociodemographic Determinants Of Post-Maternal Delivery Health Outcomes In Oye Ekiti, Ekiti State
Problem Of Pregnancy And Abortion On Girl Child Education In Nigeria
Malaria In Pregnancy Among Pregnant Women Attending Antenatal Clinic In Garki Hospital Abuja
Sex Education And Prevention Of Unwanted Pregnancy Among Teenage Girl In Choba Community
Teenage Out-Of-Wedlock Pregnancy And Educational Pursuit Among Youths
Level Of Awareness And Prevention Of Anaemia In Pregnancy Among Pregnant Women
A Study To Determine The Incidence Of Prolonged Labour In Sacred Heart Catholic Hospital Obudu
Factors Influencing Ectopic Pregnancy Among Women Of Childbearing Age In Obudu Local Government Area
Effectiveness Of Antenatal Screening On Gestational Diabetes In Sacred Heart Hospital, Obudu
Evaluation Of Simple Contraceptives In The Prevention Of Pregnancy Among Women Of Childbearing Age
Academic Effect Of Early Pregnancy Among Junior High School Girls Enugu State
An Evaluation Of The Knowledge Of Health Workers On Fetal And Maternal Factors As Causes Of Dystocia
The Prevalence, Causes And Prevention Of Maternal Mortality Among Women Of Reproductive Age
Knowledge And Effects Of Rhesus Factor Incompatibility In Pregnancy Among Pregnant Women
Evaluation Of Health Concerns And Attitude Of Women Towards Utilization Of Modern Contraceptives
Effect Of Malnutrition In Pregnancy For Both Mother And Child


