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Epidemiology of urinary tract infections and antibiotics sensitivity among pregnant women at Khartoum North Hospital

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Urinary tract infections (UTI) can lead to poor maternal and perinatal outcomes. Investigating epidemiology of UTI and antibiotics sensitivity among pregnant women is fundamental for care-givers and health planners. A cross sectional study has been conducted at Khartoum north teaching hospital Antenatal Care Clinic between February-June 2010, to investigate epidemiology of UTI and antibiotics resistance among pregnant women. Structured questionnaires were used to gather data from pregnant women. UTI was diagnosed using mid stream urine culture on standard culture media Out of 235 pregnant women included, 66 (28.0%) were symptomatic and 169 (71.9%) asymptomatic. the prevalence of bacteriuria among symptomatic and asymptomatic pregnant women were (12.1%), and (14.7%) respectively, with no significant difference between the two groups (P = 0.596), and the overall prevalence of UTI was (14.0%). In multivariate analyses, age, gestational age, parity, and history of UTI in index pregnancy were not associated with bacteriuria. Escherichia coli (42.4%) and S. aureus (39.3%) were the commonest isolated bacteria. Four, 2, 2, 3, 4, 2 and 0 out of 14 E. coli isolates, showed resistance to amoxicillin, naladixic acid, nitrofurantoin, ciprofloxacin, co-trimoxazole, amoxicillin/clavulanate and norfloxacin, respectively. Escherichia coli were the most prevalent causative organisms and showing multi drug resistance pattern, asymptomatic bacteriuria is more prevalent than symptomatic among pregnant women. Urine culture for screening and diagnosis purpose for all pregnant is recommended.
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RESEARCH Open Access
Epidemiology of urinary tract infections and
antibiotics sensitivity among pregnant women
at Khartoum North Hospital
Hamdan Z Hamdan
1
, Abdel Haliem M Ziad
2
, Salah K Ali
3
, Ishag Adam
4*
Abstract
Background: Urinary tract infections (UTI) can lead to poor maternal and perinatal outcomes. Investigating
epidemiology of UTI and antibiotics sensitivity among pregnant women is fundamental for care-givers and health
planners.
Methods: A cross sectional study has been conducted at Khartoum north teaching hospital Antenatal Care Clinic
between February-June 2010, to investigate epidemiology of UTI and antibiotics resistance among pregnant
women. Structured questionnaires were used to gather data from pregnant women. UTI was diagnosed using mid
stream urine culture on standard culture media
Results: Out of 235 pregnant women included, 66 (28.0%) were symptomatic and 169 (71.9%) asymptomatic. the
prevalence of bacteriuria among symptomatic and asymptomatic pregnant women were (12.1%), and (14.7%)
respectively, with no significant difference between the two groups (P= 0.596), and the overall prevalence of UTI
was (14.0%). In multivariate analyses, age, gestational age, parity, and history of UTI in index pregnancy were not
associated with bacteriuria. Escherichia coli (42.4%) and S. aureus (39.3%) were the commonest isolated bacteria.
Four, 2, 2, 3, 4, 2 and 0 out of 14 E. coli isolates, showed resistance to amoxicillin, naladixic acid, nitrofurantoin,
ciprofloxacin, co-trimoxazole, amoxicillin/clavulanate and norfloxacin, respectively
Conclusion: Escherichia coli were the most prevalent causative organisms and showing multi drug resistance
pattern, asymptomatic bacteriuria is more prevalent than symptomatic among pregnant women. Urine culture for
screening and diagnosis purpose for all pregnant is recommended.
Introduction
Due to several anatomical and hormonal changes, preg-
nant women are more susceptible to develop Urinary
tract infections (UTI) [1]. UTI is a major health pro-
blem, it has been reported among 20% of the pregnant
women and it is the most common cause of admission
in obstetrical wards [2]. Symptomatic and asymptomatic
bacteriuria have been reported among 17.9% and 13.0%
pregnant women, respectively [3].
UTI (perhaps if untreated) can lead to serious obste-
tric complications, poor maternal and perinatal out-
comes e.g. intrauterine growth restriction, pre-
eclampsia, caesarean delivery and preterm deliveries [4].
Furthermore, it has been observed that asymptomatic
bacteriuria can lead to cystitis and pyelonephritis [5]
which can lead to acute respiratory distress, transient
renal failure, sepsis and shock during pregnancy [6].
Screening of pregnant women for UTI can minimize
these UTI associated complications [7]. Recently various
risk factors of UTI during pregnancy have been
reported; perhaps these are varied according the geogra-
phical, social and biological settings [8]. Escherichia coli-
with its multidrug resistant strains- has been found to
be the commonest cause of UTI among pregnant
women [9,10].
Investigating epidemiology of UTI (prevalence, risk
factors, bacterial isolates and antibiotic sensitivity) dur-
ing pregnancy is fundamental for care givers and health
planners to guide the expected interventions. While an
extensive published literature concerning UTI during
* Correspondence: ishagadam@hotmail.com
4
Faculty of Medicine, University of Khartoum, Khartoum, Sudan
Full list of author information is available at the end of the article
Hamdan et al.Annals of Clinical Microbiology and Antimicrobials 2011, 10:2
http://www.ann-clinmicrob.com/content/10/1/2
© 2011 Hamdan et al; licensee BioMed Central Ltd. This is an Open Access art icle distributed under the terms of the Creative
Commons Attri bution License (http://creativecommons.org /licenses/by/2.0), which permits unrestricte d use, distribution, and
reproductio n in any medium, provided the original work is properly cited.
pregnancy is available from other African countries [11],
there is no published data concerning UTI in pregnant
Sudanese women. Thus, this was the objective of this
study which has been conducted at the Antenatal Care
Clinic of Khartoum North hospital during the period of
February-June 2010.
Methods
A cross-sectional study has been conducted at Khartoum
North hospital Antenatal Care Clinic during the period
of February-June 2010. Consecutive pregnant women
who attended the Antenatal Care Clinic for the first time
was approached to participate in the study. Those with
known underline renal pathology or chronic renal disease
were excluded. After signing an informed consent, rele-
vant medical, obstetrical and socio-demographic charac-
teristics were gathered using pre-tested questionnaires.
Every woman was inquired for history suggestive of UTI
(urgency, frequency, loin pain etc) and history of using
antibiotics in the index pregnancy. Maternal weight,
height, and body mass index (BMI) was calculated as
weight in kilograms divided by height in meters squared.
Maternal haemoglobin was measured.
Mid stream urine samples were collected using sterile
container on the same day of enrolment. All the speci-
mens were analyzed within an hour of collection using
dipstick (Mannheim GmbH, Germany) following manu-
facturers instructions, then samples were analyzed for
culture and sensitivity. By Using standard quantitative
loop a 1 μland10μl were used to inoculate urine sam-
ple on Cysteine lactose electrolyte deficient Agar, Mac-
Conkey and Blood agar plates (OXOID-England). Plates
were incubated for 24 hr at 37°C. A diagnosis of UTI
was made when there were at least 10
5
colony forming
unit (CFU)/ml of urine. For contaminated specimens,
repeat culture was performed. Identification was done
using in house biochemical testing [12]. S. aureus was
identified by colonial morphology, gram positive stain-
ing, positive catalase activity, and positive coagulation
of citrated rabbit plasma (bioMe rieux, MarcylEtoile,
France). Disc diffusion method was used to determine
susceptibility of the isolates as previously described
[13]. Individual colonies were suspended in normal sal-
ine to 0.5 McFarland and using sterile swabs the sus-
pensions were inoculated on Muller Hinton agar for
18-24 hr. E. coli ATCC 25922 was used as control
strains [14].
For gram-negative and positive bacteria the following
discs were tested: amoxicillin (25 μg), co-trimoxazole
(SXT) (1.25/23.75 μg), nitrofurantoin (300 μg), cipro-
floxacin (5 μg), nalidixic acid (30 μg), amoxicillin-clavu-
lanic acid (20 μg/10 μg), and norfloxacin (5 μg),
Symptomatic patients were given amoxicillin/clavulanate
as empirical treatment before culture results. All patients
were asked to come back for results after 2 days. Then
patients care at Antenatal Care Clinic has been continued
by her managing obstetrician in the particular unit.
Statistics
Data were entered in the computer using SPSS for win-
dows version13.0 and double checked before analysis.
Means and proportions of the socio-demographic and
obstetrical characteristics were calculated and compared
between the growth positive and negative groups using
student tand X
2
tests, respectively. Univariate and mul-
tivariateanalysiswereusedwith isolate positive group
as dependent variable and socio-demographic and obste-
trics variables as independent variables. Probability
values of <0.05 were considered as statistically signifi-
cant for all results.
Results
Two hundred and thirty-five pregnant women were
enrolled at the mean (SD) gestational age of 29 (7.9)
weeks. The mean (SD) of their age and parity were 27.5
(14.6) years and 2.6 (2.4), respectively. Out of 235 preg-
nant women, 66 (28.0%) had symptoms suggestive of
UTI. The prevalence of bacteriuria among symptomatic
and asymptomatic pregnant women were (12.1%), and
(14.7%), respectively, with no significant difference
between the two groups, and the overall prevalence of
UTI was (14.0%). Interestingly out of 33 who had signif-
icant bacteriuria, 14 (42.2%) had a history of UTI in
current pregnancy and received antibiotic for that
UTI. There was no significant difference in the socio-
demographic and clinical data between bacteriuric and
abacteriuric women, table 1.
Risk factors of urinary tract infections
None of the investigated factors (age, gestational age,
parity, symptoms and body mass index) were found as
risk factor for UTI in univariate and multivariate analy-
sis, table 2.
Bacterial isolates and their sensitivity
Eighteen (54.5%) and 15 (45.4%) of the 33 isolates were
gram negative and positive bacteria, respectively. E. coli
[14 (42.4%)] was the most predominant organism iso-
lated. Other isolates were S. aureus [13 (39.3%)], K.
pneumoniae [3 (9%)], group B streptococcus [2 (6%)] and
P. aeruginosa [1 (3%)].
Four, 2, 2, 3, 4, 2 and 0 out of 14 E. coli isolates,
showed resistance to amoxicillin, naladixic acid, nitro-
furantoin, ciprofloxacin, co-trimoxazole, amoxicillin/cla-
vulanate and norfloxacin, respectively. Thirteen S.
aureus isoltes showed resistant to amoxicillin (1), nor-
floxacin (3), co-trimoxazole (5), and naladixic acid (5).
K. pneumonia isolates (3) have resistance to amoxicillin
Hamdan et al.Annals of Clinical Microbiology and Antimicrobials 2011, 10:2
http://www.ann-clinmicrob.com/content/10/1/2
Page 2 of 5
(2), both naladixic acid and amoxicillin/clavulanate (1).
There was no resistance to co-trimoxazole, nitrofuran-
toin, norfloxacin and ciprofloxacin. One of the two
group B streptococcus isolates has resistance to naladixic
acid while sensitive to amoxicillin, nitrofurantoin, amox-
icillin/clavulanate, norfloxacin, co-trimoxazole and
ciprofloxacin. One P. aeruginosa isolate has resistance to
amoxicillin, nitrofurantoin, and co-trimoxazole, while
sensitive to naladixic acid, ciprofloxacin, amoxicillin/cla-
vulanate, norfloxacin.
Outof33whohadpositiveculturegrowth4hada
nitrate test positive, while 202 who had no growth in
the culture media only one had a false positive nitrate
test, this make the sensitivity and specificity of the
nitrate test versus culture growth as 12.1% and 99.5%
respectively.
Discussion
The main findings of this study were: the prevalence of
UTI among pregnant women was 14.0% - regardless to
the womens age, parity and gestational age -and E. coli
was the commonest isolated organism with multi resis-
tance toward different antibiotics. The prevalence of
UTI among these women is similar to the prevalence of
UTI among pregnant women in the neighbor countries
e.g. 14.6% and 11.6% in Tanzania and Ethiopia [3,11].
Age, parity and gestational age were not associated
with UTI in this study as well as in neighboring Tanza-
nia [3]. However, maternal age, parity and morbid obe-
sity have been previously observed as risk factors for
UTI among pregnant women [8,15,16]. Likewise in this
study gestational age was not found as risk factor for
UTI among these women. Recently, it has been reported
that, UTI developed in third trimester [17]. Perhaps the
susceptibility of UTI during this period is due to uretral
dilatation which started as early as 6 week and reaching
the maximum during 22-24 weeks [9].
Other factors like low socio-economic status, sexual
activity, washing genitals precoitus, postcoitus, not void-
ing urine postcoitus and washing genitals from back to
front have observed as risk factors for UTI during preg-
nancy [15,18]. These factors have not been investigated
in the current study; otherwise the results would have
been changed. According to the traditions in central
Sudan, it might have been difficult to enquire about
washing genitalia and sexual activity; otherwise patients
co-operation would be lost. Interestingly high prevalence
of urinary tract infection has been reported among
Sudanese females with genital mutilation [19], which
was widely practiced in Central Sudan [20].
In this study E. coli was the most common pathogen
(77.7% of the Gram-negative isolates, 42.4% of all iso-
late). This goes with results that obtained in Tanzania
where E. coli was 38% of the Gram-negative isolates and
25% of all isolate [21]. Likewise, many authors have the
same findings e.g. in Pakistan and India [8,22]. In this
study E. coli showed multidrug resistance mainly to
amoxicillin, co-trimoxazole and nitrofurantoin. In Africa
e.g. Tanzania, Kenya and Senegal it have been reported
that, E. coli in urinary isolates have a high antimicrobial
resistance pattern [3,10,23]. Likewise Gales et al and
Williams et al have reported high resistance of E. coli
towards different antimicrobials in Latin American and
Costa Rica, respectively [24,25]. Although, S. aureus was
known for years as rare urinary isolate [26], recently it
has been reported to be the most frequent pathogen
among pregnant women in Nigeria [27]. In this setting
it was found the second most prevalent bacteria, this is
in concert to the other previous observation [8].
In this study, 42.4% women who had positive isolate
received an antibiotic in the index pregnancy. It has
Table 1 Obstetrical characteristic between bacteriuric and
abacteriuric women in Khartoum north hospital, Sudan
Variables Women with
Bacteriuria
Women without
Bacteriuria
P
Age, years 25.7(5.3) 27.8(15.6) 0.438
Parity 2(2.1) 2.7(2.5) 0.132
Gestational Age,
weeks
29.6(6.9) 29.2(8.1) 0.783
Weight, Kg 65.8(9) 67.8(7.1) 0.245
Height, meter 1.6(6.) 1.6(6.) 0.007
Body mass index 24.8(2.7) 24.7(2.5) 0.845
History of UTI 14(42.4) 95(47) 0.623
History of
Antibiotic use
14(42.4) 89(44) 0.861
Hemoglobin, g/dl 9.7 (.9) 9.7 (0.9) 0.901
Dysuria 8(24.2) 58(28.7) 0.596
Urgency 1(3) 5(2.5) 1.000
Fever 33(100) 2(1) 1.000
Vomiting 33(100) 2(1) 1.000
Data were shown as mean (SD) or n (%) as applicable.
Table 2 Factors associated with UTI in pregnancy in
Khartoum North Hospital, Sudan using univariate and
multivariate analyses
Variables Univariate analysis Multivariate analysis
OR 95%CI POR 95%CI P
Age 0.9 0.8-1.0 0.2 0.9 0.8-1.0 0.2
Body mass index 1.0 0.8-1.1 0.8 1.0 0.8-1.2 0.4
Parity 0.8 0.7-1.0 0.1 0.9 0.7-1.1 0.4
Gestational age 1.0 0.9-1.0 0.7 1.0 0.9-1.0 0.9
Dysuria 0.7 0.3-1.8 0.5 0.8 0.3-2.5 0.8
Urgency 1.2 0.1-10.8 0.8 1.9 0.1-22.1 0.5
History of UTI 0.8 0.3-1.7 0.6 0.3 0.1-6.6 0.4
History of antibiotic use 0.9 0.4-1.9 0.8 3.0 0.1-64.9 0.4
Abbreviations: OR, Odds Ratio; CI, confidence interval.
Hamdan et al.Annals of Clinical Microbiology and Antimicrobials 2011, 10:2
http://www.ann-clinmicrob.com/content/10/1/2
Page 3 of 5
been shown that anti-microbial resistance to one drug
does not always correlate to the consumption of the
same drug or closely related drugs [28]. Inappropriate
antimicrobial use can lead to inadequate therapy and
contribute to further drug resistance [29]. The inap-
propriate 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 guide-
lines for therapy [22] or to the availability of antimicro-
bials without prescription and perhaps it was prescribed
by non-skilled practitioners [30].
Conclusion
There was high prevalence of asymptomatic bacteriuria
among pregnant women in this setting regardless to
womens age, parity and gestational age. E. coli with its
multi resistance towards antibiotics was the most com-
mon isolated organism. Thus urine culture should be
performed as screening and diagnostic tool of UTI in
pregnancy in this setting.
Ethics
This study was approved by Sudan Medical specializa-
tion Ethics Review Board, Sudan.
Acknowledgements
The authors are very grateful to all the patients for their co-operation.
Funding The study was funded by University of Khartoum, Khartoum,
Sudan
Author details
1
Faculty of Medicine, Al-Neelain University, Khartoum, Sudan.
2
Khartoum
North Hospital, Khartoum, Sudan.
3
National health laboratory, Khartoum,
Sudan.
4
Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
Authorscontributions
HZA and AMZ carried out the study and participated in the statistical
analysis and procedures. IA coordinated and participated in the design of
the study, statistical analysis and the drafting of the manuscript. All the
authors read and approved the final version.
Competing interests
The authors declare that they have no competing interests.
Received: 14 November 2010 Accepted: 18 January 2011
Published: 18 January 2011
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doi:10.1186/1476-0711-10-2
Cite this article as: Hamdan et al.: Epidemiology of urinary tract
infections and antibiotics sensitivity among pregnant women
at Khartoum North Hospital. Annals of Clinical Microbiology and
Antimicrobials 2011 10:2.
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Hamdan et al.Annals of Clinical Microbiology and Antimicrobials 2011, 10:2
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... This prevalence of UTI is similar to that reported in Nepal (Raza S, Pandey S, Bhatt C (2011) (19.7%) and in Tanzania (Masinde et al., 2009) (18%). However, It is higher than the study done in Khartoum State (Hamdan et al., 2011), where the prevalence of UTI was (14.0%), in north Nigeria (Ali and Abdallah, 2019) (15.8%), and lower than study carried in Egypt (Younis et al., 2019) andin Saudi Arabia (El-Kashif, 2019), were the prevalence of UTI in pregnant women was (49.3%), and (53,5%), respectively. The reason for this variation may attribute them to differences in the environment, social habits of the community, hygiene standards and educational levels. ...
... Asymptomatic pregnant women showed a prevalence rate of (72.3%), which is higher than in symptomatic pregnant women with a prevalence rate of (27.7%). This relatively agrees with a previous study done in Sudan (Hamdan et al., 2011), that showed a high prevalence rate of UTI's in asymptomatic pregnant women, and similar to a study conducted in North West Ethiopia (Demilie et al., 2012). ...
... There was no statistically significant association between the age of the pregnant women and UTI. These findings agree with the previous study in Sudan (Hamdan et al., 2011), as well as in India (Dash et al., 2013); and higher than another study done in India (Sujatha and Nawani, 2014), where the highest incidence reported in the age group of 21-30 years, and in Ghana (Turpin et al., 2007), the highest incidence was reported in the age group of 35-39 year. ...
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Pregnancy causes numerous changes in the woman's body that increase the likelihood of Urinary Tract Infections (UTI's). UTI's during pregnancy is associated with risks to both the fetus and the mother, and Escherichia coli (E.coli) is the most common cause. The aim of this study was to determine prevalence of urinary tract infections (UTI's) during pregnancy, risk factors and antimicrobial susceptibility profiles of associated bacterial pathogens in Khartoum Hospitals. A cross-sectional hospital-based study, conducted among 230 pregnant women attending antenatal clinics. Their socio-demographic profile and risk factors obtained using a structured questionnaire. Urine samples tested microbiologically by standard procedures. Kirby-Bauer technique performed for testing commonly used antimicrobial agents by measuring the susceptibility of the isolated organisms according to CLSI guidelines. Out of 230 pregnant women included; 47 (20.4%) had a significant bacteriuria, (40.4%; 19/47) was symptomatic, and (59.6%; 28/47) was asymptomatic UTIs. Among pregnant women who had significant bacteriuria, only 1 (2.1%) had history of UTI during this pregnancy and 46 (97.9%) had no history. Gram-negative bacteria were more prevalent (68.1%). E.coli was the common isolate (31.9%; 15/47). More than 60% of the total isolated bacterial pathogens were resistance to ampicillin, amoxyclave and clindamycin, followed by ≥ 35% to 3 rd generation cephalosporins, nitrofurantoin and norofloxacin. UTI are prevalent in pregnant women in Sudan, regardless age, parity and gestational age. The significant bacteriuria, signs and symptoms, and a previous UTI were found significantly associated with UTI's during pregnancy. Resident social class and employment status were protective, while other factors such as high level of education, parity, history of abortion were not protective. The E. coli was the common isolate and carbapenems, aminoglycosides, quinolones were the drug of choice. Therefore, UTI screening is essential during pregnancy.
... fetal death (Glaser & Schaeffer, 2015;Tadesse et al., 2018;Kaduma et al., 2019). Escherichia coli is the main microorganism causing UTI during pregnancy causing both asymptomatic and symptomatic infections that are related to specific uropathogenic Escherichia coli (UPEC) strains (Hamdan et al., 2011;Forsyth et al., 2018). These strains have been identified by differential expression of virulence factors including adhesins, toxins, surface antigens, and iron acquisition systems, which allow UPEC to evade the immune system and adapt to their new environment in the host urinary tract (Bien et al., 2012;Terlizzi et al., 2017). ...
... Samples were collected from the first-morning microorganismo causante de UTI durante el embarazo ocasionando infecciones tanto sintomáticas como asintomáticas que se relacionan con cepas específicas de Escherichia coli uropatógena (UPEC) (Hamdan et al., 2011;Forsyth et al., 2018). Estas cepas se han identificado por la expresión diferencial de factores de virulencia que incluyen adhesinas, toxinas, antígenos superficiales y sistemas de adquisición de hierro, los cuales le permiten a UPEC evadir el sistema inmunológico y adaptarse a su nuevo entorno en el tracto urinario del hospedero (Bien et al., 2012;Terlizzi et al., 2017 ...
... The to what was reported in the present study (Hamdan et al., 2011;Parveen et al., 2012;Forson et al., 2018). ...
Article
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Escherichia coli uropatógena (UPEC) es el principal agente etiológico involucrado en las infecciones del tracto urinario (ITU), una de las infecciones bacterianas más comunes en seres humanos. Las ITU son más prevalentes en mujeres, donde el riesgo de padecerlas aumenta durante el embarazo. El objetivo del presente estudio fue determinar la prevalencia de ITU producidas por UPEC en pacientes embarazadas, así como los factores de virulencia y la resistencia a antibióticos de las cepas aisladas. Se identificó a Escherichia coli mediante pruebas bioquímicas convencionales, para posteriormente realizar su genotipificación mediante PCR para la identificación de los factores de virulencia. El análisis de susceptibilidad a antibióticos se realizó mediante el método de Kirby-Bauer de difusión en agar. La prevalencia de ITU en pacientes embarazadas fue de 32%, siendo UPEC el microorganismo más prevalente (36%) en las infecciones. Se determinó que las cepas de UPEC fueron resistentes principalmente a ampicilina (100%), carbenicilina y cefalotina (89%). El gen agn43 fue el más prevalente (78%) en las cepas de UPEC, seguido de papC (67%). Interesantemente, una de las cepas aisladas poseía hasta seis genes de virulencia. Finalmente, nuestro estudio muestra que las ITU en pacientes embarazadas son ocasionadas principalmente por cepas de UPEC, las cuales poseen factores de virulencia y de resistencia a múltiples antibióticos, lo que en su conjunto dificulta el tratamiento de las infecciones e incrementa la posibilidad del desarrollo de complicaciones durante el embarazo.
... The overall prevalence of UTI in pregnant women in this study was 16.4%. This is comparable to the prevalence of UTI reported in in Mwanza City, Tanzania 16.8% 10 23 . This variation in prevalence might be due to across different studies from one country to another and among regions of the same country might be attributed to the difference in associated factors, sample size, social habits of the community, the standard of personal hygiene and education 24 . ...
... In this study the symptomatic study was 9.5%, These result of symptomatic UTI were agree with a study conducted from in Khartoum Sudan 12.1% 23 www.nature.com/scientificreports/ In this study, Gram-negative bacteria isolates were more prevalent (71%) than Gram-positive bacteria isolates (29%). ...
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The aim of this study was to determine the prevalence, antimicrobial susceptibility pattern and associated factors of urinary tract infection (UTI) among pregnant women attending Hargeisa Group Hospital (HGH), Hargeisa, Somaliland. A cross-sectional study was conducted at HGH, Hargeisa, Somaliland and participants were selected by systematic random sampling technique. Clean catch midstream urine samples were collected from 422 participants and cultured and antimicrobial susceptibility pattern was determined for the isolates. Univariable and multivariable logistic regression analyses were utilized to identify the independent risk factors for UTI. The prevalence of UTI was 16.4% (95% CI 13.3–19.9). The predominant bacteria isolate was E. coli (43.5%) followed by Coagulase negative staphylococcus ( CoNS ) 11(16%), S. aureus 9(13%), K. pneumonia 6(8.7%), Pseudomonas aeruginosa 5(7.2%), Proteus mirabilis 4(5.8%), Citrobacter spp 3(4.4%) and M. morganii 1(1.5%) Gram negative bacilli were resistant to ampicillin (96%) and tetracycline (71.4%) and Gram-positive cocci were also resistant to ampicillin (90%), tetracycline (55%). Multidrug resistance was observed in 85.5% of bacterial isolated. No formal education participants, previous history of catheterization and previous history of UTI had 3.18, 3.22 and 3.73 times respectively more likely to develop UTI than their counterparts. Culture and susceptibility test is vital for appropriate management of UTI in the study area.
... Coagulase negative staphylococci (CoNs) were highly resistant to ampicillin (81.8%), tetracycline (54.5%), and amoxicillin clavulanic acid ( 23 . This variation in prevalence might be due to across different studies from one country to another and among regions of the same country might be attributed to the difference in associated factors, sample size, social habits of the community, the standard of personal hygiene and education. ...
... The prevalence of UTI among symptomatic and asymptomatic pregnant women in this study was 9.5% and 6.9% respectively. In this study the symptomatic study was 9.5%, These result of symptomatic UTI were agree with a study conducted from in Khartoum Sudan 12.1% 23 In this study, susceptibility pattern of Gram-negative bacteria showed that most of the isolates were sensitive to meropenem (95.9%), ceftriaxone (79.6%), nor oxacin (77.5%), gentamicin (75.5%), nitrofurantoin (75.5%) and cipro oxacin (71.4%) and comparable studies conducted in different study area like in Addis Ababa, Ethiopia that showed highly sensitive to meropenem (75.2%), nitrofurantoin (93.1%), gentamicin (85.2%), ceftriaxone (82.2%), cefuroxime (79.3%), and cipro oxacin (75.2%) 46 and in South Nigeria showed sensitive to gentamicin (53% -100%), imipenam (67%-93%), cipro oxacin (between 57%-75%) 48 , In Hawassa, Southern Ethiopia the present study, 80% of Gram negative bacteria were susceptible to meropenem, cipro oxacin, gentamicin, nitrofurantoin, and norfoxacin 49 . In this study, the highest resistance was shown to ampicillin (93%-100%) among gram-negative bacteria, this due to the drug is with low cost and often can be purchased without prescription in different areas. ...
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The aim of this study was to determine the prevalence, antimicrobial susceptibility pattern and associated factors of urinary tract infection (UTI) among pregnant women attending Hargeisa Group Hospital (HGH), Hargeisa, Somaliland. A cross-sectional study was conducted at HGH, Hargeisa, Somaliland and participants were selected by systematic random sampling technique. Clean catch midstream urine samples were collected from 422 participants and cultured and antimicrobial susceptibility pattern was determined for the isolates. Univariable and multivariable logistic regression analyses were utilized to identify the independent risk factors for UTI The prevalence of UTI was 16.4 % (95% CI: 13.3–19.9). The predominant bacteria isolate was E. coli (43.5%). Gram negative bacteria were resistant to ampicillin (96%) and tetracycline (71.4%) and Gram-positive bacteria were also resistant to ampicillin (90%), tetracycline (55%). Multidrug resistance was observed in 89.9% of bacterial isolated. No formal education participants were 3.18 times, previous history of catheterization had 3.22 times and previous history of UTI had 3.73 times more likely to develop UTI than their counterparts respectively. Culture and susceptibility test is vital for appropriate management of UTI in the study area.
... 31% nonpregnant) [19]. Perhaps the susceptibility to UTIs during pregnancy is due to urethral dilation [20]; the environment, low socioeconomic status, poor personal hygiene, and hormonal & physiological changes could also contribute to the risk of UTIs [19]. ...
... Due to this, clinicians may miss these cases and complications may ensue later in an infected individual. e best ways of preventing catheter-associated urinary tract infections are to avoid unnecessary use of a catheter, maintaining strict techniques during insertion, and their prompt removal when they are no longer needed [19,20]. ...
Article
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Background. Urinary tract infection is one of the most common health problems worldwide, afflicting many women in reproductive age, especially in developing countries. Increased risk of infection has been attributed to pregnancy and antimicrobial resistance. Objective. To compare the prevalence, antimicrobial susceptibility pattern of the bacteria and associated factors of urinary tract infections among pregnant and nonpregnant women attending public health facilities, Harar, Eastern Ethiopia. Methods. A health facility-based comparative cross-sectional study was conducted among 651 randomly selected women from public health facilities, Harar, Eastern Ethiopia, between February 2017 and December 2017. Pertinent data were collected through a face-to-face interview using a structured questionnaire. e midstream urine specimen was collected and cultured on cysteine-lactose-electrolyte-deficient agar and blood agar. Pure isolates were tested against the ten most prescribed antimicrobials using the Kirby-Bauer disk diffusion method. Data were entered and analysed using Statistical Program for Social Sciences version 21. A p value <0.05 was considered statistically significant. Results. e overall prevalence of significant bacteriuria was 23% (95% CI: 13.6, 26.8). e higher proportion of bacteria were isolated from pregnant women (14.1%) compared to nonpregnant women (8.9%). Escherichia coli (28.8%) and Streptococcus aureus (14.3%) were the most common isolates. E. coli was resistant to amoxicillin (83.3%), trimethoprim-sulfamethoxazole (78.6%), and ciprofloxacin (81%), whereas S. aureus was resistant to chloramphenicol (81%), erythromycin (81%), and amoxicillin (76.2%). Current symptoms, and history of catheterization increase the likelihood of urinary tract infections. Conclusion. Pregnant women were more likely infected with bacterial pathogens than nonpregnant women. Current symptoms, and catheterization increase the odds of urinary tract infections. More than half of the isolates were resistant to the commonly prescribed antimicrobials. Regular assessment of urinary tract infections and antimicrobial resistance are recommended to provide effective therapy and thereby prevent urinary tract complications.
... The association of demographic factors and UTI has been controversial, with some studies showing increased risk with advanced maternal age and multiparity [16]. However, Hamdan et al. found no significant association [17]. Our study showed nulliparous women to be more likely to develop UTI. ...
Article
Background A urinary tract infection (UTI) is a common medical condition complicating pregnancy with adverse maternal and perinatal outcomes. This study aimed to assess any adverse maternal and perinatal morbidity related to UTI in pregnancy, focusing on identifying common uropathogens and their antibiotic sensitivity and resistance patterns. Methods We conducted a retrospective cohort study at Corniche Hospital, Abu Dhabi. The study population consisted of 549 women in the exposed group (i.e., those with at least one episode of UTI in pregnancy in 2018) and 329 in the comparison group (i.e., those without UTI). Statistical analysis was done using SPSS Statistics for Windows, Version 19.0 (SPSS Inc., Chicago, IL). The study's primary outcome measures were preterm birth, recurrent UTI, pyelonephritis, and low birth weight (LBW). Results Women who had a UTI during pregnancy had more preterm deliveries than those without a UTI (c2=7.092; p=0.007). Recurrent UTI was observed in 26.6% of women with UTI, while the incidence of pyelonephritis was relatively low in this group (1.45%). There was no significant association between LBW and UTI in pregnancy (c2=0.097; p=0.756). The most common bacteria isolated from women with UTI were Group B Streptococcus (GBS, 31.3%), followed by Escherichia coli (30.9%). They were sensitive to a wide range of antibiotics. Conclusion According to our results, significant predictors of bacteriuria in pregnancy history include UTI, renal calculi, and nulliparity. Women with UTI in pregnancy are more likely to have preterm delivery. However, adequate management can minimize other complications like pyelonephritis and adverse perinatal outcomes. Available evidence prompts the recommendation of routine screening for asymptomatic bacteriuria (ASB) in early pregnancy to minimize complications and identify those women at significant risk for preterm delivery.
... The prevalence, however, was lower than similar studies conducted at the Cape Coast Teaching Hospital (56.5%) and the Ghana Police Hospital (31.6%) (Boye et al., 2012;. Other studies conducted in Saudi Arabia, Uganda, Sudan, and Nigeria reported a higher prevalence of ASB among pregnant women (Al-mijalli, 2017;Andabati and Byamugisha, 2009;Ezeome et al., 2006;Hamdan et al., 2011;Oli et al., 2011) whereas studies conducted in United Arab Emirate and Northwest Ethiopia showed lower prevalence (Abdullah and Al-Moslih, 2005;Alemu et al., 2012). The varying prevalence among these studies is a result of the varying population characteristics including age, educational level, genital and personal hygiene, socioeconomic status and habits of the community, health care during pregnancy, and sexual activities. ...
Article
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Asymptomatic bacteriuria can lead to urinary tract infections in as many as 20% of pregnant women. Asymptomatic bacteriuria in pregnancy can also lead to preterm births and low birth weights. The objective of this study was to profile uro-pathogens and describe the population-based prevalence, the antimicrobial sensitivity pattern, and ascertain the risk factors for asymptomatic bacteriuria among pregnant women attending the antenatal clinic of Ho Teaching Hospital, in Ghana. Urine samples were cultured, isolates identified and antibiotic sensitivity testing was done using the Clinical and Laboratory Standard Institute (CLSI) guidelines. 46 (13.7%) out of 335 pregnant women had asymptomatic bacteriuria. The most frequently isolated bacteria were Pseudomonas species (26.1%) followed by Escherichia coli (21.7%). All isolates (n=46; 100%) were resistant to Augmentin whereas 87% of the isolates (n=40) were susceptible to Gentamicin. However, most of the isolates were multi-resistant to antibiotic drugs. No education (p=0.019) and first trimester (p=0.046) of pregnancy were risk factors for asymptomatic bacteriuria. Pseudomonas aeruginosa was the most frequent organism isolated. All the uro-pathogens were resistant to Augmentin, while high rates of resistance to Tetracycline, Amikacin, Norfloxacin, and Levofloxacin were observed. The study reveals that asymptomatic bacteriuria was significantly associated with the first trimester of pregnancy and having no education.
... Asymptomatic Bacteriuria refers to the presence of bacteria in the urine of a patient without showing any signs and symptoms. It is a condition in which urine culture reveals a significant growth of pathogens that is greater than 10 5 bacterial/ml, but without the patient showing symptoms [1]. Asymptomatic bacteriuria is common during pregnancy, the apparent reduction in immunity of pregnant women appears to encourage the growth of both commensal and non-commensal organisms. ...
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The purpose of this research work is to compare the activity of medicinal plant(Aframomum melegueta) and conventional antibiotic against Asymptomatic Bacteriuria isolates from pregnant women attending antenatal clinic in a major primary health center in Akoko, south ,Ondo state Nigeria. The target Asymptomatic Bacteriuria isolates which is inherent in pregnant women with no observable features. The rate of growth/ death of Asymptomatic Bacteriuria Isolates were x-rayed. Bacteria were isolated from Urine of pregnant women attending antenatal clinic in Public health care Akungba Akoko, Ondo state, Nigeria and were identified using conventional method. The antibiotic susceptibility test and antimicrobial screening of ethanol seed extract of Aframomum melegueta were determined using disc diffusion and agar well diffusion methods respectively. The eleven(11) bacteria identified were Klebsiella pneumoniae (three,3), Proteus mirabilis, Proteus vulgaris, Bacillus subtilis(Two,2),Pseudomonas aeruginosa, Enterobacter cloacae (Two,2), Escherichia coli (three,3), Bacillus cereus, Serratia mercesiens, Enterobacter aerogens. E. coli and klebsiella pneumoniae were the most common isolates. The second most common isotales was Original Research Article Osuntokun et al.; IJPR, 8(2): 12-43, 2021; Article no.IJPR.74930 13 Enterobacter cloacae.. Klebsiella pneumonia and Proteus mirabilis were resistant to Ampicillin, Ceporex, Nalixadic acid and Septrin. E. coli, the most common isolate was sensitive to Gentamycin and most of the antibiotics used. The antimicrobial screening of ethanol seed extract of Aframomum melegueta shows zones of inhibition with diameter ranging from 1-25mm. Secondary metabolite screening indicates the presence of flavonoid, tannins, saponins, alkaloids, cardiac glycosides. Ultraviolet spectrophotometer was also used to determine the Growth dynamic /Death rate of the isolates, the addition of antibiotics to the organism at the 48 th hour speed up the death rate of the isolates, the addition of ethanol seed extract at the 48 th hour also speed up the death rate of the isolates from the urine samples. The results of this study validate the use of Aframomum melegueta seed in the traditional treatment of Asymptomatic bacteriuria in pregnant women.
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Objective: Urinary tract infection (UTI) is the most common bacterial infections during pregnancy. It is associated with different maternal and neonatal adverse outcomes such as low birth weight, preterm birth, still birth, preeclampsia, maternal anemia, sepsis, and amnionitis, even when the infection is asymptomatic. However, in Ethiopia, it is represented with fragmented and inconclusive pocket studies. Therefore, this systematic review and meta-analysis is aimed at estimating the pooled prevalence of UTI and its associated factors among pregnant women in Ethiopia. Methods: PubMed/Medline, Embase, Cochrane Library, Google Scholar, and local sources were used to access eligible studies. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was applied for critical appraisal. Heterogeneity and publication bias were evaluated using I 2 statistic, funnel plot asymmetry, and Egger's tests. Random effect model was employed to estimate the pooled burden of UTI and its associated factors among pregnant women with its corresponding odds ratio (OR) and 95% confidence interval (CI). Result: From all systematically searched articles, 14 studies were eligible for this analysis. The overall pooled prevalence of UTI among pregnant women in Ethiopia was 15.37% (95% CI: 12.54, 18.19). Family monthly income (OR = 3.8 and 95% CI: 1.29, 11.23), parity (OR = 1.59 and 95% CI: 1.01, 2.50), history of catheterization (OR = 2.76 and 95% CI: 1.31, 5.84), and history of UTI (OR = 3.12 and 95% CI: 1.74, 5.60) were factors significantly associated with UTI among pregnant women in Ethiopia. Conclusion: The overall pooled estimate of UTI among pregnant women in Ethiopia was higher compared with CDC estimation which was 8%. Family monthly income < 1000ETB, multipara, previous history of catheterization, and history of UTI were factors increased burden of UTI during pregnancy. So, strategies targeting in economic reforms, universal access of family planning, and standardized prenatal care service should be addressed to alleviate this high prevalence of UTI during pregnancy.
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Urinary tract infections (UTI) are the most common bacterial infections during pregnancy and these infections. Untreated UTI can be associated with serious obstetric complications. This cross-sectional study was carried out to determine the prevalence of UTI among symptomatic and asymptomatic pregnant women attending Bugando Medical centre (BMC) in Mwanza, Tanzania. A total of 247 pregnant women were enrolled, of these 78 (31.5%) were symptomatic and 169 (68.4%) asymptomatic. UTI was diagnosed using mid stream urine (MSU) culture on standard culture media and urinalysis was done using rapid dip stick. The prevalence of bacteriuria among symptomatic and asymptomatic pregnant women were 17.9% and 13.0% respectively, with no significant difference between the two groups (p = 0.307). Using univariate analysis there was no association of parity (p = 0.825), gestational age (p = 0.173), education (p = 0.615), age (p = 0.211) and marital status (p = 0.949) with bacteriuria. The sensitivity and specificity of urine dipstick was 38.9% and 86.7% respectively. Escherichia coli (47.2%) and Enterococcus spp (22.2%) were the most commonly recovered pathogens. The rate of resistance of Escherichia coli to ampicillin, tetracycline, sulfamethaxazole/trimethoprim, gentamicin, ciprofloxacin, nitrofurantoin, ceftriaxone, and imipenem were 53%, 58.8%, 64.7%, 5.9%, 11.8%, 5.9%, 29.4% and 0%, respectively. In conclusion, asymptomatic bacteriuria among pregnant women is prevalent in our setting and majority of Escherichia coli are resistant to ampicillin, tetracycline, SXT and ceftriaxone. Due to low sensitivity of rapid dip stick, routine urine culture and susceptibility testing is recommended to all pregnant women at booking.
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Knowledge of antimicrobial resistance pattern in Escherichia coli, the predominant pathogen associated with urinary tract infection (UTI), is important as a guide in selecting empirical antimicrobial therapy. The aim of this study was to determine the antibiotic susceptibility patterns of E. coli strains isolated from adult outpatients with UTI, in Izmir, Turkey. This study was performed with isolates from outpatients with UTI, collected from 5 university and tertiary-care hospitals in Izmir, Turkey. Isolates were analyzed by standard methods and antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method. A total of 4,534 E. coli strains (3,449 females and 1,085 males) were examined. Antibiotic resistance rates of the isolates for female and male, respectively: Ampicillin (61.8%, 78.7%), amoxicillin-clavulanic acid (36.6%, 59.1%), cefuroxime (22.5%, 41.3%), cefotaxime (18.2%, 35.8%), piperacillin-tazobactam (11.6%, 31.2%), amikacin (8.3%, 13.9%), gentamicin (24.9%, 40%), trimethoprim-sulfamethoxazole (42.1%, 57.3%), and ciprofloxacin/norfloxacin (42.1%, 63.3%). Extended spectrum beta-lactamase rate was found to be 18.3% and 26.1% for females and males, respectively. The isolates were significantly more resistant to all antibiotics in men than in females in this study (p<0.001). The most important finding of our study is that a considerable proportion of the studied E. coli isolates were resistant to most antibiotics except amikacin. These data provide useful information for clinicians in determining the appropriate empirical antimicrobial regimen, and help authorities to formulate antibiotic prescription policies.
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Uropathogenic Escherichia coli are increasingly becoming resistant to flouroquinolones and to other commonly available antimicrobials. We sought to investigate the genetic basis for fluoroquinolone and extended spectrum beta-lactam (ESBL) resistance in 17 fluoroquinolone-resistant (MIC of levofloxacin and ciprofloxacin >32 microg/ml) E. coli isolated from patients with urinary tract infections (UTIs). We applied PCR and Pulsed Field Gel Electrophoresis (PFGE) to characterize resistance genes and to determine clonal relatedness of strains, respectively. Twelve of the 17 E. coli were resistant to multiple drugs, including ampicillin, co-amoxyclav, cefotaxime, ceftriaxone, ceftazidime and gentamicin and nalidixic acid and produced plasmid-mediated CTX-M-15 type ESBLs and CMY-2 AmpC type enzymes. The other 5 E. coli that were non-ESBL-producing were multiply resistant to ampicillin, nitrofurantoin, cefoxitin, nalidixic acid. Resistance to fluoroquinolones resulted from a combination of the presence of qnrA, qnrB, ciprofloxacin acetylating enzyme designated aac(6')-1b-cr, and mutations in the two amino acid substitutions; 83 Serine (TCG) to Leucine (TTG) and 87 Aspartic acid (GAC) to Asparagine (AAC). Antibiogram patterns and PFGE of E. coli showed that these were community acquired UTI caused by pockets of clonally-related and some discreet strain types. Plasmid-mediated CTX-M-15 beta-lactamases and CMY-2 AmpC enzymes and fluoroquinolone resistant E. coli are becoming increasingly prevalent in hospitals in Kenya, posing a major challenge in the management of UTIs.
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Background: Data regarding the evolution of antimicrobial resistance are needed to suggest appropriate empirical treatment of urinary tract infections (UTI) in developing countries. To assess the antimicrobial susceptibility of Escherichia coli, the predominant pathogen in community-acquired UTI, a prospective multicenter study was carried out in Dakar, Senegal. Methodology: From February 2004 to October 2006, 1010 non-duplicate E. coli strains were collected from four centres. Antimicrobial susceptibility testing was performed using disk diffusion method according to the recommendations of the CA-SFM (2004). Results: Most of the isolates were resistant to amoxicillin (73.1%), amoxicillin-clavulanic acid (67.5%), cephalothin (55.8%), and trimethoprim/sulfamethoxazole (68.1%). Extended spectrum beta-lactamase was detected in 38 strains. The overall resistance rates to nalidixic acid, norfloxacin and ciprofloxacin were 23.9%, 16.4% and 15.5%, respectively. Most of the strains were susceptible to gentamicin, nitrofurantoin and fosfomycin (respective susceptibility rates, 93.8%, 89.9%, and 99.3%). During this period, a significant decrease in sensitivity was observed for cephalothin, fluoroquinolones and trimethoprim/sulfamethoxazole (p<0.001). Conclusions: These data suggest that trimethoprim/sulfamethoxazole may no longer be used as empirical treatment for community-acquired UTI in Dakar. In order to preserve the activity of fluoroquinolones for future years, alternatives such as fosfomycin or nitrofurantoin should be considered.
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A case-control study determined the association of urinary tract infection (UTI) with genital hygiene practices and sexual activity in pregnant women attending prenatal clinics in Babol, Islamic Republic of Iran. A sample of 100 pregnant women with positive urine cultures (cases) were compared with 150 healthy pregnant women matched for age, social, economic and education status and parity (controls). Escherichia coli was the infecting organism in 83% of cases. Factors associated with UTI included sexual intercourse > or = 3 times per week (OR = 5.62), recent UTI (OR = 3.27), not washing genitals precoitus (OR = 2.16), not washing genitals postcoitus (OR = 2.89), not voiding urine postcoitus (OR = 8.62) and washing genitals from back to front (OR = 2.96).
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To determine the prevalence of obesity and its effect on maternal and fetal outcomes among pregnant women at the Johannesburg Hospital, South Africa. A retrospective study of 767 pregnant women divided into BMI groups. Complications such as pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), urinary tract infection (UTI), preterm labor, preterm rupture of membranes (PROM), induction of labor (IOL), postdates, fetal weight, and fetal outcome were compared among the BMI groups. Seasonal variation in BMI was measured. Descriptive statistics included mean with 95% confidence interval or median with interquartile range. Inferential statistics included t test, chi(2) test, analysis of variance (ANOVA), and analysis of covariance. Among the study population, 337 (44%) were obese or morbidly obese. The complications of GDM (P<0.001), UTI (P=0.002), and failed IOL (P=0.003) were significantly more common among morbidly obese women. There was no seasonal variation in BMI. The prevalence of obesity in pregnancy was high in South African women and was associated with an increase in complications.
Article
To determine the frequency, risk factors and pattern of urinary complaints during pregnancy. A descriptive study was conducted in the Obstetric and Gynaecology Department of Isra University Hospital, Hyderabad from 1st January to 30th August 2008. Total 232 women were selected to ascertain the frequency and pattern of urinary symptoms as well as the risk factors of urinary tract infection (UTI) such as age, parity, education, past history of UTI and haemoglobin among women attending an antenatal clinic. All pregnant women irrespective of age, parity and gestational age were included, while women with known underlying renal pathology, chronic renal disease, renal transplant, diabetes or taking immunosuppressant therapy were excluded. Informed consent was taken and data collected on a self designed proforma. All the women underwent complete examination of urine. Dipstick test was performed on midstream urine and urine was cultured incase of positive dipstick test and women with urinary symptoms. Data was analyzed on SPSS version 11. Odds ratio and 95% confidence interval were calculated among the categorical parameters by applying the Fisher's exact test. Out of 232 women, 108(46.5%) reported urinary symptoms which were due to pregnancy induced changes on urinary system as no growth was obtained on urine culture, while 10 (4.3%) were due to underlying UTI. Most common urinary symptom in these women was abnormal voiding pattern 85 (40.3%) followed by irritative symptoms and voiding difficulties. Illiteracy, history of sexual activity, low socioeconomic (monthly income < Rs. 10,000 / month) group, past history of UTI and multiparity were found to be risk factors for UTI in these women. On complete urine examination, 222 (95.6%) patients either did not reveal any pus cells or had less than 5 WBC/HPF. Out of 108 cultures, only 10 (4.3%) specimens showed growth. E-coli was the most commonly detected organism 7 (3%) followed by S-aureus in 3 (1.3%). The common urinary symptoms encountered in the studied women were abnormal voiding pattern followed by irritative symptoms. Majority of urinary symptoms were due to pregnancy related changes in the urinary system. Past history of UTI, sexual activity, lower socioeconomic group and multi parity were significant risk factors for UTI.