ABSTRACT
Asymptomatic bacteriuria refers to the presence and multiplication of bacteria in the bladder urine in the absence of symptoms of urinary tract infection. Asymptomatic bacteriuria has been observed to be a strong criterion for urinary tract infection. It is therefore a means of predicting urinary tract infection (UTI). It is common among pregnant women and females. Untreated asymptomatic bacteriuria (ASB) during pregnancy may cause serious complications such as pyelonephritis and delivery of premature or low birth weight infant. This study assessed the prevalence of asymptomatic bacteriuria and the antibiotic susceptibility pattern of the urinary bacterial isolates from pregnant women attending antenatal care clinic at Abia state University Teaching Hospital, Aba, Abia State, Nigeria. Mid-stream urine samples were collected from 100 pregnant women attending antenatal care at Abia state University Teaching Hospital, Aba, Abia State, Nigeria between the ages of 18-49 years. Each specimen was cultured on Cystine Lactose Electrolyte Deficient (CLED) agar using standard bacteriological methods. Identification of suspected colonies and antibiotic sensitivity testing were done. Thirty-eight samples (38) which represent 38.0% showed significant bacteriuria while 62 samples (62.0%) showed no bacteriuria or no significant bacterial growth. Escherichia coli was found to be the most predominant, (36.8%) followed by Proteus spp, (21.1%), Psedomonas aeruginosa (18.4%), Staphylococcus aureus (15.8%) and the least Klebsiella spp. (7.9%). Nitrofurantoin, Ciprofloxacin, Ofloxacin, Gentamicin and Ceftazidime were very effective antimicrobial agents against the isolates while the isolates were highly resistant to Cefexime and Augmentin (Co-amoxiclav). E. coli was the most common bacteria for asymptomatic bacteruria among pregnant women attending antenatal care at Abia state University Teaching Hospital, Aba, Abia State, Nigeria in this study. Education on the importance of inclusion of urine screening in antenatal care should be emphasized.
TABLE OF CONTENTS
Title Page i
Certification ii
Dedication iii
Acknowledgements iv
Table of Contents v
List of Tables vi
List of Figures vii
Abstract x
CHAPTER
ONE
1.0
Introduction 2
1.1
Aim and objectives 3
1.1.1
Aim 3
1.1.2 Objectives 3
CHAPTER TWO
2.0 Literature
review 5
2.1 Urinary
tract infection (UTI) 5
2.2 Asymptomatic
bacteriuria 7
2.2.1 Historical aspects 8
2.2.2 Causes and pathogenesis of asymptomatic bacteriuria 9
2.3
Etiology of urinary tract infection 10
2.4 Incidence
of urinary tract infection 11
2.5 Epidemiology 12
2.6 Risk
factors for asymptomatic bacteriuria 14
2.7 Prevalence
of asymptomatic bacteriuria 15
2.8 Classification
of urinary tract infection 17
2.8.1 Lower urinary tract infection 17
2.8.2 Upper
Urinary Tract Infection 17
2.8.3 Uncomplicated
Urinary Tract Infection 17
2.8.4 Complicated
Urinary Tract Infection 17
2.9 Outcome
of asymptomatic bacteriuria 18
2.10 Complications 18
2.11 Treatment
of asymptomatic bacteriuria 22
2.12
Pathogenic organisms causing urinary tract
infection 23
2.12.1 Escherichia
coli 24
2.12.2 Staphylococcus aureus 24
2.12.3 Klebsiella spp. 24
2.12.4 Pseudomonas spp. 25
CHAPTER
THREE
3.0 Materials and method 26
3.1 Study
area 26
3.2 Study
population 26
3.3
Sample
collection 26
3.4 Media preparation 27
3.5
Inoculation
and isolation 27
3.6
Identification and
characterization of isolates 27
3.6.1 Gram stain technique 27
3.7
Biochemical
tests 28
3.7.1
Catalase test 28
3.7.2 Oxidase
test 28
3.7.3
Coagulase test
3.7.4 Indole test 28
3.7.4
Citrate utilization test 29
3.7.5
Triple sugar iron agar (TSIA) 29
3.8
Antibiotic
sensitivity testing 30
CHAPTER
FOUR
4.0
Results 32
CHAPTER
FIVE
5.0
Discussion 37
5.1 conclusion 39
5.2 references
Appendix
LIST OF TABLES
TABLES TITLE PAGES
1 Socio-demographic
characteristics of women attending antenatal care at Abia State
University Teaching
Hospital, Aba, Abia State.
Screened for asymptomatic
bacteriuria. 33
2.
Prevalence of bacteria isolated from urine of
pregnant women attending Antenatal care
at Abia State University Teaching
Hospital, Aba,
Abia State. 34
3 Antibiotic susceptibility
pattern of bacteria isolates from pregnant women attending
antenatal care at Abia State University Teaching Hospital, Aba, Abia State. 35
LIST OF FIGURES
FIGURE TITLE PAGE
1 Average
percentage susceptibility of different antimicrobial agents against bacteria isolates from urine samples
of pregnant women attending
antenatal care at Abia State University Teaching Hospital, Aba, Abia State. 36
CHAPTER ONE
1.0
INTRODUCTION
Bacteriuria is a clinical condition that refers to the
presence of one or more bacteria in urine. It is basically a disease condition
caused by a wide variety of bacteria. The upper urethra is the most frequent
site of infection within the urinary tract, but the entire system is always at
risk of invasion by bacteria once one of the parts is infected (Kunin, 1997).
The
term 'bacteriuria' means the presence of bacteria in urine. It may results from
contamination during or after collection of urine or it may indicate the
presence of bacteria in bladder urine.
To
distinguish among these possibilities, the term “significant bacteriuria” was
introduced which was defined as the occurrence of 105 or more
bacteria per ml of voided midstream urine aseptically collected. Bacteriuria
can be divided into symptomatic and asymptomatic (Kunin, 1997).
Asymptomatic bacteriuria refers to
the presence and multiplication of bacteria in the bladder urine in the absence
of symptoms of urinary tract infection while symptoms are present in
symptomatic cases.
Bacterial infections of the urinary
tract are commonly seen in outpatients, hospitalized patients and apparently
healthy populations.
Asymptomatic bacteriuria occurs
reliably more frequently in females as compared with males and it is a major
criterion of urinary tract infection (UTI) (Nurullaev, 2004). Reasons adduced to
this include shorter and wider urethra and its proximity to the anus.
Asymptomatic bacteriuria (ASB) accounts for 2-10% pregnancies in developed
countries while incidence is much more in developing and under- developed
countries.
Asymptomatic bacteriuria is a major
risk factor for the development of urinary tract infections (UTIs) during
pregnancy resulting in serious medical and obstetrical complications if untreated.
In pregnancy, various hormonal and mechanical changes lead to significant
alterations in the urinary tract like dilatation, decrease in peristalsis in
the ureter and decrease in bladder tone. In addition, the physiological
increase in plasma volume during pregnancy, decreases urine concentration
leading to decreased ability of the lower urinary tract to resist invading
organisms (Belty et al., 1998).These
changes have a profound impact on the acquisition and natural history of
bacteriuria and lead to an otherwise healthy woman susceptible to serious
infection complications. Also a number of conditions like low socioeconomic
status, multiparty, illiteracy, medical disorders like diabetes mellitus and
sickle cell trait are also associated with increased incidence of asymptomatic
bacteriuria in pregnancy.
Symptomatic
bacteriuria poses no problems because of its easy diagnosis and treatment due
to its overt symptoms but asymptomatic bacteriuria is difficult to diagnose
which is more common in pregnant women.
Therefore
to prevent untoward complications in the mother and baby that may arise due to
asymptomatic bacteriuria; it has been suggested to do routine screening for all
pregnant women attending the antenatal clinic even in the absence of symptoms (Maclean,
2001).
Knowledge of the nature, cause and outcome of
bacteriuria has obviously been based on the study of the development of
symptoms and signs over a period of time. This infection in adult usually leads
to the irritation of urethral mucosa, causing frequent painful urination with
turbid urine (Kaye and Santoro, 1979). In infants there may be unexplained
jaundice or an appearance suggestive of sepsis. In healthy individuals the
normal kidney and bladder urine are sterile, but the urethral and introital
flora consist largely of non-pathogenic Corynebacterium, Lactobacillus,
Staphylococcus epidermis, Gardnerel lavaginalis and non-haemolytic
streptococci, while E-coli may be absent or found in small quantities
(Farr, 1970).
The state of bacteriuria is detected by qualitative
urine culture indicated by finding more than 105 colony forming
units (CFU) (Buckley et al., 2000).
Urinary tract infection (UTI) is a common health
problem among women compared with men due to shorter urethra, closer proximity
of the anus with vagina, and pathogen entry facilitated by sexual activity
(Feltosa et al., 2009). It is
estimated that one in three women of childbearing age contracts urinary tract
infection which may manifest symptoms or remain asymptomatic (Duarte et al., 2008). Pregnant women are more
susceptible to urinary tract infection, owing to altered anatomical and
physiological state during pregnancy (Abdullah and Al-Moslih, 2005).
In Nigeria and many other developing
countries, routine urine culture for detecting asymptomatic bacteriuria is not
carried out for antenatal women probably due to cost and delay in obtaining
culture result (Imade et al., 2010).
Strip urinalysis is often preferred by most clinicians to culture in accessing
urine in pregnant women because of speed and simplicity. Though this method can
detect presence of protein, nitrite, and leucocytes esterase enzyme which may
suggest bacteriuria, its sensitivity is low (Colgan et al., 2006). Moreover, unlike culture, strip urinalysis fails to
identify the etiologic agents and the antibiotic sensitivity pattern. This
practice will not allow for proper management of urinary tract infection in
pregnant women attending antenatal care thus increasing their risk of coming
down with complications.
Due to the above reasons, the burden
of urinary tract infection in pregnant women and its associated complications
in this environment may still be highly underestimated.
1.2
AIM AND OBJECTIVES
1.2.1 AIM
The broad aim of this research is to determine the
prevalence of asymptomatic bacteriuria among pregnant women attending antenatal
care at Abia state University Teaching Hospital Aba, Abia State, Nigeria.
1.1.2 OBJECTIVES
1. To
determine the bacterial species in the urine sample of patients.
2. To
determine the antibiotic profiles of the bacterial isolates.
3. To
determine the demographics, those that affect/contribute more to/predispose
patients to infection.
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