ABSTRACT
Urine Sample from pregnant women were analysed for bacteriuria. The result of irinalysis reveals the appearance –yellow and Cloudy, pH 6.0, protein-ve, Glucose-ve,Blood-ve, Urobilinogen. Normal, Ketone-ve, Nitrate tve, Bilirubin-ve, Ascobic acid –ve in some of the samples. The result of urine microscopy reveal pus cells. 4-6/HPF, Epithelial cell +++, red cells nil, yeast cells nil, crystal nil. Bacterial isolated from the culture include. Staphylococcus aureus, Escheriachia Coli, Klebsiella Spp. The sensitivity test conducted gave the following results. Staphylococcus aureus was sensitive to streptomycin(++), Ciprofloxacin (+++), Amoclox(+) and resistant to cefuroxine. Klebsiella Spp was sensitive to Ciprofloxine (+++) Ofloxacin (++) and resistant to streptomycin, Ampicillin, Ceporex and Nalidixic acid. Eschriachia Coli was sensitive to gentamycin (++), Ofloxacin (+++), Streptomycin (+++) and resistant to Amoxlox and Ampicillin.
CHAPTER ONE
INTRODUCTION
1.1 Background of 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 millions visits to out patient clinic, 1 million visits to emergency departments, and 100,000 hospitalization annually (5) (chin et al 2011).
Many different microorganisms can cause urinary tract infection (UTIS), though the most common pathogens causing the simple ones in the community are Esherichia Coli and other Enterobacteriacae, which accounts approximately 75% of the isolates (Kebira et al, 2009).
In complicated Urinary tract infections and hospitalized patients, organisms such as Enterococcuss Faecalis and Highly resistant, gram-ve rods including Pseudomoinas Spp. are comparatively more common. The relative frequency of the pathogens varies depending upon age, sex, catheterization and hospitalization.
Urinary tract infection cases is often started empirically an therapy is based on information determined from the antimicrobial resistance pattern of the urinary pathogen. However, a large proportion of uncontrolled antibiotic usage has contributed to the emergency of resistant bacterial Infections (7-10). As a result, the prevalence of antimicrobial resistance among urinary track has been increasing world wide. (Biadglegene. et al, 2009).
Associated resistance i.e, the fact that a bacterium resistant to one antibiotics is often much more likely to be resistant to other antibiotics, drastically decreases the chances of getting a second empirical attempt right. Resistance rates to the most common prescribe drugs used in the treatment of (UTI) vary considerably in different areas, world-wide. The estimation of local etiology and susceptibility profile could support the most effective empirical treatment. Therefore, investigating epidemiology of (UTIS), the prevalence risk factors, are bacterial isolates and antibiotics sensitivity is fundamental for care givers and health planner to guide the expected intervention.
• Statement of the Problem
In most developing countries including Nigeria, screening for UTI in pregnancy using microbial culture is not considered as an essential part of antenatal care (ANC) (Alemu et al., 2012). Moreover, routine culture test is not carried out for antenatal patients instead many clinicians choose for the strip urine analysis method for assessing urine in pregnant women (Lele et al., 2016). The true picture such specimen cannot quantify the extent of infection in such a patient as well as provide antimicrobial therapy, which is usually seen as a case of culture test. Antibiotics are usually given empirically before the results of a urine culture are performed. To ensure appropriate therapy, current knowledge of the organism that causes UTIs and their antibiotic susceptibility pattern is important (Getachew et al., 2012).
Under the administrative center of Southern Nations Nationalities People Region of Nigeria (SNNPR), Nsukka University Comprehensive Specialized Hospital (ESUTH) is the one which is equipped with microbiology laboratory that provides culture and drug susceptibility tests. There is a trend among professionals who are working at health centers and hospital level to diagnose patient’s particularly pregnant women who visit the ANC clinics to confirm UTI (Tadesse et al., 2014). Rather they are engaged to use urine microscopy with color chromatographic tests or urine dipstick test which doesn’t explain which bacteria caused the infection (Lele et al., 2016). Those trends with the above mentioned problems have initiated to conduct research on this thematic area in addition to the absence of similar published studies done in the study area to provide a possible approach to the treatment. There is no evidence that determines the prevalence of urinary bacteria among pregnant in Nsukka, Southern Nigeria. Although symptoms are good markers of UTI during pregnancy special care has to be directed towards the asymptomatic cases (Murtaza, 2002). Therefore, the primary aim of this study is to determine uropathogens and drug susceptibility pattern in order to create awareness and base line evidence for health professionals to use appropriate empirical treatment in line with microbiological tests for those who are working hospital and health centers, as well as for the policy makers for the improvement of maternal and child health.
• Significance of the Study
The finding of this study provides evidence based guidance to shift/choose the drug regimen that is commonly prescribed to urinary tract infections for decision making body and to the health professional who are working at the health institutions. This study was also determining urinary bacteria and drug susceptibility pattern in order to create awareness to the community and base line evidence for health professionals to use appropriate empirical treatment in line with microbiological tests for those who are working hospital and health centers, as well as for the policy makers for the improvement of material and child health.
The data of our finding to give an area based prevalence of urinary tract infection among symptomatic and asymptomatic pregnant, so as it helps to provide sustainably and enough distribution of the therapy by health institution and the other concerned body. The finding of our study also helped in improving the health of the mother and the baby.
• Objectives
• General objective
To evaluate the bacterial profile, antibiotic susceptibility pattern and associated risk factors of UTI among pregnant women attended ANC at Nsukka University Comprehensive Specialized, Hospital (ESUTH) from (March to July, 2023)
• Specific objectives
• To find out the magnitude of urinary tract infection among pregnant women attended ANC at ESUTH.
• To assess the distribution of uropathogen isolated from both symptomatic and asymptomatic UTI among pregnant women attended ANC at ESUTH.
• To determine the antimicrobial sensitivity pattern of bacteria causing urinary tract infection among pregnant women attended ANC at ESUTH.
• To identify the associated risk factors for UTI among pregnant women attended ANC at ESUTH.
• Research questions
This study was answering the following basic questions:
• What is the magnitude of UTI among pregnant women attended ANC at ESUTH?
• Do urinary bacterial pathogens are isolated from both symptomatic and asymptomatic pregnant with UTI?
• Which bacterial species have the most antimicrobial sensitivity pattern commonly prescribed for UTI in pregnant women attended ANC at ESUTH?
• What are different factors were identified likely to increase risk of UTI?
• Limitation of the Study
During conducting this research work the researcher was faced many constraints. Those were:
• Has a higher cost.
• A longer time is needed to achieve the number of bacterial colonies necessary for a sensitive result.
• It needs professionals and laboratories qualified for its elaboration.
• Gap giving appropriate information during the interview due to lack of awareness on pregnant women and the like some of the main challenges/ limitations for the research work.
• Scope of the Study
This study was target/focused on the assessment of the bacterial profile, antibiotic susceptibility pattern and associated risk factors of UTI among pregnant women attended ANC. It was specifically being conducted in Nsukka University Comprehensive Specialized Hospital (ESUTH), Southern Nigeria.
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