Asymptomatic Bacteriuria in Pregnant Women - Study at a Tertiary Maternity care Hospital in Hyderabad

Abstract

Journal homepage: http://www.ijcmas.com Urinary Tract Infections (UTIs) commonly occurs in pregnancy, due to the morphological and physiological changes that take place in the genitourinary tract.Asymptomatic bacteriuria refers to the presence of bacteria in urine, and is a condition in which urine culture reveals a significant growth of pathogens that is greater than 10 5 bacteria/ml, but without the patient showing symptoms (Gilbert et al., 2005). The apparent reduction in immunity of pregnant women appears to encourage the growth of both commensal and non-commensal microorganisms (Scott et al., 1990). The most untoward consequence of Asymptomatic bacteriuria in pregnancy is severe renal damage. Asymptomatic bacteriuria in some woman may lead to pyelonephritis or cystitis during pregnancy, while in others there may be no symptoms of urinary tract infection through-out gestation, but may develop urinary tract infection during puerperium. Pregnancy enhances the progression from asymptomatic to symptomatic bacteriuria which could lead to pyelonephritis and adverse obstetric outcomes such as prematurity, low birth weight (Connolly and Thorp, 1999) and higher fetal mortality rates (Nicolle, 1994;Delzell and Leferre, 2000). This study therefore was carried out to determine the prevalence of Asymptomatic bacteriuria (ASB) in pregnant women and to isolate, identify the causative organisms; and to test the antimicrobial susceptibility of isolated pathogens. A total of 200 pregnant women who came for ante-natal checkup in outpatient department at Govt. Maternity Hospital, Nayapool. Hyderabad were studied over a period of one year. Clean catch midstream urine sample was collected into a sterile container and then subjected to culture method. Out of 200 patients studied, significant bacteriuria was noted in 36 (18%) cases and 8(4%) patients had insignificant bacteriuria. Highest incidence of 22 cases (61.11%) were reported in the age group of 26-35 years. It was found that Asymptomatic bacteriuria showed significant increase with respect to parity, higher incidence was seen in multi gravidae 58.9% (3 and 4th parity). Incidence of Asymptomatic bacteriuria was found to decrease with the increase in gestation time, maximum number were noted in first trimester 19 (52.78%) followed next by second trimester 13 (36.11%) and in third trimester 4 (11.11%). E. coli 20 (55.56%),was the most common etiological agent followed by Klebsiella spp in 9 cases (25%) Coagulase negative Staphylococcus in 2 cases (5.56%) and Pseudomonas spp in 2 cases (5.56%), Proteus mirabilis and Enterobacter, Staphylococcus aureus each in one case (2.78%) all the strains were sensitive to imipenem and meropenem. As asymptomatic bacteriuria is associated with complications in pregnancy, it is therefore imperative that pregnant women be screened for bacteriuria, periodically in every trimester of the gestational period. Routine urine culture tests should be carried out for all antenatal women to detect asymptomatic bacteriuria, and every positive case should ...

Effectiveness of antenatal screening of asymptomatic bacteriuria in reduction of prematurity and low birth weight: Evaluating a point-of-care rapid test in a pragmatic randomized controlled study

“…To help achieve the required sample size and to facilitate the resource mobilization for the study site, the study was conducted in a government tertiary care hospital, Gandhi Hospital, Secunderabad, India, from February 2017 to February 2018. The study hospital receives walk-in patients mostly from the areas within and around Secunderabad and Hyderabad, which are twin cities in the state of Telangana, India with a combined population of nearly 700,000, and a reported prevalence of ASB in pregnancy as 18% [21] . Referred patients from even other districts of Telangana are also catered by the hospital since it is a tertiary care hospital.…”

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“…Indeed, the higher tWBC in the present study confirms the value recently reported by Musa and colleagues (2016) among pregnant women undergoing antenatal care in a sister tertiary health institution in Sokoto. Whether the higher leucocytosis in the third trimester of pregnancy in our results was due to physiological leucocytosis of pregnancy (Wang et al, 2016;Malikarjun et al, 2018), even when a similar northern Nigerian average is lower could still be explained in possible differences in the stress (pregnancy and otherwise) which these groups of pregnant women undergo and for our study which focused only on the third trimester during which stress is expected to be more profound requires further research. Given that these study groups were from the different geo-political zones of Nigeria with their different culture and women lifestyles, and stress levels during pregnancy may be a possible explanation as pointed out to be a major factor in leukocytosis of pregnancy (Chandra et al, 2012).…”

“…Third trimester of pregnancy is associated with some form of stress including those arising from the rapidly growing foetus and uterus (Ciliberto andGertie, 1998, Kaur et al, 2014). This stress, together with some other factors of pregnancy require the body immune systems adjusting to meet up the challenges (Mor and Cardenas, 2010) and may be reflected in WBC profile seen as leucocytosis (Pughikumo et al, 2015, Gebreweld et al, 2018, Wang et al, 2016, Malikarjun et al, 2018Duru et al, 2016). This however, doesn't exclude the presence of some other reasons that may occasion leucocytosis in pregnancy such as infection (Ramsay, 2010;Serrano et al, 2011) or gestational diabetes mellitus (Pattanathaiyanon et al, 2014).…”

Bacteriological profile and antibiogram of uropathogens isolated from obstetrics and gynaecology patients in a tertiary care hospital

“…This was similar to a study conducted by Nahab et al done among pregnant women in Al Samawa City of Iraq, Rosana et al in a community health centre in Jakarta, Indonesia, and Rao in a tertiary maternity care hospital in Hyderabad. 19,25,26 On the contrary, fewer studies found K. pneumoniae as the dominant uropathogen. 27 After E. coli, Enterococcus species (19.7%), K. pneumoniae (16.7%) were the dominant pathogens in this study.…”