Prevalence and antimicrobial susceptibility patterns of urinary tract infections among expectant mothers attending Kasangati Health Centre-IV, Wakiso District, Uganda
Mon, Isaac Dak Thou
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Urinary tract infections (UTIs) are the most common bacterial infections during pregnancy. Untreated UTI can be associated with serious obstetric complications. This cross-sectional study was carried out to determine the prevalence and antimicrobial susceptibility patterns of UTI among expectant mothers attending antennal services at Kasangati Health Centre IV, Wakiso district- Uganda. A total of 150 pregnant women were enrolled in this study. 150 clean catch midstream urine samples were collected and general urine microscopic examination and culture were carried out, information on the age, gestational age, level of education and residence were also collected. Susceptibility testing patterns of the following antibiotics: Gentamycin, tetracycline, amoxicillin/clavulanic acid, ampicillin, erythromycin, trimethoprimsulfamethoxazole, ciprofloxacin, and ceftriaxone were tested against the isolated organisms using disc diffusion method. UTI was diagnosed using clean-catch mid-stream urine (MSU) culture. Using > 105 colony forming unit per milliliter as significant level of bacteriuria. The prevalence of culture-positive urine samples in this study was 20.7% (31/150). Five different bacteria were isolated in this study (E. coli, Streptococcus spp, Coagulase negative staphylococcus, coagulase positive staphylococcus and an Enterococci). E. coli was the most isolated bacteria followed by Streptococcus spp and coagulase negative Staphylococcus. Microscopic examination of the 150 samples revealed high percentage of pus cells and low percentage of red blood cells. 26% (n=39) of the urine samples had pus cells and 22% (n=33) were significant (>5) pus cells, 30% (n=45) of the samples had red blood cells present. Urine culture results showed 20.7% (31/150) urine samples had significant growth of bacteria where as 74% (111/150), 4% (6/150) and 1% (2/150) of the samples had non-significant growth, mixed growth and no growth respectively. For Gram staining of the significant cultures, 51.6% (n=16%) were Gram positives and 48.6% (n=15) were Gram negatives. Majority of the isolates were Gram positive (51.6%) with Staphylococcus spp being the most frequent isolate followed by Streptococcus spp and Enterococci spp (50%, 43.75% and 6.25% respectively). E. coli was found to be the only Gram-negative isolate (48.4%). Generally, E. coli and Staphylococcus species were sensitive to Gentamicin, Imipenem, ciprofloxacin and Ceftriaxone and they were resistant to Ampicillin, Trimethoprim-Sulfamethoxazole and Tetracycline. In conclusion, the overall prevalence of urinary tract infection among the pregnant women was 20.7%. The prevalence of asymptomatic and symptomatic UTI among the study participants was 11.1% (9/123) and 14.8% (4/27) respectively. E. coli was the most common etiological agent of UTI in pregnancy followed by Streptococcus spp. This study found a number of bacterial isolates with high resistance to the commonly prescribed drugs from pregnant women with UTI. Generally, E coli and Staphylococcus species were sensitive to Gentamicin, Imipenem, ciprofloxacin and Ceftriaxone and were resistant to Ampicillin, TrimethoprimSulfamethoxazole and Tetracycline. Streptococcus spp and enterococcus spp were sensitive to Ampicillin, Penicillin and Erythromycin and were generally resistant to TrimethoprimSulfamethoxazole and Tetracycline. these were commonly prescribed antibiotic agents that were exhibiting antibiotic resistance and hence need to carry out sensitivity testing for expectant mothers with suspected symptoms of UTIs. These findings underscore the importance of screening all pregnant women for significant bacteriuria, so that positive cases should be treated subsequently with the most appropriate antibiotics in order to reduce the adverse effects on both maternal and foetal health.