Prevalence of asymptomatic bacteriuria in pregnancy, associated factors, uropathogens and their sensitivity patterns in women attending antenatal care in Mbale hospital.

Abstract

Background: Urinary tract infections (UTIs) are the most common nosocomial and community acquired infection Worldwide and is the leading cause for which antibiotics are prescribed in pregnancy. UTI is difficult to diagnose in pregnancy as its symptoms are quite confusing and at times taken as pregnancy associated symptoms while in other cases, it is asymptomatic (ASBP). ASBP is associated with various complications such as 30-40% incidence of pyelonephritis, pre-eclampsia, eclampsia, chronic renal disease, premature birth, low birth weight, postpartum UTIs and higher foetal mortality rates. Screening for ASBP has been proven essential and cost effective. Objectives: To determine the prevalence of ASBP, associated factors, uropathogens and their sensitivity patterns and phenotypic mechanisms of resistance in women attending antenatal care at Mbale Regional Referral hospital(MRRH). Materials and methods: This was a cross sectional study carried out at MRRH Antenatal clinic (ANC). Using a systematic sampling method, 587 ANC attending asymptomatic mothers of any gestation age were enrolled. Questionnaires were used to collect sociodemographic and clinical characteristics information. Urine dipsticks were used to screen for presence of asymptomatic bacteriuria positive samples were subjected to culture and drug sensitivity tests. Data was analyzed using STAT 15 and p values < 0.05 were considered statistically significant. Results: Out of the 587 urine samples collected, 22 grew on culture giving us ASBP prevalence of 3.75% (22/587). Median age of positivity was 28.5yrs (SD 6) and 26 yrs.(SD7) for negativity. Majority of participants were HIV negative (89.6%), Multigravida (72.1%) and with normal haemoglobin concentration (96.3%). The most statistically significant factor associated with ASBP was teenage age. The most common isolated uropathogens were E. coli (n=13, 46.4%) and S.aureus (n=9, 32.1%) respectively. Significant multidrug resistance patterns were exhibited. Most uropathogens exhibited over 50% to the commonly used drugs in UTI management leaving us with Cephalosporins, carbapenems, Vancomycin and gentamycin as alternative choices. Conclusion and recommendations: ASBP is common in Eastern Uganda. Screening and treatment based on culture and drug sensitivity tests is encouraged.