Assessment of Asymptomatic Bacteriuria and Sterile Pyuria among Antenatal Attendants in hospitals in Northern Ghana

Abstract

Background Asymptomatic bacteriuria (ASB) and sterile pyuria (SP) are complexities of UTI whose prevalence are not known in the northern sector of Ghana. Our aim was to determine the occurrence of sterile pyuria and asymptomatic bacteriuria among pregnant women accessing antenatal care at a secondary and tertiary care hospitals in Tamale, northern Ghana.Methods A cross sectional study was conducted by screening 530 pregnant women with no signs of acute urinary tract infection attending antenatal clinic for a period of 6 months. Midstream urine was collected for microscopy, quantitative urine culture and antibiotic susceptibility testing. Data analysis was carried out using the Statistical Package for Social Sciences version 20.Results Of the 390 and 90 women screened for ASB, prevalence was 20% and 35.5% respectively at Tamale Central and Tamale Teaching Hospital. Sterile pyuria was found among 66% of the 50 women presenting at Tamale Central Hospital. More than 64% of isolates recovered from ASB patients were S. aureus and coagulase negative Staph. ( CoNS ). Escherichia coli was the dominant species among members of the enterobacteriaceae isolated. Highest susceptibility was recorded against gentamicin and amikacin while most resistance was to Ampicillin, cotrimoxazole, chloramphenicol and nitrofurantoin. Resistance to imipenem and vancomycin were 28.8% and 52%, with strains showing multiple drug resistance of between 81-92%.Conclusion The prevalence of asymptomac bacteriuria is appreciably higher (20-35.5%) than documented rates in the southern sector of the country. The presence of sterile pyuria which may be an indication of asymptomatic renal impairment and most often overlooked in antenatal management is 66%. Empirical treatment of UTIs at the Tamale Central and Teaching Hospital without confirmation of susceptibility may result in treatment failure. It is necessary to screen and treat pregnant women for ASB and SP due to the complications associated with these conditions.

Escherichia Coli From Urine Samples of Pregnant Women as an Indicator for Antimicrobial Resistance in the Community: a Field Study From Rural Burkina Faso.

“…The ASB proportion in the present study was lower compared to some earlier studies from sub-Saharan Africa, citing proportions of 7% − 40% (22)(23)(24)(25), but it was comparable to those found in other studies (26,27). The presently lower proportions of ASB may be related to the stringent de nition, i.e.…”

“…The presently lower proportions of ASB may be related to the stringent de nition, i.e. including only Enterobacterales as signi cant organisms, whereas in most other studies with higher ASB proportions, Staphylococci represented a substantial number of cases (22)(23)(24)(25).…”

“…Trimesters 1, 2 and 3 comprised respectively 3.9%, 32.7% and 63.5% of samples. The median (IQR) age was similar among the three trimester groups (25 [20-30], 24 [19][20][21][22][23][24][25][26][27][28][29][30] and 26 [21][22][23][24][25][26][27][28][29][30]) years respectively, although this difference was statistically signi cant (p < 0.0001).…”

Escherichia coli from urine samples of pregnant women as an indicator for antimicrobial resistance in the community: a field study from rural Burkina Faso

“…The ASB proportion in the present study was lower compared to some earlier studies from sub-Saharan Africa, citing proportions of 7-40% [17,[22][23][24], but it was comparable to those reported elsewhere (range 1.9-9.5%) [25,26]. The presently lower proportions of ASB may be related to the stringent definition, i.e.…”

The prevalence and management strategies of gestational urinary tract infections (UTI) in Kisumu County, Kenya

“…The current rate of gestational UTI prevalence in this region is much higher as compared to 27.6% reported in the general population among adults attending medical care in Kiambu level 5 hospital (15), and 21.5% among pregnant women attending ANC in Nairobi, Kenya (16). Other similar hospital-based studies in Sub-Saharan Africa have shown varying prevalence rates of gestational UTI infections; 3.7% Mbale, Uganda (35), 35% in Mbarara Uganda (36), 15.7 % in Ethiopia (28) and 20% and 35.5% in Tamale Central and Tamale Teaching hospitals in Ghana (37) and 18.8% in Sri Lanka, following urine culture and biochemical analysis during investigations. A systematic review of studies on the prevalence of gestational uro-pathogens and their antimicrobial resistance patterns in developing countries in Asia and Africa reported an overall rate of 13.5%.…”