Urinary pathogenic bacterial profile, antibiogram of isolates and associated risk factors among pregnant women in Ambo town, Central Ethiopia: a cross-sectional study

Abstract

BackgroundUrinary tract infection (UTI) is a well-known bacterial infection posing serious health problem in pregnant women. A study was conducted in pregnant women with the objectives of estimating prevalence of UTI, determining antibiogram of the bacterial isolates and assessment of the potential risk factors associated with UTI.MethodsA cross-sectional study design was used to collect 300 mid-stream urine samples from pregnant women from March 2016 to December, 2016. Samples were inoculated into Cysteine Lactose Electrolyte Deficient medium (CLED). Colonies from CLED were subcultured onto MacConkey and Blood agar plates. A standard agar disc diffusion method was used to determine antimicrobial susceptibility. Chi-square (X 2 ) test & logistic regression were used to show associations between UTI and explanatory variables & identify the predictors of UTI, respectively.ResultsThe age of pregnant women enrolled in this study ranges from 16 to 46 years (mean ± standard deviation = 25 ± 4.7 years).The overall prevalence of UTI in pregnant women was 18.7% (95% confidence interval [CI]: 14.4–23.54%).The prevalence of symptomatic and asymptomatic UTI was 20.4% (95% CI: 13.09–29.46%) and 17.8% (95% CI: 12.70–23.83%) respectively. The predominant bacteria identified were E. coli (46.4%), S. aureus (14.3%), coagulase negative Staphylococci [CoNS] (14.3%) and Proteus species (10.6%). Majority of Gram-negative bacteria isolates were resistant to ampicillin (70%), ceftriaxon (66%), gentamicin (68%) and nitrofurantoin (64%) while 75–100% of the Gram positive isolates were resistance to ampicillin. Multiple drug resistance was observed in all of the isolates. Multivariable logistic regression revealed that the odds of acquiring UTI was 4.78 times higher in pregnant women earning monthly income of ≤500 Ethiopian Birr (21.18 USD) as compared to those earning monthly income >2001 Ethiopian Birr [84.79 USD] (P = 0.046). Similarly, the risk of UTI was higher in those who eat raw meat (OR = 2.04, 95% CI: 1.09, 3.83, P = 0.026) and had previous UTI history (OR = 2.29, 95% CI = 1.15–4.56, P = 0.019) as compared to those who eat cooked meat and had no previous history of UTI.ConclusionsThe prevalence & antimicrobial resistance of uropathogens was high. Health education, continuous surveillance of UTI and their antimicrobial resistance pattern are essential to reduce the consequence of symptomatic and asymptomatic bacteriuria and multi-drug resistant bacteria in pregnant women.

Asymptomatic Uropathogenic Bacteriuria Among Pregnant and Non-pregnant Women at St Luke’s Hospital Anua, Offot Ukwa District Uyo: A Reassessment Case-Control Approach

“…Highest prevalence of ASB uropathogens was observed in the age range of 26-31 years for both pregnant and nonpregnant women and the mean ages of 23.3±5.2 and 24.2±5.6 years were stipulated for pregnant and non-pregnant women respectively in this study, which was similar to that reported in Hawassa referral hospital [12], Ambo town [16] Gondar tertiary teaching hospital [6] in Ethiopian cities, Benin city [1,39], Ibadan [33] and University of Uyo teaching hospital, Nigeria [4]. The increased prevalence observed within this age range may be attributed to multiparity which has been documented as one of the risk factors for ASB in pregnant women in many populations [4,[15][16][17]44). This is in tandem with the result of this present study.…”

“…In this present study conducted at Anua, Offot Ukwa district, the highest rate of ASB uropathogens was observed in the third trimester pregnancy, which is in harmony with other researches [1,12,16,20] in Ibadan, Ethiopia and Sri Lanka but disagrees with others [4,6] that reported highest prevalence in the first trimester and second trimester pregnancy. Several anatomical and hormonal changes in pregnancy lead to urethral dilation and urinary stasis which contributed to increased risk of developing urinary tract infection [2,45].…”

“…The result of this study is higher than the prevalence of 3.6% in Sri Lanka [20], 6%-10.6% in north west and central Ethiopia [19], 2.3% and 4.7% documented among ASB pregnant women without and with DM or GDM respectively [34], 8% and 11% for ASB and UTI respectively by Kumar et al [36] in other populations. Also 9% in Nsukka [37], 10.7% in Ibadan [33], approximately between 18 to 19% in some developing central and West African countries [4,12,16,21] and 23.9% in Sagamu, Nigeria [38] which are lower prevalence rates. In contrast, higher prevalence of 45.3% [39] and 55% [1] in Benin, 54% in Akwa metropolis [40], 72.5% in Lagos State [41], 78.7% in Ebonyi State [42] and 86.6% in Oyo State [43], all Nigerian populations.…”

“…In addition, the control subjects who refused to participate and/or fully cooperate with the guidelines of the study were excluded. Asymptomatic bacteriuria is defined as the presence of significant bacteria (≥10 5 Cfu/ml) in two consecutive clean-voided mid-stream urine specimen in a patient without signs or symptoms according to Gessese et al, [16].…”

“…The prevalence of ASB or UTI is influenced by several factors like socio-economic status of patients, increased maternal age, high parity, poor perineal hygiene, sexual activity, anatomic /functional urinary tract abnormality, history of recurrent UTIs, diabetes mellitus, etc as reported by investigators [4,[15][16][17]. The prevalence and epidemiological distribution of ASB uropathogens varies geographically; like in Ethiopia it is between 7% to 18.8% [12,[18][19] and a lower prevalence rate of 3.6% in Sri Lanka [20].…”