Research Article | Open Access

Pragya Lakshmi1,2 , Ranjan Kumar Srivastava2 and Alok Bharadwaj1

1Department of Biotechnology and Microbiology, GLA University, Mathura – 281 406, India.
2Department of Microbiology, Patna Medical College, Patna – 800 004, India
J Pure Appl Microbiol, 2019, 13 (1): 561-565 | Article Number: 5446
Received: 12/01/2019| Accepted: 22/02/2019 | Published: 25/03/2019
Abstract

Urinary tract infection is common among pregnant women. It can be either asymptomatic or symptomatic. This study was done on 225 pregnant women which comprised of both asymptomatic and symptomatic urinary tract infection in the Department of Microbiology Patna Medical College and Hospital, Patna and Department of Biotechnology and Microbiology GLA University, Mathura. The prevalence of asymptomatic bacteriuria in the present study was 7.42%, while for symptomatic cases it was 76%. E.coli was the commonest organism responsible for bacteriuria. Semi quantitative culture remains the gold standard for detecting bacteriuria. Of the different antibiotics used Amikacin, Nitrofurantoin, Meropenem, Piperacillin-Tazobactum were the most effective drugs in order to treat bacteriuria.

Keywords

UTI, Bacteriuria, Semi quantitative culture, E.coli, Screening tests.

Introduction

During pregnancy urinary tract infection is one of the commonest infection encountered in clinical practice. It may be asymptomatic or symptomatic . Asymptomatic bacteriuria which is also known as covert bacteriuria is defined as finding more than 10colony forming units on culture of urinary samples from pregnant women. Symptomatic bacteriuria presents with symptoms like dysuria, fever, abdominal pain, urgency, increased frequency of micturition. Untreated ASB can lead to symptomatic cystitis in approximately 30% of patients and Pyelonephritis in 50% of patients1. Semiquantitative urine culture of midstream urine sample is the gold standard in screening and diagnosis of bacteriuria2. The prevalence of asymptomatic bacteriuria from reported studies is 2-11%3. There are varied physiological, anatomical and hormonal factors responsible for urinary tract infection during pregnancy. Commonest organism  responsible are E.coli followed by Klebsiella, Proteus, coagulase negative staphylococci and Pseudomonas4-8. Untreated bacteriuria can lead to low birth weight infants and preterm birth. Different screening tests has been tried to detect bacteriuria during pregnancy but none was found to be adequate to replace semiquantitative urine culture. It has been found that antibiotic treatment reduces the incidence of adverse perinatal outcomes and various maternal complications.

Associated Risk Factors
The risk factors include short urethra and its proximity to the anal canal which predisposes to bacterial colonization. Certain hormonal changes which occur during pregnancy which results in smooth muscle relaxation of ureter and bladder, leading to dilation of ureter and increased ureterovesical reflux. Pressure of the foetus on the ureter causes obstruction to the ureters leading to statis and infection. Glycosuria during pregnancy may be an additional factor.

Materials and Methods

This prospective study was conducted on pregnant women with both asymptomatic and symptomatic urinary tract infection in the department of Microbiology Patna Medical College and Hospital, Patna and department of Biotechnology and Microbiology GLA University, Mathura . Pregnant women of varying gestational period coming for antenatal check up in the outpatient department and admitted in the obstetrics and Gynaecology Department during the period from March 2017 to December 2017 were studied .Informed consent was obtained for participation in this study.

Sample Size
A total of 225 pregnant women were studied.

Sample Collection
A clean catch midstream urine sample was collected in a sterile universal container.

Investigations
Samples thus collected were subjected to urine microscopy and culture was done by semiquantitative method on MacConkey and Cystine Lactose Electrolyte Deficient (CLED) medium by using a calibrated loop and incubated at 37 degree Celsius. Gram staining, Motility test, catalase test, oxidase test , coagulase test and different biochemical tests were done for organism identification.

Antibiotic sensitivity tests was done by Kirby- Bauer method on nutrient agar and Muller Hinton agar plate.

RESULTS

Urine Microscopy for Pyuria
Out of 175 aymptomatic bacteriuria studied sample 47 (26.85%) were micro-scopically positive and 128(73.14%) were negative (Table 1).

Out of 175 Aymptomatic Bacteriuria Studied sample 47 (26.85%) were microscopically positive and 128(73.14%) were negative.

Table (1):
Urine Microscopy for Asymptomatic Bacteriuria

Microscopy
Number
Percentage
Positive
            47
                26.85
Negative
           128
                73.14
Total
           175
                100

Out of 50 symptomatic pregnant women studied sample 41(82%) were microscopically positive and 9(18%) were negative (Table 2).

Out of 50 Symptomatic Pregnant women Studied sample 41(82%) were microscopically positive and 9(18%) were negative.

Table (2):
Urine Microscopy for Symptomatic Pregnant women

    Microscopy
    Number
   Percentage
      Positive
      41
      82
      Neagtive
      9
     18
     Total
   50
  100

Findings of Culture for Asymptomatic Bacteriuria cases
Out of  175 Studied Sample 13 (7.42%) were culture positive and 162 (92.58%) were culture negative (Table 3).

Out of 175 Studied Sample 13 (7.42%) were culture positive and 162 (92.58%) were culture negative

Table (3):
Findings of Culture for Asymptomatic Bacteriuria cases

Asymptomatic bacteriuria
Number
Percentage
Culture Positive
            13
               7.42
Culture Negative
            162
               92.58
Total
            175
               100

Findings of Culture for Symptomatic Pregnant Women
Out of 100 studied sample 38(76%) were culture positive and 12(24%) were culture negative (Table 4).

Out of 100 Studied Sample 38(76%) were culture positive and 12(24%) were culture negative.

Table (4):
Findings of Culture for Symptomatic Pregnant women

Symptomatic Bacteriuria
          Number
               Percentage
Culture Positive
          38
                 76
Culture Negative
          12
                 24
  Total
          50
               100

Commonest Pathogen Isolated
The commonest pathogen isolated was E.coli (Table 5).

Commonest Pathogen isolated was E.coli

Table (5):
showing various bacterial isolates in asymptomatic and symptomatic Bacteriuric cases.

Organisms No of cases Percentage
E.coli         30      56.66
Klebsiella pneumoniae         8      15.09
Coagulase negative Staphylococcus        5       9.43
Staphylococcus aureus       3       5.66
Pseudomonas aeruginosa       2      3.77
Proteus mirabilis       4      7.54
  Candida      1      1.88
Total   53  100.00

Treatment Outcome
The pregnant women treated as per Culture and sensitivity report were followed up for recurrence of symptoms during pregnancy. Repeat urine culture was done after 15 days of completion of antimicrobial therapy. All treated pregnant women were found to be cured of bacteriuria after initial antimicrobial therapy, however 30 pregnant women(13.33%) again became symptomatic and routine urine microscopy and culture was done and were treated as per sensitivity report. They were also advised to get thoroughly investigated after delivery for urinary tract abnormalities.

Table (6):
Antibiotic Sensitivity test

E.coli

(30)

Klebsiella spp.

  (8)

Coagulase Negative Staph(5) S.aureus

(3)

Pseudomonas spp.

(2)

Proteus spp.

(4)

Candida

(1)

Ampicillin 1(3.33%) 0 1(20%) 0 0 1(25%) 0
Amoxycillin

Clavulanic acid

4(13.33%) 0 2(40%) 1(33.33%) 0 1(25%) 0
Amikacin 24(80%) 5(62.5%) 0 1(33.33%) 1(50%) 2(50%) 0
Cotrimoxazole 12(40%) 2(25%) 2(40%) 1(33.33%) 0 2(50%) 0
Cephalexin 5(16.66%) 2(25%) 3(60%) 1(33.33%) 0 0 0
Ceftriaxone 6(20%) 2(25%) 3(60%) 1(33.33%) 0 0 0
Meropenem 19(63.33%) 6(75%) 4(80%) 2(66.66%) 1(50%) 1(25%) 0
Nitrofurantoin 21(70%) 6(75%) 3(60%) 1(33.33%) 0 1(25%) 0
Piperacillin

Tazobactum

16(53.33%) 4(50%) 2(40%) 1(33.33%)   0 1(25%) 0
Cefoperazone

Sulbactum

18(60%) 5(62.5%) 1(20%) 1(33.33%)   1(50%) 1(25%) 0
Discussion

The prevalence of asymptomatic bacteriuria in the present study was 7.42% (13/175), while for symptomatic cases it was 76% (38/50). This is within the reported range of 3-10% by other workers. Mathew et al, 1998 reported a prevalence of 6.8% in his study at Christian Medical College, Vellore9 and Lavanya et al, 2002 reported prevalence of 8.4% in a study at AIIMS Delhi 10. Studies conducted in different countries like, Ehopia (1998), USA (2000), Malaysia (2002), Turkey( 2005), Iran (2007) showed a prevalence of 3-10% 11,12,13,14,15.

Bacterial detection by microscopy in asymptomatic cases was 26.85% while in symptomatic group it was  82% this is in line with findings of other studies.

Commonest organism isolated in this study was E.coli (56%) followed by Klebsiella (15%). Other organisms isolated were Coagulase negative Staphylococci (9.4%), Staphylococcus aureus (5.6%), Pseudomonas spp (3.7%), Proteus spp( 7.5%) and Candida (1.8%). Gayathree et al from Karnataka found E.coli in 51.6% of samples from asymptomatic pregnant women and Staphylococcus and Klebsiella in 9.6% of cases16. In another study by Kheya Mukherjee et al from West Bengal, E.coli was the commonest organism isolated (57.14%)17 . Study conducted by Nithya-sree et al, from Tamil Nadu E.coli was isolated in 65.11% followed by Klebsiella and Staphylococcus aureus in 11.62% cases18.

Of the different antibiotics used for the sensitivity tests most effective antimicrobials for E.coli found in this study were Amikacin (80%), Nitrofurantoin (70%), Meropenem (63.3%), Piperacillin- tazobactum (53.3%) while Ampicillin was the least sensitive drug. This finding is almost similar to findings of Anu Mary Bose et al from Kerala19.

CONCLUSION

This study was done on 225 samples which comprised of both asymptomatic and symptomatic bacteriuria. Our study showed E.coli as the commonest organism. Screening of all pregnant women should be done during their first antenatal visit followed by urine culture in order to detect bacteriuria. Pregnant women who are detected with bacteriuria  should be treated with appropriate antibiotics based on the antibiotics sensitivity tests. Educational status and level of personal hygiene of all women should be improved specially those belonging to low socio-economic group in order to eradicate bacteriuria.

Acknowledgments

None

Conflict of Interest

The authors declare no conflict of interest.

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