Asymptomatic Bacteriuria Among Pregnant Women Attending Antenatal Care At Abia State University Teaching Hospital, Abia State, Nigeria (Absuth)

ABSTRACT

Asymptomatic bacteriuria refers to the presence and multiplication of bacteria in the bladder urine in the absence of symptoms of urinary tract infection. Asymptomatic bacteriuria has been observed to be a strong criterion for urinary tract infection. It is therefore a means of predicting urinary tract infection (UTI). It is common among pregnant women and females. Untreated asymptomatic bacteriuria (ASB) during pregnancy may cause serious complications such as pyelonephritis and delivery of premature or low birth weight infant. This study assessed the prevalence of asymptomatic bacteriuria and the antibiotic susceptibility pattern of the urinary bacterial isolates from pregnant women attending antenatal care clinic at Abia state University Teaching Hospital, Aba, Abia State, Nigeria. Mid-stream urine samples were collected from 100 pregnant women attending antenatal care at Abia state University Teaching Hospital, Aba, Abia State, Nigeria between the ages of 18-49 years. Each specimen was cultured on Cystine Lactose Electrolyte Deficient (CLED) agar using standard bacteriological methods. Identification of suspected colonies and antibiotic sensitivity testing were done. Thirty-eight samples (38) which represent 38.0% showed significant bacteriuria while 62 samples (62.0%) showed no bacteriuria or no significant bacterial growth. Escherichia coli was found to be the most predominant, (36.8%) followed by Proteus spp, (21.1%), Psedomonas aeruginosa (18.4%), Staphylococcus aureus (15.8%) and the least Klebsiella spp. (7.9%). Nitrofurantoin, Ciprofloxacin, Ofloxacin, Gentamicin and Ceftazidime were very effective antimicrobial agents against the isolates while the isolates were highly resistant to Cefexime and Augmentin (Co-amoxiclav). E. coli was the most common bacteria for asymptomatic bacteruria among pregnant women attending antenatal care at Abia state University Teaching Hospital, Aba, Abia State, Nigeria in this study. Education on the importance of inclusion of urine screening in antenatal care should be emphasized.

TABLE OF CONTENTS

Title Page ﾿            i

Certification ﾿            ii

Dedication ﾿            iii

Acknowledgements ﾿            iv

Table of Contents ﾿             v

List of Tables ﾿            vi

List of Figures ﾿            vii

Abstract ﾿             x

CHAPTER ONE

1.0 ﾿ Introduction ﾿ 2

1.1 ﾿ Aim and objectives ﾿ 3 

1.1.1 ﾿ Aim ﾿ 3

1.1.2 ﾿ Objectives ﾿ 3

CHAPTER TWO

2.0 ﾿ Literature review ﾿ 5

2.1 ﾿ Urinary tract infection (UTI) ﾿ 5

2.2 ﾿ Asymptomatic bacteriuria ﾿ 7

2.2.1 ﾿ Historical aspects ﾿ 8

2.2.2 ﾿ Causes and pathogenesis of asymptomatic bacteriuria ﾿ 9

2.3 ﾿ Etiology of urinary tract infection ﾿ 10

2.4 ﾿ Incidence of urinary tract infection ﾿ 11

2.5 ﾿ Epidemiology ﾿ 12

2.6 ﾿ Risk factors for asymptomatic bacteriuria ﾿ 14

2.7 ﾿ Prevalence of asymptomatic bacteriuria ﾿ 15

2.8 ﾿ Classification of urinary tract infection ﾿ 17

2.8.1 ﾿ Lower urinary tract infection ﾿ 17

2.8.2 ﾿ Upper Urinary Tract Infection ﾿ 17

2.8.3 ﾿ Uncomplicated Urinary Tract Infection ﾿ 17

2.8.4 ﾿ Complicated Urinary Tract Infection ﾿ 17

2.9 ﾿ Outcome of asymptomatic bacteriuria ﾿ 18

2.10 ﾿ Complications ﾿ 18

2.11 ﾿ Treatment of asymptomatic bacteriuria ﾿ 22

2.12 ﾿ Pathogenic organisms causing urinary tract infection ﾿ 23

2.12.1 ﾿ Escherichia coli ﾿ 24

2.12.2 ﾿ Staphylococcus aureus ﾿ 24

2.12.3 ﾿ Klebsiella spp. ﾿ 24

2.12.4 ﾿ Pseudomonas spp. ﾿ 25

CHAPTER THREE

3.0 ﾿ Materials and method ﾿ 26

3.1 ﾿ Study area ﾿ 26

3.2 ﾿ Study population ﾿ 26

3.3 ﾿ Sample collection ﾿ 26

3.4 ﾿ Media preparation ﾿ 27

3.5 ﾿ Inoculation and isolation ﾿ 27 ﾿

3.6 ﾿ Identification and characterization of isolates ﾿ 27

3.6.1 ﾿ Gram stain technique ﾿ 27

3.7 ﾿ Biochemical tests ﾿ 28

3.7.1 ﾿ Catalase test ﾿ 28

3.7.2 ﾿ Oxidase test ﾿ 28

3.7.3 ﾿ Coagulase test

3.7.4 ﾿ Indole test ﾿ 28

3.7.4 ﾿ Citrate utilization test ﾿ 29

3.7.5 ﾿ Triple sugar iron agar (TSIA) ﾿ 29

3.8 ﾿ Antibiotic sensitivity testing ﾿ 30

CHAPTER FOUR

4.0 ﾿ Results ﾿ 32

CHAPTER FIVE

5.0 ﾿ Discussion ﾿ 37

5.1 ﾿ conclusion ﾿ 39

5.2 ﾿ references

Appendix