Microbiological profile of asymptomatic bacteriuria in pregnancy
Keywords:Asymptomatic bacteriuria in pregnancy, Pregnancy, Screening tests, Semi-quantitative culture, UTI
Background: Asymptomatic bacteriuria is the presence of actively multiplying bacteria within the urinary tract in the absence of any symptoms. Anatomical and physiological changes make women more susceptible to UTI in pregnancy. The objective of present study was to determine the percentage of pregnant women with asymptomatic bacteriuria and its microbiological profile.
Methods: A total of 555 antenatal women who had no clinical features of urinary tract infection were recruited for this study over a period of one year. Clean catch mid-stream urine sample was collected and semi quantitatively cultured immediately. Significant bacteriuria was identified and antibiotic sensitivity found out by conventional methods.
Results: Significant growth was observed in 26 samples. There was no association between age, parity, gravidity, period of gestation and asymptomatic bacteriuria. Gram stain was found to be the best screening test. Escherichia coli were the commonest organism isolated. Escherichia coli and Staphylococcus saprophyticus were the most resistant organisms.
Conclusions: Escherichia coli, the most common organism isolated, was resistant to most of the commonly used antibiotics. Wet film examination, the most commonly used screening test in our set up, was less sensitive and specific. So culture has to be done in all antenatal cases for screening asymptomatic bacteriuria of pregnancy.
Leslie C, Albert B, Max S. Topley and Wilson's microbiology and microbial infections. 10th ed. London: Edward Arnold. 1998;3.
Cunningham FG, Gant NF, Laveno KJ. Renal and urinary tract disorders. Williams Obstetrics. 24thEd. New York: McGraw-Hill Medical Publishing Division; 2014:1052-56.
Forbes BA, Sahm DF, Weissfeld AS. Infections of urinary tract. Bailey and Scott's Diagnostic microbiology. 12th ed. Missouri: Mosby Elsevier. 2007:842-54.
Mandell GL, Bennett JE, Dolin R. Urinary tract infections. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 7th ed; 2009:957-976.
Anantnarayanan R, Ananthanarayanan PJ, Kapil A. Paniker’s text book of microbiology. 9th Ed; 2013:277-280.
Imade PE, Izekor PE, Eghafona NO, Enabulele OI, Ophori E. Asymptomatic bacteriuria among pregnant women. N Am J Med Sci. 2010;2(6):263-6.
Colgan R, Nicolle LE, Mcglone A, Thomas M. Hooton. Asymptomatic bacteriuria in adults. Am Family Physician. 2006;74(6):985-90.
Chandel LR, Kanga A, Thakkur K, Mokta KK, Sood A, Chauhan S. Prevalance of pregnancy associated asymptomatic bacteriuria: a study done in a tertiary care hospital. J Obstet Gynaecol India. 2012;62(5):511-4.
Lavanya SV, Jogalakshmi D. Asymptomatic bacteriuria in antenatal women. Indian J Med Microbiol. 2002; 20(2):105-6.
Jain V, Das V, Agarwal A, Pandey A. Asymptomatic bacteriuria and obstetric outcome following treatment in early versus late pregnancy in north Indian women. Indian J Med Res. 2013;137(4):753-8.
Demilie T, Beyene G, Melaku S, Tsegaye W. Urinary bacterial profile and antibiotic susceptibility pattern among pregnant women in north west ethiopia. Ethiop J Health Sci. 2012;22(2):121-8.
Hagay Z, Levy R, Miskin A, Milman D, Sharabi H, Insler V. Uriscreen, a rapid enzymatic urine screening test: useful predictor of significant bacteriuria in pregnancy. Obstet Gyaecol. 1996;87:410-3.
Simmons NA, Williams JD. Use of a solid reagent in the triphenyl tetrazolium chloride test for bacteriuria. J Clinic Pathol. 1967;20:767-9.
Khattak AM, Khan H, Akhtar W, Mahsud I, Ashiq B. Accuracy of Griess test to predict asymptomatic bacteriuria during pregnancy. Gomal J Med Sci. 2004;2(1):20-4.
Ansari HQF, Rajkumari A. Prevalence of asymptomatic bacteriuria and associated risk factors among antenatal women attending a tertiary care hospital. J Med Allied Sci. 2011;1(2):74-8.
Patil SS, Mahale K, Krishna S, Mariraj J, Kalabhavi AS, Sathyanarayan MS. Evaluation of gram stain of uncentrifuged urine as a screening method for diagnosis of urinary tract infections. Curr Res Medic Med Sci. 2011;1(2):19-21.
Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. Twenty-Fifth Informational Supplement. M100-S25. 2015;35(3).
Lee M, Bozzo P, Einarson A, Koren G. Urinary tract infections in pregnancy. Can Fam Physician. 2008;54(6):853-4.
Jayalakshmi J, Jayaram VS. Evaluation of various screening tests to detect asymptomatic bacteriuria in pregnant women. Indian Journal of Pathology and Microbiology. 2013;51(3):379-81.
Jennifer P, Cyril R, Piyumi P, Nimesha G, Renuka J. Asymptomatic bacteriuria in pregnancy: prevalence, risk factors and causative organisms. Sri Lankan J Infec Diseas. 2012;1(2);42-6.
Prasanna B, Naimisha M, Swathi K, Shaik MV. Prevalence of asymptomatic bacteriuria in pregnant women, isolates and their culture sensitivity pattern. Int J Curr Microbiol Applied Sci. 2015;4(8):28-35.
Kerure SB, Surpur R, Sagarad SS, Hegadi S. Asymptomatic bacteriuria among pregnant women. Int J Reprod Contracep Obstet Gynecol. 2013;2(2):213-6.
Hamdan HZ, Ziad AHM, Ali SK, Adam I. Epidemiology of urinary tract infections and antibiotics sensitivity among pregnant women at Khartoum North Hospital. Ann Clin Microbiol Antimicrob. 2011;10(2):1-5.
Alemu A, Moges F, Shiferaw Y, Tafess K, Kassu A, Anagaw B et al. Bacterial profile and drug susceptibility pattern of urinary tract infection in pregnant women at University of Gondar Teaching Hospital, Northwest Ethiopia. BMC Res Notes. 2012;5:197.
Cardoso CL, Muraro CB, Siqueira VL, Guilhermetti M. Simplified technique for detection of significant bacteriuria by microscopic examination of urine. J Clin Microbiol. 1998;36(3):820-3.
Taneja N, Chatterjee SS, Singh M, Sivapriya S, Sharma M, Sharma SK. Validity of quantitative unspun urine microscopy, dipstick test leucocyte esterase and nitrite tests in rapidly diagnosing urinary tract infections. J Assoc Physicians India. 2010;58:485-7.
Willy Fred Nabbugodi, J. Wanyoike Gichuhi, and N. W. Mugo. Aetiology and antibiotic sensitivity pattern among antenatal women presenting with lower abdominal pains at Kenyatta National Hospital, Nairobi, Kenya. Open Access J Sci Tech. 2015;3:1-6.
Mokube MN, Atashili J, Halle-Ekane GE, Ikomey GM, Ndumbe PM. Bacteriuria amongst Pregnant Women in the Buea Health District, Cameroon: Prevalence, Predictors, Antibiotic Susceptibility Patterns and Diagnosis. PLoS One. 2013;8(8):e71086.
Siddiqui SM, Deshmukh AB, Afreen U, Bhanap PL. Evaluation of screening tests to detect asymptomatic bacteriuria in obstretic patients at Noor Hospital, Warudi, Jalna, Maharashtra. MedPulse-Int Med J. 2014;1(10):623-6.
Berger SA, Bogokowsky B, Block C. Rapid screening of urine for bacteria and cells by using a catalase reagent. J Clinic Microbiol. 1990;28(5):1066-7.
Shilpa K, Bernaitis L, Jiji Mathew, Shobha KL, Ramyasree A, Manthena A. Comparison of urine microscopy and culture from urinary tract infection - a retrospective study. International Journal of Health Information and Medical Research. 2015;2(1):12-7.
Pezzlo M. Detection of urinary tract infections by rapid methods. Clinic Microbiol Reviews. 1988;1(2):268-80.
Gayathree L, Shetty S, Deshpande SR, Venkatesha DT. Screening for asymptomatic bacteriuria in pregnancy: an evaluation of various screening tests at the Hassan District Hospital, India. J Clinic Diagno Res. 2010;(4):2702-6.
Mukherjee K, Golia S, Vasudha CL, Babita, Bhattacharjee D, Chakroborti G. A study on asymptomatic bacteriuria in pregnancy: prevalence, etiology and comparison of screening methods. Int J Res Med Sci. 2014;2(3):1085-91.
Udawat M, Nithyalakshmi J, Sumathi G, Mallure S. A study on the prevalence of asymptomatic bacteriuria and their antibiogram pattern among pregnant women in a tertiary care hospital. J Evolution Med Dent Sci. 2014;3(28):7920-7.
Nithyalakshmi J, Vijayalakshmi. Bacterial profile and antibiogram pattern of UTI in pregnant women at tertiary care teaching hospital. Int J Pharma and Bio Sci.2014;5(4):201-7.
Vaijanathrao CY, Nalini YL, Reddy CM. Antibiotic sensitivity pattern of uropathogens: a comparative study between symptomatic and asymptomaic bacteriuria in pregnant women. Int J Curr Microbiol Applied Sci. 2015;4(6):689-95.
Roopa C, Biradar S. Incidence, microbiological profile and antibiotic susceptibility pattern of symptomatic and asymptomatic bacteriuria in antenatal women. Int J Curr Microbiol Applied Sci.2015;4(9):962-8.
Ayoade F, Moro DD, Ebene OL. Prevalence and antimicrobial susceptibility pattern of asymptomatic urinary tract infections of bacterial and parasitic origins among university students in redemption camp, Ogun State, Nigeria. Open J Med Microbiol. 2013;3:219-26.
Teshale AM, Desta K, Mulugeta G, Asamene N, Birara M, Fentaw S et al. Prevalence and antibiotics susceptibility pattern of common bacterial uropathogens isolated from pregnant women attending antenatal care clinic at St. Paul Hospital Millennium Medical College And Selam, Health Center, Addis Ababa. Ethiopia. 2015;2(9):1288-130