Urinary Tract Infection During Pregnancy: Prevalence, Associated Risk Factors and Treatment Outcome Based on Antimicrobial Sensitivity Pattern

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


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 10 5 colony 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 patients 1 . Semiquantitative urine culture of midstream urine sample is the gold standard in screening and diagnosis of bacteriuria 2 . 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 Pseudomonas 4-8 . 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.

MATERIAL 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.

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).

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).

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

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 Journal of Pure and Applied Microbiology and were treated as per sensitivity report. They were also advised to get thoroughly investigated after delivery for urinary tract abnormalities.
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.

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.