ABSTRACT                                             

This study investigates the bacteriological aetiology and Urinary Tract Infections (UTIs) among pregnant women attending antenatal clinics at hospitals in Enugu metropolis.70 mid-stream urine samples were collected and cultured for the presence of bacterial pathogens, 38 of which showed significant bacterial growth while the remaining 32 showed no significant bacterial growth.

Bacterial agents were isolated from 38 pregnant women and were identified as: Escherichia coli; Klebsiellaspp., Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureusand Staphylococcus epidermidis. Escherichia coli 15(39.5%)was the commonest offending bacterial pathogen isolated. Other bacterial pathogens incriminated in this study were Klebsiellaspp. 9 (23.7%), Proteus mirabilis 6 (15.8%), Pseudomonas aeruginosa4(10.5%), Staphylococcus aureus2 (5.3%) and Staphylococcus epidermidis2 (5.3%). The study indicated a low incidence of Urinary tract infections(38.0%),though most of the pregnant women showed no clinical manifestation.

INVESTIGATION OF UTI IN PREGNANCY

Table of Contents

Chapter one

Urinary tract infections

Objectives of the research

1.3     Justification

Chapter two

2.1     Urinary tract infections: causes and symptoms

2.1.1   Causes of urinary tract infections

Symptoms of urinary tract infections

Diagnosis and treatment of urinary tract infection

2.2.1   Diagnosis

2.2.2   Treatments of urinary tract infections

2.3     Urinary tract infections and pregnancy

Chapter three

3.0   Materials and methods

3.1     Study area

3.2     Sample collection

3.3     Characterization and identification of bacteria from urine samples

3.4     Bacteria identification

3.4.1    Gram staining

3.4.2    Motility test

3.5      Biochemical tests

Chapter Four

4.0    Results

Chapter five

5.0     Discussion, conclusion, and recommendation

5.1     Discussion

5.2     Conclusion

5.3     Recommendations

References

INVESTIGATION OF UTI IN PREGNANCY

CHAPTER ONE

1.0                                 INTRODUCTION

1.1     URINARY TRACT INFECTIONS

Urinary Tract Infections (UTIs) are associated with the multiplication of organisms in the urinary tract. UTI defined as the microbial invasion of any of the tissues of the urinary tract extending from the renal cortex to the urethral meatus (DelzellandLefevre, 2000). The urinary tract includes the organs that collect and store urine and release it from the body which include: kidneys, ureters, bladder, urethra and accessory structures. Urine formed in the kidney is a sterile fluid that serves as a good culture medium for the proliferation of bacteria (Omonigho et al., 2001). UTI is evident by the presence of 105 microorganisms or of a single strain of bacterium per ml in two consecutive midstream samples of urine (Davidson et al.,1989). UTI could be described based on the part of the tract affected, for the upper tract, it is called Pyelonephritis and the lower part, cystitis (Stamm, 1998).

Urinary tract infections are the second most common type of infection in the body and account for around 8.1 million visits to health care providers each year (Onyemelukwe et al., 2003).  Over 50% of all women will experience at least one UTI during their lifetime, with 20-30% experiencing recurrent UTI (Brook et al., 2001). Women are more likely to develop UTIs than men, due to anatomical differences; the urethra is shorter in women than in men, and it is closer to the anus, making it more likely that bacteria are transferred to the bladder. With each UTI, the risk that a woman or man will have another UTI increases.  Pregnant women are not more likely to develop a UTI than other women, but if one does occur in a pregnant woman then it is more likely to travel up to the kidneys due to anatomical changes affecting the urinary tract in pregnancy (Dimetry et al., 2007).  As a UTI in pregnancy can prove dangerous for both maternal and infant health, most pregnant women are tested for bacteriuria, even if asymptomatic, and treated with prophylactic antibiotics. Most UTIs are not serious, but some can lead to serious problems, particularly with upper urinary tract infections. Recurrent or long-lasting kidney infections (chronic) can cause permanent damage, and some sudden kidney infections (acute) can be life-threatening, particularly if septicemia (bacteria entering the bloodstream) occurs.They can also increase the risk of women delivering low birth weight or premature infants (Dimetry et al., 2007).

UTI has been reported among 20% of the pregnant women and it is the most common cause of admission in obstetrical wards (Bacak et al., 2005).

Anatomically UTI can be classified into lower urinary tract infection involving the bladder and urethra and upper urinary tract infection involving the kidney, pelvis, and ureter. The majority of the UTI occur due to ascending infection (Orenstein and Wong, 1999; Delzell and Lefevre, 2000). Three common clinical manifestations of UTIs in pregnancy are: asymptomatic bacteriuria, acute cystitis and acute pyelonephritis (Loh and Silvalingam, 2007).

UTI is defined as the presence of at least 100,000 organisms per milliliter of urine in an asymptomatic patient, or as more than 100 organisms/mL of urine with accompanying pyuria (>5 WBCs/mL) in a symptomatic patient. Particularly in asymptomatic patients, a diagnosis of UTI should be supported by a positive culture for auropathogen(Emilie et al., 2011). Untreated asymptomatic bacteriuria is a risk factor for acute cystitis (40%) and pyelonephritis (25-30%) in pregnancy. These cases account for 70% of all cases of symptomatic UTI among unscreened pregnant women (Emilie et al., 2011).  Symptomatic and asymptomatic bacteriuria have been reported among 17.9% and 13.0% pregnant women, respectively (Masinde et al., 2009).

Pregnancy increases the risk of UTI. At around 6th week of pregnancy, due to the physiological changes of pregnancy the ureters begin to dilate. This is also known as “hydronephrosis of pregnancy”, which peaks at 22-26 weeks and continues to persist until delivery. Both progesterone and estrogens levels increase during pregnancy and these will lead to decreased ureteral and bladder tone. Increased plasma volume during pregnancy leads to decrease urine concentration and increased bladder volume. The combination of all these factors lead to urinary stasis and uretero-vesical reflux (Delzell and Lefevre, 2000).Additionally, theapparent reduction in immunity of pregnant women appears toencourage the growth of both commensal and non-commensalmicroorganisms (Scott et al., 1999). The physiological increase in plasmavolume during pregnancy decreases urine concentration and upto 70% pregnant women develop glucosurea, whichencourages bacterial growth in the urine (Patterson and Andrriole, 1987; Lucas and Cunningham, 1993).

Female gender itself is a risk factor because of short urethra, its proximity to vagina and anus and inability of women to empty their bladder completely. High incidence is seen in lower socioeconomic group (Wesley, 2002). Sexual activity and certain contraceptive methods are also said to increase the risk (Bandyopadhyay et al., 2005) The anatomical relationship of female’s urethra and the vagina makes it liable to trauma during sexual intercourse as well as bacteria been massaged up the urethra into the bladder during pregnancy/child birth (Arthur et al., 1975; Duerden et al., 1990). Abnormalities of urinary tract or stones, diabetes mellitus, immunosupression and past history of UTI tend to increase the risk (Patterson and Andriole, 1997).

Urinary tract infection during pregnancy contributes significantly to maternal and perinatal morbidity (Akerele et al., 2002). Abortion, small birth size, maternal anemia, hypertension, preterm labour, phlebitis, thrombosis and chronic pyelonephritis are related to urinary tract infection during pregnancy (Akerele et al., 2002; Onuh et al., 2006).

1. coli remains the predominant organism implicated in urinary tract infection in pregnancy, though recent reports show changes in pattern of the infection (Onuh et al., 2006). Recent studies in Nigeria show an increasing involvement of Klebsiella Spp. Staphylococcus aureus, Proteus spp., and Pseudomonas spp. in urinary tract infection in pregnancy (Abdul andOnile, 2001).

Studies have also shown that treatment of bacteriuria during pregnancy reduces the incidence of these complications (Patterson and Andriole, 1987) and lowers the long-term risk of sequelae following asymptomatic bacteriuria (Barr et al., 1985).

1.2     OBJECTIVES OF THE RESEARCH

This objectives of this research are to;

1. Investigate the Urinary tract infections in pregnancy
2. Investigate Urinary tract infections in relation to age distributions of pregnant women.
3. Determine percentage of occurrence and distribution of bacterial pathogens in Urinary tract infections among pregnant women

1.3    JUSTIFICATION

Urinary tract infections typically occur when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder. Although the urinary system is designed to keep out such microscopic invaders, these defenses sometimes fail. When that happens, bacteria may take hold and grow into a full-blown infection in the urinary tract. Antibiotic sensitivity can be tested with urine culture, making it useful in the selection of antibiotic treatment.