Investigation Of Uti In Pregnancy
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Investigation Of Uti In Pregnancy
ABSTRACT
This study looks on the bacteriological aetiology and Urinary Tract Infections (UTIs) among pregnant women who visit antenatal clinics at hospitals in the Enugu metropolitan.70 mid-stream urine samples were collected and cultured for the presence of bacterial pathogens; 38 of them showed substantial bacterial growth, whereas the other 32 showed no significant bacterial growth.
Bacterial agents recovered from 38 pregnant women included Escherichia coli, Klebsiella spp., Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus epidermidis.
Escherichia coli 15 (39.5%) was the most prevalent bacterial pathogen isolated. Other bacterial pathogens implicated in this investigation included Klebsiellaspp. 9 (23.7%), Proteus mirabilis 6 (15.8%), Pseudomonas aeruginosa4 (10.5%), Staphylococcus aureus2 (5.3%), and Staphylococcus epidermidis2 (5.3%). The study found a modest frequency of urinary tract infections (38.0%), however the majority of pregnant women had no clinical manifestation.
Chapter one
1.0 Introduction
1.1 Urinary Tract Infections
Urinary system Infections (UTIs) are connected with the proliferation of organisms in the urinary system. A UTI is defined as microbial infiltration of any urinary tract tissue extending from the renal cortex to the urethral meatus (DelzellandLefevre, 2000).
The kidneys, ureters, bladder, urethra, and ancillary structures make up the urinary tract, which collects, stores, and excretes urine. Urine is a sterile fluid produced by the kidneys that serves as an excellent culture medium for bacterial growth (Omonigho et al., 2001).
UTI is defined as the presence of 105 germs or a single strain of bacteria per ml in two consecutive midstream urine samples (Davidson et al., 1989). UTI can be classified according to the part of the tract afflicted; the upper tract is referred to as pyelonephritis, and the lower tract as cystitis (Stamm, 1998).
Urinary tract infections are the second most prevalent type of infection in the body, accounting for around 8.1 million visits to health care providers annually (Onyemelukwe et al., 2003). Over half of all women will have at least one UTI in their lifetime, with 20-30% enduring recurrent UTI (Brook et al., 2001).
Women are more prone than men to acquire UTIs due to anatomical variations; the urethra in women is shorter and closer to the anus, increasing the likelihood that bacteria will be transported to the bladder. With each UTI, the likelihood of a woman or man developing another UTI increases.
Pregnant women are not more likely to get a UTI than other women, but if one does, it is more likely to spread to the kidneys due to structural changes in the urinary tract during pregnancy (Dimetry et al., 2007).
Because a UTI in pregnancy can be harmful to both maternal and infant health, most pregnant women are screened for bacteriuria, even if they are asymptomatic, and treated with preventive antibiotics.
The majority of UTIs are minor, but some, particularly upper urinary tract infections, can cause serious issues. Recurrent or long-lasting kidney infections (chronic) can cause irreversible damage
whereas some acute kidney infections can be fatal, especially if septicaemia (bacteria entering the bloodstream) develops.They may also raise the likelihood of mothers having low birth weight or early babies (Dimetry et al., 2007).
UTI has been observed in 20% of pregnant women and is the leading reason of admission in obstetrical wards (Bacak et al., 2005).
Anatomically, UTI can be divided into two types: lower urinary tract infections involving the bladder and urethra, and upper urinary tract infections involving the kidney, pelvis, and ureter. The majority of UTIs result from an ascending infection (Orenstein and Wong, 1999; Delzell and Lefevre, 2000).
Asymptomatic bacteriuria, acute cystitis, and acute pyelonephritis are three common clinical symptoms of urinary tract infections during pregnancy (Loh and Silvalingam, 2007).
A UTI is defined as the presence of at least 100,000 organisms per millilitre of urine in an asymptomatic patient or more than 100 organisms/mL of urine with concomitant pyuria (>5 WBCs/mL) in a symptomatic patient. A positive culture for auropathogen should support a UTI diagnosis, especially in asymptomatic individuals (Emilie et al., 2011).
Untreated asymptomatic bacteriuria increases the incidence of acute cystitis (40%) and pyelonephritis (25-30%) in pregnancy. These cases make up 70% of all symptomatic UTIs in unscreened pregnant women (Emilie et al., 2011). Symptomatic bacteriuria has been recorded in 17.9% and 13.0% of pregnant women, respectively (Masinde et al., 2009).
Pregnancy raises the risk of UTI. The ureters begin to dilate about the sixth week of pregnancy as a result of pregnancy-related physiological changes. This is also known as “hydronephrosis of pregnancy,” and it peaks between 22 and 26 weeks and lasts till birth. During pregnancy, both progesterone and oestrogen levels increase, resulting in reduced ureteral and bladder tone.
Increased plasma volume during pregnancy causes decreased urine concentration and increased bladder volume. The combination of these factors causes urine stasis and uretero-vesical reflux (Delzell and Lefevre, 2000).
Furthermore, the apparent loss in immunity in pregnant women appears to promote the proliferation of both commensal and non-commensal microbes (Scott et al., 1999).
The physiological increase in plasma volume during pregnancy lowers urine concentration, and up to 70% of pregnant women acquire glucosurea, which promotes bacterial growth in urine (Patterson and Andrriole, 1987; Lucas and Cunningham, 1993).
Female gender is a risk factor due to the short urethra, its proximity to the vagina and anus, and women’s inability to fully empty their bladder. The frequency is highest in the lower socioeconomic groups (Wesley, 2002). According to Bandyopadhyay et al. (2005), sexual activity and certain contraceptive techniques enhance the risk.
The anatomical link between the female urethra and the vagina makes it susceptible to stress during sexual intercourse, as well as microorganisms being massaged up the urethra into the bladder during pregnancy/childbirth (Arthur et al., 1975; Duerden et al., 1990).
Abnormalities of the urinary tract or stones, diabetes, immunosuppression, and a history of UTI all enhance the risk (Patterson and Andriole, 1997).
Urinary tract infections during pregnancy considerably increase maternal and perinatal morbidity (Akerele et al., 2002). Urinary tract infection during pregnancy has been linked to abortion, small birth size, maternal anaemia, hypertension, premature labour, phlebitis, thrombosis, and chronic pyelonephritis (Akerele et al. 2002; Onuh et al. 2006).
coli remains the most common bacterium involved in urinary tract infections during pregnancy, while new reports indicate that the infection pattern has changed (Onuh et al., 2006).
Recent studies in Nigeria reveal an increasing involvement of Klebsiella spp., Staphylococcus aureus, Proteus spp., and Pseudomonas spp. in urinary tract infections during pregnancy (Abdul and Onile, 2001).
Treatment of bacteriuria during pregnancy has also been proven to lessen the occurrence of these issues (Patterson and Andriole, 1987) and the long-term risk of sequelae following asymptomatic bacteriuria (Barr et al., 1985).
1.2 Objectives of the Research
The objectives of this study are to:
Investigate urinary tract infections in pregnancy.
Investigate the relationship between urinary tract infections and the age distribution of pregnant mothers.
Determine the percentage and distribution of bacterial pathogens in urinary tract infections among pregnant women.
1.3 Justification.
Urinary tract infections often develop when bacteria enter the urinary tract via the urethra and grow in the bladder. Although the urinary system is designed to keep such minuscule invaders out, these defences are not always effective.
When this happens, bacteria may take hold and cause a full-blown urinary tract infection. Urine culture can be used to determine antibiotic sensitivity, which can help with antibiotic treatment selection.
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