ASYMPTOMATIC BACTERIURIA IN PREGNANCY: EVALUATION OF REAGENT STRIPS IN COMPARISON TO MICROBIOLOGICAL CULTURE

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ASYMPTOMATIC BACTERIURIA IN PREGNANCY: EVALUATION OF REAGENT STRIPS IN COMPARISON TO MICROBIOLOGICAL CULTURE

Abstract

Background Asymptomatic bacteriuria in pregnancy is the major risk factor for symptomatic urinary tract infection during pregnancy. Screening and identification of bacteriuria during pregnancy have been recommended.

Setting Antenatal clinic of the University College Hospital, Ibadan.

Objectives
The specific objectives of the study were to determine the prevalence of
asymptomatic bacteriuria at the University College Hospital, Ibadan, to determine
the bacterial isolates responsible for the asymptomatic bacteriuria and their
antibiotic sensitivity pattern and to evaluate the diagnostic accuracy of dipstick test
for nitrite and leucocyte esterase in comparison to laboratory culture

Methodology The study was descriptive and cross sectional in design. All consecutive patients
presenting for the first antenatal visit between 1st of April and 31st of May 2006,
who met the inclusion criteria and who consented to participate in the study were
recruited. Two hundred and five patients participated in the study. Urine samples
were obtained from the participants after adequate counselling and education.
Each sample was subjected to two tests; reagent dipstick test for nitrite and
leucocyte esterase and routine laboratory culture. Participants were requested to
come back to the hospital one week after sample collection for review with culture
result. Participants whose urine culture reports were positive for bacteriuria were
treated according to the antibiotic sensitivity pattern. They were also followed up
2
after completion of antibiotic therapy with repeated urine culture to ensure
clearance of bacteriuria.

Results
The prevalence of asymptomatic bacteriuria among our obstetric patients was
10.7%. The prevalence was higher among women aged between 16-20 years
(33.3%) and 31-35 years (12.1%); those with no formal education (33.3%);
Christian women (12.7% compared to 4.7% among Muslims) and women with
genotypes AS and AC (16.4% and 16.7% respectively). Prevalence was also
higher among para 2 and in 2nd and 3rd trimesters. However the influence of these
demographic parameters, parity and gestational age on prevalence rate of
asymptomatic bacteriuria were not statistically significant.
The bacterial pathogens causing asymptomatic bacteriuria were predominantly
coliforms (Klebsiella and E. coli) accounting for 45.5% and staphylococcus
saprophyticus (27.3%). Only gentamycin, nitrofurantoin and ofloxacin
demonstrated high efficacy against these uropathogens (Antibiotic sensitivity rate
between 72.7%-81.8%). Combined use of leucocyte esterase and nitrite strip
demonstrated a reasonable level of accuracy in detecting asymptomatic bacteriuria
with sensitivity, specificity and negative predictive values of 50%, 92.9% and
93.9% respectively.

Conclusion
Prevalence of asymptomatic bacteriuria in this centre is relatively high and this
underscores the need for routine screening of our pregnant women for this
condition. Leucocyte esterase–nitrite dipstick demonstrates fair sensitivity and high
specificity and may be more cost-effective for screening for asymptomatic
bacteriuria in our low resource setting.

ASYMPTOMATIC BACTERIURIA IN PREGNANCY: EVALUATION OF REAGENT STRIPS IN COMPARISON TO MICROBIOLOGICAL CULTURE

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