BACTERIAL PROFILE AND DRUG SUSCEPTIBILITY PATTERNS OF URINARY TRACT INFECTIONS AMONG PREGNANT WOMEN IN ENUGU, NIGERIA

Abstract

Background: Urinary tract infection (UTI) is the most common bacterial infection
during pregnancy and this can be symptomatic or asymptomatic. UTI during pregnancy
may cause complications such as pyelonephritis, hypertensive disease of pregnancy,
anaemia, chronic renal failure, premature delivery and foetal mortality. Thus there is
the need for its detection and treatment with safe and sensitive antibiotics to avoid
maternal and perinatal mortality.
Objectives: The study aims to determine the prevalence, aetiologic agents and
antimicrobial susceptibility pattern of UTI among pregnant women in Enugu, Nigeria as
well as to assess the accuracy of urine microscopy in screening for UTI in pregnancy
using urine culture as the standard.
Methodology: The study was done in the University of Nigeria Teaching Hospital,
Ituku/Ozalla. It was cross-sectional in design and the research subjects were 233
consecutive symptomatic and consenting pregnant women out of the 1,652 women that
were screened using symptoms of urinary tract infection. A pre-tested and anonymous
questionnaire was administered individually to the sample population and their urine
samples tested microscopically, cultured and then the antibiotics sensitivity tested.
Results: The prevalence of symptomatic Urinary Tract infection in pregnancy was 4.7%
(78/1652 [95% CI: 3.8%, 5.9%] ). The commonest organisms isolated were coliform
bacillus (51.2%),
S taphylococcus aureus (28.2%) and
Escherichia coli (12.8%). The
antibiotic with the highest frequency of microbial sensitivity was ceftriazone (76.9%),
followed by clindamycin (69.0%), ofloxacin (68.5%), ciprofloxacin (65.7%) and
perfloxacin (63.2%). The antibiotic with the least frequency of microbial sensitivity was
ampiclox (0.0%, 0/8). The comparative accuracy measures of the urine microscopy
using the low threshold and high threshold white blood cells per high power field
respectively were sensitivity 43.6%/ 28.9% while the specificity was 93.5%/ 97.5%. The
positive predictive values using the low and high thresholds respectively were 77.3%
and 84.6% while the negative predictive values using the same thresholds respectively
were 76.7% and 73.9%.
Conclusion: The prevalence of urinary tract infection among symptomatic pregnant
women is comparatively low in the study area. with Coliform bacilli as the commonest
isolated organism and ceftriazone as the antibiotic the isolated organisms are most
sensitive to. The accuracy of urine microscopy in relation to urine culture in this study is
low. It is recommended that antibiotics should be commenced after taking of sample for
culture, using the sensitivity patterns suggested in the study. Urine microscopy using
the number of w.b.c/h.p.f should not be used to triage pregnant women to those that
will further need urine culture. The policy of routine drug sensitivity/resistance
surveillance and monitoring studies should be put in place to keep physicians updated
on most effective empirical treatment of UTIs.

BACTERIAL PROFILE AND DRUG SUSCEPTIBILITY PATTERNS OF URINARY TRACT INFECTIONS AMONG PREGNANT WOMEN IN ENUGU, NIGERIA