ANALYSIS OF UTI IN PREGNANCY
ANALYSIS OF UTI IN PREGNANCY
The purpose of this study is to look into the bacteriological aetiology and Urinary Tract Infections (UTIs) among pregnant women who visit antenatal clinics at hospitals in Enugu.
70 mid-stream urine samples were collected and cultured for the presence of bacterial pathogens, with 38 demonstrating considerable bacterial growth and the other 32 demonstrating no significant bacterial growth.
Bacterial agents recovered from 38 pregnant women included E. coli, Klebsiellaspp., Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus epidermidis.
The most common offending bacterial pathogen isolated was Escherichia coli 15 (39.5%). Klebsiellaspp. 9 (23.7%), Proteus mirabilis 6 (15.8%), Pseudomonas aeruginosa4 (10.5%), Staphylococcus aureus2 (5.3%), and Staphylococcus epidermidis2 (5.3%) were also implicated in this investigation.
The study found a modest frequency of urinary tract infections (38.0%), however the majority of pregnant women had no clinical manifestation.
INFECTIONS OF THE URINARY TRACT
Urinary Tract Infections (UTIs) are caused by germs multiplying in the urinary tract. UTI is defined as microbial infiltration of any urinary tract tissue extending from the renal cortex to the urethral meatus (DelzellandLefevre, 2000).
The urinary tract consists of the organs that collect, store, and expel urine from the body, which include the kidneys, ureters, bladder, urethra, and auxiliary structures. Urine produced by the kidney is a sterile fluid that can be used as an excellent culture medium for bacterial growth (Omonigho et al., 2001).
The presence of 105 germs or a single strain of bacteria per ml in two consecutive midstream urine samples indicates UTI (Davidson et al.,1989).
UTI can be classified based on which section of the tract is affected: Pyelonephritis for the upper tract and cystitis for the lower tract (Stamm, 1998).
Urinary tract infections are the body's second most prevalent type of infection, accounting for around 8.1 million visits to health care providers each year (Onyemelukwe et al., 2003). Over half of all women will have at least one UTI in their lives, with 20-30% having recurring UTI (Brook et al., 2001).
Women are more likely than men to acquire UTIs due to physical variations; the urethra in women is shorter and closer to the anus, making bacteria transfer to the bladder more likely. The likelihood of a woman or man having another UTI increases with each UTI.
Pregnant women are not more prone than other women to have a UTI, but if one does arise, it is more likely to go up to the kidneys due to structural changes in the urinary tract during pregnancy (Dimetry et al., 2007).
Because a UTI during pregnancy can be harmful to both maternal and infant health, most pregnant women are tested for bacteriuria, even if they are asymptomatic, and given prophylactic antibiotics. Most UTIs are not serious, but some, particularly higher urinary tract infections, can cause major issues.
Recurrent or long-term kidney infections (chronic) can be fatal, and some rapid kidney infections (acute) can be fatal, especially if septicemia (bacteria entering the bloodstream) occurs.
They may also raise the likelihood of mothers having low birth weight or early babies (Dimetry et al., 2007).
UTI has been recorded in 20% of pregnant women and is the most prevalent reason for obstetrical ward admission (Bacak et al., 2005).
Lower urinary tract infection (UTI) involves the bladder and urethra, while upper urinary tract infection (UTI) involves the kidney, pelvis, and ureter. Most UTIs are caused by ascending infection (Orenstein and Wong, 1999; Delzell and Lefevre, 2000).
Asymptomatic bacteriuria, acute cystitis, and acute pyelonephritis are the three most common clinical symptoms of UTIs in pregnancy (Loh and Silvalingam, 2007).
In an asymptomatic patient, UTI is defined as the presence of at least 100,000 organisms per millilitre of urine, or more than 100 organisms/mL of urine with concomitant pyuria (>5 WBCs/mL) in a symptomatic patient.
A positive culture for auropathogen should be used to support a diagnosis of UTI, especially in asymptomatic individuals (Emilie et al., 2011). In pregnancy, untreated asymptomatic bacteriuria is a risk factor for acute cystitis (40%) and pyelonephritis (25-30%).
In unscreened pregnant women, these cases account for 70% of all cases of symptomatic UTI (Emilie et al., 2011). Bacteriuria, both symptomatic and asymptomatic, has been recorded in 17.9% and 13.0% of pregnant women, respectively (Masinde et al., 2009).
The risk of UTI increases during pregnancy. The ureters begin to dilate about the sixth week of pregnancy as a result of the physiological changes that occur throughout pregnancy. This is also known as “hydronephrosis of pregnancy,” and it occurs between 22 and 26 weeks of pregnancy and lasts till birth.
During pregnancy, progesterone and oestrogen levels rise, resulting in reduced ureteral and bladder tone. During pregnancy, increased plasma volume results in decreased urine concentration and increased bladder volume. All of these factors combine to cause urinary stasis and uretero-vesical reflux (Delzell and Lefevre, 2000).
Furthermore, pregnant women's apparent decrease in immunity appears to promote the proliferation of both commensal and non-commensal microbes (Scott et al., 1999).
During pregnancy, the physiological increase in plasma volume decreases urine concentration, and up to 70% of pregnant women develop glucosurea, which promotes bacterial development in the urine (Patterson and Andrriole, 1987; Lucas and Cunningham, 1993).
The female gender is a risk factor because of the narrow urethra, its proximity to the vagina and anus, and women's inability to completely empty their bladder.
The frequency is highest in the lower socioeconomic groups (Wesley, 2002). Sexual activity and some contraceptive techniques have also been linked to an increased risk (Bandyopadhyay et al., 2005).
Because of the anatomical link between the female urethra and the vagina, it is vulnerable to injuries during sexual intercourse as well as microorganisms rubbed up the urethra into the bladder during pregnancy/childbirth (Arthur and al., 1975; Duerden et al., 1990).
Urinary tract abnormalities or stones, diabetes mellitus, immunosuppression, and a history of UTI all raise the risk (Patterson and Andriole, 1997).
Urinary tract infection during pregnancy has been linked to increased 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).
Though recent data suggest alterations in the pattern of infection, E. coli remains the most common organism implicated in urinary tract infection in pregnancy (Onuh et al., 2006). Recent research in Nigeria suggest that Klebsiella Spp., Staphylococcus aureus, Proteus spp., and Pseudomonas spp. are increasingly involved in urinary tract infection in pregnancy (Abdul andOnile, 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 goals of this study are as follows:
Look into urinary tract infections during pregnancy.
Examine the prevalence of urinary tract infections in relation to the age distribution of pregnant women.
Determine the prevalence and distribution of bacterial pathogens in pregnant women's urinary tract infections.
In most cases, urinary tract infections originate when bacteria enter the urinary tract through the urethra and grow in the bladder.
Although the urinary system is designed to keep such minuscule invaders out, these defences do fail from time to time. Bacteria may take root and grow into a full-blown infection in the urinary tract if this occurs. Urine culture can be used to determine antibiotic sensitivity, making it valuable in antibiotic treatment selection.