ASYMPTOMATIC BACTERIURIA AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINIC OF GENERAL HOSPITAL EKWULOBIA

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TABLE OF CONTENT

Title                                                                                 i

Approval                                                                          ii

Dedication                                                                       iii

Acknowledgement                                                            iv

Table of Contents                                                             v

 

CHAPTER ONE

Introduction                                                                   1

Aim of Study                                                                    3

Significance of Study                                                               4

Scope of study                                                                 4

CHAPTER TWO

Literature Review                                                           5

Prevalence of asymptomatic bacteriuria in pregnancy     5

Predisposing Factors                                                                7

Symptoms                                                                        9

Complications of asymptomatic bacteriuria in pregnancy        9

Expectation (prognosis)                                                   10

Treatment of Asymptomatic Bacteriuria                           10

Diagnosis                                                                         13

CHAPTER THREE

Materials and Methods                                                    15

Study area                                                                       15

Study Population                                                             15

Collection of Specimen                                                    15

Preparation of culture media                                           16

Centrifugation                                                                  16

Microscopy                                                                      16

Isolation                                                                           17

Antibiotic Sensitivity test                                                 17

Identification and characterization of bacteria isolates    17

Gram Reaction                                                                 18

Biochemical Test                                                             19

Oxidase Test                                                                    19

Coagulase Test                                                                 20

Indole Test                                                                       21

Motility Test                                                                     21

Ureaese Test                                                                    22

Citrate utilization test                                                      22

Sugar fermentation test                                                   23

Mannitol test                                                                   23

References                                                                       24

ABSTRACT

Studies on asymptomatic bacteriuria among pregnant women attending antenantal clinic of the General Hospital Ekwulobia was undertaken, hundred urine samples were collected then centrifriged and 1ml of the supernatant was inoculated on the prepared Nutient Agar and Mac Conkey agar then incubated at 370c for 48 hours. Pure colonies were obtained by sub culturing. Morphological and biochemical characterization of the isolates identified bacteria of the general Staphylococcus, Streptococcus, Proteus and Escherichia. The result showed that 72(72%) of the pregnant women are asymptomatic. E. coli was sensitive to Reflacine but resistant to Tarivid, Staphylococcus aureus was sensitive to gentamycin and resistant to Nalidix acid. There is need for routine screening of urine of pregnant women as part of antenatal health care for pregnant women in Nigeria

CHAPTER ONE

INTRODUCTION

Asymptomatic bacteriuria refers to the presence of bacteria in Urine. It is a conduction in which urine reveals a significant growth of pathogens that is greater than 105 bacteria/ml, but without the patient showing symptoms of urinary tract infection (UTI) (Girbert et al; 2005).

This common during pregnancy. The apparent reduction in immunity of pregnant women appears to encourage the growth of both commensal and non-commensal microorganism (Scott et al; 1990).

The physiological increase in plasma volume during pregnancy decrease urine concentration and up to 70% pregnant woman develop glucosurea, which encourage bacteria growth in urine (Patterson et al; 1987 luces et al; 1993).

Pregnancy enhances the progression from asymptomatic bacteriuria which could lead to pyelonephrintis and adverse obstetric  out comes such as prematurity, low birth weight (Connotly et al; 1999) and higher foetal mortality rates (Nicolle, 1994, Delzell et al; 2000) the adverse effects  of undiagnosed asymptomatic bacteriuria on mother and child have made researchers to suggest routine culture screening for all pregnant women attending antenatal clinic (Kirlam, 2005) in order to prevent mother and child from any form of complication that may arise due to infection.

However, in many hospitals in developing countries including Nigeria, routine urine culture test is not carried out for antenatal patients. Probably due to cost implication and time factors for culture result (Usually 48 hour’s period) instead many clinicians opt for the strip urinalysis method for accessing urine in pregnant women.

The true picture of such urine specimen cannot be fully accessed as the strip cannot qualify the extent of infection in such a patient as well as provide antimicrobial therapy which is usually seen in the case of culture test. In many health centers in developing countries. The attention of clinicians and health care providers  is usually on the presence of glucose and protein in urine specimens with less attention on possible asymptomatic infection.

The incidence of asymptomatic bacteriuria is reported as 2-4% during pregnancy. Pregnant  women and their unborn foetuses may be at risk of complication Guyton, 1996, Lindsay, 2003, Bloomberg etal; 2005).

Quantitative criteria for identifying significant bacteriuria in an asymptomatic person is at least 100cfu/mc of urine from a catheterized specimen (Warren et al; 1982, hysky et al; 1987, saint et al; 2003). According to the infections disease society of America (IDSA) guideline. The diagnosis of asymptomatic bacteriuria in pregnant women is appropriate only if the same species is present in quantities at least 10cfu/ml in at least two consecutive voided specimens (Nicolle, 2003, Nicolle et al; 2005).

AIM OF STUDY

Asymptomatic bacteriuria is common in pregnant women and if untreated could lead to serious complications. Although asymptomatic bacteriuria could also lead to such complications, this fact is not well known.

This study is to determining the prevalence of asymptomative bacteruiria among pregnant women attending antenatal clinic at the General Hospital Ekwulobia.

SIGNIFICANCE OF STDY

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