Abstract
Asymptomatic bacteriuria (ASBU) is an important health problem among pregnant women, particularly in low-income countries. This study aimed to estimate the prevalence of ASBU and potential risk factors among pregnant women attending antenatal care centers in Addis Ababa. It also aimed to identify causal bacterial pathogens and to assess their antimicrobial susceptibility. A health facility-based cross-sectional study was conducted from March to June 2019. Urine samples from a total of 281 pregnant women with no symptoms of urinary tract infection were tested for ASBU. Women whose urine samples carried greater than or equal to 105 colony-forming units (CFU) of bacteria per milliliter of urine when grown on plate count agar were considered positive for ASBU. Bacterial pathogens were isolated from urine samples of women with ASBU using standard microbiological techniques. Antimicrobial susceptibility of isolates was investigated using the Kirby–Bauer disk diffusion method on Muller–Hinton agar plates. Of 281 pregnant women examined, 44 (15.7%) were positive for ASBU. Logistic regression analysis of the putative risk factors tested in the current study showed that none of them were significantly associated with the occurrence of ASBU (p > 0.05). The most frequently isolated bacterial species were Escherichia coli 17 (30.2%), Proteus 13 (23.2%), and Enterococcus 11 (19.6%). All of the E. coli, Citrobacter, and Klebsiella isolates and 84.6% of Proteus were resistant to ampicillin. All bacterial isolates were resistant to at least one of the antimicrobials tested. Resistance to three or more antimicrobials was detected in 15 (88.2%) of E. coli, 13 (100%) of Proteus, and 8 (72.7%) of Enterococcus isolates. Resistance to as many as 7 antimicrobials among E. coli, 8 antimicrobials among Proteus, and 7 antimicrobials among Enterococcus isolates was recorded. Detection of ASBU in a substantial number of pregnant women in this study warrants the need for a detailed study on possible risks of developing symptomatic urinary tract infection (UTI) and associated complications. Multidrug resistance to several antimicrobials was observed in the majority of bacterial isolates. Regular assessment of antimicrobial susceptibility of uropathogens to commonly prescribed antimicrobials and implementation of prudent use of antimicrobials are recommended.
Highlights
Asymptomatic bacteriuria (ASBU) is defined as the existence of bacteria in urine at a load of 105 colony-forming units (CFU)/ml or more in the absence of clinical symptoms of urinary tract infection [1, 2]
Understanding the rate of occurrence of ASBU among pregnant women, factors associated with its occurrence, identification of bacterial pathogens involved, and their antimicrobial susceptibility is vital in advising clinicians on appropriate management of urinary tract infection and associated complications. erefore, this study aimed to assess the occurrence of ASBU, risk factors associated with ASBU, bacterial pathogens involved, and their antimicrobial susceptibility among pregnant women attending antenatal care services in Addis Ababa, Ethiopia
Presence of high load of bacteria in the urine of pregnant women is reported to lead to complications like pyelonephritis and septicemia and may result in low birth weight and still birth [9]. e current study showed that the prevalence of ASBU among pregnant women attending antenatal care services in Addis Ababa was 15.7% which is in line with 18.8% prevalence reported from south Ethiopia [14], but lower than the prevalence reported from Northern Ethiopia (21.2%) [26] and Nigeria (24.7%) [12]
Summary
Asymptomatic bacteriuria (ASBU) is defined as the existence of bacteria in urine at a load of 105 CFU/ml or more in the absence of clinical symptoms of urinary tract infection [1, 2]. Both genders and all age groups are prone to ASBU, it is more common in women due to the proximity of female urethra to the anus which facilitates colonization of the periurethral area with bacteria from gastrointestinal tract [3]. Pregnant women are prone to urinary tract infection and ASBU due to physiologic changes associated with pregnancy like. A general decline in immunity during pregnancy predisposes women to infection [7]
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