Asymptomatic Bacteriuria in Antenatal Cases: A Cross-sectional Study from Southern Rajasthan, India

Abstract

Introduction: Due to various anatomical and physiological changes during pregnancy, women are more prone to develop Urinary Tract Infections (UTI), which may progress to involve the upper urinary tract resulting in acute pyelonephritis, or may involve the lower tract resulting in acute cystitis. Aim: To study Asymptomatic Bacteriuria (ASB) in antenatal cases and to isolate, identify, and establish the antimicrobial susceptibility pattern of the pathogens responsible for ASB. Materials and Methods: This cross-sectional study was conducted from January 2020 to December 2020 on 363 antenatal cases attending Obstetrics Outpatient Department (OPD) in RNT Medical College, Udaipur, Rajasthan, India. The samples were processed within one hour of collection and tested (samples were cultured, and Gram’s staining and wet mount were done) for the presence of significant ASB and the sensitivity pattern of the isolates. The statistical analysis of the variables was assessed using the odds ratio and a p-value <0.05 was considered significant. Results: A total of 363 samples were evaluated; 44 samples showed significant bacteriuria in culture, with the most commonly isolated organism being Enterococcus faecalis 25 (56.8%), followed by Escherichia coli 14 (31.8%), Klebsiella pneumoniae 2 (4.5%), Enterococcus faecium 2 (4.5%), and Pseudomonas species 1 (2.3%). Gram-positive isolates were highly sensitive to amoxyclav, nitrofurantoin, vancomycin, linezolid, and imipenem, while showing reduced sensitivity to amoxicillin and nalidixic acid. Gram-negative isolates were highly sensitive to gentamicin, ceftaclav, cefoperazone- sulbactam, piperacillin-tazobactam, linezolid, vancomycin and imipenem and showed the least sensitivity to amoxicillin, cephalexin, and ceftriaxone. Conclusion: To prevent serious complications in both the mother and the foetus, urine culture and antimicrobial sensitivity testing by Kirby-Bauer disk diffusion method in the first and second trimester in antenatal women should be done as a routine procedure for the early diagnosis of ASB.