Abstract
Asymptomatic bacteriuria can lead to urinary tract infections in as many as 20% of pregnant women. Asymptomatic bacteriuria in pregnancy can also lead to preterm births and low birth weights. The objective of this study was to profile uro-pathogens and describe the population-based prevalence, the antimicrobial sensitivity pattern, and ascertain the risk factors for asymptomatic bacteriuria among pregnant women attending the antenatal clinic of Ho Teaching Hospital, in Ghana. Urine samples were cultured, isolates identified and antibiotic sensitivity testing was done using the Clinical and Laboratory Standard Institute (CLSI) guidelines. 46 (13.7%) out of 335 pregnant women had asymptomatic bacteriuria. The most frequently isolated bacteria were Pseudomonas species (26.1%) followed by Escherichia coli (21.7%). All isolates (n=46; 100%) were resistant to Augmentin whereas 87% of the isolates (n=40) were susceptible to Gentamicin. However, most of the isolates were multi-resistant to antibiotic drugs. No education (p=0.019) and first trimester (p=0.046) of pregnancy were risk factors for asymptomatic bacteriuria. Pseudomonas aeruginosa was the most frequent organism isolated. All the uro-pathogens were resistant to Augmentin, while high rates of resistance to Tetracycline, Amikacin, Norfloxacin, and Levofloxacin were observed. The study reveals that asymptomatic bacteriuria was significantly associated with the first trimester of pregnancy and having no education. Key words: Bacteriuria, urinary tract infections, prevalence, Ghana, Ho Teaching Hospital, antimicrobial resistance.
Highlights
Asymptomatic bacteriuria (ASB) is the presence of true bacteriuria without subjective evidence of urinary tract infection (UTI) such as dysuria, urgency, and frequency (Cortes-Penfield et al, 2018)
The overall prevalence rate of bacteria growth in the urine of pregnant women attending Ho Teaching Hospital is 13.7% and comparably higher than similar studies conducted in other hospitals in Ghana such as; the Komfo Anokye Teaching Hospital (7.3%), the University Hospital, Kumasi (9.5%), and the Korle Bu Teaching Hospital (5.5%) (Labi et al, 2015; Obirikorang et al, 2012; Tupin et al, 2007)
Other studies conducted in Saudi Arabia, Uganda, Sudan, and Nigeria reported a higher prevalence of ASB among pregnant women (Al-mijalli, 2017; Andabati and Byamugisha, 2009; Ezeome et al, 2006; Hamdan et al, 2011; Oli et al, 2011) whereas studies conducted in United Arab Emirate and Northwest Ethiopia showed lower prevalence (Abdullah and AlMoslih, 2005; Alemu et al, 2012)
Summary
Asymptomatic bacteriuria (ASB) is the presence of true bacteriuria without subjective evidence of urinary tract infection (UTI) such as dysuria, urgency, and frequency (Cortes-Penfield et al, 2018). The bacteria are persistent, actively multiplying within the urinary tract and this can lead to infection in as many as 20% of pregnant women (Al-mijalli, 2017). The prevalence of ASB in pregnant women is 4 to 7%. The burden of ASB vis a vis UTI differs geographically and it is on the rise across the regions (Chamoun, 2020). The burden of UTI (progression of ASB) is estimated to be 150 million cases per year (WHO, 2005b) and it is predominantly increasing in developing countries than in developed countries (WHO, 2005a). There is an increase in healthcareassociated infection varying between 5.7 and 19.1% and this includes asymptomatic bacteriuria (WHO, 2005a)
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