Urinary Tract Infections (UTIs) during pregnancy are among the most common infections worldwide and can lead to poor perinatal and maternal outcomes. This study determined the prevalence of UTIs during pregnancy, associated risk factors and antimicrobial susceptibility profiles of associated bacterial pathogens. A cross-sectional study was conducted among 210 pregnant women attending antenatal clinic at Pumwani Maternity hospital. Their social-demographic profiles were obtained using a structured questionnaire. Cultures were done from midstream urine and antimicrobial susceptibility testing determined using the disc diffusion test. The overall prevalence of UTI was 15.7% regardless of the women’s age, parity and stage of gestation. Prevalence of asymptomatic and symptomatic bacteriuria was 4.3% and 11.4% respectively. Material of undergarment and frequency of changing the undergarments were found to contribute significantly to the acquisition of UTI (P < 0.05). E. coli was the most predominant UTI organism at (44.5%) followed by K. pneumoniae (21.2%) and S. aureus (15.1%). Almost a half (over 49%) of all Gram-negative organisms showed resistance prevalence against third generation cephalosporins, fluoroquinolones, Sulfamethoxazole-Trimethoprim, Cefoxitin, Nitrofurantoin and Amoxicillin-clavulanic acid. Gram-positive strains were susceptible to Amoxicillin-clavulanic acid, Nitrofurantoin, Linezolid and Ofloxacin. The prevalence of multi-drug resistance (MDR) in all study isolates was 96%. Our data suggest a serious resistance trend among UTI strains and more should be done to slow down this trend. Pregnant women should be screened by urine culture and treatment be guided by the antimicrobial susceptibility data.
In developing countries, UTIs are among the most common health problems affecting women in their reproductive ages. Pregnant women are more susceptible to UTIs due to a combination of hormonal and physiologic changes that predispose them to bacteriuria [
Globally, the prevalence of UTI in pregnancy ranges between 13% - 33% with symptomatic bacteriuria occurring in 1% - 18% while asymptomatic cases are noted in 2% - 10% of women [
In many hospitals in developing countries such as Kenya, routine urine culture is not carried out even for antenatal mothers. Currently, most patients are treated empirically without culture and antimicrobial susceptibility testing (AST) and treatment is therefore based on empiric guidelines that are rarely updated [
Results of this study provide critical data to care givers and health planners regarding diagnosis, common etiological agents and probable treatment options with regard to antimicrobial resistance. This study also identified associated risk factors for UTI amongst pregnant women attending antenatal clinic at Pumwani Maternity Hospital (The largest antenatal clinic in Kenya).
This was a cross sectional study carried out at Pumwani Maternity Hospital, an obstetric and referral hospital for expectant mothers in Nairobi, the Kenyan capital. The study targeted pregnant women seeking antenatal care services at the Hospital.
Systematic random sampling technique was employed in recruiting participants until the expected study sample was attained. A structured questionnaire was used for gathering socio-demographic and lifestyle data from the participants. Participants were instructed on how to collect clean-catch midstream urine after signing the consent form. Each sample bottle had a date of collection and bar-code linked to the participant's questionnaire which was in turn linked to confidential patient information file.
Urine aliquots of 10 µl were plated directly on CLED, MacConkey and blood agar plates and incubated aerobically at 35˚C - 37˚C for 24 hours. Colony counts yielding bacterial growth of ≥100,000 (105) CFU/ml or more of pure isolates were deemed significant UTI cases whereas those yielding lower values were deemed as contaminants. At least 3 colonies of similar morphology per patient were randomly selected from UTI plates and purified before biochemical identification. Gram stain was done for all colonies analyzed and biochemical tests carried out to identify the isolates to the species level [
Antimicrobial susceptibility testing of pure isolates was performed according to the Kirby-Bauer disc diffusion method [
Data analysis was done using using the SAS software, version 9.3 (SAS Institute). Chi-square test was applied for P-value derivation for socio-demographic and risk factors associated with UTIs. Binary logistic regression analysis was carried out to generate the adjusted odds ratio with 95% confidence interval, an alpha of less than 0.05 (P < 0.05) was considered statistically significant.
A total of 210 pregnant women were recruited in the study. The overall prevalence of UTI was 15.7%. Prevalence of asymptomatic and symptomatic bacteriuria was 4.3% and 11.4% respectively.
Pregnant mothers in the age group of 21 - 30 years had the highest prevalence of UTI at 75.8% followed by those aged 31 - 40 years at 12.1%, below 20 years of age at 9.1% while those above the age of 40 years had the least prevalence of 3%. UTI prevalence was also high among mothers in the second trimester (60.6%) compared to third trimester (24.2%) and first trimester (15.2%). High prevalence of bacteriuria was observed among multiparous mothers (72.7%) as compared to nulliparous (27.3%). Despite these variations, there was no significant association between UTI and maternal age, parity, occupation, gestation, marital status or level of education P > 0.05,
Among the lifestyle factors surveyed, mothers with multiple partners were two times more likely to develop a UTI (OR 2.45; P > 0.05) compared to those with a single partner
From the 99 UTI isolates identified, 78 (78.8%) were gram negative while 21 (21.2%) were gram positive bacteria. E. coli was the most predominant UTI isolate at 44.5% followed by K. pneumoniae (21.2%) and S. aureus (15.1%). Other organisms included P. aeroginosa, Acinetobacter spp. and Enterococcus spp. each at 6.1%. Analysis of 15% of the urine samples that would have been classified as