Urinary slow urine output which results favorable growth condition

Urinary tract infection(UTI) is an infection caused by the
presence and growth of Microorganisms anywhere in the urinary tract 1. The  infection is mainly caused by bacteria which
is present in digestive tract, vagina or around the urethra entrance to the
urinary tract and then travel to bladder and kidney 2.

 

Escherichia coli
is
the most frequent organism isolated from subjects with UTI   and is responsible for at least 75 to 80 percent
of cases. Klebsiella pneumoniae, Proteus
species, staphylococcal species, enterococci, and group B streptococci also commonly isolated
organism 3-5.

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Urinary tract infection affects all age groups,  but women particularly pregnant  women are more susceptible than men, due
to  short urethra, easy contamination of
urinary tract with fecal flora 6. In addition, lower socioeconomic
status, history of catheterization, multiparity and past history of urinary
tract infection may contribute to the development of UTI in pregnancy 7-9.

 

Urinary
tract infection causes about 150 million deaths per year worldwide.
Approximately 40% – 50% of women can develop the disease 10. It is also the most common
infection and complications in pregnant women 11.

Pregnancy increases the risk of UTIs due
to hormonal changes and expanding uterus put pressure on the bladder leads  slow urine output which results favorable
growth condition for bacteria and increase UTI in pregnancy 12. 
But in many cases infection is asymptomatic. Asymptomatic bacteriuria
(ABU) is bacteria present in urine in the absence of
clinical signs or symptoms of urinary infection in the host 13, 14.

Asymptomatic bacteriuria is major risk
factor for the development of UTIs during pregnancy accounting for 70% 15. If untreated
causes 40%  cystitis and 30%
pyelonephritis which might lead to delivery of premature or low-birth-weight
infants3, intrauterine growth
retardation, preterm labor, intrauterine fetal death, and increased prenatal
mortality and morbidity16. Maternal complications include
anemia, preeclampsia, renal failure, and septicemia 17. 
Even if pyelonephritis is treated immediately, the condition
significantly increases mortality, 
impairment of mental and motor development 11. Incidence of these
complications can be decreased by early screening and treating promptly of ABU
during pregnancy 18. Early detection
and treatment of ABU can prevent the development of a UTI by 80% to 90% 19. And prevent
preterm labor by up to 20%20.

According to the American College of
Obstetricians and Gynecologists, screening of ABU is recommended in all
pregnant women21 and Urine cultures are
recommended early in pregnancy  to detect
ABU22 . Pregnant
women with asymptomatic bacteriuria should receive antibiotic therapy directed
at the cultured organism23. So screening for asymptomatic
bacteriuria has been included as one of the cost-effective strategies for
improving maternal and neonatal health in developing countries24.

 In the
developing countries  including
Ethiopia  with  high level of poverty, ignorance, and poor
hygienic practices 25, 
mainly microscopy and Dipstick tests are used as routinely diagnostic
method  to detect ABU although this  tests could not be a reliable test to detect
significant bacteriuria9, 26and antimicrobials are widely
used  empirically 27.The  impact of antimicrobial overuse on the
antimicrobial susceptibility of human pathogens impairs the effectiveness of current
and future antimicrobial agents and emergence of resistant bacterial infections
has been increasing which, in recent years, has become a major problem 28.

 

 Currently, in Ethiopia data regarding the
prevalence of ASB, antibiotic susceptibility patterns and associated factors
among pregnant women have been released at different health facility 28-30. However, such data are missing from the study
area and the antibiotic susceptibility patterns vary according to regional and
geographical location and also change through time. Besides, in Tigray region,
there is no facility for culture, except in the capital city of the region,
Diagnosis of ASB is mainly based on microscopy and reagent strip test and the
treatment is on empirical basis. This may lead to the overuse of antibiotics
and development of resistant microbial species. Therefore, this study will be
determine the prevalence, antimicrobial
susceptibility pattern and associated risk factors of asymptomatic bacteriuria among
pregnant women in Adigrat Hospital.  The
current study result will deliver adequate information to guide the clinicians on the proper management
and prevent empirical treatment of pregnant women with ASB. In
addition, the study will also provide baseline information for further related
studies