PREVALENCE OF URINARY TRACT INFECTION AMONG PREGNANT WOMEN

                               

 INTRODUCTION

Urinary Tract Infection is an infection that affects the part of urinary tract that includes kidney, ureter, bladder and urethra. UTI infection causes 150 millions death worldwide per year.  UTIs are the second common complications in pregnant women after anemia. The infection that affects the lower urinary tract is known as a bladder infection (Cystitis) and the infection that affects the upper urinary tract is known as kidney infection (pyelonephritis).

UTIs are frequently encountered in pregnant women and pyelonephritis is the most common serious medical condition seen in pregnancy. The change in the urinary tract is the main reason behind the UTIs in pregnancy and is most commonly seen in time period of 6 weeks to 24 weeks. If the urinary tract infections are not diagnosed and treated in the time then it can adversely affect the health of mother and infants.

 

RISK FACTORS OF UTI IN PREGNANT WOMEN

- Previous history of Urinary Tract Infection

- Age

- Number of childbirths

- Immunodeficiency

- Urinary Tract abnormalities

- Poor hygiene and cleanliness

 

CAUSES

Pregant women are at greater risk of Urinary Tract Infection because of hormonal changes, anatomical changes, physiological changes, dilation of ureters and renal pelvis. UTIs are generally the bacterial inflammation and the common bacteria responsible for the UTIs are Escherichia Coli, Staphylococcus spps, Proteus spps, Gardenerella Vaginalis, Klebsiealla e.t.c . Other causes include glycosuria ( Increased level of glucose in urine, increased stasis of urine in the bladder e.t.c

Among different pathogens causing urinary tract infections, E.coli is most commonly and frequently encountered pathogen.

SIGNS AND SYMPTOMS

Globally, 5-7% of pregnant women have been reported to have asymptomatic urinary tract infection. Such kind of aymptomatic condition also lead to symptomatic infection resulting in pyelonephritis, hypertension, prematurity and perinatal death of the fetus. Studies have indicated that 25% - 40% of untreated pregnant women with asymptomatic bacteriuria will eventually develop to acute pyelonephritis as the most common cause of predelivery hospitalization. The common symptoms include urinating frequently dysuria, pain and pressure in the area of bladder, Backpain, chills, nausea e.t.c

 

COMPLICATIONS

 Premature rupture of fetal membrane, Septicemia, Shock, Respiratory failure,Impairment of mental and motor development in child,Fetal death,Premature delivery,Low birth weight,Cesarean delivery.

 

COMPARATIVE STUDY OF UTI AND PATHOGEN CAUSING UTI AT DIFFERENT HOSPITAL OF NEPAL

 

Fig:  Status of UTI Infection among pregnant women at Ram Janaki Hospital and Norvic Hospital and Banke and Baidya Hospital

The given bar diagram represent the urinary tract infection among pregnant women visiting Ram Janaki Hospital and Norvic Hospital and Banke and Baidya Hospital. As per the information obtained, the UTI infection among pregnant women is 41.53% at Ram Janaki Hospital and 37.84% at Norvic Hospital and Banke and Baidya Hospital. Taking average of these hospital, around 40% of pregnant women are victims of UTIs. The rate is high and the infection may lead to various complications so the policymakers and health planners must also be focused towards reducing the rate of UTIs. Awareness and education to women about the causes and symptoms of UTI is necessary.

 

PROFILE OF PATHOGEN CAUSING UTI IN PREGNANCY

 

Among the different causative agent isolated and identified at these hospitals. Most of the infection were caused by Escherichia coli which is 48.6% (average of hospitals) followed by Klebsiella Pneumoniae (18.2) %. The rate of infection by various kinds of pathogens can be easily illustrated by pie chart shown below.

                     

STATUS IN DIFFERENT COUNTRIES OF THE WORLD

The prevalence of UTIs in pregnant women in India is found to be from 3% to 24%. In the context of Nepal, rate ranges from 27% to 45%. The rate of infection is low in developed countries as compared to developing countries.

DIAGNOSIS

Analysis of urine and quantitative urine cultures are important for the diagnosis of UTIs. Midstream Urine is mostly preferred for the identification of pathogens.

 

PREVENTIVE MEASURES

        1) Early screening for pathogens and proper treatment for infected cases 

        2) Eliminate refined foods,  caffeine, alcohol, and sugar  

       3) Wear loose clothes, avoid tight fitting pants

       4) Take food rich in Vitamin c, zinc and B carotene

 

TREATMENT

Different kinds of antibiotics are given according to the bacteria isolated and identified. Generally, amikacin , impipenem, nalidixic acid are administered against gram positive bacilli whereas vancomycin, tetracycline, amoxyclav are administered against gram negative bacilli.

 

REFERENCE

Ø http://mcrr.info/index.php/mcrr/article/view/143

Ø https://www.healthynewbornnetwork.org/resource/prevalence-of-asymptomatic-bacteriuria-during-pregnancy-at-a-tertiary-care-hospital-of-province-no-2-nepal/

Ø https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4585427/

Ø Ananthanarayan and Paniker’s Textbook Of Microbiology

    By: Sajina Paudel (paudelsazeena@gmail.com)

     Bsc.MLT 5th Semester, SHAS