karbala journal of pharmaceutical sciences

Background: Urinary tract infection is a common source of bacterial infections in human and they considered mutually with anemia and hypertension as the most medical complications during pregnancy ,with observe to the point that most of urinary tract infections are asymptomatic in pregnant women and the incidence rate of asymptomatic urinary tract is about 2-13% during pregnancy, this could lead to serious complications such as prematurity ,low birth weight ,hypertension and higher fetal mortality rates if untreated ; urinalysis is one of the important and useful urological tests for diagnosis of such infections, microscopic examination of urine and the dipstick urinalyses (leukocytes esterase test, nitrite test) are common tests used for detecting bacteriuria and pyuria.
Objective: to study the prevalence of asymptomatic bacteriuria by using and evaluation various screening rapid tests of urinalysis, bacterial uropathogens and their antimicrobial susceptibility pattern in pregnant women attending educational hospital for Gynecology and Obstetrics in Kerbela.
Patients and Method: In this study (480) pregnant woman their mean age 28.3±4.8 ranges (19-39),( apparently healthy without any signs or symptoms of urinary tract infection were included),attended to educational hospital for Gynecology and Obstetrics in Kerbela during the period (MAR-DEC 2010) were investigated for asymptomatic bacteriuria,all urine samples were collected then submitted for routine urinalysis and bacterial culture, Gram’s stain, dipstick and urine microscopy, antimicrobial susceptibility were done using disc diffusion method .
Results: of 480 samples,(27)women (5.6%)showed urine culture results indicating significant bacteriuria, the dominant uropathogens was E.coli 11 (40.71% ,Ciprofloxacin, Gentamicin and Nalidixic acid to be the most effective antibiotics; all isolates showed resistance for Ampicillin, Ciprofloxacin to be the drug of choice to treat UTIs.
The Gram’s stain was the most specific (98.8%) and sensitive (92.5%) among the rapid tests that had been used, the sensitivity of leukocytes esterase test was 70.3% higher than nitrite test 66.6%while specificity was88.5% which is lower than nitrite test 97.1%, the positive predictive value and negative predictive value for nitrite test were 58%, 97.9% respectively while for leukocytes esterase test record 26.7%, 98% respectively.
The positive predictive value and negative predictive value for Gram’s stain) 83.3%, 99.5%) were higher than that recorded in both nitrite test and leukocytes esterase.
Conclusions:
1-a total of 27 isolates different pathogens were identified among the E.coli was the dominant one, the drugs Ciprofloxacin and Gentamicin Nalidixic acid, were found the most effective against the uropathogens isolates and hence it might be the drug of choice to treat urinary tract infection in pregnant women.
2-Gram’s stain of uncentrifuged urine was observed to be the best among the screening tests which were evaluated and urine culture remained the gold standard for the detection of bacteriuria
3-antimicrobial susceptibility of the isolated uropathogens does not show significant differences with some other studies.