The association between significant bacteriuria and pre-eclampsia among pregnant women at Bugando Medical Centre and Sekou Toure Regional Referral Hospital-Mwanza Tanzania; A 1:2 Matched Case Control Study
- Mwanza, Tanzania: Catholic University of Health and Allied Sciences [CUHAS - Bugando] : c2017
- xiii; 44 Pages Includes References and Appendices
ABSTRACT:
BACKGROUND: Significant bacteriuria is common in pregnant women and is associated with adverse outcome to both mother and child. It is commonly caused by Escherichia coli, its prevalence ranges from 8% to 26% worldwide. Pre-eclampsia is a condition where there is onset of high blood pressure >135/90mmHg at second half of pregnancy and proteinuria. Several studies have reported association between UTI and preeclampsia/eclampsia, however in our setting there is limited data on association of preeclampsia and significant bacteriuria to guide rational therapy and avert adverse maternal-fetal outcome
AIM: To determine the association of UTI with significant bacteriuria and preeclampsia among pregnant women attending at Bugando Medical Centre(BMC) and Sekoutoure Region Referral Hospital(SRRH) in Mwanza, Tanzania.
METHODS: This was a 1:2 matched case control study involving 131 pregnant women with preeclampsia (cases) and 262 without pre-eclampsia (controls). One case was matched with two controls by age and gravidity. Following a written voluntary consent to every study participant, demographic, obstetric and other clinical information were collected using structured pretested questionnaire. Mid-stream urine (MSU) was collected for culture and antimicrobial susceptibility testing. Those with positive culture were treated according to susceptibility results and preeclamptic patient were treated according to BMC or SRRH guideline. Analysis was done by STATA software version 13.0.
RESULTS: The median age (interquartile range) of enrolled 393 pregnant women was 25 (21-32) years, with 162 (41.2%) and 231(58.8%) being from BMC and SRRH respectively. Of the 393 participants, 110 (27.9%) had significant bacteriuria with predominance of Escherichia coli, 50 (45.5%) and Klebsiella spp, 25(22.7%). Over three quarters of isolated bacterial species were resistant to ampicilin and trimethoprimsulphamethoxazole; whereas the resistant to ceftriaxone ranged from 16% to 42%. Of the 131 pregnant women with preeclampsia, their mean current systolic and diastolic blood pressure were 160.5 ± 16.1mmHg and 104.6 ± 11.0 mmHg respectively. Pregnant women with significant bacteriuria were found to have 7.7 odds of developing preeclampsia compared those without significant bacteriuria [OR=7.7, 95% CI (4.11- 14.49); p-value<0.001].
CONCLUSION: Pregnant women with significant bacteriuria are significantly more likely to develop preeclampsia compared those without significant bacteriuria. Therefore, routine urine culture and susceptibility testing among pregnant women with preeclampsia should be introduced in the antenatal clinics to guide specific antimicrobial therapy. A study to ascertain the maternal fetal outcomes will be of interest in the future.
= OPERATIONAL DEFINITIONS Asymptomatic bacteriuria Refers to the presence of one clear-voided urine specimen yielding positive cultures (≥ 105CFU/ml) of the same microorganism, in a patient without urinary symptoms. OPERATIONAL DEFINITIONS Mid-stream urine specimen a urine specimen obtained from the middle part of clean catch of urine OPERATIONAL DEFINITIONS Pre-eclampsia is a condition where there is onset of high blood pressure > 135/90 mmHg in the second half of pregnancy (> 20 weeks gestation age) and proteinuria OPERATIONAL DEFINITIONS Severe preeclampsia when there is high blood pressure more than 155/105mmHg and proteinuria OPERATIONAL DEFINITIONS Symptomatic UTI Refers to the patient yielding positive urine culture (105 CFU/mil) with UTI symptoms OPERATIONAL DEFINITIONS Significant bacteriuria Refers to the patient yielding positive urine culture (105 CFU/mil) with or without UTI symptoms. OPERATIONAL DEFINITIONS Proteinuria Presence of greater than normal amounts of protein in urine (i.e. >3g/dl)
= LIST OF ABBREVIATIONS ASB Asymptomatic Bacteriuria BMC Bugando Medical Centre CFU Colony Forming Unit CUHAS Catholic University of Health and Allied Sciences GOPD Gynecological Out Patient Department IUGR Intra Uterine Growth Restriction MSU Mid-Stream Urine SRRH Sekoutoure Regional Referral Hospital UTI Urinary Tract Infection IL Interleukin TNF Tumor Necrosis Factor