TY  - BOOK
AU  -   Joshua Kaduma
AU  - Clotilda Chuma
AU  - Jeremiah Seni 
TI  -  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                                                                                                                                            
PY  - 2017///
CY  - Mwanza, Tanzania:  
PB  - Catholic University of Health and Allied Sciences [CUHAS - Bugando]
KW  -  
N2  - 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

ER  -