Prevalence of asymptomatic bacteriuria in antenatal women at tertiary care centre: One year cross sectional study

Introduction and Need for the study:

Urinary tract infections (UTIs) are more frequent in women because of shorter urethra and its close proximity to anus and vagina. In pregnancy the risk increases further more due to lowered immunity, the presences of glucose in urine (renal glycosuria), and urinary stasis resulting from the relaxing effect of progesterone on smooth muscle.

During routine antenatal visits, urine tests are commonly done to check for the presence of protein and sugar, along with microscopic examination is performed to detect red blood cell, pus cells, casts and other elements. A urine culture is also advised to detect bacteriuria. The prevalence of asymptomatic bacteriuria (ASB) ranges from 5-12% in developing countries and 2-7% in western countries. Asymptomatic bacteriuria is defined as the presence of persistent and rapidly multiplying bacteria in the urinary tract without any symptoms of urinary tract infection. A clean catch urine sample containing >105 colony forming units (CFU) per ml is considered significant for bacteriuria. Urine culture remains the gold standard for its diagnosis and is most effective as a screening tool.

The most common causative organism responsible for asymptomatic bacteriuria is Escherichia coli (80-85%), followed by staphylococci, klebsiella, pseudomonas and other. ASB is associated with various adverse outcomes for mother and fetus. Maternal complications may include symptomatic urinary tract infections in about 25% of affected women, chronic drug-resistant infections, acute pyelonephritis, preeclampsia, anemia, chorioamnionitis, endometritis, and postpartum UTIs. Fetal complications can involve prematurity, intrauterine growth restrictions (IUGR), low birth weight, and increased perinatal mortality. Early diagnosis and appropriate treatment can effectively prevent these complications. Hence, routine screening for ASB in all pregnant women is crucial. This study highlights the importance of such screening practices.

Asymptomatic bacteriuria (ASB) is defined as >105 CFU /ml of the same bacterial species in a clean catch midstream urine sample without any symptoms of urinary tract infections. Asymptomatic bacteriuria is common in pregnant women and is associated with factors such as age, living standards, parity, sexual activity, communities, different ethnicities, past history of urinary tract infection (UTI), urinary tract abnormalities, maternal history, medical history, socio-economic status, education status .and has been implicated in adverse pregnancy outcomes.

During pregnancy, physiological changes like ureteral dilation, urinary stasis, and hormonal fluctuation increases the susceptibility to bacteriuria. In India, the report prevalence of ASB among pregnant women ranges from 7.3% to 25.3%, with variations likely due to differences in study population, location and screening technique. If left untreated, asymptomatic bacteriuria (ASB) during pregnancy can lead to serious maternal and fetal complications. Therefore, routine screening and timely management of ASB in pregnant women are crucial to improve pregnancy outcomes.

Escherichia coli remains the most commonly isolated uro-pathogen in cases of asymptomatic bacteriuria (ASB) among pregnant women in India, followed by Klebsiella pneumoniae and Staphylococcus aureus. Antibiotic susceptibility studies indicate that these organisms often show resistance to commonly prescribed antibiotics, emphasizing the importance of conducting urine culture and sensitivity testing to guide effective treatment. Despite the proven advantage of early detection routine urine culture and sensitivity screening is still not widely practiced in many healthcare facilities in India. This study aims to assess the prevalence of asymptomatic bacteriuria (ASB) in pregnant women attending a tertiary care hospital, identify the causative organisms, and evaluate their antibiotic resistance profile.

Data collection procedure:

·       Over a period of 12months, the women in 2nd and 3rd trimester visiting to obstetrics and gynecology OPD at tertiary care center (KLEs DR. Prabhakar Kore Hospital, Belagavi) are going to be included in the study.

·       After informed consent the respective antenatal women midstream urine specimen will be send to the microbiology lab for urine culture and sensitivity.

·       After 72 hours the report is collected and noted.

·       In addition to the above details, the demographics (maternal age, residence, occupation, socio- economic status, educational status) of pregnant women will be obtained and their antenatal record is noted.

·       Detailed antenatal history and presenting complaints will also be noted.

·       The general examination and obstetrics examination of the pregnant women will be noted.

·       Routine obstetrics investigations will be noted. (Complete blood count, Urine routine and examination, Serum Thyroid Stimulating Hormone, DIPSI, HIV status, HBsAg status, VDRL status).

·       Intra-natal events of each pregnant women and feto-maternal outcome involved in the study will be noted