Asymptomatic bacteriuria among pregnant women attending antenatal care at Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia: magnitude, associated factors and antimicrobial susceptibility pattern

Abstract

Background: Asymptomatic bacteriuria is one of the major risk factors for the development of UTIs during pregnancy which accounts for about 70% of the cases. If not screened and treated early, it will proceeds to some complications like pre-eclampsia, symptomatic acute cystitis and acute pyelonephritis. However, in most of developing countries including Ethiopia, there is no guideline that recommends routine screening of pregnant women for asymptomatic bacteriuria. There is no study conducted in in the selected study area to see the magnitude of asymptomatic bacteriuria and antimicrobial susceptibility pattern of isolates among pregnant women. Objective: The aim of this study was to determine the magnitude, associated factors and antimicrobial susceptibility pattern of asymptomatic bacteriuria among pregnant women attending antenatal care at Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia from March to April 2019. Methods: A hospital based cross sectional study was conducted on 281 pregnant women selected by convenient sampling technique. A structured questionnaire was used to collect data from the study participants and mid-stream fresh urine was used for culture, for isolation and identification of bacteriuria. Then data were checked and entered into EPI-data version 3.1 and analyzed by Statistical Package for Social Science software version 22. The results were presented by using frequencies, percentages, tables and figures. After bivariate and multivariate logistic regression analysis, variables with a p-value < 0.05 at 95% confidence interval were considered as statistically significant. Results: The overall prevalence of asymptomatic bacteriuria was 19.9 % (95% CI: 16.4% - 24.6%). Six different bacterial isolates were identified of which Escherichia coli the most dominant isolate (44.6%) was followed by Coagulase negative Staphylococci (28.6) and Staphylococcus aureus (10.7 %). Direction of wiping after genital wash (AOR (adjusted odd ratio) = 2.853; 95% CI: 1.255, 4.320), post coital urination (AOR= 3.160; 95% CI: 1.173, 6.514) and catheterization (AOR= 3.122; 95% CI: 1.378, 7.072) were factors significantly associated with asymptomatic bacteriuria. Escherichia coli were sensitive to ceftriaxone (92.0%), Gentamycin (68.0%) and Augmentin (60.0%) and Cotrimozazole (68%). The overall drug resistances to two or more than two antibiotics were observed in 58.9% of isolates. Conclusion: The overall prevalence of asymptomatic bacteriuria among pregnant women in the study was higher compared to previous studies conducted in Ethiopia. Direction of wiping after genital wash, catheterization and post coital urination increases the odds of asymptomatic bacteriuria. Almost half of the isolates were resistances to two or more than two antibiotics. Pregnant women

should be screened by urine culture and treatment be guided by the antimicrobial susceptibility tests. In addition to this health education on the predisposing factors is strongly recommended.