tract infection (UTI) is an infection caused by the presence and growth of
microorganism in genitourinary system 1. UTI affects all age groups but is
more common in females due to factors like short urethra, pregnancy and
proximity to anal orifice 12. Urinary tract infection is a common problem
among pregnant women and a serious cause of maternal and perinatal morbidity
and mortality 3.
There are different forms of UTI
depending on which part of the urinary tract is infected. Asymptomatic
bacteriuria is a bacterial urinary tract infection that occurs without any
symptoms. 20-30% of pregnant women with untreated asymptomatic bacteriuria may
develop symptomatic UTI, such as cystitis or pyelonephritis 1. Urethritis is
the Infection of urethra with bacteria, protozoa, viruses, or fungi. Main
symptoms are dysuria and urethral discharge (purulent, whitish, or mucoid) 1.
Pyelonephritis is the most common urinary tract complication in pregnant women,
occurring approximately 2% of all pregnancies 3. Acute pyelonephritis is characterized by fever, flank
pain, and general malaise. Acute
Cystitis involves only the lower urinary tract; it
is characterized by inflammation of the bladder as a result of bacterial or nonbacterial
causes, dysuria, urgency, frequency of urination, and sometimes suprapubic pain
women are at increased risk for UTIs, beginning in week 6 and peaking during
weeks 22 to 24 18. Several physiological, anatomical and personal
factors contribute to this problem during pregnancy 19. For
example, uretheral dilatation, increased bladder volume and decreased bladder
tone with increased urinary stasis. Some unsound personal hygiene may increase
the risk of infection. Several socio-demographic characteristics were found
significantly associated with UTIs, age being 30 years and more, illiterates
and low educational level and low socio-economic level. Significant
associations with UTIs were also found in multigravidae 4th and more, those
having more than one child and those who previously suffered UTIs 20.
Dipstick urinalysis has become the most
frequently used test due to its reliable rates and fast results. Studies have
shown that dipstick urinalysis in combination with clinician judgment, greatly
improves diagnostic accuracy in the patient with nonspecific symptoms 4.
Pregnant women should be treated when
bacteriuria is identified. Cephalexin (Keflex), Erythromycin, Nitrofurantoin
(Macrodantin), Sulfisoxazole (Gantrisin), Amoxicillin-clavulanic acid
(Augmentin), Fosfomycin (Monurol), and Trimethoprim-sulfamethoxazole (Bactrim)
are the antibiotic choices for the treatment of UTI during pregnancy. The
choice of antibiotic should address the most common infecting organisms (i.e.,
gramnegative gastrointestinal organisms) 21. The antibiotic should also be
safe for the mother and fetus.
The prevalence of UTIs in pregnancy
globally ranges from 13%-33% with asymptomatic bacteriuria occurring in 2–10%
during pregnancies while symptomatic has been found to account for 1-18% during
pregnancies 4,5. E. coli is the most common UTI-associated
pathogen with a rate of 63% in the Philippines. The predominance of E. coli is
usually attributed to the urinary stasis, which is common in pregnancy 6.
According to a study done in Ibadan, South-Western Nigeria
the most implicating organism causing urinary tract infections among pregnant
women was E. coli and it was
responsible for 42.1% of the cases of UTI followed by S. aureus (28.9%), K.
aerogenes (18.4%) and P. aeruginosa (5.3%)
7. This finding is similar to other reports which suggest that gram negative
bacteria, particularly E.coli is the
commonest pathogen isolated in patients with UTI 8,9,10,11,12.
As with many infectious
diseases, it appears that the disease burden of Asymptomatic Bacteriuria
(ASB)/UTI in pregnancy is greatest in some of the poorest nations 13. The economic burden of UTI in adult
women is significant. The health care direct and indirect costs associated with
UTIs in terms of bed occupation, staff and supply are also large and include
substantial out-of-pocket expenses for the patients (Griebling, 2011) 14. The
prevention of the complications that lead to neonatal deaths is likely to have
an even larger health and economic impact and should be placed at the center of
the research agenda. For example, prenatal care practices that can prevent
life-threatening complications include the detection and treatment of
preeclampsia, intermittent presumptive treatment of malaria, and immunization
of pregnant women with tetanus toxoid 15,16,17.
The findings of this study will help
determine if socio-demographic variables may affect the incidence of Urinary
Tract Infection among pregnant women. This could also insight awareness among
people, especially pregnant women, who have no idea that UTI during pregnancy
could happen in association with their socio-demographic profile.