Spectrum of Uropathogens and its Antibiotic Susceptibility in Pregnant Women with Symptomatic Urinary Tract Infection in a Nigerian Teaching Hospital. Running headline: Urinary Tract Infection in Pregnancy

Abstract

Background: Urinary tract infections (UTI) are the most common bacterial infections in pregnancy and associated with maternal and perinatal morbidity and mortality.Objectives: To determine the current uropathogens and their antibiotic susceptibility pattern and to compare the pregnancy outcome among clinical UTI and non clinical UTI cohorts.Patients and methods: This was a prospective matched cohort study carried out between 1st January, 2012 and 30th June, 2012 at the department of Obstetrics and Gynaecology of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. The study population was made up of 200 pregnant women with clinical signs and symptoms of urinary tract infections and 200 pregnant women without clinical signs and symptoms ofurinary tract infection as control matched with maternal age group, parity and gestational age.Results: Of 3442 obstetric patients seen 200 had clinically diagnosed UTI in pregnancy giving a rate of 5.8%. Age bracket 21- 30years and multipara had highest frequency of significant bacteriuria. Low social status and third trimester of pregnancy were identified risk factors for UTI in pregnancy. Frequency of maternal anaemia (p=0.02) and hypertension (p=0.03) were significantly higher among subjects than control. The common bacterial uropathogen isolated were Escherichia coli (46.7%), Staphylococcus aureus (17.9%), Proteus spp.(13.3%) and Klebsiella spp. (11.1%). The antibiotics with highest coverage included Co-amoxyclave (81%), Gentamicin (68.8%) and Cefuroxime (54.4%).Conclusion: Maternal anaemia and hypertension were significantly higher among subjects than control. Gram negative isolates were predominantand E. coli was the most common isolated bacteria. Co-amoxyclave had highest coverage against the bacteria. Therefore, co-amoxyclave is  recommended for empirical use for urinary tract infection in pregnancy in this locality.Keywords: Uropathogens, urinary tract infection, pregnancy, antibiotic sensitivity