Urinary Tract Infection (UTI)

Prevalence and bacteriology of culture-

positive urinary tract infection among
pregnant women with suspected urinary
tract infection at Mbarara regional referral
hospital, South-Western Uganda
Syifa Firza Aziza
Urinary tract infection (UTI)
● more common during pregnancy because the hormonal and mechanical
changes in the urinary tract make women more vulnerable starting from
6 weeks through 24 weeks.
● Urinary tract infection in pregnancy involves
ü Urethra
ü Bladder
ü Ureter
ü Kidneys
● Most of the infections are limited to the bladder and urethra but can
lead to kidney infection.
Predisposing pregnancy factors

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HORMONAL COMPRESSION INTERLEUKIN-6 CONTAMINATION

Progesterone may also • Uterine enlargement and and serum antibody e.Coli because of the
induce smooth muscle relative dextrorotation responses to E. coli proximity of the anal
relaxation in the ureter. • the right ovarian venous antigens appear to be orifice to the urethra.
plexus that crosses over the lower in pregnant
ureter, and finally bladder women
pressure and capacity are
also altered due to
decreased tone. rotation.
Signs and Symptoms

DYSURIA BLOOD CRAMPS

Pain or burning (dysuria) Blood or mucus in Cramps or pain in the
the urine lower abdomen

FEVER CLOUDY PAIN

Chills, fever, sweats, Change in amount pressure or tenderness
leaking of of urine, cloudy, in the suprapubic
urine (incontinence) smells foul area of the bladder
or unusually strong
 Acute Cystitis & Acute Pyelonephritis
Acute Cystitis
• Involves only the lower urinary tract
• Is characterised by inflammation of the
bladder
• Signs and symptoms include haematuria,
dysuria, suprapubic discomfort, nocturia
• Acute cystitis is complicated by upper urinary
tract disease (i.e. pyelonephritis) in 15–50 per
cent of cases
• Acute cystitis occurs in 1–2 per cent of
pregnancies
Acute Pyelonephritis
• Is the most common urinary tract
complication in pregnant women, occurring
in approximately 2 per cent of all
pregnancies
• Is characterised by fever, flank pain and
tenderness in addition to significant
bacteriuria
• Other symptoms may include nausea,
vomiting, dysuria
• Women with additional risk factors (e.g.
immunosuppression, diabetes, sickle cell
anaemia, neurogenic bladder, recurrent or
persistent UTIs before pregnancy) are at an
increased risk for a complicated UTI
Additive parameters of UTI classification and severity assessment

The Geneva Foundation for Medical Education and Research, 2011

RF: Risk Factor

 Dipstick
Diagnosis of UTI
1 A positive leucocyte esterase dipstick
during Pregnancy test suffices in most instances to
indicate urine infection and start
further tests.

Urine Microscopy
2 • If clinical findings suggest UTI, urine microscopy
may be indicated even if the leucocyte esterase
dipstick test is negative.
• Pyuria is most accurately measured by counting
leucocytes in unspun fresh urine using an
emocytometer chamber; more than 10 white blood
cells (WBCs)/mL is abnormal.
• Microscopic haematuria is found in about half of
cystitis cases.

Urine Culture
3 It should be considered in the following circumstances:
• Immunosuppression.
• Recent urinary tract instrumentation.
• Recent exposure to antibiotics.
• Recurrent infection.
• Advanced age.
• Any amount of uropathogen grown in culture
from a suprapubic aspirate should be considered
evidence of a UTI. A mid-stream sample of urine
should be collected after separating the labia.
• Urine specimens may be obtained by suprapubic
aspiration or catheterisation.
Kultur urine adalah metode pemeriksaan untuk mendeteksi adanya bakteri di dalam urine, sebagai
pertanda dari infeksi saluran kemih. Selain mendeteksi keberadaan bakteri, kultur urine juga dapat
digunakan untuk menentukan jenis bakteri penyebab infeksi

BPJS : Urin sederhana (PH, berat jenis, kejernihan,

warna, leukosit, eritrosit)
Bacteriology of UTI during pregnancy

Escherichia coli
responsible for about 80
per cent of urinary tract
infections.

Staphylococcus Saprophyticus
represented 6–17 per cent.

Other organism
Fungus, parasites, protozoa
3 per cent.
Management of UTI
during Pregnancy
Duration of antibiotic treatment for
uncomplicated acute cystitis:

ü Fosfomycin is given in a single dose

ü Nitrofurantoin monohydrate
/macrocrystals is given for five to seven
days
ü β-lactam agents are given for three to
seven days
 Complications
Maternal Fetal

● Intrauterine growth
● Anaemia retardation
● Chorioamnionitis ● Intrauterine death
● Symptomatic acute ● Low birthweight
cystitis and acute ● Prematurity of baby
pyelonephritis
 Prevention

HYDRATION VIT & MINERAL HYGIENE

6 – 8 glasses of water Vit. C (250–500 mg), Avoid : cream antiseptic,
β-carotene (25 000–50 000 IU hygiene sparays, strong soap
each day. Fruit juices. per day)
zinc (30–50 mg per day)

URINATE UNDERWEAR CLEAN & DRY

It is advisable to urinate Loose cotton underwear and After urinating, the genital
pantyhose should be area should be clean and dry
before and after
worn and changed every day. and should be wiped from
intercourse. the front to the back.
]
 LATAR BELAKANG
Infeksi saluran kemih (ISK) pada wanita hamil berkontribusi sekitar 25%
dari semua infeksi dan termasuk di antara infeksi bakteri klinis yang paling
sering terjadi. Perubahan kehamilan pada wanita yang meliputi anatomi,
fisiologis dan hormonal membuat mereka rentan terkena ISK. Jika tidak
diobati, ISK dalam kehamilan dikaitkan dengan komplikasi serius pada ibu
dan janin. Komplikasi ini dapat dikurangi dengan diagnosis yang cepat dan
tepat serta pengobatan yang tepat yang juga mengurangi keadaan darurat
resistensi obat. Resistensi antimikroba adalah masalah kesehatan utama
dalam pengobatan ISK. Kami menentukan prevalensi, bakteriologi dan
kerentanan antimikroba dari gejala infeksi saluran kemih pada ibu hamil di
RS Rujukan Daerah Mbarara.
 METODE
• peneliti melakukan studi cross-sectional dari November
2019 hingga Februari 2020 yang melibatkan 400 wanita
hamil dengan gejala ISK.
• Informasi pasien diperoleh dengan menggunakan kuesioner
terstruktur.
• peneliti mengumpulkan spesimen urine midstream bersih
untuk kultur dan melakukan pengujian kerentanan
antimikroba mengikuti standar Clinical and Laboratory
Standards Institute.
• Data dimasukkan ke perangkat lunak RED-cap Version 8.2
dan kemudian diekspor ke Stata Versi 14.1 untuk analisis.
 CRITERIA

Inclusion Exclusion
- Lower abdominal pain - Failed to produce urine
- Frequency of micturition - Vaginal bleeding
- Urning micturition
- Panful micturition
- Nausea and or vomiting
- Hematuria
- fever
 STUDY PROCEDURE

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FORMULA RESPONDENTS PERMISSION SAMPLE

Kish Leslie (1965) 400 whom - Informed Collected urine 30
formula selected using consent ml sealed the bottle
consecutive - questionnaire and using a cold box
sampling to identify
leukocytes counts
RESULT
DISCUSSION

Johnson (2021) Solomon (2016)

(Kadebe, 2016) (Matalingana,2015)

Common & Dominant Pathogen of UTI
 CC Conclusion
• Our study recorded :
• The dominant isolates in our study were Klebsiella pneumoniae and E. coli.
These two organisms were highly resistant to the commonly used
antibiotics.
• UTI in pregnancy was significantly associated with previous UTI.
• We encourage all clinicians to base diagnosis of UTI in pregnancy on urine
culture.
• Empirical treatment of UTI should be avoided as sensitivity varies for each
organism, for each drug and over time. Particular interest should be given
to pregnant women with a history of UTI.
• We should also educate pregnant women to avoid over-the-counter
antibiotics as this is likely to worsen antibiotic resistance.
• Also, we recommend screening for bacteriuria in all pregnant women.
TERIMA KASIH