Pregnancy and asymptomatic bacteriuria- A study from a tertiary care teaching hospital, Hyderabad

Introduction: Asymptomatic bacteriuria is found in 2 to 10% of pregnant women. Complications like acute pyelonephritis, postpartum UTI, hypertension, anemia, prematurity, low birth weight babies and prenatal death may occur if untreated. Hence early detection and treatment are of considerable importance. Materials and Methods: A crosssectional study was conducted for a period of one year. A clean catch midstream urine sample was collected from pregnant women as a part of routine antenatal screening. The samples were processed according to standard microbiological techniques –wet mount examination, gram staining, glucose test paper, culture and antibiotic susceptibility testing. Results: Of the 200 samples received from the study group, 28(14%) were culture positive. The prevalence of culture positivity was more in the third trimester (19.4%).The predominant organisms isolated were gram negative bacteria like Escherichia coli (35.7%) and Klebsiella spp (28.5%). E.coli and Klebsiella showed variable resistance to fluoroquinolones, cephalosporins, aminoglycosides, betalactam and betalactam inhibitor combination. However the isolates of E.coli were sensitive to carbapenams and polymixins. Isolates of Klebsiella spp were sensitive to Polymixins. The predictive accuracy of different screening tests with culture was calculated. The sensitivity, specificity, positive predictive value, negative predictive value of grams staining is more compared to urine wet mount examination and urine test paper method in early detection of bacteruria. Conclusion: Early detection and treatment for asymptomatic bacteriuria is of considerable importance as 40% of asymptomatic cases develop into pyelonephritis The choice of antibiotic should be based on urine culture, stage of gestation, clinical data and the characteristics of the antibiotic.