1.1 Introduction
Urinary tract infections refer to the presence of microbial pathogen within the urinary tract and it is usually classified by the infection site, bladder (Cystitis), kidney (Pyelonephritis or urine (Bacteria) and also can be a Asymptomatic or symptomatic (UTI) that occur in a normal genitourinary tract with no prior instrumentation are considered as Uncomplication whereas Complicated Infections are diagnosed in genitourinary tracts that have structural or functional abnormalities Urethral catheters, and are frequently asymptomatic (3,4) (kriptke, 2005).
It has been estimated that globally symptomatic (UTIS) result in as many as 7 million visits to outpatient clinic, 1 million visits to emergency departments, and 100,000 hospitalization annually (chin et al 2011). Many different microorganisms can cause urinary tract infection, though the most common pathogens causing the simple ones in the community are Esherichia Coli and other Enterobacteriacae, which accounts approximately 75% of the isolates (Kebira et al, 2009).
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research questions, Limitation of the study and Definition of technical terms.
1.2 Background of Study
Urinary Tract Infection (UTI) is a common health problem among pregnant women (Saidi et al, 2005). This usually begins in week 6 and peaks during week 22 to 24 of pregnancy due to a number of factors including ureteral dilatation, increased bladder Volume and decreased bladder tone. Along with decreased ureteral tone which contributes to increased urinary stasis and ureterovesical reflux (chaliha et al, 2002). Up to 70% of pregnant women develop glyucosuria, which encouraged bacteria growth in the urine (AI Issa, 2009). It may manifest as Asympromatic bacteriuria (ASB) or symptomic Bacteriuria (SB).
The prevalence of asymptomatic bacteriuria UTI has been previously reported to be 2% to 13% in pregnant women (Delzell et al, 2000). Compared with that of symptomatic Bacteriuria in (UTI) which occur in 1-18% during pregnancy. Urinary tract infection (UTI) during pregnancy may cause complications such as Pyelonephritis, hypertensive disease of pregnancy, anaemia, chronic renal failure premature delivery and foetal mortality (Dwyer, et al 2002).
The incidence of these complications can be decreased by treating promptly Asymptomatic Bacteriuria (ASB) and Symptomatic (SB) during pregnancy due to the potential adverse sequelea of Urinary tract infection in pregnancy. Most clinic perform routine urinalysis of midstream urine specimen during one or more antenatal clinic (ANC) visits (Smaill 2007). However, culture and antimicrobial drug susceptibility testing are needed for surveillar purposes to guide the clinician on the proper management and prevent empirical treatment of pregnant women with (ASB) and (SB). A limited spectrum of organisms cause UTI and these include Escherichia Coli, which accounts for the majority of uncomplicated urinary tract infection Isolates (crupta, et al, 2001). Others are Staphylococcus Saprophyticus, Klebsiella Spp, Proteus Spp, Enterococcus Spp and Enterobacter Spp (Massinde et al., 2009).
Treatment of UTI varies with the type diagnosed (complicated or uncomplicated UTI), but is usually empirical because of the common spectrum of urinary pathogens involve (Nickel et al., 2005; Nabbugodi et al., 2015). Antimicrobial resistance is a major public health problem worldwide. This is caused in part by the overuse and abuse of antimicrobials in clinical situations where they are not necessary or in prolonged courses of therapy when shorter durations are as effective (Hassan et al., 2011; Amin et al., 2009; Ali et al., 2014; Lee et al., 2016; Sultana et al., 2018).
The importance of pre-natal laboratory urine screening for bacteria to identify patients with asymptomatic bacteriuria cannot be underestimated. However, some women with UTI may present in the hospital at the late stage of the pregnancy. This hinders effective treatment of urinary infection and there may be no positive birth outcome even If antimicrobials had been administered (Morita et al., 2013; Siakwa et al., 2018; Bjerklund-Johansen et al., 2015). Most women with UTI are not aware of this condition. The infection is later diagnosed at the late stage of pregnancy which hinders effective treatment or positive birth outcome. UTI is a serious health problem affecting millions of people each year and is the leading cause of Gram-negative bacteremia. Establishment of base-line data is a very critical epidemiological effort in mitigating the complications of UTI in pregnancy.
As a result, the prevalence of antimicrobial resistance among urinary track has been increasing worldwide (Biadglegene. et al, 2009). In complicated Urinary tract infections and hospitalized patients, organisms such as Enterococcuss Faecalis and highly resistant, gram -ve rods including Pseudomoinas Spp. are comparatively more common. The relative frequency of the pathogens varies depending upon age, sex, catheterization and hospitalization.
Urine is an ultra-filtrate of blood with different molecules and salts and does not usually have bacteria as a normal constituent. When a bacterium finds its way into the urinary tract and multiplies there, it may cause infection. Though UTI affects both male and female, women are more susceptible than men due to the short urethra in females, lack of prostatic secretion, pregnancy and proximity of the female urinary tract to the rectal region which facilitates contamination of the urinary tract with faecal organisms (Ahmed et al., 2016; Valiquette et al., 2001).
Therefore, in Delta State where the research was carried out, the activities that was conducted is to know the Bacteria Associated with Urinary Tract Infection in Pregnant Women and their Antibiotic Susceptibility.
1.3 Statement of Problems
Investigation revealed that the prevalence of UTI among pregnant women has been reported to be high regardless of the women’s age, parity and gestational age and E. coli is suspected to be the commonest isolated organism with multi resistance toward different antibiotics. Previously the prevalence of UTI among pregnant women in the neighbor countries has been indicated to be 14.6% and 11.6% in Tanzania and Ethiopia (Masinde, et al., 2009). It has been shown that anti-microbial resistance to one drug does not always correlate to the consumption of the same drug or closely related drugs (Kahlmeter, et al., 2003).
Inappropriate antimicrobial use can lead to inadequate therapy and contribute to further drug resistance (Fluit and Schmitz, 2001). The inappropriate use of antimicrobial in low income countries is perhaps due to the lack of adequate knowledge about drugs and non-availability or non-accessibility of guidelines for therapy (Mathai, et al.. 2004), or to the availability of antimicrobials without prescription and perhaps it was prescribed by non-skilled practitioners (Yilmaz, et al., 2009).
1.4 Aim and Objectives of Study
The aim of the study is to determine the Bacteria Associated with Urinary Tract Infection in Pregnant Women and their Antibiotic Susceptibility. In achieving this aim, the following specific objectives were laid out as follows:
- To characterize UTI causing pathogens from urine samples in pregnant women;
- To determine antimicrobial resistance of Escherichea coli isolates from urine samples in pregnant women;
- To identify the presence of unnoticed Urinary Tract Infection (UTI) among pregnant women; and
- To compare antimicrobials susceptibility pattern on Escherichia coli isolates in inpatient and out-pregnant mothers
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- Is there any significance in antimicrobials susceptibility pattern on Escherichia coli isolates in inpatient and out-pregnant mothers?
- Does the presence of unnoticed Urinary Tract Infection (UTI) have significant effect on pregnant women?
- What is the criterion of characterizing Escherichea coli isolates from urine samples in pregnant women?
- What is the level of antimicrobial resistance of Escherichea coli isolates from urine samples in pregnant women?
1.6 Research Hypothesis
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
Hypothesis One
- H0: The presence of unnoticed Urinary Tract Infection (UTI) does not have significant effect on pregnant women
- H1: The presence of unnoticed Urinary Tract Infection (UTI) has significant effect on pregnant women
1.7 Significance of Study
This study will be of immense benefit to academic students and other researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study contributes to knowledge and could serve as a guide for other study.
1.8 Scope of Study
The scope of the research is focused on the Bacteria Associated with Urinary Tract Infection in Pregnant Women and their Antibiotic Susceptibility.
1.9 Limitations of the Study
During the course of this study, many things militated against its completion, some of which are:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
- Lack of Initial Cooperation from Respondents: A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.
1.10 Definition of Terms
Urinary Tract Infection (UTI):
Urinary Tract Infection is the microbial invasion and subsequent multiplication in any parts of the urinary tract.
