Correlation of clinical features of Urinary tract infection in pregnancy with Isolation of uropathogens

Abstract

Background: Urinary tract infection in pregnancy has prevalence rates of 2-10% and is associated with adverse maternal and neonatal outcomes. Diagnosis depends on clinical features and can be confirmed with urine culture. There is paucity of local data correlating clinical diagnosis of UTI with laboratory outcomes in order to give credence to empiric therapy. The evidence from this study will help make a simple clinical decision tree for syndrornic management of UTI for use in resource constrained settings. Objective: To correlate clinical features of UTI with uropathogen isolation among pregnant women with a clinical diagnosis of UTI. Study Design: Cross-sectional analytical study. Setting: Kenyatta National Hospital, Nairobi. Kenya. Outcome Measures: Quanlitative urinalysis, urine culture and sensitivity. Methodology: All consenting pregnant women seen in the antenatal clinic and labour ward with signs and symptoms of UTI were recruited into the stUdy until the sample size of 137 was reached. The women completed a questionnaire that had sections on demographic and obstetric details, relevant past medical history and presenting complaints of the urinary tract, before being requested to provide a urine specimen. Midstream urine specimen was then obtained by the clean catch method and used for qualitative urine analysis, culture and sensitivity. Samples were processed and analysed at Kenyatta National Hospital microbiology laboratory. Laboratory data was then entered into the lab section of the questionnaire by the principal investigator. Data analysis was done using Statistical Package for Social Scientists (SPSS)/PCI programme. Results: The most common symptoms of UTI were suprapubic pain (97.1 %), urgency (94.2%), frequency (92%) and loin pain (91.2%). Loin tenderness and suprapubic tenderness occurred in 02%. Leukocyte esterase was identified in 43% on dipstick urinalysis and bacteria detected in 41.2%. Presence of nitrite was associated with 66.7% bacterial isolation rates. Overall bacterial isolation rate was 41.6%, the commonest of which were E.coli (52.6%) and Staphyllococus (33.6%). Fever was associated with high bacterial isolation rate (77.8%) and suprapubic and loin tenderness 42% and 40.1 % respectively. Urgency, suprapubic pain, loin pain, frequency and dysuria were associated with bacterial isolation rates of 39-47%. Nitrofurantoin, amoxicillinclavulanic acid, cefuroxime were associated with bacterial sensitivity of 91.2%, 77.2% and 73.7