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Antibiotic Susceptibility of Bacterial Strains Causing Asymptomatic Bacteriuria in Pregnancy: a Cross- Sectional Study in Harare, Zimbabwe

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Antibiotic Susceptibility of Bacterial Strains Causing Asymptomatic Bacteriuria in Pregnancy: a Cross- Sectional Study in Harare, Zimbabwe MOJ Immunology Antibiotic Susceptibility of Bacterial Strains causing Asymptomatic Bacteriuria in Pregnancy: A Cross- Sectional Study in Harare, Zimbabwe Abstract Research Article Background and objective antibiotic susceptibility pattern: Effective among treatmentisolated bacterial of asymptomatic species among bacteriuria pregnant in Volume 6 Issue 1 - 2018 pregnancy requires susceptible drugs. The aim of this study was to determine womenMaterials with and asymptomatic Methods bacteriuria. : This study was conducted at 4 selected primary health 1Department of Nursing Science, University of Zimbabwe, care facilities in Harare, including pregnant women registering for antenatal Zimbabwe care at gestation between 6 and 22 weeks and without urinary tract infection 2Department of Medical Microbiology, University of Zimbabwe, symptoms. Asymptomatic bacteriuria was diagnosed by culture test of all Zimbabwe 3 midstream urine samples following screening by Griess nitrate test. Susceptibility Department of Obstetrics and Gynaecology, University of Zimbabwe, Zimbabwe test was done for all positive 24 hour old culture using the disk diffusion test. The resistant and intermediate. 4Institute of Clinical Medicine, University of Oslo, Norway minimum inhibitory concentration was measured and categorized as susceptible, Results *Corresponding author: : Tested antibiotics included gentamycin (88.2%), ceftriaxone (70.6%), Department of Nursing Science,Judith Mazoe Musona Street, Rukweza, PO Box nitrofurantoin (76.5%), ciprofloxacin (82.4%), ampicillin (67.6%) and norfloxacin University of Zimbabwe, College of Health Sciences, (61.8%). Prevalence of asymptomatic bacteriuria was 14.2% (95% CI, 10.28% to 19.22%). Coagulase negative staphylococcus was the most popular (29.4%) A198, Harare, Zimbabwe, Tel: 00263773917910; Email: bacteria followed by Escherichia coli (23.5%). Gentamycin (83.3%), ciprofloxacin Received: | Published: (75%) and ceftriaxone (70.8) overally had the highest sensitivity. Nitrofurantoin wasConclusion overally least sensitive (19.2%) but highly resistant (80.8%). January 04, 2018 January 23, 2018 for asymptomatic bacteriuria in pregnancy. Susceptibility test is a recommended test to guide: Drugtreatment resistance during was pregnancy. noted to be common among bacteria responsible Keywords: Asymptomatic bacteriuria; Pregnancy; Effective treatment; Antibiotic; Susceptibility test; Resistance; Susceptible; Minimum inhibitory concentration Abbreviations: ASB: Asymptomatic Bacteriuria; UTI: Urinary Tract Infection; UTIs: Urinary Tract Infections; MIC: Minimum important intervention to be implemented at primary care level Inhibitory Concentration [3,8,5]. Screening and treatment of ASB during pregnancy is an treatment decreases risk of acute urinary tract infection from Introduction [9]. Treatment of ASB in pregnancy using effective antibacterial Asymptomatic bacteriuria (ASB), a type of urinary tract national40% to 1 toguidelines 4% [3-10]. recommend All complications screening of ASB and during treatment pregnancy of infection (UTI), is one of common infections in pregnancy are reduced by antibiotic therapy [9]. Several international and available for selection for treatment of ASB in pregnancy including, more than 100 000 colony forming units per millilitre (cfu/ amoxil,ASB to reduceampicillin, risk ofcephasporin, pyelonephritis nitrofurantoin, [6]. Several antibioticstrimethoprim are ml)requiring in culture antibiotic of midstream treatment. urine ASB obtained is defined from asan growthindividual of and sulfamethoxazole [2]. Treatment of ASB with antibiotics in without signs and symptoms of asymptomatic bacteriuria [1,2]. and physiological changes occurring during pregnancy increase pregnancy aims to clear the infection, which is only possible if the ASB prevalence generally ranges from 2% to 10% [3]. Anatomic Susceptibilityisolated bacterium test informsis susceptible on effectiveness to it [6]. Selection of antibiotics of antibiotic against to treat ASB need to be based on antibiotic susceptibility results [9]. the risk of ASB [4]. When ASB is untreated in pregnancy it often infectious organisms and degree of bacterial resistance pattern pregnancyprogresses latercomplications in pregnancy and to adverse pyelonephritis, birth outcomes an acute including(UTI) [5]. Pyelonephritis is symptomatic bacteriuria associated with several selection of effective antibiotics for pathogenic strain and to prevent[11]. The prescribing test results and help administration to guide cliniciansof resistant on and appropriate ineffective UTIpre- latereclampsia, in pregnancy preterm birth,if ASB low is undetectedbirth weight and and untreated neonatal death [6,7]. Up to 40% of pregnant women develop a symptomatic antibiotics [11,12]. Results of the test are often categorized Submit Manuscript | http://medcraveonline.com MOJ Immunol 2018, 6(1): 00184 Antibiotic Susceptibility of Bacterial Strains causing Asymptomatic Bacteriuria in Copyright: 11 Pregnancy: A Cross- Sectional Study in Harare, Zimbabwe ©2018 Rukweza et al. as susceptible, resistant or intermediate depending on size of Inclusion and exclusion criteria minimum inhibition concentration (MIC) [11]. Susceptible result guaranteed to be inhibited by usual concentrations of an antibiotic Pregnant women registering and visiting sites with gestation implies that growth of the bacterial strain is likely though not between 6 and 22 weeks declaring no urinary tract infection symptoms, no clinical presentation of any infection and willing for the site of infection where the MIC is small and or equal to to participate were included in this study. Excluded were women diameter than the susceptible breakpoint [12]. Bacteria strain is who presented with urinary tract infection symptoms, those said to be resistant when the usually achievable concentrations who were unwell and who were unwilling to participate. Once of antibiotic will not inhibit growth of the isolate and treatment consent for a communication of their voluntary participation and recruited participants were required to submit their signed is highly likely to fail with MIC higher or equal than resistant another consent for permission to transport their urine to the laboratory. onbreakpoint antibiotic [11]. treatment Intermediate effect categoryand possibly means increasing response dose rate may be lower than for susceptible isolates and that there is uncertainty Urine specimen collection help to prevent ineffectiveness of drug, where MIC is between resistant and susceptible [12]. Empirical treatment, a common Mid- stream urine samples were collected in a surgically clean reportspractice, internationally is only useful andabout effective bacterial for resistancesome pathogens among with strains no enriched sanitizers to reduce risk of contamination of urine history of resistance [12]. There is presently alarmingly increasing labelled specimen bottles. Hands were cleaned with alcohol samples.Griess nitrite Perineal test area cleaning was also discouraged. causeresponsible a delay for in UTIsproper including treatment, ASB resulting [10-13]. inAntibiotic prenatal resistance mortality was known in the world since 2000 and is currently believed to and morbidity [1]. Knowledge of local sensitive and resistant All urine samples were screened for ASB using the Griess pattern of uro-pathogens is therefore required for efficacy and nitrite test, a nitrite detecting test, which assumes that almost empiricalprevention therapies of resistant before rates. sensitivity Accurate results susceptibility are out andresults even will in all bacterial species causing ASB have nitrate reductase which also help nurses and doctors with a guide on determination of aconverts laboratory nitrate in inthe a sampleMedical to Microbiologynitrite. All Griess Department positive samples of the could be promoting development of multidrug resistant bacterial were stored in a cooler box with ice packs and transported to settings where culture is unavailable. Empirical approach, which laboratory, a medical microbiologist performed culture test failure, prolonged hospital admissions and increased costs of care University of Zimbabwe. As soon as the samples arrived at the strains. These will be difficult to clear and a result in treatment bacterial colony, and antibiotic susceptibility. to confirm diagnosis, identify causative bacteria, quantify the Culture test and asymptomatic bacteriuria diagnosis Screeningand treatment of the and disease infant during or maternal antenatal deaths care is [14]. unavailable. In Zimbabwe Urine cultureASB screening and susceptibility and treatment test in is pregnancy not routinely is not done well possibly understood. due in primary health care centres possibly due to unavailability Uncentrifuged samples were incubated for 24 hours at 370C. to its high cost. Empirical treatment of UTIs is popularly practiced Bacterial growth of more than 103 cfu/ml was considered approach could be promoting development of multidrug resistant significant for ASB. Growth below 103 cfu/ml bacteria was bacterialof culture strainstest in theseresulting settings in ineffective in Zimbabwe. antibiotic Wide usetreatment. of this considered contaminated. If no growth occurred the sample was confirmedAntibiotic negative susceptibility for ASB. test required to guide treatment choice on empirical therapies for UTIS,Knowledge including of ASBantibiotic in pregnancy susceptibility in the country.patterns The is aimtherefore of this The disk diffusion test was used
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