Urinary slow urine output which results favorable growth condition

Urinary tract infection(UTI) is an infection caused by thepresence and growth of Microorganisms anywhere in the urinary tract 1. The  infection is mainly caused by bacteria whichis present in digestive tract, vagina or around the urethra entrance to theurinary tract and then travel to bladder and kidney 2. Escherichia coliisthe most frequent organism isolated from subjects with UTI   and is responsible for at least 75 to 80 percentof cases.

Klebsiella pneumoniae, Proteusspecies, staphylococcal species, enterococci, and group B streptococci also commonly isolatedorganism 3-5. Urinary tract infection affects all age groups,  but women particularly pregnant  women are more susceptible than men, dueto  short urethra, easy contamination ofurinary tract with fecal flora 6. In addition, lower socioeconomicstatus, history of catheterization, multiparity and past history of urinarytract infection may contribute to the development of UTI in pregnancy 7-9. Urinarytract infection causes about 150 million deaths per year worldwide.Approximately 40% – 50% of women can develop the disease 10. It is also the most commoninfection and complications in pregnant women 11.

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Pregnancy increases the risk of UTIs dueto hormonal changes and expanding uterus put pressure on the bladder leads  slow urine output which results favorablegrowth condition for bacteria and increase UTI in pregnancy 12. But in many cases infection is asymptomatic. Asymptomatic bacteriuria(ABU) is bacteria present in urine in the absence ofclinical signs or symptoms of urinary infection in the host 13, 14. Asymptomatic bacteriuria is major riskfactor for the development of UTIs during pregnancy accounting for 70% 15. If untreatedcauses 40%  cystitis and 30%pyelonephritis which might lead to delivery of premature or low-birth-weightinfants3, intrauterine growthretardation, preterm labor, intrauterine fetal death, and increased prenatalmortality and morbidity16. Maternal complications includeanemia, preeclampsia, renal failure, and septicemia 17. Even if pyelonephritis is treated immediately, the conditionsignificantly increases mortality, impairment of mental and motor development 11.

Incidence of thesecomplications can be decreased by early screening and treating promptly of ABUduring pregnancy 18. Early detectionand treatment of ABU can prevent the development of a UTI by 80% to 90% 19. And preventpreterm labor by up to 20%20.According to the American College ofObstetricians and Gynecologists, screening of ABU is recommended in allpregnant women21 and Urine cultures arerecommended early in pregnancy  to detectABU22 . Pregnantwomen with asymptomatic bacteriuria should receive antibiotic therapy directedat the cultured organism23. So screening for asymptomaticbacteriuria has been included as one of the cost-effective strategies forimproving maternal and neonatal health in developing countries24.

 In thedeveloping countries  includingEthiopia  with  high level of poverty, ignorance, and poorhygienic practices 25, mainly microscopy and Dipstick tests are used as routinely diagnosticmethod  to detect ABU although this  tests could not be a reliable test to detectsignificant bacteriuria9, 26and antimicrobials are widelyused  empirically 27.The  impact of antimicrobial overuse on theantimicrobial susceptibility of human pathogens impairs the effectiveness of currentand future antimicrobial agents and emergence of resistant bacterial infectionshas been increasing which, in recent years, has become a major problem 28.  Currently, in Ethiopia data regarding theprevalence of ASB, antibiotic susceptibility patterns and associated factorsamong pregnant women have been released at different health facility 28-30. However, such data are missing from the studyarea and the antibiotic susceptibility patterns vary according to regional andgeographical location and also change through time. Besides, in Tigray region,there is no facility for culture, except in the capital city of the region,Diagnosis of ASB is mainly based on microscopy and reagent strip test and thetreatment is on empirical basis. This may lead to the overuse of antibioticsand development of resistant microbial species.

Therefore, this study will bedetermine the prevalence, antimicrobialsusceptibility pattern and associated risk factors of asymptomatic bacteriuria amongpregnant women in Adigrat Hospital.  Thecurrent study result will deliver adequate information to guide the clinicians on the proper managementand prevent empirical treatment of pregnant women with ASB. Inaddition, the study will also provide baseline information for further relatedstudies