Prevalence of undiagnosed asymptomatic bacteriuria and associated risk factors during pregnancy: a cross-sectional study at two tertiary centres in Cairo, Egypt

Mohamed Abdel-Aziz Elzayat, Ashton Barnett-Vanes, Mohamed Farag Elmorsy Dabour, Feng Cheng, Mohamed Abdel-Aziz Elzayat, Ashton Barnett-Vanes, Mohamed Farag Elmorsy Dabour, Feng Cheng

Abstract

Background: The prevalence of asymptomatic bacteriuria (ASB) during pregnancy is poorly understood in Egypt-a country with a high birth rate.

Objectives: To determine the prevalence of ASB among pregnant women booking at El Hussein and Sayed Galal Hospitals in Al-Azhar University in Egypt; and to observe the relationship between ASB prevalence and risk factors such as socioeconomic level and personal hygiene.

Setting: Obstetrics and gynaecology clinics of 2 university hospitals in the capital of Egypt. Both hospitals are teaching and referral hospitals receiving referrals from across over the country. They operate specialist antenatal clinics 6 days per week.

Participants: A cross-sectional study combining the use of questionnaires and laboratory analysis was conducted in 171 pregnant women with no signs or symptoms of urinary tract infection (1 case was excluded). Samples of clean catch midstream urine were collected and cultured using quantitative urine culture and antibiotic sensitivity tests were performed.

Results: Of 171 pregnant women, 1 case was excluded; 17 cases (10%, 95% CI 5.93% to 15.53%) were positive for ASB. There was a statistically significant relation between the direction of washing genitals and sexual activity per week-and ASB. Escherichia coli was the most commonly isolated bacteria followed by Klebsiella. Nitrofurantoin showed 100% sensitivity, while 88% of the isolates were resistant to cephalexin.

Conclusions: The prevalence of ASB seen in pregnant women in 2 tertiary hospitals in Egypt was 10%. E. coli and Klebsiella are the common organisms isolated. The direction of washing genitals and sexual activity significantly influences the risk of ASB. Pregnant women should be screened early for ASB during pregnancy; appropriate treatment should be given for positive cases according to antibiotic sensitivity screening. Cephalexin is likely to be of limited use in this management.

Keywords: Asymptomatic Bacteriuria; Egypt; Urinary Tract Infection; Urine Culture.

Conflict of interest statement

Competing interests: None declared.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Figures

Figure 1
Figure 1
Urine culture and microscopic urinalysis. Proportion (%) of pregnant women with ASB in the study (A); proportions of causative uropathogens isolated from positive cases (B); microscopic analysis of bacterially positive urine cases (C). ASB, asymptomatic bacteriuria; E. coli, Escherichia coli; RBC, red blood cell.
Figure 2
Figure 2
The proportion (%) of sensitivity/resistance susceptibility of isolated bacteria to different antibiotics using discs' diffusion method; commercially purchased antimicrobial discs of known MICs were placed aseptically over the surface of the sensitivity agar. The plates were incubated for 24 hours, and the zones of growth inhibition were estimated. MIC, minimum inhibitory concentration.

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