Correlation of clinical features of Urinary tract infection in pregnancy with Isolation of uropathogens
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Date
2008Author
Ogindo, Joacquem O
Type
ThesisLanguage
enMetadata
Show full item recordAbstract
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