TITLE: women develop glycosuria that encourages bacterial growth in

TITLE: A study of prevalence of asymptomatic bacteriuria among pregnant women attending Obstetrics & Gynaecology department in a tertiary care hospital of eastern Odisha.INTRODUCTION:                    Urinary tract infection (UTI) among pregnant women is a common occurrence. This is due to the anatomical and physiological alterations that occurs during the course of pregnancy. The incidence of UTI among pregnant women has been reported to be as high as 8%.Majority of the pregnant women develop ureteral dilation that persists till delivery. Increase in bladder volume and reduced tone of bladder accompanied by decreased ureteral tone leads to increased urinary stasis and vesicoureteral reflux. About two thirds of pregnant women develop glycosuria that encourages bacterial growth in urine. Rise in level of progesterone and estrogen makes the urinary tract less capable in resisting the invasion of bacteria. So these factors are the major contributors of UTI.                    Asymptomatic bacteriuria (ABU) is defined as a condition in which urine culture reveals at least 105 CFU/ml of urine in absence of any urinary symptoms. It is the most common bacterial infection during pregnancy with a prevalence of 2-10%. The most common pathogen causing ABU is Escherichia coli, followed by Klebsiella spp., Proteus spp. And among gram positives Staphylococcus saprophyticus, Streptococcus are less common etiological agents.                    ABU during pregnancy requires treatment otherwise may lead to symptomatic urinary infection or recurrent asymptomatic bacteriuria. Several studies in India have proved that UTI during pregnancy leads to maternal complications like pyelonephritis , preeclamptic toxaemia (PTE), preterm premature rupture of membranes (PPROM) ,besides that fetal complications include preterm birth ,intrauterine growth retardation (IUGR), low birth weight (LBW) and perinatal mortality.                     In developing countries like India where most of the people live in rural areas having low socio-economic status, the incidence of ABU is high because of poor sanitation, lack of general hygiene and lack of awareness of consequences. Various studies have also revealed prevalence of ABU to be higher in older age group because of decrease in glycogen deposition and reduction in colonization of lactobacillus leading to enhanced bacterial adhesion and invasion thereby making them prone to UTI. Though it is reported to be widespread in India yet it has not received due attention.                        Hence there is a need to study the prevalence of ABU in pregnant women, its correlation with age, gravid status, trimester of pregnancy, common pathogens causing it and the resistance pattern of antimicrobial agents. The outcome of the study will help us to suggest the implication of screening for ABU among pregnant women in routine antenatal programme. OBJECTIVES:To determine the prevalence of ABU among pregnant women attending antenatal clinic.Correlate the distribution of cases according to age, parity, gravida, and trimesters of pregnancy.Isolation and identification of bacterial uropathogens. Ascertain the resistance pattern of the etiological agents.To evaluate the effects of literacy and socio economic status on ABU.METHODOLOGY:This observational prospective study will be carried out in SCB MCH Cuttack, a tertiary care hospital and the highest referral centre in eastern Odisha, after an approval from  institutional ethics committee.Type of study-prospective study.Study design-cross sectional hospital based study.Study population-Pregnant women with out any signs and symptoms of UTI attending antenatal clinic of our hospital for routine check up over a period of two months.Sample size-100 pregnant women.Selection criteria-       Inclusion criteria: (1)Pregnant women with out any signs and symptoms of UTI.(2)Living with single partner and having active sexual life.        Exclusion criteria: (1)Pregnant women having signs and symptoms of UTI.(2)Suffering from diabetes mellitus or any co-morbid illness.(3)Patients with immunosuppressed status.(4)History of previous catheterization of bladder and any antibiotic consumption for any ailment with in past 4 weeks. (5)Women having sexual relations with multiple partners.(6)Congenital anomalies of urinary tract.Data collection-The patients will be explained about the purpose of the study and the procedures of collection of urine sample. Those who are willing a written consent will be obtained. They will be screened as per the inclusion and exclusion criteria. A detailed history of their age, parity, literary status, sexual practice, hygiene, last menstrual period, personal habits, antibiotic history socioeconomic status will be obtained.Sample collection- Elegible patients will be instructed to instructed to clean the vulva using sterile gauze soaked in normal saline starting from the front and going backwards. Then collect the clean catch mid stream urine in a sterile container.             The samples are to be transported immediately to the laboratory without any delay.Processing of sample-Wet mount: The collected urine sample will be shaked well a drop will be taken on a clean slide and a cover slip will be put over it. The pus cells will be counted under high power microscope. If pus cells are found more than 5 and less than 15 per high power field, they will be noted in actual numbers. As pus cells beyond 15 cannot be counted they will be noted more than 15.Culture- All samples will be cultured on CLED agar( cysteine lactose electrolyte deficient) and blood agar plates using a calibrated loop i.e internal diameter of 4mm and incubated at 37 C overnight.         The culture plates will be examined the next day. Colony count having bacterial growth more than 105 CFU/ml of pure isolates will be processed further for identification. The isolates will be identified using standard biochemical tests. The isolates will be subjected to antibiotic sensitivity testing on Muller Hinton agar plates by disc diffusion method as per the CLSI guidelines.Data analysis-After identification the data will be analysed statistically using SPSS  software and the prevalence in different age groups, parity, socio economic status will be analysed with reference to the clinical history obtained from the patients.

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