COMPARATIVE STUDY OF ASYMPTOMATIC BACTERIURIA IN HIV POSITIVE AND NEGATIVE PREGNANT WOMEN AT THE LAGOS UNIVERSITY TEACHING HOSPITAL
BACKGROUND: Asymptomatic Bacteriuria (ASB) in pregnancy predisposes to the development of pyelonephritis, which leads to obstetrics complications like preterm labour and low birth weight infants.
AIM: To compare the burden of ASB among HIV positive and HIV negative pregnant women attending the Lagos University Teaching Hospital (LUTH) antenatal clinics.
METHODS: A cross-sectional comparative study among HIV positive and HIV negative pregnant women at LUTH was carried out. Relevant socio-demographic and clinical data were collected using a structured proforma. “Clean catch” urine samples were collected for processing.
RESULTS: Among the 288 patients equally divided between the two groups, 81(28.1%) had ASB of which 31.9% (46/81) were HIV positive and 24.3% (35/81) were HIV negative pregnant women. There was significant association between the gestational age and presence of ASB in HIV positive pregnant women in the 3rd trimester (p=0.012). Occurrence of ASB was also higher in HIV positive pregnant women with CD4 count < 500 cells/mm3 (54.3%) and viral load < 1000copies/ml (76.1%). Gram negative rod, Enterobacter agglumerans 25(8.6%) was the most common microbe isolated in both groups. Coagulase negative staphylococcus species 22(7.6%) was common in HIV positive group. The isolates were sensitive to Amikacin and Fosfomycin.
The high prevalence among the study population reinforces the need for screening and treatment of ASB in pregnancy. The antibiotics with the highest sensitivity of > 50% were Amikacin and Fosfomycin.
Routine screening for and treatment of ASB in pregnancy should be an integral part of obstetric care especially in the third trimester and should be included in antenatal guidelines in settings where it isn’t currently the practice.
Due to its sensitivity, ease of administration and safety profile in pregnancy, further research can be carried out on the prophylactic use of fosfomycin in pregnant women with high risk for ASB.