Skip to main content
Download PDF

Prevalence of urinary tract infections and antibiotic susceptibility patterns of bacterial isolates in first-time ANC attendees at a secondary health facility in Ghana: a cross-sectional study

BMC Pregnancy and Childbirth volume 25, Article number: 483 (2025) Cite this article

Abstract

Background

Urinary tract infections (UTIs) in pregnant women are a common public health concern. Identifying the prevalence of bacteriuria, the causative organisms, and their anti-microbial susceptibility profiles against commonly prescribed antibiotics used to treat UTIs among pregnant women is an aim this study seeks to attain. This aim is critical in achieving the Sustainable Development Goals 3.1 and 3.2, targeted at reducing the scourge of global maternal mortality.

Methods

This hospital-based cross-sectional study was conducted among pregnant women seeking antenatal care at a secondary health facility in Ghana. Mid-stream urine samples from the study participants were collected aseptically, and their physical and biochemical composition was determined semi-quantitatively. Urine samples were examined, and microscopy was conducted, after which they were cultured. Organisms in significant urine culture growth were isolated and tested against commonly prescribed antibiotics used to treat UTIs at the facility using standard protocols to determine their antibiotic sensitivity patterns.

Results

A total of 200 pregnant women with a mean age of 27.8 ± 6.1 years participated in the study. Almost half, 48.0% (96) of all the study participants, reported for booking in the second trimester of their pregnancy. A 39.0% (78/200) positive culture growth in all the urine samples, with bacteria species responsible for the culture growth in 21.5% (43/200) of the total urine samples, was noted in this study. Ninety-one organisms were isolated, with 38.5% (35/91) being yeast-like cells, 31.9% (29/91) Escherichia coli, and 8.8% (8) Pseudomonas spp and 7.7% (7) being Klebsiella spp. There was a varying resistance of the isolated bacteria, ranging from 50.0% to 100.0%, to commonly prescribed antibiotics used in treating UTIs at the facility.

Conclusions

Bacteriuria in the study participants was relatively high, which warrants screening all pregnant women and treating those infected with appropriate anti-microbial regimens to reduce its complications. Also, the variable sensitivity of isolated bacteria to commonly prescribed antibiotics at the facility is a concern; as such, health education on anti-microbial stewardship should be incorporated into routine antenatal education for pregnant women in Ghana.

Peer Review reports

Introduction

A urinary tract infection (UTI) is a microbial infection that occurs when germs infiltrate the normally sterile urinary tract. Predominantly, these infections are caused by bacterial agents; however, fungi have also been implicated in the pathophysiology of UTIs [1]. Though it occurs in both sexes, UTIs are more common in women due to the short urethra and perineal colonization by bacteria. Urinary tract infections afflict about half of all women at some point [2], with a lifetime prevalence of 50–60% [3]. The incidence of UTI in women further increases during pregnancy due to a reduction in their immunological apparatuses and the accompanying changes in the anatomical as well as physiological and hormonal deviations [4].

Aside from pregnant women presenting with symptoms such as dysuria, lower abdominal pain, frequency, and many other symptoms predictive of a UTI, most cases appear asymptomatic [5]. A significant bacterial count of > 105 organisms or colony-forming units present per millilitre in the urine without symptoms in the urinary tract has been used to define such asymptomatic UTIs in pregnant women [5].

With a varying global incidence ranging from 4 to 45% [6, 7], UTI in pregnant women is a worldwide public health issue associated with high treatment costs, increased morbidity, treatment failure and mortality [8].

Risk factors associated with UTI in pregnant women include a history of UTI, gestational diabetes mellitus and poor personal hygiene [9, 10]. Urinary tract infections in pregnancy, if not recognized and treated early, can result in renal failure, severe respiratory distress, pyelonephritis and preterm labour for the mother, and immaturity, higher foetal mortality, low birth weight and neonatal sepsis for the developing baby and newborn [11].

Urinary tract infections in pregnancy have adverse effects on the mother, such as the development of preeclampsia, high blood pressure and anaemia [12]. In the newborn, low birth weight, stillbirths, premature birth and infant death are some of the morbidities and mortalities associated with UTI in pregnancy. Additionally, UTI in pregnancy is implicated in the development of long-term disease states in progeny. These infections have been reported to be associated with the development of childhood epilepsy, mental retardation and, in some cases, delayed development and a higher risk of attention deficit hyperactivity disorder [13]. Also, infants born to mothers with UTI during pregnancy are susceptible to respiratory, ear, nose and throat infections [14].

In low-and middle-income countries such as Ghana, there is a high health illiteracy rate. In addition, bacterial infections are frequent, and understanding of these urinary tract infections is poor among the population, posing a bigger public health concern [15]. In instances where UTI symptoms are apparent, pregnant women go to a local chemical store, which is often staffed by unskilled employees, to obtain antibiotics without a prescription [16]. Also, because bacterial culture and susceptibility testing take time, most clinicians start treating patients with empirical antibiotics before the results of the laboratory tests are ready. As a result, antibiotic resistance and treatment failure have emerged, putting strain on the already scarce resources of such low-middle-income countries.

This study, therefore, sought to determine the prevalence of significant bacteriuria, the causative organisms and their anti-microbial susceptibility profiles against commonly prescribed antibiotics used to treat UTIs among pregnant women seeking antenatal care at the Tamale West Hospital, Ghana.

Methods

Study site

The study was conducted at the 200-bed capacity Tamale West Hospital (TWH), Tamale, Ghana. The Tamale West Hospital (GPS: NT- 0018–5672) is one of the two government-owned secondary hospitals in the Tamale metropolis. The TWH provides a 24-h service delivery for the people in Tamale and its environs. The hospital has an Out–Patient Department (OPD), In-Patient Unit, a Public Health Unit, Ear, Nose and Throat (ENT) Department, a Pharmacy, an Accident and Emergency, a Surgical, Neonatal Intensive Care Unit (NICU), a Mental Health, Child Health, Imaging, Laboratory, Eye Department and a Maternal Health Department under which the Ante-natal Clinic (ANC) where this is study was undertaken is located. The ANC is manned by one medical doctor, five midwives, and five medical laboratory scientists/technicians. It provides obstetrics and gynaecological services to its clients from Monday to Friday. The facility attends to an average of 50 clients daily on an outpatient basis [17].

Study population

The study population comprised all pregnant women seeking antenatal care at the ANC unit of the Tamale West Hospital (TWH), Tamale. Pregnant women who came for booking (first-time ANC attendees with their current) were included in the study. Pregnant women with underlying renal disease or pathology, those on antibiotics or who had been on antibiotics for at least two weeks prior to the clinic attendance were excluded from the study.

Study type, sampling technique and sample size determination

This hospital-based cross-sectional study employing a convenience sampling technique to select the study participants was conducted from January to June 2022 after obtaining ethical approval from the Ethical Review Committee (ERC) of the Tamale Teaching Hospital, Tamale, Ghana (TTHERC/25/06/21/03). The first 12 pregnant women who visited the facility for antenatal care every Monday, Wednesday and Friday were recruited into the study once they met the inclusion.

Using a margin of error of 5% and 95% confidence level and an estimated prevalence of UTI in pregnant women of 17.5% [18], a minimum sample size of 190 was obtained, of which 5% was added to take care of attrition.

Data collection tools and data collection

A self-designed data collection tool was used to collect participants' data and record laboratory findings. Information on participants'socio-demographic characteristics, urinalysis and antibiotic sensitivity test were obtained.

Socio-demographic characteristics

Participants' socio-demographic characteristics, such as age, educational level, occupational status, marital status, place of residence, religious affiliation, and gestational age were recorded. Educational level was classified as none if the respondent has no formal education, basic if the highest education attained is a junior high school, secondary if the respondent has attained at least a secondary/vocational education and tertiary if the respondent has attained any tertiary level of education. Religious affiliation was classified as Islam if the participant belongs to the Islamic faith or Christianity if the respondent is a Christian. The place of residence was categorized as rural if the participant resides in a locality with a population of < 5000 people or urban if the place of residence is ≥ 5000 [19].

Obstetric and medical characteristics of study participants

Obstetrics and medical characteristics of study participants, like gestational age of the pregnancy at booking, dysuria, frequency and urgency of urination, and lower abdominal pain, were collected. Gestational age at booking was defined as the first trimester if the pregnancy is < 14 weeks, the second trimester if the pregnancy is 14–27 weeks, and the third trimester if the pregnancy is ≥ 28 weeks as determined by ultrasonography estimate based crown-rump length (for less than 14 weeks) and biparietal diameter/femur length/head circumference/abdominal circumference if > 14 weeks [20]. Participants' discomfort when urinating (dysuria), their frequency of urinating defined as voiding out urine once every 1 or 2 h, and the urgency of urinating [21] were recorded.

Urine sample collection and biochemical analysis

A 10–15 ml mid-stream urine sample from each participant was collected aseptically into two dry, sterilized, capped, and labelled urine sample bottles for urinalysis [22]. The physical characteristics (colour, presence of blood clots, deposits and debris) of each urine sample were examined macroscopically immediately after the collection recorded, and the biochemical composition of one sample was determined semi-quantitatively using URIT 10 V Urine Reagent Strips [23]. Briefly, the reagent strip was immersed into a thoroughly mixed uncentrifuged urine sample for not more than one second and withdrawn. Excess urine was wiped off with sterile tissue paper, after which the strip was interpreted per the manufacturer's colour code.

The second urine sample was sealed and stored at 37 °C and transferred immediately to the Public Health Laboratory, Tamale Teaching Hospital, a travelling time of about 5 min from the Tamale West Hospital for laboratory analysis. The samples were microscopically examined using standard protocols for pus cells, bacteria, and ova, after which they were cultured, and antibiotic sensitivity testing was performed on positive cultures.

Culture of urine samples and susceptibility test

A urine culture was performed on each sample. In brief, a loopful (10 µl) of urine sample was taken and inoculated on Cystine Lysine Electrolyte Deficient (CLED) agar (Biotic Laboratories Ltd, U.K) incubated aerobically for 24 h at 37 °C. Colony forming units (CFU) ≥ 105 CFU/ml of bacterial growth was considered positive. Pure bacteria colonies were then isolated and identified presumptively using conventional standard biochemical methods and confirmed using the Analytical Profile Index 20 (BioMérieux, Inc., Durham, USA) [24].

Antibiotic susceptibility test using the disc diffusion method (Kirby Bauer) on Müller-Hinton agar medium was used to determine the sensitivity of pure isolates of the bacteria against commonly prescribed antibiotics administered in the treatment of UTI at the facility (cefuroxime 30 µg, ceftriaxone 30 µg, Augmentin (amoxicillin/clavulanic acid µg), nalidixic acid 30 µg, and nitrofurantoin 300 µg) (Oxoid™, Thermo Fisher, UK) and the results interpreted according to the Clinical and Laboratory Standard Institute (CLSI) criteria [25]. Reference strains of S. aureus (ATCC- 25,923) and E. coli (ATCC- 25922) were tested as controls.

Data analysis

All fully completed data collection tools were entered into the Statistical Package for the Social Sciences (v26) (IBM, USA) for analysis. Frequencies and percentages were reported for categorical variables, whereas the mean and standard deviation (S.D.) were presented for continuous variables. A Chi-square association and a student t-test, where appropriate, were used to determine the association between study variables and performed at a 95% significant level. The statistical significance of a two-tailed p-value of less than 0.05 was then determined.

Results

Socio-demographic characteristics of study participants

In all, 200 pregnant women with a mean age of 27.8 ± 6.1 years participated in the study. The majority, 60.5% (121), were aged 20 to 29 years, 74.5% (149) were self-employed, 41.0% (82) had no formal education, 97.5% (195) were married, 75.5% (151) were Dagombas, and 81.0% (162) resided in an urban settlement. There was no statistical association between the socio-demographic characteristics of study participants and the culture outcome (Table 1).

Table 1 Socio-demographic characteristics of study participants
Full size table

Obstetric and medical characteristics of study participants

The majority, 48.0% (96) of all the study participants, reported for booking in the second trimester of their current pregnancy. However, when study participants were stratified by culture outcome, the majority, 67.7% (63) of those who had negative cultures, reported for booking in the first trimester. Most, 91.5% (183) of the participants did not experience any dysuria, 93.5% (187) had a normal frequency of urination, and 97.5% (195) had no urgency to urinate. Regarding participants experiencing lower abdominal pain, most, 82.5% (165) did not experience any pain. There was no statistical association between the study variables and participants'obstetric and medical characteristics (Table 2).

Table 2 Obstetric and medical characteristics of study participants
Full size table

Physical and biochemical analysis of urine samples

Most, 82.5% (165) of the urine samples from the participants were yellowish in colour, and 95.5% (190) had no glucose. Almost forty percent (77) of the samples had no proteins, with 36.0% (72) having some traces of proteins in their urine and 25.5% (51) having proteinuria. Almost all the urine samples, 99.0% (198) had no nitrite, with half (102) having no leukocytes, 30.0% (60) having leukocytes, and 19.0% (38) having traces of leukocytes. When the presence or absence of leukocytes was stratified by culture outcome, positive samples had a higher percentage of 51.7% (31/60) of leukocytes. The presence of leukocytes in urine samples was marginally significantly associated with culture outcomes (Table 3).

Table 3 Physical and biochemical analysis of urine samples
Full size table

Prevalence of UTI-causing organisms among the study participants

A 39.0% (78/200) positive culture growth of all the urine samples, with bacteria species responsible for the culture growth in 21.5% (43/200) of the total urine samples was noted in this study. Ninety-one organisms were isolated from the 78 positive culture growth, of which 61.5% (56/91) were bacteria species. The most predominantly isolated organisms were yeast-like cells, 38.5% (35/91), Escherichia coli, 31.9% (29/91), Pseudomonas spp, 8.8% (8), Klebsiella spp, 7.7% (7). Mixed microbial organisms were identified in the samples of nine respondents. Out of these, two microbial organisms were identified in 8 samples and three organisms were identified in one sample. (Fig. 1).

Fig. 1
figure 1

Frequency of UTI-causing organisms among the study participants

Full size image

UTI-causing organisms stratified by trimester of booking

When the isolated microorganisms responsible for the UTI were stratified by the trimester of booking, most of the yeast-like cells 68.6% (24/35), Escherichia coli 48.3% (14/29) and Klebsiella spp 57.1% (4/7) were cultured from respondents who reported for booking in the second trimester of their pregnancy (Fig. 2).

Fig. 2
figure 2

UTI-causing organisms stratified by trimester of booking

Full size image

Antibiotic susceptibility patterns of bacterial isolate responsible for the UTI

Presented in Fig. 3 are the antibiotic susceptibility patterns of isolated bacteria species responsible for the UTI against commonly prescribed antibiotics at the study facility. Escherichia coli exhibited varying sensitivity against the commonly prescribed antibiotic, with 69.0% (20) being sensitive to nitrofurantoin, 66.7% (19) sensitive to cefuroxime, 57.1% (17) to ceftriaxone, 34.5% (10) to amoxicillin/clavulanic acid and 31.0% (9) to nalidixic acid. Klebsiella spp exhibited 66.7% (5), 57.1% (4), 57.1% (4), 42.9 (3) and 14.3% (1) sensitivity to cefuroxime, nalidixic acid, nitrofurantoin, and ceftriaxone, respectively. The highest sensitivity exhibited by Pseudomonas spp was 42.9% (3) to cefuroxime, indicating some anti-microbial resistance. All the Enterobacter spp tested were sensitive to nalidixic acid; nevertheless, they exhibited a sensitivity of 66.7% (2) to ceftriaxone and nitrofurantoin and a 50.0% (1) sensitivity to cefuroxime. However, all the Enterobacter spp were resistant to amoxicillin/clavulanic acid (Augmentin).

Fig. 3
figure 3

Antibiotic susceptibility patterns of bacteria isolate responsible for UTI against commonly prescribed antibiotics at the study facility

Full size image

Discussion

Urinary tract infection in pregnancy is a common public health problem. Identifying the prevalence of bacteriuria, the causative organisms, and their anti-microbial susceptibility profiles against commonly prescribed antibiotics used to treat UTIs among pregnant women is critical in achieving the Sustainable Development Goals 3.1 and 3.2 targeted at reducing the global maternal mortality ratio to less than 70 per 100,000 live birth and preventing deaths of newborns and children under five years of age by 2023.

The 39.0% prevalence of UTI reported in this study is similar to the 39.8% reported by Vicar, Acquah [26] within the same geographical region, albeit in a different district of the Northern Region of Ghana. On the contrary, the prevalence report in this study was higher than the 17.5% reported by Fosu, Quansah [18] and the 13.7% by Ahiatrogah, Annan [27] among similar study participants in the Bolgatanga and the Ho municipalities, respectively, and also the 35% reported by Johnson, Stephen [28] in South-Western Uganda. The differences in prevalence among these studies can be attributed to the variability in demographic parameters such as age, socioeconomic status, level of schooling, community behaviour, genital and personal hygiene, healthcare during pregnancy, and sexual behaviour of the study participants within the different geographical regions.

The 38.0% prevalence of yeast-like cells noted in the urine samples of the study participants was within the prevalence range of 30.7% by Waikhom, Afeke [29] and 36.5% by Konadu, Owusu-Ofori [30] in Ghana, and the 30% reported by Eskezia et al. in Ethiopia [31]. Also, our prevalence of yeast-like cells was consistent with the 33% pooled prevalence of yeast-like infections reported by Mushi, Olum [32] in a systematic review of such infections in sub-Saharan Africa. This relatively high prevalence is not unusual as these yeast-like cells are frequent colonizers of the vagina of females during pregnancy due to the high levels of oestrogen, which creates a conducive environment for the growth of such organisms. Nevertheless, this should be a concern for worry as infection of the vagina by yeast-like cells and related organisms are associated with higher incidences of low birth and preterm [33].

The relatively higher percentage of UTI (52.6%) reported among these pregnant women residing in rural areas confirms earlier findings of Mwambete and Msigwa [34], in which they reported a similarly higher prevalence of UTI in pregnant women in rural dwellers in Tanzania and also by Afoakwa, Agyei Domfeh [35] in the Akuapem- North District, Ghana. The higher prevalence of UTIs among rural dwellers observed in this study could be attributed to their lower health education, standard of personal hygiene and socioeconomic status of rural dwellers as compared to urban as was espoused by Tadesse, Teshome [36] and Al-Mamoryi and Al-Salman [37].

The mean age of the study participants is consistent with earlier works by Karikari, Saba [38] and Vicar, Acquah [26] within the same geographical location of this study. Similarly, the mean age noted in this study is within the reproductive age of Ghanaian women, as indicated in the Ghana Demographic Health Survey (GDHS, 2022). Also, findings in this study, in which pregnant women aged 20–29 had the highest prevalence of UTI, were congruent with those of Yadav and Prakash [39] in Nepal and Belete [40] in Ethiopia. The age range of 20–29, in which the mean age of the participants of this study falls, is associated with increased sexual activity, which invariably increases infection.

Most participants residing in an urban area are expected as the Tamale metropolis is primarily urban, notwithstanding some peri-urban dwellings on the outskirts. The Tamale metropolis has been reported to be the second fastest-growing urban area in West Africa attracting various workforce, a fact noted in this study [41].

As reported by Laari, Anab [42] and confirmed in this study, most pregnant women report for booking in the first and second trimesters of their pregnancy. Early booking increases the likelihood of being diagnosed with any infection early for prompt medical intervention. Also, it is a good practice that is generally encouraged for pregnant women as any disease state and complication can be detected early during the pregnancy for treatment to commence.

Escherichia coli as the most common bacterial isolate associated with UTI among pregnant women seeking medical care at all levels of the health structure in both low-and-middle-income countries and high-income countries has been widely reported in the literature [6, 18, 35, 43] and a fact confirmed in this study. E coli, a Gram-negative bacterium, is part of the normal flora of the vagina and the rectum flora, eliciting protective host immune responses. Unfortunately, E. coli can also asymptomatically colonise the human bladder.

The presence of leukocytes in 30.0% of all the study participants was within the same range of 25.3% reported by Nkwelle, Akoachere [44] in Cameroon. Leukocyturia, an innate response to inflammation in the urinary tract, has been well-documented [45]. Cai, Lanzafame [46] have postulated the presence of leukocytes in the urine of pregnant women to be a biomarker in the development of symptomatic UTIs, as such, pregnant women should be given special attention and monitored.

The high proportion of isolated organisms in women in their second trimester aligned with previous studies by Al-Mamoryi and Al-Salman [37]. As opined by Kourtis, Read [47], a positive relationship exists between increasing gestation from week 22 and a decline in various physiological and immunological states of pregnant women, making them prone to infections.

E coli, as with the other isolated organisms in this study, had varying sensitivity to the tested antibiotics, which is consistent with Eghbalpour, Vahdat [48] and Elzayat, Barnett-Vanes [49] in other jurisdictions. There has been widespread reportage of the increase in the administration of these antibiotics with or without prescriptions, resulting in various defensive adaptations by these bacteria, leading to resistance to these drugs due to their inapt utilization [50, 51].

A worrying concern in this study worth noting is the decreased sensitivity of isolated bacteria against the commonly prescribed antibiotics at the study facility, a concern previously articulated by Johnson, Stephen [28]. Additionally, it must be emphasized that all Enterobacter spp are resistant to amoxicillin/clavulanic acid (Augmentin), which is a cause for worry in this era of anti-microbial resistance. Onemu, Ige [52] have reported similar anti-microbial resistance trends. Most of these antibiotics are sold over the counter, making them readily available to all and sundry, leading to their subsequent abuse.

This study was a facility-based cross-sectional, so its findings cannot be generalized to the whole population. Another limitation was the inability to repeat the test to confirm the presence of the gastrointestinally-related Shigella spp. in one urine.

Conclusion

Bacteriuria in these pregnant women noted in this study is high, which warrants the need to screen all pregnant women and treat those infected with appropriate anti-microbial regimens to reduce its complications. Education on antibiotic resistance and its negative effect on the individual and society should be incorporated into routine ANC education for pregnant women.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

ANC:

Antenatal Clinic

TWH:

Tamale West Hospital

UTI:

Urinary tract infection

References

  1. Morocco E, Ferzandi T. Urinary Tract Infections and Asymptomatic Bacteriuria. In: Shoupe D, editor. Handbook of Gynecology. Cham: Springer International Publishing; 2023. p. 93–101.

    Chapter  Google Scholar 

  2. François M, Hanslik T, Dervaux B, Le Strat Y, Souty C, Vaux S, et al. The economic burden of urinary tract infections in women visiting general practices in France: a cross-sectional survey. BMC Health Serv Res. 2016;16(1):365.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Medina M, Castillo-Pino E. An introduction to the epidemiology and burden of urinary tract infections. Ther Adv Urol. 2019;11:1756287219832172.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Emami A, Javanmardi F, Pirbonyeh N. Antibiotic resistant profile of asymptomatic bacteriuria in pregnant women: a systematic review and meta-analysis. Expert Rev Anti Infect Ther. 2020;18(8):807–15.

    Article  CAS  PubMed  Google Scholar 

  5. Houlihan E, Barry R, Knowles SJ, Eogan M, Drew RJ. To screen or not to screen for asymptomatic bacteriuria in pregnancy: a comparative three-year retrospective review between two maternity centres. Eur J Obstet Gynecol Reprod Biol. 2023;288:130–4.

    Article  CAS  PubMed  Google Scholar 

  6. Amala SE, Karibi-Botoye R, Nwokah EG, Pius MT. Prevalence of Asymptomatic Bacteriuria in Pregnancy and Urinary Tract Infection in Non-pregnant Symptomatic Women. Am J Biomed Sci. 2021;13(4):172–83.

  7. Ngong IN, Fru-Cho J, Yung MA, Akoachere JFKT. Prevalence, antimicrobial susceptibility pattern and associated risk factors for urinary tract infections in pregnant women attending ANC in some integrated health centers in the Buea Health District. BMC Pregnancy Childbirth. 2021;21(1):673.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015;13(5):269.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Badran YA, El-Kashef TA, Abdelaziz AS, Ali MM. Impact of genital hygiene and sexual activity on urinary tract infection during pregnancy. Urol Ann. 2015;7(4):478–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Rafat D, Agrawal A, Khalid S, Khan AU, Nawab T, Sultan A. Bacterial abundance and antimicrobial resistance patterns of uropathogens among pregnant women with asymptomatic bacteriuria: Association with glycemic status. Eur J Obstet Gynecol Reprod Biol. 2024;21:100263.

    Article  CAS  Google Scholar 

  11. Nteziyaremye J, Iramiot SJ, Nekaka R, Musaba MW, Wandabwa J, Kisegerwa E, et al. Asymptomatic bacteriuria among pregnant women attending antenatal care at Mbale Hospital, Eastern Uganda. PLoS One. 2020;15(3):e0230523.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Piazzolla HR, Modin F, Halkjær SI, Petersen AM, Calum H, Holm A. The association between bacteriuria and adverse pregnancy outcomes: a systematic review and meta-analysis of observational studies. J Antimicrob Chemother. 2024;79(2):241–54.

    Article  CAS  PubMed  Google Scholar 

  13. Cohen R, Gutvirtz G, Wainstock T, Sheiner E. Maternal urinary tract infection during pregnancy and long-term infectious morbidity of the offspring. Early Human Dev. 2019;136:54–9.

    Article  Google Scholar 

  14. Bilgin H, Yalinbas EE, Elifoglu I, Atlanoglu S. Maternal urinary tract infection: is it associated with neonatal urinary tract infection? J Family Reprod Health. 2021;15(1):8.

    PubMed  PubMed Central  Google Scholar 

  15. Mostafa A, Abdelzaher A, Rashed S, AlKhawaga SI, Afifi SK, AbdelAlim S, et al. Is health literacy associated with antibiotic use, knowledge and awareness of antimicrobial resistance among non-medical university students in Egypt? A cross-sectional study. BMJ Open. 2021;11(3):e046453.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ahiabu M-A, Magnussen P, Bygbjerg IC, Tersbøl BP. Treatment practices of households and antibiotic dispensing in medicine outlets in developing countries: The case of Ghana. Res Social Adm Pharm. 2018;14(12):1180–8.

    Article  PubMed  Google Scholar 

  17. Hospital TW. History and Departments of Tamale West Hospital. In: Health Mo, editor. 2021.

  18. Fosu K, Quansah E, Dadzie I. Antimicrobial profile and asymptomatic urinary tract infections among pregnant women attending antenatal clinic in bolgatanga regional hospital, Ghana. Microbiol Res J Int. 2019;28(3):1–8.

    Article  Google Scholar 

  19. Gss G, Demographic IG, Health survey,. Rockville, Maryland. USA: Ghana Statistical Service (GSS), Ghana Health Service (GHS) and ICF International; 2014. p. 2015.

    Google Scholar 

  20. ACOG. Committee opinion no. 700: methods for estimating the due date. Obstet Gynecol. 2017;129(5):e150–4.

    Article  Google Scholar 

  21. Wrenn K. Dysuria, frequency, and urgency. Clinical Methods: The History, Physical, and Laboratory Examinations 3rd edition. 1990.

  22. Turpin C, Minkah B, Danso K, Frimpong E. Asymptomatic bacteriuria in pregnant women attending antenatal clinic at Komfo Anokye Teaching Hospital, Kumasi. Ghana Ghana Med J. 2007;41(1):26–9.

    PubMed  Google Scholar 

  23. Limited UMEC. URIT 10V Urine Reagent Strips2020.

  24. Altheide ST. Biochemical and Culture-Based Approaches to Identification in the Diagnostic Microbiology Laboratory. Clin Lab Sci. 2020.

  25. CLSI. M100. Performance Standards for Antimicrobial Susceptibility Testing. CLSI supplement 28th ed. Wayne, PA: Clinical and Laboratory Standards Institute; 2018 January 11, 2018.

  26. Vicar EK, Acquah SE, Wallana W, Kuugbee ED, Osbutey EK, Aidoo A, et al. Urinary tract infection and associated factors among pregnant women receiving antenatal care at a primary health care facility in the Northern Region of Ghana. Int J Microbiol. 2023;2023:3727265.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ahiatrogah DK, Annan JJ, Ofori LA, Awudzi B, Owusu-Ofori A, Owusu M, et al. Microbiological profile of asymptomatic bacteriuria in pregnant women in Volta Region, Ghana. J Microbiol Antimicrob. 2021;13(2):27–36.

    Article  Google Scholar 

  28. Johnson B, Stephen BM, Joseph N, Asiphas O, Musa K, Taseera K. Prevalence and bacteriology of culture-positive urinary tract infection among pregnant women with suspected urinary tract infection at Mbarara regional referral hospital, South-Western Uganda. BMC Pregnancy Childbirth. 2021;21:1–9.

    Article  Google Scholar 

  29. Waikhom SD, Afeke I, Kwawu GS, Mbroh HK, Osei GY, Louis B, et al. Prevalence of vulvovaginal candidiasis among pregnant women in the Ho municipality, Ghana: species identification and antifungal susceptibility of Candida isolates. BMC Pregnancy Childbirth. 2020;20:1–14.

    Article  Google Scholar 

  30. Konadu DG, Owusu-Ofori A, Yidana Z, Boadu F, Iddrisu LF, Adu-Gyasi D, et al. Prevalence of vulvovaginal candidiasis, bacterial vaginosis and trichomoniasis in pregnant women attending antenatal clinic in the middle belt of Ghana. BMC Pregnancy Childbirth. 2019;19:1–10.

    Article  Google Scholar 

  31. Eskezia A, Teklemichael AM, Alemayehu T. The prevalence and risk factors of vaginal Candida species and group B Streptococcus colonization in pregnant women attending antenatal care at Hawassa university comprehensive specialized hospital in Hawassa City, Southern Ethiopia. BMC Pregnancy Childbirth. 2025;25(1):299.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Mushi MF, Olum R, Bongomin F. Prevalence, antifungal susceptibility and etiology of vulvovaginal candidiasis in sub–Saharan Africa: a systematic review with meta-analysis and meta-regression. Medical Mycology. 2022;60(7):myac037.

    Article  CAS  PubMed  Google Scholar 

  33. Leli C, Mencacci A, Meucci M, Bietolini C, Vitali M, Farinelli S, et al. Association of pregnancy and Candida vaginal colonization in women with or without symptoms of vulvovaginitis. Minerva Ginecol. 2013;65(3):303–9.

    CAS  PubMed  Google Scholar 

  34. Mwambete KD, Msigwa M. Prevalence of asymptomatic urinary tract infections among pregnant women residing in a rural and an urban area in Tanzania. East Cent Afr J Pharm Sci. 2017;20(1–3):27–32.

    Google Scholar 

  35. Afoakwa P, AgyeiDomfeh S, OppongAfranie B, OhuiOwusu D, Donkor S, KormlaSakyi K, et al. Asymptomatic bacteriuria and anti-microbial susceptibility patterns among women of reproductive age. A cross-sectional study in primary care, Ghana. Med Sci. 2018;6(4):118.

    Google Scholar 

  36. Tadesse E, Teshome M, Merid Y, Kibret B, Shimelis T. Asymptomatic urinary tract infection among pregnant women attending the antenatal clinic of Hawassa Referral Hospital, Southern Ethiopia. BMC Res Notes. 2014;7(1):1–5.

    Article  Google Scholar 

  37. Al-Mamoryi NA, Al-Salman AS. Prevalence of symptomatic urinary tract infections and asymptomatic bacteriuria in Iraqi pregnant women of Babylon Governorate. Med J Babylon. 2019;16(1):5–12.

    Article  Google Scholar 

  38. Karikari AB, Saba CKS, Yamik DY. Assessment of asymptomatic bacteriuria and sterile pyuria among antenatal attendants in hospitals in northern Ghana. BMC Pregnancy Childbirth. 2020;20(1):239.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Yadav K, Prakash S. Prevalence of asymptomatic bacteriuria during pregnancy at a Tertiary Care Hospital of Province No. 2, Nepal. Tribhuvan Univ J Microbiol. 2019;6:32–8.

    Article  Google Scholar 

  40. Belete MA. Bacterial profile and ESBL screening of urinary tract infection among asymptomatic and symptomatic pregnant women attending antenatal care of northeastern Ethiopia region. Infect Drug Resist. 2020;13:2579–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Namwinbown T, Imoro ZA, Weobong CAA, Tom-Dery D, Baatuuwie BN, Aikins TK, et al. Patterns of green space change and fragmentation in a rapidly expanding city of northern Ghana West Africa. City Environ Interact. 2024;21:100136.

    Article  Google Scholar 

  42. Laari JL, Anab M, Jabong DP, Abdulai K, Alhassan AR. Maternal Age and Stage of Pregnancy as Determinants of UTI in Pregnancy: a case of Tamale, Ghana. Infect Dis Obstet Gynecol. 2022;2022:3616028.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Cotton E, Geraghty R, Umranikar S, Saeed K, Somani B. Prevalence of asymptomatic bacteriuria among pregnant women and changes in antibiotic resistance: a 6-year retrospective study. J Clin Urol. 2024;17(1):9–15.

    Article  Google Scholar 

  44. Nkwelle CE, Akoachere J-FTK, Ndip LM, Nzang FA, Esemu SF, Ndip RN. Asymptomatic Urinary Tract infection in Pregnant and Non-pregnant Women in the Limbe Health District of Cameroon: A Phenotypic and Biochemical analytic study. 2022.

  45. Rosen Anne L, Lint Michael A, VoelkerDayne H, Gilbert Nicole M, Tomera Christopher P, Santiago-Borges J, et al. Secretory leukocyte protease inhibitor protects against severe urinary tract infection in mice. mBio. 2024;15(2):e02554-23.

    PubMed  PubMed Central  Google Scholar 

  46. Cai T, Lanzafame P, Caciagli P, Migno S, Mereu L, Mattevi D, et al. Role of increasing leukocyturia for detecting the transition from asymptomatic bacteriuria to symptomatic infection in women with recurrent urinary tract infections: a new tool for improving antibiotic stewardship. Int J Urol. 2018;25(9):800–6.

    Article  PubMed  Google Scholar 

  47. Kourtis AP, Read JS, Jamieson DJ. Pregnancy and infection. N Engl J Med. 2014;370(23):2211–8.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Eghbalpour F, Vahdat S, Shahbazi R, Mohebi S, Kholdi S, Hadadi M, et al. Pathogenic features of urinary Escherichia coli strains causing asymptomatic bacteriuria during pregnancy. Gene Rep. 2022;27:101559.

    Article  CAS  Google Scholar 

  49. Elzayat MAA, Barnett-Vanes A, Dabour MFE, Cheng F. Prevalence of undiagnosed asymptomatic bacteriuria and associated risk factors during pregnancy: a cross-sectional study at two tertiary centres in Cairo Egypt. BMJ Open. 2017;7(3):e013198.

    Article  Google Scholar 

  50. Windels EM, Van den Bergh B, Michiels J. Bacteria under antibiotic attack: Different strategies for evolutionary adaptation. PLoS Pathog. 2020;16(5):e1008431.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Christaki E, Marcou M, Tofarides A. Antimicrobial resistance in bacteria: mechanisms, evolution, and persistence. J Mol Evol. 2020;88(1):26–40.

    Article  CAS  PubMed  Google Scholar 

  52. Onemu SO, Ige RF, Onemu-Metitiri MO, Uyigue PO, Obeagu EI. The prevalence of asymptomatic bacteriuria in pregnant women in Akure, Ondo State, Nigeria. DYSONA-Life Sci. 2024;5(1):1–8.

    Google Scholar 

Download references

Acknowledgements

We acknowledge the invaluable contribution of all the staff at the Antenatal Clinic of the Tamale West Hospital and the laboratory personnel at the Public Health Laboratory, Tamale Teaching Hospital, Ghana.

Funding

The authors received no funding from any source. The work was solely funded through the authors'resources.

Author information

Authors and Affiliations

  1. Department of Biological Sciences, Faculty of Biosciences, University for Development Studies, Tamale, Ghana

    Kwame Opare-Asamoah & Saeed F. Majeed

  2. Department of Clinical Microbiology, School of Medicine, University for Development Studies, Tamale, Ghana

    Ezekiel Kofi Vicar

  3. Department of Pharmaceutical Chemistry, School of Pharmacy and Pharmaceutical Sciences, University for Development Studies, Tamale, Ghana

    Jerry Xola Sosu

  4. Department of Midwifery and Women’s Health, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana

    Eunice Nyarko & Philomena Ajanaba Asakeboba

  5. Department Of Community Health And Preventive Medicine, School of Medicine University for Development Studies, Tamale, Ghana

    Sulemana Zakariah Mustapha, Kanyite Ayisha Mumuni & Nana Kofi Yeboah Aboagye

  6. Department of Preventive Health Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana

    Vida Nyagre Yakong

  7. Department of Ear, Nose and Throat, School of Medicine, University for Development Studies, Tamale, Ghana

    Kwadwo Fosu Antwi

  8. Department of Biochemistry and Molecular Medicine, School of Medicine, University for Development Studies, Tamale, Ghana

    Julius T. Dongdem

Authors
  1. Kwame Opare-Asamoah
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Ezekiel Kofi Vicar
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Jerry Xola Sosu
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Eunice Nyarko
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Sulemana Zakariah Mustapha
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Kanyite Ayisha Mumuni
    View author publications

    You can also search for this author inPubMed Google Scholar

  7. Nana Kofi Yeboah Aboagye
    View author publications

    You can also search for this author inPubMed Google Scholar

  8. Saeed F. Majeed
    View author publications

    You can also search for this author inPubMed Google Scholar

  9. Philomena Ajanaba Asakeboba
    View author publications

    You can also search for this author inPubMed Google Scholar

  10. Vida Nyagre Yakong
    View author publications

    You can also search for this author inPubMed Google Scholar

  11. Kwadwo Fosu Antwi
    View author publications

    You can also search for this author inPubMed Google Scholar

  12. Julius T. Dongdem
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

KOA and SZM conceived the idea. EN and JXS collected the samples and did the laboratory analysis. EKV, NKYA and SFM analyzed and interpreted the data. SZM and KAM drafted the manuscript. KFA and PAA supervised the work and interpreted the results. KOA, VNY and JTD reviewed the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Kwame Opare-Asamoah.

Ethics declarations

Ethics approval and consent to participate

This study was conducted in accordance with the Helsinki Declaration. Ethical approval for the study was obtained from the Ethics Review Committee (ERC) of the Tamale Teaching Hospital, Tamale, Ghana (TTHERC/25/06/21/03). A thumb-printed informed consent to participate was obtained from all the study participants.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Opare-Asamoah, K., Vicar, E.K., Sosu, J.X. et al. Prevalence of urinary tract infections and antibiotic susceptibility patterns of bacterial isolates in first-time ANC attendees at a secondary health facility in Ghana: a cross-sectional study. BMC Pregnancy Childbirth 25, 483 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12884-025-07614-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12884-025-07614-z

Keywords

BMC Pregnancy and Childbirth

ISSN: 1471-2393

Contact us