Urinary Tract Infection Caused by Bacteria in Pregnant women from Kassala State, Sudan


 Background Urinary tract infection is a common disease prevailing in pregnancy: microorganisms, mostly bacteria, cause it. Result The prevalence of urinary tract infection was very high (70.9%). The most common isolate were Listeria spp. (38.85%) and Streptococcus spp. (28.06%), less common isolates were Vibrio cholera, Neisseria sp. and E. coli with percentages (16.55%,10.07% and 6.47%), respectively. Conclusion five bacteria species associated with urinary tract infection in pregnant women recorded in this study. Vibrio cholera and Neisseria sp.it was first time recorded in Sudan.


Background
Urinary tract infection (UTI) pathogens invades and multiply any urinary tract tissues from the kidney to the urethra [1]. UTI infection includes viruses, fungi, bacteria and mycoplasma [2]. Various microorganisms can be involved in UTI, which has a notable role in increasing the number of stillbirth deliveries [3]. Its related problems are the cause of nearly 150 million annual deaths per year worldwide. The disease can be develop in 40% − 50% of women and 5% of men [4].
The most common UTI isolates of bacteria in Khartoum were Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, Staphylococcus aureus, Pseudomonas spp. and Staphylococcus [5,6]. From Khartoum North, E. coli and S. aureus reported as the most common [7]. Females are more prone to UTI than males due to their moist genitalia and physiological changes in the urinary tract during pregnancy [8], pregnancy and sexual activities [9]. Pregnant women are at higher risk than non-pregnant [8]. Some complicated risk increase with the presence of UTI like preterm birth, preterm labor, preeclampsia, ammonites, pregnancy induced hypertension and anemia [10], pyelonephritis during pregnancy is most frequent health issues as result of UTI [11].

Results
Isolation of bacteria from urine samples Bacteriuria colonies were selected as different isolates according to their cultural characteristics on the isolation plates. The strains were maintained at 4 o C on nutrient agar medium.

Cultural characteristics of bacteriuria isolates
One hundred thirty-nine bacterial isolates belonging to ve genera were obtained. These were fty-four isolates of Listeria, thirty-nine isolates of Streptococcus and fourteen isolates of Neisseria were isolated using a blood agar medium .Twenty-three isolates of vibrio cholera and nine isolates of Echeria coli were selectively isolated on Mac-Conkey agar media. (Fig. 1and 2).

Microscopic characteristics and Biochemical tests
In this study, the Gram-positive rods isolates were (38.85%) and the Gram negative rod isolates were (23.02%). The Gram-negative Diplococci were (10.07%) and the Gram-negative Cocci were (28.06%) as shown in Fig. 3.
Biochemical tests were carried out to con rm the presence of the species of bacteriuria from the selected groups. The catalase test gave 100% positive results. Urease test gave 28.06% positive and 71.94% negative reactions. In the oxidase test 26.62% were positive and 73.38% were negative. The indole test recorded 23.02% positive and 76.98% negative results (Table 1).  [12]. The overpopulation of this border city might cause the difference in bacteria isolated. This study revealed that the UTI in pregnant women in Kassala caused by bacteria is 70.9%. In Khartoum the prevalence of UTI was 14.0% [7] and 35% [12]. In Nigeria 61.5% and 56% recorded by [13,9] respectively, while Assefa et al. [14] reported 11% in Ethiopia. The present study found that Listeria isolates were the most common (38.85%). In Khartoum E. coli was reported as the most common UTI causative agent [5,7,12].Also Escherichia coli is most common isolates in the other countries (9, 13, 15,16). The prevalence of Streptoococcus was also high (28.06%), rare cases causes by it [2]. Vibrio cholera (16.55%) and Neisseria sp (10.07%) were reported for the rst time as UTI agent in Sudan, as the registered in Taiwan [17].less common isolates was Escherichia coli (6.47%).

Conclusion
The study recorded that the UTI in pregnant women in Kassala is very high, it caused by ve bacteria species associated with urinary tract infection. The highest scores were Listeria sp. and Streptococcus sp., Vibrio cholera and Neisseria sp.it rst recorded in Sudan.

Study design
This UTI study design was carried out, under ethical clearance, as cross sectional hospital based, at Kassala New Hospital (Alsaudi) and Abdurrahman Elmobark Medical Center (AEMC), Kassala, Sudan.

Sample collection and culturing of bacteria
A total of 196 pregnant women with clinical symptoms and a-symptoms of UTI referred to Alsaudi and AEMC were investigated. The women's age varied from 15 to 40 years. Clean-Catch midstream urine method was used [18,19]. Urine samples were Culturing in MacConkey Agar Mediumm and Blood Agar Medium.
Characterization and identi cation of bacteriuria According to Cheesbrough and Bergey's Manual for Determinative Bacteriology [20,21], identi cation and characterization of bacteriuria were carried out.

Microscopic examination
The bacterial cells were staining (gram reaction) according Collins et al. [22].

Biochemical tests
Urease, Oxidase, Indole and Catalase biochemical tests used for bacteriuria identi cation in this study were conducted according to [23,24]. Availability of data and material

Abbreviations
The dataset supporting the conclusions of this article is included within the article (and its additional le).

Competing interests
The authors declare that they have no competing interests.

Funding
Not applicable.
Authors' contributions SAMA performed the experimental work and wrote the manuscript. Neisseria on blood agar medium