The importance of bacteriological urine examination during pregnancy is due to the fact that the presence of pathogenic microflora in it can lead to the development of infectious processes in the urinary tract. Pregnant women have an increased risk of developing urinary tract infections due to anatomical and hormonal changes that lead to dilation of the ureter and urine stagnation. In addition, a variety of somatic pathologies can increase the risk of developing urinary tract infections in pregnant women. The most frequent pathogens infecting urinary tract is E.coli. Often there are also such pathogens of urinary tract infections as Enterobacteriaceae (K. pneumoniae, Enterococcus spp.), Group B Streptococcus, Gardnerella vaginalis. Exacerbation of urinary tract infections during pregnancy is accompanied by an increased risk of obstetric and neonatal complications. The timely isolation and identification of the infectious agent of its susceptibility to antibiotics is the key and a means of reducing the frequency of pregnancy complications and improving perinatal outcomes. The purpose of this work is to analyze the composition of the urinary tract microbial population in women at different stages of pregnancy. Material and methods. We analyzed the results of bacteriological study of 1719 urine specimens of pregnant women aged 19 to 37 years. The women applied for medical assistance to the women's consultation, perinatal centers and gynecological departments of Dnipropetrovsk City Clinical Hospital, Ukraine, in 2017. The term of pregnancy is from 7 to 38 weeks. Results and discussion. Positive results of the urinalysis of the surveyed women were revealed in the sixth part of the samples (16.1%). The largest part of the positive results was detected in the 1st trimester of pregnancy – 47.6% of the samples. In this period the first study is carried out in accordance with current guidelines. In the 2nd and 3rd trimesters the proportion of positive results was less, 28.2% and 24.2% respectively. The highest percentage of positive tests was found among women hospitalized in the maternity ward, often in urgent cases. Positive results were analyzed according to the composition of microorganisms. 55.6 % of Gram-negative floras and 44.4% of Gram-positive floras were detected. It was established that Enterococcus spp. and E.coli were predominant in all trimesters in the urine of pregnant women; it was 41.2% and 39.0% respectively. In the examined women Enterococcus spp. dominated in the first trimester (45.4% against 34.8% of Е. сoli), and E.coli – in the 2nd (42.3% against 37.2% of Enterococcus spp.) and 3rd (43.3% against 37.3 %) trimester. E.cloacae, K.pneumoniae and P.mirabilis were present in pregnant women urine in all trimesters, but in smaller quantities. The share of other agents (S.epidermidis, P.аeruginosa, Candida, A.baumannii, C.freundii, S.aureus, S.haemoliticus) appeared to be quite small. The study found a partial resistance to antibiotics used to treat urinary tract infections in pregnant women: of Enterococcus spp. to nitrofurans, phosphomycin, and of E.coli – to ampicillin, amoxicillin clavulanate, phosphomycin, cephalosporins. Conclusions. The study revealed that Enterococcus spp. and E.coli were predominant in the urine of pregnant women in all trimesters. Enterococcus spp. dominated in the first trimester and E.coli in the 2nd and 3rd trimesters. E.cloacae, K.pneumoniae and P.mirabilis were presented in small quantities. The share of other agents was very small. The partial resistance of the main isolated pathogens to antibiotics used during pregnancy is revealed. It is important for us to analyze in details the frequency of microbial associations in the urine of pregnant women, and to investigate the relationship between the detection of pathogens in the urine and the presence of urinary tract infections at different stages of pregnancy in women living in this region.
Keywords: pregnant women, trimesters of pregnancy, bacteriuria, pathogens of urinary tract infections, resistance to antibiotics
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