Urinary tract infection (UTI) is one of the most common infections seen in clinical practice particularly in Nepal with a high rate of morbidity and financial cost¹. Most of the key factors predisposing to UTI have been attributed to poor personal hygiene and urinary tract abnormalities^2–5. The causative agents for urinary tract infection vary from place to place and they also vary in their susceptibility and resistance patterns^6,7. UTIs are caused by different microbial pathogens⁸.

In pregnant women, physiological and anatomical changes in the urinary tract, as well as immune system changes during pregnancy increase the prevalence of UTI and in some cases lead to the symptomatic infection, resulting in serious risks for both mother and fetus^6,7,9. Increasing age, parity⁸, diabetes, sickle cell anemia, history of UTI, urinary tract disorders and immune deficiency may increase the risk of UTI in pregnant women^9–12.The most common pathogenic organisms of UTI are Staphylococcus saprophyticus, Escherichia coli, Klebsiella pneumoniae, S. aureus, Proteus spp, Pseudomonas aeruginosa, and enterococci^8,13,14.To date,no data regarding the UTIs from Norvic and Baidya and Banskota (B&B) hospital has not been documented. This study is designed to determine the bacterial uropathogens and their association with sociodemographic variables.

A cross-sectional study was conducted at Norvic Hospital and B&B Hospital, Kathmandu, Nepal from March to October 2019. The hospitals are located at Kathmandu valley, the capital city of Nepal. The study population comprised of 510 pregnant women attending the antenatal clinic in the hospital. The demographic data was collected using questionnaires. Clean catch mid-stream urine samples were collected from all participants using the wide-mouthed sterile capped container. The data entry was done in MS excel and analysis was performed using SPSS V-16. Descriptive summaries were presented, and a Chi-square test (χ2) was used to assess the association between sociodemographic variables and pathogens present in the urine. P-value less than 0.05 were considered as statistically significant. The study was ethically approved by the institutional review board of College of OPJS University. Participation was fully voluntary, and consent was obtained from all participants. Any information obtained during the study was kept confidential, and Doctors manage those women with UTI.

Out of 510 urine samples among pregnant women, 193(37.84%) of urine samples revealed with significant bacteriuria.

Out of total 510 samples, 193 were positive for bacterial growth. On bacterial identification and isolation, most of the bacteria isolated were gram negative. Among them, E. coli was the most predominant isolate with highest incidence (61.6%). Table 2

Table 3

Deposits	Percentage (number)
Pus cells	214(41.9)
RBC	74(14.5)
Ca oxalate	15(2.9)
Ammonium phosphate	11(2.1)
Ammonium ureates	9(1.7)
Mucus threads	17(3.3)
Glucose	20(3.9)

On physical examination of urine, it was found that urine color was light yellow in 82% of cases while 11.17% have deep yellow and remaining 2.7% have colorless (Table4) Out of 510 samples, 85.09% had acidic PH, 14.5% had alkaline PH and only 0.3% had the neutral PH (Table 5). The biochemical reactions showed clear transparency in 64.4% of urine samples out of total 510 urine samples (Table 4). While 29.8% had slight turbidity and 3.7% had turbidity on biochemical reaction (Table 6). The presence of significant number of pus cells was predominant in urine samples. It was in 41.9% of urine samples Table 3 .

The data included demographic variables (age, education, religion, blood group, and BMI). All statistical analyses were performed in spss, Chi-square test was used to compare qualitative data. P value < 0.05 was considered statistically significant. There were no significant relationships between UTIs and the variables of age, BMI, religion. There were significant differences in blood group and maternal educational level Table 7 .

The prevalence of significant in this study was 37.84%. It agrees with the previous reports to 54/139 (38.8%) registered by Kabugo et al. ^[15] in Mulago hospital. The prevalence of UTIs in this current study was found to be higher than the ones previously recorded in the following studies in Uganda: 67/300 (22.33%) by Tibyangye et al. ^[16] in Bushenyi District, 82/339 (24.2%) by Odongo et al. ^[17] in Gulu, 40/399 (10%) by Mwaka et al. ^[18] in Mulago, but in contrast to this, Our prevalence is also lower than that obtained by some other authors ^[18,19,20],.They also explained the reason for this could probably due to poor housing, ventilation, sanitation and drainage systems. Moreover, they also added that it could be pronounced due to lack of proper personal and environmental hygiene, population susceptibility and other factors like low socio-economic status and sexual intercourse among pregnant women. During gestation, there is more possibility of bacterial colonization in urethra by the bacteria originated from the gastro-intestinal and perineal flora. The other established fact that the urethra in females is shorter, wider and close to the anus contribute to the higher prevalence of the UTI in women and so in pregnancy in this study. Although biochemical analysis of urine revealed mostly clear transparency (64.4%), the remarkable cases had slight turbidity (29.8%) and turbidity (3.7%), which could be due to presence of bacteria, pus cells, RBCs, proteins and other deposits (Table 6) found in this study. However, most of the pregnant women (82.74%) revealed with normal urine color and transparency, the overall incidence of bacteriuria was 37.84% signifying a negative correlation between urine color and bacteriuria. High educational level was protective. Educational level attained may be an indicator of the socioeconomic status of the women. Lower levels of education and low socioeconomic status have been related to higher prevalence of bacteriuria in others studies ^{[18, 20].}In addition, no significant correlation was observed between the age of pregnant women and acquisition of UTI. Similar finding also reported by Hamdan et al ^[23] on UTI in Sudan and Kovavisarach et al ^[21] Variation in studies may be due to differences in geographical location, socioeconomic status, setting of study (primary care, general hospital and community), sample size and variation in screening tests

UTIs are very common during pregnancy and Escherichia coli are still the dominant organism responsible for UTI among pregnant women. Our research has shown that there is an association between the educational status of participants and various pathogens in urine samples (quarantined colonies). The study reveals that a sociodemographic characteristic plays an important role in UTIs. Therefore, screening for early diagnosis and treatment of bacteriuria in women during pregnancy is necessary to prevent its complications. Periodic health examination and awareness programs can help to improve the health status as well as quality of life in women. This study highlights the need of toilet facility to each and every house which was one of the significant risk factors for urinary tract infection. Similarly, they should be aware of other risk factors. There is need to raise awareness of UTI and to expand services for prevention of UTI by maintaining hygienic condition

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