Prevalence, antimicrobial susceptibility profile and predictors of asymptomatic bacteriuria among pregnant women in Adigrat General Hospital, Northern Ethiopia

Antimicrobial resistance and ESBL production in uropathogenic Escherichia coli: a systematic review and meta-analysis in Ethiopia

Background

Antimicrobial resistance (AMR) is a serious threat to global health systems. Escherichia coli is a major cause of urinary tract infections (UTIs). Understanding the AMR patterns of uropathogenic E. coli (UPEC) is crucial for effective public health interventions worldwide.

Objectives

This systematic review and meta-analysis aimed to consolidate existing research and provide a comprehensive information on AMR UPEC in Ethiopia.

Methods

We systematically searched databases such as PubMed, Web of Science, and Science Direct, along with including articles from Google Scholar. Data were extracted into Microsoft Excel and analysed using STATA 17.0. Cohen's kappa was computed to assess reviewer agreement, while the I2 statistic evaluated heterogeneity. Egger's tests were conducted to detect publication bias, and random-effects models were utilized to estimate the pooled resistance, with AMR rates for each antibiotic pooled separately.

Results

UPEC showed resistance rates, ranging from 3.64% (95% CI: -4.38% to 11.67%) for amikacin to 85.32% (95% CI: 78.6%-92.04%) for ampicillin. Highest resistance was to ampicillin (85.32%), followed by amoxicillin at 82.52% (95% CI: 74.3%-90.74%), tetracycline at 60.67% (95% CI: 51.53%-69.81%) and trimethoprim/sulfamethoxazole at 57.17% (95% CI: 49.93%-64.42%). Conversely, resistance rates were lower for amikacin at 3.64% and meropenem at 5.26% (95% CI: 2.64%-7.88%). UPEC demonstrated a pooled MDR rate of 79.17% (95% CI: 70.32%-88.01%) and a pooled ESBL production rate of 29.16% (95% CI: 22.36%-38.55%).

Conclusions

High levels of AMR were observed in UPEC strains, highlighting a critical public health issue requiring urgent action through robust antimicrobial stewardship and surveillance to preserve effective UTI treatment options.

Microbiological and Antimicrobial Susceptibility Pattern of Asymptomatic Bacteriuria in Pregnant Women Attending SQUH

Objectives

Our research aimed to study the microbiology and antimicrobial resistance in asymptomatic bacteriuria (ASB) among Omani pregnant women.

Methods

We conducted a retrospective study that included data from 196 Omani pregnant women with ASB who received care at Sultan Qaboos University Hospital from 2010-2019. Data were obtained from the patients' electronic medical records including demographics, clinical details, isolated organisms, antimicrobial susceptibility results, and prescribed antibiotics.

Results

ASB was detected in 56.1% of cases during the third trimester. Klebsiella pneumoniae(32.1%) was the most frequently isolated organism, followed by Escherichia coli (29.6%). Twenty-one (10.7%) isolates were extended-spectrum beta-lactamase (ESBL)-producing organisms. The overall microbiological susceptibility pattern showed that organisms have a high susceptibility rate to nitrofurantoin reaching 82.8%, followed to a lesser extent by cefuroxime and augmentin. The susceptibility of E. coli and K. pneumoniae to cefuroxime was 74.1% and 71.4%, respectively. Only 52.4% of all isolated ESBL-producing organisms were susceptible to nitrofurantoin.

Conclusions

K. pneumoniae and E. coli were the most frequently isolated bacteria in ASB, representing 60.7% of total isolates. A high prevalence of ESBL-producing organisms, 10.7% of the total isolates, was observed. Cefuroxime is an appropriate empirical antibacterial therapy for ASB and urinary tract infection in pregnant women. Nitrofurantoin should be considered for empirical antibiotic therapy in settings of high prevalence of ESBL-producing organisms.

Prevalence, antimicrobial susceptibility profile, and associated risk factors of uropathogenic Escherichia coli among pregnant women attending Dr. Sumait Hospital Mogadishu, Somalia

Background

Uropathogenic Escherichia coli (UPEC) is a strain of E. coli commonly associated with urinary tract infections. In addition, antibiotic resistance in UPEC is one of the most significant health problems. This study was conducted to determine the prevalence, antimicrobial resistance, and factors linked to uropathogenic Escherichia coli (UPEC) in pregnant women.

Methods

This cross-sectional study was conducted within a hospital setting between August 2022 and December 2022. Using consecutive convenient sampling, the research enrolled 220 pregnant women. The urine samples obtained from these women were cultured on MacConkey and blood agar and incubated at 37°C overnight, followed by sub-culturing on Mueller Hinton media. Bacterial identification involved Gram staining and biochemical characterization (TSI, indole, citrate, methyl red, urea agar, and motility tests). Conversely, susceptibility tests were performed using the Kirby-Bauer disk diffusion method. A binary logistic regression model and analysis of odds ratios (ORs) were employed to evaluate the risk factors associated with E. coli infection, and statistical significance was attributed to p-values of ≤0.05.

Results

Out of the 220 urine samples examined, 42 (19%) exhibited a positive culture, indicating an E. coli infection in pregnant women. Our analysis revealed that income, gestational age, and history of UTIs were identified as risk factors associated with E. coli infection. Most E. coli isolates demonstrated sensitivity to amikacin (100%), nitrofurantoin (85.7%), amoxicillin/clavulanic acid, and meropenem (83.3%).

Conclusion

The prevalence of E. coli was remarkable. It could be recommended that pregnant women in antenatal care have routine culture and antimicrobial susceptibility tests to prevent transmission of resistant pathogens and complications in both pregnant mothers and the unborn baby.

Antimicrobial resistance pattern of Klebsiella isolated from various clinical samples in Ethiopia: a systematic review and meta-analysis

BACKGROUND

The burden of Klebsiella drug resistance to antimicrobials is a major public health concern worldwide; particularly the problem is severe in developing countries including Ethiopia. Therefore, the aim of this systematic review and meta-analysis is to establish the pooled estimate of Klebsiella drug resistance; and antimicrobial-specific resistance pattern among Klebsiella clinical isoaltes in Ethiopia.

METHODS

Articles were searched from PubMed, Google Scholar, and Science direct and grey literature from 2009 to 2019. Four authors have independently extracted data on the prevalence and antimicrobial resistance pattern of the isolates. Statistical analysis was conducted by using Open meta-analyst (version 3.13) and Comprehensive meta-analysis (version 3.3). The main outcome measures were the overall Klebsiella resistance; and drug-specific resistance patterns. A random-effects model was used to determine the pooled resistance prevalence with 95% confidence interval (CI), and significant heterogeneity was considered at p < 0.1; and I2 > 50% using DerSimonian and Laird method. In addition, subgroup analyses were conducted to improve the outcome.

RESULT

We obtained 174 potentially relevant studies through searching electronic databases, and finally, 35 eligible studies were included for meta-analysis. A total of 13,269 study samples participated, from which 1017 Klebsiella species were isolated. The overall Klebsiella resistance in Ethiopia was found to stand at 53.75% (95% CI: 48.35-58.94%). Based on the subgroup analyses; the highest (64.39%); and lowest (46.16%) values were seen in Southern Nations, Nationalities, and Peoples of Ethiopia; and Tigray regions respectively; and the highest Klebsiella resistance was reported to ampicillin (90.56%), followed by amoxicillin (76.01%) and trimethoprim-sulfamethoxazole (66.91%). A relatively low level of resistance rate was observed to amikacin (16.74%) and cefoxitin (29.73%).

CONCLUSION

The pooled Klebsiella resistance was found to be considerably high (53.75%) to most of the essential antibiotics in Ethiopia. Klebsiella was highly resistant to ampicillin and amoxicillin but relatively lower to amikacin. Therefore, appropriate interventional strategies need to be taken to address the emerging resistance of Klebsiella species.

Magnitude, Associated Risk Factors, and Trend Comparisons of Urinary Tract Infection among Pregnant Women and Diabetic Patients: A Systematic Review and Meta-Analysis

Urinary tract infection (UTI) remains the most common bacterial infection that affects millions of people around the world, especially pregnant women (PW) and people with diabetes mellitus (DM). This systematic review and meta-analysis was aimed at finding the pooled prevalence of UTI and its associated risk factors among PW and DM patients. Scientific articles written in English were recovered from PubMed, ScienceDirect, Web of Science, Google Scholar, Cochrane Library, Google Engine, and University Library Databases. "Prevalence," "urinary tract infection," "associated factors," "pregnant women," "diabetic patients," and "Ethiopia" were search terms used for this study. For critical appraisal, PRISMA-2009 was applied. Heterogeneity and publication bias were evaluated using Cochran's Q, inverse variance (I2), and funnel plot asymmetry tests. A random effect model was used to calculate the pooled prevalence of UTI and its associated factors among both patients, along with the parallel odds ratio (OR) and 95% confidence interval (CI). For this meta-analysis, a total of 7271 participants were included in the 25 eligible studies. The pooled prevalence of UTI in Ethiopia among both patients was 14.50% (95% CI: 13.02, 15.97), of which 14.21% (95% CI: 12.18, 16.25) and 14.75% (95% CI: 12.58, 16.92) were cases of DM and PW, respectively. According to the subgroup analysis, the highest prevalence was observed in the Oromia region (19.84%) and in studies conducted from 2018 to 2022 (14.68%). Being female (AOR: 0.88, and 95% CI: 0.11, 1.65, P = 0.01) and having an income level ≤ 500ETB (AOR: 4.46, and 95% CI: -1.19, 10.12, P = 0.03) were risk factors significantly associated with UTI among patients with DM and PW, respectively. Furthermore, a history of catheterization (AOR = 5.58 and 95% CI: 1.35, 9.81, P < 0.01), urinary tract infection (AOR: 3.52, and 95% CI: 1.96, 5.08, P < 0.01), and symptomatic patients (AOR: 2.32, and 95% CI: 0.57, 4.06, P < 0.01) were significantly associated with UTI in both patients. Early diagnosis and appropriate medication are necessary for the treatment of UTI in patients with DM and PW.

Asymptomatic bacteriuria of pregnant women in a tertiary care centre

BACKGROUND

Asymptomatic bacteriuria (ASB) is commonly seen during pregnancy due to the various morphological, hormonal, and physiological changes the body undergoes. If left undiagnosed, it can lead to conditions such as pyelonephritis and preterm delivery which could culminate in causing maternal and fetal morbidity and mortality. Therefore, this study aims to determine the prevalence, risk factors, microbial profile, and antibiotic susceptibility patterns associated with ASB in a tertiary healthcare center.

MATERIALS AND METHODS

A cross-sectional study was carried out where 150 urine samples were obtained from pregnant women within the gestational age of 13-36 weeks. Randomized stratified sampling was the method of sampling used. A questionnaire was also administered to them to determine potential risk factors. The samples were cultured and identified using biochemical tests. Antibiotic susceptibility tests were carried out by Kirby-Bauer disc diffusion method. Statistical analysis was carried out using Chi-square test. The graphs and tables were generated using Microsoft Excel and Word.

RESULTS

Out of the 150 samples that were obtained, 8 samples had significant bacteriuria which is a prevalence of 5.33%. Escherichia coli was the most frequently isolated organism accounting to 45% of the isolates. The other organisms that were isolated were Enterococcus, Klebsiella pneumoniae, Coagulase negative staphylococcus (CONS), Candida albicans, and Group B Streptococcus which measured to 11% of the total distribution each. In the antibiotic sensitivity tests, among the gram-negative isolates, marked resistance to Ampicillin and Amoxycillin along with sensitivity to Cotrimoxazole and Nitrofurantoin. Of the gram-positive isolates, there was sensitivity to Ampicillin and Nitrofurantoin. A positive correlation was seen between the age groups of 23-27 and the prevalence of ASB.

CONCLUSION

The prevalence of ASB in this study shows that ASB is not uncommon in the population. Despite the World Health Organization (WHO) guidelines and National Health Mission recommendations to make urine check-ups a routine, it not carried out, possibly due to cost implications. However, it poses a risk for severe maternal and fetal outcomes and hence, should be screened for on a regular basis. Thus, this study emphasizes the importance of screening pregnant women for ASB for promoting better maternal and fetal health.

Prevalence of asymptomatic bacteriuria among pregnant women and changes in antibiotic resistance: a 6-year retrospective study

Objective:

Asymptomatic bacteriuria (ASB) during pregnancy is a risk factor for development of urinary tract infections and pyelonephritis, which can lead to maternal and foetal consequences. This study aimed to determine the prevalence of ASB during pregnancy, the most common causative pathogens and their resistance patterns.

Methods:

A retrospective analysis was performed using microbiology laboratory data from urine sample cultures from pregnant women collected at our University hospital over a 6-year period (2014–2019). Identification and susceptibility testing were performed using standard microbiology procedures based on British Society of Antimicrobial Chemotherapy and European Committee on Antimicrobial Susceptibility Testing.

Results:

From a total of 18,938 urine samples, 1522 (8.04%) were positive for bacteriuria, the most common isolates were Escherichia coli and Coliform (lactose fermenters) ( n = 1171, 76.9%), followed by Enterococcus faecalis and other enterococci ( n = 191, 12.5%). In 2019, the resistance of E. coli was 56.8%, 25.3% and 4.7% to amoxicillin, trimethoprim and gentamicin, respectively, with an increasing pattern of resistance to trimethoprim and gentamicin from 2014 to 2019. The resistance rates to nitrofurantoin were 1% and 5.5% for E. coli and Group B Streptococcus, respectively.

Conclusion:

Our study shows the trends of antimicrobial resistance in this vulnerable group and will help confirm treatment effectiveness and direct guideline recommendations locally and internationally.

Level of Evidence:

2b

Asymptomatic Bacteriuria, antimicrobial susceptibility pattern and associated risk factors among pregnant women attending antenatal care in Assosa General Hospital, Western Ethiopia

Background

Asymptomatic bacteriuria is a common problem in pregnant women and about 40% of women with untreated asymptomatic bacteriuria during pregnancy develop pyelonephritis, which might lead to low birth weight, premature rupture of membranes, and preterm labour. Therefore, this study aimed to assess the prevalence of asymptomatic bacteriuria, antimicrobial susceptibility pattern of the isolates among pregnant women attending the antenatal care of Assosa general hospital, western Ethiopia.

Methods

A facility-based cross-sectional study was conducted from January to February 2019. Two hundred and eighty-three pregnant women with no symptoms of urinary tract infections participated in the study. Bacterial isolates were identified as per the standard bacteriological procedure using colony characteristics, Gram-staining, and series of biochemical tests. Antimicrobial susceptibility test was carried out by Kirby- Bauer disk diffusion technique on Muller-Hinton agar medium and the diameter of zone of inhibition was interpreted according to Clinical Laboratory Standard Institute guidelines.

Results

The overall prevalence of asymptomatic bacteriuria among pregnant women in this study was 13.78% (i.e. 39 out of 283 urine samples were positive for bacterial isolates). E. coli was the most predominant isolate (53.8%) followed by K. pneumoniae (17.95%), S. aureus (15.4%), and coagulase-negative staphylococci (12.8%). Gram-negative bacteria were highly resistant to tetracycline (96.4%), and ampicillin (90.5%).

Conclusion

Significant bacteriuria was observed in asymptomatic pregnant women. A large number of the bacterial isolates were resistant to the commonly used antimicrobial drugs.

Prevalence of Urinary Tract Infection and Its Associated Factors among Pregnant Women in Ethiopia: A Systematic Review and Meta-Analysis

OBJECTIVE

Urinary tract infection (UTI) is the most common bacterial infections during pregnancy. It is associated with different maternal and neonatal adverse outcomes such as low birth weight, preterm birth, still birth, preeclampsia, maternal anemia, sepsis, and amnionitis, even when the infection is asymptomatic. However, in Ethiopia, it is represented with fragmented and inconclusive pocket studies. Therefore, this systematic review and meta-analysis is aimed at estimating the pooled prevalence of UTI and its associated factors among pregnant women in Ethiopia.

METHODS

PubMed/Medline, Embase, Cochrane Library, Google Scholar, and local sources were used to access eligible studies. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was applied for critical appraisal. Heterogeneity and publication bias were evaluated using I 2 statistic, funnel plot asymmetry, and Egger's tests. Random effect model was employed to estimate the pooled burden of UTI and its associated factors among pregnant women with its corresponding odds ratio (OR) and 95% confidence interval (CI).

RESULT

From all systematically searched articles, 14 studies were eligible for this analysis. The overall pooled prevalence of UTI among pregnant women in Ethiopia was 15.37% (95% CI: 12.54, 18.19). Family monthly income (OR = 3.8 and 95% CI: 1.29, 11.23), parity (OR = 1.59 and 95% CI: 1.01, 2.50), history of catheterization (OR = 2.76 and 95% CI: 1.31, 5.84), and history of UTI (OR = 3.12 and 95% CI: 1.74, 5.60) were factors significantly associated with UTI among pregnant women in Ethiopia.

CONCLUSION

The overall pooled estimate of UTI among pregnant women in Ethiopia was higher compared with CDC estimation which was 8%. Family monthly income < 1000ETB, multipara, previous history of catheterization, and history of UTI were factors increased burden of UTI during pregnancy. So, strategies targeting in economic reforms, universal access of family planning, and standardized prenatal care service should be addressed to alleviate this high prevalence of UTI during pregnancy.

Characteristics of Women with Urinary Tract Infection in Pregnancy

Background: Urinary tract infection (UTI) is the most common bacterial infection in pregnancy. Known risk factors for UTI in pregnancy include diabetes and certain urologic conditions. Other maternal characteristics might also be associated with risk and could provide clues to the etiology of UTI in pregnancy. Our objective was to identify maternal characteristics associated with UTI in pregnancy. Materials and Methods: We used data from pregnant women participating in the National Birth Defects Prevention Study, a population-based study of risk factors for major structural birth defects in 10 U.S. sites, from 1997 to 2011. In cross-sectional analyses, we used multivariable log-binomial regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for associations between self-reported maternal characteristics and UTI in pregnancy. Results: In our sample of 41,869 women, the overall prevalence of reported UTI in pregnancy was 18%, but ranged from 11% to 26% between study sites. In adjusted models, diabetes was moderately associated with higher UTI prevalence (PR 1.39, 95% CI: 1.24-1.57). Higher UTI prevalence was associated even more strongly with low educational attainment (PR 2.06, 95% CI: 1.77-2.40 for some high school vs. graduate school), low household income (PR 1.64, 95% CI: 1.46-1.84 for <$10,000 vs. ≥$50,000), and race/ethnicity (PR 1.45, 95% CI: 1.13-1.80 for American Indian or Alaska Native vs. White women). Conclusions: About one in six women reported UTI in pregnancy but the prevalence varied markedly by geography and maternal characteristics. This variability could provide clues to the causes of UTI in pregnancy.

Asymptomatic Bacteriuria among Pregnant Women in Addis Ababa, Ethiopia: Prevalence, Causal Agents, and Their Antimicrobial Susceptibility

Asymptomatic bacteriuria (ASBU) is an important health problem among pregnant women, particularly in low-income countries. This study aimed to estimate the prevalence of ASBU and potential risk factors among pregnant women attending antenatal care centers in Addis Ababa. It also aimed to identify causal bacterial pathogens and to assess their antimicrobial susceptibility. A health facility-based cross-sectional study was conducted from March to June 2019. Urine samples from a total of 281 pregnant women with no symptoms of urinary tract infection were tested for ASBU. Women whose urine samples carried greater than or equal to 10⁵ colony-forming units (CFU) of bacteria per milliliter of urine when grown on plate count agar were considered positive for ASBU. Bacterial pathogens were isolated from urine samples of women with ASBU using standard microbiological techniques. Antimicrobial susceptibility of isolates was investigated using the Kirby–Bauer disk diffusion method on Muller–Hinton agar plates. Of 281 pregnant women examined, 44 (15.7%) were positive for ASBU. Logistic regression analysis of the putative risk factors tested in the current study showed that none of them were significantly associated with the occurrence of ASBU (p > 0.05). The most frequently isolated bacterial species were Escherichia coli 17 (30.2%), Proteus 13 (23.2%), and Enterococcus 11 (19.6%). All of the E. coli, Citrobacter, and Klebsiella isolates and 84.6% of Proteus were resistant to ampicillin. All bacterial isolates were resistant to at least one of the antimicrobials tested. Resistance to three or more antimicrobials was detected in 15 (88.2%) of E. coli, 13 (100%) of Proteus, and 8 (72.7%) of Enterococcus isolates. Resistance to as many as 7 antimicrobials among E. coli, 8 antimicrobials among Proteus, and 7 antimicrobials among Enterococcus isolates was recorded. Detection of ASBU in a substantial number of pregnant women in this study warrants the need for a detailed study on possible risks of developing symptomatic urinary tract infection (UTI) and associated complications. Multidrug resistance to several antimicrobials was observed in the majority of bacterial isolates. Regular assessment of antimicrobial susceptibility of uropathogens to commonly prescribed antimicrobials and implementation of prudent use of antimicrobials are recommended.

Bacterial Profile and asymptomatic bacteriuria among pregnant women in Africa: A systematic review and meta analysis

BACKGROUND

Different physiologic changes that occur during pregnancy, such as Hydroureter, dilatation of the renal pelvis, glycosuria and aminoaciduria, and low urine production predispose pregnant women for ascending urinary tract infection. Globally, 2% to 15% of the pregnant women have urinary tract infection without specific symptoms. Therefore, this study aimed to estimate the prevalence of asymptomatic bacteriuria (ABU) in pregnant women in Africa.

METHODS

Systematic search of published studies done on PubMed, EMBASE, Web of Science, SCOPUS, PsychInfo, CINAHL, and google scholar for gray literature. All published observational studies until October 30, 2020 were included. This meta-analysis follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quality of studies was assessed by modified Newcastle-Ottawa Scale (NOS). Meta-analysis was carried out using a random-effects method with the double arcsine transformation approach using the STATA™ Version 14 software. Trim and fill analysis was done to correct presence of significant publication bias. The study protocol is prospectively registered on PROSPERO, registration number CRD42020212601.

FINDINGS

From 3393 obtained studies, 48 studies from 12 African countries involving 15, 664 pregnant women included in this Meta-analysis. The overall pooled prevalence of asymptomatic bacteriuria among pregnant women in Africa after correction for publication bias by trim and fill analysis was found to be 11.1% (95% CI: 7.8, 14.4). The most common bacterial isolates involved in the etiology of ABU was Escherichia coli with pooled prevalence 33.4% (95% CI: 27.3 - 39.4).

INTERPRETATION

Asymptomatic bacteriuria is substantial among pregnant women in Africa. Therefore, all pregnant women should be tested for the presence of asymptomatic bacteriuria. A screening program must be based not only on the incidence but also on a cost-efficacy evaluation and a microbiological evaluation.

FUNDING

There was no funding source for this study.

Antimicrobial resistance and ESBL profile of Uropathogens among pregnant women at Edna Adan Hospital, Hargeisa, Somaliland

BACKGROUND

The emergence and spread of antimicrobial resistance (AMR) among uropathogens is increasing, especially in resource limited settings due to a number of reasons. The production of Extended Spectrum β-Lactamase (ESBL) by some strains of E. coli and methicillin resistant Staphylococcus species, limits the choice of antimicrobials in the treatment of urinary tract infection (UTI) globally. However, little is known about the type of uropathogenes and their current AMR profile among pregnant women in Hargeisa, Somaliland.

METHODS

Clean-catch mid-stream urine samples were collected and processed for bacteriological culture and antimicrobial sensitivity testing (AST). Ceftazidime (30µg) and Cefotaxime (30µg) disks were used for ESBL screening as per CLSI guideline and each ESBL screening positive isolate were phenotypically confirmed by a combination disk test.

RESULTS

Among 376 study participants, 79 (21.0%) had significant bacteriuria (SBU). Majority at 58(73.4%) of the isolates were Gram-negative. The most predominant isolate was E.coli, 36(45.6%) followed by K. pneumonea 16(20.3%) and S. aureus at 9(11.4 %). The proportion of ESBL producing isolates was 25(32.9%). Gram-negatives showed high level resistance to ampicillin, amoxicillin, cefotaxime, and cephalexin at 87%, 85%, 57%, and 52%, respectively. Previous history of UTI, monthly income, educational status and having dysuria were significantly associated with SBU (p<0.05).

CONCLUSION

Relatively high prevalence of uropathogens and an increased level of drug resistance were documented. Therefore, continued surveillance on the type of uropathogens and their AMR pattern is needed to ensure appropriate recommendations for the rational empirical treatment of UTI and for policy input.

Bacterial uropathogens and susceptibility testing among patients diagnosed with urinary tract infections at Hiwot Fana Specialized University Hospital, Eastern Ethiopia

Background:

Urinary tract infection is a common infection posing a significant healthcare burden globally. Currently, it is becoming hard to manage due to the drug resistance of uropathogens. This study aimed to evaluate the rate of culture positivity and the susceptibility pattern of isolates among clinically diagnosed patients with urinary tract infection.

Methods:

An institution-based cross-sectional study was conducted on patients clinically diagnosed with urinary tract infections and received a drug prescription at Hiwot Fana Specialized University Hospital from August 2018 to June 2019. A clean-catch mid-stream urine specimen was collected and bacterial identification and susceptibility test were performed using standard microbiological methods. Data were entered into EpiInfo 7 and exported to STATA 15 for analysis. Data were analyzed using descriptive analysis and bi-variate and multivariate regression analyses and presented with graphs, frequency, and tables.

Results:

A total of 687 urine samples were collected from patients with clinically diagnosed urinary tract infections. The mean age was 31 years and 56.62% were female. 28.38% of the participants had a culture-positive result, of which 86.15% had monomicrobial infections. Inpatients (AOR = 3.8, 95% CI = (1.8–7.9)) and hypertensive patients (AOR = 2.1, 95% CI = (1.1–4.4)) had higher odds of culture-positive results. Staphylococcus species (35.3%), E. coli (25.34%), Pseudomonas species (6.8%), and other Enterobacterales are isolated. Most isolates showed resistance to more than one drug, and amikacin, gentamicin, and nitrofurantoin showed relatively higher activity against isolates.

Conclusion:

About one-third of the clinically diagnosed patients with urinary tract infection were culture-positive with many types of bacterial uropathogens. Inpatients and hypertensive patients had a higher risk of developing bacterial infections. Bacterial isolates showed different percentages of susceptibility to the tested antibiotics.

A systematic review and meta-analysis on the prevalence of Escherichia coli and extended-spectrum β-lactamase-producing Escherichia coli in pregnant women

PROPOSE

The aim of the present study was to determine the prevalence of E. coli and extended-spectrum β-lactamase-producing (ESBL) E. coli in pregnant women in a systematic review and meta-analysis study.

METHODS

We searched important databases, including Medline (PubMed), Embase, Scopus, Web of sciences, Cochrane library, Ovid, and CINHAL to retrieve all articles reporting the prevalence of ESBL E. coli in pregnant women that published from January 1990 to June 2020.

RESULTS

The pooled prevalence of E. coli in pregnant women with and without symptoms of UTI after combining 82 studies with a sample size of 33,118 was 29% (29%; %95 CI 23, 36%). The prevalence based on urine, Feacal, and vagina samples was 26% (% 95 CI 19-34%), 77% (% 95 CI 22-98%), and 32% (% 95 CI 17-48%), respectively. Also, 19 studies with a sample size of 9,200 reported ESBL E. coli prevalence in pregnant women. After combining the results of these studies, the pooled prevalence of ESBL E. coli in pregnant women was 34% (34%; %95 CI 24, 43%). The pooled prevalence of E. coli in pregnant women with HIV was 9%(9%; %95 CI 7, 11%).

CONCLUSION

According to the results of this study, the prevalence of E. coli and ESBL E. coli is high in pregnant women. Also, the overuse of antibiotics was higher in European and Asian pregnant women than other continents.

Prevalence of Asymptomatic Bacteriuria, Associated Factors and Antimicrobial Susceptibility Profile of Bacteria Among Pregnant Women Attending Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia

Introduction

Asymptomatic bacteriuria (ASB) is the presence of bacteria in significant quantity in the absence of signs and symptoms of urinary tract infection (UTI). ASB, if it occurs during pregnancy, can cause serious complications both among fetus and pregnant women.

Objective

The aim of this study was to determine the prevalence of ASB, its associated factors, and antimicrobial susceptibility profile of bacterial isolates among pregnant women.

Methods

A cross-sectional study was conducted from July to September 2019 among 290 pregnant women at Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. Clean-catch midstream urine specimens were collected using sterile containers and cultured on MacConkey agar and sheep blood agar to isolate bacteria. Socio-demographic and obstetric data were collected using a structured questionnaire. Data were analyzed by SPSS version 22. The association between ASB and risk factors was assessed using logistic regressions. A p-value ≤0.05 was considered as a cut point to determine the significant association.

Results

From 290 study participants, 16.9% with 95 CI [13.1, 21.5] were positive for ASB. The predominant bacteria were Escherichia coli (43%) and Staphylococcus aureus (20%). Majority of E. coli (91.0%) were susceptible to nitrofurantoin and gentamycin; most of them were resistant to amoxicillin (86.4%) and cotrimoxazole (77.7%). The proportion of multi-drug resistance (MDR) isolates was 57.1%. Previous infection with UTI, previous history of catheterization, and natural abortion were significantly associated with ASB.

Conclusion

In the study area, ASB is prevalent in the study area indicating the importance of screening of ASB and possible treatment to prevent its consequences.

Bacterial Profile and ESBL Screening of Urinary Tract Infection Among Asymptomatic and Symptomatic Pregnant Women Attending Antenatal Care of Northeastern Ethiopia Region

Background

Urinary tract infection is a common cause of morbidity in pregnant women. Emergence of antimicrobial resistance particularly ESBL production among bacterial uropathogens is increasing and becoming principal cause of treatment failure. The aim of this study was to determine the bacterial profile, their antimicrobial susceptibility patterns, risk factors and identify ESBL-producing bacterial uropathogens.

Patients and Methods

A hospital-based cross-sectional study was conducted in the Northeastern Ethiopia region. A total of 323 pregnant women were included and structured questionnaire was used to collect sociodemographic and risk factor-related data. About 10mL freshly voided midstream urine specimen was collected, transported and processed according to standard operating procedures. The data obtained were entered into SPSS version 22 and descriptive statistics, chi-square, bivariate and multivariate logistic regression analyses were performed. P-value ≤0.05 with corresponding 95% confidence interval were considered for statistical significance.

Results

The overall prevalence of UTI was 15.5% (50/323). The predominant bacterial isolates were Escherichia coli 17 (33.3%) followed by coagulase-negative staphylococci 15 (30.0%) and Staphylococcus aureus 14 (27.5%). Previous history of UTI (AOR=8.824, 95% CI: 3.769,20.654, P<0.001) and history of catheterization (AOR=3.270, 95% CI: 1.316,8.122, P=0.011) were significantly associated with the occurrence of bacterial UTI. Gram-negative isolates showed high level of resistance to ampicillin 12 (60.0%) and relatively low level of resistance to nitrofurantoin 5(25.0%), norfloxacin 5 (25.0%) and ceftazidime 3 (15.0%). Gram-positive uropathogens showed higher resistance for penicillin 29 (93.5%) and trimethoprim-sulfamethoxazole 23 (79.3%) whereas all isolates were sensitive 29 (100.0%) to nitrofurantoin. Moreover, multidrug resistance was observed among 41 (80.4%) of the isolates, and 3 (15.8%) of isolated gram-negative bacteria were ESBL producers.

Conclusion

High prevalence of bacterial UTI and MDR for commonly prescribed drugs were observed with significant number of ESBL producers. Therefore, instant UTI culture assessment of pregnant women, especially those having possible risk factors such as previous histories of UTI and catheterization; moreover, appropriate prescription and use of antibiotics are necessary.

Asymptomatic Bacteriuria among Pregnant Women Attending Antenatal Care at Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia: Magnitude, Associated Factors, and Antimicrobial Susceptibility Pattern

Background

Asymptomatic bacteriuria is one of the major risk factors for the development of urinary tract infections during pregnancy which accounts for about 70% of the cases. However, there is no guideline which recommends routine screening of pregnant women for asymptomatic bacteriuria in most of developing countries including Ethiopia. Thus, the aim of this study was to determine the magnitude, associated factors, and antimicrobial susceptibility pattern of asymptomatic bacteriuria among pregnant women.

Methods

A cross-sectional study was conducted from March to April 2019. Data were collected through face-to-face interview and analyzed using Statistical Package for Social Science version 22. A test of association was performed using logistic regression and P value less than 0.05 was considered statistically significant.

Results

The overall prevalence of asymptomatic bacteriuria was 19.9%. Direction of wiping after genital wash, postcoital urination, and catheterization were factors significantly associated with asymptomatic bacteriuria. Most of the isolated Gram positive were highly sensitive to Ceftriaxone (90.9%). Coagulase-negative staphylococci showed higher sensitivity to Augmentin (75.0) and Ceftriaxone (87.5%), whereas they showed resistance to Clindamycin (68.7%) and Ampicillin (62.5%). Gram-negative bacteria isolates showed higher sensitivity to Ceftriaxone (88.2%), Gentamycin (67.5%), and Augmentin (64.7%), while they showed resistance to Ampicillin (70.5%) and Clindamycin (50.0%).

Conclusion

The overall prevalence of asymptomatic bacteriuria among pregnant women in this study was high. Direction of wiping after genital wash, catheterization, and postcoital urination increases the odds of asymptomatic bacteriuria. Therefore, health education on the predisposing factors is strongly recommended.

Factors associated with multidrug-resistant bacteria in a cohort of patients with asymptomatic bacteriuria who underwent urological surgery

BACKGROUND

Although the factors associated to bacterial resistance in patients with asymptomatic bacteriuria (ASB) have been studied in pregnant, fertile age women, patients with spinal cord injury, and those with urogynecological disorders, nothing is known about the factors associated with multidrug-resistant (MDR) bacteria in patients with ASB and planned urological procedures. This study therefore sought to identify the sociodemographic and clinical factors associated with MDR bacteria in a cohort of patients with ASB scheduled for urological procedures.

METHODS

We conducted a nested case-control study on a cohort of patients with ASB and planned urological procedures at 3 Colombian medical centers. Cases were patients with MDR bacteria and controls were patients without MDR bacteria.

RESULTS

A total of 184 patients were included, 41.8% (n = 77) of whom presented ASB with MDR bacteria. The factors linking ASB with MDR bacteria were: advanced age (odds ratio, 1.03; 95% confidence interval, 1.01-1.06) and hospitalization within the 3-month period before surgery (odds ratio, 2.35; 95% confidence interval, 1.08-5.21).

CONCLUSIONS

Bacterial resistance is frequent among patients with ASB and planned urological procedures. Advanced age and prior hospitalization should be borne in mind for patients with planned urological procedures because they are factors associated with the presence of MDR bacteria.

Type of bacterial isolates and antimicrobial resistance profile from different clinical samples at a Referral Hospital, Northwest Ethiopia: five years data analysis

OBJECTIVE

Antimicrobial resistance (AMR) is one of the most serious global public health threats that exert a significant burden in terms of patient morbidity and mortality and financial crises in many developing countries including Ethiopia. Knowledge on the type of predominantly circulating pathogens with their respective AMR profile in a given area is essential for optimal patient care. This study was aimed at assessing the types of bacterial isolates and their AMR profile identified from a range of clinical samples at Debre Markos Referral Hospital, Northwest Ethiopia, over a period of 5 years (2013 to 2017).

RESULTS

From the total of 514 different clinical samples processed in the stated time frame, about 240 (46.7%) yield bacterial growth. Majority of the identified bacteria were isolated from stool culture 68 (28.3%) followed by urine 56 (23.3%), ear discharge 54 (22.5%) and wound swabs at 26 (10.8%). Most of the clinical isolates were Gram-negative at 171 (71.25%). The predominant isolate was S. aureus at 41 (17.1%) followed by Salmonella species, 40 (16.7%), Escherichia coli 36 (15%) and Pseudomonas aeruginosa at 26 (11.7%). Generally, the isolates were found resistant at (60-100%) against ampicillin, co-trimoxazole, doxycycline, gentamicin, norfloxacin and tetracycline. Gram-positive isolates were found relatively sensitive to ceftriaxone, erythromycin and vancomycin at (71-84%).

The etiology and prevalence of urinary tract infection and asymptomatic bacteriuria in pregnant women in Iran: a systematic review and Meta-analysis

BACKGROUND

Urinary tract infection (UTI) is a common clinical problem in pregnant women. Bacteriuria in pregnancy without antibiotic treatment could result in complications. This study aims to investigate the etiology and prevalence of UTI and asymptomatic bacteriuria (ASB) in pregnant women in Iran.

METHOD

This meta-analysis follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To avoid bias, all steps of the study were carried out independently by two researchers. We conducted a comprehensive search on all the related literature in national databases, including IranDoc, SID, Barakat Knowledge Network System, RICST, Magiran, Iranian National Library and international databases, including Scopus, Embase, Science Direct, PubMed/ Medline, Cochrane Library, Web of Sciences, EBSCO, as well as Google Scholar search engine until June 2018. After considering the inclusion/exclusion criteria and qualitative evaluation, studies were analyzed based on random effects model using Comprehensive Meta-Analysis Software Version 2.

RESULTS

In 31 studies with a sample size of 20,309, the prevalence of ASB in pregnant Iranian women was estimated to be 8.7% (95%CI: 7.2-10.4). The lowest and highest prevalence of ASB were observed in the third trimester (6.1% [95%CI: 2.1-16.4]) and first trimester (11.7% [95%CI: 7.9-16.9]), respectively. Subgroup analysis of the prevalence of ASB based on geographical region (P = 0.002) and province (P <  0.001) was significant but for the quality of studies (P = 0.51) was not significant. In 17 studies including 48,731 pregnant women, the prevalence of UTI was estimated to be 9.8% (95%CI: 7.6-12.5). The test for subgroup differences of prevalence of UTI for province (P <  0.001) was significant but for geographical region (P = 061) and quality of studies (P = 0.11) was not significant. Meta-regression model for the prevalence of UTI and ASB in pregnant women in Iran based on year of the studies was significant (P <  0.001). The most common microorganism involved in the etiology of UTI (61.6% [95%CI: 51.6-70.7]) and ASB (63.22% [95%CI: 51.2-73.8]) was E. coli.

CONCLUSION

UTI and ASB are prevalent in pregnant women in Iran. Therefore, UTI screening is essential in pregnant women. The most common microorganism involved in the etiology of UTI and ASB in pregnant women in Iran is E.coli.