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

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.

Detection of multidrug-resistant organisms of concern including Stenotrophomonas maltophilia and Burkholderia cepacia at a referral hospital in Kenya

Regular monitoring of bacterial susceptibility to antibiotics in clinical settings is key for ascertaining the current trends as well as re-establish empirical therapy. This study aimed to determine bacterial contaminants and their antimicrobial susceptibility patterns from medical equipment, inanimate surfaces and clinical samples obtained from Thika Level V Hospital (TLVH), Thika, in Central Kenya. Three hundred and five samples were collected between the period of March 2021 to November 2021 and comprised urine, pus swabs, catheter swabs, stool, and environmental samples. Bacterial identification and antimicrobial susceptibility were performed using VITEK 2 and disc diffusion respectively. We observed that Coagulase-negative Staphylococci (28 /160, 17.5%) were the most commonly isolated species from clinical samples followed by E. coli (22 /160 13.8%) and S. aureus (22/160, 13.8%). The bed rails were the mostly contaminated surface with S. aureus accounting for 14.2% (6/42). Among the clinical samples, pus swabs yielded the highest number of pathogens was pus (92/160). Trauma patients had the highest proportion of isolates (67/160, 41.8%). High level of antimicrobial resistance to key antimicrobials, particularly among Enterobacterales was observed. Extended Spectrum Beta Lactamase (ESBL) phenotype was noted in 65.9% (29/44) of enteric isolates. While further ESBL genetic confirmatory studies are needed, this study highlights the urgent need for actions that mitigate the spread of antibiotic-resistant bacteria.

Real world drug treatment models for pregnancy complicated with urinary tract infection in China from 2018 to 2022: a cross-section analysis

Objective: Urinary tract infection (UTI) is common in pregnant women. The selection of anti-infection plans during pregnancy must take into account the dual factors of patient pregnancy status and urinary tract infection anti-infection treatment, as well as the efficacy, cost, risk, and potential adverse reactions associated with each method applied to individual patients. Consequently, there are numerous drugs from which to choose; presently, there is no unified conclusion regarding the choice of drug therapy, and there is a lack of long-term drug treatment for UTI during pregnancy. Our objective is to investigate the actual drug treatment patterns of UTI patients during pregnancy in China over the past 5 years, with a particular emphasis on the trend and rationality of antibiotic use in these patients over the past 5 years. Method: We conducted a cross-sectional analysis of data from a China Medical Association-supervised hospital prescription analysis cooperation initiative. From January 2018 to December 2022, the information is extracted from prescriptions/medical orders of patients with UTI during pregnancy. Using a primary anatomical therapeutic chemistry (ATC) classification code and the US Food and Drug Administration (FDA) classification, we quantified the frequency of drug use and drug types. We also calculated the prevalence of the most frequently prescribed antibacterial medications and assessed the efficacy of anti-infection plans based on drug labels and guidelines. Results: Among the 563 patients included in this research, Chengdu (36.59%), Guangzhou (27.72%), and Shanghai (8.70%) were the top three cities. Over the course of 5 years, the average age was 29.60% ± 6.59 years, with approximately 60.21% of women between the ages of 25 and 34. Each patient's primary anti-infection medications were statistically analyzed. Cephalosporins (403, 71.58%), enzyme inhibitors (66, 11.72%), and penicillins (34, 6.04%) were the first few categories, followed by the most commonly used cephalosporins. Cefuroxime, ceftriaxone, and cefdinib, rounded out the top five. Cefoxitin and cefaclor. According to the 5-year change in dosage, cephalosporins have always ranked first. Three of the top five most expensive drugs are cephalosporins, carbapenems, and enzyme inhibitors. Teicoplanin, tigecycline, nifurtel, linezolid, and quinolones ranked among the top five in terms of per-patient drug costs for patients receiving comprehensive treatment drugs. Conclusion: In the 5 years of research, the average age of patients who visit a doctor has not increased substantially, but the opportunity cost of female fertility has increased, which has severely impeded the fulfillment of fertility desires. The selection of medications is generally reasonable, and the dosage of the first-line cephalosporins recommended by the guidelines is relatively high in this study. The dosage of furantoin and fosfomycin, which are more prevalent in urinary tract infections, is however relatively low. In addition, some expensive pharmaceuticals may increase patients' financial burden. On the premise of meeting clinical needs, future research will focus on how to further improve the level of rational drug use in outpatient clinics, attain economical, safe, and effective drug use, and thus reduce the economic burden on patients.

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.

Urinary Tract Infection and Associated Factors among Pregnant Women Receiving Antenatal Care at a Primary Health Care Facility in the Northern Region of Ghana

Urinary tract infection (UTI) is frequently encountered during pregnancy and is associated with adverse maternal, fetal, and neonatal effects. However, very little information is available on the prevalence of UTI among pregnant women in the northern part of Ghana, a region with a high birth rate. This study employed a cross-sectional analysis of the prevalence, antimicrobial profile, and risk factors associated with UTI in 560 pregnant women attending primary care for antenatal check-ups. Sociodemographic obstetrical history and personal hygiene information were obtained using a well-structured questionnaire. Afterward, clean catch mid-stream urine samples were collected from all participants and subjected to routine microscopy examination and culture. Of 560 pregnant women, 223 cases (39.8%) were positive for UTI. There was a statistically significant association between sociodemographic, obstetric, and personal hygiene variables and UTI (p < 0.0001). Escherichia coli (27.8%) was the commonest bacterial isolate followed by CoNS (13.5%) and Proteus species (12.6%). These isolates exhibited greater resistance to ampicillin (70.1-97.3%) and cotrimoxazole (48.1-89.7%) but were fairly susceptible to gentamycin and ciprofloxacin. Gram-negative resistance to meropenem was up to 25.0%, and Gram positives resistance to cefoxitin and vancomycin was up to 33.3% and 71.4% respectively. The current findings extend our knowledge of the high frequency of UTIs and associated risk factors in pregnant women with E. Coli being the predominant and usual isolate. Variation existed in the resistance pattern of isolates to various drugs, underscoring the need to perform urine culture and susceptibility before treatment.

Uropathogenic bacterial profile and antibiotic susceptibility pattern of isolates among gynecological cases admitted to Jimma Medical Center, South West Ethiopia

Urinary tract infection (UTI) is one of the most common bacterial infections in women; about 50% of women get during their life time. Moreover, it is a common health problem in patients with gynecological pathologies, which increases the chance of acquiring infection. The aim of this study was to determine the bacterial profile that causes UTI and their antibiotic susceptibility pattern among admitted gynecological cases. A cross-sectional study was conducted in south west Ethiopia region. A total of 386 patients admitted with gynecological cases were recruited by sequential sampling technique and structured questionnaire was used to collect socio-demographic and risk factor-related data. About 10 ml freshly voided midstream and catheterized urine specimens were collected using sterile containers. Identification of isolate was done using culture characteristics, gram staining, and a series of biochemical tests. The antibiotic susceptibility test was performed as per the Kirby-Bauer disc diffusion technique. The data obtained were entered into EpiData Version 3.1 and analyzed using SPSS Version 25. A P value of less than 0.05 was used as a level of significance. In this study, the overall prevalence of UTI was 25.4%. Escherichia coli was the most frequently isolated bacteria, which accounted for 38 (37.6%), followed by Klebsiella species 22 (21.8%), CONS 14 (13.9%), Staphylococcus aureus 10 (9.9%), Enterobacter species 6 (5.9%), Citrobacter species 5 (4.9%), Proteus mirabilis 4 (4%), and Pseudomonas aeroginosa 2(2%). Histories of UTI (AOR = 1.977, 95% CI 1.06, 3.68, P = 0.032) and catheterization (AOR = 2.38, 95% CI 1.28, 4.45, P = 0.006) were found to be statistically associated with significant bacteriuria. Gram-negative isolates showed a high level of resistance, 88.3% for ampicillin and 66.2% for tetracycline, and a relatively low level of resistance against ceftazidime, 22.1%, and meropenem, 3.9%. Gram-positive uropathogens showed a high level of resistance to penicillin, 91.6%, whereas all isolates were sensitive 100.0% to nitrofurantoin. Furthermore, 80 (79.2%) of the isolates had multidrug resistance, and 16 (26.7%) of both E. coli and Klebsiella spp. produced Extended spectrum β-lactamase (ESBL). In this study, a high prevalence of uropathogenic bacteria and multidrug resistance for commonly prescribed drugs were observed with a significant number of ESBL producers. Therefore, screening admitted gynecological patients, especially for those who have history of catheterization and UTI, by urine culture and antimicrobial susceptibility testing is important.

Isolation, Identification, Characterization, and Plasmid Profile of Urinary Tract Infectious Escherichia coli from Clinical Samples

Objective

In recent times, urinary tract infection (UTI) is one of the most widely recognized bacterial diseases all over the planet. UTI influences individuals of any age and gender. The target of this study is to concentrate on the recurrence of uropathogens, the antimicrobial susceptibility pattern of the isolates, and the plasmid profile of people from the government clinics of Karaikudi.

Methods

From July 2017 to December 2017, 100 urine tests were gathered and handled for the isolation of pathogenic microbes. In total, 89 isolates were found from the samples collected.

Results

Escherichia coli was discovered as the most common bacterial isolate screened from the UTI-infected people, accounting for 28.09 percent of all isolates. E. coli was seen to be the highest prevalent bacterium for UTI in all age groups and demonstrated resistance to routinely used medications, especially cefpodoxime and novobiocin, which have been 100 percent resistant. The E. coli isolates screened were positive for beta-lactamase and film generation, and they have strong antimicrobial resistance. As a result, the E. coli strains with the highest prevalence of virulence determinants have become more resistant to many medications because they support the microorganism in overcoming the host's defense and colonizing or entering the urinary system. The amplified 16S rRNA product was analyzed, and phylogenetic relationships were determined. The presence of TEM (56 percent), CTX-M (64 percent), SHV (40 percent), and OXA (60 percent) was discovered. Among E. coli isolates, CTX-M was the most common extended spectrum-beta lactamase (ESBL). Multiplex PCR was also used to identify the existence of CTX-M subgroups in E. coli isolates.

Conclusion

Finally, we urge that antibiotic selection should be predicated on the awareness of the specific prevalence and that novel antimicrobial medicines for urinary infections be developed to combat the overuse of antibiotics.

Trends of Antimicrobial Susceptibility in Clinically Significant Coagulase-Negative Staphylococci Isolated from Cerebrospinal Fluid Cultures in Neurosurgical Adults: a Nine-Year Analysis

Coagulase-negative staphylococci (CoNS) are the main pathogens in health care-associated ventriculitis and meningitis (HCAVM). This study aimed to assess antimicrobial susceptibility. Moreover, the treatment and clinical outcome were described. All neurosurgical adults admitted to one of the largest neurosurgical centers in China with clinically significant CoNS isolated from cerebrospinal fluid cultures in 2012 to 2020 were recruited. One episode was defined as one patient with one bacterial strain. Interpretive categories were applied according to the MICs. The clinical outcomes were dichotomized into poor (Glasgow Outcome Scale 1 to 3) and acceptable (Glasgow Outcome Scale 4 to 5). In total, 534 episodes involving 519 patients and 16 bacteria were analyzed. Over the 9 years, eight antimicrobial agents were used in antimicrobial susceptibility tests, including six in over 80% of CoNS. The range of resistance rates was 0.8% to 84.6%. The vancomycin resistance rate was the lowest, whereas the penicillin resistance rate was the highest. The linezolid (a vancomycin replacement) resistance rate was 3.1%. The rate of oxacillin resistance, representing methicillin-resistant staphylococci, was 70.2%. There were no significant trends of antimicrobial susceptibility over the 9 years for any agents analyzed. However, there were some apparent changes. Notably, vancomycin-resistant CoNS appeared in recent years, while linezolid-resistant CoNS appeared early and disappeared in recent years. Vancomycin (or norvancomycin), the most common treatment agent, was used in 528 (98.9%) episodes. Finally, 527 (98.7%) episodes had acceptable outcomes. It will be safe to use vancomycin to treat CoNS-related HCAVM in the immediate future, although continuous monitoring will be needed. IMPORTANCE Coagulase-negative staphylococci are the main pathogens in health care-associated ventriculitis and meningitis. There are three conclusions from the results of this study. First, according to antimicrobial susceptibility, the rates of resistance to primary antimicrobial agents are high and those to high-level agents, including vancomycin, are low. Second, the trends of resistance rates are acceptable, especially for high-level agents, although long-term and continuous monitoring is necessary. Finally, the clinical outcomes of neurosurgical adults with coagulase-negative staphylococci-related health care-associated ventriculitis and meningitis are acceptable after treatment with vancomycin. Therefore, according to the antimicrobial susceptibility and clinical practice, vancomycin will be safe to treat coagulase-negative staphylococci-related health care-associated ventriculitis and meningitis.

Prevalence and antimicrobial susceptibility pattern of urinary tract infection among pregnant women attending Hargeisa Group Hospital, Hargeisa, Somaliland

The aim of this study was to determine the prevalence, antimicrobial susceptibility pattern and associated factors of urinary tract infection (UTI) among pregnant women attending Hargeisa Group Hospital (HGH), Hargeisa, Somaliland. A cross-sectional study was conducted at HGH, Hargeisa, Somaliland and participants were selected by systematic random sampling technique. Clean catch midstream urine samples were collected from 422 participants and cultured and antimicrobial susceptibility pattern was determined for the isolates. Univariable and multivariable logistic regression analyses were utilized to identify the independent risk factors for UTI. The prevalence of UTI was 16.4% (95% CI 13.3-19.9). The predominant bacteria isolate was E. coli (43.5%) followed by Coagulase negative staphylococcus (CoNS) 11(16%), S. aureus 9(13%), K. pneumonia 6(8.7%), Pseudomonas aeruginosa 5(7.2%), Proteus mirabilis 4(5.8%), Citrobacter spp 3(4.4%) and M. morganii 1(1.5%) Gram negative bacilli were resistant to ampicillin (96%) and tetracycline (71.4%) and Gram-positive cocci were also resistant to ampicillin (90%), tetracycline (55%). Multidrug resistance was observed in 85.5% of bacterial isolated. No formal education participants, previous history of catheterization and previous history of UTI had 3.18, 3.22 and 3.73 times respectively more likely to develop UTI than their counterparts. Culture and susceptibility test is vital for appropriate management of UTI in the study area.

Bacterial profile and antimicrobial resistance patterns of common bacteria among pregnant women with bacteriuria in Ethiopia: a systematic review and meta-analysis

Background

Globally, antimicrobial resistance (AMR) restricted the armamentarium of the health care providers against infectious diseases, mainly due to the emergence of multidrug resistant. This review is aimed at providing contemporary bacterial profile and antimicrobial resistance pattern among pregnant women with significant bacteriuria.

Methods

Electronic biomedical databases and indexing services such as PubMed/MEDLINE, Web of Science, EMBASE and Google Scholar were searched. Original records of research articles, available online from 2008 to 2021, addressing the prevalence of significant bacteriuria and AMR pattern among pregnant women and written in English were identified and screened. The relevant data were extracted from included studies using a format prepared in Microsoft Excel and exported to STATA 14.0 software for the outcome measure analyses and subgrouping.

Results

The data of 5894 urine samples from 20 included studies conducted in 8 regions of the country were pooled. The overall pooled estimate of bacteriuria was 15% (95% CI 13–17%, I² = 77.94%, p < 0.001) with substantial heterogeneity. The pooled estimate of Escherichia coli recovered from isolates of 896 urine samples was 41% (95% CI 38–45%) followed by coagulase-negative Staphylococci, 22% (95% CI 18–26%), Staphylococcus aureus, 15% (95% CI 12–18%), Staphylococcus saprophytic, 12% (95% CI 6–18%) Proteus mirabilis, 7% (95% CI 4–10%), Enterococcus species, 6% (0–12%), Pseudomonas aeruginosa, 4% (2–6%), Citrobacter species, 4% (95% CI 2–4%), Group B streptococcus, 3% (1–5%), and Enterobacter species, 2% (1–4%). Multidrug resistance proportions of E. coli, Klebsiella species, Staphylococcus aureus and Coagulase negative staphylococci, 83% (95% CI 76–91%), 78% (95% CI 66–90%), 89% (95% CI 83–96%), and 78% (95% CI 67–88%), respectively.

Conclusion

The result of current review revealed the occurrence of substantial bacteriuria among pregnant women in Ethiopia. Resistance among common bacteria (E. coli, Klebsiella species, Staphylococci species) causing UTIs in pregnant women is widespread to commonly used antibiotics. The high rate of drug resistance in turn warrants the need for regular epidemiological surveillance of antibiotic resistance and implementation of an efficient infection control and stewardship program.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00404-021-06365-4.

The Bacterial Profile and Antimicrobial Susceptibility Patterns of Urinary Tract Infection Patients at Pawe General Hospital, Northwest Ethiopia

Urinary tract infection remains the most common infection widespread worldwide in both community and hospital settings. Rapidly increasing antibiotic resistance of uropathogens is resulting in limited treatment options. Thus, understanding the current uropathogens and their antimicrobial susceptibilities is essential for effective urinary tract infection treatment. The purpose of this study was to isolate, characterize, and determine the antimicrobial susceptibility patterns of bacterial pathogens associated with urinary tract infection at Pawe General Hospital in Northwest Ethiopia. A hospital-based cross-sectional study design was conducted from January to April, 2020, at Pawe General Hospital. Midstream urine specimens were collected from 141 individuals with suspected urinary tract infection for bacteriological identification and antimicrobial susceptibility testing. Among the 141 study participants, twenty-nine (20.6%) showed significant bacteriuria. Escherichia coli (42.6%) had the highest proportion of isolated uropathogen followed by Klebsiella spp. and Pseudomonas spp. each (10.7%); Proteus spp. (9.3%); coagulase negative staphylococci, Staphylococcus aureus, and Enterobacter spp. each (6.7%); Citrobacter spp. (4%); and Enterococcus faecalis and Streptococcus spp. each (1.3%). Outpatient isolates showed a resistance of 64% and 78.6% to amoxicillin-clavulanic acid and tetracycline, respectively. Inpatients showed 63.9% and 87.2% of resistance to cephalexin and tetracycline. It was also observed that all the isolates have a multiple antimicrobial resistance index greater than 0.20 except Citrobacter spp. (0.142) in inpatients. Even though in this locality, most isolates were sensitive to ceftriaxone, gentamicin, ciprofloxacin, nitrofurantoin, and norfloxacin, they are considered appropriate antimicrobials for empirical treatment of urinary tract bacterial infections. Periodic monitoring of etiology and drug susceptibility is highly recommended, along with health education on the transmission and causes of urinary tract infection.

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.

Epidemiologic and molecular characterization of β-lactamase-producing multidrug-resistant uropathogenic Escherichia coli isolated from asymptomatic hospitalized patients

Uropathogenic Escherichia coli (UPECs) are the predominant cause of asymptomatic bacteriuria (ABU) and symptomatic UTI. In this study, multidrug-resistant (MDR) ABU-UPECs from hospitalized patients of Kolkata, India, were characterized with respect to their ESBL phenotype, acquisition of β-lactamase genes, mobile genetic elements (MGEs), phylotype property, ERIC-PCR profile, sequence types (STs), clonal complexes (CCs) and evolutionary and quantitative relationships and compared to the symptomatic ones to understand their epidemiology and evolutionary origin. Statistically significant incidence of ESBL producers, β-lactamase genes, MGEs and novel phylotype property (NPP) among ABU-UPECs similar to the symptomatic ones indicated the probable incidence of chromosomal plasticity on resistance gene acquisition through MGEs due to indiscriminate drug usage. ERIC-PCR typing and MLST analysis showed clonal heterogeneity and predominance of ST940 (CC448) among asymptomatic isolates akin to symptomatic ones along with the evidence of zoonotic transmissions. Minimum spanning tree analysis showed a close association between ABU-UPEC with known and unidentified STs having NPPs with isolates that belonged to phylogroups clade I, D, and B2. This is the first study that reported the occurrence of MGEs and NPPs among ABU-UPECs with the predominance of ESBL production which displayed the deleterious effect of MDR among this pathogen demanding alternative therapeutic interventions. Moreover, this study for the first time attempted to introduce a new approach to ascertain the phylotype property of unassigned UPECs. Withal, increased recognition, proper understanding and characterization of ABU-UPECs with the implementation of appropriate therapeutic measures against them when necessary are the need of the era which otherwise might lead to serious complications in the vulnerable population.

Antimicrobial Resistance among Pregnant Women with Urinary Tract Infections Attending Antenatal Clinic at Levy Mwanawasa University Teaching Hospital (LMUTH), Lusaka, Zambia

Introduction

Globally, there is a growing concern over antimicrobial resistance (AMR) which is currently estimated to account for more than 700,000 deaths per year worldwide. AMR undermines the management of infectious diseases in general especially in pregnancy where significant bacteriuria continues to be a serious cause of maternal and perinatal morbidity and mortality. We therefore aimed to determine the prevalence of AMR and the associated factors among pregnant women with urinary tract infections (UTIs) attending antenatal clinic at a selected hospital in Lusaka, Zambia.

Methods

This was a hospital-based, cross-sectional study conducted between November 2018 and May 2019. Interviewer-administered questionnaire was used to assess the sociodemographic characteristics and behavioural characteristics. Laboratory tests were also conducted. Descriptive statistics of study participants were used to describe the characteristics of the respondents. Chi-square was used to assess the association between categorical variables. The logistic regression analysis was carried out to generate the adjusted odds ratio with 95% confidence interval.

Results

Overall (n = 203), the prevalence of UTI was 60% (95% CI: 53.3%-66.7%). The most isolated bacteria were E. coli (59%) and Klebsiella (21%). The prevalence of AMR was found to be 53% (95% CI: 46.1%-59.8%). The drugs highly resistant to antimicrobials were nalidixic acid (88.3%), ampicillin (77.8%), and norfloxacin (58.5%), while the least resistant drug was chloramphenicol (20%). There were no important significant predictors to AMR among pregnant women observed in this study.

Conclusion

We found high burden of AMR closely linked to observe high prevalence of UTI suggested in this small population. This suggests a need to develop integrated surveillance systems that aim for early and regular screening of pregnant women for UTI as well as concurrent determination of antibiotic susceptibility patterns. This is important to prevent complications that may endanger maternal and fetal health outcomes. Furthermore, further research is needed to explore reasons for this high prevalence of AMR including examining possible attribution to the misuse of drugs so as to inform, enforce, or adjust the prescription-only policies and enforce antimicrobial stewardship programs.