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Al Kadri HM, El-Metwally AA, Al Sudairy AA, Al-Dahash RA, Al Khateeb BF, Al Johani SM. Antimicrobial resistance among pregnant women with urinary tract infections is on rise: Findings from meta-analysis of observational studies. J Infect Public Health 2024; 17:102467. [PMID: 38850585 DOI: 10.1016/j.jiph.2024.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 04/23/2024] [Accepted: 05/27/2024] [Indexed: 06/10/2024] Open
Abstract
Pregnant women have a higher risk of urinary tract infections (UTIs) compared to non-pregnant women, making antibiotics necessary for treatment. However, prescribing antibiotics without culture and sensitivity tests may contribute to antimicrobial resistance. A meta-analysis using R was conducted to determine the prevalence of antibiotic resistance patterns in UTIs among pregnant women. We identified observational studies published in the last 10 years and used a random effects model to calculate the pooled prevalence. The prevalence of Gram-negative organisms causing UTIs in pregnant women was 67 %, while Gram-positive organisms were 22 %. The burden of Gram-positive organisms exhibiting antimicrobial resistance was very high at 95 %, primarily to ampicillin. The most common Gram-negative organisms exhibiting antimicrobial resistance were E. coli, Klebsiella, and Pseudomonas aeruginosa, while the most common Gram-positive organisms resistant to antibiotics were Staphylococcus aureus and coagulase-negative Staphylococcus. Sensitivity and culture testing are recommended for effective treatment in pregnant women with UTIs.
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Affiliation(s)
- Hanan M Al Kadri
- Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Ashraf A El-Metwally
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Atika A Al Sudairy
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Raed A Al-Dahash
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Medicine, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Badr F Al Khateeb
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Family Medicine, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Sameera M Al Johani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
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Al Kady C, Moussally K, Chreif W, Farra A, Caluwaerts S, Wertheim H, Soukarieh D, Gordillo Gomez F, Dibiasi J, Lenglet A. Overuse of antibiotics for urinary tract infections in pregnant refugees, Lebanon. Bull World Health Organ 2024; 102:389-399. [PMID: 38812803 PMCID: PMC11132156 DOI: 10.2471/blt.23.291235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/21/2022] [Accepted: 02/22/2024] [Indexed: 05/31/2024] Open
Abstract
Objective To determine whether adding urine culture to urinary tract infection diagnosis in pregnant women from refugee camps in Lebanon reduced unnecessary antibiotic use. Methods We conducted a prospective, cross-sectional study between April and June 2022 involving pregnant women attending a Médecins Sans Frontières sexual reproductive health clinic in south Beirut. Women with two positive urine dipstick tests (i.e. a suspected urinary tract infection) provided urine samples for culture. Bacterial identification and antimicrobial sensitivity testing were conducted following European Committee on Antimicrobial Susceptibility Testing guidelines. We compared the characteristics of women with positive and negative urine culture findings and we calculated the proportion of antibiotics overprescribed or inappropriately used. We also estimated the cost of adding urine culture to the diagnostic algorithm. Findings The study included 449 pregnant women with suspected urinary tract infections: 18.0% (81/449) had positive urine culture findings. If antibiotics were administered following urine dipstick results alone, 368 women would have received antibiotics unnecessarily: an overprescription rate of 82% (368/449). If administration was based on urine culture findings plus urinary tract infection symptoms, 144 of 368 women with negative urine culture findings would have received antibiotics unnecessarily: an overprescription rate of 39.1% (144/368). The additional cost of urine culture was 0.48 euros per woman. Conclusion A high proportion of pregnant women with suspected urinary tract infections from refugee camps unnecessarily received antibiotics. Including urine culture in diagnosis, which is affordable in Lebanon, would greatly reduce antibiotic overprescription. Similar approaches could be adopted in other regions where microbiology laboratories are accessible.
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Affiliation(s)
- Christine Al Kady
- South Beirut Project, Lebanon Mission, Operational Center Brussels, Médecins Sans Frontières, Domtex Building, Fifth Floor, Hamra Main Street, Beirut, Lebanon
| | | | - Wafaa Chreif
- South Beirut Project, Lebanon Mission, Operational Center Brussels, Médecins Sans Frontières, Domtex Building, Fifth Floor, Hamra Main Street, Beirut, Lebanon
| | - Anna Farra
- Middle East Medical Unit, Médecins Sans Frontières, Beirut, Lebanon
| | | | - Heiman Wertheim
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Kingdom of the Netherlands
| | | | | | - Johanna Dibiasi
- South Beirut Project, Lebanon Mission, Operational Center Brussels, Médecins Sans Frontières, Domtex Building, Fifth Floor, Hamra Main Street, Beirut, Lebanon
| | - Annick Lenglet
- International Centre for Antimicrobial Resistance Solutions, Copenhagen, Denmark
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Barnawi Y, Alghamdi A, Ibrahim A, Al-Anazi L, Alhumaida G, Alotaibi R, Khan M, Baz D, Alraey M, Alkazemi A, Alqhatani H, Waggas H. Prevalence of urinary tract infections in pregnant women and antimicrobial resistance patterns in women in Riyadh, Saudi Arabia: a retrospective study. BMC Infect Dis 2024; 24:502. [PMID: 38762526 PMCID: PMC11102606 DOI: 10.1186/s12879-024-09385-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/07/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) are one of the most common health problems worldwide and mainly affect women. This study aimed to evaluate the prevalence of UTIs in pregnant women and determine the antimicrobial resistance patterns of bacterial pathogens isolated from pregnant and nonpregnant women in Riyadh, Saudi Arabia. METHODS This retrospective cohort study was conducted at an academic medical center in Riyadh, Saudi Arabia, from January to June 2022. The study included all urine cultures performed for adult women during the study period. We excluded urine culture performed for women on antibiotics prescribed for any infection, children, and men. Using the SPSS (version 27) package, descriptive statistics and chi-square tests were used to analyze the data, and p < 0.05 was considered to indicate statistical significance. RESULTS A total of 2,418 urine cultures performed during the study period were included (985 and 1,433 for pregnant and nonpregnant women, respectively). The overall prevalence of UTIs in pregnant women was 5% (95% CI 3.6-6.4); 10 (1%) women were symptomatic, and 40 (4%) women were asymptomatic. Of the entire cohort, 244 (10.1%) women were diagnosed with UTIs based on bacterial cultures. The predominant bacteria in both pregnant and nonpregnant women were Escherichia coli (134, 54.9%), followed by Klebsiella pneumoniae (48, 19.6%). The antibiotic susceptibility criteria for Escherichia coli and Klebsiella pneumoniae were as follows: nitrofurantoin (94% and 18.8%, respectively), amoxicillin-clavulanic acid (82.8% and 70.8%, respectively), ciprofloxacin (65.7% and 83.3%, respectively), trimethoprim-sulfamethoxazole (65.7% and 79.2%, respectively) and cephalothin (47% and 68.8%, respectively). CONCLUSION Compared to the findings of other similar studies, the prevalence of UTIs was lower in pregnant women. This may be because the patient population was composed of healthy and educated women who received prenatal education and underwent prenatal assessment as per institutional guidelines. Nitrofurantoin and amoxicillin-clavulanic acid are recommended for use as an empirical therapy for UTIs in pregnant and nonpregnant women because bacteria have the least amount of resistance to these drugs.
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Affiliation(s)
- Yasmin Barnawi
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia
- Pharmacy Department, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | - Ahlam Alghamdi
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia.
| | - Alnada Ibrahim
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia
| | - Lina Al-Anazi
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia
| | - Ghada Alhumaida
- College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia
| | - Reema Alotaibi
- College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia
| | - Mohammad Khan
- Department of Microbiology, King Abdullah Bin Abdul-Aziz University Hospital, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia
| | - Dareen Baz
- College of Medicine, AlFaisal University, P.O. Box 50927, Riyadh, 11533, Saudi Arabia
| | - Mohammed Alraey
- Infectious Diseases Department, King Abdullah bin Abdulaziz University Hospital, P.O. Box 84428, Riyadh, 11671, Saudi Arabia
| | - Afrah Alkazemi
- Department of Pharmacy Practice, College of Pharmacy, Kuwait University, P.O. Box 5969, Safat, 13060, Kuwait
| | - Hajar Alqhatani
- Department of Pharmaceutical Care, Ministry of National Guard Health Affairs, P.O. Box 22490, Riyadh, 11426, Saudi Arabia
- King Abdullah International Medical Research Center, P.O. Box 3660, Riyadh, 11481, Saudi Arabia
- King Saud Bin Abdul-Aziz University for Health Sciences, P.O. Box 3660, Riyadh, 11481, Saudi Arabia
| | - Hadeel Waggas
- Department of Obstetrics and Gynecology, King Abdullah bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia
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Jin J, Li C, He Y, Pan J, Zhu J, Tang J. Real world drug treatment models for pregnancy complicated with urinary tract infection in China from 2018 to 2022: a cross-section analysis. Front Pharmacol 2024; 15:1349121. [PMID: 38348394 PMCID: PMC10859756 DOI: 10.3389/fphar.2024.1349121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/15/2024] [Indexed: 02/15/2024] Open
Abstract
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.
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Affiliation(s)
| | | | | | - Jiaqian Pan
- Department of Pharmacy, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - JiaLei Zhu
- Department of Pharmacy, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jing Tang
- Department of Pharmacy, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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Bratosin F, Folescu R, Krupyshev P, Popa ZL, Citu C, Ratiu A, Rosca O, Ilie AC. Comparative Analysis of Microbial Species and Multidrug Resistance Patterns Associated with Lower Urinary Tract Infections in Preterm and Full-Term Births. Microorganisms 2024; 12:139. [PMID: 38257966 PMCID: PMC10821109 DOI: 10.3390/microorganisms12010139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 12/31/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
The rise of multidrug-resistant organisms has significantly complicated the clinical management of urinary tract infections (UTIs), particularly in the context of pregnancy. This study aimed to identify and analyze the significant differences in microbial species and multidrug resistance patterns associated with UTIs in preterm versus full-term births, determine the bacterial species significantly associated with preterm birth, and describe the antibiotic resistance patterns affecting pregnant women with UTIs. This case-control study was conducted in western Romania and focused on pregnant women with UTIs admitted from 2019 to 2023. Data were retrospectively collected from 308 patients with positive cultures. Statistical analyses, including the Chi-square test, Fisher's exact test, and logistic regression models, were employed to compare the proportions of microbial species and resistance patterns between preterm (n = 126) and full-term (n = 182) birth groups and identify factors independently associated with preterm birth. The study found no significant differences in demographic or lifestyle factors between the groups. However, significant differences were observed in several infection and inflammation markers. The median white blood cell count was higher in the preterm group (12.3 vs. 9.1, p = 0.032), and the median C-reactive protein level was significantly higher in the preterm group (18 vs. 7, p < 0.001). The preterm group exhibited a higher incidence of multidrug-resistant organisms, notably ESBL-producing organisms (19.8% vs. 4.4%, p < 0.001) and carbapenem-resistant Enterobacteriaceae (4.8% with p = 0.003). Notably, the resistance to amoxicillin was significantly higher in the preterm group (20.6% vs. 6.6%, p < 0.001). Significant bacterial associations with preterm births included Group B Streptococcus (OR 2.5, p = 0.001) and Enterobacter spp. (OR 1.8, p = 0.022). The study confirmed significant differences in microbial species and multidrug resistance patterns between UTIs associated with preterm and full-term births. The higher prevalence of certain bacteria and increased resistance to commonly used antibiotics in the preterm group underscore the need for tailored antimicrobial therapies and robust microbial identification in managing UTIs during pregnancy.
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Affiliation(s)
- Felix Bratosin
- Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (O.R.)
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Methodological and Infectious Diseases Research Center, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Roxana Folescu
- Department of Family Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Pavel Krupyshev
- Faculty of General Medicine, I.M. Sechenov First Moscow State Medical University, Bolshaya Pirogovskaya Ulitsa 2, 119435 Moscow, Russia;
| | - Zoran Laurentiu Popa
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.C.); (A.R.)
| | - Cosmin Citu
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.C.); (A.R.)
| | - Adrian Ratiu
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.C.); (A.R.)
| | - Ovidiu Rosca
- Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (O.R.)
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Methodological and Infectious Diseases Research Center, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Adrian Cosmin Ilie
- Department III Functional Sciences, Division of Public Health and Management, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
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Pietropaolo A. Urinary Tract Infections: Prevention, Diagnosis, and Treatment. J Clin Med 2023; 12:5058. [PMID: 37568460 PMCID: PMC10420219 DOI: 10.3390/jcm12155058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Urinary tract infections (UTIs) are common pathologies that can affect patients of every age and background [...].
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Affiliation(s)
- Amelia Pietropaolo
- Urology Department, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK;
- European Association of Urology-Young Academic Urologists (EAU-YAU) Urolithiasis and Endourology Working Group, NL-6803 AA Arnhem, The Netherlands
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