Determination of antibiotic resistance rates of Escherichia coli and Klebsiella pneumoniae isolates, which are the causative agents of urinary tract infection in pregnant women

Abstract

Aim: Urinary tract infections are common infections during pregnancy. Infections seen during pregnancy have a spectrum ranging from asymptomatic bacteriuria to cystitis, pyelonephritis and, urosepsis. In this study, it was aimed to determine the antibiotic resistance rates of Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) isolates isolated from urinary cultures of pregnant women who applied to the Ankara Training and Research Hospital. 
 Material and Method: The identification and antibiotic susceptibility of E. coli and K. pneumoniae isolates isolated from urinary samples of pregnant women who applied to the Ankara Training and Research Hospital between January 2021 and December 2022 were investigated with VITEK-2 (Biomerioux, France) fully automated system, and the presence of extended-spectrum beta-lactamase (ESBL) was investigated by combined disc diffusion method. The obtained data were analysed retrospectively.
 Results: Bacterial growth was detected in 1090 (1.2%) out of a total of 8923 urine samples over a two-year period. 480 (4.4%) of the microbial agents reproducing in urine culture were E. coli and 105 (0.96%) were K. pneumoniae. The rate of extended-spectrum beta-lactamase (ESBL) in E. coli strains was 16.04% (77/480), and the rate of ESBL in K. pneumoniae strains was 20.9% (22/105). Resistance rates of amoxicillin-clavulanic acid, ceftriaxone, phosphomycin, ciprofloxacin, piperacillin-tazobactam, nitrofurantoin, imipenem, meropenem, ertapenem in ESBL negative E. coli strains were 15.9%, 8.82%, 20%, 11.1%, 5.88%, 0%, 0%, 0% and 0%, respectively. Resistance rates of amoxicillin-clavulanic acid, ceftriaxone, phosphomycin, ciprofloxacin, piperacillin-tazobactam, nitrofurantoin, imipenem, meropenem, ertapenem in ESBL positive E. coli strains were determined as 66.5%, 100%, 2.2%, 33.8%, 11.5%, 0%, 0%, 0% and, 0%, respectively. Resistance rates of amoxicillin-clavulanic acid, ceftriaxone, phosphomycin, ciprofloxacin, piperacillin-tazobactam, nitrofurantoin, imipenem, meropenem, ertapenem in ESBL negative K. pneumoniae strains were 53%, 100%, 12.5%, 28.5%, 2.2%, 3.5%, 0%, 0% and, 4.5%, respectively. Resistance rates of amoxicillin-clavulanic acid, ceftriaxone, phosphomycin, nitrofurantoin, ciprofloxacin, piperacillin-tazobactam, imipenem, meropenem, ertapenem in ESBL positive K. pneumoniae strains were 62.5%, 100%, 12.5%, 35%, 28.5%, 22.7%, 0%, 0% and, 4.5%, respectively.
 Conclusion: According to the antibiotic susceptibility data in our hospital, phosphomycin or carbapenems may be preferred due to the low resistance rate in the empirical treatment of E. coli-related urinary tract infections in pregnant women. In the treatment of urinary tract infections due to K. pneumoniae, phosphomycin, piperacillin-tazobactam or carbapenems may be preferred due to low resistance rates.