Microbiological Profile and Antimicrobial Susceptibility Pattern of Uropathogens Isolated From Pregnant Women Attending a Tertiary Care Hospital in Central India

Abstract

Introduction: Urinary tract infections (UTIs) are more common in females than males, and during pregnancy, frequency is increased due to hormonal changes affecting the anatomy and physiology. If not treated on time, complications may develop in both the mother and fetus. This study aimed to analyze the microbiological (bacterial and yeast) profile of the isolated uropathogens and their antimicrobial susceptibility. Methods: Aseptically collected urine specimens were processed by the standard loop method. Identification of uropathogens was done by standard microbiological tests, and antimicrobial susceptibility was performed as per the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Out of 400 study participants, UTI was detected in 26.75% (107/400) of cases. Overall, Escherichia coli (42.99%, 46/107) was the most frequently isolated uropathogen followed by Candida species (20.56%, 22/107), whereas, among gram-positive bacteria, Enterococcus faecalis (7.47%, 8/107) was the commonest. Among Enterobacterales , extended-spectrum beta-lactamase (ESBL) and AmpC beta-lactamase (AmpC) production was observed in 19.35% (12/62, eight E. coli and four Klebsiella ) and 6.45% (4/62, all E. coli ) isolates, respectively. However, all the gram-negative organisms showed 100% (n=70) sensitivity to carbapenems. Among staphylococci, 50% (2/4) of isolates were methicillin-resistant, and high-level aminoglycoside resistance (HLAR) was observed in 75% (6/8) of Enterococcus faecalis isolates, but all were sensitive to vancomycin, linezolid, and nitrofurantoin. Among Candida species, non-albicans Candida (NAC) species (59%, 13/22) outweigh the number of Candida albicans (41%, 9/22), with Candida tropicalis (22.72%, 5/22) being the commonest NAC. All the Candida species were susceptible to voriconazole, whereas fluconazole resistance was observed in 31.81% (7/22) of Candida isolates, with a higher percentage in NAC species (22.72%, 5/22) than in Candida albicans (9.09%, 2/22). Conclusions: UTIs in pregnancy are caused by a spectrum of both gram-negative bacilli and gram-positive cocci. Moreover, there is a rise of both Candida albicans and NAC species as uropathogens, with the emergence of fluconazole resistance. There is an increased prevalence of asymptomatic bacteriuria in pregnancy, which necessitates the screening of pregnant females for UTI using culture and antimicrobial susceptibility testing.