Prevalence of bacterial uropathogens and their antimicrobial susceptibility patterns among pregnant women in Eastern Ethiopia: hospital-based cross-sectional study

Abstract

Background Urinary tract infection (UTI) is the commonest bacterial infections during pregnancy, leading to significant maternal and prenatal morbidity and mortality. Method This hospital-based cross-sectional study during November 2017 to January 2018 was aimed to determine hospital-based antibacterial susceptibility patterns of bacterial uropathogens among 200 pregnant women in Eastern Ethiopia. ~ 10–20 ml clean-catch midstream urine samples were collected by the study participants. The well-mixed urine samples standardized to 1 µl have inoculated onto Cystine Lactose Electrolyte-Deficient and MacConkey agar. The inoculum was cultured at 37 °C under aerobic conditions for 18–48 h and examined macroscopically to evaluate the colony appearance and size of colonies. The isolate on the plates with pure growth and colonies ≥ 105 CFU/ml were further subjected to biochemical identification and susceptibility testing according to the standard procedures explained in the Clinical and Laboratory Standards Institute guideline. SPSS version 25 was used for data analysis. Descriptive statistics such as frequency, percentage, and cross-tabulation were used to present the findings in the form of graphs and tables. Results The response rate for this study was 98.04%. Thirty-one bacteria were isolated among the 200 urine samples processed, which gave the overall UTI prevalence of 15.5%. The majority (90.3%) of the isolates were Gram-negative. Escherichia coli (45.2%) was the most frequent isolated uropathogen which followed by Proteus spp. (22.6%), Klebsiella pneumoniae (16.1%), Staphylococcus aureus (9.7%), and Pseudomonas aeruginosa (6.5%). Among the isolates, 96.4% of them were susceptible to amikacin and followed by nitrofurantoin (90.3%), and gentamicin (83.9%). However, high rates of resistance to ampicillin (58.1%), amoxicillin-clavulanate (51.6%), and cotrimoxazole (51.6%) were observed. Overall, 16(51.6%) of the bacterial isolates had developed multiple drug resistance to the selected antimicrobials. Conclusion In general, the overall prevalence of UTI was high, 15.5%. Most of isolated bacterial uropathogens were Gram-negative bacteria, and Escherichia coli was the most frequent isolate. The majority of the isolates were susceptible to amikacin, nitrofurantoin, and gentamicin. However, a high rate of resistance was observed to ampicillin, amoxicillin-clavulanate, and cotrimoxazole. More than half of the isolated bacteria had multiple drug-resistant features. Therefore, periodic and continuous urine culture for screening and diagnosis is mandatory to reduce the consequence of UTI and multidrug resistance bacteria in pregnancy.

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

“…E. coli was the most frequent etiological agent of UTI, accounting for up to 37.6% of isolated cases. This finding is in agreement with the findings from Ethiopia, 35.7% 31 , Nigeria, 34.2% 32 and India, 37.3% 33 . The possible explanation for this high isolation rate of E. coli in the present finding could be due to the significant abundance of E. coli in the rectal area, which in turn via contamination ascends through genitalia to the urinary tract and causes UTI and it could also be due to E. coli having various enhanced virulence factors specific for colonization and invasion of the urinary epithelium, such as P-fimbriae and S-fimbriae adherence factors which mediate the attachment of E. coli to viginal and uroepithelial cells 34 .…”

Prevalence, antibiotic resistance pattern for bacteriuria from patients with urinary tract infections

“…experience two or more episodes annually. 12,[17][18][19] Owing to less concern regarding hygiene, old adults (>65 years) had the highest incidence, followed by young adults. 20 Therefore, UTIs complicate the daily lives of people of all ages, notably middle-aged adult women and the oldadult population.…”

Prevalence of uropathogens in catheter associated urinary tract infections and their antimicrobial susceptibility.

“…1 A most recent study conducted by Ejerssa and companions (2021) reported that >70% of uropathogens were sensitive to gentamicin, chloramphenicol, amikacin and nitrofurantoin. 14 The findings of a study performed by Patel and coworkers (2021) highlighted that among the gram negative pathogens, most resistant drug was ciprofloxacin (95.12 percent), followed by cefipime (87.80 percent), piperacillin-tazobactem, meropenam, (85.37 percent). 12 Increase in antibiotic resistance among uropathogens demonstrates that these are nosocomial infections and therefore complicated to treat.…”

“…13 The emergence of antibiotic resistance among urinary pathogens has been increasing worldwide and it becomes an important global public health problem especially among emerging countries. 14 For urinary tract infection, a most favorable treatment requires knowledge regarding local epidemiology as well as antimicrobial susceptibility profiles. Resistance mechanisms have been developed by uropathogens to frequently prescribed antibiotics that limits treatment alternatives of successful therapies.…”