Rising prevalence of multidrug-resistant uropathogenic bacteria from urinary tract infections in pregnant women

Abstract

Objectives This study aimed to determine the prevalence of urinary tract infections (UTI) in pregnant women and characterise the uropathogenic bacterial strains associated with symptomatic and asymptomatic bacteriuria in Lahore, Pakistan. Methods Between December 2018 and June 2019, we analysed the uropathogenic bacterial strains from midstream urine samples in 80 pregnant women. The age of the pregnant women ranged from 19 to 45 years, and they resided in urban and rural areas. We also recorded socioeconomic factors in this cohort. The isolated strains were phenotypically identified and evaluated for multiple drug resistance (MDR) patterns against recommended antimicrobial drugs. Results Of the 80 pregnant women, 65 had UTI, reflecting an 81% prevalence of UTI in women during pregnancy. The majority of participants aged 24–35 years, were multipara, and were in their third trimester. Results showed that 67 uropathogenic bacterial strains belonged to Escherichia (31%), Klebsiella (23%), Pseudomonas (16%), Streptococcus (4%), Enterococcus (4%), Staphylococcus (4%), and Proteus (3%) genera, as identified using biochemical characterisation. The highest overall resistance of Escherichia was seen against amoxicillin, pipemidic acid, and ampicillin; for Klebsiella against pipemidic acid, ampicillin, and cefotaxime; and for Pseudomonas against ciprofloxacin and cefotaxime. The three strains with the highest MDR were identified using 16S rRNA as Pseudomonas aeruginosa strain UA17, Escherichia coli strain UA32, and Klebsiella pneumoniae strain UA47. Conclusion In this study, the MDR uropathogenic strains showed the highest resistance pattern. The alarming signs of MDR uropathogenic infections are infrequently addressed and thus, urgent attention to this matter is essential.

Multidrug Resistance of Uropathogens at Governmental Hospitals in the Gaza Strip/Palestine

“…Regarding to our study, MDR in Gaza governmental hospitals is (37%) for E. coli and (53%) for Klebsiella spp., respectively. We demonstrated very high prevalence of Gramnegative isolates and this in agreement with a study in Lahore, Pakistan conducted between December 2018 and June 2019, which reported that prevalence of 92%Gram negative [13]. Another study in Ethiopia reveled that Gram-negative bacteria caused 90% of UTI cases while gram-positive bacteria cause only 10% of the cases [14].…”

Uropathogens and antimicrobial susceptibility profiles of asymptomatic bacteriuria among pregnant women receiving antenatal care in traditional birth attendants homes in Ikono, Akwa- Ibom State, Nigeria

“…This is in concomitant to the findings in Pakistan in which the highest MDR was observed in Klebsiella species and other microorganisms. 33 Also similar finding to our present study was highlighted by Nteziyaremye et al, in Eastern Uganda where some isolates were found to have a high level of multidrug resistance especially for Pseudomonas species, Klebsiella species and Staphylococcus aureus. 39…”

“…Other findings have been reported in Turkey, Ethiopia, Cameroon, NigeriaPakistan, and India where Escherichia coli and Klebsiella pneumoniae were the first and second most prevalent pathogens. 2,7,28,[34][35]23,9,25,26,33,31,38 Some authors reported Staphylococcus species or Streptococcus pyogenes to be the second most common uropathogen; but accounting for the third cause of bacteriuria in our study. Variation in geographical location, uses of antibiotic with or with-out prescription by qualify medical personnel are common in rural and urban settlements which may have accounted for these differences.…”

“…40 Also similar drug sensitivity pattern was found to be 67% to 55% for some antimicrobial drugs like imipenem, etc against some uropathogens including Escherichia coli, Klebsiella species, Pseudomonas species, Staphylococcus species, etc, as reported in Lahore, Pakistan. 33 In our present study, the highest multidrug resistance (MDR) was observed in both gram positive and negative isolates like Staphylococcus saprophyticus, Proteus species and Klebsiella species between 100-60%. This is in concomitant to the findings in Pakistan in which the highest MDR was observed in Klebsiella species and other microorganisms.…”

“…This prevalence rate in our present study is similar to documented research in Akwa Ibom State and Lahore, Pakistan, among pregnant women that were asymptomatic. 25,26,33 In contrast, higher prevalence of 45.3% was observed among pregnant women visiting health facility in Benin and 55% for those visiting traditional birth attendant home in Benin city, 83% in Nagpur, a rural settlement in India. 29,9,31 in Jos, Nigeria, and 8.9% in Northern Tanzania.…”