Iranian Society of Gynecology Oncology

Document Type : Original Research Article

Author

Department of Biology, College of Education for Pure Sciences, University of Karbala, Karbala, Iraq

Abstract

Background & Objective: Increasing urinary tract infections (UTI) in pregnant women was a reason for which this study aimed to find out the spread of bacteria in them and also study the resistance of bacteria to antibiotics and the type of resistance.
Materials & Methods: During November 2022, 50 urine samples were collected from pregnant women with symptoms of UTI. Direct microscopy tests were conducted on the samples. The samples were cultured on the media of MacConkey agar (MAC) and blood agar. Biochemical tests were performed and diagnosed using the VITEC-2 system.  Antibiotic susceptibility screening test was done for all isolates.
Results: Of the 50 bacterial isolates diagnosed and isolated from pregnant women with UTI, 84% were gram-negative and 16% were gram-positive. The most prevalent bacteria were E. coli, with a rate of 60%, followed by Proteus mirabilis, with a rate of 12%. All E. coli isolates were resistant (100%) to the AMOX antibiotic, and the isolates showed high resistance (87%) to CFR, CN, CZ, CXM, CAE, CPD, CRO NA and SXT antibiotics. 13.3% of E.coli isolates were extended detection and response (XDR), 50% and 25% of Staphylococcus hominis and aureus isolates were XRD, respectively.
Conclusion: E. coli is the most common and most resistant bacteria of type XRD, and gram-positive bacteria, staph bacteria, showed resistance to type XRD. In addition, gram-negative bacteria showed high resistance to many antibiotics, including AMOX, CFR, CN, CZ, CXM, and CAE. Gram-positive bacteria showed complete resistance against BENPEN, OXA, CLIN, TEC, VAN, TET, FUS and VAN.

Highlights

 E. coli is the most common and most resistant bacteria of type XRD, and gram-positive bacteria, staph bacteria, showed resistance to type XRD. In addition, gram-negative bacteria showed high resistance to many antibiotics, including AMOX, CFR, CN, CZ, CXM, and CAE. Gram-positive bacteria showed complete resistance against BENPEN, OXA, CLIN, TEC, VAN, TET, FUS and VAN.

Keywords

Main Subjects

1. Larcombe JH. Urinary Tract Infection in Women Aged 18-64: Doctors', Patients', and Lay Perceptions and Understandings, Durham University, Durham, UK, 2012.
2. Gupta K, Hooton TM, Stamm WE. Increasing antimicrobial resistance and the management of uncomplicated community-acquired urinary tract infections. Ann Intern Med. 2001;135(1):41-50. [DOI:10.7326/0003-4819-135-1-200107030-00012] [PMID]
3. Demilie T, Beyene G, Melaku S, Tsegaye W. Urinary bacterial profile and antibiotic susceptibility pattern among pregnant women in North West Ethiopia. Ethiop J Health Sci. 2012;22(2):121-8.
4. Beyene G, Tsegaye W. Bacterial uropathogens in urinary tract infection and antibiotic susceptibility pattern in Jimma University specialized hospital, southwest ethiopia. Ethiop J Health Sci. 2011;21(2):141-6. [DOI:10.4314/ejhs.v21i2.69055] [PMID] [PMCID]
5. Wax RG, Lewis K, Salyers AA, Taber H, editors. Bacterial Resistance to Antimicrobials, CRC Press, Boca Raton, FL, USA, 2007. [DOI:10.1201/9781420008753]
6. Tadesse BT, Ashley EA, Ongarello S, Havumaki J, Wijegoonewardena M, González IJ, et al. Antimicrobial resistance in Africa: a systematic review. BMC Infect Dis. 2017;17:616-23. [DOI:10.1186/s12879-017-2713-1] [PMID] [PMCID]
7. World Health Organization. Antimicrobial Resistance, World Health Organization. Geneva, Switzerland. 2014. Available from: [http://www.who.int/mediacentre/factsheets/fs194/en]
8. Melander EV, MD KE, Jönsson G, Mölstad S. Frequency of penicillin-resistant pneumococci in children is correlated to community utilization of antibiotics. Pediatr Infect Dis J. 2000;19(12):1172-7. [DOI:10.1097/00006454-200012000-00011] [PMID]
9. Chavkin W, Breitbart V, Elman D, Wise PH. National survey of the states: policies and practices regarding drug-using pregnant women. Am J Public Health. 1998;88(1):117-9. [DOI:10.2105/AJPH.88.1.117] [PMID] [PMCID]
10. Ndmason LM, Marbou WJ, Kuete V. Urinary tract infections, bacterial resistance and immunological status: a cross sectional study in pregnant and non-pregnant women at Mbouda Ad-Lucem Hospital. Afr Health Sci. 2019;19(1):1525-35. [DOI:10.4314/ahs.v19i1.26] [PMID] [PMCID]
11. Ghaima KK, Khalaf ZS, Abdulhassan AA, Salman NY. Prevalence and antibiotic resistance of bacteria isolated from urinary tract infections of pregnant women in Baghdad hospitals. Biomed Pharmacol J. 2018;11(4):1989-94. [DOI:10.13005/bpj/1573]
12. Yeta KI, Michelo C, Jacobs C. Antimicrobial resistance among pregnant women with urinary tract infections attending antenatal clinic at levy mwanawasa university teaching hospital (LMUTH), lusaka, Zambia. Int J Microbiol. 2021;2021:1-9. [DOI:10.1155/2021/8884297] [PMID] [PMCID]
13. Johnson B, Stephen BM, Joseph N, Asiphas O, Musa K, Taseera K. Prevalence and bacteriology of culture-positive urinary tract infection among pregnant women with suspected urinary tract infection at Mbarara regional referral hospital, South-Western Uganda. BMC Pregnancy Childbirth. 2021;21(1):1-9. [DOI:10.1186/s12884-021-03641-8] [PMID] [PMCID]
14. Assefa A, Asrat D, Woldeamanuel Y, Abdella A, Melesse T. Bacterial profile and drug susceptibility pattern of urinary tract infection in pregnant women at Tikur Anbessa Specialized Hospital Addis Ababa, Ethiopia. Ethiop J Health Sci. 2008;46(3):227-35.
15. Uneke CJ, Alo MN. Nongonococcal and nonchlamydial microbial isolates from high vaginal swabs of Nigerian women diagnosed with pelvic inflammatory disease. Internet J Infect Dis. 2007;6(1):1-6. [DOI:10.5580/1d0c]
16. Nworie A, Eze UA. Prevalence and aetiologic agents of urinary tract infection in pregnancy in abakaliki metropolis. Cont J Med Res. 2010;4:18-23.
17. Smaill FM, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev. 2019(11):CD000490. [DOI:10.1002/14651858.CD000490.pub4] [PMID] [PMCID]
18. Vazquez JC, Abalos E. Treatments for symptomatic urinary tract infections during pregnancy. Cochrane Database Syst Rev. 2011(1):CD002256. [DOI:10.1002/14651858.CD002256.pub2] [PMID] [PMCID]
19. World Health Organization. WHO Report on Surveillance of Antibiotic Consumption; WHO: Geneva, Switzerland, 2018.
20. Gizachew Z, Kassa T, Beyene G, Howe R, Yeshitila B. Multi-drug resistant bacteria and associated factors among reproductive age women with significant bacteriuria. Ethiop Med J. 2019;57(3):31-43.
21. Sekikubo M, Hedman K, Mirembe F, Brauner A. Antibiotic overconsumption in pregnant women with urinary tract symptoms in Uganda. Clin Infect Dis. 2017;65(4):544-50. [DOI:10.1093/cid/cix356] [PMID]
22. Mehlhorn AJ, Brown DA. Safety concerns with fluoroquinolones. Ann Pharmacother. 2007;41(11):1859-66. [DOI:10.1345/aph.1K347] [PMID]