Abstract

Background: UTI is a common bacterial complication in pregnancy, and has significant morbidity in both the mother and child. The appearance of the antimicrobial resistance (AMR) especially the extended-spectrum beta-lactamase (ESBL) and multidrug resistance (MDR) makes the empirical therapy more complicated. This research was done to establish the prevalence, microbial spectrum, antimicrobial susceptibility, and independent predictors of ESBL-positive UTIs among pregnant women.
Methods: A cross-sectional research study was conducted on 250 pregnant women at Tikrit in Iraq who attended antenatal clinics. Urine samples of the midstream were also cultured and antimicrobial susceptibility testing was done on the isolates. The combination disk method was used to detect ESBL. Multivariate logistic regression was used to predict independent predictors of ESBL-producing Gram-negative infections. The statistical significance was determined at p<0.05.
Results: Bacteriuria of significance was observed in (51.6%) participants with the highest rate observed in the second trimester (44.9%). The gram-negative organisms were dominant (70%), with the lead taken by Escherichia coli (51.9%) and Klebsiella pneumoniae (17.8%). The highest susceptibility (>85%) was retained by nitrofurantoin and ampicillin and TMP-SMX had limited activity. At the species level, K. pneumoniae was found to be much less susceptible to both nitrofurantoin and ampicillin than E. coli (p<0.05). Maternal age ≥ 35 years (adjusted OR 2.86), diabetes mellitus (adjusted OR 2.79), and past UTI history (adjusted OR 2.94) were the independent predictors of ESBL-positive infection. The prevalence rate of overall MDR and ESBL was 34.7% and 23.5%, respectively, and the highest prevalence rate of K. pneumoniae was 47.8% and 34.8% in terms of MDR and ESBL rates, respectively.
Conclusions: MDR and ESBL prevalence are high in this obstetric population of UTIs. Screening and culture-guided therapy based on risks and cultures are suggested, as the optimal way of improving the maternal-fetal outcome and antimicrobial stewardship.