Antimicrobial Resistance among Pregnant Women with Urinary Tract Infections Attending Antenatal Clinic at Levy Mwanawasa University Teaching Hospital (LMUTH), Lusaka, Zambia.

Kekelwa Inyambo Yeta,Charles Michelo,Choolwe Jacobs,Faham Khamesipour

doi:10.1155/2021/8884297

Abstract

Introduction Globally, there is a growing concern over antimicrobial resistance (AMR) which is currently estimated to account for more than 700,000 deaths per year worldwide. AMR undermines the management of infectious diseases in general especially in pregnancy where significant bacteriuria continues to be a serious cause of maternal and perinatal morbidity and mortality. We therefore aimed to determine the prevalence of AMR and the associated factors among pregnant women with urinary tract infections (UTIs) attending antenatal clinic at a selected hospital in Lusaka, Zambia. Methods This was a hospital-based, cross-sectional study conducted between November 2018 and May 2019. Interviewer-administered questionnaire was used to assess the sociodemographic characteristics and behavioural characteristics. Laboratory tests were also conducted. Descriptive statistics of study participants were used to describe the characteristics of the respondents. Chi-square was used to assess the association between categorical variables. The logistic regression analysis was carried out to generate the adjusted odds ratio with 95% confidence interval. Results Overall (n = 203), the prevalence of UTI was 60% (95% CI: 53.3%–66.7%). The most isolated bacteria were E. coli (59%) and Klebsiella (21%). The prevalence of AMR was found to be 53% (95% CI: 46.1%–59.8%). The drugs highly resistant to antimicrobials were nalidixic acid (88.3%), ampicillin (77.8%), and norfloxacin (58.5%), while the least resistant drug was chloramphenicol (20%). There were no important significant predictors to AMR among pregnant women observed in this study. Conclusion We found high burden of AMR closely linked to observe high prevalence of UTI suggested in this small population. This suggests a need to develop integrated surveillance systems that aim for early and regular screening of pregnant women for UTI as well as concurrent determination of antibiotic susceptibility patterns. This is important to prevent complications that may endanger maternal and fetal health outcomes. Furthermore, further research is needed to explore reasons for this high prevalence of AMR including examining possible attribution to the misuse of drugs so as to inform, enforce, or adjust the prescription-only policies and enforce antimicrobial stewardship programs.

Highlights

There is a growing concern over antimicrobial resistance (AMR) which is currently estimated to account for more than 700,000 deaths per year worldwide
We have found the prevalence of urinary tract infection to be 60% among pregnant women with urinary tract infections (UTIs) attending antenatal clinic at a selected hospital in Ampicillin Nitrofurantoin Vancomyocin
Conclusion e UTI prevalence of 60% found among pregnant women in this study is generally much higher than most studies undertaken, which is indicative of the level of menace urinary tract infections in Zambia. is is alarming concern considering the adverse effects of untreated UTI on the mother and fetus such as kidney infections, preterm birth, low birth weight, and miscarriages. e highest causative agent of urinary tract infections was found to be E. coli which is another concern considering that it has the highest resistant strains which is resistant to the 3rd generation cephalosporins implying that treatment of severe infections relies on carbapenems which are more expensive and might be a challenge for low-income countries

Summary

Introduction

There is a growing concern over antimicrobial resistance (AMR) which is currently estimated to account for more than 700,000 deaths per year worldwide. We aimed to determine the prevalence of AMR and the associated factors among pregnant women with urinary tract infections (UTIs) attending antenatal clinic at a selected hospital in Lusaka, Zambia. Ere were no important significant predictors to AMR among pregnant women observed in this study. Further research is needed to explore reasons for this high prevalence of AMR including examining possible attribution to the misuse of drugs so as to inform, enforce, or adjust the prescription-only policies and enforce antimicrobial stewardship programs. About 150 million people worldwide are diagnosed with urinary tract infections (UTIs) [1]. About 50% of women will suffer from at least one urinary tract infection (UTI) during their adult life including during pregnancy. Ere are many different pathogenic microorganisms (bacteria, fungi, protozoa, and viruses) which cause UTIs among pregnant women. E. coli and other Enterobacteriaceae are the most and account approximately 75% of the isolates [4]

Results

Discussion

Conclusion