Abstract
Objective:We aimed to determine antibiotic susceptibility patterns of ESBL- and non-ESBL bacteria isolated from pregnant women with UTI in antenatal wards in Khartoum State, Sudan.Methods:This cross-sectional study was conducted during April-July 2016 at different hospitals in Khartoum State. Mid-stream urine samples were obtained from 150 hospitalized pregnant women and cultured on CLED (Cystine Lactose Electrolyte Deficient) agar. Microorganisms were identified using standard microbiological procedures. Isolated Gram-negative bacteria were tested for antibiotic susceptibility and ESBL screening using modified Kirby- Bauer method and Double Disc Synergy Test (DDST) respectively.Results:Urine culture revealed positive results in 33/150 (22%) and the most prevalent isolates were Gram negative bacteria (18/33, 54.5%). Among gram-negative bacteria, isolates of E. coli were the most prevalent accounting 66.6% (12/18) followed by K. pneumoniae (4/18, 22.2%) and K. oxytoca (2/18, 11.1%). ESBL was detected in 8/18 (44.4%) of the Gram-negative isolates. Of note, imipenem was the most susceptible antibiotic for ESBL-producer and non-ESBL producer Gram negative isolates, accounting 100% susceptibility for both bacterial groups. Overall susceptibility rates were also high for ciprofloxacin (13/18, 72.2%). In other hand, co-trimoxazole and amoxicillin showed high resistance pattern for ESBL-producer and non-ESBL producer isolates; 27.8%, 44.4% and 38.9%, 38.9% susceptibility rates of co-trimoxazole and amoxicillin for ESBL-producer and non-ESBL producer isolates, respectively.Conclusions:Imipenem remains the most powerful option for ESBL- and non-ESBL bacteria causing UTIs in pregnant women. However, due to tremendous increase of antibiotic-resistant, antibiotic-susceptibility testing is recommended as a routine investigation for admitted pregnant women.
Highlights
Urinary tract infection (UTI) represents the most common bacterial infection in pregnancy and the third common cause of human infections after respiratory and intestinal infections
All Gram-negative bacilli isolates which showed a diameter of inhibition zone less than 17 mm for ceftazidime, less than 19 mm for ceftriaxone and less than 22 mm for cefotaxime were selected for testing ESBL enzyme production using Double Disc Synergy Test (DDST) as previously reported
Amoxicillin/clavulanic acid (20/10μg) disc was placed in the center of the plate and ceftazidime (30μg) and cefotaxime (30μg) discs were placed 15 mm apart center to center to amoxicillin/clavulanic acid and incubated aerobically for 18-24 hrs at 37 ̊C. 21 Any increase in the inhibition zone towards the disc of amoxicillin/clavulanic acid was considered as positive result for ESBL enzyme production
Summary
Urinary tract infection (UTI) represents the most common bacterial infection in pregnancy and the third common cause of human infections after respiratory and intestinal infections. Asymptomatic bacteriuria is defined as growth of bacteria in the urinary tract of individuals without signs or symptoms associated with urinary or genital organs. It considered a frequent health problem among pregnant women, occurring within 2–10% of all pregnancies.[2,3,4,5,6] If not properly treated, asymptomatic bacteriuria can lead to acute pyelonephritis in 30% of pregnant women[7] and increase the risk for severe complication such as early delivery, hypertension, pre-eclampsia, low birth weight and postpartum endometritis.[8,9]
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