Trends in the epidemiology of urinary tract infections in pregnancy at a tertiary hospital in Johannesburg: Are contemporary treatment recommendations appropriate?

Trusha Nana,Vindana Chibabhai,Shastra Bhoora

doi:10.4102/sajid.v36i1.328

Abstract

BackgroundUrinary tract infections (UTIs) are common during pregnancy and are associated with maternal and foetal complications. Empiric antibiotic choices in pregnancy require consideration of efficacy and safety, resulting in limited oral options. With rapidly evolving antibiotic resistance, surveillance to guide empiric treatment recommendations is essential.MethodsA retrospective analysis of urine culture isolates from the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) Obstetrics Department for 1 January 2015 to 31 December 2020 was performed.ResultsThe top 3 pathogens were Escherichia coli, Enterococcus faecalis and Klebsiella pneumoniae. For E. coli susceptibility to cefuroxime declined (95% to 81%, p < 0.0001). Similarly, the E. coli extended spectrum beta-lactamase rate increased from 5% to 10% (p = 0.04). E. coli susceptibility to nitrofurantoin (93%) and fosfomycin (96%) remained high. In 2019, carbapenem-resistant K. pneumoniae emerged. Ampicillin susceptibility was high amongst the E. faecalis isolates. Amoxicillin-clavulanate demonstrated high levels of activity against the top 3 uropathogens.ConclusionThe Essential Drug List recommended antibiotics for lower UTIs, nitrofurantoin and fosfomycin, are appropriate empiric options for E. coli, the most common uropathogen in the CMJAH obstetric population. The high rate of E. faecalis susceptibility to nitrofurantoin reported from other Gauteng tertiary obstetric patients, suggests that nitrofurantoin will provide adequate empiric cover for a large proportion of UTIs. However, the determination of the E. faecalis nitrofurantoin and fosfomycin susceptibility rates in the CMJAH obstetric population will provide useful data. Periodic surveillance at the various levels of antenatal care in different regions of South Africa and the determination of risk factors for infections with resistant uropathogens is needed.

Highlights

Urinary tract infections (UTIs) are common during pregnancy and are associated with maternal and foetal complications
The Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) is a 1088 bed tertiary facility located in Johannesburg, South Africa
In 2020, these two organisms were the causative pathogens in 62.8% of the UTIs

Summary

Introduction

Urinary tract infections (UTIs) are common during pregnancy and are associated with maternal and foetal complications. Towards the mid-second trimester, the growing gravid uterus compresses the urogenital system, worsening hydronephrosis, urinary stasis and utero-vesical reflux These collective adaptations favour asymptomatic and symptomatic UTIs.[1] Asymptomatic bacteriuria (ASB), defined as the presence of ≥ 105 colony forming units (CFUs)/mL of a bacterial species in a voided urine specimen in the absence of UTI symptoms or signs, is most common.[2] Asymptomatic bacteriuria occurs in 2% – 15% of pregnancies and is associated with an increased risk of preterm labour.[1,2,3,4] Screening for and treatment of ASB are recommended early in pregnancy.[2,3] Treatment of ASB decreases the risk of pyelonephritis and may reduce premature birth and very low http://www.sajid.co.za

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