Belete Melaku Ashagrie
Department of Medical Laboratory Science, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia.
Infect Drug Resist. 2020 Jul 28;13:2579-2592. doi: 10.2147/IDR.S258379. eCollection 2020.
Urinary tract infection is a common cause of morbidity in pregnant women. Emergence of antimicrobial resistance particularly ESBL production among bacterial uropathogens is increasing and becoming principal cause of treatment failure. The aim of this study was to determine the bacterial profile, their antimicrobial susceptibility patterns, risk factors and identify ESBL-producing bacterial uropathogens.
A hospital-based cross-sectional study was conducted in the Northeastern Ethiopia region. A total of 323 pregnant women were included and structured questionnaire was used to collect sociodemographic and risk factor-related data. About 10mL freshly voided midstream urine specimen was collected, transported and processed according to standard operating procedures. The data obtained were entered into SPSS version 22 and descriptive statistics, chi-square, bivariate and multivariate logistic regression analyses were performed. P-value ≤0.05 with corresponding 95% confidence interval were considered for statistical significance.
The overall prevalence of UTI was 15.5% (50/323). The predominant bacterial isolates were 17 (33.3%) followed by coagulase-negative staphylococci 15 (30.0%) and 14 (27.5%). Previous history of UTI (AOR=8.824, 95% CI: 3.769,20.654, P<0.001) and history of catheterization (AOR=3.270, 95% CI: 1.316,8.122, P=0.011) were significantly associated with the occurrence of bacterial UTI. Gram-negative isolates showed high level of resistance to ampicillin 12 (60.0%) and relatively low level of resistance to nitrofurantoin 5(25.0%), norfloxacin 5 (25.0%) and ceftazidime 3 (15.0%). Gram-positive uropathogens showed higher resistance for penicillin 29 (93.5%) and trimethoprim-sulfamethoxazole 23 (79.3%) whereas all isolates were sensitive 29 (100.0%) to nitrofurantoin. Moreover, multidrug resistance was observed among 41 (80.4%) of the isolates, and 3 (15.8%) of isolated gram-negative bacteria were ESBL producers.
High prevalence of bacterial UTI and MDR for commonly prescribed drugs were observed with significant number of ESBL producers. Therefore, instant UTI culture assessment of pregnant women, especially those having possible risk factors such as previous histories of UTI and catheterization; moreover, appropriate prescription and use of antibiotics are necessary.
尿路感染是孕妇发病的常见原因。细菌尿路病原体中抗菌药物耐药性的出现，尤其是超广谱β-内酰胺酶（ESBL）的产生正在增加，并成为治疗失败的主要原因。本研究的目的是确定细菌谱、它们的抗菌药敏模式、危险因素，并识别产ESBL的细菌尿路病原体。
在埃塞俄比亚东北部地区进行了一项基于医院的横断面研究。共纳入323名孕妇，并使用结构化问卷收集社会人口学和危险因素相关数据。按照标准操作程序收集约10mL新鲜中段尿标本，进行转运和处理。将获得的数据录入SPSS 22版，并进行描述性统计、卡方检验、二元和多元逻辑回归分析。P值≤0.05及相应的95%置信区间被认为具有统计学意义。
UTI的总体患病率为15.5%（50/323）。主要的细菌分离株为大肠埃希菌17株（33.3%），其次是凝固酶阴性葡萄球菌15株（30.0%）和克雷伯菌属14株（27.5%）。既往UTI病史（调整后比值比[AOR]=8.824，95%置信区间：3.769,20.654，P<0.001）和导尿史（AOR=3.270，95%置信区间：1.316,8.122，P=0.011）与细菌性UTI的发生显著相关。革兰阴性菌分离株对氨苄西林的耐药率较高，为12株（60.0%），对呋喃妥因、诺氟沙星和头孢他啶的耐药率相对较低，分别为5株（25.0%）、5株（25.0%）和3株（15.0%）。革兰阳性尿路病原体对青霉素和甲氧苄啶-磺胺甲恶唑的耐药率较高，分别为29株（93.5%）和23株（79.3%），而所有分离株对呋喃妥因均敏感，为29株（100.0%）。此外，41株（80.4%）分离株存在多重耐药，3株（15.8%）分离的革兰阴性菌为ESBL生产者。
观察到细菌性UTI的高患病率以及常用药物的多重耐药，且有相当数量的ESBL生产者。因此，对孕妇，尤其是那些有UTI既往史和导尿等可能危险因素的孕妇，应立即进行UTI培养评估；此外，合理处方和使用抗生素是必要的。
