Department of Medical Microbiology, National Health Laboratory Service, Durban; and School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
S Afr Med J. 2020 Aug 31;110(9):872-876. doi: 10.7196/SAMJ.2020.v110i9.14468.
Urinary tract infection (UTI) is one of the most common infections during pregnancy, which can lead to significant maternal and perinatal morbidity and mortality if left untreated. Challenges when treating UTIs in pregnancy include fetal protection and resistance development of uropathogens. Currently, the Essential Medicines List recommends nitrofurantoin to treat cystitis and ceftriaxone to treat pyelonephritis in pregnant women.
To determine common pathogens causing UTI in pregnancy and their antibiotic susceptibility patterns.
A retrospective analysis was performed of laboratory data for positive urine specimens from obstetric departments of 6 KwaZulu- Natal Province hospitals during 2011 - 2016. Identification and susceptibility testing were performed using the VITEK 2 system. Results were interpreted according to the breakpoints of the Clinical and Laboratory Standards Institute, USA.
From 5 971 positive urine specimens, the most common isolate was Escherichia coli (n=3 236; 54.2%), followed by Klebsiella pneumoniae (n=770; 12.9%). Group B streptococcus (GBS) (n=239; 4.0%) and Enterococcus faecalis (n=251; 4.2%) were the most common Gram-positive pathogens. E. coli displayed significant resistance to trimethoprim-sulfamethoxazole (65.1%), cephalothin (38.3%), cefuroxime (27.3%), ciprofloxacin (16.9%) and amoxicillin-clavulanic acid (17.1%). Resistance to ceftriaxone and nitrofurantoin remained low ‒ 9.1% and 7.7%, respectively. Among Gram-positive pathogens, GBS displayed 100% penicillin susceptibility and E. faecalis showed 92.9% susceptibility to ampicillin.
E. coli is unsurprisingly the most common cause of UTI in pregnancy in KwaZulu-Natal. Susceptibility to ceftriaxone and nitrofurantoin remains good. Among Gram positives, GBS is prevalent and susceptible to penicillin, while E. faecalis is susceptible to ampicillin. As antimicrobial resistance evolves, routine surveillance is necessary to modify recommended empirical antibiotic use.
尿路感染（UTI）是孕妇最常见的感染之一，如果不治疗，可能会导致严重的母婴围产期发病率和死亡率。治疗孕妇 UTI 时面临的挑战包括胎儿保护和尿路病原体的耐药性发展。目前，基本药物清单推荐使用呋喃妥因治疗膀胱炎和头孢曲松治疗肾盂肾炎。
确定导致孕妇 UTI 的常见病原体及其抗生素敏感性模式。
对 2011 年至 2016 年期间夸祖鲁-纳塔尔省 6 家医院妇产科阳性尿液标本的实验室数据进行回顾性分析。使用 VITEK 2 系统进行鉴定和药敏试验。结果根据美国临床和实验室标准协会的折点进行解释。
从 5971 份阳性尿液标本中，最常见的分离株是大肠埃希菌（n=3236；54.2%），其次是肺炎克雷伯菌（n=770；12.9%）。B 组链球菌（GBS）（n=239；4.0%）和粪肠球菌（n=251；4.2%）是最常见的革兰氏阳性病原体。大肠埃希菌对甲氧苄啶-磺胺甲恶唑（65.1%）、头孢噻吩（38.3%）、头孢呋辛（27.3%）、环丙沙星（16.9%）和阿莫西林-克拉维酸（17.1%）的耐药性显著。对头孢曲松和呋喃妥因的耐药性仍然较低，分别为 9.1%和 7.7%。在革兰氏阳性病原体中，GBS 对青霉素的敏感性为 100%，粪肠球菌对氨苄西林的敏感性为 92.9%。
在夸祖鲁-纳塔尔，大肠埃希菌是导致孕妇 UTI 的最常见原因，这并不意外。对头孢曲松和呋喃妥因的敏感性仍然良好。在革兰氏阳性菌中，GBS 普遍存在且对青霉素敏感，而粪肠球菌对氨苄西林敏感。随着抗菌药物耐药性的演变，需要进行常规监测以修改推荐的经验性抗生素使用。
