Bacterial profile and antimicrobial resistance patterns of common bacteria among pregnant women with bacteriuria in Ethiopia: a systematic review and meta-analysis

Background Globally, antimicrobial resistance (AMR) restricted the armamentarium of the health care providers against infectious diseases, mainly due to the emergence of multidrug resistant. This review is aimed at providing contemporary bacterial profile and antimicrobial resistance pattern among pregnant women with significant bacteriuria. Methods Electronic biomedical databases and indexing services such as PubMed/MEDLINE, Web of Science, EMBASE and Google Scholar were searched. Original records of research articles, available online from 2008 to 2021, addressing the prevalence of significant bacteriuria and AMR pattern among pregnant women and written in English were identified and screened. The relevant data were extracted from included studies using a format prepared in Microsoft Excel and exported to STATA 14.0 software for the outcome measure analyses and subgrouping. Results The data of 5894 urine samples from 20 included studies conducted in 8 regions of the country were pooled. The overall pooled estimate of bacteriuria was 15% (95% CI 13–17%, I2 = 77.94%, p < 0.001) with substantial heterogeneity. The pooled estimate of Escherichia coli recovered from isolates of 896 urine samples was 41% (95% CI 38–45%) followed by coagulase-negative Staphylococci, 22% (95% CI 18–26%), Staphylococcus aureus, 15% (95% CI 12–18%), Staphylococcus saprophytic, 12% (95% CI 6–18%) Proteus mirabilis, 7% (95% CI 4–10%), Enterococcus species, 6% (0–12%), Pseudomonas aeruginosa, 4% (2–6%), Citrobacter species, 4% (95% CI 2–4%), Group B streptococcus, 3% (1–5%), and Enterobacter species, 2% (1–4%). Multidrug resistance proportions of E. coli, Klebsiella species, Staphylococcus aureus and Coagulase negative staphylococci, 83% (95% CI 76–91%), 78% (95% CI 66–90%), 89% (95% CI 83–96%), and 78% (95% CI 67–88%), respectively. Conclusion The result of current review revealed the occurrence of substantial bacteriuria among pregnant women in Ethiopia. Resistance among common bacteria (E. coli, Klebsiella species, Staphylococci species) causing UTIs in pregnant women is widespread to commonly used antibiotics. The high rate of drug resistance in turn warrants the need for regular epidemiological surveillance of antibiotic resistance and implementation of an efficient infection control and stewardship program.

Comparison of Urine Flow Cytometry on the UF-1000i System and Urine Culture of Urine Samples from Urological Patients

<b><i>Introduction:</i></b> The aims of this study were to evaluate urine flow cytometry (UFC) as a tool to screen urine samples of urological patients for bacteriuria and to compare UFC and dipstick analysis with urine culture in a patient cohort at a urological department of a university hospital. <b><i>Methods and Material:</i></b> We screened 662 urine samples from urological patients (75.2% male; 80.7% inpatients; mean age 58 years). UFC results were compared to microbiological urine culture. <b><i>Results:</i></b> The accuracy in using the UFC-based parameters for detecting cultural bacteriuria was 91.99% and 88.97% for ≥10⁵ colony-forming units (CFU)/mL and ≥10⁴ CFU/mL, respectively. UFC and leukocyte dipstick analysis measured leukocyturia similarly (Pearson correlation coefficient 0.87, <i>p</i> value &#x3c;0.01%), but dipstick analysis scored less accurately on bacteriuria (accuracy 59.37% and 62.69%). UFC remained effective in subgroup analysis of patients of both sexes and with different urological conditions with its overall use only slightly impaired when assessing gross hematuria (NPV 84.62% for ≥10⁴ CFU/mL). UFC also reliably removed those urine samples below cutoffs with negative predictive values of 99.28% for ≥10⁵ CFU/mL and 95.86% for ≥10⁴ CFU/mL. <b><i>Conclusion:</i></b> Counting bacteria with UFC is an accurate and rapid method to determine significant bacteriuria in urological patients and is superior to dipstick analysis or indirect surrogate parameters such as leukocyturia. When UFC is available, we recommend it to be used for the diagnosis of bacteriuria over findings obtained by dipstick analysis.

Significant bacteriuria among requested repeat urine samples and its clinical correlation

Background and Objectives: Urinary tract infections (UTI) are the most common bacterial infections in both outpatient and inpatient department received for routine bacterial culture and sensitivity. We looked for significant bacteriuria in re- quested repeat urine sample after primary urine culture yielded significant growth (>105 CFU/ml) of ≥3 types of colonies. Also studied, different isolates grown with their sensitivity pattern and contamination rates of urine samples from different departments. Materials and Methods: In routine, primary urine cultures yielding ≥3 types of colonies on Cystine Lactose Electrolyte Deficient (C.L.E.D) were requested for repeat samples, collected with aseptic precautions after proper instructions. Data was analyzed for the Microbiological profile and its clinical correlation. Results: Among 617 received requested urine samples, 292 (47.3%) yielded significant bacteriuria. Clinical details were available for 252 cases out of which 100 (39.7%) showed asymptomatic bacteriuria, 87 (34.5%) complicated UTI and 65 (25.7%) uncomplicated UTI. Null hypothesis was rejected as 292 (47.3%) of the received repeat samples showed significant bacteriuria and 325 (53%) showed normal flora/no growth i.e. there is a 50% chance of getting either a positive culture or normal flora/no growth in repeat urine samples after the primary urine culture showed ≥3 types of colonies. It indicates the importance of requesting repeat urine samples for an accurate urine culture report. Male patients were significantly associ- ated with significant bacteriuria and complicated UTI (p= 0.001). Escherichia coli (n=112, 28%) was the most common fol- lowed by Klebsiella species (n=66, 16.4%) and Enterococcus species (n=69, 17.2%). 183 (45.6%) isolates were Multi-Drug Resistant (MDR) Gram Negative Bacilli (GNBs), Escherichia coli (50.3%) being most common. Vancomycin Resistant Enterococcus (VRE) (n=8, 2.0%) was also isolated. Conclusion: Our study justifies the rationale for asking a repeat urine samples which helps in providing an appropriate mi- crobiological report with antibiotic sensitivity pattern, hence preventing unwanted reporting of commensals/contaminants facilitating evidence based therapy.

Prevalence of and factors associated with significant bacteriuria among pregnant women attending the antenatal clinic of Adeoyo Maternity Hospital, Yemetu, Ibadan, Nigeria

Background: Significant bacteriuria is commonly reported in pregnancy which greatly predisposes pregnant women to urinary tract infection (UTI), one of the commonest health challenges in pregnancy worldwide especially in developing countries such as Nigeria. The objectives of this study are to determine the prevalence of and factors associated with significant bacteriuria among pregnant women attending the antenatal clinic (ANC) of Adeoyo Maternity Hospital, Yemetu, Ibadan, Nigeria, as well as determine the bacterial aetiology and antimicrobial susceptibility patterns of the isolates.Methodology: This is a laboratory-based cross-sectional study of 206 pregnant women between the ages of 15 and 47 years attending the ANC of the hospital, selected by simple random sampling method. Demographic and clinical data were obtained from the subjects using a structured questionnaire. Clean-catch specimen of mid-stream voided urine was collected from each subject participant. Urine samples were processed for culture and isolation of significant bacterial pathogens using standard bacteriological methods, and isolates identified to species level by the combination of colony morphology, Gram reaction, conventional biochemical tests and Analytical Profile Index (API) 20E test kits. Antibiotic susceptibility testing of the isolates to selected antibiotics was performed using the disk diffusion method.Results: The prevalence of significant bacteriuria in the study population was 8.7% (18/206), with 27.8% (5/18) symptomatic and 72.2% (13/18) asymptomatic. All isolated bacteria were Gram-negative with the most frequent being Escherichia coli 9 (50.0%), followed by Klebsiella pneumoniae 6 (33.3%), Pseudomonas aeruginosa 1 (5.6%), Acinetobacter haemolyticus 1 (5.6%) and Enterobacter aerogenes 1 (5.6%). The isolates were most sensitive to gentamicin (100%) and nitrofurantoin (94.4%), while they demonstrated highest resistance to amoxicillin-clavulanic acid (33.3%). Significant bacteriuria was associated with pyuria (p=0.01) and past history of UTI (p=0.004).Conclusions: The high prevalence of asymptomatic significant bacteriuria in this study necessitates the need for screening and treatment of pregnant women for this entity to prevent the subsequent development of UTI that may have grave consequences on pregnancy outcome. French title: Prévalence et facteurs associés à une bactériurie significative chez les femmes enceintes fréquentant la clinique prénatale de la maternité Adeoyo, Yemetu, Ibadan, Nigéria Contexte: Une bactériurie importante est couramment signalée pendant la grossesse, ce qui prédispose grandement les femmes enceintes aux infections des voies urinaires (IVU), l'un des problèmes de santé les plus courants pendant la grossesse dans le monde, en particulier dans les pays en développement comme le Nigéria. Les objectifs de cette étude sont de déterminer la prévalence et les facteurs associés à une bactériurie significative chez les femmes enceintes fréquentant la clinique prénatale (CPN) de l'hôpital de maternité Adeoyo, Yemetu, Ibadan, Nigéria, ainsi que de déterminer l'étiologie bactérienne et les modèles de sensibilité aux antimicrobiens de les isolats. Méthodologie: Il s'agit d'une étude transversale en laboratoire portant sur 206 femmes enceintes âgées de 15 à 47 ans fréquentant les CPN de l'hôpital, sélectionnées par une méthode d'échantillonnage aléatoire simple. Les données démographiques et cliniques ont été obtenues auprès des sujets à l'aide d'un questionnaire structuré. Un échantillon propre d'urine évacuée à mi-chemin a été recueilli auprès de chaque participant sujet. Les échantillons d'urine ont été traités pour la culture et l'isolement d'agents pathogènes bactériens importants à l'aide de méthodes bactériologiques standard, et les isolats ont été identifiés au niveau de l'espèce par la combinaison de la morphologie de la colonie, de la réaction de Gram, des tests biochimiques conventionnels et des kits de test de l'indice de profil analytique (API) 20E. Les tests de sensibilité aux antibiotiques des isolats aux antibiotiques sélectionnés ont été effectués à l'aide de la méthode de diffusion sur disque. Résultats: La prévalence de la bactériurie significative dans la population étudiée était de 8,7% (18/206), avec 27,8% (5/18) symptomatique et 72,2% (13/18) asymptomatique. Toutes les bactéries isolées étaient Gram-négatives, la plus fréquente étant Escherichia coli 9 (50,0%), suivie de Klebsiella pneumoniae 6 (33,3%), Pseudomonas aeruginosa 1 (5,6%), Acinetobacter haemolyticus 1 (5,6%) et Enterobacter aerogenes 1 (5,6%). Les isolats étaient les plus sensibles à la gentamicine (100%) et à la nitrofurantoïne (94,4%), alors qu'ils présentaient la résistance la plus élevée à l'amoxicilline-acide clavulanique (33,3%). Une bactériurie significative était associée à une pyurie (p=0,01) et à des antécédents d'infection urinaire (p=0,004). Conclusions: La prévalence élevée de bactériurie significative asymptomatique dans cette étude nécessite le dépistage et le traitement des femmes enceintes pour cette entité afin de prévenir le développement ultérieur d'infections urinaires pouvant avoir de graves conséquences sur l'issue de la grossesse.

Drug Susceptibility Pattern and Associated Factors of Bacteria Isolated from Urinary Tract Infection among Pregnant Women Attending Antenatal Care in Teaching Referral Hospital, Southeast Ethiopia

Background: Urinary tract infection (UTI) is caused by bacteria from the digestive tract which climbs the opening of the urethra and begins to multiply to cause infection. UTI in pregnancy is associated with significant morbidity for both mother and baby. In most developing countries including Ethiopia, screening for UTI in pregnancy is not considered an essential part of Antenatal Care. This study aimed to assess the bacterial profile and antibiotic susceptibility pattern and associated risk factors among pregnant women in Madda Walabu University Goba Referral Hospital, Southeast Ethiopia. Methods: An institution-based cross-sectional study was conducted from June-August, 2020 . A total of 234 pregnant women were enrolled; data were collected using a structured questionnaire by a trained interviewer. Urine samples were collected from all pregnant women and culture on cysteine lysine electrolytes deficiency medium. Data were analyzed using SPSS 20.0. Descriptive statistics were used to explain the study participants with relevant variables. Logistic regression was used for data comparison. P-value <0.05 was accepted as statistically significant. Results: The overall prevalence of UTI was 23.9% among both asymptomatic and symptomatic groups. Of this screened midstream urine samples showed that 16% and 32.2%, had significant bacteriuria in the asymptomatic and symptomatic groups respectively. The prevalence of UTI was significantly associated with previous history of catheterization and urinary tract infection (p<0.05). E. coli was the most frequently isolated organism (42.9%) followed by coagulase-negative Staphylococcus (26.8%), and S. aureus (12.5%). Gram-negative and Gram-positive bacteria accounted for (59%) and (41%) respectively. Gram-negative isolates showed resistance to ampicillin, naldixic acid and trimethoprim/sulfamethoxazole. Also, all Gram-negative bacterial isolates revealed a high level of resistance against trimethoprim/sulfamethoxazole. Conclusion: Significant bacteriuria has been observed from both symptomatic and asymptomatic pregnant women. The majority of the isolates were resistant to commonly prescribed antibiotics. This calls for an early screening of all pregnant women for UTI and those found to be infected need treatment with an appropriate drug to avoid complications.

Asymptomatic Bacteriuria among Pregnant Women Attending a Tertiary Care Hospital in Western Nepal: A Cross-sectional Prospective Study

INTRODUCTION Urinary tract of female undergoes tremendous changes during pregnancy which increases their risk of acquiring infection. Asymptomatic bacteriuria is a common entity among pregnant women which refers to significant bacteriuria (>105 bacteria per ml of urine) without any typical symptoms of urinary tract infection. Asymptomatic bacteriuria can lead to various maternal and fetal complications if not detected and treated on time. MATERIAL AND METHODS Total 280 urine samples were collected in sterile universal containers from pregnant women not showing typical symptoms of urinary tract infection at the time of sample collection. Urine samples were inoculated in both MacConkey agar and Blood agar by semi quantitative culture method. Culture plates were reported after 24 hours of incubation at 370C. Bacteria isolated were subjected to antibacterial susceptibility testing by modified Kirby-Bauer disc diffusion method. RESULTS Out of 280 urine cultures, 213 samples were sterile. Significant bacteriuria was seen in 25 cases (8.9%) followed by insignificant bacteriuria (20, 7.14%) and contamination (17, 6.10%). Highest number of cultures positive were in age group 21-30 years (19, 9.1%,). Out of 25 cases of significant bacteriuria, 60% were primigravida and 40% were multigravida. The most common organism isolated was Escherichia coli (10, 60%) followed by Klebsiella pneumoniae (5, 40%). CONCLUSION Screening of all pregnant women for asymptomatic bacteriuria is essential during their antenatal checkup. Escherichia coli is the commonest organism that cause asymptomatic bacteriuria. Appropriate antibiotic therapy is absolutely necessary for positive cases on the basis of antimicrobial susceptibility result to prevent unwanted obstetric complications.

Establishment of the Risk Prediction Model for Significant Bacteriuria in Adult Patients with Automated Urine Analysis

<b><i>Introduction:</i></b> Urinary tract infections (UTIs) have been proven to be the most encountered bacterial infection in humans. We hope to establish a prediction model for significant bacteriuria by comprehensively analyzing the relevant parameters of age, gender, and urine automatic analysis data. <b><i>Methods:</i></b> A retrospective study was performed at Tai’an Central Hospital. All samples included in the study were tested for urine culture and urine automatic analysis. Data analysis was conducted with the SPSS. <b><i>Results:</i></b> The binary logistic regression module is used to establish the forecast formula, which gender, age, leukocyte count, bacterial count, leukocyte esterase, and nitrite were included. Receiver operating characteristic (ROC) curves showed that the area under ROC curve (AUC) of the prediction model was 0.878, bigger than the AUCs of the other 6 independent variables. The sensitivity and specificity of prediction model were 61.68 and 95.98%, respectively. The positive and the negative predictive values of the predictive model are 87.13 and 85.02%, respectively. <b><i>Conclusions:</i></b> The prediction formula obtained in our study can achieve good prediction effect for significant bacteriuria, which can effectively avoid the treatment delay or antibiotic abuse caused by the subjective judgment of doctors.

Biofilm Detection on Catheter Associated Uropathogenic Bacteriuria among Fistula Patients Attending National Obstetric Fistula Centre Ningi, Bauchi State, Nigeria

Background: Biofilm production caused by bacteria plays a vital role in catheter associated urinary tract infection (UTI) or bacteriuria being responsible for persistence and recurrent infection. Biofilms forming bacteria are difficult to eradicate due to antimicrobial resistance to the commonly used antibiotic. Biofilms are currently estimated to be responsible for over 65% of nosocomial infections and 80% of microbial infections. This study aimed to perform biofilm detection on uropathogenic bacterial isolates among fistula patients attending National Obstetric Fistula centre Ningi and investigate the antimicrobial susceptibility pattern. Methods: A total of 217 strains of significant bacteriuria were isolated from vesico vaginal fistula (VVF) patients. A cross sectional study was conducted at the hospital. The urine samples were collected and cultured on CLED and blood agar media while confirmation was done using their biochemical reaction. The detection of biofilms formation on the isolates was performed using tube adherence and Congo red agar method. Antimicrobial susceptibility testing was carried out by disc diffusion method on Muller Hinton agar. Results: Out of 217 significant bacteriuria isolated, 38 strains produced biofilms;28 strains tested positive on tube adherence method while 15 strains were positive on Congo red agar method. Bacteria that produced biofim showed multiple drug resistance compared to the platonic bacterial cells. All the biofilm producers showed 100% resistant to septrin, ampiclox, gentamycin and amoxicillin. There was no significant value between tube adherence and Congo red agar method with P value > 0.05. Conclusion: Biofilm detection should form part of routine testing while antimicrobial susceptibility testing is paramount on better choice of antibiotic therapy for proper management to reduce economic lost, treatment failure and drug resistance.

Antibiograms of uropathogens in obstetric patients

Background: Urinary tract infections (UTI) are the most commonly encountered infections inobstetric patients. Aim: The current study was undertaken to find the spectrum of micro-organismsresponsible for causing UTI in obstetric patients and to find out the most appropriate antibiotic.Materials and Methods: Consecutive patients in different stages of pregnancy with or withoutsymptoms of UTI attending the antenatal clinic from June 2019 to November 2020 were screenedfor significant bacteriuria. The bacterial uropathogens isolated were then subjected to antimicrobialsusceptibility testing and screened for ESBL production and methicillin resistance. Results: Duringthe 18-month study period, out of the 110 samples screened, a total of 66 (60%) samples of urinefrom pregnant females, in different stages of pregnancy were found to be positive on culture. TheEnterobacteriaceae accounted for nearly 69.69% of the isolates and E. coli alone accounted for42.42% of the urinary isolates followed by Acinetobacter 19.69%. Among the Gram-positive cocci,Enterococcus 25.75% were more frequently isolated than Staphylococcus aureus (4.54%).Significantly high resistance was noted to the beta-lactam group of antimicrobials, fluoroquinolonesand cotrimoxazole, both by the Gram-negative bacilli as well as Gram-positive cocci. Resistance wasquite low against the aminoglycosides and nitrofurantoin and virtually absent against imipenem.Conclusion: The susceptibility patterns seen in our study seem to suggest that it is necessary toobtain sensitivity reports before initiation of antibiotic therapy in cases of suspected UTI.

Drug Susceptibility Pattern and Associated Factors of Bacteria Isolated from Urinary Tract Infection among Pregnant Women Attending Antenatal Care in Teaching Hospital, Southeast Ethiopia

Background: Urinary tract infection is caused by bacteria from the digestive tract which climbs the opening of the urethra and begins to multiply to cause infection. This study aimed to assess the bacterial profile and antibiotic susceptibility pattern and associated risk factors among pregnant women in Madda Walabu University Goba Referral Hospital, Southeast Ethiopia. Methods: An institution-based cross-sectional study was conducted from June-August, 2019. A total of 234 pregnant women were enrolled; data were collected using a structured questionnaire by a trained interviewer. Urine samples were collected from all pregnant women and culture on cysteine lysine electrolytes deficiency medium. Data were analyzed using SPSS 20.0. Descriptive statistics were used to explain the study participants with relevant variables. Logistic regression was used for data comparison. P-value <0.05 was accepted as statistically significant. Results: The overall prevalence of UTI was 23.9% among both asymptomatic and symptomatic groups. Of this screened midstream urine samples showed that 16% and 32.2%, had significant bacteriuria in the asymptomatic and symptomatic groups respectively. The prevalence of UTI was significantly associated with previous history of catheterization and urinary tract infection. E. coli was the most frequently isolated organism (42.9%) followed by coagulase-negative Staphylococcus (26.8%), and S. aureus (12.5%). Gram-negative and Gram-positive bacteria accounted for (59%) and (41%) respectively.Conclusion: Significant bacteriuria has been observed from both symptomatic and asymptomatic pregnant women. The majority of the isolates were resistant to commonly prescribed antibiotics. This calls for an early screening of all pregnant women for UTI and those found to be infected need treatment.