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CC BY-NC-ND 4.0 · J Lab Physicians 2011; 3(02): 098-103
DOI: 10.4103/0974-2727.86842
Original Article

Rising Prevalence of Antimicrobial Resistance in Urinary Tract Infections During Pregnancy: Necessity for Exploring Newer Treatment Options

Meher Rizvi
Department of Microbiology JNMCH, AMU, Aligarh 202 002, India
,
Fatima Khan
Department of Microbiology JNMCH, AMU, Aligarh 202 002, India
,
Indu Shukla
Department of Microbiology JNMCH, AMU, Aligarh 202 002, India
,
Abida Malik
Department of Microbiology JNMCH, AMU, Aligarh 202 002, India
,
Shaheen › Author Affiliations Source of Support: Nil
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ABSTRACT

Background: Urinary tract infections (UTI) are one of the most common medical complications of pregnancy. The emergence of drug resistance and particularly the Extended-spectrum beta-lactamase production by Escherichia coli and methicillin resistance in Staphylococci, limits the choice of antimicrobials.

Materials and Methods: Patients in different stages of pregnancy with or without symptoms of urinary tract infection attending the antenatal clinic of obstetrics and gynaecology were screened for significant bacteriuria, by standard loop method on 5% sheep blood agar and teepol lactose agar. Isolates were identified by using standard biochemical tests and antimicrobial susceptibility testing was done using Kirby Bauer disc diffusion method.

Results: A total of 4290 (51.2%) urine samples from pregnant females showed growth on culture. Prevalence of asymptomatic bacteriuria 3210 (74.8%) was higher than symptomatic UTI 1080 (25.2%). Escherichia coli was the most common pathogen accounting for 1800 (41.9%) of the urinary isolates. Among the gram-positive cocci, coagulase negative species of Staphylococci 270 (6.4%) were the most common pathogen. Significantly high resistance was shown by the gram negative bacilli as well as gram positive cocci to the β-lactam group of antimicrobials, flouroquinolones and aminoglycosides. Most alarming was the presence of ESBL in 846 (47%) isolates of Escherichia coli and 344 (36.9%) isolates of Klebsiella pneumoniae, along with the presence of methicillin resistance in 41% of Staphylococcus species and high-level aminoglycoside resistance in 45(30%) isolates of Enterococcus species. Glycopeptides and carbepenems were the only group of drugs to which all the strains of gram positive cocci and gram negative bacilli were uniformly sensitive, respectively.

Conclusions: Regular screening should be done for the presence of symptomatic or asymptomatic bacteriuria in pregnancy and specific guidelines should be issued for testing antimicrobial susceptibility with safe drugs in pregnant women so that these can be used for the treatment. For empirical treatment cefoperazone-sulbactum can be recommended, which is a safe drug, covering both gram positive and gram negative organisms and with a good sensitivity.

Keywords

Antimicrobial resistance - extended-spectrum beta-lactamase - high-level aminoglycoside resistance - MRSA - pregnancy - urinary tract infection


Publication History

Article published online:
09 May 2020

© 2011.

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  • REFERENCES

  • 1 National Institute for Health and Clinical Excellence (NICHE). Antenatal care: Routine care for the healthy pregnant women. London: NICE (Clinical Guidance 6) 2003. Available from: http://www.nice.org.uk/nicemedia/pdf/CG062NICEguidline.pdf. [Last accessed on 2011 Mar 30].
  • 2 Leticia AJ, Patrick JW, Henry ER. Urinary tract infections in pregnancy. Available from: http://emedicine.medscape.com/article/452604-overview. [Last accessed on 2011 Mar 4].
  • 3 Canadian communication group. Screening for asymptomatic bacteriuria in pregnancy. Ottawa 1994.
  • 4 Savage WE, Hajj SN, Kass EH. Demographic and prognostic characteristics of bacteuria in pregnancy. Medicine (Baltimore) 1967;46:385-407.
  • 5 Robertson JG, Livingstone JR, Isdale MH. The managment and complications of asymptomatic bacteriuria in pregnancy. Report of a study on 8,275 patients. J Obstet Gynaecol Br Commonw 1968;75:59-65.
  • 6 Romero R, Oyarzun E, Mazor M, Sirtori M, Hobbins JC, Bracken M. Meta-analysis of the relationship between asymptomatic bacteuria and preterm delivery /low birth weight. Obstet Gynaecol 1989;73:576-82.
  • 7 Hooton TM. Pathogenesis of urinary tract infections: an update. J Antimicrob Chemother 2000;46 Suppl A:1-7.
  • 8 Maclean AB. Urinary tract infection and pregnancy. In: Cattell WR, editor. Infections of the kidney and urinary tract. Oxford: Oxford University Press; 1996.
  • 9 Noscovicova M, Dubrava M, Cernak P, Harsanyi M. Reality of antibiotic treatment in hospitalised patients. Prakticky lekar 1994;74:275-7.
  • 10 Nicolle LE. Short term therapy for urinary tract infection: success and failure. Int J Antimicrob Agents 2008;31 Suppl 1:S40-5.
  • 11 Rubin RH, Beam TR, Stamm WE. An approach to evaluating antibacterial agents in the treatment of urinary tract infection. Clin Infect Dis 1992;14 Suppl 2:S246-51.
  • 12 Collee JG, Fraser AG, Marmion BP, Mackey SA, McCartney. Practical Medical Microbiology. In: Collee JG, Miles RS, Watt B, editors. Tests for the identification of Bacteria. 14th ed. New Delhi, India: Elsevier; 2006. p. 131-49.
  • 13 Clinical and Laboratory Standards Institute. Performance standards for antimicrobial disk susceptibility tests. Wayne Pa: Clinical and Laboratory Standards Institute: M2-A9; 2006.
  • 14 Clinical and Laboratory Standards Institute. Performance standards for antimicrobial disk susceptibility tests. Wayne Pa: Clinical and Laboratory Standards Institute: M100-S16; 2006.
  • 15 Rizvi M, Fatima N, Rashid M, Shukla I, Malik A, Usman A, et al. Extended spectrum AmpC and metallo-beta-lactamases in Serratia and Citrobacter spp. in a disc approximation assay. J Infect Dev Ctries 2009;3:285-94.
  • 16 Lee K, Chong Y, Shin HB, Kim YA, Yong D, Yum JH. Modified Hodge and EDTA-disk synergy tests to screen metallo-beta-lactamase-producing strains of Pseudomonas and Acinetobacter species. Clin Microbiol Infect 2001;7:88-91.
  • 17 Murray PR, Baron EJ, Jorgenson JH, et al. Manual of Clinical Microbiology. In: Swenson JM, Hindler JF, Jorgenson JH, editors. Special phenotypic methods for detecting antibacterial resistance. 8th ed. Washington DC: ASM Press; 2003. p. 1179.
  • 18 Okonko IO, Ijandipe LA, Ilusanya AO, Donbraye-Emmanuel OB, Ejembi J, Udeze AO, et al. Incidence of urinary tract infection (UTI) among pregnant women in Ibadan, South-Western Nigeria. Afr J Biotech 2009;8:6649-57.
  • 19 Pais P, Khurana R, George J. Urinary tract infections: a retrospective survey of causative organisms and antibiotics prescribed in a tertiary care setting. Indian J Pharmacol 2002;34:278-80.
  • 20 Taneja N, Rao P, Arora J, Dogra A. Occurence of ESBL and Amp-C-â-lactamases and susceptibility to newer antimicrobial agents in complicated UTI. Indian J Med Res 2008;127:85-8.
  • 21 Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing, 14th information supplement. Wayne Pa: Clinical and Laboratory Standards Institute; 2004.M100-S14.
  • 22 Khan F, Shukla I, Rizvi M. The role of non-β-lactam antimicrobials and screening for vancomycin resistance in methicillin resistant Staphylococcus aureus. Malays J Microbiol 2011;7: accepted for publication.
  • 23 Nardiello S, Pizzella T, Ariviello R. Risk of antibacterial agents in pregnancy. Infez Med 2002;10:8-15.
  • 24 Peterson TF, Andriole VT. Detection, significance and therapy of bacteuria in pregnancy. Update in the managed health care era. Infect Dis Clin North Am 1997;11:593-608.
  • 25 Christensen B. Which antibiotics are appropriate for treating bacteriuria in pregnancy? J Antimicrob Chemother 2000;46 Suppl 1:29-34.
  • 26 Krcmery S, Hromec J, Demesova D. Treatment of lower urinary tract infection in pregnancy. Int J Antimicrob Agents 2001;17:279-82.
  • 27 Available from: http://www.orgyn.com/resources/genrx/D003344.asp. [Last accessed on 2011 Mar 5].
  • 28 Cotrimoxazole improves pregnancy outcomes (Reuters health). Available from: http://.aidsmeds.com/articles/1667_11308.shtml. [Last accessed on 2006 Dec 15].
  • 29 Sulfamethoxazole and trimethoprim. Available from: http://www.medicinet.com/s_lfamethoxazole_andtrimethoprim/article.htm. [Last accessed on 2011 Mar 5].
  • 30 Graninger W. Pivmecillinam- therapy of choice for lower urinary tract infection. Int J Antimicrob Agents 2003;22 Suppl 2:73-8.