Comparison of Asymptomatic Bacteriuria Agents and Antimicrobial Susceptibility in Term and Preterm Pregnancies

Yıl 2022, Cilt: 24 Sayı: 3, 247 - 251, 30.12.2022

Özlem Aydın Damla Dökmeci Güney Ahmet Naci Emecen Pinar Ergen İhsan Ayhan Reyhan Ayaz

https://doi.org/10.18678/dtfd.1163770

Öz

Aim: The aim of this study was to compare the resistance to asymptomatic bacteriuria (ABU) between term and preterm pregnancies.
Material and Methods: Pregnant women aged 17-41 years who were followed up in the obstetrics department of our hospital and whose urine cultures were sent to the laboratory for analysis and reported as ABU were included in the study. Patients were divided into two groups according to gestational weeks as preterm (<37 weeks) and term (≥37 weeks). The results were compared between the two groups.
Results: From among a total of 123 pregnant women, 29 (23.6%) delivered at preterm and 94 (76.4%) at term. The most frequently identified pathogen throughout the study group was 52.0% (n=64) Escherichia coli (E. coli), followed by 16.3% (n=20) Streptococcus agalactiae (S. agalactiae). There was no statistically significant difference in terms of the distribution of E. coli and S. agalactiae between the term and preterm groups (p=0.698 and p=0.930). E. coli was resistant to ampicillin 56.3% (n=36), to cefuroxime 40.6% (n=26). While fosfomycin resistance was 1.6% (n=1), nitrofurantoin resistance was not found. Extended-spectrum beta-lactamase positivity was 23.4% (n=15) in E. coli strains. No statistically significant difference was found in antibiotic resistance rates of E. coli strains between the term and preterm groups.
Conclusion: The most commonly isolated pathogen was E. coli which was highly resistant to beta-lactams. Screening of pregnant women for ABU and treatment with appropriate antibiotics; is the most effective way to prevent both maternal and fetal complications and antimicrobial resistance.

Anahtar Kelimeler

pregnancy, asymptomatic bacteriuria, antibiotic resistance

Term ve Preterm Gebelerde Asemptomatik Bakteriüri Etkenleri ve Antimikrobiyal Duyarlılığın Karşılaştırılması

Öz

Amaç: Bu çalışmanın amacı, asemptomatik bakteriüri (ASB) etkenlerinin direnç paternlerini term ve preterm gebelikler arasında karşılaştırmaktır.
Gereç ve Yöntemler: Hastanemiz kadın doğum bölümünde takip edilen ve idrar kültürleri laboratuvarda incelenmek üzere gönderilen ve ASB olarak rapor edilen 17-41 yaş arası gebeler çalışmaya dahil edildi. Hastalar gebelik haftalarına göre preterm (<37 hafta) ve term (≥37 hafta) olmak üzere iki gruba ayrıldı. Sonuçlar iki grup arasında karşılaştırıldı.
Bulgular: Toplam 123 gebeden 29'u (%23,6) preterm, 94'ü (%76,4) term doğum yaptı. Tüm çalışma grubunda en sık izole edilen patojen %52,0 (n=64) ile Escherichia coli (E. coli) idi ve bunu %16,3 (n=20) ile Streptococcus agalactiae (S.agalactiae) izlemekteydi. Term ve preterm grupları arasında E. coli ve S. agalactiae dağılımı açısından istatistiksel olarak anlamlı bir fark yoktu (p=0,698 ve p=0,930). E. coli suşları ampisiline %56,3 (n=36) oranında, sefuroksime %40,6 (n=26) oranında dirençliydi. Fosfomisin direnci %1,6 (n=1) olarak belirlenirken, nitrofurantoin direnci saptanmadı. E. coli suşlarında genişletilmiş spektrumlu beta-laktamaz pozitifliği %23,4 (n=15) olarak tespit edildi. Term ve preterm grupları arasında E. coli suşlarının antibiyotik direnç oranları bakımından istatistiksel olarak anlamlı fark saptanmadı.
Sonuç: En sık izole edilen patojen bakteri, beta laktamlara oldukça dirençli olan E. coli idi. Gebelerin ASB için taranması ve uygun antibiyoterapi ile tedavisi; maternal ve fetüste gelişecek komplikasyonları ve antimikrobiyal direnci önlemede etkili bir yoldur.

Anahtar Kelimeler

gebelik, asemptomatik bakteriüri, antibiyotik direnci

Kaynakça

• Nteziyaremye J, Iramiot SJ, Nekaka R, Musaba MW, Wandabwa J, Kisegerwa E, et al. Asymptomatic bacteriuria among pregnant women attending antenatal care at Mbale Hospital, Eastern Uganda. PLoS One. 2020;15(3):e0230523.
• Aktün LH, Karaca N, Akpak YK. Asymptomatic bacteriuria in pregnancy: prevalence, antibiotic susceptibility, and related demographic factors. Bezmialem Science. 2018;6(3):163-7.
• Nicolle LE, Gupta K, Bradley SF, Colgan R, DeMuri GP, Drekonja D, et al. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2019;68(10):e83-110.
• Angelescu K, Nussbaumer-Streit B, Sieben W, Scheibler F, Gartlehner G. Benefits and harms of screening for and treatment of asymptomatic bacteriuria in pregnancy: a systematic review. BMC Pregnancy Childbirth. 2016;16(1):336.
• Tokak S, Eriç Horasanlı J. Asymptomatic bacteriuria in pregnant women: frequency, antimicrobial susceptibility profile, causative microorganisms and risk factors. FLORA. 2020;25(4):555-62. Turkish.
• Aşgın N, Eroğlu S, Kal Çakmaklıoğulları E. Which antibiotics should be first line options for empirical treatment of urinary tract infections during pregnancy? ANKEM Derg. 2018;32(3):94-102. Turkish.
• Emami A, Javanmardi F, Pirbonyeh N. Antibiotic resistant profile of asymptomatic bacteriuria in pregnant women: a systematic review and meta-analysis. Expert Rev Anti Infect Ther. 2020;18(8):807-15.
• Kalita D, Deka S. Asymptomatic bacteriuria in pregnancy. The New Indian Journal of OBGYN. 2015;2(1):8-19.
• Sujatha R, Nawani M. Prevalence of asymptomatic bacteriuria and its antibacterial susceptibility pattern among pregnant women attending the antenatal clinic at Kanpur, India. J Clin Diagn Res. 2014;8(4):DC01-3.
• Wing DA, Fassett MJ, Getahun D. Acute pyelonephritis in pregnancy: an 18-year retrospective analysis. Am J Obstet Gynecol. 2014;210(3):219.e1-6.
• Sheiner E, Mazor-Drey E, Levy A. Asymptomatic bacteriuria during pregnancy. J Matern Fetal Neonatal Med. 2009;22(5):423-7.
• US Preventive Services Task Force, Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana M, et al. Screening for Asymptomatic Bacteriuria in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2019;322(12):1188-94.
• eucast.org [Internet]. European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 9.0, 2019. [Cited: 2022 July 26]. Available from: https://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_tables/v_9.0_Breakpoint_Tables.pdf.
• Prasanna B, Naimisha M, Swathi K, Shaik MV. Prevalence of asymptomatic bacteriuria in pregnant women, isolates and their culture sensitivity pattern. Int J Curr Microbiol Appl Sci. 2015;4(8):28-35.
• Chunchaiah S, Nagothi NP, Roopakala BM, Rangaiah N. A prospective study of prevalence, risk factors, isolates & antimicrobial sensitivity pattern in Asymptomatic Bacteriuria among Antenatal women in Rajarajeswari Medical College & Hospital. Indian J Obstet Gynecol Res. 2016;3(3):229-33.
• Ali IE, Gebrecherkos T, Gizachew M, Menberu MA. Asymptomatic bacteriuria and antimicrobial susceptibility pattern of the isolates among pregnant women attending Dessie referral hospital, Northeast Ethiopia: A hospital-based cross-sectional study. Turk J Urol. 2018;44(3):251-60.
• Loh K, Sivalingam N. Urinary tract infections in pregnancy. Malays Fam Physician. 2007;2(2):54-7.
• Oladeinde BH, Omoregie R, Oladeinde OB. Asymptomatic urinary tract infection among pregnant women receiving ante-natal care in a traditional birth home in Benin City, Nigeria. Ethiop J Health Sci. 2015;25(1):3-8.
• Dange SC, Shah A, Dravid MN. Asymptomatic bacteriuria in pregnancy. Int J Res Rev. 2016;3(3):45-9.
• Andabati G, Byamugisha J. Microbial aetiology and sensitivity of asymptomatic bacteriuria among ante-natal mothers in Mulago hospital, Uganda. Afr Health Sci. 2010;10(4):349-52.
• Enayat K, Fariba F, Bahram N. Asymptomatic bacteriuria among pregnant women referred to outpatient clinics in Sanandaj, Iran. Int Braz J Urol. 2008;34(6):699-707.
• Sonkar N, Banerjee M, Gupta S, Ahmad A. Asymptomatic bacteriuria among pregnant women attending tertiary care hospital in Lucknow, India. Dubai Med J. 2021;4(1):18-25.
• Onu FA, Ajah LO, Ezeonu PO, Umeora OU, Ibekwe PC, Ajah MI. Profile and microbiological isolates of asymptomatic bacteriuria among pregnant women in Abakaliki, Nigeria. Infect Drug Resist. 2015;8:231-5.
• Matuszkiewicz-Rowińska J, Małyszko J, Wieliczko M. Urinary tract infections in pregnancy: old and new unresolved diagnostic and therapeutic problems. Arch Med Sci. 2015;11(1):67-77.
• Wilkie ED, Oluduro AO, Abike TO, Chukwudum CV. Phenotypic and molecular characterization of multiple-resistant gram-negative bacteria in urine of pregnant women attending antenatal clinic of Mother and Child hospital, Ondo, Nigeria. Afr J Microbiol Res. 2021;15(5):209-16.
• Dash M, Sahu S, Mohanty I, Narasimham MV, Turuk J, Sahu R. Prevalence, risk factors and antimicrobial resistance of asymptomatic bacteriuria among antenatal women. J Basic Clin Reprod Sci. 2013;2(2):92-6.
• Walani SR. Global burden of preterm birth. Int J Gynaecol Obstet. 2020;150(1):31-3.
• Uncu Y, Uncu G, Esmer A, Bilgel N. Should asymptomatic bacteriuria be screened in pregnancy? Clin Exp Obstet Gynecol. 2002;29(4):281-5.
• Lallar M, ul Haq A, Nandal R. Asymptomatic bacteriuria: predisposing factors and correlation with preterm labor in low resource settings. Int J Reprod Contracept Obstet Gynecol. 2014;3(2):403-8.
• Smaill FM, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev. 2019;2019(11):CD000490.