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

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.

Recurrent Urinary Tract Infections Management in Women : A Review = الإلتهابات المتكررة للمسالك البولية عند النساء و طرق علاجها : مراجعة

“…The rate of E. coli resistance to fluoroquinolones, even in uncomplicated UTIs, varies between countries with rates reported as 0.5-7.6% in Europe, 45 15% in Korea, 46 and up to 35% in some parts of India. 47 Penicillins and cephalosporins are considered safe during pregnancy, but trimethoprim, sulphonamides, and fluoroquinolones should be avoided. Oral antibiotic therapy resolves 94% of uncomplicated UTIs, although recurrence is not uncommon.…”

Prevalence of UTI among Pregnant Women and Its Complications in Newborns

“…23,27 The functional urinary tract abnormalities and diabetes mellitus can also increase susceptibility to UTIs during pregnancy. 18,21 The Pressure of gravid uterus on ureter causing stasis of urine flow which is attributed to humoral and immunological changes during normal pregnancy may increase the risk of UTI. 10 The changes in urine chemical composition with elevated glucose and amino acids levels facilitate bacterial growth.…”

Safety of Canephron® N for the treatment of urinary tract infections in the first trimester of pregnancy

“…In addition, the number of antimicrobial agents safe for use during pregnancy is further limited by the emergence of drug resistance amongst various bacterial species [6,13]. Thus, there is a need for alternative treatment modalities for addressing UTIs that occur during pregnancy.…”

“…Between 5 and 10 % of women experience a UTI during pregnancy, usually asymptomatic bacteriuria, acute cystitis and pyelonephritis [2]. The majority of UTIs are caused by bacterial species of enteric origin, namely Escherichia coli, which accounts for 70-85 % of cases [3], as well as Klebsiella pneumoniae, Staphylococcus aureus and the Group B streptococci [4][5][6]. If not properly treated, these infections can have serious consequences for the mother and fetus increasing the risk of pre-eclampsia, premature birth and low neonatal birth weight [1].…”

“…Due to their potential teratogenic effects, certain antibiotics are unsuitable for use in pregnant women [9]. Antimicrobial agents considered safe in pregnancy are of the β lactam class including the penicillins, cephalosporins and fosfomycin trometamol [6,10].…”