1,2Ogban, G. I., *1,2Iwuafor, A. A., 3Idemudo, C. U., 2Ben, S. A., 4Ushie, S. N., and 1,2Emanghe, U. E.
1Department of Medical Microbiology and Parasitology, University of Calabar, Calabar, Nigeria
2Department of Medical Microbiology and Parasitology Main Laboratory, University of Calabar Teaching Hospital, Calabar, Nigeria
3Department of Public Health, University of Calabar, Calabar, Nigeria 4Department of Medical Microbiology and Parasitology, Nnamdi Azikiwe University, Awka, Nigeria *Correspondence to: tonyiwuafor@unical.edu.ng; +2348033441539
Abstract:
Background: Severe infections caused by carbapenem-resistant Enterobacteriaceae (CRE) have mortality rate exceeding 50%. On the strength of this, this study sought to determine the prevalence of urinary tract infection (UTI) in pregnancy caused by CRE and associated risk factors in University of Calabar Teaching Hospital (UCTH), Nigeria, with the aim of making recommendations that can stem the tide of UTI caused by this bacterial strain in the hospital.
Methodology: This was a descriptive cross-sectional study of 349 consecutively selected pregnant women attending antenatal clinic of UCTH, Calabar, Nigeria, between September 2020 and August 2021. Demographic/ clinical data and risk factors were collected with semi-structured interviewer-administered questionnaire. Voided mid-stream urine (MSU) sample was collected from each participant and transported to the medical microbiology laboratory of the hospital for microbiological analysis using conventional culture and biochemical identification methods. Antimicrobial susceptibility test (AST) on each isolate was performed by the disk diffusion technique against selected antibiotics. Phenotypic carbapenemase production from presumptive carbapenem resistant isolates following AST was confirmed by the modified Hodge test (MHT). Data analysis was done on SPSS version 19.0. Association of risk factors with the prevalence of UTI caused by CRE was determined using Chi square or Fisher Exact test, with p<0.05 considered statistically significant.
Results: The prevalence of UTI among the pregnant women was 10.0% (35/349), with prevalence of 6.6% for Escherichia coli (23/349) and 3.5% (12/349) for Klebsiella pneumoniae. Antibiotic susceptibility test result showed that piperacillin-tazobactam was the most active antibiotic in vitro, with 82.9% isolates sensitive to it while sensitivity to imipenem (60.0%) and meropenem (40.0%) was low. A total 17 (48.6%) of the 35 isolates were resistant to carbapenems in the AST and 12 (34.3%) were carbapenemase-producing strains on MHT while 5 (14.3%) were non-carbapenemase-mediated resistance (NCMR). None of the demographic characteristics or risk factors analysed was significantly associated with UTI caused by CRE in the pregnant women (p>0.05).
Conclusion: To stem the rising trend of UTIs in pregnancy caused by carbapenem resistant uropathogens, pregnant women receiving antenatal care in UCTH, Calabar should be routinely screened for UTI and offered appropriate treatment if indicated based on microbiological test results
Keywords: UTI; Pregnancy, Enterobacteriaceae, carbapenem-resistant, emerging threat
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