Prevalence, Antimicrobial Susceptibility Profiles and Genotypic Characterization of Isolates obtained from Urine Samples of Pregnant Women Attending Antenatal Clinic at Pumwani Maternity Hospital, Kenya

Abstract

Urinary Tract Infections (UTIs) during pregnancy are among the most common infections worldwide and can lead to poor perinatal and maternal outcomes. A cross-sectional study was conducted among 210 pregnant women attending antenatal clinic at Pumwani Maternity hospital. Ethical clearance was granted by KEMRI/ Scientific and Ethics Review Unit and Administrators of Pumwani Maternity Hospital. Their social-demographic profiles were obtained using a structured questionnaire. Cultures were done from midstream urine and antimicrobial susceptibility testing determined using the disc diffusion test. The genetic diversity of the isolates was determined using molecular techniques. The overall prevalence of UTI was 15.7%. E. coli was the most predominant UTI organism at (44.5%). Barrier methods of contraceptives, material of undergarment and frequency of changing the undergarments were found to contribute significantly to the acquisition of UTI (P<0.05). Almost a half (over 49%) of all Gram-negative organisms showed resistance prevalence against third generation Cephalosporins, Fluoroquinolones, Sulfamethoxazole-Trimethoprim, Cefoxitin, Nitrofurantoin and Amoxicillin-clavulanic acid. Gram-positive strains were susceptible to Amoxicillin-clavulanic acid, Nitrofurantoin, Linezolid and Ofloxacin. The blaTEM gene was the most prevalent at 58.1%, blaCTX-M at 45.2% blaSHV at 29%, and blaOXA gene at 22.6%. Genetic analysis revealed diverse genotypic characteristics of the isolates clustered in small groupings of highly similar strains. In conclusion, UTIs are still a burden to maternal and child health and can therefore vastly contribute to poor perinatal and maternal outcomes. There is a need to educate women, on factors that could predispose them to UTIs especially during pregnancy. Our data suggest a serious resistance trend among UTI strains and more research should be done to slow down this trend.