Original Research

Trends in the epidemiology of urinary tract infections in pregnancy at a tertiary hospital in Johannesburg: Are contemporary treatment recommendations appropriate?

Trusha Nana, Shastra Bhoora, Vindana Chibabhai
Southern African Journal of Infectious Diseases | Vol 36, No 1 | a328 | DOI: https://doi.org/10.4102/sajid.v36i1.328 | © 2021 Trusha Nana, Shastra Bhoora, Vindana Chibabhai | This work is licensed under CC Attribution 4.0
Submitted: 21 August 2021 | Published: 09 December 2021

About the author(s)

Trusha Nana, Department of Clinical Microbiology and Infectious Diseases, University of the Witwatersrand, Johannesburg, South Africa; and, Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Services, Johannesburg, South Africa
Shastra Bhoora, Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa; and, Department of Obstetrics and Gynaecology, Charlotte Maxeke Johannesburg Academic Hospital, South Africa; and, Gauteng Department of Health, Johannesburg, South Africa; and, Department of Obstetrics and Gynaecology, Faculty of Medicine, Baylor College, Houston, United States of America
Vindana Chibabhai, Department of Clinical Microbiology and Infectious Diseases, University of the Witwatersrand, Johannesburg, South Africa; and, Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Services, Johannesburg, South Africa


Share this article

Bookmark and Share

Abstract

Background: Urinary tract infections (UTIs) are common during pregnancy and are associated with maternal and foetal complications. Empiric antibiotic choices in pregnancy require consideration of efficacy and safety, resulting in limited oral options. With rapidly evolving antibiotic resistance, surveillance to guide empiric treatment recommendations is essential.

Methods: A retrospective analysis of urine culture isolates from the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) Obstetrics Department for 1 January 2015 to 31 December 2020 was performed.

Results: The top 3 pathogens were Escherichia coli, Enterococcus faecalis and Klebsiella pneumoniae. For E. coli susceptibility to cefuroxime declined (95% to 81%, p < 0.0001). Similarly, the E. coli extended spectrum beta-lactamase rate increased from 5% to 10% (p = 0.04). E. coli susceptibility to nitrofurantoin (93%) and fosfomycin (96%) remained high. In 2019, carbapenem-resistant K. pneumoniae emerged. Ampicillin susceptibility was high amongst the E. faecalis isolates. Amoxicillin-clavulanate demonstrated high levels of activity against the top 3 uropathogens.

Conclusion: The Essential Drug List recommended antibiotics for lower UTIs, nitrofurantoin and fosfomycin, are appropriate empiric options for E. coli, the most common uropathogen in the CMJAH obstetric population. The high rate of E. faecalis susceptibility to nitrofurantoin reported from other Gauteng tertiary obstetric patients, suggests that nitrofurantoin will provide adequate empiric cover for a large proportion of UTIs. However, the determination of the E. faecalis nitrofurantoin and fosfomycin susceptibility rates in the CMJAH obstetric population will provide useful data. Periodic surveillance at the various levels of antenatal care in different regions of South Africa and the determination of risk factors for infections with resistant uropathogens is needed.


Keywords

urinary tract infections; asymptomatic bacteriuria; pregnancy; antimicrobial resistance; surveillance; trends

Metrics

Total abstract views: 330
Total article views: 245


Crossref Citations

No related citations found.