J Seni1, J N Tito2, S J Makoye2, H Mbena3, H S Alfred4, F van der Meer5, J D D Pitout6, S E Mshana2, R DeVinney6. 1. Department of Microbiology and Immunology, Weill-Bugando School of Medicine, Catholic University of Health and Allied Sciences (CUHAS), P.O. Box 1464, Mwanza, Tanzania; Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1, Canada. Electronic address: senijj80@gmail.com. 2. Department of Microbiology and Immunology, Weill-Bugando School of Medicine, Catholic University of Health and Allied Sciences (CUHAS), P.O. Box 1464, Mwanza, Tanzania. 3. Department of Obstetrics and Gynaecology, Bugando Medical Centre (BMC), P.O. Box 1370 and Catholic University of Health and Allied Sciences (CUHAS), P.O. Box 1464, Mwanza, Tanzania. 4. Sengerema District Designated Hospital, P.O. Box 20, Sengerema, Mwanza, Tanzania. 5. Faculty of Veterinary Medicine: Ecosystem and Public Health, University of Calgary, Calgary, AB, Canada. 6. Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1, Canada.
Abstract
OBJECTIVES: The aim of this multicentre study was to evaluate the magnitude of significant bacteriuria (SB) as well as the implicated bacterial pathogens, antimicrobial resistance (AMR) profiles and risk factors for SB among pregnant women attending different levels of healthcare facilities (HCFs) in Tanzania in order to guide antimicrobial therapy and preventive measures. METHODS: Information on sociodemographic and clinical characteristics, midstream urine culture and antimicrobial susceptibility testing was collected from 1828 pregnant women between March 2016 and May 2017. Data were analysed using STATA v.13.0 software. RESULTS: The prevalence of SB among pregnant women was 17.7% (323/1828; 95% CI 16.0-19.5%), with a predominance of Escherichia coli (164/323; 50.8%), Klebsiella spp. (55/323; 17.0%) and Staphylococcus aureus (28/323; 8.7%). Moreover, 37.5% (121/323) of bacteria were multidrug-resistant [84.3% (102/121) Gram-negative bacteria and 15.7% (19/121) in Gram-positive bacteria; P<0.001]. Third-generation cephalosporin resistance in E. coli, Klebsiella spp. and other Enterobacteriaceae was 13.4%, 21.8% and 27.5%, respectively, and was higher in strains from a tertiary hospital (OR=3.27, 95% CI 1.02-10.49; P=0.046) compared with lower HCFs. Predictors of SB among pregnant women were lack of formal occupation, current hospital admission and presence of co-morbidities. CONCLUSIONS: The prevalence of SB among pregnant women in this study was high (17.7%) and was within the same range reported 10 years ago in a single-centre baseline study. However, there is an increase in AMR in the cascade of referral healthcare system, underscoring the need for health facility level-specific antimicrobial stewardship.
OBJECTIVES: The aim of this multicentre study was to evaluate the magnitude of significant bacteriuria (SB) as well as the implicated bacterial pathogens, antimicrobial resistance (AMR) profiles and risk factors for SB among pregnant women attending different levels of healthcare facilities (HCFs) in Tanzania in order to guide antimicrobial therapy and preventive measures. METHODS: Information on sociodemographic and clinical characteristics, midstream urine culture and antimicrobial susceptibility testing was collected from 1828 pregnant women between March 2016 and May 2017. Data were analysed using STATA v.13.0 software. RESULTS: The prevalence of SB among pregnant women was 17.7% (323/1828; 95% CI 16.0-19.5%), with a predominance of Escherichia coli (164/323; 50.8%), Klebsiella spp. (55/323; 17.0%) and Staphylococcus aureus (28/323; 8.7%). Moreover, 37.5% (121/323) of bacteria were multidrug-resistant [84.3% (102/121) Gram-negative bacteria and 15.7% (19/121) in Gram-positive bacteria; P<0.001]. Third-generation cephalosporin resistance in E. coli, Klebsiella spp. and other Enterobacteriaceae was 13.4%, 21.8% and 27.5%, respectively, and was higher in strains from a tertiary hospital (OR=3.27, 95% CI 1.02-10.49; P=0.046) compared with lower HCFs. Predictors of SB among pregnant women were lack of formal occupation, current hospital admission and presence of co-morbidities. CONCLUSIONS: The prevalence of SB among pregnant women in this study was high (17.7%) and was within the same range reported 10 years ago in a single-centre baseline study. However, there is an increase in AMR in the cascade of referral healthcare system, underscoring the need for health facility level-specific antimicrobial stewardship.
Authors: Bugwesa Z Katale; Gerald Misinzo; Stephen E Mshana; Harriet Chiyangi; Susana Campino; Taane G Clark; Liam Good; Mark M Rweyemamu; Mecky I Matee Journal: Antimicrob Resist Infect Control Date: 2020-08-06 Impact factor: 4.887