Antibiotic resistant profile of asymptomatic bacteriuria in pregnant women: a systematic review and meta-analysis

ABSTRACT

Objectives

Different microorganisms contribute in the pregnancy bacteriuria, which resistance microorganisms limited the therapeutic options for the treatment and increasing the related risks to pregnant women and their pregnancy. Based on this, asymptomatic bacteriuria and the use of inappropriate empirical antibiotics are dangerous in the emergence of pregnancy complications and the incidence of drug resistant.

Methods

A comprehensive systematic search was performed on all international databases including Scopus, PubMed, Web of Science, Medline, Cochrane library during 2000 – June 2019. This meta-analysis, which was registered by a pre-defined protocol in PROSPRO, carried out in accordance with PRISMA guideline. Relevant articles were included in the analysis if reported the susceptibility pattern of antimicrobial resistance related to asymptomatic bacteria in pregnant women with no acute diseases. Overall prevalence and related 95% confidence interval for resistance in different asymptomatic infections were estimated by inverse variance method. The random effect model was used in case of considerable heterogeneity.

Results

Results of this analysis demonstrated different resistance rate against studied classes of antibiotics. Nitrofurantoin resistance in E. coli, Klebsiella sp, P. aeruginosa, and Staphylococcus aureus isolates were estimated 0.22 (95%CI: 0.15–0.30), 0.40 (95%CI: 0.26–0.54), 0.81 (95%CI: 0.59–0.97), 0.34 (0.11–0.63), respectively. Subgroups analysis showed highest resistance in E. coli isolates, in Asia and Africa against Cefotaxime and Ampicillin, respectively.

Conclusion

In summary, increasing resistance rate in urinary tract infection (UTI)-related agents is a risk factor that endangers both mother and fetus. Health care providers should consider screening as the radical part of infection control strategies. Due to low resistance rate to Nitrofurantoin, this drug can be a good choice for UTI treatment in pregnancies, but it should use with caution

KEYWORDS:

• Urinary tract infection
• pregnancy
• meta-analysis
• asymptomatic bacteriuria

Author contributions

Amir Emami designed the study, collecting the data and monitoring the data collection, and wrote the manuscript. Fatemeh Javanmardi helped in designing the study, statistical analysis plan, cleaned and analyzed the data and implemented the study. Neda Pirbonyeh monitored the data collection and helped in writing.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data availability statement

Current study is a meta-analysis paper, and the characteristics of included studies are provided in Supplementary file 1.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded for publication.