Bacterial Profile and ESBL Screening of Urinary Tract Infection Among Asymptomatic and Symptomatic Pregnant Women Attending Antenatal Care of Northeastern Ethiopia Region

Figures & data

Table 1 Sociodemographic Characteristics of the Study Participants (n=323) in Dessie Referral Hospital (DRH), Northeastern Ethiopia

Variables	Frequency	Percent (%)
Age (years)
15–24	108	33.4
25–34	183	56.7
35–44	32	9.9
Residence
Urban	271	83.9
Rural	52	16.1
Occupation
House wife	188	58.2
Self employed	48	14.9
Student	14	4.3
Employed	73	22.6
Educational level
Illiterate	41	12.7
Only read and write	21	6.5
Primary school	75	23.2
Secondary school	92	28.5
College and above	94	29.1
Marital status
Single	9	2.8
Married	301	93.2
Divorced	8	2.5
Widowed	5	1.5
Monthly family income (USD)
≤20	33	10.2
21–40	76	23.5
41–60	27	8.4
61–80	37	11.5
>80	150	46.4

Figure 1 Frequency of UTI among asymptomatic and symptomatic pregnant women in DRH, Northeastern Ethiopia.

Table 2 Bivariate and Multivariate Logistic Regression Analyses of Factors Associated with UTI Among Pregnant Women (n=323) Attending ANC in DRH, Northeastern Ethiopia

Variables	Culture		COR (95% CI)	P-value	AOR (95% CI)	P-value
	SB Negative No. (%)	SB Positive No. (%)
Age (years)
15–24	92 (85.2)	16 (14.8)	1
25–34	154 (84.2)	29 (15.8)	1.083 (0.558, 2.101)	0.814	NA
35–44	27 (84.4)	5 (15.6)	1.065 (0.357, 3.173)	0.910	NA
Residence
Urban	225 (83.0)	46 (17.0)	1
Rural	48 (92.3)	4 (7.7)	0.408 (0.140, 1.186)	0.100	0.355 (0.096, 1.311)	0.120
Occupation
House wife	151 (80.3)	37 (19.7)	1.742 (0.795, 3.820)	0.166	0.786 (0.233, 2.644)	0.697
Self employed	45 (93.8)	3 (6.3)	0.474 (0.122, 1.849)	0.282	0.237 (0.047, 1.192)	0.081
Student	13 (92.9)	1 (7.1)	0.547 (0.064, 4.697)	0.582	0.675 (0.056, 8.197)	0.758
Employed	64 (87.7)	9 (12.3)	1
Educational level
Illiterate	32 (78.0)	9 (22.0)	2.362 (0.897, 6.347)	0.088	3.613 (0.764, 17.093)	0.105
Only write and write	17 (81.0)	4 (19.0)	1.976 (0.554, 7.047)	0.294	3.995 (0.664, 24.042)	0.130
Primary school	62 (82.7)	13 (17.3)	1.761 (0.725, 4.277)	0.211	2.626 (0.704, 9.788)	0.150
Secondary school	78 (84.8)	14 (15.2)	1.508 (0.663, 3.592)	0.354	2.246 (0.676, 7.468)	0.187
Higher education	84 (89.4)	10 (10.6)	1
Marital status
Single	7 (77.8)	2 (22.2)	1
Married	255 (84.7)	46 (15.3)	0.631 (0.127, 3.135)	0.574	NA
Others	11 (84.6)	2 (15.4)	0.636 (0.072, 5.613)	0.684	NA
Family monthly income (USD)
≤20	28 (84.8)	5 (15.2)	0.778 (0.276, 2.193)	0.635	NA
21–40	66 (86.8)	10 (13.2)	0.660 (0.302, 1.443)	0.298	NA
41–60	24 (88.9)	3 (11.1)	0.545 (0.153, 1.937)	0.348	NA
61–80	33 (89.2)	4 (10.8)	0.528 (0.173, 1.612)	0.262	NA
>80	122 (81.3)	28 (18.7)	1
Gravidity
Primigravida	121 (89.0)	15 (11.0)	1
Multigravida	152 (81.3)	35 (18.7)	1.857 (0.969, 3.559)	0.062	0.974 (0.337, 2.820)	0.962
Parity
Nullipara	121 (89.0)	15 (11.0)	1
Primipara	85 (79.4)	22 (20.6)	2.088 (1.024, 4.257)	0.043	1.777 (0.661, 4.772)	0.254
Multipara	67 (83.8)	13 (16.3)	1.565 (0.703, 3.485)	0.273	1.272 (0.431, 9.373)	0.372
Gestational period
1–3 months	31 (88.6)	4 (11.4)	1
4–6 months	83 (80.6)	20 (19.4)	1.867 (0.591, 5.898)	0.287	NA
7–9 months	159 (85.9)	26 (14.1)	1.267 (0.413, 3.887)	0.679	NA
Current symptoms of UTI
Yes	58 (73.4)	21 (26.6)	2.684 (1.427, 5.050)	0.002	1.219 (0.492, 3.023)	0.669
No	215 (88.1)	29 (11.9)	1
History of UTI
Yes	66 (63.5)	38 (36.5)	9.932 (4.904, 20.114)	0.000	8.824 (3.769, 20.654)	0.000*
No	207 (94.5)	12 (5.5)	1
History of catheterization
Yes	27 (58.7)	19 (41.3)	5.584 (2.785, 11.197)	0.000	3.270 (1.316, 8.122)	0.011*
No	246 (88.8)	31 (11.2)	1
History of DM
Yes	5 (71.4)	2 (28.6)	2.233 (0.421, 11.844)	0.345	NA
No	268 (84.8)	48 (15.2)	1
History of HIV/AIDS
Yes	15 (75.0)	5 (25.0)	1.911 (0.662, 5.519)	0.231	1.301 (0.326, 5.191)	0.709
No	258 (85.1)	45 (14.9)	1
History of hospitalization (last 3 months)
Yes	11 (64.7)	6 (35.3)	3.248 (1.143, 9.233)	0.027	2.999 (0.735, 12.235)	0.126
No	262 (85.6)	44 (14.4)	1
History of antibiotic use (last 3 months)
Yes	35 (71.4)	14 (28.6)	2.644 (1.297, 5.390)	0.007	1.342 (0.524, 3.435)	0.539
No	238 (86.9)	36 (13.1)	1
Previous use of contraceptives
Hormonal	195 (87.8)	27 (12.2)	0.570 (0.293, 1.109)	0.098	0.486 (0.202, 1.166)	0.106
IUD	8 (57.1)	6 (42.9)	3.088 (0.945, 10.088)	0.062	2.343 (0.487, 11.273)	0.288
No	70 (80.5)	17 (19.5)	1
Genitourinary abnormality
Yes	42 (73.7)	15 (26.3)	2.357 (1.184, 4.692)	0.015	2.343 (0.487, 11.273)	0.288
No	231 (86.8)	35 (13.2)	1

Note: *Statistically significant at P<0.05.

Abbreviations: SB, significant bacteriuria; AOR, adjusted odds ratio; COR, crude odds ratio; 1, reference group; 95% CI, 95% confidence interval; DM, diabetic mellitus; UTI, urinary tract infection; NA, not applicable.

Table 3 Frequency of Bacterial Uropathogens of Symptomatic and Asymptomatic UTI Among Pregnant Women Attending ANC at DRH, Northeastern Ethiopia

Bacterial Isolates	Asymptomatic (n=244) No. (%)	Symptomatic (n=79) No. (%)	Total (n=323) No. (%)
Gram negative	10 (50.0)	10 (50.0)	20 (39.2)
E. coli	9 (30.0)	8 (38.1)	17 (33.3)
K. pneumoniae	1(3.3)	1 (4.8)	2 (3.9)
Enterobacter species	0 (0)	1 (4.8)	1 (2.0)
Gram positive	20 (64.5)	11 (35.5)	31 (60.8)
S. aureus	8 (26.6)	6 (28.6)	14 (27.5)
CoNS	10 (33.3)	5 (23.8)	15 (30.0)
S. agalactiae	2 (6.7)	0 (0)	2 (3.9)
Total	30 (58.8)	21 (41.2)	51 (100)

Table 4 Antimicrobial Susceptibility Pattern of Gram-Negative Bacteria (n=20) Isolated from Urine Culture Among Pregnant Women (n=323) at DRH, Northeastern Ethiopia

Isolates (n)	Pattern	Antimicrobial Agents
		CIP	TTC	SXT	F	NOR	CRO	AMC	CTX	CAZ	AMP	AMK	GN
E. coli (17)	S	12 (70.6)	8 (47.1)	11(64.7)	12(70.6)	13(76.5)	12(70.6)	7 (41.2)	5 (29.4)	13 (76.5)	2 (11.8)	11(64.7)	9 (52.9)
	I	0 (0.0)	0 (0.0)	0 (0.0)	1 (5.9)	0 (0.0)	0 (0.0)	5 (29.4)	7 (41.2)	2 (11.8)	4 (23.5)	0 (0.0)	2 (11.8)
	R	5 (29.4)	9 (52.9)	6 (35.3)	4 (23.5)	4 (23.5)	5 (29.4)	5 (29.4)	5 (29.4)	2 (11.8)	11(64.7)	6(35.3)	6 (35.3)
K. pneumoniae (2)	S	0 (0.0)	1 (50.0)	0 (0.0)	1 (50.0)	1 (50.0)	1 (50.0)	0 (0.0)	0 (0.0)	1 (50.0)	0 (0.0)	0 (0.0)	0 (0.0)
	I	1 (50.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	1 (50.0)	0 (0.0)	0 (0.0)	1 (50.0)	0 (0.0)
	R	1 (50.0)	1 (50.0)	2(100.0)	1 (50.0)	1 (50.0)	1 (50.0)	2(100.0)	1 (50.0)	1 (50.0)	2 (100.0)	1 (50.0)	2(100.0)
Enterobacter species (1)	S	1 (100.0)	1(100.0)	0 (0.0)	1(100.0)	1(100.0)	1(100.0)	1(100.0)	1(100.0)	1 (50.0)	0 (0.0)	0 (0.0)	0 (0.0)
	I	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	1(100.0)	1(100.0)	0 (0.0)
	R	0 (0.0)	0 (0.0)	1(100.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
Total (20)	S	13 (65.0)	10 (50.0)	11(55.0)	14(70.0)	15(75.0)	14(70.0)	8 (40.0)	6 (30.0)	15 (75.0)	2 (10.0)	11(55.0)	9 (45.0)
	I	1 (5.0)	0 (0.0)	0 (0.0)	1 (5.0)	1 (5.0)	0 (0.0)	5 (25.0)	8 (40.0)	2 (10.0)	5 (25.0)	2 (10.0)	2 (10.0)
	R	6(30.0)	10 (50.0)	9 (45.0)	5 (25.0)	5 (25.0)	6 (30.0)	7 (35.0)	6 (30.0)	3 (15.0)	13(65.0)	7 (35.0)	9 (45.0)

Abbreviations: CIP, ciprofloxacin; TTC, tetracycline; SXT, trimethoprim-sulfamethoxazole; F, nitrofurantoin; NOR, norfloxacin; CRO, ceftriaxone; AMC, amoxicillin-clavulanic acid; CTX, cefotaxime; CAZ, ceftazidime; AMP, ampicillin; AMK, amikacin; GN, gentamicin; R, resistant; I, intermediate; S, sensitive.

Table 5 Antimicrobial Susceptibility Pattern of Gram-Positive Bacteria (n=31) Isolated from Urine Culture Among Pregnant Women (n=323) at DRH, Northeastern Ethiopia

Isolates (n)	Pattern	Antimicrobial Agents
		CL	E	PEN	CAF	CIP	TTC	SXT	F	NOR	CRO	AMP	VA
S. aureus (14)	S	12 (85.7)	2 (14.3)	0 (0.0)	10(71.4)	10 (71.4)	4 (28.6)	2 (14.3)	14 (100.0)	11 (78.6)
	I	0 (0.0)	5 (35.7)	0 (0.0)	1 (7.1)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	1 (7.1)	NT	NT	NT
	R	2 (14.3)	7 (50.0)	14 (100.0)	3 (21.4)	4 (28.9)	10 (71.4)	12 (85.7)	0 (0.0)	2 (14.3)
CoNS (15)	S	10 (66.7)	5 (33.3)	2 (13.3)	7 (46.7)	10 (66.7)	8 (53.3))	4 (26.7)	15(100.0)	11 (73.3)
	I	0 (0.0)	3 (20.0)	0 (0.0)	1 (6.7)	1 (6.7)	0 (0.0)	0 (0.0)	0 (0.0)	2 (13.3)	NT	NT	NT
	R	5 (33.3)	7 (46.7)	13 (86.7)	7 (46.7)	4 (26.7)	7 (46.7)	11 (73.3)	0 (0.0)	2 (13.3)
S. agalactiae (2)	S	1 (50.0)	1 (50.0)	0 (0.0)	2(100.0)		1 (50.0)				2(100.0)	1(50.0)	2(100.0)
	I	0 (0.0)	1 (50.0)	0 (0.0)	0 (0.0)	NT	0 (0)	NT	NT	NT	0 (0.0)	0 (0.0)	0 (0.0)
	R	1 (50.0)	0 (0.0)	2 (100.0)	0 (0.0)		1 (50.0)				0 (0.0)	1(50.0)	0 (0.0)
Total (31)	S	23 (74.2)	8 (25.8)	2 (6.5)	19(61.3)	20 (70.0)	13 (42.0)	6 (20.7)	29 (100.0)	22 (75.9)	2(100.0)	1(50.0)	2(100.0)
	I	0 (0.0)	9 (29.0)	0 (0.0)	2 (6.5)	1 (3.4)	0 (0.0)	0 (0.0)	0 (0.0)	3 (10.3)	0 (0.0)	0 (0.0)	0 (0.0)
	R	8 (25.8)	14 (45.2)	29 (93.5)	10(32.3)	8(27.6)	18 (58.0)	23 (79.3)	0 (0.0)	4 (13.8)	0 (0.0)	1(50.0)	0 (0.0)

Abbreviations: CoNS, coagulase-negative staphylococci; CL, clindamycin; E, erythromycin; PEN, penicillin; CAF, chloramphenicol; CIP, ciprofloxacin; TTC, tetracycline; SXT, trimethoprim-sulfamethoxazole; F, nitrofurantoin; NOR, norfloxacin; CRO, ceftriaxone; AMP, ampicillin; VA, vancomycin; R, resistant; I, intermediate; S, sensitive; NT, not tested.

Table 6 Multidrug Resistance Patterns of Bacterial Isolates (n=51) from Pregnant Women (n=323) at DRH, Northeastern Ethiopia

Bacterial Isolates	Total (%)	Antimicrobial Resistance Pattern
		Ro	R1	R2	R3	R4	R5	MDR
Gram negatives	20 (39.2)	3(15.0)	2(10.0)	4 (20.0)	2 (10.0)	1 (5.0)	8 (40.0)	16 (80.0)
E. coli	17 (33.3)	3(17.6)	2(11.8)	3(17.6)	1 (5.9)	1 (5.9)	7 (41.2)	13 (76.5)
K. pneumoniae	2 (3.9)	0 (0.0)	0 (0.0)	0 (0.0)	1 (50.0)	0 (0.0)	1 (50.0)	2 (100.0)
Enterobacter spp.	1 (2.0)	0 (0.0)	0 (0.0)	1(100.0)	0 (0.0)	0 (0.0)	0 (0.0)	1 (100.0)
Gram positives	31 (60.8)	0 (0.0)	4 (12.9)	4 (12.9)	6 (19.4)	8 (25.8)	9 (29.0)	25 (80.6)
S. aureus	14 (27.5)	0 (0.0)	1 (7.1)	1 (7.1)	3 (21.4)	6 (42.9)	3 (21.4)	13(92.9)
CoNS	15 (29.4)	0 (0.0)	3 (20.0)	2 (13.3)	2 (13.3)	2 (13.3)	6 (40.0)	11 (73.3)
S. agalactiae	2 (3.9)	0 (0.0)	0 (0.0)	1 (50.0)	1 (50.0)	0 (0.0)	0 (0.0)	1 (50.0)
Total	51(100.0)	3 (5.9)	6 (11.8)	8 (15.7)	8 (15.7)	9 (17.6)	17(33.3)	41(80.4)^a

Notes: Non-susceptible to 1 agent in 3 antimicrobial categories. ^aPercent is computed from total number of isolates, based on which MDR definition is applied.

Abbreviations: R0, no antibiotic resistance; R1, resistance to one; R2, resistance to two; R3, resistance to three; R4, resistance to four; ≥ R5, resistance to five and more drugs; MDR, multidrug resistant.

Table 7 Prevalence of ESBL Production Among Gram-Negative Uropathogens Isolated from Pregnant Women at DRH, Northeastern Ethiopia

Bacterial Isolates	Total n (%)	ESBL Positive n (%)	ESBL Negative n (%)
E. coli	17 (89.5)	2 (11.8)	15 (88.2)
K. pneumoniae	2 (10.5)	1 (50.0)	1 (50.0)
Total n (%)	19 (100)	3 (15.8)	16 (84.2)

Abbreviation: ESBL, extended-spectrum beta-lactamase.

Table 8 Prevalence of ESBL-Producing Gram-Negative Bacterial Uropathogens vs Clinical Variables of Pregnant Women at DRH, Northeastern Ethiopia

Variables	ESBL Production		P-value
	ESBL Negative No. (%)	ESBL Positive No. (%)
Current symptom of UTI
Symptomatic	6 (66.7)	3 (33.3)	0.087
Asymptomatic	10 (100.0)	0 (00)
History of UTI
Yes	11 (78.6)	3 (21.4)	0.376
No	5 (100.0)	0 (0.0)
History of catheterization
Yes	5 (71.4)	2 (28.6)	0.296
No	11 (91.7)	1 (8.3)
History of diabetes mellitus
Yes	1 (100.0)	0 (0.0)	0.842
No	15 (83.3)	3 (16.7)
History of HIV/AIDS
Yes	1 (50.0)	1 (50.0)	0.298
No	15 (88.2)	2 (11.8)
History of hospitalization in the last 3 months
Yes	2 (40.0)	3 (60.0)	0.010*
No	14 (100.0)	0 (0.0)
History of antibiotic use in the last 3 months
Yes	4 (57.1)	3 (42.9)	0.036*
No	12 (100.0)	0 (0.0)
Genitourinary abnormality
Yes	5 (71.4)	2 (28.6)	0.296
No	11 (91.7)	1 (8.3)

Notes: Fisher’s Exact Test used. *Statistically significant at P<0.05.