Extended Spectrum Beta-Lactamase (ESBL) Producing Uropathogens in Pregnancy

Aims & Objectives: 1.To isolate the uropathogens from cases of asymptomatic bacteriuriain pregnancy. 2.Estimate rate of incidence of culture proven cases of asymptomatic urinary tract infection.3.To carry out antimicrobial susceptibility testing of these isolates to commonly used antimicrobials & find out their ability to produce ESBL.Methodology:Urine sample was collected from antenatal women attending January 2018 to November 2018 pregnant women's attending antenatal clinic in BKL Walawalkar Rural Hospital at OBGY department were included in study. The recovered isolates which fit into inclusion criteria are first identified using standard bacteriological techniques and are subjected to antimicrobial sensitivity testing to commonly used urinary antimicrobials The microorganisms isolated from these sample were also subjected to detection of ESBL production by standard disc diffusion testing method/ disc potentiation test.Results: A total of 180 pregnant ladies were enrolled during study period, urine sample was collected from them, out of this 180 samples, 33 (18.33%) were found to be culture positive cases of significant asymptomatic urinary tract infection. The different etiological agents were isolated during this study such as Escherichia coli (n=18) , Klebsiella species (n=8), Pseudomonas aeruginosa,pseudomonas species staphylococcus aureus and candida albicans. Antimicrobial susceptibility testing and detection of ESBL production were carried out in these different isolates surprisingly we found 15 (54%) isolates were ESBL positive. It was observed in study that some antimicrobial agents like, Fosfomycin (92.85%), Amoxicillin clavulanic acid (89.28%) & Cefuroxime (60.71%), Ceftazidime (57.14%), Cefotaxime (53.71%) & Nitrofurantoin (50%) were showed high resistance pattern in vitro.Conclusion:Urinary tract infection is one of the most common infection in pregnancy .The urinary tract infection is often asymptomatic in pregnant women's. It was observed that significant proportion of pregnant women's had significant asymptomatic bacteriuria.The isolates showed huge percentage of ESBL Producers .which was alarming. Our study focus on need of careful screening antenatal women's for asymptomatic bacteriuria and also emphasizes the need for microbiology laboratories to adequately screen for ESBL-producing strains of the family Enterobacteriaceae, to avoid post partum complications in mother as well as new born.