Prevalence, Aetiological Agents and Antimicrobial Resistance Patterns of Urinary Tract Infections among Pregnant Women Attending Mother and Child Hospital, Akure, South-West Nigeria

Abstract

Background: Urinary tract infections (UTIs) remain an important obstetric concern because physiological changes during pregnancy increase susceptibility to bacterial colonisation and may contribute to adverse maternal and neonatal outcomes. Aims: This study determined the prevalence, aetiological agents and antimicrobial resistance patterns of UTIs among pregnant women attending Mother and Child Hospital, Akure, South-West Nigeria. Study Design: A cross-sectional, laboratory-based study. Place and Duration of Study: Mother and Child Hospital, Akure, Ondo State, Nigeria, from October to December 2023. Methodology: Two hundred midstream urine samples were collected from pregnant women aged 21–45 years who met the inclusion criteria. Participants were enrolled by simple random sampling. Samples were examined macroscopically and microscopically, cultured on CLED, blood and MacConkey agars, and isolates were identified using standard biochemical tests. Antimicrobial susceptibility testing was performed using the Kirby–Bauer disk diffusion method in accordance with CLSI (2024) guidelines. Results: Significant bacteriuria was recorded in 90 of 200 participants, giving a prevalence of 45%. Escherichia coli was the predominant isolate (57.7%), followed by Klebsiella pneumoniae (22.2%), Proteus mirabilis (16.6%) and Staphylococcus aureus (3.3%). The highest prevalence was observed among women aged 26–30 years (82.1%); the mean age was 32.85 ± 6.13 years. Maternal age was significantly associated with UTI prevalence (χ² = 12.84, df = 4, p = 0.012). Higher in vitro sensitivity was observed to 82% nitrofurantoin and 75% gentamicin. 87% ofloxacin and 60% streptomycin showed in vitro activity, they are clinically restricted or contraindicated in this cohort due to established foetal toxicities. Notable resistance was recorded against amoxicillin (66%), cotrimoxazole (69%), cefuroxime (64%), Augmentin (58), chloramphenicol (63%), ceftriaxone (54%), pefloxacin (57%) and erythromycin (73%). All isolates had MAR indices >0.2. Conclusion: UTIs were common among the pregnant women and were mainly associated with multidrug-resistant Gram-negative bacteria, particularly Escherichia coli. Routine antenatal screening, susceptibility-guided treatment with emphasis on safe first-line antibiotic such as nitrofurantoin and antimicrobial stewardship are important in reducing maternal and neonatal complications among pregnant women.