ESBL Mediated Antimicrobial Nonsusceptibility of Uropathogenic Escherichia coli and Klebsiella pneumoniae Isolates from Pregnant Women in Nnewi, Nigeria

Abstract

Background and Objective: Extended Spectrum β-lactamase (ESBL) producing Urinary Tract Infection (UTI) is an important public health issue due to lack of therapeutic antibiotic options and the danger it portends to the pregnant woman. This study was carried out to determine the prevalence and response to antimicrobials of ESBL-producing uropathogenic E. coli and K. pneumoniae, among pregnant women on ante natal care. Study Design/Materials and Methods: Two hundred and fifteen pregnant women across three different hospitals in Nnewi North L.G.A of Anambra State were screened for these uropathogens. Modified Double Disc Synergy test (MDDST) was carried out on the isolates to phenotypically determine the presence of ESBL. Plasmid profiling as well as plasmid curing studies were undertaken. Molecular characterization of the phenotypically confirmed ESBL positive isolate via Polymearse Chain Reaction (PCR) was carried out using three ESBL primers (bla-TEM, bla-SHV, bla-CTX-M). Results: 192 isolates were obtained of which 75(39.1%) were E. coli and 117(60.9%) were K. pneumoniae. A total of 130 (67.7%) of the pregnant women had ESBL-mediated UTI, the highest rate reported in recent times in Nigeria. Molecular characterization of the ESBL types revealed a predominance of bla-TEM (91.9%), followed by bla-SHV (73.3%) and bla-CTX-M (56.8%). Conclusion: The Majority of the isolates harbored multiple ESBL genes. Curing studies were largely ineffectual as most of the isolates retained their resistance determinants regardless of the concentration of the curing agent (acridine orange).