Antimicrobial susceptibility and risk factors of asymptomatic bacteriuria among pregnant women attending antenatal care at public health facilities in Debre Markos town, Northwest Ethiopia.

backgroundIn pregnant women, asymptomatic bacteriuria is a public health problem. Untreated asymptomatic bacteriuria is the primary cause of cystitis and pyelonephritis, which increase prenatal mortality and morbidity. Limited research has been conducted on asymptomatic bacteriuria in our study setting. Thus, this study aimed to assess antimicrobial susceptibility and risk factors of asymptomatic bacteriuria among pregnant women who attended antenatal care at public health facilities in Debre Markos town, Northwest Ethiopia.

methodsUsing a consecutive convenience sampling technique, an institutionally based cross-sectional study was carried out in Debre Markos town's health facilities between May 1, 2023, and July 30, 2023. Pretested structured questionnaires were used to collect clinical and sociodemographic data. Additionally, a sterile container was used to collect the midstream urine sample, which was then inoculated onto sheep blood agar, MacConkey agar (MAC), and cysteine-lactose-electrolyte-deficient agar (CLED). Gram stain, biochemical tests, and colony morphology were used to identify and characterize the isolates. On Mueller-Hinton agar (MHA), the disk diffusion method was used to determine the antimicrobial susceptibility pattern. EpiData 3.0 was used to enter the data. Finally, bivariable and multivariable logistic regression was performed via SPSS version 23 to identify related factors, with a P value < 0.05 being deemed statistically significant.

resultsThe overall prevalence of asymptomatic significant bacteriuria (ASB) among study participants was 30/185 (16.2%; 95% CI 10.8-21.6). Escherichia coli (E. coli) 13/30 (43.3%) is the predominant isolates, and followed by Staphylococcus aureus (S. aureus) accounting for 10/30 (33.3%), Coagulase-negative Staphylococcus (CoNS) 6/30 (20.0%), and Pseudomonas aeruginosa (P. aeruginosa) 2/30 (3.3%) decreasingly. Six (100%) CoNS isolates were susceptible to norfloxacin, trimethoprim-sulfamethoxazole, tetracycline, and nitrofurantoin. About 11/13 (84.6%) of E. coli was susceptible to ceftriaxone, imipenem, gentamicin, and norfloxacin. In contrast, E. coli was resistant to cefuroxime 6/13 (54.5%) and amoxicillin-clavulanic acid 9/13 (69.2%). Despite this, only a few number of P. aeruginosa strains were isolated, and were 100% susceptible to amoxicillin-clavulanic acid, ciprofloxacin, meropenem, and norfloxacin. Asymptomatic bacteriuria was significantly associated with a history of UTI (AOR = 7.281; 95% CI: 2.53-20.96; P = 0.001), catheterization (AOR = 6.985; 95% CI: 1.61-28.91; P = 0.007), diabetes mellitus (AOR = 5.009; 95% CI: 1.55-16.19; P = 0.007), and vaginal douching (AOR = 3.125; 95% CI: 1.10-8.92; P = 0.033) by considering P < 0.05 as significant association.

conclusionASB prevalence was 16.2%; E. coli was the predominant isolate; the MDR rate was 40%. Diabetes, vaginal douching, catheterization, and prior UTI were associated with ASB. Routine urine culture should be considered for targeted screening and culture-guided therapy for high-risk groups. Further studies are needed to evaluate prophylaxis and treatment outcomes.