Antimicrobial resistance among pregnant women with urinary tract infections attending antenatal clinic at Levy Mwanawasa university teaching hospital Lusaka, Zambia

Abstract

Introduction: Globally, bacterial infections are a major cause of morbidity and mortality, particularly in low income countries. The global emergence of antimicrobial resistance undermines the management of infectious diseases. Internationally, there is a growing concern over antimicrobial resistance (AMR) which is currently estimated to account for more than 700, 000 deaths per year worldwide. Objectives: The main objective of this research was to determine the prevalence of antimicrobial resistance (AMR) and factors associated with AMR among pregnant women with Urinary Tract Infections (UTIs) attending antenatal clinic at Levy Mwanawasa University Teaching Hospital (LMUTH), Lusaka Zambia. Methodology: This was a hospital based, cross sectional study conducted at levy Mwanawasa University Teaching Hospital among pregnant women attending antenatal clinic. Interviewer administered questionnaire was used to assess the socio-demographic characteristics. Basic descriptive statistics (proportions, mean) of study participants were used to describe the characteristics of the variables of respondents. Categorical variables were summarized in the form of numbers and percentages and presented in table format. Chi square was used to assess the association between categorical variables. The logistic regression analysis was carried out to generate the adjusted odds ratio with 95% confidence interval. Results: The prevalence of UTI was 60% (95% CI,53.3%-66.7%) with the most isolated bacteria being E. coli (59), Staphylococcus aureus (17) and Klebsiella (21). There was significant association between gestational age and HIV with UTI. The prevalence of AMR was found to be 53% (95% CI,46.1%-59.8%). The highest resistant drugs being Nalidixic acid (88.3%), Norfloxacine (58.5%) and ampicillin (77.8%), the least resistant were chloramphenicol (20%), ciprofloxacin (30.5%) and nitrofurantoin (40%). There were no significant predictor variables to AMR. Conclusion: Generally, a much higher prevalence of UTI than most studies undertaken has been found in this study, indicative of the level of menace urinary tract infections. Therefore, early screening of pregnant women for UTI causing uropathogens and determining their antibiotic susceptibility pattern is an important intervention to prevent complications that may endanger the life of both the pregnant women and the fetus. The prevalence of AMR was as well high. This is attributed to the misuse of drugs hence need to re-enforce prescription-only policies and implementing antimicrobial stewardship programmes least we be in an error in which we have ineffective antibiotics. Key words: Antimicrobial resistance (AMR), Susceptibility patterns, Urinary tract infections (UTI), Prevalence, Bacterial uropathogen