Vol 8, Issue 1, 2015 ISSN - 0974-2441 PREVALENCE OF EXTENDED SPECTRUM BETA LACTAMASE PRODUCING UROPATHOGENS IN PREGNANT WOMEN REKHA THAPA 1 *, PRAMILA LAMICHHANE 2 *, MEGHA RAJ BANJARA 1 , GANESH PRASAD ACHARYA 3 1 Department of Microbiology, Tribhuvan University, Kathmandu, Nepal. 2 Department of Microbiology, Universal College of Medical Sciences, Bhairahawa, Nepal. 3 Department of Pathology, Paropakar Maternity and Women’s Hospital, Thapathali, Kathmandu, Nepal. Email: thaparekha101@yahoo.com Received: 07 November 2014, Revised and Accepted: 22 November 2014 ABSTRACT Objective: This study aims to determine the prevalence of urinary tract infection (UTI) among pregnant women and multidrug-resistant (MDR) uropathogens with reference to extended spectrum beta-lactamase (ESBL) producers. Methods: Three hundred urine specimens collected from pregnant women were studied. A semi-quantitative method was used for diagnosis of UTI. Isolation, identification, and antimicrobial susceptibility of an organism was done by standard microbiological procedure. ESBLs production was detected by double-disc synergy test method. Results: UTI was found among 30.5% of pregnant women. Among 137 Gram-negative bacterial isolates, 72.0% were found to be MDR while only 7.30% were ESBL producers. Among total of Escherichia coli and Klebsiella pneumoniae isolates, 7.69% and 15.38%, respectively, were found to be ESBL producers. Parity (odds ratio [OR]: 1.58, p<0.05), education status (OR: 4.07, p<0.01), occupation of pregnant women (OR: 1.86, p<0.05), times of bathing (OR: 3.45, p<0.01), history of UTI (OR: 20.79, p<0.01) were found to be significantly associated with UTI from both univariate and multivariate analysis. Gentamicin, nitrofurantoin, ceftazidime, and amikacin were found to be the most effective antibiotic against uropathogens. Conclusion: Frequent and consistent evaluation of the prevalence, etiologic agents, and predisposing factors of UTI during pregnancy is necessary in developing countries like Nepal in order to reduce its devastation effects during pregnancy on both maternal and fetal health. It is essential to have a regular and routine monitoring of ESBL producing clinical isolates in laboratory practice. Keywords: Pregnant women, Urinary tract infection, Multidrug resistance, Extended spectrum beta-lactamase. INTRODUCTION Urinary tract infection (UTI) is the second most common infectious presentation in the community affecting all age group across the life span. Worldwide, about 150 million people are diagnosed with UTI each year, costing the global economy in excess of six billion US dollars [1]. UTI is common during pregnancy due to a number of factors including ureteral dilatation, increased bladder volume and decreased bladder tone, along with decreased ureteral tone which contributes to increased urinary stasis and ureterovesical reflux [2]. Up to 70% of pregnant women develop glycosuria, which encourages bacterial growth in the urine [3]. Although UTI may be caused by any pathogen that colonizes the urinary tract (e.g., fungi, parasites, and viruses), most causative agents are bacteria of enteric origin [4]. The bacteria causing UTI in pregnancy essentially mirror those in non- pregnant patients [5]. UTI during pregnancy has been associated with complications such as pyelonephritis, hypertensive disease of pregnancy, anemia, chronic renal failure, premature delivery, and fetal mortality [6,7]. Uropathogens have shown a slow but steady increase in resistance to several antibiotics over the last decades. Extended-spectrum beta- lactamases (ESBL) producing enterobacteriaceae are among the most problematic multidrug resistance (MDR) bacteria worldwide [8] and are increasingly causing UTI both in hospitalized patients and outpatients making infections difficult to treat [9]. ESBLs are the beta-lactamases capable of hydrolyzing penicillin, broad-spectrum cephalosporins, and monobactams, and are generally derived from TEM and SHV-type enzymes but do not effect cefamycins and carbapenems. ESBLs are often located on plasmids that are transferable from strain to strain and between bacterial species [10]. Delay in the detection and reporting of ESBL production by Gram- negative bacilli (GNB) is associated with prolonged hospital stay, increased morbidity, mortality, and health-care costs [11]. Frequent and consistent evaluation of the prevalence, etiologic agents, and predisposing factors of UTI during pregnancy is necessary in developing countries like Nepal in order to reduce its devastation effects during pregnancy on both maternal and fetal health. It is essential to have a regular and routine monitoring of ESBL producing clinical isolates in laboratory practice where there is excessive use of antibiotics and lack of adequate antimicrobial resistance surveillance. MATERIALS AND METHODS Across sectional descriptive study was done from June to December 2010 among 300 pregnant women attending their antenatal checkup at Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal. Structured questionnaires were used to collect demographic data, behavioral characteristics, and history of the patient. Midstream urine was collected and processed in the microbiology laboratory. Semi-quantitative culture technique was used to detect the presence of significant bacteriuria. Culture was done on blood Agar (Hi-Media, India) and McConkey Agar (Hi-Media, India). Diagnosis of UTI was made when there were at least 10 5 organisms/ml of urine. A single isolated colony was considered for further studies, and identification was done using standard conventional, morphological, cultural, and biochemical tests [12]. Antibiotics susceptibility testing of GNB was performed by Kirby-Bauer disc diffusion method following CLSI recommendation. The antibiotic discs (Hi-Media, India) used were gentamicin (10 µg), amikacin (30 µg), cephalexin (30 µg), ceftazidime (30 µg), cefotaxime (30 µg), ciprofloxacin (5 µg), ofloxacin (5 µg), norfloxacin (10 µg), ampicillin (10 µg), cotrimoxazole (25 µg), and nitrofurantoin (300 µg). Research Article