Kalifa Sanneh Darboe

Background/Objectives: Urinary tract infections (UTIs) can predispose women to preeclampsia and prematurity, which are common causes of maternal and neonatal morbidity and mortality. In low-middle-income countries (LMICs), the capacity for screening and treating UTIs is limited. In sub-Saharan Africa, AMR surveillance data are scarce, especially in vulnerable populations such as pregnant women. The aim of this study was to determine the prevalence and antimicrobial resistance patterns of community-acquired urinary tract infections among pregnant women attending the antenatal clinics of three hospitals in Gambia. Methods: This was a hospital-based, cross-sectional, multicenter study conducted between November 2022 and January 2023. Patient information was obtained via a pre-tested questionnaire. The urine samples were analyzed via Gram staining and biochemical tests to determine the causative organisms. We also used antibiotic sensitivity testing to identify resistance patterns. The data collected were analyzed via SPSS version 20 and tested for associations at a significance level of p ≤ 0.05. Results: The prevalence of significant bacteriuria was 5% (n=100). Escherichia coli (40%) and Staphylococcus aureus (40%) were the most common uropathogens. The prevalence of resistance was found for trimethoprim/sulfamethoxazole and ampicillin, and multi-drug resistance was detected in only one isolate (Citrobacter freundii). Conclusion: This study revealed bacterial isolates with prevalent resistance to commonly prescribed drugs for community-acquired UTIs in pregnant women and suggested alternatives such as ceftriaxone, nitrofurantoin, erythromycin, and nalidixic acid as empirical treatment options. We recommend consistent health to combat drug resistance caused by inappropriate antibiotic use.

Background: Antimicrobial resistance poses a public health threat for the treatment of community-acquired urinary tract infections. This study determined the susceptibility patterns of uropathogens and associated risk factors among outpatients diagnosed with urinary tract infections at the Kanifing General Hospital in the Gambia. Methods: A cross-sectional analytic study was conducted among patients with suspected urinary tract infections at Kanifing General Hospital from March to May 2021. Data on socio-demographic and other risk factors were collected from the study participants using a structured pre-tested questionnaire. Mid-stream urine samples were collected, and bacteria identification and antimicrobial susceptibility testing done using standard microbiological methods. Descriptive and inferential statistical analysis were done to determine factors associated with urinary tract infection at 95% confidence level and a p -value < 0.05. Results: A total of 422 patients were enrolled with 82.5% (348/422) being females. The prevalence of community acquired urinary tract infection was 12.8% (54/422). Escherichia coli was the most prevalent isolate (74.1%, 40/54), followed by Klebsiella spp (8.5%, 10/54). Antimicrobial resistance was highest for Ampicillin (87.0%, 47/54), Trimethoprim/Sulfamethoxazole (77.8%, 42/54) and Tetracycline (75.9%, 41/54). Uropathogens sensitivity was 77.8% (42/54) for Nitrofurantoin and 75.9% (41/54) for Ceftazidime. Being female (aOR 5.90 95% CI = 1.48–23.67), previous history of urinary tract infection (aOR 2.34, 95% CI = 1.06–5.14), use of unprescribed antibiotics (aOR 2.0, 95% CI = 1.05–3.62) and having no formal education (aOR 8.02, 95% CI = 1.04–62.0) were significant factors associated for having uropathogenic bacterial infection. Conclusion: E. coli was the most prevalent uropathogen isolated. Ciprofloxacin, Nitrofurantoin and Ceftazidime were the most sensitive antibiotics. Routine surveillance of susceptibility of uropathogenic bacteria would be helpful to update clinicians on the choice of antibiotics.