Epidemiology and Risk Factors for Multi-drug Resistant Bacterial Urinary Tract Infections among Pregnant Women in Qatar

Sufia Athar¹, Adila Shaukat², Lolwa Mohammad Ansari¹

Department of Obstetrics and Gynecology, AWH, Qatar

Department of Infectious Diseases, AWH, Qatar

Abstract

Objective: Infections caused by multiple drug-resistant organisms are on the rise worldwide. Urinary tract infections (UTI) are one of the commonest infections in pregnancy. These infections are known to be associated with poor feto-maternal outcomes. UTIs caused by drug-resistant organisms (MDRO) have a higher likelihood of complications like pyelonephritis and sepsis in the mother and adverse neonatal outcomes. Hence a clinical survey was conducted to assess the epidemiology and risk factors associated with UTIs caused by drug-resistant organisms. 

Design: A case-control study

Methods: A case-control study was conducted at a secondary hospital. Women delivered between 2016-2019 were included. All patients with UTI caused by multiple drug-resistant organisms were included in the study and control patients were selected with random sampling. The prevalence of urinary tract infections and UTIs caused by multiple drug-resistant organisms during pregnancy was assessed. Epidemiological and risk factors were observed in women with UTI caused by MDRO and compared with women with UTI caused by non-MDRO. The odds ‘ratio was calculated for statistical analysis. 

Results: 21520 women delivered between 2016-2019. The overall prevalence of UTI in pregnancy was 1.88%. Out of these 11.88% had UTIs caused by drug-resistant organisms. 72.92% of these were caused by extended-spectrum β-lactamases producing Escherichia coli.  Nulliparity, maternal age of more than 30 years and infections in the third trimester were identified as epidemiological factors for MDRO-associated UTIs. Body mass index of more than 30 kg/m2 (OR-3.13, 95% CI-1.51-6.51, P<0.05), maternal anemia (OR-4.26, 95% CI-2.05-8.85,P<0.05), multiple catheterizations in labor  (OR-2.27, 95% CI-1.03-5.02,P<0.05) and prolonged catheterization(OR-2.23, 95% CI-1.03-4.81,P<0.05)  had positive co-relation with MDRO UTIs. Gestational diabetes and multiple vaginal examinations in labour were noted to have a higher likelihood for MDRO UTIs but the results were not statistically significant(p<0.05). 

Conclusions: High prevalence of MDRO-associated UTIs was noted despite complying with the anti-microbial stewardship best practice guidelines in the country. Identifying the risk factors would aid in the appropriate management and follow-up of these cases to reduce pregnancy complications.