The status of antibiotic resistance in bacteria causing complicated urinary tract infections in pregnant women with urolithiasis
DOI:
https://doi.org/10.37800/RM.3.2026.686Keywords:
drug resistance, empirical treatment, microbial spectrum, complicated pregnancy, virulence factors, antibiotic susceptibilityAbstract
Relevance: Antimicrobial resistance among uropathogens in complicated urinary tract infections (UTIs) in pregnant women, especially when combined with urolithiasis, complicates the administration of empirical therapy and jeopardizes the safety of both the mother and the fetus, underscoring the need to update local microbiological data.
This study aimed to assess the nature and prevalence of antibiotic resistance among uropathogens causing complicated urinary tract infections associated with urolithiasis in pregnant women.
Materials and Methods: This retrospective descriptive analysis was conducted from June to September 2023 at a tertiary-level urology center in Kyrgyzstan. The study included 110 medical records of pregnant patients with clinically confirmed complicated pyelonephritis associated with urolithiasis. Urine cultures were performed on CLED agar, as well as on Endo and CHROMagar Orientation media. Microorganisms were identified using the VITEK 2 Compact system and biochemical tests. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method. ESBL production, multidrug resistance, and resistance to selected antimicrobial groups were analyzed using descriptive statistics and comparative tests in SPSS 25.0.
Results: Gram-negative bacteria predominated, especially Escherichia coli (45%), followed by Staphylococcus spp. (10.5%), Klebsiella spp. (10%), Pseudomonas aeruginosa (9%) and Staphylococcus aureus (5.5%). Among Enterobacteriaceae, 58.3% were ESBL producers and 41.7% were multidrug-resistant. The highest susceptibility was observed for fosfomycin, meropenem, and tobramycin (100%), followed by amikacin (85.5%) and levofloxacin (78.8%). Ampicillin, amoxicillin/clavulanate, and trimethoprim showed low activity (<30%).
Conclusion: The findings support local microbiological monitoring, avoidance of highly resistant empirical agents, and culture-guided therapy in pregnant women with complicated UTIs associated with urolithiasis.
References
1. Acharya S, Sajjad T, Rehman M, Shahsawar Z, Ermatova M. Comprehensive analysis of urinary tract infections: Etiology, risk factors, antibiotic resistance trends, and preventive strategies for improved patient outcomes in Jalalabad, Kyrgyzstan. Eur J Sci Multidiscipl Res. 2025;1(1):38-46.
https://doi.org/10.63666/ejsmr.1694-9013.1.I.2025.18
2. Gyawali M, Ermatova M, Khadka RR, Sajjad T, Rehman M, Shahsawar Z, Sadyrova A. Pregnancy characteristics and delivery outcomes of individual mothers hospitalized at Jalalabad, Kyrgyzstan. Eur J Theor Appl Sci. 2024;2(4):210-216.
https://doi.org/10.59324/ejtas.2024.2(4).17
3. Abdirasulova Zh, Manvendra S, Begmatova D, Bugubaeva M, Kalmatov R. Recurrent urinary tract infections in women: An observational study between Kyrgyzstan and India. Bull Osh State Univ Med. 2023;1(1):49-60.
https://doi.org/10.52754/16948831_2023_1(1)_7
4. Al Kadri HM, El-Metwally AA, Al Sudairy AA, Al-Dahash RA, Al Khateeb BF, Al Johani SM. Antimicrobial resistance among pregnant women with urinary tract infections is on rise: Findings from meta-analysis of observational studies. J Infect Public Health. 2024;17(7):102467.
https://doi.org/10.1016/j.jiph.2024.05.055
5. Ali A, Reda D, Ormago M. Prevalence and antimicrobial susceptibility pattern of urinary tract infection among pregnant women attending Hargeisa Group Hospital, Hargeisa, Somaliland. Sci Rep. 2022;12:1419.
https://doi.org/10.1038/s41598-022-05452-z
6. Yeta K, Michelo C, Jacobs C. Antimicrobial resistance among pregnant women with urinary tract infections attending antenatal clinic at Levy Mwanawasa University Teaching Hospital (LMUTH), Lusaka, Zambia. Int J Microbiol. 2021;2021:8884297.
https://doi.org/10.1155/2021/8884297
7. Belete M, Saravanan M. A systematic review on drug-resistant urinary tract infection among pregnant women in developing countries in Africa and Asia; 2005-2016. Infect Drug Resist. 2020;13:1465-1477.
https://doi.org/10.2147/IDR.S250654
8. Johnson B, Stephen B, Joseph N, Asiphas O, Musa K, Taseera K. Prevalence and bacteriology of culture-positive urinary tract infection among pregnant women with suspected urinary tract infection at Mbarara regional referral hospital, South-Western Uganda. BMC Pregn Childbirth. 2021;21(1):159.
https://doi.org/10.1186/s12884-021-03641-8
9. Министерство здравоохранения КР. Положение о Республиканском научном центре урологии при Национальном госпитале при Министерстве здравоохранения [Интернет]. Информационная система КОНТИНЕНТ; 2005 [дата доступа: 03.02.2026]. Адрес доступа:
Ministry of Health of the Kyrgyz Republic. Regulation on the Republican Scientific Center of Urology at the National Hospital under the Ministry of Health [Internet]. Information system CONTINENT; 2005 [cited 2026 Feb 3]. Russian. Available from:
https://continent-online.com/Document/?doc_id=30304951#pos=1;-122
10. World Medical Association. WMA Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Participants [Internet]. Wma.net. WMA - the World Medical Association-WMA Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Participants; 2024. Available from:
https://www.wma.net/policies-post/wma-declaration-of-helsinki/
11. World Health Organization. ICD-10 Version: 2019 [Internet]. ICD-10 Version: 2019. Available from:
https://icd.who.int/browse10/2019/en
12. IBM. SPSS Statistics [Internet]. IBM. www.ibm.com; 2024. Available from:
https://www.ibm.com/products/spss-statistics
13. Mahamane Salissou MT. Antimicrobial resistance patterns of urinary tract infection organisms isolated from pregnant women’s urinary samples at Lancet Clinical Laboratories in Zimbabwe, 2021. J Midwifery. 2023;8(2):113-120.
https://doi.org/10.25077/jom.8.2.113-120.2023
14. Al-Shahrani G, Belali T. Frequency of drug-resistant bacterial isolates among pregnant women with UTI in maternity and children’s hospital, Bisha, Saudi Arabia. Sci Rep. 2024;14(1):7397. https://doi.org/10.1038/s41598-024-58275-5
15. Patnool R, Wadhwani A, Balasubramaniam V, Ponnusankar S. Antimicrobial resistance and implications: Impact on pregnant women with urinary tract infections. Pure Appl Microbiol. 2022;16(2):769-781.
https://doi.org/10.22207/jpam.16.2.20.
16. Anton G, Gheorghe L, Radu V, Scripcariu I, Vasilache I, Cărăuleanu A, Condriuc I, Socolov R, Onofrei P, Pruteanu A, Ursu R, Gisca T, Socolov D. Multidrug-resistant urinary tract infections in pregnant patients and their association with adverse pregnancy outcomes – A retrospective study. J Clin Med. 2024;13(22):6664.
https://doi.org/10.3390/jcm13226664
17. Ghouri F, Hollywood A, Ryan K. ‘There is no choice apart from antibiotics…’: Qualitative analysis of views on urinary infections in pregnancy and antimicrobial resistance. Health Expect. 2020;23(3):644-650.
https://doi.org/10.1111/hex.13044
18. Abate D, Marami D, Letta S. Prevalence, antimicrobial susceptibility pattern, and associated factors of urinary tract infections among pregnant and non-pregnant women at public health facilities, Harar, Eastern Ethiopia: A comparative cross-sectional study. Can J Infect Dis Med Microbiol. 2020;2020:9356865.
https://doi.org/10.1155/2020/9356865
19. Emami A, Javanmardi F, Pirbonyeh N. Antibiotic-resistant profile of asymptomatic bacteriuria in pregnant women: A systematic review and meta-analysis. Expert Rev Anti Infect Ther. 2020;18(8):807-815.
https://doi.org/10.1080/14787210.2020.1759420
20. Denoble A, Reid H, Krischak M, Rosett H, Sachdeva S, Weaver K, Heine R, Dotters-Katz S. Bad bugs: Antibiotic-resistant bacteriuria in pregnancy and risk of pyelonephritis. Am J Obstet Gynecol MFM. 2022;4(2):100540.
https://doi.org/10.1016/j.ajogmf.2021.100540
21. Taha A. Bacteriological profile, antimicrobial susceptibility, and factors associated with urinary tract infection in pregnant women. J Infect Devel Countr. 2024;18(3):391-398. https://doi.org/10.3855/jidc.18239
22. Von Vietinghoff S, Shevchuk O, Dobrindt U, Engel D, Jorch S, Kurts C, Miethke T, Wagenlehner F. The global burden of antimicrobial resistance – Urinary tract infections. Nephrol Dial Transplant. 2023;39(4):581-588.
https://doi.org/10.1093/ndt/gfad233
23. Zhao F, Yang H, Bi D, Khaledi A, Qiao M. A systematic review and meta-analysis of antibiotic resistance patterns, and the correlation between biofilm formation with virulence factors in uropathogenic E. coli isolated from urinary tract infections. Microb Pathogen. 2020;144:104196.
https://doi.org/10.1016/j.micpath.2020.104196
24. Abbott I, Peel T, Cairns K, Stewardson A. Antibiotic management of urinary tract infections in the post-antibiotic era: A narrative review highlighting diagnostic and antimicrobial stewardship. Clin Microbiol Infect. 2023;29(10):1254-1266.
https://doi.org/10.1016/j.cmi.2022.05.016
25. Angulo-Zamudio UA, Flores-Villaseñor H, Leon-Sicairos N, Zazueta-Armenta D, Martínez-Villa FA, Tapia-Pastrana G, Angulo-Rocha J, Murillo-Llanes J, Barajas-Olivas MF, Canizalez-Roman A. Virulence-associated genes and antimicrobial resistance patterns in bacteria isolated from pregnant and non-pregnant women with urinary tract infections: The risk of neonatal sepsis. Canad J Microbiol. 2023;69(12):488-500.
https://doi.org/10.1139/cjm-2023-0046
26. Polo J, Sánchez J, Arca-Suárez J, Estella Á, González P, Blasco M, Gil A, Del Mar Periañez Párraga L, De Novales F. The importance of antimicrobial strategies associated with clinical cure and increased microbiological eradication in patients with complicated urinary tract infections and high risk of relapse. Eur Urolog Open Sci. 2025;71:165-171.
https://doi.org/10.1016/j.euros.2024.12.001
27. Zilberberg M, Nathanson B, Sulham K, Shorr A. Multiple antimicrobial resistance and outcomes among hospitalized patients with complicated urinary tract infections in the US, 2013-2018: A retrospective cohort study. BMC Infect Dis. 2021;21(1):159.
https://doi.org/10.1186/s12879-021-05842-0
28. Chelkeba L, Fanta K, Mulugeta T, Melaku T. Bacterial profile and antimicrobial resistance patterns of common bacteria among pregnant women with bacteriuria in Ethiopia: A systematic review and meta-analysis. Arch Gynecol Obstet. 2022;306(3):663-686.
https://doi.org/10.1007/s00404-021-06365-4
29. Zilberberg M, Nathanson B, Sulham K, Shorr A. Antimicrobial susceptibility and cross-resistance patterns among common complicated urinary tract infections in U.S. hospitals, 2013 to 2018. Antimicrob Agents Chemother. 2020;64(8):e00346-20.
https://doi.org/10.1128/AAC.00346-20
30. Matalka A, Al-Husban N, Alkuran O, Almuhaisen L, Basha A, Eid M, Elmuhtaseb M, Al Oweidat K. Spectrum of uropathogens and their susceptibility to antimicrobials in pregnant women: A retrospective analysis of 5-year hospital data. J Int Med Res. 2021;49(5):1-14.
https://doi.org/10.1177/03000605211006540
31. Bunduki G, Heinz E, Phiri V, Noah P, Feasey N, Musaya J. Virulence factors and antimicrobial resistance of uropathogenic Escherichia coli (UPEC) isolated from urinary tract infections: A systematic review and meta-analysis. BMC Infect Dis. 2021;21(1):753.
https://doi.org/10.1186/s12879-021-06435-7
32. Di Gangi S, Neuner-Jehle S, Baumann R, Plate A. Factors affecting decisions to use antibiotic-sparing treatment approaches in women with uncomplicated urinary tract infections: A scoping review protocol. JBI Evid Synthes. 2025;23(6):1266-1273.
https://doi.org/10.11124/JBIES-24-00159
33. Asmat U, Mumtaz M, Malik A. Rising prevalence of multidrug-resistant uropathogenic bacteria from urinary tract infections in pregnant women. J Taibah Univ Med Sci. 2021;16(1):102-111. https://doi.org/10.1016/j.jtumed.2020.10.010
34. Mohamed F, Dahie H, Mohamoud J, Adam M, Dirie H. Prevalence, antimicrobial susceptibility profile, and associated risk factors of uropathogenic Escherichia coli among pregnant women attending Dr. Sumait Hospital, Mogadishu, Somalia. Front Public Health. 2024;11:1203913. https://doi.org/10.3389/fpubh.2023.1203913
35. Stewart A. The effect of antioxidants on the morphology and function of ovaries in rats inflammatory process (pregnancy) within the framework of the analysis of the assessment of their action and effectiveness on nuclear and cytoplasmic maturation of oocytes. Bull Med Biol Res. 2024;6(4):45-54.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 У. Садырбеков, А. Усупбаев, М. Азеев, Н. Садырбеков, Р. Курбаналиев
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The articles published in this Journal are licensed under the CC BY-NC-ND 4.0 (Creative Commons Attribution – Non-Commercial – No Derivatives 4.0 International) license, which provides for their non-commercial use only. Under this license, users have the right to copy and distribute the material in copyright but are not permitted to modify or use it for commercial purposes. Full details on the licensing are available at https://creativecommons.org/licenses/by-nc-nd/4.0/.
