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

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 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: 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. 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. Odds ‘ratio was calculated for statistical analysis. 

Results

21520 women delivered between 2016-2019. 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 more than 30 years and infections in 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 labor were noted to have higher likelihood for MDRO UTIs but the results were not statistically significant(p<0.05). 

Conclusions

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