Escherichia coli from urine samples of pregnant women as an indicator for antimicrobial resistance in the community: a field study from rural Burkina Faso.
ANC
Antimicrobial resistance
Asymptomatic bacteriuria
Burkina Faso
Community
Escherichia coli
Pregnancy
Rural Africa
Journal
Antimicrobial resistance and infection control
ISSN: 2047-2994
Titre abrégé: Antimicrob Resist Infect Control
Pays: England
ID NLM: 101585411
Informations de publication
Date de publication:
05 09 2022
05 09 2022
Historique:
received:
31
07
2021
accepted:
03
08
2022
entrez:
5
9
2022
pubmed:
6
9
2022
medline:
9
9
2022
Statut:
epublish
Résumé
In low- and middle-income countries, surveillance of antimicrobial resistance (AMR) is mostly hospital-based and, in view of poor access to clinical microbiology, biased to more resistant pathogens. We aimed to assess AMR among Escherichia coli isolates obtained from urine cultures of pregnant women as an indicator for community AMR and compared the AMR results with those from E. coli isolates obtained from febrile patients in previously published clinical surveillance studies conducted within the same population in Nanoro, rural Burkina Faso. We furthermore explored feasibility of adding urine culture to standard antenatal care in a rural sub-Saharan African setting. Between October 2016-September 2018, midstream urine samples collected as part of routine antenatal care in Nanoro district were cultured by a dipslide method and screened for antibiotic residues. Significant growth was defined as a pure culture of Enterobacterales at counts of ≥ 10 Significant growth was observed in 202/5934 (3.4%) cultures; E. coli represented 155 (76.7%) of isolates. Among E. coli isolates, resistance rates to ampicillin, cotrimoxazole and ciprofloxacin were respectively 65.8%, 64.4% 16.2%, compared to 89.5%, 89.5% and 62.5% among E. coli from clinical isolates (n = 48 of which 45 from blood cultures). Proportions of extended spectrum beta-lactamase producers and multidrug resistance were 3.2% and 5.2% among E. coli isolates from urine in pregnant women versus 35.4%, and 60.4% respectively among clinical isolates. The E. coli isolates obtained from healthy pregnant women had significantly lower AMR rates compared to clinical E. coli isolates, probably reflecting the lower antibiotic pressure in the pregnant women population. Adding urine culture to the routine urine analysis (dipstick) of antenatal care was feasible. The dipslide culture method was affordable and user-friendly and allowed on-site inoculation and easy transport; challenges were contamination (midstream urine sampling) and the semi-quantitative reading. Provided confirmation of the present findings in other settings, E. coli from urine samples in pregnant women may be a potential indicator for benchmarking, comparing, and monitoring community AMR rates across populations over different countries and regions.
Sections du résumé
BACKGROUND
In low- and middle-income countries, surveillance of antimicrobial resistance (AMR) is mostly hospital-based and, in view of poor access to clinical microbiology, biased to more resistant pathogens. We aimed to assess AMR among Escherichia coli isolates obtained from urine cultures of pregnant women as an indicator for community AMR and compared the AMR results with those from E. coli isolates obtained from febrile patients in previously published clinical surveillance studies conducted within the same population in Nanoro, rural Burkina Faso. We furthermore explored feasibility of adding urine culture to standard antenatal care in a rural sub-Saharan African setting.
METHODS
Between October 2016-September 2018, midstream urine samples collected as part of routine antenatal care in Nanoro district were cultured by a dipslide method and screened for antibiotic residues. Significant growth was defined as a pure culture of Enterobacterales at counts of ≥ 10
RESULTS
Significant growth was observed in 202/5934 (3.4%) cultures; E. coli represented 155 (76.7%) of isolates. Among E. coli isolates, resistance rates to ampicillin, cotrimoxazole and ciprofloxacin were respectively 65.8%, 64.4% 16.2%, compared to 89.5%, 89.5% and 62.5% among E. coli from clinical isolates (n = 48 of which 45 from blood cultures). Proportions of extended spectrum beta-lactamase producers and multidrug resistance were 3.2% and 5.2% among E. coli isolates from urine in pregnant women versus 35.4%, and 60.4% respectively among clinical isolates.
CONCLUSIONS
The E. coli isolates obtained from healthy pregnant women had significantly lower AMR rates compared to clinical E. coli isolates, probably reflecting the lower antibiotic pressure in the pregnant women population. Adding urine culture to the routine urine analysis (dipstick) of antenatal care was feasible. The dipslide culture method was affordable and user-friendly and allowed on-site inoculation and easy transport; challenges were contamination (midstream urine sampling) and the semi-quantitative reading. Provided confirmation of the present findings in other settings, E. coli from urine samples in pregnant women may be a potential indicator for benchmarking, comparing, and monitoring community AMR rates across populations over different countries and regions.
Identifiants
pubmed: 36064435
doi: 10.1186/s13756-022-01142-7
pii: 10.1186/s13756-022-01142-7
pmc: PMC9446845
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
112Informations de copyright
© 2022. The Author(s).
Références
Int J Environ Res Public Health. 2013 Nov 25;10(12):6235-54
pubmed: 24287850
Afr Health Sci. 2010 Dec;10(4):349-52
pubmed: 21416036
Oman Med J. 2012 Jan;27(1):31-5
pubmed: 22359722
PLoS Negl Trop Dis. 2019 Oct 14;13(10):e0007782
pubmed: 31609964
Int J Epidemiol. 2012 Oct;41(5):1293-301
pubmed: 23045201
BMC Res Notes. 2018 Dec 17;11(1):901
pubmed: 30558656
Niger J Clin Pract. 2010 Dec;13(4):409-12
pubmed: 21220855
N Am J Med Sci. 2010 Jun;2(6):263-6
pubmed: 22574301
Front Microbiol. 2020 Sep 25;11:567235
pubmed: 33101240
Lancet Infect Dis. 2018 Aug;18(8):e248-e258
pubmed: 29519767
Infect Dis Clin North Am. 1997 Sep;11(3):593-608
pubmed: 9378925
Clin Infect Dis. 2019 May 2;68(10):e83-e110
pubmed: 30895288
Microbiol Spectr. 2015 Oct;3(5):
pubmed: 26542046
Int J Antimicrob Agents. 2009 Nov;34(5):407-13
pubmed: 19505803
Clin Microbiol Infect. 2005 Mar;11(3):199-203
pubmed: 15715717
Clin Microbiol Infect. 2021 Apr;27(4):590-596
pubmed: 32505586
PLoS One. 2017 Jul 10;12(7):e0178577
pubmed: 28692655
Antimicrob Resist Infect Control. 2019 Oct 31;8:169
pubmed: 31695911
Front Med (Lausanne). 2019 Sep 23;6:205
pubmed: 31608280
Clin Microbiol Rev. 2013 Apr;26(2):289-307
pubmed: 23554418
Drugs Real World Outcomes. 2018 Sep;5(3):193-206
pubmed: 30155832
Clin Chim Acta. 2000 Jul;297(1-2):305-11
pubmed: 10841931
Ghana Med J. 2007 Mar;41(1):26-9
pubmed: 17622336
Antimicrob Resist Infect Control. 2016 May 14;5:18
pubmed: 27186369
Int J Clin Pract. 2019 Sep 18;:e13422
pubmed: 31532050
Clin Microbiol Infect. 2016 Oct;22(10):891.e1-891.e4
pubmed: 27404368
Clin Microbiol Infect. 2017 Jul;23(7):426-433
pubmed: 28506781
PLoS One. 2014 Feb 14;9(2):e89103
pubmed: 24551225
BMC Pregnancy Childbirth. 2020 Apr 22;20(1):239
pubmed: 32321461