Bacterial profile and antimicrobial resistance patterns of common bacteria among pregnant women with bacteriuria in Ethiopia: a systematic review and meta-analysis

Abstract

Background: Globally, antimicrobial resistance (AMR) restricted the armamentarium of the health care providers against infectious diseases, mainly due to the emergence of multidrug resistant. This review is aimed at providing contemporary bacterial profile and antimicrobial resistance pattern among pregnant women with significant bacteriuria.

Methods: Electronic biomedical databases and indexing services such as PubMed/MEDLINE, Web of Science, EMBASE and Google Scholar were searched. Original records of research articles, available online from 2008 to 2021, addressing the prevalence of significant bacteriuria and AMR pattern among pregnant women and written in English were identified and screened. The relevant data were extracted from included studies using a format prepared in Microsoft Excel and exported to STATA 14.0 software for the outcome measure analyses and subgrouping.

Results: The data of 5894 urine samples from 20 included studies conducted in 8 regions of the country were pooled. The overall pooled estimate of bacteriuria was 15% (95% CI 13-17%, I² = 77.94%, p < 0.001) with substantial heterogeneity. The pooled estimate of Escherichia coli recovered from isolates of 896 urine samples was 41% (95% CI 38-45%) followed by coagulase-negative Staphylococci, 22% (95% CI 18-26%), Staphylococcus aureus, 15% (95% CI 12-18%), Staphylococcus saprophytic, 12% (95% CI 6-18%) Proteus mirabilis, 7% (95% CI 4-10%), Enterococcus species, 6% (0-12%), Pseudomonas aeruginosa, 4% (2-6%), Citrobacter species, 4% (95% CI 2-4%), Group B streptococcus, 3% (1-5%), and Enterobacter species, 2% (1-4%). Multidrug resistance proportions of E. coli, Klebsiella species, Staphylococcus aureus and Coagulase negative staphylococci, 83% (95% CI 76-91%), 78% (95% CI 66-90%), 89% (95% CI 83-96%), and 78% (95% CI 67-88%), respectively.

Conclusion: The result of current review revealed the occurrence of substantial bacteriuria among pregnant women in Ethiopia. Resistance among common bacteria (E. coli, Klebsiella species, Staphylococci species) causing UTIs in pregnant women is widespread to commonly used antibiotics. The high rate of drug resistance in turn warrants the need for regular epidemiological surveillance of antibiotic resistance and implementation of an efficient infection control and stewardship program.

Keywords: Antimicrobial resistance; Ethiopia; Meta-analysis; Pregnant women; Significant bacteriuria; Urinary tract infection.

Fig. 1

The process of identification, screening, checking for eligibility and inclusion into the final analyses

Fig. 2

Forest plot showing the overall prevalence of significant bacteriuria among pregnant women in Ethiopia, 2021

Fig. 3

Forest plot showing the prevalence of asymptomatic bacteriuria among pregnant women in Ethiopia, 2021

Fig. 4

Forest plot showing the prevalence of symptomatic bacteriuria among pregnant women in Ethiopia, 2021

Fig. 5

Forest plot showing the prevalence of Gram-negative bacteriuria among pregnant women in Ethiopia, 2021

Fig. 6

Forest plot showing the prevalence of Gram-positive bacteriuria among pregnant women in Ethiopia, 2021

Fig. 7

Forest plot showing the prevalence of bacteriuria among pregnant women by study period in Ethiopia, 2021

Fig. 8

Forest plot showing the prevalence of bacteriuria among pregnant women by region in Ethiopia, 2021

Fig. 9

Forest plot showing the prevalence of E. coli among pregnant women by region in Ethiopia, 2021

Fig. 10

Forest plot showing the prevalence of Coagulase negative staphylococci among pregnant women by region in Ethiopia, 2021

Fig. 11

Forest plot showing the prevalence of S. aureus among pregnant women by region in Ethiopia, 2021

Fig. 12

Forest plot showing the prevalence of Klebsiella species among pregnant women by region in Ethiopia, 2021

Fig. 13

Pattern of antimicrobial resistance of Gram-negative bacteria among pregnant women in Ethiopia. 2021

Fig. 14

Forest plot showing the prevalence of ESBL E. coli among pregnant women

Fig. 15

Forest plot showing the prevalence of ESBL Klebsiella species among pregnant women

Fig. 16

Forest plot showing the prevalence of multidrug-resistant E. coli among pregnant women

Fig. 17

Forest plot showing the prevalence of multidrug-resistant Klebsiella species among pregnant women

Fig. 18

Pattern of antimicrobial resistance of Gram-positive bacteria among pregnant women in Ethiopia, 2021

Fig. 19

Forest plot showing the prevalence of multidrug-resistant S. aureus among pregnant women

Fig. 20

Forest plot showing the prevalence of multidrug-resistant coagulase-negative Staphylococci among pregnant women