Examination of broad-spectrum beta-lactamase-producing E. coli vaginal colonization and antibiotic resistance in pregnant women: A pilot study in Iran

Document Type : Original Article

Authors

1 Department of Gynecology and Obstetrics, School of Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran

2 Department of Microbiology and Immunology, Faculty of Medicine, Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, Iran

3 Social Determinants of Health (SDH) Research Center, Kashan University of Medical Sciences, Kashan, Iran

4 Department of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran

Abstract

Objectives: Urinary tract infection (UTI) is a common complication during pregnancy that can have severe consequences for both the mother and the fetus. ESBL-producing strains of E. coli present a significant challenge in terms of treatment during pregnancy. This study aims to identify pregnant women carrying beta-lactamase-producing E. coli and assess the antibiotic resistance patterns of these isolates.
Methods: This cross-sectional study investigated the presence of broad-spectrum beta-lactamase-producing E. coli isolates in pregnant women attending medical centers affiliated with Kashan University of Medical Sciences. Vaginal colonization, associated complications, and antibiotic resistance profiles were assessed. The antibiogram test using the disc diffusion method was employed to determine colonization and antibiotic susceptibility, while PCR testing was used to detect genes associated with beta-lactamase production.
Results: Among the 175 samples collected, 51 samples tested positive for E. coli, with 15 of these samples containing ESBL-producing isolates. A significant correlation was observed between the frequency distribution of E. coli isolates and factors such as age, history of urinary tract infections, body mass index, and previous abortions in pregnant women. Among the 15 ESBL-producing E. coli isolates, the blaSHV, blaTEM, and blaCTX-M resistance genes were detected in 12 (80%), 9 (60%), and 1 (6.66%) isolates, respectively.
Conclusion: The prevalence of ESBL-producing E. coli in pregnant women underscores the urgent need for public health interventions to combat antibiotic resistance.

Highlights

Somayeh Gharehhssanlou [Pubmed] [Google Scholar]

 

Keywords

Main Subjects


  1. Yousefi Z, KhaieKaramoddin M, Vahedian M, Ahmadian H. Prevalence of vaginal infections during pregnancy and its association with preterm birth. J Med Sci Health Services, Yazd Shahid Sadooghi. 2001;10.
  2. Shoja M, Shoja E, Gharaei M. Prevalence and affecting factors on preterm birth in pregnant women Referred to Bentolhoda hospital-Bojnurd. J North Khorasan Unive Med Sci. 2016;7(4): 855-63. doi:10.29252/jnkums.7.4.855
  3. Davari Tanha F, Valadan M, Kave M, Bagher zadeh Jalilvands HM. Prevalence and risk factors of recurrent preterm delivery in three hospitals of Tehran University. J Tehran Unive Med Sci. 2007;65 (2): 34-9.
  4. Sohrabi D, Ghanbari Gorgani M. Study of risk factors during pregnancy on preterm birth in women-ValiAsr Hospital Zanjan-2007. J Oroomiie Nurs Midwifery School. 2011;9(2).
  5. Sehhati-Shafaii F, Asadollahy M, Piri R, Naghavi-Behzad M, Farzollahpour F. Prevalence and risk factors of preterm labor in Health Educational Centers of Northwest Iran (2009-2010). Life Sci J. 2013; 10(3):231-6.
  6. Dalibalta S, Abukhaled Y, Samara F. Factors influencing the prevalence of polycystic ovary syndrome (PCOS) in the United Arab Emirates. Rev Environ Health. 2022. doi:10.1515/reveh-2021-0036 PMid:35538690
  7. Lamont R, Sawant S. Infection in the prediction and antibiotics in the prevention of spontaneous preterm labour and preterm birth. Minerva ginecologica. 2005;57(4):423-33.
  8. Haider G, Zehra N, Munir AA, Haider A. Risk factors of urinary tract infection in pregnancy. J Pakistan Med Association. 2010;60(3):213.
  9. Nasi GI, Georgakopoulou KI, Theodoropoulou MK, Papandreou NC, Chrysina ED, Tsiolaki PL, et al. Bacterial Lectin FimH and Its Aggregation Hot-Spots: An Alternative Strategy against Uropathogenic E. coli. Pharmaceutics. 2023;15(3):1018. doi:10.3390/pharmaceutics15031018 PMid:36986878 PMCid:PMC10058141
  10. Akya A, Salimi Ghale E. Resistance to Aminoglycoside Antibiotics in Escherichia coli Isolated from Urinary Tract Infection in Iran in 2000-2012: A Systematic Review. J Rafsanjan Unive Med Sci. 2019; 18 (3):285-304.
  11. Pajohanfar NS, Miri M, Mehrabadi S, Rahmani Bilandi R. Green space and preterm birth: A systematic review study. Iranian J Obstet Gynecol Infertil. 2020;23(6):97-109.
  12. Azami M, Jaafari Z, Masoumi M, Shohani M, Badfar G, Mahmudi L, et al. The etiology and prevalence of urinary tract infection and asymptomatic bacteriuria in pregnant women in Iran: a systematic review and Meta-analysis. BMC Urol. 2019;19:1-15. doi:10.1186/s12894-019-0454-8 PMid:31146773 PMCid:PMC6543660
  13. Raza S, Pandey S, Bhatt C. Microbiological analysis of the urine isolates in Kathmandu medical college teaching hospital, Kathmandu, Nepal. Kathmandu Unive Med J. 2011;9(4):295-7. doi:10.3126/kumj.v9i4.6348 PMid:22710542
  14. Govil V, Rashmi R, Ritu R, Rani A, Puhal S, Bajaj N. Anesthetic management of a pregnant patient with uncontrolled hyperthyroidism for emergency caesarean section - a case report. Novel Clin Med. 2023; 2(3): 163-167. doi: 10.22034/ncm.2023.412332.1112
  15. Smaill FM, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane database of systematic reviews. 2019(11). doi:10.1002/14651858.CD000490.pub4 PMid:31765489 PMCid:PMC6953361
  16. Danino D, Melamed R, Sterer B, Porat N, Hazan G, Gushanski A, et al. Mother-to-child transmission of extended-spectrum-beta-lactamase-producing Enterobacteriaceae. J Hospital Infect. 2018; 100(1):40-6. doi:10.1016/j.jhin.2017.12.024 PMid:29330015
  17. Arafi V, Hasani A, Sadeghi J, Varshochi M, Poortahmasebi V, Hasani A, et al. Uropathogenic Escherichia coli endeavors: an insight into the characteristic features, resistance mechanism, and treatment choice. Arch Microbiol. 2023;205(6):226. doi:10.1007/s00203-023-03553-5 PMid:37156886
  18. Hassuna NA, Rabie E, Mahd W, Refaie M, Yousef R, Abdelraheem W. Antibacterial effect of vitamin C against uropathogenic E. coli in vitro and in vivo. BMC Microbiol. 2023; 23 (1):1-12. doi:10.1186/s12866-023-02856-3 PMid:37081381 PMCid:PMC10116447
  19. Cassier P, Lallechere S, Aho S, Astruc K, Neuwirth C, Piroth L, et al. Cephalosporin and fluoroquinolone combinations are highly associated with CTX-M β-lactamase-producing Escherichia coli: a case-control study in a French teaching hospital. Clin Microbiol Infect. 2011;17(11):1746-51. doi:10.1111/j.1469-0691.2010.03349.x PMid:20840333
  20. Pitout JD, Laupland KB. Extended-spectrum β-lactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet infect Dis. 2008;8(3):159-66. doi:10.1016/S1473-3099(08)70041-0 PMid:18291338
  21. Joji RM, Al-Mahameed AE, Al Jishi T, Fatani DI, Saeed NK, Jaradat A, et al. Molecular detection of plasmid-derived AmpC β-lactamase among clinical strains of Enterobacteriaceae in Bahrain. Ann Thoracic Med. 2021;16(3):287. doi:10.4103/atm.ATM_523_20 PMid:34484445 PMCid:PMC8388573
  22. Thuo TG. Antimicrobial Resistance Profiles and Clonal Relatedness of Pseudomonas aeruginosa Strains Recovered from Wounds Infections of Patients Presenting in Tigoni District Hospital, Kenya: JKUAT-COHES; 2021.
  23. Ballesteros-Monrreal MG, Mendez-Pfeiffer P, Barrios-Villa E, Arenas-Hernández MM, Enciso-Martínez Y, Sepúlveda-Moreno CO, et al. Uropathogenic Escherichia coli in Mexico, an overview of virulence and resistance determinants: Systematic review and meta-analysis. Arch Med Res. 2023. doi:10.1016/j.arcmed.2023.01.001 PMid:36725379
  24. Pathak KN, Sen S. Implementing the Updated Guidelines in Routine Clinical Microbiology Reporting. Infect Drug Resistance. 2022:1945-6. doi:10.2147/IDR.S367337 PMid:35480053 PMCid:PMC9035451
  25. Chamoun K, Farah M, Araj G, Daoud Z, Moghnieh R, Salameh P, et al. Surveillance of antimicrobial resistance in Lebanese hospitals: retrospective nationwide compiled data. Int J infect Dis. 2016;46: 64-70. doi:10.1016/j.ijid.2016.03.010 PMid:26996458
  26. Moghnieh R, Araj GF, Awad L, Daoud Z, Mokhbat JE, Jisr T, et al. A compilation of antimicrobial susceptibility data from a network of 13 Lebanese hospitals reflecting the national situation during 2015-2016. Antimicrobial Resistance Infect Con. 2019;8(1):1-17. doi:10.1186/s13756-019-0487-5 PMid:30828445 PMCid:PMC6381724
  27. Al-Mayahie SM. Phenotypic and genotypic comparison of ESBL production by vaginal Escherichia coli isolates from pregnant and non-pregnant women. Ann Clin Microbiol Antimicrobials. 2013; 12(1):1-7. doi:10.1186/1476-0711-12-7 PMid:23617811 PMCid:PMC3661376
  28. Sáez-López E, Cossa A, Benmessaoud R, Madrid L, Moraleda C, Villanueva S, et al. Characterization of vaginal Escherichia coli isolated from pregnant women in two different African sites. PLoS One. 2016; 11(7):e0158695. doi:10.1371/journal.pone.0158695 PMid:27387665 PMCid:PMC4936694
  29. Sáez-López E, Guiral E, Fernández-Orth D, Villanueva S, Goncé A, López M, et al. Vaginal versus obstetric infection Escherichia coli isolates among pregnant women: antimicrobial resistance and genetic virulence profile. PloS One. 2016;11(1):e0146531. doi:10.1371/journal.pone.0146531 PMid:26784330 PMCid:PMC4718642
  30. Jalilian N, Kooshkiforooshani M, Ahmadi S, Nankali A. Colonisation with extended-spectrum β-lactamase-producing Enterobacteriaceae in pregnant/post-partum women: Systematic review and meta-analysis. J Global Antimicrobial Resistance. 2019;19:338-47. doi:10.1016/j.jgar.2019.06.010 PMid:31212106
  31. Ghaddar N, Anastasiadis E, Halimeh R, Ghaddar A, Matar GM, Abou Fayad A, et al. Phenotypic and genotypic characterization of extended-spectrum beta-lactamases produced by Escherichia coli colonizing pregnant women. Infect Dis Obstet Gynecol. 2020;2020. doi:10.1155/2020/4190306 PMid:32327921 PMCid:PMC7168714
  32. Barcaite E, Bartusevicius A, Tameliene R, Maleckiene L, Vitkauskiene A, Nadisauskiene R. Group B streptococcus and Escherichia coli colonization in pregnant women and neonates in Lithuania. Int J Gynecol Obstet. 2012;117(1):69-73. doi:10.1016/j.ijgo.2011.11.016 PMid:22265188
  33. Shams S, Hashemi A, Kermani S, Esmkhani M, Tarashi S. Determination of Extended-spectrum Beta-lactamase Genes (blaTEM, blaSHV, blaCTX-M) in Escherichia coli Strains Isolated from Clinical Specimenes in Ali-Ibne Abi Talib Hospital in Qom, Iran. Qom Unive Med Sci J. 2016;10(1):30-9.