Genotypic characterization of extended-spectrum β-lactamase producing urinary isolates among pregnant women in Ho municipality, Ghana

Robert K Adedze-Kpodo; Patrick K Feglo; Eric Agboli; Richard H Asmah; Precious K Kwadzokpui

doi:10.1016/j.heliyon.2022.e12513

Genotypic characterization of extended-spectrum β-lactamase producing urinary isolates among pregnant women in Ho municipality, Ghana

Heliyon. 2022 Dec 22;8(12):e12513. doi: 10.1016/j.heliyon.2022.e12513. eCollection 2022 Dec.

Authors

Robert K Adedze-Kpodo¹, Patrick K Feglo², Eric Agboli³, Richard H Asmah⁴, Precious K Kwadzokpui^{5

6}

Affiliations

¹ South Tongu District Hospital, Sogakope, Ghana.
² Department of Clinical Microbiology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
³ Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Ho, Ghana.
⁴ College of Health Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Legon, Ghana.
⁵ Department of Medical Laboratory Science, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana.
⁶ Medical Laboratory Department, Ho Teaching Hospital, Ho, Ghana.

Abstract

Objective: The case of antibiotic resistance has become a major global concern and Extended Spectrum β-lactamase (ESBL) producing organisms have so far remained the biggest culprit. The consequences of urinary tract infection (UTI) and antibiotic resistance among pregnant women cannot be underestimated. We investigated UTI and ESBL production among urinary pathogens isolated from pregnant women.

Method: We obtained non-repeat, clean catch midstream urine samples from 1345 pregnant women suspected of having UTI for bacterial identification at the Ho Teaching Hospital Laboratory between June 2013 and March 2015. The isolates were taken through relevant biochemical testing for identification and then subjected to antimicrobial agents for susceptibility testing using the disc diffusion method. We tested for ESBL production by the combined disc method and ESBL positive (+ESBL) phenotype isolates were genotyped for Bla_TEM, Bla_SHV, and Bla_CTX-M using polymerase chain reaction (PCR). Data were analyzed using SPSS v24 and p-values < 0.05 were considered statistically significant.

Results: Of the 1345 urine samples tested, 230 (17.1%, 95% CI: 15.1%-19.1%) yielded significant bacteriuria. The most common bacterium isolated was Staphylococcus aureus (29.6%) followed closely by Escherichia coli (28.7%) both of which were highest during the second trimester of gestation. We isolated 152 gram-negative isolates with 41.4% (63/230) being + ESBL. Of the 63 + ESBL, 45 (71.4%) possessed bla_TEM, 42 (66.7%) had bla_CTX-M and 2 (3.2%) possessed bla_SHV genes; 38 possessed multiple ESBL genes comprising 2 with both SHV and TEM genes and 36 with both CTX-M and TEM genes.

Conclusion: High prevalence of UTI and persistent transmission of ESBLs among pregnant women in the Ho Municipality is worrying and a course for public health concern. We recommend urine culture during pregnancy as a routine laboratory investigation to avoid birth-related complications.

Keywords: Antenatal clinic; Antimicrobial; Extended spectrum β-lactamase; Pregnancy; Urinary bacteria.