Prevalence, bacterial etiology, and antimicrobial susceptibility patterns of urinary tract infections among pregnant women in rural West Amhara, Ethiopia

Urinary Tract Infections (UTIs) in pregnant women can lead to pyelonephritis and preterm birth. Our objective was to assess UTI prevalence, etiology, antimicrobial susceptibility, and risk factors among pregnant women receiving antenatal care in rural Amhara, Ethiopia. From a pregnancy cohort in West Gojjam and South Gondor, we consecutively enrolled 604 women from 12 health centers and screened for UTI at ≤ 24 weeks gestational age from August 2020 to June 2022. Women provided urine samples for culture, dipstick, and antibiotic susceptibility testing. Medical history and demographic data were also collected from enrolled participants. We conducted descriptive statistics to describe UTI prevalence and logistic regression to examine risk factors for UTIs. The overall prevalence of UTI was 3.5% (21/604, 95% CI = 2.0%-4.9%), among which 43% were symptomatic and 57% were asymptomatic. Common uropathogens were Escherichia coli (57.1%), Klebsiella pneumoniae (14.3%), and Enterococcus faecalis (14.3%). Among all isolates, resistance was high for ampicillin (66.7%) and amoxicillin-clavulanic acid (40.0%). The majority of isolates (76.2%) were susceptible to nitrofurantoin, cotrimoxazole, and cefpodoxime. Maternal age > 20 years was significantly associated with lower odds of UTI (aOR = 0.29, 95% CI = 0.09-1.00, p = 0.05). Urine dipstick (nitrite or leukocyte esterase) had low sensitivity (37.5%) but higher specificity (93.9%) to identify positive culture. In conclusion, in rural communities in Amhara, there is high resistance to first-line antibiotics used to treat UTI in pregnancy and a need for accurate, low-cost UTI diagnostic methods. Increasing access to effective treatment of UTI in low- and middle-income countries is needed to improve maternal and pregnancy outcomes.