PP11 - Antimicrobial resistance patterns of colonizing Escherichia coli and Klebsiella pneumoniae from urine samples of pregnant women as an indicator for antimicrobial resistance in a rural community in Sri Lanka

Abstract

Introduction

Antimicrobial resistance (AMR) in bacteria causing common community-acquired infections is increasing gradually worldwide and has a significant impact on mortality, morbidity, and treatment costs. Asymptomatic gut colonization with these resistant bacteria serves as a reservoir for the spread of AMR in the community. Most available AMR data originate from hospital-based settings and may not reflect AMR rates at the community level. This research aims to address the gap in community-level AMR data.

Objectives

This study was conducted to assess antibiotic resistance patterns, determine the prevalence of extended-spectrum beta-lactamase (ESBL) production among colonizing Escherichia coli and Klebsiella pneumoniae, and describe the factors associated with AMR Enterobacteriaceae colonization.

Design, setting and methods

In this descriptive cross-sectional study, urine samples were collected from pregnant mothers attending antenatal clinics in the Kalutara District and cultured using a semi-quantitative method. E. coli and K. pneumoniae isolates with colony counts between 10³ and <10⁵ CFU/mL were further processed for antibiotic sensitivity testing according to the Clinical and Laboratory Standards Institute (CLSI) M100, 33rd Edition. The combined disc method was used to detect ESBL production.

Results

A total of 252 pregnant women were included in the study. A total of 69 isolates were identified, comprising 31 (44.9%) E. coli and 38 (55.1%) K. pneumoniae. Of these, 63 (91.3%) isolates exhibited resistance to at least one antibiotic from the 13-antibiotic panel tested. ESBL producers were recovered from the urine of 5.2% (13, n=252) women. Multi-drug resistance (MDR) was identified in 8.7% (6, n=69) of isolates. No isolates showed carbapenem resistance. None of the studied factors were significantly associated with colonization by ESBL-producing E. coli or K. pneumoniae.

Conclusions

A considerable proportion of resistance to at least one antibiotic was observed, with a notable ESBL prevalence of 5.2%, highlighting the growing concerns of community-related antimicrobial resistance (AMR). Although carbapenem resistance was not detected, the presence of MDR highlights the importance of vigilant surveillance and timely targeted interventions to prevent AMR.