EVALUATION OF DIAGNOSTIC FRAMEWORK OF UTI INFECTION CAUSED BY ESBL PRODUCING BACTERIA IN PREGNANT WOMEN

Abstract

Background: Pregnancy-related urinary tract infections can vary from asymptomatic bacteriuria to acute cystitis and pyelonephritis. If left untreated, these infections can cause maternal sepsis, premature labor, and low birth weight. ESBL-producing Gram-negative bacteria like Escherichia coli and Klebsiella pneumoniae reduce the efficacy of widely used antibiotics, making identification and treatment more difficult, while hormonal changes and ureteral dilatation during pregnancy enhance susceptibility to infection. Objectives: Determine the frequency and pattern of ESBL-producing uropathogens, investigate their relationship to gestational age, and study antibiotic susceptibility and dosing practices in order to evaluate the diagnostic framework for UTIs in pregnancy. Methods: From June 2025 to March 2026, 1,190 pregnant women with and without UTI symptoms participated in a hospital-based observational study. Antimicrobial susceptibility and ESBL generation were assessed in accordance with CLSI standards after midstream urine samples were cultured and organisms were identified using standard procedures and VITEK® 2 Compact. Results: 208 women (17.5%) had culture-confirmed UTIs, mostly caused by K. pneumoniae and E. coli. 50.8% of significant Gram-negative pathogens were ESBL-producing isolates, with the third trimester having the highest prevalence (24.9%; p < 0.001). Fosfomycin and nitrofurantoin were good choices for simple lower UTIs, while carbapenems, particularly meropenem, had the highest susceptibility and were more frequently used for severe infections. Conclusion: Pregnancy-related UTIs are frequently caused by ESBL-producing E. coli and K. pneumoniae, which have significant multidrug resistance and an increased risk in the later trimesters. To enhance maternal-fetal outcomes and promote antibiotic stewardship, routine urine culture, early ESBL detection, and susceptibility-guided therapy—using carbapenems for severe infections and fosfomycin or nitrofurantoin for susceptible lower UTIs—are essential.