The Distribution Of Escherichia Coli In Pregnant Women And Antimicrobial Susceptibility Patterns Of The Isolates In Selected Rural Areas

ABSTRACT

BACKGROUND: Escherichia coli (E. coli) is a bacterium that can asymptomatically colonize a woman’s vagina and up to 31% of pregnant women are colonized worldwide. Furthermore, vaginal colonization with E. coli is associated with adverse pregnancy outcomes, such as preterm birth and stillbirth. It is also associated with neonatal sepsis or meningitis when transmitted to the foetus through amniotic fluid or to the neonate during delivery. To date in Namibia data on the colonization and the antibiotic susceptibility patterns of E. coli in pregnant women is sparse. This study aimed at determining the prevalence of E. coli, antimicrobial susceptibility patterns and genetic based resistance of the isolates from pregnant women at 35 weeks of gestation and above, who attended antenatal screening at Eenhana, Okongo, Onandjokwe state hospitals.

STUDY DESIGN: The descriptive cross-sectional study targeted pregnant women who were at 35 weeks of gestation and above. A convenience sampling technique was used to recruit 208 pregnant women for the study. Both qualitative and quantitative data were collected using structured questionnaires. A participant consent form was signed prior to recruitment in the study and socio-demographic information was captured in a questionnaire by registered nurses. A lower vaginal swab was collected from each participant.

RESEARCH METHODOLOGY: In total, 208 lower vaginal swabs were collected from participants by registered nurses. Samples were transported to the laboratory using a cold chain system. All swabs collected were cultured on MacConkey agar and the growth was confirmed on Chromogenic Agar. Presumptive E. coli isolates were confirmed by molecular techniques using the real time Polymerase Chain Reaction (PCR). Gene confirmed E. coli isolates were tested against selected antibiotics for empiric treatment of patients using the Kirby Bauer Disk Diffusion method and results were interpreted according to the Clinical Laboratory Standards Institute (CLSI) guideline (2018). All isolates were also screened for the presence of selected β-lactam genes [blaTEM, blaFOX, blaCTXM, blaSHV and blaMOX] using conventional PCR. Statistical analysis was performed using the Bonferroni's Multiple Comparison Test, and a P value < 0.05 was considered statistically significant.

RESULTS: Out of a total of 208 pregnant women screened, thirty-one (14.9%) were colonized by E. coli. Maternal E. coli colonization was high in pregnant women between the ages of 20-39 (11.5%), those with a low level of education (10.1%), unemployed (13.0%), unmarried (12.5%) and rural dwelling (12.5%). The study also revealed that E. coli was largely isolated from pregnant women with no history of miscarriage (12.5%) and stillbirth (13.9%), while E. coli was prevalent in women with 1-2

parity (7.7%). Significant association was reported between E. coli colonization and maternal age, habitat, marital status, education, employment, parity (P values