Profile and phenotypes of resistance of microorganisms from pregnant women with asymptomatic bacteriuria in Russia

Abstract number: p724

Shevelev  A., Kulakov  V., Ankirskaya  A., Nikonov  A., Belokrysenko  S., Krasnopolski  V., Dvoinikova  E., Ailamazyan   E., Savicheva  A., Ershov  G., Nikiforovski  N., Stratchounski   L.

Background: 

Asymptomatic bacteriuria (ASB) is common during pregnancy. But their adequate empirical antimicrobial treatment is possible only if resistance of the UTI pathogens in region is well established.

Methods: 

During the 2002–2003 prospective epidemiological study involved 132 pregnant women aged 16 to 43 years with ASB (>105 CFU/ml) at 6 Russian community health-care centres in Moscow, Smolensk, Volgograd and St-Petersburg. After re-identification, MICs for 7 of antimicrobials were determined by agar dilution method and interpreted using NCCLS/CLSI 2003 guidelines.

Results: 

129 urine isolates with ASB were collected. E. coli was the predominant pathogen (65.1%), followed by Klebsiella spp. (9.3%), Enterobacter spp. (8.5%), P. mirabilis (6.2%), Staphylococcus spp. (3.1%) and Enterococcus spp. (2.3%). Antimicrobial resistance rates of E. coli were as follows: ampicillin–29.8%; co-trimoxazole–12.0%; gentamicin–6.0%; cefuroxime–4.8%; amoxicillin/clavulanate–3.6%; nitrofurantoin–3.6% and fosfomycin–0%. The most active antimicrobials (sensitivity 91–100%) against Klebsiella spp. were cefuroxime, cefotaxime, gentamicin and fosfomycin; against P. mirabilis–amoxicillin/clavulanate, cefuroxime, cefotaxime, gentamicin and fosfomycin; against Enterobacter spp. – cefotaxime, gentamicin and fosfomycin.

Conclusions: 

The main problem with uropathogens in Russia is a high level of E. coli resistance to aminopenicillins and co-trimoxazole. These antimicrobials should no longer be used as drugs of choice in the treatment of ASB. The most active antimicrobials against non-E. coliEnterobacteriaceae isolates were cefotaxime, gentamicin and fosfomycin.