Antimicrobial Resistance and Multidrug Resistance Patterns of Uropathogens İsolated from Pregnant Women with Asymptomatic Bacteriuria

Abstract

Objective: This study aimed to evaluate the prevalence of asymptomatic bacteriuria (ASB) in the second half of pregnancy, identify causative microorganisms, and assess their antimicrobial resistance and multidrug resistance (MDR) patterns in Kırşehir, Türkiye. Materials and Methods: Between April-December 2024, 182 pregnant women without urinary tract infection symptoms were screened at Kırşehir Training and Research Hospital. Midstream urine samples were cultured, and bacterial isolates were identified and tested for antimicrobial susceptibility using the BD Phoenix™ automated system. Data were interpreted according to EUCAST 2024 criteria. Results: ASB prevalence was 37.36%. Escherichia coli (51.47%) was the most common pathogen, followed by Candida spp. (17.65%), Klebsiella pneumoniae (8.82%), and Streptococcus agalactiae (7.36%). In Gram-negative isolates, the highest resistance was to ampicillin (72.7%), cefazolin (43.2%), and amoxicillin-clavulanate (40.9%), with universal susceptibility to amikacin, carbapenems, and nitrofurantoin. Gram-positive isolates showed the highest resistance to moxifloxacin and tetracycline (41.7% each). MDR was detected in 20% of Escherichia coli, 16.7% of Klebsiella pneumoniae, 60% of Streptococcus agalactiae, and 66.6% of Staphylococcus epidermidis isolates. Conclusion: ASB prevalence during second half of pregnancy was high, and a significant proportion of pathogens demonstrated MDR. The findings highlight the necessity of culture-based diagnosis and region-specific empirical therapy. High resistance to ampicillin and trimethoprim–sulfamethoxazole suggests that empirical protocols should be updated according to local antibiograms. Strengthening antibiotic stewardship and expanding routine ASB screening are critical to reducing maternal–fetal complications.