Muradiye Yıldırım, Şevki Çelen
Journal of Health Sciences and Medicine - 2025;8(6):1118-1123
Aims: To investigate the disease-causing potential of the most common uropathogens, Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) , as well as the effects of treatment alternatives on maternal and neonatal health, by analysing clinical outcomes and microbiological susceptibility patterns. Methods: The retrospective cohort study included women diagnosed with acute cystitis between 14 and 28 weeks of gestation, who subsequently delivered. Those with chronic kidney disease, hypertension, diabetes mellitus, steroid therapy or fetal structural or chromosomal disorders were excluded. Obstetric, clinical and laboratory characteristics were recorded. Information on patients with recurrent episodes, progression of acute pyelonephritis, and outcomes of pregnancy and neonates was also recorded. The findings were analysed, and a p value of less than 0.05 was considered significant. Results: A total of 276 pregnant women were diagnosed with acute cystitis and met the study criteria of urine culture positivity. E. coli growth was detected in 148 women (53.7%), K. pneumoniae in 42 women (15.2%). Patients in the E. coli group were younger and had a lower body-mass index than those in the K. pneumoniae group (p<0.001). Laboratory values for white blood cells and C-reactive protein were higher in E. coli infections while hematocrit was lower (p<0.001). Among those with E. coli growth, the extended-spectrum beta-laktamase (ESBL) positivity rate was 11.1% (n: 16), compared to 14.3% (n: 6) among those with Klebsiella , however no statistically significant difference was observed. Recurrence of infection and acute pyelonephritis progression rates were comparable in both groups. There was no difference in birth weeks, birth weight, preterm birth, premature rupture of the membranes, fetal growth restriction, preeclampsia, admission to the neonatal intensive care unit, neonatal infection or Apgar scores. The highest resistance rates in E. coli pathogens were found to be to ampicillin and amoxicillin-clavulanic acid, whereas in K. pneumoniae pathogens, resistance was found to be highest to amoxicillin-clavulanic acid and ceftriaxone. Extended-spectrum beta-laktamase positivity (ESBL)-positive E. coli strains were most susceptible to carbapenems, nitrofurantoin, piperacillin-tazobactam and fosfomycin. Similarly, ESBL-positive K. pneumoniae strains were most susceptible to carbapenems, piperacillin-tazobactam and fosfomycin. Conclusion: The gold standard for identifying pathogens in urinary tract infections during pregnancy is remains urine combined culture with antibiotic susceptibility testing. Early screening, accurate diagnosis, and timely treatment of urinary tract infections are essential to safeguard both maternal and neonatal health. In obstetric practice, the judicious use of targeted antibiotics-appropriate in both spectrum and duration-is critical to minimize the development of antimicrobial resistance.
