Virulence Factors in Escherichia Coli Causing Urinary Tract Infection in Pregnant Women.

Background and objectives: UTI is one of the most common bacterial infections in pregnant women. E. coli is the most frequent urinary pathogen isolated from 40-60% of all uncomplicated UTI. Untreated UTI in pregnancy leads to low-birthweight, premature delivery, pre-eclampsia, postpartum endometritis, pyelonephritis etc. Historically, the measurement of virulence has led to measurable outcomes like morbidity and mortality of the host. Therefore, screening for UTI and determining their virulence in pregnancy is important to prevent these complications. The objectives are to isolate E. coli species from the pregnant women suffering from urinary tract infection, to determine the urovirulence factors and to study the antimicrobial susceptibility pattern of the E. coli isolates. Material and methods: Inclusion criteria: Pregnant women suspected of UTI. Exclusion criteria: Cases who are on antibiotic therapy. Virulence tests like Mannose Resistant Haemagglutination test (MRHA), Cell Surface Hydrophobicity (CSH), ⍺ Haemolysin Production, Serum Resistance (SR) test and Gelatinase test (GT) were done on E. coli isolates. AST was performed by Kirby-Bauer’s disk diffusion method. Results: Out of 683 urine samples tested, 405 samples exhibited significant growth. Among 405 isolates, all the 285 E. coli isolates exhibited virulence markers, and 50% of E. coli isolates exhibited more than one virulence marker. Serum resistance is the commonest and Gelatinase production is the least common virulence marker. The overall sensitivity of E. coli is 89.8% to Cefotaxime, 83.8% to Nitrofurantoin, 56.1% to Amoxiclav, 52.2% to Netilmicin, 42.4% to Cotrimoxazole, and 41% to Gentamicin. Conclusion: Virulence markers such as serum resistance, ⍺ - haemolysin production and MRHA contributed to highest virulence. This study reflects the importance of identifying virulence markers, to prevent mortality and morbidity in pregnant women. The highest prevalence of resistance in UTI, calls for stringent policies for rational drug use and infection control measures in hospital practices. [ABSTRACT FROM AUTHOR]