Abstract
The sample of study was 95 urine sample were collected from Al-Ramadi maternity and children teaching hospital in Al-Ramadi city from pregnant women with urinary tract infection (UTI).
A urine sample was collected and cultured in many culture media (Blood agar, MacConkey agar, Chocolate agar and Mullar Hinton agar). In addition to indicator and measurement of antibiotic sensitivity and resistant for each sample and bacteria type.
The result showed high infection bacteria in urinary tract sample were Escherichia coli (E.coli) and staphylococcus. In addition to the most antibiotics have sensitivity to bacterial infection were Ceftriaxone, Amikacin, Amoxicillin, and Gentamicin. The results also showed that the most antibiotic work and related with all type of bacteria that affects the urinary system were Ciprofloxacin and Amoxicillin.
Keywords: E.coli, Staphylococcus, Pregnant women .

Introduction

Urinary  infections are a serious health issue that occasioned  through wide  group of pathogens, however , most common include Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, Enterococcus faecalis, and Staphylococcus saprophyticus. the increase in infection  rates and antimicrobial impedance among uropathogenic menace the increase the economic load of infection(Nicolle ,2014  )

Bacteria are prokaryotes free living microorganisms often containing one cell. Bacteria represent  the first forms of life to show on Earth and  found in  its habitats. Bacteria have a role in several stages of the nutrition cycle through recycle nutrients and the  nitrogen fixation from atmosphere. The nutrients cycle include the dead body decomposition; bacteria are responsible for the decay stage in this cycle( Gupta et al.,2016 ).

Adequate nutrients are found in the tissue and blood to assist the proliferation of microorganisms. The body has a defense system that provides it the natural immune, or innate impedance, against different microbes and allows it to protect against microbial infestation of its tissues(Brandes et al.,2019).

Staphylococcus is a Gram-positive bacteria that has size ( 0.5 – 1.5 μm) distinguished as a single cocci that splits to generate clusters of similar grapes( Kloos and  Bannerman ,1994 ) .

Gram negative are  nonsporulated, rod shape, facultative anaerobic, coliform bacteria belong to  Escherichia genus such as  E. coli found in the food,  environment, and  lower digestive system. E. coli is a non-acid fast bacillus that  found  pairs or alone ) Köhler and Dobrindt,2011).

Proteus is a Gram-negative bacteria distinguished as aerobic,  rod shape, motile that travels over surfaces this is a merit  that allows it to reproduce at temperatures ( 20 – 37 °C)( O’Hara et al.,2000 ).

Antibiotics are the chemical materials that microbes produce or  semisynthetic chemicals that come from a microorganism that taken in small amounts either kill or stop  other microorganisms development . Bacteriostatic factors  are prevent the  germs development , whereas bactericidal factors  break down them (Muteeb et al.,2023).

This study aimed to find the distribution of bacterial infection on the pregnant women with urinary tract infection .Find the most type of bacterial infection on a sample of pregnant women with UTI.Find the most appropriate type of antibiotic that use to treatment of UTI

Material and Methods

Specimens collection

 Hospital environment

In this study, samples are obtained from people suffering from urinary tract infections in the Ramadi Teaching Hospital and from maternity and Children’s Teaching Hospital in the city of Ramadi.

Samples were collected in special tubes, the samples were coded, and the necessary tests were performed. Continue Sample collection for a period of three months from 11/1/2023 to 2/1/2024

Cultivation of samples

Samples were brought and cultured as follows:

Streaking models taken from patients with urinary tract infections were implanted on the culture media were blood agar, Nutrient agar, and chocolate agar and incubated in the incubator for 24 hours at a temperature of 37 ° C. After reading the positive results based on the shape and color of the colony as a preliminary diagnosis, then a catalase and oxidase test was conducted on them. The media were used Nutrient agar, blood agar and chocolate agar for the primary isolation of bacteria (staphylococcus, Escherichia coli, Proteus spp., Pseudomonas aeruginosa.

Results and Discussion

The study done in Al-Ramadi teaching hospital- Al-Ramadi city. Anbar providence- Iraq to showed the most bacterial infection, antibiotic sensitivity and resistant on a samples of women pregnant with urinary tract infections (UTI).

The result classified as age periods for sample, number and type of bacteria infected, type of antibiotic that uses, and the relation between antibiotic that uses with bacterial infection.

In the table 1 showed the frequency and percent of age periods for sample study. The result showed that higher percent for age period is 31-35 years with percent (35.8%). After that the age period 26-30 years with percent (25.3%). Age period 21-25 years was have (23.2%) from all participant. The least percent of age period participants was 15-20 years with percent (15.8), that indicate the married women in this age was less in our populations Figure 1.

Table 1: Age period for sample study

Figure 1: showed the percent of age period for sample study

Table (2) showed the frequency and percent of type of bacterial for sample infected with UTI. The higher percent was for E-coli with percent (56.8%). The most infected with UTI is caused by E-coli. The staphylococcus take the second causes of UTI with percent (28.4%). The others bacteria that found in the sample study was (Proteus spp., Pseudomonas aeruginosa) with percent (4.2, 3.2%) respectively. Also in the sample was founded four sample as normal with percent (4.2%)Figure 2.

Table 2: Type of bacteria for sample study

Figure 2: showed the percent of type of bacteria for sample study

Table 3 showed the frequency and percent of antibiotic that used in the study to showed the sensitivity and resistant against bacterial infection.

The result showed that the higher antibiotic that work as sensitive for bacterial infection as common was Ciprofloxacin with percent (55.8%) while the resistant was (44.2%). The Amoxicillin have (37.9%) as sensitivity work on bacterial infection. Less than these two antibiotic, Nitrofurantoin has a sensitivity percent of all bacterial infection (33.7%). In addition to others antibiotics (Gentamicin, Amikacin, Ceftriaxone, Nalidixic acid, and Tetracycline) have less sensitivity toward bacterial infection with percent (32.6, 30.5, 29.5, 24.2, 23.2 %) respectively.

In the other side, the result of the study showed that higher percent of antibiotic resistant against bacterial was Tetracycline with percent (76.8%), while less antibiotic resistant was Ciprofloxacin with percent (44.2%).

Table3: Type of Antibiotics and distribution of resistance and sensitivity for Antibiotic in a sample of the study

Table (4)clarify the relation between antibiotics and bacterial type. The study result showed higher effect for Amoxicillin, Amikacin, Gentamicin, and Ceftriaxone with all bacteria type in the study with X² (15.9, 11.3, 11, and 9.83) and p-value (0.003, 0.023, 0.027 and 0.043) respectively. The result prove that the most common antibiotic that use to treatment of UTI is these four antibiotics (Amoxicillin, Amikacin, Gentamicin, and Ceftriaxone).

The most antibiotic use to treatment of Staphylococcus is Amoxicillin then Gentamicin. In addition to, the most antibiotic use to treatment of E.coli is Ciprofloxacin and Ceftriaxone. Proteus spp. had high sensitivity toward Gentamicin. Pseudomonas aeruginosa have high sensitive toward Amikacin  Figures 3-10.

Table 4:The relation of Antibiotics with resistant and sensitivity for Antibiotic in a sample of the study

Figure 3: shows the Frequency effect of ceftriaxone on type of bacteria

Figure 4: shows the Frequency effect of Amikacin on type of bacteria

Figure 5: shows the Frequency effect of Amoxicillin on type of bacteria

Figure 6: shows the Frequency effect of Ciprofloxacin on type of bacteria

Figure 7: shows the Frequency effect of Nalidixic acid on type of bacteria

Figure 8: shows the Frequency effect of Gentamicin on type of bacteria

Figure 9: shows the Frequency effect of Nitrofurantion on type of bacteria

Figure 10: shows the Frequency effect of tetracycline on type of bacteria

Discussion

UTIs can progress to more serious kidney infections (pyelonephritis), which can lead to complications such as preterm labor, low birth weight, and maternal sepsis. Recurrent UTIs during pregnancy may increase the risk of developing chronic kidney disease later in life.[86]

UTIs during pregnancy have been associated with adverse fetal outcomes, including preterm birth, intrauterine growth restriction (IUGR), and neonatal sepsis. There’s evidence to suggest that maternal UTIs may also contribute to long-term health issues in offspring, such as hypertension and chronic kidney disease ( Wang et al.,2015 ).

Urinary infection in pregnant is asymptomatic and its diagnosis represent  challenging. Urinary infection symptoms related  to the risk of development infection) Kazemier et al.,2015).

Antibiotics represent  protective treatment during pregnancy in urinary infection.

According to the American College of Obstetricians and Gynecologists, common antibiotics such as penicillins, nitrofurantoin , and cephalosporins are considered safety during pregnancy. Trimethoprim-sulfamethoxazole) represent safety during second and third trimester (ACOG,2020).

Antibiotic treatment of UTIs in pregnant women helps prevent complications such as kidney infections, preterm labor, low birth weight, and neonatal sepsis. Effective treatment of UTIs reduces the risk of adverse outcomes for both the mother and the baby( Cook et al.,2020).

Cephalexin is frequently applied to treat urinary infection in pregnant. It is considered safety during pregnancy)Cash,2023).Amoxicillin/clavulanic acid (Augmentin) included amoxicillin ,and clavulanic acid, is prescribed for pregnant with urinary infection ) CDC ,2019).

Trimethoprim/sulfamethoxazole is another antibiotic to treat urinary infection, but avoided during pregnancy in the first trimester, because its concerns with potential birth defects. (Briggs et al.,2020 ).

Conclusions

The result of this study approved that the most bacterial type of infection on urinary tract is E.coli and staphylococcus.The most Antibiotics work as sensitive on the sample study were Ceftriaxone, Amikacin, Amoxicillin, and Gentamicin.The most Antibiotics work as resistant on the sample study were Tetracycline and Nalidixic acid.The antibiotic work to treatment all type of urinary tract bacterial infection were Amoxicillin and Ciprofloxacin.

Acknowledgment

Non

Conflicts Interest

Non

References

Write references in APA system

• Nicolle, L. E. (2014). Urinary Tract Infections in the Older Adult. Clinics in Geriatric Medicine, 30(1), 107–121.
• Kloos W.E,and  Bannerman, T.L (1994) Update on clinical significance of coagulase-negative staphylococci. Clin Microbiol Rev 7: 117-140.
• Köhler, C. D., and Dobrindt, U. (2011). What defines extraintestinal pathogenic Escherichia coli?. International journal of medical microbiology, 301(8), 642-647.
• O’Hara, C. M., Brenner, F. W., Steigerwalt, A. G., Hill, B. C., Holmes, B., Grimont, P. A., … & Brenner, D. J. (2000). Classification of Proteus vulgaris biogroup 3 with recognition of Proteus hauseri sp. nov., nom. rev. and unnamed Proteus genomospecies 4, 5 and 6. International journal of systematic and evolutionary microbiology, 50(5), 1869-1875.
• Brandes, R., Lang, F., & Schmidt, R. F. (Eds.). (2019). Physiologie des Menschen: mit Pathophysiologie. Springer-Verlag.
• Muteeb, G., Rehman, M. T., Shahwan, M., & Aatif, M. (2023). Origin of Antibiotics and Antibiotic Resistance, and Their Impacts on Drug Development: A Narrative Review. Pharmaceuticals (Basel, Switzerland), 16(11), 1615. https://doi.org/10.3390/ph16111615
• Gupta, A., Gupta, R., & Singh, R. L. (2016). Microbes and Environment. Principles and Applications of Environmental Biotechnology for a Sustainable Future, 43–84. https://doi.org/10.1007/978-981-10-1866-4_3
• Wing, D. A., & Fassett, M. J. (2015). The Effect of Symptomatic Maternal Urinary Tract Infection on Neonatal Mortality. Obstetrics & Gynecology, 126(6), 1095–1100.
• Kazemier, B. M., Koningstein, F. N., Schneeberger, C., Ott, A., Bossuyt, P. M., de Miranda, E., Vogelvang, T. E., Verhoeven, C. J. M., Langenveld, J., Woiski, M., Oudijk, M. A., van der Ven, J. E. M., Vlegels, M. T. W., Kuiper, P. N., Feiertag, N., Pajkrt, E., de Groot, C. J. M., Mol, B. W. J., & Geerlings, S. E. (2015). Maternal and Neonatal Consequences of Treating Pregnant Women with Urinary Tract Infection: A Population-Based Cohort Study. Clinical Infectious Diseases, 61(9), 1367–1375.
• American College of Obstetricians and Gynecologists (ACOG). (2020). Practice Bulletin No. 199: Obstetric Analgesia and Anesthesia. Obstetrics & Gynecology, 135(3), e95–e105.
• Cook, E., Ramirez, M., & Turrentine, M. (2020). Time has come for routine penicillin allergy testing in obstetrics. American Journal of Perinatology Reports, 10(01), e15-e19.
• Cash, J. C. (Ed.). (2023). Family practice guidelines. Springer Publishing Company.
• Centers for Disease Control and Prevention (CDC. ((2019). CDC yellow book 2020: health information for international travel. Oxford University Press.
• Sachs, H. C., Committee on Drugs, Frattarelli, D. A., Galinkin, J. L., Green, T. P., Johnson, T., … & Van den Anker, J. (2013). The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics, 132(3), e796-e809.
• Briggs, G. G., Freeman, R. K., Towers, C. V., & Forinash, A. B. (2021). Briggs drugs in pregnancy and lactation: a reference guide to fetal and neonatal ris.k. Lippincott Williams & Wilkins.