Publication:

Antimicrobial susceptibility patterns of uropathogens among pregnant women in Mogadishu, Somalia

Background Urinary tract infections (UTIs) are common in pregnancy and pose serious health risks, yet data on uropathogens and antimicrobial resistance (AMR) in Somali pregnant women are limited. This study was carried out to investigate the causative uropathogens, their resistance patterns, and associated factors to multidrug resistance (MDR) among pregnant women at Banadir Maternal and Child Hospital in Mogadishu.

Methods A cross-sectional study was conducted from August to December 2024 involving 200 pregnant women. Clean-catch midstream urine samples were cultured and tested using standard microbiological methods and antimicrobial susceptibility testing per CLSI 2024 guidelines. Statistical analysis including chi-square and logistic regression was performed to identify predictors of MDR.

Results Among participants, 38.5% were illiterate, and half were aged between 21 and 25 years. Escherichia coli (59.5%) and Klebsiella spp. (15.5%) were the predominant pathogens. Ciprofloxacin was highly effective against E. coli (94.1%), while nitrofurantoin showed complete efficacy. Klebsiella spp. exhibited high resistance to meropenem (83.8%), gentamicin (80.0%), ceftriaxone (75.0%) and nitrofurantoin (100%). Gram-positive bacteria showed notable β-lactam resistance. UTIs were most common in the second trimester (40%). MDR was observed in 80% of isolates. Primigravida status was strongly associated with MDR, with nearly all primigravida (86.9%) versus few multigravida (3.6%) having MDR infections (AOR=318.25; 95% CI: 27.25-3716.52; p<0.001).

Conclusions The study underscores the need for routine urine culture, tailored antibiotic therapy, and enhanced surveillance to inform antenatal care and antimicrobial stewardship in Somalia.