Epidemiological characteristics and pathogen profiles of non-Escherichia coli gram-negative urinary tract infections in pregnant women: insights from Makassar, Indonesia

Abstract

Introduction: urinary tract infections (UTIs) during pregnancy pose significant health risks for both mother and fetus. While Escherichia coli is the most common causative agent, non-Escherichia coli gram-negative bacteria also contribute to UTIs, with their specific prevalence and characteristics in pregnant women needing further elucidation, particularly in local contexts. This study aimed to identify gram-negative non-Escherichia coli bacteria causing UTIs in pregnant women and to determine their epidemiological characteristics in Makassar, Indonesia. Methods: a cross-sectional study was conducted at the Clinical Microbiology Laboratory of Hasanuddin University Hospital, Makassar, from July to August 2024. The study utilized 38 non-Escherichia coli bacterial isolates from urine cultures of pregnant women diagnosed with UTIs at various community health centers. After re-culturing on MacConkey Agar, bacterial identification was performed using the API 20e system. Epidemiological data were collected from medical records and questionnaires. Results: among 38 non-Escherichia coli isolates, Enterobacter cloacae was most prevalent (34.2%), followed by Klebsiella pneumoniae spp. Pneumoniae (23.7%). Most isolates (76.3%) were lactose fermenters. Epidemiologically, the 25-34 age group dominated (71.0%), with the highest UTI incidence in first pregnancies (47.4%) and the second trimester (44.7%). Significantly, 97.4% of pregnant women with UTI symptoms did not seek treatment. Conclusion: Enterobacter cloacae is the most common non-Escherichia coli gram-negative UTI bacterium in this Makassar cohort. Key epidemiological characteristics were elucidated, revealing a substantial proportion of women not seeking treatment for UTI symptoms. These findings underscore the importance of local surveillance and targeted health education interventions for pregnant women regarding UTI management.

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