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Background <p>Urinary tract infections (UTIs) are among the most common bacterial infection during pregnancy, and a leading cause of maternal and neonatal morbidity. In Palestine, limited data exist on the burden, microbial etiology, and antimicrobial resistance. This study aimed to determine the incidence, microbial profiles, antimicrobial resistance patterns, and recurrence of UTIs among pregnant women attending primary healthcare clinics in Nablus, Palestine.</p> Methodology <p>A prospective cohort study was conducted between December 2024 and May 2025 across 12 primary healthcare clinics in Nablus, Palestine. Pregnant women aged 18 and older were enrolled. Screening for UTIs was conducted under a combination of study-directed testing and routine clinical practice, where urine culture was more frequently performed in symptomatic women or when clinically indicated. Data were collected using structured questionnaires and laboratory analyses, including urine cultures and antibiotic susceptibility testing. Sociodemographic, obstetric, and clinical data were collected, with a 90-day follow-up to assess recurrence.</p> Results <p>Out of 485 women, 279 underwent urine culture, of whom 115 (41.2%) had confirmed UTIs. <i>Escherichia coli</i> (38.3%) and <i>Staphylococcus aureus</i> (22.6%) were the most commonly isolated pathogens. Multidrug resistance (MDR), defined as a non-susceptibility to at least one agent in three or more antimicrobial categories, was observed in 55.7% of isolates with particularly high resistance to ampicillin, cefixime, and fosfomycin. Pregnancy-appropriate options such as nitrofurantoin (81.6%) and fosfomycin (64.7%) retained moderate activity. Symptom severity correlated with MDR status, with women reporting frequent urination, abdominal pain, or higher symptom scores more likely to harbor resistant pathogens (<i>p</i> &lt; 0.001). At 90-day follow-up, 18 women (15%) developed recurrent UTIs, frequently associated with MDR organisms. Most diagnosed women were primarily treated with empirical antibiotics according to routine clinical practice.</p> Conclusions <p>Pregnant women in Palestine face a high burden of UTIs, dominated by <i>E. coli</i> and <i>S. aureus</i>, with alarming levels of multidrug resistance. Strengthening culture-based diagnosis, local resistance surveillance, and antimicrobial stewardship in antenatal care is crucial to improving maternal outcomes and mitigating the spread of antimicrobial resistance.</p>

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Bacterial profiles, antibiotic resistance, and recurrence of UTIs during pregnancy: a prospective cohort study from Palestine

  • 期刊论文

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  • 发表日期：

    2026年7月9日

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  • Lara Z. Khatatba,
  • Dala N. Daraghmeh

摘要

Background

Urinary tract infections (UTIs) are among the most common bacterial infection during pregnancy, and a leading cause of maternal and neonatal morbidity. In Palestine, limited data exist on the burden, microbial etiology, and antimicrobial resistance. This study aimed to determine the incidence, microbial profiles, antimicrobial resistance patterns, and recurrence of UTIs among pregnant women attending primary healthcare clinics in Nablus, Palestine.

Methodology

A prospective cohort study was conducted between December 2024 and May 2025 across 12 primary healthcare clinics in Nablus, Palestine. Pregnant women aged 18 and older were enrolled. Screening for UTIs was conducted under a combination of study-directed testing and routine clinical practice, where urine culture was more frequently performed in symptomatic women or when clinically indicated. Data were collected using structured questionnaires and laboratory analyses, including urine cultures and antibiotic susceptibility testing. Sociodemographic, obstetric, and clinical data were collected, with a 90-day follow-up to assess recurrence.

Results

Out of 485 women, 279 underwent urine culture, of whom 115 (41.2%) had confirmed UTIs. Escherichia coli (38.3%) and Staphylococcus aureus (22.6%) were the most commonly isolated pathogens. Multidrug resistance (MDR), defined as a non-susceptibility to at least one agent in three or more antimicrobial categories, was observed in 55.7% of isolates with particularly high resistance to ampicillin, cefixime, and fosfomycin. Pregnancy-appropriate options such as nitrofurantoin (81.6%) and fosfomycin (64.7%) retained moderate activity. Symptom severity correlated with MDR status, with women reporting frequent urination, abdominal pain, or higher symptom scores more likely to harbor resistant pathogens (p < 0.001). At 90-day follow-up, 18 women (15%) developed recurrent UTIs, frequently associated with MDR organisms. Most diagnosed women were primarily treated with empirical antibiotics according to routine clinical practice.

Conclusions

Pregnant women in Palestine face a high burden of UTIs, dominated by E. coli and S. aureus, with alarming levels of multidrug resistance. Strengthening culture-based diagnosis, local resistance surveillance, and antimicrobial stewardship in antenatal care is crucial to improving maternal outcomes and mitigating the spread of antimicrobial resistance.