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040			_cDLC
041			_aEnglish
100			_aJ Seni _923416
245			_aMulticentre evaluation of significant bacteriuria among pregnant women in the cascade of referral healthcare system in North-Western Tanzania _b bacterial pathogens, antimicrobial resistance profiles and predictors
260			_aMwanza, Tanzania: _bElsevier & _b Catholic University of Health and Allied Sciences [CUHAS – Bugando] _c2019/6/1
300			_aPages 173-179
490			_vJournal of Global Antimicrobial Resistance Volume 17
520			_aAbstract Objectives: The aim of this multicentre study was to evaluate the magnitude of significant bacteriuria (SB) as well as the implicated bacterial pathogens, antimicrobial resistance (AMR) profiles and risk factors for SB among pregnant women attending different levels of healthcare facilities (HCFs) in Tanzania in order to guide antimicrobial therapy and preventive measures. Methods: Information on sociodemographic and clinical characteristics, midstream urine culture and antimicrobial susceptibility testing was collected from 1828 pregnant women between March 2016 and May 2017. Data were analysed using STATA v.13.0 software. Results: The prevalence of SB among pregnant women was 17.7% (323/1828; 95% CI 16.0–19.5%), with a predominance of Escherichia coli (164/323; 50.8%), Klebsiella spp. (55/323; 17.0%) and Staphylococcus aureus (28/323; 8.7%). Moreover, 37.5% (121/323) of bacteria were multidrug-resistant [84.3% (102/121) Gram-negative bacteria and 15.7% (19/121) in Gram-positive bacteria; P < 0.001]. Third-generation cephalosporin resistance in E. coli, Klebsiella spp. and other Enterobacteriaceae was 13.4%, 21.8% and 27.5%, respectively, and was higher in strains from a tertiary hospital (OR = 3.27, 95% CI 1.02–10.49; P = 0.046) compared with lower HCFs. Predictors of SB among pregnant women were lack of formal occupation, current hospital admission and presence of co-morbidities. Conclusions: The prevalence of SB among pregnant women in this study was high (17.7%) and was within the same range reported 10 years ago in a single-centre baseline study. However, there is an increase in AMR in the cascade of referral healthcare system, underscoring the need for health facility level-specific antimicrobial stewardship.
700			_aJN Tito _945367
700			_a SJ Makoye _945368
700			_a H Mbena _923710
700			_a HS Alfred _945369
700			_aF van der Meer _923634
700			_a JDD Pitout _945370
700			_aSE Mshana _923705
700			_aR DeVinney _923421
856			_uhttps://doi.org/10.1016/j.jgar.2018.12.024
942			_2ddc _cVM
999			_c19426 _d19426