ORIGINALARTICLE

SENSITIVITY PATTERN OF CEFIXIME AGAINST UROPATHOGENS CAUSING URINARY TRACT

INFECTION IN PREGNANT WOMEN

Syeda Maria Shah¹, Fauzia Afridi², Ayesha Jehangir¹

How to cite this article

ABSTRACT

OBJECTIVES

This study aimed to determine the susceptibility pattern of cexime against

uropathogens causing urinary tract infections among pregnant women

attending a tertiary care hospital in Peshawar, Pakistan.

Shah SM, Afridi F, Jehangir A.

Sensitivity Pattern of Cexime

Against Uropathogens Causing

Urinary Tract Infection in Pregnant

METHODOLOGY

Women. J Gandhara Med Dent Sci.

A descriptive cross-sectional study was conducted in the Department of

Obstetrics and Gynaecology at Khyber Teaching Hospital, Peshawar, with

approval from the Institutional Ethical Review Committee. The study was

carried out over six months (June 30 2024, to December 31 2024). A total of

197 pregnant women with culture-conrmed UTI were enrolled through

consecutive non-probability sampling. Midstream urine specimens were

collected aseptically and processed for routine examination, culture, and

antibiotic susceptibility testing. Culture and sensitivity testing were

performed according to Clinical and Laboratory Standards Institute (CLSI)

guidelines (the latest available hospital-level laboratory protocol). Cexime

susceptibility was reported as sensitive or resistant according to the standard

zone interpretation used in the institutional microbiology laboratory. Data

were analysed using SPSS version 20. Quantitative variables were

summarised as means ± standard deviations. The chi-square test was used for

subgroup analysis, and binary logistic regression was used to identify

predictors of cexime sensitivity. A p-value ≤ 0.05 was considered

statistically signicant. Odds ratios (OR) with 95% condence in tervals (CI)

were reported.

2026;13(3):93-97.

https://doi.org/10.37762/jgmds.13-3.865

Date of Submission: 18-02-2026

Date Revised:

Date Acceptance:

18-06-2026

19-06-2026

¹Post Graduate Resident, Department of

Obstetrics and Gynecology, Khyber

Teaching Hospital, Peshawar

Correspondence

²Fauzia Afridi, Associate Professor,

Department of Obstetrics and

Gynecology, Khyber Teaching Hospital,

Peshawar

+92-333-9154231

afridifauzia@gmail.com

RESULTS

Among 197 pregnant women with culture-conrmed UTIs, Escherichia coli

was the most common uropathogen (83.8%). Overall, 36.5% of isolates were

sensitive to cexime, while 63.5% were resistant. Chi-square analysis

demonstrated no signicant association between cexime sensitivity and age,

BMI, education, residence, or uropathogen type. Binary logistic regression

identied education as the only signicant predictor of cexime sensitivity

(OR = 1.89, 95% CI: 1.16-3.08, p = 0.010).

CONCLUSION

A high level of cexime resistance was observed among uropathogens,

particularly E. coli. These ndings highlight the importance of urine culture

and susceptibility testing before antibiotic selection. However, broader

multicenter studies with multiple antibiotics and additional clinical variables

are needed before changing empirical treatment policies.

KEYWORDS: Urinary Tract Infection, Cexime Sensitivity, Pregnancy,

Uropathogens.

INTRODUCTION

guidelines have been released globally to help doctors

choose the best antibiotic for every individual while

considering the safety prole of both the mother and

the fetus.²Because of things like lower bladder tone,

ureter dilatation and elevated bladder capacity, pregnant

women are more vulnerable to having a UTI. Preterm

childbirth, premature delivery, intrauterine fetal death,

chronic renal failure, anaemia, and hypertension are

among the consequences that might arise from these

physiological changes, including urine retention and

Urinary tract infections (UTIs) are

common

worldwide illness that aects over 150 million people

annually, with women accounting for most cases. Due

to several physiological, structural, and hormonal

variations, pregnancy raises the risk of UTI,

endangering the health of both the expecting mother

and the baby. About 50-60% of pregnant women get a

UTI, which is a frequent and serious health problem.¹

Treating UTIs during pregnancy is crucial, and care

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Sensitivity Pattern of Cexime Against Uropathogens Causing Urinary Tract

enhanced vesicoureteral reux. To avoid these negative METHODOLOGY

consequences, early identication and treatment of

This descriptive analytical cross-sectional study was

UTIs throughout pregnancy are crucial. A study of 564

pregnant women aged 17-44 showed that 48 (8.50%)

had urinary tract infections during pregnancy. The

sensitivity of these etiologic agents to antibiotics varied,

with Piperacillin-tazobactam having the highest overall

sensitivity (89.6%), followed by Meropenem (87.5%),

Nitrofurantoin (87.5%), and Cexime (68.8%).³About

8% of pregnant women in the US suer from lower

urinary tract infections (LUTIs), which are among the

most common medical conditions. In addition to taking

into consideration the impaired breakdown of drugs

during pregnancy and possible hazards of teratogenicity

or fetal harm related to certain antibiotics, treatment

should focus on the most common uropathogens.

Escherichia coli is the most common cause of urinary

tract infections, accounting for 80–90% of pregnancy-

related UTIs.^4,5One of the main causes of inappropriate

antibiotic prescriptions has been identied by clinical

signs of UTI without obtaining a urine culture.⁶

Antibiotic-resistant UTI infections are becoming more

common worldwide, which aects hospitals as well as

conducted at the Department of Gynaecology and

Obstetrics at KTH, Peshawar, from June 30 to

December 31, 2024, after obtaining approval from the

research review board. A total of 197 pregnant women

in the age range of 18 to 45 years diagnosed with

urinary tract infection were enrolled and evaluated for

sensitivity to cexime. The patients were excluded

when there was a history of antibiotic use in the last

month, patients with urogenital anomalies, malignancy

comorbid

conditions

diabetes

and

immunocompromised patients like those taking

steroids. Sample size was 197, calculated using the

WHO sample size calculator with a 95% condence

interval, a 7% margin of error, and an anticipated

frequency of 40.6% for Cexime sensitivity.⁵Written

informed consent was obtained from participants prior

to their inclusion. A structured proforma was used to

document demographic information and clinical

history. For all patients included in the study,

midstream urine samples were collected under sterile

conditions and promptly sent to the laboratory for

routine analysis and culture. Antibiotic susceptibility

testing was performed on isolated uropathogens to

determine their sensitivity or resistance to cexime.

Other commonly used antibiotics for UTI treatment,

such as Trimethoprim-sulfamethoxazole, nitrofurantoin,

and ciprooxacin, were also included in the testing. All

culture and sensitivity testing was done under the

supervision of a consultant microbiologist with a

minimum of 5 years of experience. Urinary tract

infection was conrmed based on urine culture with a

bacterial count of >105 colony-forming units (CFU)/ml

in a midstream urine sample collected in an air-tight,

sterile jar. Antibiotic susceptibility testing was

performed using the Kirby-Bauer disk diusion

method, interpreted according to CLSI guidelines,

M100-S25, 2024 version (as implemented in the

the

community.

Treatment

sometimes

begins

experimentally before the results of susceptibility

testing and urine cultures are available. Continuous

surveillance of resistance trends is crucial to improving

empirical

antibiotic

treatment

recommendations,

reducing hospital stays, improving patient outcomes,

and reducing healthcare costs.⁷The increasing

prevalence of antimicrobial resistance has become a

major global public health concern. Inappropriate

empirical antibiotic use contributes to the emergence of

resistant uropathogens, resulting in treatment failure,

prolonged illness, increased healthcare costs, and

adverse maternal and fetal outcomes. Continuous

surveillance of local antimicrobial susceptibility

patterns is therefore essential for evidence-based

empirical therapy. The signicance of this study lies in

optimising antibiotic therapy for urinary tract infections

institutional

laboratory

protocol).

Cexime

(UTIs)

during

pregnancy

evaluating

the

susceptibility was categorised as sensitive or resistant

based on zone diameter interpretation. When cexime

produced an inhibitory zone of 14mm or more for a

bacterium at 37 °C, that specic microorganism was

said to be sensitive to cexime and an inhibitory zone

of less than 14mm was considered resistant. The

obtained data were analysed using SPSS version 20.0.

The mean and standard deviation (SD) were calculated

for all quantitative variables, such as age and BMI,

while the categorical variables, such as education

status, residence, and sensitivity to cexime, were

susceptibility pattern of cexime against common

uropathogens. The findings may improve empirical

treatment,

reduce

antimicrobial

resistance

and

complications, and support evidence-based clinical

guidelines. As cexime susceptibility varies across

regions and local data in Pakistan are limited, the

objective of the present study was to determine the

susceptibility pattern of cexime against uropathogens

causing UTIs among pregnant women presenting to the

Department of Obstetrics and Gynaecology, Khyber

Teaching Hospital, Peshawar, Pakistan.

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Sensitivity Pattern of Cexime Against Uropathogens Causing Urinary Tract

Table 1: Baseline Characteristics of Study Participants (n = 197)

presented as frequencies and percentages. Eect

Parameters

Frequency %age P-Value

modifiers such as age, educational status, BMI, and

residence were handled through stratication. Chi-

square test was used for subgroup analysis. Binary

logistic regression was applied to determine predictors

of cexime sensitivity. Odds ratios (OR) with 95%

confidence intervals were reported. A p-value ≤ 0.05

was considered statistically signicant.

Age (years)

18-25 years

26-30 years

31-35 years

36-40 years

41-45 years

112

18.8

39.1

21.3

13.2

7.6

11.7

42.1

46.2

43.1

46.7

10.2

43.1

56.9

0.958

BMI (kg/m²) less than 18

18-24

0.426

0.052

0.381

Greater than 24

RESULTS

Education

Primary or

Secondary

Higher

below

Among 197 pregnant women with culture-positive

urinary tract infection, cexime sensitivity was

observed in 72 (36.5%) isolates, while 125 (63.5%)

were resistant. Age was categorised into groups, with

the highest frequency in the 26-30 years age group

(39.1%), followed by the 31–35 years age group

(21.3%), while participants aged 41-45 years

represented the smallest proportion (7.6%). A BMI

more than 24.0kg/m²was observed in 91 patients

(46.2%). Regarding residence, 112 patients (56.9%)

resided in rural areas, as reported in Table 1.

Escherichia coli was the most frequently isolated

organism (83.8%), followed by Pseudomonas (6.1%)

and Klebsiella pneumoniae (5.1%). The least common

organisms were Pantoea species and Citrobacter (0.5%

each). No statistically signicant dierence was

observed in the distribution of uropathogens (p =

0.066). (Table 2) Overall, cexime sensitivity was

observed in 72 patients (36.5%), while 125 patients

(63.5%) were resistant, as shown in Table 3. On

stratied analysis using the Chi-square test, cexime

sensitivity did not show a statistically signicant

association with age (p = 0.958), BMI (p = 0.426),

education level (p = 0.052), residence (p = 0.381), or

uropathogen type (p = 0.066). To identify independent

predictors of cexime sensitivity, a binary logistic

regression analysis was performed (Table 4). Education

was the only variable signicantly associated with

cefixime sensitivity (OR = 1.893, 95% CI: 1.164–

3.080, p = 0.010). In contrast, age (OR = 0.739, 95%

CI: 0.343-1.591, p = 0.439), BMI (OR = 1.379, 95%

CI: 0.865-2.197, p = 0.176), residence (OR = 1.255,

95% CI: 0.680-2.317, p = 0.467), and uropathogen type

(OR = 0.817, 95% CI: 0.608-1.097, p = 0.178) were not

signicantly associated with cexime sensitivity.

Residence

Urban

Rural

Table 2: Distribution of Uropathogens Isolated from Urine

cultures (n = 197)

Parameters

Uropathogen E coli

Frequency %age P-Value

165

83.8

6.1

5.1

0.066

Pseudomonas 12

Klebsiella

pneumoniae

proteus

Pantoea Spp

Enterobacter

Citrobacter

diversus

2.5

0.5

1.5

0.5

Table 3: Cexime Sensitivity Pattern among Isolated

Uropathogens (n = 197)

Frequency

%age

36.5

63.5

Cexime Sensitivity Yes

Pattern

125

Table 4: Logistic Regression Analysis to Analyse the Predictors of

Cefixime Sensitivity (n = 197)

Variables

S.E. Wald P-

Value

95% C.I.for

EXP(B)

Lower Upper

Age (years)

0.392 0.598 0.439 0.739 0.343 1.591

0.303

BMI(kg/m²) 0.321 0.238 1.827 0.176 1.379 0.865 2.197

Education

0.638 0.248 6.611 0.010 1.893 1.164 3.080

Residence 0.227 0.313 0.529 0.467 1.255 0.680 2.317

Uropathogen -0.202 0.150 1.812 0.178 0.817 0.608 1.097

Constant

-0.948 0.872 1.184 0.277 0.387

DISCUSSION

This study demonstrates a high level of cexime

resistance among uropathogens in pregnant women,

particularly E. coli. The predominance of E. coli is

consistent with global literature. The signicant

prevalence among women with an elevated body mass

index (BMI) is consistent with recent ndings that

relate an elevated BMI prior to pregnancy to a greater

likelihood of UTIs.^8,9The study's applicability across a

variety of community contexts, where the availability of

diagnostics and antibiotic use may differ, is highlighted

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Sensitivity Pattern of Cexime Against Uropathogens Causing Urinary Tract

by the distribution pattern among urban and rural a comprehensive study of antibiotic resistance in

residents. E. coli was the most common urinary tract pregnancy-related UTIs, although South Asia had

pathogen, accounting for

large percentage of particularly high cephalosporin resistance rates.¹⁷

infections, in line with local and worldwide statistics on Cefixime sensitivity in E. coli was shown to be poor in

both community-wide and pregnancy-related UTIs.^10,11another study conducted in a similar setting, strongly

It is consistent with previous studies. While the supporting our ndings and suggesting a regional

uncommon discovery of Pantoea species and issue.¹⁸This highlights the rapid development of

Citrobacter diversus highlights that unusual infectious resistance compared with earlier research or studies

agents are sometimes identied, potentially in from areas with more stringent antibiotic regulations,

situations involving repeated infection or concurrent where higher susceptibility rates were nevertheless

host illnesses, the segregation of other organisms, such documented 10 years ago.¹⁹

Pseudomonas

aeruginosa

and

Klebsiella

pneumoniae, conforms to anticipated trends.¹²The

strikingly low overall sensitivity to cexime is the

LIMITATIONS

study's most notable finding. This suggests a signicant Its single-centre design restricts generalizability due to

degree of resistance that seriously compromises the potential regional variation in antimicrobial resistance

medication's eectiveness as an oral rst-line patterns. Only cexime was evaluated, limiting

treatment. Although this incidence is signicantly comparison with other commonly used antibiotics in

lower than some previous ndings, it supports a pregnancy and reducing clinical interpretability.

growing body of recent data showing that Gram- Although

susceptibility

testing

was

performed

negative uropathogens are becoming increasingly according to Clinical and Laboratory Standards Institute

resistant to third-generation cephalosporins, especially (CLSI) guidelines as implemented in the institutional

in low- and middle-income countries.^13,14Increasing laboratory, the absence of details on CLSI version,

antimicrobial

resistance

among

Gram-negative quality control strains, disk potency, and ESBL

uropathogens has been widely reported, particularly in confirmation limits methodological reproducibility.

low-

and

middle-income

countries.¹⁵Cexime Furthermore, obstetric variables such as gestational age,

sensitivity did not signicantly correlate with patient trimester, parity or pregnancy outcomes were not

age, BMI, or place of residence in subgroup analyses.

The slightly increased sensitivity observed in patients

over 30 years of age compared with those with a normal

body mass index (BMI) was not statistically signicant,

indicating that resistance is common and not limited to

certain demographic groups within the pregnant

community. There was a trend toward a substantial

correlation with educational attainment, with highly

educated individuals exhibiting the least sensitivity.

This unexpected result calls for further research, but it

may be linked to dierences in healthcare availability,

self-treatment, or past antibiotic exposure patterns

across socioeconomic groups.¹⁶Important insights were

obtained from analysis by pathogen kind. The variation

in sensitivity patterns across uropathogens was only

marginally signicant, despite E. coli showing the

routinely collected in the original study protocol.

Finally, the relatively small number of non- Escherichia

coli isolates reduced the statistical power of subgroup

analyses and limits condence in organism-specic

comparisons. Collectively, these limitations constrain

the generalizability of the ndings and underscore the

need for larger, multicenter studies with comprehensive

microbiological and clinical characterisation.

CONCLUSIONS

The present study demonstrates that E. coli is the

predominant uropathogen among pregnant women with

urinary tract infection and that a substantial proportion

of isolates were resistant to cexime. These findings

emphasise the importance of obtaining urine culture

and antimicrobial susceptibility results whenever

possible to guide appropriate antibiotic therapy. Given

the single-centre design and evaluation of only one

antimicrobial agent, further multicenter prospective

greatest

degree

resistance.

Interestingly,

Pseudomonas isolates showed a comparatively high

sensitivity rate; however, this nding should be

interpreted cautiously, as it is based on a limited

sample. On the other hand, Enterobacteriaceae other

than E. coli have also shown signicant resistance.

Given its prevalence, the elevated resistance in E. coli

is particularly worrisome, as it means cexime would

be ineective against a signicant number of the most

prevalent illnesses. Our results on cexime sensitivity

are especially striking when compared to current

research. Signicant regional diversity was reported in

studies

incorporating

multiple

antibiotics

and

comprehensive clinical variables are warranted to

inform empirical treatment recommendations.

CONFLICT OF INTEREST: None

FUNDING SOURCES: None

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Sensitivity Pattern of Cexime Against Uropathogens Causing Urinary Tract

12. Kaur R, Kaur R. Symptoms, risk factors, diagnosis and

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AUTHORS CONTRIBUTION

2020;36:144.

PMID:

Syeda Maria Shah - Concept & Design; Data Acquisition;

Data Analysis/Interpretation; Drafting Manuscript; Final

Approval

https://doi.org/10.11604/pamj.2020.36.144.22965.

33014247.

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resistance pattern of bacteria causing urinary tract infection in

pregnant women in Yazd, Iran. Infect Dis Obstet Gynecol.

Fauzia Afridi - Concept & Design; Data Acquisition; Critical

Revision; Supervision; Final Approval

Ayesha Jehangir - Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Final Approval

The authors accept responsibility for all aspects of the work

and will ensure that any concerns regarding the accuracy or

integrity of any part are properly investigated and resolved.

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