upload_fwswnton3arzs4klsl2tjodctg.pdf

47

J Gandhara Med Dent Sci

October - December 2026

ORIGINAL ARTICLE

:

BACTERIAL PROFILE AND ANTIMICROBIAL SUSCEPTIBILITY PATTERNS OF URINARY

TRACT INFECTION IN PREGNANT WOMEN AT THQ SWABI

Nilofar

1

, Nadia Rani

2

, Hina Safdar

3

, Arifa

4

, Alina Khalid

5

How to cite this article

Nilofar, Rani N, Safdar H, Arifa,

Khalid A.

Bacterial Proﬁle and

Antimicrobial Susceptibility Patterns

of Urinary Tract Infection in Pregnant

Women at THQ Swabi.

J Gandhara

Med Dent Sci. 2026; 13(4): 47-52.

Date Submission:

04-06-2026

Date Revised:

10-09-2026

Date Acceptance:

10-09-2026

1

Demonstrator, Department of

Pathology, Gajju Khan Medical

College Swabi

4

Senior Registrar, Department of

Gynae, Gajju Khan Medical College

Swabi

Correspondence

2

Nadia Rani, Assistant Professor,

Department of Gynae, Gajju Khan

Medical College Swabi

+92-346-5639046

peerfaqir@gmail.com

ABSTRACT

OBJECTIVES

This study aimed to determine bacterial isolates, antimicrobial susceptibility

patterns, and selected factors associated with culture-positive urinary tract

infection

among

pregnant

women

presenting

at

Tehsil

Headquarters

Hospital, Swabi.

METHODOLOGY

This

descriptive

cross-sectional

study

included

102

pregnant

women

with

suspected

urinary

tract

infection

from

May

to

November

2023

using

non-

probability

consecutive

sampling.

Clinical

and

obstetric

information,

urinalysis

ﬁndings,

and

recent

antibiotic

exposure

were

recorded.

Clean-

catch

midstream

urine

specimens

were

processed

for

culture,

bacterial

identiﬁcation,

and

antimicrobial

susceptibility

testing

in

the

laboratory.

Associations

with

culture

positivity

were

evaluated

using

chi-square

or

Fisher’s exact tests, followed by binary logistic regression.

RESULTS

The

mean

age

was

28.10

±

6.00

years.

Signiﬁcant

bacterial

growth

was

detected

in

78

(76.5%)

specimens.

Escherichia

coli

was

the

predominant

isolate,

accounting

for

36

(46.2%)

culture-positive

samples,

followed

by

Klebsiella pneumoniae in 17 (21.8%) and Staphylococcus saprophyticus in 8

(10.3%).

Overall

susceptibility

was

highest

to

fosfomycin

(89.7%),

nitrofurantoin

(85.9%),

and

amikacin

(85.9%),

whereas

resistance

was

highest to ampicillin (83.3%) and cotrimoxazole (69.2%). On multivariable

analysis,

more

than

ﬁve

pus

cells

per

high-power

ﬁeld

remained

independently associated with culture-positive infection (AOR 3.262, 95% CI

1.073–9.916; p=0.037).

CONCLUSION

Culture-positive

urinary

tract

infection

was

common

in

this

selected

antenatal

population,

with

E.

coli

predominating.

High

resistance

to

commonly

used

agents

supports

culture-guided

treatment,

antimicrobial

stewardship, and periodic local antibiogram surveillance, while pregnancy-

speciﬁc

safety

considerations

should

guide

ﬁnal

antibiotic

selection

in

routine antenatal care settings.

KEYWORDS:

Pregnancy,

Urinary

Tract

Infection,

Bacterial

Proﬁle,

Antimicrobial Susceptibility, Escherichia Coli, Fosfomycin, Nitrofurantoin

INTRODUCTION

Urinary

tract

infection

(UTI)

is

a

common

bacterial

infection

during

pregnancy

and

may

range

from

asymptomatic bacteriuria to cystitis and pyelonephritis.

Pregnancy-related

anatomical

and

physiological

changes-including

ureteric

dilatation,

urinary

stasis,

altered

bladder

emptying,

and

changes

in

immune

response-can

increase

susceptibility

to

bacterial

colonization and ascending infection.

1,2,3,4

Untreated or

inadequately

treated

infection

is

clinically

important

because

it

may

progress

to

pyelonephritis

and

contribute to maternal morbidity and adverse pregnancy

outcomes.

Clinical

diagnosis

can

be

challenging

because

urinary

frequency

and

mild

lower-abdominal

discomfort may occur in normal pregnancy, while some

women

with

signiﬁcant

bacteriuria

have

few

or

no

symptoms.

Urinalysis,

including

pyuria,

nitrite,

and

leukocyte esterase, can support clinical assessment, but

urine

culture

remains

the

conﬁrmatory

method

for

identifying signiﬁcant bacterial growth and provides the

basis

for

organism-directed

antimicrobial

therapy.

1,3,4

This

is

particularly

important

in

pregnancy,

where

unnecessary

exposure

to

ineﬀective

drugs

should

be

avoided.

The

bacterial

proﬁle

of

UTI

varies

by

geography,

patient

population,

healthcare

setting,

and

prior

antibiotic

exposure.

Enteric

Gram-negative

organisms predominate in most series, with Escherichia

coli

generally

the

leading

isolate,

followed

by

Klebsiella,

Proteus,

and

other

uropathogens;

Gram-

http://doi.org/10.37762/jgmds.13-4.947

3

Demonstrator, Department of

Anatomy, Gajju

Khan Medical

College Swabi

5

Demonstrator, Department of

Biochemistry, Gajju Khan Medical

College Swabi

48

J Gandhara Med Dent Sci

October - December 2026

positive

organisms

such

as

Staphylococcus

saprophyticus

and

Enterococcus

species

may

also

occur.

5,6,7

Because

the

distribution

of

organisms

and

resistance

phenotypes

changes

over

time,

local

microbiological

surveillance

is

necessary

to

support

rational

empirical

therapy

while

culture

results

are

pending.

Antimicrobial

resistance

further

complicates

management.

Repeated

empirical

prescribing,

incomplete courses, non-prescription antibiotic use, and

community

exposure

can

reduce

the

activity

of

commonly

used

agents.

Studies

in

pregnant

and

reproductive-age

women

have

reported

substantial

resistance

to

older

drugs

such

as

ampicillin

and

cotrimoxazole,

whereas

nitrofurantoin

and

fosfomycin

often

retain

useful

in

vitro

activity

for

lower

urinary

tract

isolates.

8,9,10

Nevertheless,

susceptibility

alone

does not determine treatment in pregnancy; drug safety,

gestational

age,

renal

function,

allergy

history,

and

whether

infection

is

conﬁned

to

the

lower

tract

must

also

be

considered.

District-level

hospitals

serve

large

urban and rural antenatal populations but may have less

published

resistance

surveillance

than

tertiary

referral

centres.

Local

data

from

THQ

Swabi

were

therefore

needed

to

characterize

the

organisms

encountered

in

pregnant

women

with

suspected

UTI

and

their

antimicrobial susceptibility patterns. The present study

also examined selected clinical, obstetric, and urinalysis

factors associated with culture positivity, with the aim

of

supporting

culture-guided

management

and

antimicrobial stewardship in routine antenatal care.

METHODOLOGY

This descriptive cross-sectional study was conducted at

Tehsil

Headquarters

Hospital,

Swabi,

in

collaboration

with the Department of Pathology, MTI-GKMC/BKMC

Swabi, Khyber Pakhtunkhwa, from May to November

2023. Ethical approval was granted by the Oﬃce of the

Chairman, Ethical Review Board, MTI-GKMC/BKMC

Swabi

(F.No.

2258/Ethical

Board/GKMC;

20

May

2023).

Written

informed

consent

was

obtained,

and

participant

information

was

kept

conﬁdential.

The

required sample was estimated using the WHO single-

population proportion formula

with a 95% conﬁdence

level,

an

anticipated

prevalence

of

50%

because

no

setting-speciﬁc

estimate

was

available,

and

a

10%

margin of error. The minimum calculated sample

was

96; allowing approximately 5% for incomplete records

or

sample

loss

produced

a

ﬁnal

target

of

102.

Non-

probability

consecutive

sampling

was

used.

Pregnant

women in

any

trimester

with

symptoms

suggestive

of

urinary

tract

infection

or

suspected

asymptomatic

bacteriuria

were

eligible.

Women

with

contaminated

specimens,

known

chronic

renal

disease,

incomplete

records,

or

refusal

to

provide

urine

were

excluded.

Recent antibiotic exposure was retained as a measured

variable rather than an exclusion criterion. A structured

proforma recorded age, residence, trimester, gravidity,

tract

infection,

recent

antibiotic

exposure,

dysuria,

urinary

frequency,

urgency,

lower

abdominal

pain,

fever,

ﬂank

pain,

and

relevant

urinalysis ﬁndings including pus cells, red blood cells,

nitrite,

and

leukocyte

esterase.

Clean-catch

midstream

urine was collected in sterile wide-mouthed containers

after patient instruction and transferred promptly to the

microbiology laboratory. Culture-positive

urinary tract

infection

was

deﬁned

in

the

submitted

protocol

as

signiﬁcant

bacterial

growth.

Bacterial

identiﬁcation

used

colony

morphology,

Gram

staining,

and

relevant

biochemical tests. The source document does not state

the

quantitative

culture

threshold,

culture

media/incubation conditions, or complete identiﬁcation

workflow;

these

should

be

added

from

laboratory

records before publication. Antimicrobial susceptibility

testing was performed on culture-positive isolates using

the

laboratory's

standard

procedures.

Tested

agents

were fosfomycin, nitrofurantoin, amikacin, meropenem,

ceftriaxone,

amoxicillin-clavulanate,

ceﬁxime,

gentamicin,

ciproﬂoxacin,

cotrimoxazole,

and

ampicillin.

The

submitted

manuscript

records

susceptibility

as

sensitive

or

resistant

but

does

not

specify

the

disk-diﬀusion/automated

method,

CLSI

or

EUCAST interpretive standard and version, handling of

intermediate

results,

or

quality-control

strains.

These

methodological

details

require

author/laboratory

verification.

Data

were

analyzed

using

IBM

SPSS

Statistics version 26.

RESULTS

A

total

of

102

pregnant

women

were

included.

The

mean

age

was

28.10

±

6.00

years;

67

(65.7%)

participants were from rural areas, 46 (45.1%) were in

the

second

trimester,

and

63

(61.8%)

were

multigravida. Signiﬁcant bacterial growth was found in

78

(76.5%)

specimens.

Escherichia

coli

was

the

most

frequent

isolate,

followed

by

Klebsiella

pneumoniae

and

Staphylococcus

saprophyticus.

Overall

susceptibility was highest to fosfomycin, nitrofurantoin,

and

amikacin,

while

resistance

was

highest

to

ampicillin

and

cotrimoxazole.

Among

culture-positive

samples, E. coli accounted for 46.2%, K. pneumoniae

21.8%, and S. saprophyticus 10.3%, with less frequent

Proteus,

Enterococcus,

Pseudomonas,

and

S.

aureus

isolates.

Fosfomycin

was

sensitive

in

70/78

isolates

(89.7%);

nitrofurantoin

and

amikacin

were

each

sensitive in 67/78 (85.9%). Ampicillin was resistant in

65/78 (83.3%) and cotrimoxazole in 54/78 (69.2%). On

bivariate testing, nitrite positivity and >5 pus cells/HPF

were associated with culture positivity. In multivariable

Bacterial Proﬁle and Antimicrobial Susceptibility Patterns of Urinary

49

J Gandhara Med Dent Sci

October - December 2026

analysis,

>5

pus

cells/HPF

remained

independently

associated with culture-positive infection (AOR 3.262,

95% CI 1.073–9.916; p=0.037), whereas previous UTI,

recent antibiotic use, and nitrite positivity did not retain

statistical signiﬁcance.

Table 1: Demographic, Obstetric, Clinical, and Urinalysis

Characteristics

Variable

n (%age)

Age, years

28.10 ± 6.00

Age range, years

18–40

Age Group

≤20 years

14 (13.7%)

21–30 years

60 (58.8%)

31–40 years

28 (27.5%)

Residence

Rural

67 (65.7%)

Urban

35 (34.3%)

Trimester

First trimester

18 (17.6%)

Second trimester

46 (45.1%)

Third trimester

38 (37.3%)

Gravidity

Primigravida

39 (38.2%)

Multigravida

63 (61.8%)

Previous history

of UTI

Yes

28 (27.5%)

No

74 (72.5%)

Recent antibiotic

use

Yes

19 (18.6%)

No

83 (81.4%)

Clinical and Urinalysis Findings

Clinical

Symptoms

Dysuria

72 (70.6%)

Increased urinary

frequency

63 (61.8%)

Urgency

41 (40.2%)

Lower abdominal

pain

44 (43.1%)

Fever

22 (21.6%)

Flank pain

16 (15.7%)

Asymptomatic

bacteriuria

11 (10.8%)

Urine routine

ﬁndings

Pus cells >5/HPF

81 (79.4%)

Pus cells/HPF

19.53 ± 14.08

RBC present in

urine

78 (76.5%)

RBC/HPF

3.42 ± 3.27

Positive nitrite test

49 (48.0%)

Table 2: Urine Culture Results and Distribution of Bacterial

Isolates

Culture Result

Frequency

%age

Signiﬁcant bacterial growth

78

76.5%

No significant growth

24

23.5%

Total

102

100%

-

Bacterial Isolates among Culture

Positive Samples

Bacterial isolate

n (%)

Escherichia coli

36 (46.2%)

Klebsiella pneumoniae

17 (21.8%)

Staphylococcus saprophyticus

08 (10.3%)

Proteus species

06 (7.7%)

Enterococcus species

05 (6.4%)

Pseudomonas aeruginosa

04 (5.1%)

Staphylococcus aureus

02 (2.6%)

Total

78 (100.0%)

Table 3: Overall Antimicrobial Susceptibility Pattern among

Culture

Positive Isolates

-

Antibiotic

Sensitive n (%)

Resistant n (%)

Fosfomycin

70 (89.7%)

8 (10.3%)

Nitrofurantoin

67 (85.9%)

11 (14.1%)

Amikacin

67 (85.9%)

11 (14.1%)

Meropenem

62 (79.5%)

16 (20.5%)

Ceftriaxone

50 (64.1%)

28 (35.9%)

Amoxicillin-clavulanate

48 (61.5%)

30 (38.5%)

Ceﬁxime

44 (56.4%)

34 (43.6%)

Gentamicin

39 (50.0%)

Ciproﬂoxacin

44 (56.4%)

34 (43.6%)

Cotrimoxazole

24 (30.8%)

54 (69.2%)

Ampicillin

13 (16.7%)

65 (83.3%)

Table 4: Factors Associated with Culture-Positive Urinary Tract

Infection

Variable

Culture

Positive n

(%age)

Culture

Negative

n (%age)

p-value

Age group

≤20 years

08 (57.1%)

06 (42.9%)

0.087

21–30 years

50 (83.3%)

10 (16.7%)

31–40 years

20 (71.4%)

08 (28.6%)

Residence

Rural

53 (79.1%)

14 (20.9%)

0.386

Urban

25 (71.4%)

10 (28.6%)

Trimester

First trimester

14 (77.8%)

04 (22.2%)

0.309

Second

trimester

38 (82.6%)

08 (17.4%)

Third

trimester

26 (68.4%)

12 (31.6%)

Gravidity

Primigravida

29 (74.4%)

10 (25.6%)

0.692

Multigravida

49 (77.8%)

14 (22.2%)

UTI

Yes

25 (89.3%)

03 (10.7%)

0.061

No

53 (71.6%)

21(28.4%)

Recent

antibiotic

use

Yes

17 (89.5%)

02 (10.5%)

0.229*

No

61 (73.5%)

22 (26.5%)

Nitrite test

Positive

42 (85.7%)

07 (14.3%)

0.034

Negative

36 (67.9%)

17 (32.1%)

Pus cells

>5/HPF

Yes

66 (81.5%)

15 (18.5%)

0.040*

No

12 (57.1%)

09 (42.9%)

Table 5: Multivariable Logistic Regression For Culture-Positive

Urinary Tract Infection

Predictor

Adjusted

OR

95% CI

p-value

Previous history of

UTI: Yes vs No

3.304

0.834–13.089

0.089

Positive nitrite test:

Positive vs Negative

2.571

0.914–7.230

0.073

Pus cells >5/HPF:

Yes vs No

3.262

1.073–9.916

0.037

Recent antibiotic

use: Yes vs No

2.888

0.595–14.025

0.188

DISCUSSION

The

present

study

evaluated

the

bacterial

proﬁle

and

antimicrobial

sensitivity

pattern

among

pregnant

Bacterial Proﬁle and Antimicrobial Susceptibility Patterns of Urinary

50

J Gandhara Med Dent Sci

October - December 2026

women

with

suspected

urinary

tract

infection

at

THQ

Swabi.

In

this

study,

76.5%

of

urine

samples

showed

significant bacterial growth, indicating a high burden of

culture-positive

UTI

among

the

enrolled

pregnant

women. This high culture positivity may be related to

the fact that the study included women presenting with

suspected UTI rather than a general antenatal screening

population. Similar hospital-based studies have reported

variable

culture

positivity

depending

on

inclusion

criteria,

symptom

status,

urine

collection

method,

and

local

microbiological practices. For example,

Amin et

al.

in

Pakistan

reported

Escherichia

coli

as

the

predominant

organism

among

pregnant

women

with

suspected

UTI,

11

while

Dube

et

al.

reported

a

lower

prevalence of symptomatic UTI in a broader pregnant

population.

12

Most of

the

participants

were

in

the

age

group 21-30 years, with the highest number of culture-

positive patients in this age group in the current study.

This ﬁnding is biologically plausible given that this age

group is the most common age group for childbearing

and

has

the

highest

percentage

of

those

who

attend

antenatal classes. In the current analysis, however, there

was no signiﬁcant correlation between culture positivity

and age group. Also, Gupta et al. carried out a study on

antenatal women in an urban resettlement colony and a

slum in Delhi.

13

They highlighted the variation in UTI

patterns

in

pregnancy

based

on

local

population

characteristics,

health-seeking

behavior,

and

background risk factors.

9

In the present study, dysuria,

shortened micturition interval, low abdominal pain, and

urgency

were

the

four

most

common

symptoms.

The

listed

symptoms

are

often

associated

with

LUTI,

but

urinary

frequency

is

also

a

common

feature

during

pregnancy, caused by the physiological and anatomical

changes during pregnancy. Dube et al. reported that the

most

common

clinical

presentation

of

a

symptomatic

UTI in pregnancy is lower urinary symptoms, and that

clinical signs along with urine microscopy and culture

are

important,

not

just

clinical

signs.

12

Additionally,

ACOG notes that UTI is a spectrum of disease ranging

from

asymptomatic

bacteriuria

to

UTI

with

pyelonephritis

and

that

it

is

important

to

have

the

correct diagnosis,

as UTI

is

linked

to

poor pregnancy

outcomes

-

including

low

birth

weight

and

preterm

delivery.

14

Both

pus

cells

>5/HPF

and

positive

nitrite

test were signiﬁcantly associated with culture positivity

in

bivariate

analysis

in

the

present

study.

However,

following

multivariable

adjustments,

only

pus

cells

>5/HPF

were

an

independent

predictor

of

culture-

positive UTI. This indicates that nitrite positivity was a

good

starting

point

but

on

its

own

was

not

a

strong

predictor

once

other

factors

were

taken

into

account.

This is not unusual as nitrite tests could be negative in

infections due to non-nitrite-producing organisms or in

infections

with

a

short

bladder

incubation

time.

The

significant

result

for

pyuria

in

our

own

regression

analysis would suggest that urine microscopy is a useful

simple

screening

test

in

the

antenatal

setting,

though

urine culture is the conﬁrmatory test; the women with

>5/HPF had 3.26 times greater odds of having UTI than

women

with

≤5/HPF.

As

for

the

type

of

bacteria,

Escherichia coli was the predominant bacterium, with a

total

of

46.2%

in

this

study,

followed

by

Klebsiella

pneumoniae at 21.8%. This pattern is expected from the

accepted

microbiology

of

UTI

in

pregnancy

and

is

dominated by Gram-negative enteric ﬂora as a result of

ascending

infection

and

periurethral

colonization.

The

same

was

found

in

the

E.

coli

isolates

of

pregnant

women by Amin et al. from Pakistan, and a 2024 study

by

Taha

et

al.

11

also

identiﬁed

E.

coli

as

the

predominant

uropathogen

in

pregnant

women.

10

Mohamed

et

al.

further

highlighted

the

importance

of

uropathogenic

E.

coli

and

antimicrobial

resistance

among

pregnant

women.

15

The

second

most

common

organism

is

Klebsiella

pneumoniae,

which

has

also

been

supported

by

recent

literature.

Bacterial

isolates

identified

in

pregnant

women

attending

antenatal

care

in

Ethiopia

included

Klebsiella

pneumoniae.

16

In

contrast,

other

recent

studies

in

various

regions

have

demonstrated

that

Klebsiella

spp.,

Proteus

spp.,

Enterococcus

spp.,

Pseudomonas

spp.

and

Staphylococcus

spp.

can

also

cause

UTI

during

pregnancy.

17

Both

Gram-negative

and

Gram-positive

isolates were found in the present study, indicating that

a local antibiogram-based treatment decision is needed

rather than a pattern of just one organism. Fosfomycin

was the most sensitive drug, followed by nitrofurantoin

and amikacin in the present study. This is signiﬁcant as

empiric

antibiotic

selection

in

pregnancy

should

take

into account both the eﬀect of the antibiotic on the fetus

and

its

antimicrobial

eﬀect.

According

to

the

susceptibility

results,

Taha

et

al.

reported

that

fosfomycin, meropenem and nitrofurantoin were useful

in treating UTI.

10

ACOG also notes that nitrofurantoin

and

fosfomycin

are

not

appropriate

agents

for

pyelonephritis

because

neither

agent

reaches

adequate

levels in renal tissue and thus may not be suitable for

lower

UTI

in

pregnancy.

These

drugs

are

thus

only

recommended

for lower

UTI

or cystitis

when

there

is

evidence of culture sensitivity.

18

The high susceptibility

in

the

current

study

is

in

agreement

with

other

recent

reports

of

retained

susceptibility

of

nitrofurantoin

against

the

common

urinary

pathogens.

Among

the

pregnant women in Ghana, E. coli has been reported to

be susceptible to nitrofurantoin, while Al-Hinai et al.

19

reported high susceptibility to nitrofurantoin in urinary

isolates.

20

Overall,

these

results

support

the

value

of

nitrofurantoin

as

an

oral

treatment

in

many

clinical

situations, as long as gestational age, contraindications,

and clinical severity are taken into account. Ampicillin

Bacterial Proﬁle and Antimicrobial Susceptibility Patterns of Urinary

51

J Gandhara Med Dent Sci

October - December 2026

and

Cotrimoxazole

were

the

most

resistant

in

the

present study. This is in accordance

with the

trend of

increasing

resistance

observed

in

recent

studies

that

have been carried out in Pakistan and elsewhere. High

antibiotic

resistance

to

amoxicillin

and

cotrimoxazole

was noted among pregnant women, and a report from

Pakistan in 2024-2025 also revealed a high

frequency

of

UTI

with

E.coli

and

Klebsiella

as

major

isolates,

which

further

emphasized

the

need

for

local

antimicrobial

surveillance.

11,21

Empirical

treatment,

self-treatment, administration of incomplete courses of

antibiotics,

and

community-level

antibiotic

pressure

may

be

contributing

factors

to

the

high

level

of

resistance to commonly used antibiotics. The moderate

sensitivity

of

ceftriaxone,

ceﬁxime,

amoxicillin-

clavulanate,

ciproﬂoxacin

and

gentamicin

suggests

these drugs do not have a consistent eﬃcacy proﬁle for

empirical

therapy

in

this

context.

Ciprofloxacin

is

not

recommended

as

ﬁrst-line

treatment

in

pregnancy

unless

indicated,

and

aminoglycosides

should

be

used

with caution due to the potential for toxicity. In view of

this,

the present results

should not be considered as a

recommendation for empirical treatment in all pregnant

women,

but

rather

as

a

conﬁrmation

that

empirical

therapy

should

be

guided

by

the

pregnancy

safety

proﬁle,

severity

of

the

infection,

trimester

and

local

culture

sensitivity

proﬁle.

Current

obstetric

guidance

suggests

that

culture-based

treatment

should

be

considered as standard treatment wherever possible and

that

caution

should

be

applied

to

the

use

of

inappropriate

antibiotics

in

pregnancy.

14

The

present

study

also

revealed

that

culture

positivity

was

associated with the previous history of UTI and recent

antibiotic

use

in

logistic

regression

analysis,

although

the

association

was

not

statistically

signiﬁcant

after

adjustment.

Amin

et

al.

had

previously

found

a

UTI

history to be a predictor, and our results indicated that a

history

of

UTI

had

a

similar

direction

of

association,

albeit

with

broader

conﬁdence

intervals.

11

This

discrepancy

could

result

from

the

small

size

of

the

sample, population diﬀerences in the setting or from the

fact

that

only

a

few

culture-negative

cases

were

included. Previous history of UTI, therefore, should be

treated

as

a

clinically

important

factor

even

though

it

was not statistically signiﬁcant for the adjusted model.

The

results

of

this

study

are

of

practical

relevance

in

relation to antenatal services in low-resource areas such

as Swabi. Pregnant women who have urinary symptoms

and

also

those

suspected

of

having

asymptomatic

bacteriuria should be encouraged to have routine urine

testing.

E.

coli

and

Klebsiella

pneumoniae

were

the

predominant organisms, indicating that empirical use of

ampicillin and/or cotrimoxazole is not always the best

strategy. Hospital antibiograms are essential as patterns

of

resistance

diﬀer

from

region

to

region

and

are

changing

over

time.

Ethiopia,

Ghana,

India,

Pakistan

and

other

regions

have

recently

demonstrated

that

the

distribution and sensitivity patterns of local bacteria are

essential for rational prescribing during pregnancy.

9,16,19

The

susceptibility

proﬁle

should

be

interpreted

as

a

local

laboratory

guide

rather

than

a

universal

prescribing

hierarchy.

In

pregnancy,

selection

of

therapy

must

integrate

culture

results

with

gestational

age, allergy history, renal function, site and severity of

infection,

and

established

obstetric

guidance.

Agents

appropriate

for

uncomplicated

lower

urinary

tract

infection

may

not

be

suitable

for

pyelonephritis

or

systemic

infection.

The

high

resistance

observed

to

ampicillin and cotrimoxazole reinforces the importance

of

avoiding

uncritical

empirical

reuse

of

commonly

available

antibiotics

and

of

updating

institutional

antibiograms at regular intervals.

LIMITATIONS

This was a single-centre study of pregnant women with

suspected urinary tract infection and therefore does not

estimate

the

prevalence

of

bacteriuria

among

all

antenatal

attendees.

The

sample

size

was

modest,

and

recent antibiotic exposure was recorded but not used as

an

exclusion

criterion,

which

may

have

inﬂuenced

culture

yield

and

susceptibility

patterns.

Organism-

specific

susceptibility

matrices,

extended-spectrum

beta-lactamase status, multidrug-resistance phenotypes,

treatment

response,

recurrence,

and

maternal

or

neonatal

outcomes

were

not

evaluated.

The

submitted

manuscript

did

not

provide

the

full

laboratory

reproducibility details for the culture threshold,

media

and

incubation

conditions,

antimicrobial-susceptibility

method,

or

interpretive

standard/version;

these

details

require

author

veriﬁcation

before

publication.

Larger

multicentre

surveillance

with

standardized

microbiological

methods

would

strengthen

the

generalizability

of

the

ﬁndings.

CONCLUSIONS

Culture-positive UTI was frequent among this selected

group of pregnant women with suspected infection. E.

coli

was

the

leading

isolate;

fosfomycin

and

nitrofurantoin

showed

high

overall

in

vitro

activity,

while ampicillin and cotrimoxazole showed substantial

resistance. More than ﬁve pus cells/HPF independently

predicted

culture

positivity.

These

ﬁndings

support

culture-guided

therapy,

periodic

local

resistance

surveillance,

and

pregnancy-specific

antimicrobial

stewardship

rather

than

indiscriminate

empirical

prescribing.

CONFLICT OF INTEREST:

None

Bacterial Proﬁle and Antimicrobial Susceptibility Patterns of Urinary

52

J Gandhara Med Dent Sci

October - December 2026

FUNDING SOURCES:

None

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AUTHORS CONTRIBUTION

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.

Nilofar-

Concept

&

Design;

Data

Acquisition;

Data

Analysis/Interpretation;

Drafting

Manuscript;

Critical

Revision; Supervision; Final Approval

Nadia

Rani

-

Concept

&

Design;

Data

Acquisition;

Data

Analysis/Interpretation;

Drafting

Manuscript;

Critical

Revision; Supervision; Final Approval

Hina

Safdar-

Concept

&

Design;

Data

Acquisition;

Data

Analysis/Interpretation;

Drafting

Manuscript;

Critical

Revision; Supervision; Final Approval

Arifa

-

Concept

&

Design;

Data

Acquisition;

Data

Analysis/Interpretation;

Drafting

Manuscript;

Critical

Revision; Supervision; Final Approval

Alina

Khalid

-

Concept

&

Design;

Data

Acquisition;

Data

Analysis/Interpretation;

Drafting

Manuscript;

Critical

Revision; Supervision; Final Approval

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Bacterial Proﬁle and Antimicrobial Susceptibility Patterns of Urinary