Uropathogenic bacterial profile and antibiotic susceptibility pattern of isolates among gynecological cases admitted to Jimma Medical center, South West Ethiopia

Uropathogenic bacterial profile and antibiotic susceptibility pattern of isolates among gynecological cases admitted to Jimma Medical center, South West Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Uropathogenic bacterial profile and antibiotic susceptibility pattern of isolates among gynecological cases admitted to Jimma Medical center, South West Ethiopia Sisay Teferi, Zewdineh Sahlemariam, Mekdim Mekonnen, Rahel Tamrat, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2291466/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 May, 2023 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract Background : Urinary tract infection (UTI) is one of the most common bacterial infections in women; about 50% of women get during their life time. Moreover, it is a common health problem in patients with gynecological pathologies, which increases the chance of acquiring infection. The aim of this study was to determine the bacterial profile that causes UTI and their antibiotic susceptibility pattern among admitted gynecological cases. Methods : A cross-sectional study was conducted in south west Ethiopia region. A total of 386 patients admitted with gynecological cases were included and structured questionnaire was used to collect socio-demographic and risk factor-related data. About 10ml freshly voided midstream and catheterized urine specimens were collected using sterile containers. Identification of isolate was done using culture characteristics, gram staining, and a series of biochemical tests. The data obtained were entered into EpiData Version 3.1 and analyzed using SPSS Version 25. A P-value of less than 0.05 was used as a level of significance. Results: In this study, the overall prevalence of UTI was 25.4%. E. coli was the most frequently isolated bacteria, which accounted for 38(37.6%), followed by Klebsiella species 22(21.8%), CONS 14(13.9%), S. aureus 10(9.9%), Enterobacter species 6(5.9%), Citrobacter species 5(4.9%), P. mirabilis 4 (4%), and P. aeroginosa 2(2%). Histories of UTI (AOR = 1.977, 95% CI: 1.06, 3.68, P = 0.032) and catheterization (AOR = 2.38, 95% CI: 1.28, 4.45, P = 0.006) were found to be statistically associated with significant bacteriuria. Gram-negative isolates showed a high level of resistance, 88.3% for ampicillin and 66.2% for tetracycline, and a relatively low level of resistance against ceftazidime, 22.1%, and meropenem, 3.9%. Gram-positive uropathogens showed a high level of resistance to penicillin, 91.6%, whereas all isolates were sensitive 100.0% to nitrofurantoin. Furthermore, 80 (79.2%) of the isolates had multidrug resistance, and 16 (26.7%) of both E. coli and Klebsiella spp. produced Extended Spectrum β-lactamase. Conclusion: In this study, a high prevalence of uropathogenic bacteria and multidrug resistance for commonly prescribed drugs were observed with a significant number of Extended Spectrum β-lactamase producers. Biological sciences/Microbiology Health sciences/Medical research gynecological cases admission uropathogenic bacteria antibiotic resistance multidrug resistance Figures Figure 1 Background Urinary Tract Infection (UTI) is the most frequent human-acquired bacterial infection which affects about 150 million people all over the world each year [1]. It involves anywhere in the urinary tract, including the kidney, ureter, bladder, and urethra. It is one of the most common bacterial infections in women [2], more than 50% of women get during their life time [3]. This can be due to the ascent of a number of organisms into the bladder is easier than in men because of the relatively short urethra, the absence of bactericidal prostatic secretion, and the ease of contamination of the urinary tract with fecal flora [4]. In patients with gynecological problems, blockage of urine flow [5], anatomical and physiological changes [6], incomplete bladder emptying, frequent bladder infections, incontinence of urine and stool, and catheterization after surgical procedures may further predispose them to urinary tract infections [7, 8]. During and after gynecological surgery, bladder drainage by transurethral foleys catheter is common practice used to monitor urine output and prevent post-operative urinary retention, which is associated with an increased risk of UTIs in patients, and the daily risk of acquisition of bacteriuria when an indwelling catheter is in-situ is 3–7% [9, 10]. It is known that, UTI poses a high risk of morbidity, mortality, and significant health care costs [11]. Moreover, among patients with gynecological problem, it has been a matter of morbidity, anxiety, and long hospital stays, which occurs more frequently during the postoperative period [12]. In developing countries including Ethiopia, management of UTIs is usually empirical which may contributes for the emergency and spread of antimicrobial resistant strain which is a leading cause of treatment failure in UTI [13].As a result, clinicians are left with very limited drug choices for the treatment of urinary tract infections. One of the leading antimicrobial resistance mechanisms for many UTI causing Gram-negative bacteria is extended-spectrum β-lactamase enzyme production that hydrolyzes the β-lactam ring of antimicrobials, which gives bacterial resistance to commonly prescribed antibiotics including penicillins; first, second and third-generation cephalosporins, aztreonams [14]. Generally, most admitted gynecological cases need prolonged hospitalization and more intensive nursing care like prolonged bladder catheterization, which may contribute to the development of urinary tract infections that require extensive treatment with antibiotics. Therefore, this study was conducted to determine the bacterial etiologic agents of uropathogens and evaluate their in vitro susceptibility pattern to commonly used antibiotics among admitted gynecological cases at tertiary hospital in southwest Ethiopia. Methods Study design, setting, and population. A cross-sectional study was conducted among gynecological cases admitted from September 16 to December 30, 2021 at Jimma University Medical Center, South West Ethiopia. The study area is located 348 km away from the capital city, Addis Ababa. The annual average admission of the centre is over 20,000 patients. The service delivery sites are the outpatient department, gynecology ward, maternity and labor ward, and operation rooms. All gynecological cases admitted to the gynecology ward during the study period were included in the study population, and those treated with antibiotics within 15 days of the study's start date were excluded. Sample size and sampling techniques The sample size was calculated using a single population proportion formula , where n= number of sample size, Z is the statistics corresponding to a 95% level of confidence (1.96), d= margin of error, and P= is the assumed prevalence of uropathogenic bacteria among gynecologic cases (50%). The infection prevalence was assumed to be 50% because the current status of uropathogenic bacterial infection in the area is unknown. Therefore, the sample size was adjusted to 384 gynecological cases. A sequential sampling method was used to find study participants. Data collection methods Information on demographic variables was collected from each patients with gynecolological cases by a face-to-face interview using a structured questionnaire. Clinical data was gathered through a review of patients' medical records and consultation with a gynecologist. Specimen collection About 5 to 10 ml of urine was collected from patients by following aseptic technique and clean catch mid-stream urine (MSU) using a sterile screw-capped, wide-necked container. For those patients on a catheter, the sample was collected by aseptic techniques: cleansing the catheter port with alcohol and allowing drying time, and then aspirating the urine from the indwelling catheter with a sterile syringe. The container was labeled with the date, the name, and a code number. After collection, the specimen was immediately delivered to the microbiology laboratory for laboratory investigation. The specimens were processed within 2 hours of collection. In the event of a delay in processing, the urine specimens were refrigerated at 4°C until they were processed. Culture and identification techniques The collected urine sample was inoculated onto 5% Blood Agar, Mannitol Salt agar and MacConkey agar plates (Oxoid Ltd., Bashingstore Hampaire, UK) by streak plate methods following the standard microbiological techniques and procedures developed by Finegold and Martin [15]. After incubating the plates aerobically at 37°C for 24 hours, they were inspected for the presence or absence of bacterial growth. If colonies were found, they were counted and multiplied by the reciprocal of the loop’s volume, or 1000. Counting colonies yielding bacterial growth of > 105 cfu/ml and 3 isolated uropathogens was regarded as significant bacteriuria, and negative cultures contained no growth or mixed urogenital flora (>2 isolates). For catheter collected urine samples, the presence of symptoms or signs compatible with UTI with no other identified source of infection along with > 10 3 colony-forming units/ml and the presence of > 10 5 cfu/ml in a single catheter urine specimen in a patient without symptoms compatible with UTI is recommended as representing significant bacteriuria [16]. All positive urine cultures showing significant bacteriuria were further identified by their physical characteristics such as colony morphology, odor, swarming, and presence of hemolysis on their respective media, Gram-reaction, and pattern of biochemical reactions using the standard procedures [15]. The gram-negative rods were identified with the help of a series of biochemical tests, namely Citrate, Oxidase, Sulphur Indole Motility (SIM) media, Kligler’s Iron Agar (KIA), lysine decarboxylase, lactose fermentation, urea hydrolysis [17] . Gram-positive cocci were identified based on their Gram reaction, mannitol fermentation, catalase and coagulase tests [15]. Antimicrobial Susceptibility Testing (AST) The Kirby-Bauer disc diffusion method was employed for antibiotic susceptibility testing as recommended by Clinical Laboratory Standards Institute (CLSI) 2020 guidelines [18]. When a pure culture with significant bacteriuria was obtained, a loopful of bacteria was taken from a colony and transferred into a tube containing 5ml of sterile normal saline (0.85% NaCl) and mixed gently until it formed a homogenous suspension. The turbidity of the suspension was adjusted to an optical density equivalent to 0.5 McFarland standards. The inoculated plates were left at room temperature to dry for 3-5 minutes while the Petridish lids were in place. The following antimicrobial discs with their respective concentration were used for susceptibility testing and all the antimicrobials used for the study were obtained from Oxoid Ltd in the following concentrations: ciprofloxacin (CIP,5µg), trimethoprim-sulfamethoxazole (SXT,1.25/23.75µg), nalidixic acid (NA,30 μg ), meropenem (MEM, 10 μg ), cefotaxime (CTX,30µg), ceftazidime (CAZ,30µg), tetracycline (TTC,30 µg) nitrofurantoin (F,30µg), norfloxacin (NOR,10µg), ceftriaxone (CRO,30µg), amoxicillin-clavulanic acid (AMC,20/10µg), ampicillin (AMP,10µg), gentamicin (CN,10µg), erythromycin (E,15µg), penicillin (PEN,10µg), clindamycin (DA,10µg) and chloramphenicol (C, 30µg). Among these, nalidixic acid (NA), meropenem (MEM, 30 μg), cefotaxime (CTX, 30µg), ceftazidime (CAZ, 30µg), tetracycline (TTC, 30 µg) can be used only for gram-negative bacteria, whereas erythromycin (E, 15µg), penicillin (PEN, 10µg) and clindamycin (DA, 10µg) can be used only for gram-positive bacteria; however, the rest of the antibiotics were used for both isolates. The diameter of the zone of inhibition around each disc was measured to the nearest whole millimeter (mm) by using a ruler, and the isolate was classified as sensitive, intermediate, or resistant according to the standardized table supplied by CLSI, 2020 [18]. Detection of Extended Spectrum β -lactamase (ESBL) ESBL-producing E. coli and Klebsiella spp . were first screened for ESBL production by the phenotypic method and then confirmed by the phenotypic confirmatory test as per CLSI guidelines 2020 [18]. Phenotypic Screening for ESBL Production The ESBL screening test was performed by the standard disk diffusion method using ceftazidime (30 µg), cefotaxime (30 µg), and ceftriaxone (30 µg) (Oxoid, UK). More than one antibiotic disc was used for screening to improve the sensitivity of ESBL detection [18]. The three antibiotic discs were placed on Muller-Hinton agar and incubated at 37°C for 18–24 hours. These breakpoints for suspicion of ESBL production were: ≤ 25mm for ceftriaxone (30 g), ≤ 22mm for ceftazidime (30 g), and ≤ 27mm for cefotaxime (30 g) [18]. Phenotypic Confirmation of ESBL Producers Confirmation of suspected ESBL producers was done by using the double-disk synergy (DDS) method. On Muller Hinton agar, an Amoxicillin/clavulanic acid (20/10g) disc was placed in the center of the plate, and ceftazidime (30g) and cefotaxime (30g) discs were placed 15 mm apart, center to center. The plate was incubated at 37 o C for 18–24 hours. A ≥5mm increase in the diameter of the zone of inhibition for either of the cephalosporin-clavulanate disk combinations versus the zone diameter of the respective cephalosporin disk was considered positive, and the isolate was interpreted as an ESBL producer as recommended by CLSI guidelines 2020 [18]. Data processing and analysis Data were entered using EpiData version 3.1 and exported to SPSS version 25 software. Descriptive statistics were used to summarize socio-demographic data, bacterial profile and susceptibility patterns of isolates. Bivariate logistic regression was employed to look for associations between the outcome variable and each independent variable; and those variables significant at a p-value of less than 0.25 in the bivariate regression were then selected for the multivariate analysis model. The corresponding variables with a P-value < 0.05 at a 95% confidence interval were then considered statistically significant. Quality Assurance The legibility of the filled questionnaire and any labeling errors were confirmed immediately. Laboratory analyses were carried out using standard operating procedures. Culture media were tested for sterility and performance by incubating 5% of the batch at 35-37 o C overnight and observing the media for microbial growth. Those media which showed growth was discarded and replaced by a new sterile batch. Standard reference strains of S. aureus (ATCC25923), E. coli (ATCC25922) and P. aeruginosa (ATCC27853) were used during culture and antimicrobial susceptibility testing. E. coli ATCC 25922 was used as an ESBL-negative whereas K. pneumoniae ATCC 700603 was used as an ESBL-positive reference strain [18]. Ethical Consideration Ethical clearance was obtained from the Institutional Review Board of Jimma University (Ref.: IRB000144/2020) and all methods were performed in accordance with relevant guidelines and regulations. The support letter was obtained from Jimma University School of Medical Laboratory Science and then submitted to JMC, gynecology ward. After adequately explaining the objectives and purpose of the study, written informed consent was obtained from all the study participants before data and sample collection. All data obtained in the course of the study was kept confidential. Positive cases were referred to the attending clinician as soon as possible for their better management. Results Socio-demographic characteristics A total of 386 patients admitted with gynecological cases were included in the present study. The mean age of the study participants was 31.9 ± 11.5 years, with an age range of 15 to 70 years. About 153(39.6%) of study participants were in the age range of 25–34 years, and the majority were married (315, or 81.6%), high school (1–8; 35.2%) in their educational status, and urban dwellers (50.5%) in their residence. Based on their parity, the majority of 61.7% of the study participants were multiparous. Approximately 50.5% and 28% of the study participants had a history of catheterization and UTI, respectively. (Table: 1). Table 1 : Background characteristics of the gynecological cases (n=386) in Jimma University Medical Centre, Ethiopia Variables Category Frequency Percent (%) Age (years). 15-24 25-34 35-44 > 45 114 153 67 52 29.5 39.6 17.4 13.5 Occupation Merchant Student House wife Employed Others 53 51 220 39 23 13.7 13.2 57 10.1 6 Educational status No formal education 1-8 9-12 College and above 83 136 126 41 21.5 35.2 32.7 10.6 Parity Nullipara Primipara Multipara 83 65 238 21.5 16.8 61.7 Marital status Single Divorced Married 53 18 315 13.7 4.7 81.6 History of UTI yes No 108 278 28 72 History of catheterization yes No 195 191 50.5 49.5 ETB- Ethiopian birr UTI- Urinary Tract Infection The prevalence of UTIs and the types of bacteria isolated Of the 386 urine specimens analyzed, 98 had significant bacteriuria, with an overall prevalence of 25.4%. A total of 101 bacterial isolates (bacterial species belonging to seven genera) were identified from the study participants. The prevalence of bacteriuria among patients with gynecological cases who had undergone gynecologic surgery was 73 (31.12%). Of these, 15 (20.5%) underwent emergency surgery and 58 (79.5%) underwent elective surgery. Among patients who had undergone non-surgical procedures the prevalence was 25 (16.4%) and 32 (34.4%) of the isolates were from symptomatic cases. The prevalence of asymptomatic bacteriuria was 66 (22.5%). Of the total 101 isolates, the majority (77, or 76.2%) were gram-negative organisms, while 24(23.8%) were gram-positive bacteria. E. coli was found to be the most frequent isolate 38 (49.4% of the gram-negatives, 37.6% of all isolates), followed by Klebsiella spp. 22(21.8%) and CoNS 14(13.9%). The other isolated organisms were S. aureus 10(9.9%), Enterobacter spp. 6(5.9%), Citrobacter spp. 5(4.9%), P. mirabilis 4 (4%), and P. aeroginosa 2(2%). Of all, mixed pathogens were isolated from 3(3.1%) patients (Fig. 1). Associated risk factors of UTI Twelve independent variables were considered during the bivariate analysis of risk factors for significant bacteriuria. In multivariate analysis, histories of UTI (AOR = 1.977, 95% CI: 1.06, 3.68, P = 0.032) and catheterization (AOR = 2.38, 95% CI: 1.28, 4.45, P = 0.006) were found to have a statistically significant association with significant bacteriuria (Table 2). Table 2: Bivariate and Multivariate Logistic Regression analyses of factors associated with significant bacteriuria among gynecological cases (n = 386) admitted at Jimma University Medical Centre, Ethiopia Variables Category Culture status COR (95% CI) AOR (95% CI) P-value SB (%) NSB (%) Age in years 15-24 22(19.3) 92(80.7) 1 1 25-34 41(26.8) 112(73.2) 1.53(0.85-2.75) 0.91(0.32-2.59) 0.857 35-44 17(25.4) 50(74.6) 1.42(0.69-2.9) 0.61(0.19-1.98) 0.411 > 45 18(34.6) 34(65.4) 2.21(1.06-4.63) 1.32(0.40-4.37) 0.645 Educational level No formal education 31(37.3) 52(62.7) 1.44(0.64-3.23) 0.45(0.07-2.84) 0.399 1-8 28(20.6) 108(79.4) 0.63(0.28-1.38) 0.36(0.06-2.05) 0.251 9-12 27(21.4) 99(78.6) 0.66(0.30-1.46) 0.73(0.14-3.95) 0.719 College & > 12(29.3) 29(70.7) 1 1 Marital status Single 9(17) 44(83) 1 1 Divorced 7(38.9) 11(61.1) 3.1(0.95-10.21) 0.73(0.07-7.64) 0.793 Married 82(26) 233(74) 1.7(0.81-3.68) 0.49(0.07-3.25) 0.462 Parity Nullipara 14(16.9) 69(83.1) 1 1 Primipara 15(23.1) 50(76.9) 1.48(0.66-3.34) 1.26(0.21-7.55) 0.798 Multipara 69(29) 169(71) 2.01(1.06-3.81) 0.95(0.17-5.24) 0.953 History of UTI Yes 42(38.9) 66(61.1) 2.52(1.55-4.10) 1.98(1.06-3.68) 0.032* No 56(20.1) 222(79.9) 1 1 History of catheterization Yes 61(31.3) 134(68.7) 1.89(1.19-3.03) 2.38(1.28-4.45) 0.006* No 37(19.4) 154(80.6) 1 1 Menopausal status Pre 82(24.3) 255(75.7) 1 1 post 16(32.7) 33(67.3) 1.51(0.79-2.88) 1.06(0.23-4.98) 0.938 Pregnancy Yes 28(17.9) 128(82.1) 0.50(0.30-0.82) 1.07(0.23-4.49) 0.929 No 70(30.4) 160(69.6) 1 1 Current symptom Yes 32(34.4) 61(65.6) 1.80(1.09-3.00) 1.49(0.77-2.88) 0.232 No 66(22.5) 227(77.5) 1 1 Duration of catheter in situ 1-3 43(28.7) 107(71.3) 1 1 1-6 9(40.90) 13(59.1) 1.72(0.69-4.33) 1.14(0.36-3.63) 0.825 >7 15(53.6) 13(46.4) 2.87(1.26-6.54) 1.15(0.34-3.88) 0.823 Duration of hospital stay 1-3 41(21.7) 148(78.3) 1 1 1-6 26(24.8) 79(75.2) 1.19(0.68-2.08) 0.66(0.28-1.58) 0.354 >7 31(33.7) 61(66.3) 1.83(1.06-3.19) 0.72(0.29-1.75) 0.463 Nature of surgery Emergency Elective 15(23.8) 58(33.9) 48(76.2) 113(66.1) 0.61(0.31-1.18) 1 0.72(0.24-2.15) 1 0.560 Note : *Statistically significant at P<0.05. Abbreviations : SB - Significant Bacteriuria; NSB - Non- Significant Bacteriuria; AOR- Adjusted Odds Ratio; COR- Crude Odds Ratio; 1, reference group; 95% CI, 95% confidence interval UTI, Urinary Tract Infection; Antimicrobial susceptibility pattern of bacterial uropathogens Gram negative bacteria In this study, gram-negative uropathogens showed high levels of resistance to 68 (88.3%) for ampicillin and 51 (66.2%) for tetracycline. However, all gram-negative bacterial isolates showed a relatively low level of resistance against nitrofurantoin 21(27.3%), norfloxacin 18 (23.4%), ceftazidime 17 (22.1%), and meropenem 3 (3.9%) (Table 3). Gram-positive bacteria Out of the tested antibiotics, gram-positive bacterial isolates showed a high level of resistance to penicillin (91.6%) and trimethoprim-sulfamethoxazole (66.7%). On the other hand, all gram-positive isolates showed full sensitivity to 100.0% nitrofurantoin. Moreover, gram-positive isolates showed sensitivity towards clindamycin 79.2%, ciprofloxacin 75.0%, norfloxacin 87.5%, and amoxicillin-clavulanic acid 91.6% (Table 4). Multidrug resistance pattern of the isolates Among the total isolates (n = 101), overall, 96 (95.0%) bacterial isolates were resistant to at least one antimicrobial agent, whereas 87 (86.1%) isolates were resistant to ≥2 antimicrobials. Multidrug resistance (defined as non-susceptible to ≥1 agent in ≥3 antimicrobial categories) [19] was seen in 80 (79.2%) of all isolated bacterial uropathogens. 62 (80.5%) of gram-negative and 18(75%) of gram-positive bacteria showed multidrug resistance for the tested antimicrobial drugs. E. coli and K. pneumoniae were found to be highly resistant to most of the antibiotics tested (Table 5). ESBL-Producing Uropathogens The isolates were E. coli 38(49.3%), K. pneumoniae 21 (27.3%), Enterobacter spp. 6(7.8%), P. mirabilis 4(5.2%), Citrobacter spp. 5(6.5%), P. aeruginosa 2(2.6%), and K. oxytoca 1(1.3%). In this study, E. coli and Klebsiella spp. were the most frequently isolated bacteria, and the methods were validated for them. Of the 60 gram-negative isolates of E. coli and Klebsiella spp., 16(26.7%) were positive for ESBL production, with 10(26.3%) of the E. coli isolates and 6(27.3%) of Klebsiella spp. All ESBL-producing isolates showed 100% resistance to ceftriaxone, cefotaxime, and ceftazidime, 87.5% of drugs. However, all the ESBL-producing uropathogens were sensitive to meropenem at 100% (Table 5). Table 3: Antimicrobial susceptibility pattern of Gram-Negative bacteria isolated from urine culture of gynecological cases admitted at Jimma University Medical Centre, Ethiopia Isolates Pattern STX F AMC CTX CN NOR NA C AMP CiP CRO CAZ TET MEM E. coli (38) S 15(39.5) 31(81.6) 14(36.8) 23(60.5) 29(76.3) 29(76.3) 19(50) 25(65.8) 7(18.4) 17(44.7) 27(71.1) 30(78.9) 11(28.9) 38(100) I 2(5.3) 4(10.5) 2(5.3) 1(2.6) 1(2.6) 4(10.5) 5(13.2) R 23(60.5) 5(13.1) 20(52.6) 13(34.2) 9(23.7) 8(21.1) 18(47.4) 9(23.7) 31(81.6) 16(42.1) 11(28.9) 8(21.1) 27(71.1) K. pneum-oniae (21) S 7(33.3) 11(52.4) 3(14.3) 12(57.1) 4(19) 14(66.6) 12(57.2) 5(23.8) 6(28.6) 12(57.1) 14(66.7) 6(28.6) 19(90.5) I 1(4.8) 2(9.5) 2(9.5) 1(4.8) 2(9.5) 1(4.8) 2(9.5) 3(14.3) 7(33.3) 2(9.5) 2(9.5) R 13(61.9) 8(38.1) 16(76.2) 8(38.1) 15(71.4) 6(28.6) 7(33.3) 13(61.9) 21(100) 8(38.1) 9(42.9) 5(23.8) 13(61.9) 2(9.5) K.oxytoca (1) S 1(100) I R 1(100) 1(100) 1(100) 1(100) 1(100) 1(100) 1(100) 1(100) 1(100) 1(100) 1(100) 1(100) 1(100) P.mira- bilis (4) S 1(25) 1(25) 2(50) 1(25) 3(75) 1(25) 2(50) 3(75) 3(75) 1(25) 4(100) I 2(50) 1(25) R 4(100) 3(75) 1(25) 2(50) 3(75) 1(25) 2(50) 2(50) 4(100) 4(100) 1(25) 1(25) 3(75) Citroba- ct er spp (5) S 4(80) 5(100) 2(40) 4(80) 3(60) 2(40) 3(60) 2(40) 4(80) 4(80) 2(40) 5(100) I 2(40) 2(40) 3(60) 1(20) R 1(20) 1(20) 1(20) 2(40) 1(20) 2(40) 3(60) 5(100) 2(40) 1(20) 1(20) 2(40) P.aerogi - nos a (2) S 1(50) 1(50) 2(100) 1(50) 2(100) 2 (100) 1(50) 2(100) I 1(50) 1(50) 1(50) R 1(50) 2(100) 1(50) 1(50) 1(50) 2(100) 2(100) 2(100) 1(50) Enteroba - cter spp (6) S 2(33.3) 3(50) 3(50) 3(50) 2(33.3) 5(83.3) 3(50) 4(66.7) 2(33.3) 4(66.7) 3(50) 5(83.3) 2(33.3) 6(100) I 1(16.7) 1(16.7) 2(33.3) 1(16.7) 2(33.3) R 3(50) 2(33.3) 3(50) 1(16.7) 4(66.7) 1(16.7) 2(33.3) 2(33.3) 4(66.7) 3(50) 1(16.7) 4(66.7) Total (77) S 28(36.4) 51(66.2) 24(31.2) 44(58.4) 40(51.9) 55(71.4) 38(49.3) 40(51.9) 9(11.7) 29(37.7) 49(63.6) 58(75.3) 23(29.9) 74(96.1) I 3(3.9) 5(6.5) 10(13) 6(7.8) 2(2.6) 4(5.2) 5(6.5) 8(10.4) 17(22) 2(2.6) 3(3.9) R 46(59.7) 21(27.3) 43(55.8) 27(35.1) 35(45.5) 18(23.4) 34(44.2) 29(37.7) 68(88.3) 31(40.3) 28(36.4) 17(22.1) 51(66.2) 3(3.9) Key: AMP= Ampicillin; TET= Tetracycline; CiP= Ciprofloxacin; F= Nitrofurantoin; P= Penicillin; CRO = Ceftriaxone; STX = Trimethoprim- Sulfamethoxazole; AMC = Amoxicillin- clavulanic acid; CN = Gentamycin; NOR = Norfloxacin; C = Chloramphenicol; MEM = Meropenem; CTX = Cefotaxime; CAZ = Ceftazidime Table 4: Antimicrobial susceptibility pattern of Gram-positive bacteria isolated from urine culture of gynecological cases admitted at Jimma University Medical Centre, Ethiopia. Isolates pattern STX F AMC CN NOR C AMP CiP CRO E P DA CoNS (14) S 3(21.3) 14(100) 12(85.7) 7(50) 12(85.7) 8(57.1)) 4(28.6) 12(85.7) 12(85.7) 5(35.7) 13(92.9) I 1(7.1) 3(21.4) 1(7.1) 1(7.1) 1(7.1) 4(28.6) R 11(78.7) 1(7.1) 4(28.6) 1(7.1) 6(42.9) 9(64.3) 1(7.1) 2(14.3) 5(35.7) 14(100) 1(7.1) S. aureus (10) S 5(50) 10(100) 10(100) 7(70) 9(90) 6(60) 3(30) 6(60) 7(70) 6(60) 2(20) 6(60) I 1(10) 1(10) 2(20) 1(10) 2(20) R 5(50) 2(20) 4(40) 5(50) 3(30) 3(30) 4(40) 8(80) 2(20) Total (24) S 8(33.3) 24(100) 22(91.6) 14(58.3) 21(87.5) 14(58.3) 7(29.2) 18(75) 19(79.2) 15(62.5) 2(8.3) 19(79.2) I 1(4.2) 4(16.7) 2(8.3) 3(12.5) 2(8.3) 2(8.3) R 16(66.7) 1(4.2) 6(25) 1(4.2) 10(41.7) 14(58.3) 4(16.7) 5(20.8) 9(37.5) 22(91.6) 3(12.5) Key: AMP= Ampicillin; TE= Tetracycline; CiP= Ciprofloxacin; E= Erythromycin; DA= Clindamycin; F= Nitrofurantoin; P= Penicillin; CRO = Ceftriaxone STX =trimethoprim-sulfamethoxazole; AMC = Amoxicillin- clavulanic acid; CN = Gentamycin; NOR = norfloxacin; C = chloramphenic Table 5: Level of Antimicrobial Resistance of isolated bacterial uropathogens among gynecological cases admitted at Jimma University Medical Centre, Ethiopia. Bacterial isolates Total Antimicrobial resistance pattern ESBL Producers R0 R1 R2 R3 R4 > R5 MDR Gram negatives 77(69.3) 4(5.2) 5(6.5) 9(11.7) 9(11.7) 4(5.2) 46(59.7) 62(80.5) 16 E. coli 38(37.6) 3(7.9) 3(7.9) 6(15.8) 6(15.8) 1(2.6) 19(50) 27(71.1) 10 K. pneumoniae 21(20.8) 0 0 2(9.5) 2(9.5) 1(4.8) 16(76.2) 20(95.2) 6 K. oxytoca 1(1) 0 0 0 0 0 1(100) 1(100) 0 P. mirabilis 4(4) 0 0 0 0 0 4(100) 4(100) 0 Enterobacter spp. 6(5.9) 1(16.7) 1(16.7) 0 0 0 4(66.7) 4(66.7) 0 P. aeruginosa 2(2) 0 0 0 0 1(50) 1(50) 2(100) 0 Citrobacter spp . 5(5) 0 1(20) 1(20) 1(20) 1(20) 1(20) 4(80) 0 Gram positives 24(23.8) 1(4.2) 4(16.7) 4(16.7) 5(20.8) 5(20.8) 5(20.8) 18(75) NT CoNS 14(13.9) 0 2(14.3) 4(28.6) 4(28.6) 1(7.1) 3(21.4) 10(71.4) NT S. aureus 10(9.8) 1(10) 2(20) 0 1(10) 4(40) 2(20) 8(80) NT Total 101(100) 5(5) 9(8.9) 12(11.9) 16(15.8) 11(10.9) 48(47.5) 80(79. 2) P 16(26.7) Notes: Non-susceptible to> 1 agent in>3 antimicrobial categories. P Percent is computed from total number of isolates, based on which MDR definition is applied. Abbreviations: R0, no antibiotic resistance; R1, resistance to one; R2, resistance to two; R3, resistance to three; R4, resistance to four; ≥ R5, resistance to five and more drugs; MDR, multidrug resistant. Discussion In this study, the overall prevalence of significant bacteriuria among admitted gynecological cases was found to be 25.4%, which was in agreement with the findings of the previous studies conducted in India 24% [20], Nigeria, 26.2% [21] and USA 22.4% [22]. However, our finding was higher than other studies reported from Norway, 16.3% [23] and USA, 11.3% [24]. But, our finding was lower than the reports from Ethiopia, 58.1% [25] and Nigeria, 76.1% [26]. This inconsistency in prevalence might be due to differences in the sample size, methods employed, standard of personal hygiene, predisposing factors, and study population. Furthermore, the prevalence of uropathogenic bacteria observed in our study is still high compared to those reported in developed countries 6% [27] and this might be due to a difference in the level of health-care development [28]. In this study, gram-negative bacteria isolates were more prevalent with 77(76.2%) than gram-positive bacteria isolates with 24(23.8%). This could be due to the presence of a unique structure in gram-negative bacteria that helps with the attachment to the uroepithelial cells and prevents bacteria from being washed away by urine, allowing for multiplication and tissue invasion [29]. E. coli was the most frequent etiological agent of UTI, accounting for up to 37.6% of isolated cases. This finding is in agreement with the findings from Nigeria, 34.2% [30] and India, 37.3% [31]. The possible explanation for this high isolation rate of E. coli in the present finding could be due to the significant abundance of E. coli in the rectal area, which in turn via contamination ascends through genitalia to the urinary tract and causes UTI and it could also be due to E. coli having various enhanced virulence factors specific for colonization and invasion of the urinary epithelium, such as P-fimbriae and S-fimbriae adherence factors which mediate the attachment of E. coli to viginal and uroepithelial cells [32]. Patients with gynecological cases who underwent gynecologic surgery had 72 (30.9%) positive cultures, whereas 26 (17%) of the 153 patients who underwent non-surgical procedures had significant bacteriuria, indicating that patients with gynecological cases who underwent gynecologic surgery were more affected than those who did not. This might be due to the close proximity of the rectum to the operating field and the use of urinary catheters, which aid in emptying the bladder during the procedure, which has a strong association with the development of UTI [33]. This study's findings also show that a history of UTI has a strong association with significant bacteriuria, as shown in Table 2. Similar finding were reported from Ethiopia [25]. This is possibly due to the presence of resistant bacterial strains from those who had a previous history of UTI after poor diagnosis and ineffective treatment. The prevalence of uropathogenic bacteria in admitted gynecological cases with a history of catheterization was also significantly higher than those without a history of catheterization, which is almost similar to other reports where catheterization is the most important risk factor for the development of catheter associated bacteriuria in Northern America [34] and Ethiopia [25] this is possibly due to catheterization, which could cause urethral mucosa injury when staying for a long time and might induce hematogenous bacterial spread in the urinary tract, the formation of biofilm by gram negative bacteria, and contamination during the insertion of catheters [35, 36]. Symptoms were not associated with the significant bacteriuria in this study. From 93 patients with gynecological pathologies who complain of having symptoms that suggest symptomatic urinary tract infection, only 32/63 (34.4%) were found to have culture confirmed urinary tract infection. Similar findings were also reported in Ethiopia [25]. Symptomatic patients whose urine cultures did not show significant growth might be due to several different microorganisms that can cause UTIs, including protozoan parasites, fungi, and viruses, even though bacteria are the major causative organisms [37]. In this study, 26.7% of the gram-negative ( E. coli and Klebsiella spp.) isolates were found to be ESBL producers. ESBL production of Klebsiella isolates was 27.3%, which is slightly higher than previous findings in Jimma, Ethiopia of 23.5% [38]. The rise in the prevalence of ESBL-producing uropathogens in the current study might be due to the fact that our study participants were all hospitalized, since hospitalization was identified as the strongest independent risk factor for ESBL [39] . In this study, among gram-negative bacteria, the highest resistance was shown to ampicillin 88.3%, followed by tetracycline 66.2%. The reason may be due to the continuous use of these drugs for many years. High level of resistance to beta-lactam ring containing antibiotics could happen because of the presence of extended spectrum β-lactamase in these strains. On the other hand, about 74/77 (96.1%) of isolates were sensitive to meropenem. This might be due to the unavailability of this drug in the area. In addition, lower resistance (higher rate of sensitivity) was observed against 51/77(66.2%) nitrofurantoin, 55 (71.4%) norfloxacin and 58/77 (75.3%) ceftazidime. The possible justification for such low-level resistance might be attributable to the infrequent prescription of these drugs. Hence, they could be considered as alternative options in the treatment of UTI. Among the gram-negatives, the predominant isolate was E. coli , which is sensitive to nitrofurantoin 81.6%, ceftriaxone 78.9% and norfloxacin 76.3%. This was consistent with findings in Addis Ababa, Ethiopia [40], while high resistance was shown to ampicillin (31; 81.6%) and tetracycline (27; 71.1%), which is in line with studies from Dire-Dawa, Ethiopia [41] and Gondor, Ethiopia [42]. In this study, Klebsiella spp . showed a high rate of sensitivity to norfloxacin (14; 66.7%) and ceftriaxone (14; 66.7%), which is in line with a study done at Gondor, Ethiopia [42]. Also, the isolates showed high resistance to ampicillin 22(100%) and amoxicillin-clavulanic acid 17 (77.3%), which is similar to the study done by Belete et al. , 2020 [43]. The possible explanation of ampicillin and amoxicillin-clavulanic acid resistance might be due to their extensive use in health facilities, as this may augment the selection of uropathogens harboring the β-lactamase enzyme, which can hydrolyze penicillin. Gram-positive bacteria were relatively resistant to penicillin (91.6%) and trimethoprim-sulfamethoxazole (66.7%). This might be due to the easy availability and indiscriminate use of these drugs, which could lead to an increase in resistance. On the contrary, all tested gram-positive isolates showed sensitivity to nitrofurantoin 100.0%. The reason for the effectiveness of this drug might be due to its narrow range of clinical indications, which results in less usage. According to the international standard for the definition of drug resistance [19], multidrug resistance (non-susceptible to > 1 agent in > 3 antimicrobial categories) was observed in 79.2% of the total isolated bacterial uropathogens, which was comparable with the finding from North East Ethiopia of 80.4% [43]. However, our finding was lower than previously reported MDR prevalence in Ethiopia (95-100%) [41, 42] and Kenya 96.0% [44]. In contrast, the result of this study was higher than studies from other documented results in Ethiopia, 74.0% [45]. The possible reason for this rise in MDR might be the repeated, inappropriate, and incorrect use of antimicrobial agents in empirical treatment, which in turn raises the prevalence of resistant microorganisms in the community [41]. It could also be due to multiple resistant genes that can develop on the mobile genetic elements [46] and plasmids bearing genes-encoding ESBLs, which frequently also carry genes encoding resistance to other antimicrobial agents [14]. All ESBL-producing isolates showed 100.0% sensitivity to meropenem. Therefore, carbapenems are considered the drugs of choice in the treatment of severe infections caused by ESBL-producing bacteria [47]. All of the ESBL positive isolates showed a high level of resistance; 100.0% to ampicillin, sulphamethoxazole-trimethoprim, ceftriaxone, cefotaxime, and 87.5% to ceftazidime. The treatment of choice for ESBL-producing bacteria is very limited [14]. Such findings indicate that the use of these antibiotics for the treatment of urinary tract infections caused by ESBL-positive strains may not produce the desired effect and may result in a significant amount of treatment failure. Conversely, ESBL-positive strains can respond better to carbapenem drugs such as meropenem, which could be a better treatment option. Limitations of the Study was, it focused on admitted patients until the time of sample collection, before discharge and didn’t investigated infections that may have developed after the patients were discharged. Therefore, our study may not provide the actual prevalence of UTI in the ward. Conclusions The overall prevalence of UTI among admitted gynecological cases was 25.4%. E. coli was the most dominant pathogen, which accounted for 37.6% of the isolates, followed by Klebsiella spp . The history of UTI and history of catheterization had a statistically significant association with the uropathogenic bacterial isolates. This study also showed that Nitrofurantoin and Norfloxacin were the drugs of choice for both gram-negative and gram-positive bacteria, whereas ampicillin and trimethoprim-sulfamethoxazole were less effective for the management of UTI among our study participants. While meropenem and clindamycin were found effective against gram-negative and positive bacteria isolated, respectively, a significant number of ESBL producers (26.7%) and an alarmingly high multi-drug resistance have been shown in most of the bacterial isolates (79.2%). Abbreviations AOR Adjusted Odds Ratio ATCC American Type Culture Collection BAP Blood Agar Plate CFU Colony Forming Unite CLSI Clinical Laboratory Standard Institute CoNS Coagulate Negative Staphylococci COR Crude Odds Ratio DDS Double-Disk Synergy ESBL Extended Spectrum B- Lactamase JUMC KIA Jimma University Medical Center Kligler’s Iron Agar MSU Mid-Stream Urine QC Quality Control SIM Sulphur Indole Motility SOP Standard Operating Procedure SPSS UK Statistical Package for Social Science United Kingdom UTI Urinary Tract Infection WHO World Health Organization Declarations Acknowledgements We are thankful to our data collectors for their excellent data collection. We are grateful to the entire study participants for their kind cooperation and to Jimma University for logistical and material support. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Author information Authors and Affiliations Department of Medical laboratory Science, College of Health sciences, Mettu University, Ethiopia Sisay Teferi Guyassa School of Medical Laboratory Science, College of medical sciences, Institute of Health, Jimma University, Ethiopia Zewdineh Sahlemariam, Mekdim Mekonnen, Rahel Tamrat. School of Medical Laboratory Science, College of medical sciences, Institute of Health, Wollega University, Ethiopia Yonas Adisu Department of Biomedical Science, College of Health sciences, Mettu University, Ethiopia Tefera Darge Authors’ contributions ST: Conception of the research idea, carried out the experiment work, analyzed the data, and wrote the manuscript. SS, RT, MM, FA: supervision and review of the manuscript. TD and YA: helped data collection and edited the manuscript. All authors have read and approved the final manuscript. Corresponding author Correspondence to Sisay Teferi Funding This study was not funded. 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Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 01 May, 2023 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Major revision 15 Feb, 2023 Reviews received at journal 23 Jan, 2023 Reviewers agreed at journal 16 Jan, 2023 Reviews received at journal 13 Jan, 2023 Reviewers agreed at journal 13 Jan, 2023 Reviewers invited by journal 24 Nov, 2022 Editor assigned by journal 24 Nov, 2022 Editor invited by journal 23 Nov, 2022 Submission checks completed at journal 23 Nov, 2022 First submitted to journal 19 Nov, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2291466","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":154450511,"identity":"eec5a965-3637-4ff5-8240-a834dbe91c9b","order_by":0,"name":"Sisay Teferi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDUlEQVRIiWNgGAWjYDACZhBRIQFkHGBgSKgAiTA3EKHljI0EA1sCUMsZkAgjAS0gwNiSBtHC2Abm4tci387+8DNvw+E6fjbmYx8ezquN5m8HavlRsQ2nFoPDPMbSvDsOS0i2sSXPSNx2PHfGYcYGxp4zt3FrYeZhkOY9c1jC4H6PMUPitmO5DUAtzIxtuLXIN7M//s3bdljC/hj/Z4bEOcdy5xPSwnCYwUyaty1NwoCNh5khsaEmdwMhLUC/mFnOOWMjOeMYmzFDwrEDuRuBWg7i84t8//HHN95USPDztzE/ZvxRU5c77/zhgw9+VOBxGBAw8SC7EwQO4FUPBIw/EOw6QopHwSgYBaNgBAIAJzlZAIaYsvEAAAAASUVORK5CYII=","orcid":"","institution":"Mettu University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Sisay","middleName":"","lastName":"Teferi","suffix":""},{"id":154450512,"identity":"34b4f8dc-a1d8-4284-8132-2c7051563f76","order_by":1,"name":"Zewdineh Sahlemariam","email":"","orcid":"","institution":"Jimma University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zewdineh","middleName":"","lastName":"Sahlemariam","suffix":""},{"id":154450514,"identity":"5ba9cf16-5fc6-430f-8ffa-d3d91d080bc1","order_by":2,"name":"Mekdim Mekonnen","email":"","orcid":"","institution":"Jimma University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mekdim","middleName":"","lastName":"Mekonnen","suffix":""},{"id":154450516,"identity":"638784b8-afc2-4d0e-bc2d-2feddb3bfd1c","order_by":3,"name":"Rahel Tamrat","email":"","orcid":"","institution":"Jimma University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rahel","middleName":"","lastName":"Tamrat","suffix":""},{"id":154450519,"identity":"569f9f9e-f664-4505-8e46-b77896230d45","order_by":4,"name":"Yonas Adisu","email":"","orcid":"","institution":"Wollega University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yonas","middleName":"","lastName":"Adisu","suffix":""},{"id":154450521,"identity":"57504e7b-4421-41d9-bc24-2f1f4227531b","order_by":5,"name":"Tefera Darge","email":"","orcid":"","institution":"Mettu University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tefera","middleName":"","lastName":"Darge","suffix":""}],"badges":[],"createdAt":"2022-11-19 13:59:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2291466/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2291466/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-023-34048-4","type":"published","date":"2023-05-01T20:40:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":29663398,"identity":"d3805263-7f2c-4549-b6a3-f02d5c70d681","added_by":"auto","created_at":"2022-11-29 16:13:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":27497,"visible":true,"origin":"","legend":"\u003cp\u003eFrequency of bacterial uropathogens of symptomatic and asymptomatic UTI among gynecological cases admitted at Jimma University Medical Centre, Ethiopia\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-2291466/v1/cf208bcacc2b9b3ef85f663a.png"},{"id":44728255,"identity":"0bd667ba-9910-45d3-809c-dda79d35e2cf","added_by":"auto","created_at":"2023-10-16 21:02:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":765037,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2291466/v1/d74bbc58-d8ce-4465-bafd-d80306013492.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Uropathogenic bacterial profile and antibiotic susceptibility pattern of isolates among gynecological cases admitted to Jimma Medical center, South West Ethiopia","fulltext":[{"header":"Background","content":"\u003cp\u003eUrinary Tract Infection (UTI) is the most frequent human-acquired bacterial infection which affects about 150 million people all over the world each year [1]. It involves anywhere in the urinary tract, including the kidney, ureter, bladder, and urethra. It is one of the most common bacterial infections in women [2], more than 50% of women get during their life time [3]. This can be due to the ascent of a number of organisms into the bladder is easier than in men because of the relatively short urethra, the absence of bactericidal prostatic secretion, and the ease of contamination of the urinary tract with fecal flora [4].\u003c/p\u003e\n\u003cp\u003eIn patients with gynecological problems, blockage of urine flow [5], anatomical and physiological changes [6], incomplete bladder emptying, frequent bladder infections, incontinence of urine and stool, and catheterization after surgical procedures may further predispose them to urinary tract infections [7, 8]. During and after gynecological surgery, bladder drainage by transurethral foleys catheter is common practice used to monitor urine output and prevent post-operative urinary retention, which is associated with an increased risk of UTIs in patients, and the daily risk of acquisition of bacteriuria when an indwelling catheter is \u003cem\u003ein-situ\u003c/em\u003e is 3\u0026ndash;7% [9, 10]. It is known that, UTI poses a high risk of morbidity, mortality, and significant health care costs [11]. Moreover, among patients with gynecological problem, it has been a matter of morbidity, anxiety, and long hospital stays, which occurs more frequently during the postoperative period [12].\u003c/p\u003e\n\u003cp\u003eIn developing countries including Ethiopia, management of UTIs is usually empirical which may contributes for the emergency and spread of antimicrobial resistant strain which is a leading cause of treatment failure in UTI [13].As a result, clinicians are left with very limited drug choices for the treatment of urinary tract infections. One of the leading antimicrobial resistance mechanisms for many UTI causing Gram-negative bacteria is extended-spectrum \u0026beta;-lactamase enzyme production that hydrolyzes the \u0026beta;-lactam ring of antimicrobials, which gives bacterial resistance to commonly prescribed antibiotics including penicillins; first, second and third-generation cephalosporins, aztreonams [14].\u003c/p\u003e\n\u003cp\u003eGenerally, most admitted gynecological cases need prolonged hospitalization and more intensive nursing care like prolonged bladder catheterization, which may contribute to the development of urinary tract infections that require extensive treatment with antibiotics. Therefore, this study was conducted to determine the bacterial etiologic agents of uropathogens and evaluate their in vitro susceptibility pattern to commonly used antibiotics among admitted gynecological cases at tertiary hospital in southwest Ethiopia.\u003c/p\u003e"},{"header":"Methods ","content":"\u003ch2\u003eStudy design, setting, and population.\u003c/h2\u003e\n\u003cp\u003eA cross-sectional study was conducted among gynecological cases admitted from September 16 to December 30, 2021 at Jimma University Medical Center, South West Ethiopia. The study area is located 348 km away from the capital city, Addis Ababa. The annual average admission of the centre is over 20,000 patients. The service delivery sites are the outpatient department, gynecology ward, maternity and labor ward, and operation rooms. All gynecological cases admitted to the gynecology ward during the study period were included in the study population, and those treated with antibiotics within 15 days of the study\u0026apos;s start date were excluded.\u003c/p\u003e\n\u003ch2\u003eSample size and sampling techniques\u003c/h2\u003e\n\u003cp\u003eThe sample size was calculated using a single population proportion formula\u003cimg src=\"data:image/png;base64,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\" alt=\"image\" width=\"106\" height=\"37\"\u003e, where n= number of sample size, Z is the statistics corresponding to a 95% level of confidence (1.96), d= margin of error, and P= is the assumed prevalence of uropathogenic bacteria among gynecologic cases (50%). The infection prevalence was assumed to be 50% because the current status of uropathogenic bacterial infection in the area is unknown. Therefore, the sample size was adjusted to 384 gynecological cases. A sequential sampling method was used to find study participants. \u003c/p\u003e\n\u003ch2\u003eData collection methods\u003c/h2\u003e\n\u003cp\u003eInformation on demographic variables was collected from each patients with gynecolological cases by a face-to-face interview using a structured questionnaire. Clinical data was gathered through a review of patients\u0026apos; medical records and consultation with a gynecologist. \u003c/p\u003e\n\u003ch3\u003eSpecimen collection\u003c/h3\u003e\n\u003cp\u003eAbout 5 to 10 ml of urine was collected from patients by following aseptic technique and clean catch mid-stream urine (MSU) using a sterile screw-capped, wide-necked container. For those patients on a catheter, the sample was collected by aseptic techniques: cleansing the catheter port with alcohol and allowing drying time, and then aspirating the urine from the indwelling catheter with a sterile syringe. The container was labeled with the date, the name, and a code number. After collection, the specimen was immediately delivered to the microbiology laboratory for laboratory investigation. The specimens were processed within 2 hours of collection. In the event of a delay in processing, the urine specimens were refrigerated at 4\u0026deg;C until they were processed.\u003c/p\u003e\n\u003ch3\u003eCulture and identification techniques\u003c/h3\u003e\n\u003cp\u003eThe collected urine sample was inoculated onto 5% Blood Agar, Mannitol Salt agar and MacConkey agar plates (Oxoid Ltd., Bashingstore Hampaire, UK) by streak plate methods following the standard microbiological techniques and procedures developed by Finegold and Martin [15]. After incubating the plates aerobically at 37\u0026deg;C\u003cem\u003e \u003c/em\u003efor 24 hours, they were inspected for the presence or absence of bacterial growth. If colonies were found, they were counted and multiplied by the reciprocal of the loop\u0026rsquo;s volume, or 1000. Counting colonies yielding bacterial growth of \u003cu\u003e\u0026gt; \u003c/u\u003e105 cfu/ml and 3 isolated uropathogens was regarded as significant bacteriuria, and negative cultures contained no growth or mixed urogenital flora (\u0026gt;2 isolates). For catheter collected urine samples, the presence of symptoms or signs compatible with UTI with no other identified source of infection along with \u003cu\u003e\u0026gt;\u003c/u\u003e10\u003csup\u003e3\u003c/sup\u003e colony-forming units/ml and the presence of \u003cu\u003e\u0026gt;\u003c/u\u003e10\u003csup\u003e5\u003c/sup\u003e cfu/ml in a single catheter urine specimen in a patient without symptoms compatible with UTI is recommended as representing significant bacteriuria [16]. \u003c/p\u003e\n\u003cp\u003eAll positive urine cultures showing significant bacteriuria were further identified by their physical characteristics such as colony morphology, odor, swarming, and presence of hemolysis on their respective media, Gram-reaction, and pattern of biochemical reactions using the standard procedures [15]. The gram-negative rods were identified with the help of a series of biochemical tests, namely Citrate, Oxidase, Sulphur Indole Motility (SIM) media, Kligler\u0026rsquo;s Iron Agar (KIA), lysine decarboxylase, lactose fermentation, urea hydrolysis [17]\u003cem\u003e. \u003c/em\u003eGram-positive cocci were identified based on their Gram reaction, mannitol fermentation, catalase and coagulase tests [15]. \u003c/p\u003e\n\u003ch3\u003e Antimicrobial Susceptibility Testing (AST)\u003c/h3\u003e\n\u003cp\u003eThe Kirby-Bauer disc diffusion method was employed for antibiotic susceptibility testing as recommended by Clinical Laboratory Standards Institute (CLSI) 2020 guidelines [18]. When a pure culture with significant bacteriuria was obtained, a loopful of bacteria was taken from a colony and transferred into a tube containing 5ml of sterile normal saline (0.85% NaCl) and mixed gently until it formed a homogenous suspension. The turbidity of the suspension was adjusted to an optical density equivalent to 0.5 McFarland standards. The inoculated plates were left at room temperature to dry for 3-5 minutes while the Petridish lids were in place. \u003c/p\u003e\n\u003cp\u003eThe following antimicrobial discs with their respective concentration were used for susceptibility testing and all the antimicrobials used for the study were obtained from Oxoid Ltd in the following concentrations: ciprofloxacin (CIP,5\u0026micro;g), trimethoprim-sulfamethoxazole (SXT,1.25/23.75\u0026micro;g), nalidixic acid (NA,30 \u0026mu;g ), meropenem (MEM, 10 \u0026mu;g ), cefotaxime (CTX,30\u0026micro;g), ceftazidime (CAZ,30\u0026micro;g), tetracycline (TTC,30 \u0026micro;g) nitrofurantoin (F,30\u0026micro;g), norfloxacin (NOR,10\u0026micro;g), ceftriaxone (CRO,30\u0026micro;g), amoxicillin-clavulanic acid (AMC,20/10\u0026micro;g), ampicillin (AMP,10\u0026micro;g), gentamicin (CN,10\u0026micro;g), erythromycin (E,15\u0026micro;g), penicillin (PEN,10\u0026micro;g), clindamycin (DA,10\u0026micro;g) and chloramphenicol (C, 30\u0026micro;g). Among these, nalidixic acid (NA), meropenem (MEM, 30 \u0026mu;g), cefotaxime (CTX, 30\u0026micro;g), ceftazidime (CAZ, 30\u0026micro;g), tetracycline (TTC, 30 \u0026micro;g) can be used only for gram-negative bacteria, whereas erythromycin (E, 15\u0026micro;g), penicillin (PEN, 10\u0026micro;g) and clindamycin (DA, 10\u0026micro;g) can be used only for gram-positive bacteria; however, the rest of the antibiotics were used for both isolates. The diameter of the zone of inhibition around each disc was measured to the nearest whole millimeter (mm) by using a ruler, and the isolate was classified as sensitive, intermediate, or resistant according to the standardized table supplied by CLSI, 2020 [18].\u003c/p\u003e\n\u003ch3\u003eDetection of Extended Spectrum \u003cem\u003e\u0026beta;\u003c/em\u003e-lactamase (ESBL)\u003c/h3\u003e\n\u003cp\u003eESBL-producing \u003cem\u003eE. coli and Klebsiella \u003c/em\u003espp\u003cem\u003e. \u003c/em\u003ewere first screened for ESBL production by the phenotypic method and then confirmed by the phenotypic confirmatory test as per CLSI guidelines 2020 [18].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhenotypic Screening for ESBL Production\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ESBL screening test was performed by the standard disk diffusion method using ceftazidime (30 \u0026micro;g), cefotaxime (30 \u0026micro;g), and ceftriaxone (30 \u0026micro;g) (Oxoid, UK). More than one antibiotic disc was used for screening to improve the sensitivity of ESBL detection [18]. The three antibiotic discs were placed on Muller-Hinton agar and incubated at 37\u0026deg;C for 18\u0026ndash;24 hours. These breakpoints for suspicion of ESBL production were: \u0026le; 25mm for ceftriaxone (30 g), \u0026le; 22mm for ceftazidime (30 g), and \u0026le; 27mm for cefotaxime (30 g) [18]. \u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003ePhenotypic Confirmation of ESBL Producers\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eConfirmation of suspected ESBL producers was done by using the double-disk synergy (DDS) method. On Muller Hinton agar, an Amoxicillin/clavulanic acid (20/10g) disc was placed in the center of the plate, and ceftazidime (30g) and cefotaxime (30g) discs were placed 15 mm apart, center to center. The plate was incubated at 37\u003csup\u003eo\u003c/sup\u003eC for 18\u0026ndash;24 hours. A \u0026ge;5mm increase in the diameter of the zone of inhibition for either of the cephalosporin-clavulanate disk combinations versus the zone diameter of the respective cephalosporin disk was considered positive, and the isolate was interpreted as an ESBL producer as recommended by CLSI guidelines 2020 [18]. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData processing and analysis \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were entered using EpiData version 3.1 and exported to SPSS version 25 software. Descriptive statistics were used to summarize socio-demographic data, bacterial profile and susceptibility patterns of isolates. Bivariate logistic regression was employed to look for associations between the outcome variable and each independent variable; and those variables significant at a p-value of less than 0.25 in the bivariate regression were then selected for the multivariate analysis model. The corresponding variables with a P-value \u003cu\u003e\u0026lt;\u003c/u\u003e 0.05 at a 95% confidence interval were then considered statistically significant.\u003c/p\u003e\n\u003ch2\u003eQuality Assurance\u003c/h2\u003e\n\u003cp\u003eThe legibility of the filled questionnaire and any labeling errors were confirmed immediately. Laboratory analyses were carried out using standard operating procedures. Culture media were tested for sterility and performance by incubating 5% of the batch at 35-37\u003csup\u003eo\u003c/sup\u003eC overnight and observing the media for microbial growth. Those media which showed growth was discarded and replaced by a new sterile batch. Standard reference strains of \u003cem\u003eS. aureus\u003c/em\u003e (ATCC25923), \u003cem\u003eE. coli\u003c/em\u003e (ATCC25922) and \u003cem\u003eP. aeruginosa\u003c/em\u003e (ATCC27853) were used during culture and antimicrobial susceptibility testing. \u003cem\u003eE. coli\u003c/em\u003e ATCC 25922 was used as an ESBL-negative whereas \u003cem\u003eK. pneumoniae\u003c/em\u003e ATCC 700603 was used as an ESBL-positive reference strain [18].\u003cem\u003e \u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003eEthical Consideration\u003c/h2\u003e\n\u003cp\u003eEthical clearance was obtained from the Institutional Review Board of Jimma University (Ref.: IRB000144/2020) and all methods were performed in accordance with relevant guidelines and regulations. The support letter was obtained from Jimma University School of Medical Laboratory Science and then submitted to JMC, gynecology ward. After adequately explaining the objectives and purpose of the study, written informed consent was obtained from all the study participants before data and sample collection. All data obtained in the course of the study was kept confidential. Positive cases were referred to the attending clinician as soon as possible for their better management. \u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eSocio-demographic characteristics\u003c/h2\u003e\n\u003cp\u003eA total of 386 patients admitted with gynecological cases were included in the present study. The mean age of the study participants was 31.9 \u0026plusmn; 11.5 years, with an age range of 15 to 70 years. About 153(39.6%) of study participants were in the age range of 25\u0026ndash;34 years, and the majority were married (315, or 81.6%), high school (1\u0026ndash;8; 35.2%) in their educational status, and urban dwellers (50.5%) in their residence. Based on their parity, the majority of 61.7% of the study participants were multiparous. Approximately 50.5% and 28% of the study participants had a history of catheterization and UTI, respectively. (Table: 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e: Background characteristics of the gynecological cases (n=386) in Jimma University Medical Centre, Ethiopia\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"516\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"56.97674418604651%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables Category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.930232558139537%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.093023255813954%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"56.97674418604651%\"\u003e\n \u003cp\u003eAge (years). 15-24\u003c/p\u003e\n \u003cp\u003e25-34\u003c/p\u003e\n \u003cp\u003e35-44\u003c/p\u003e\n \u003cp\u003e\u003cu\u003e\u0026gt;\u003c/u\u003e 45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.930232558139537%\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.093023255813954%\"\u003e\n \u003cp\u003e29.5\u003c/p\u003e\n \u003cp\u003e39.6\u003c/p\u003e\n \u003cp\u003e17.4\u003c/p\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"56.97674418604651%\"\u003e\n \u003cp\u003eOccupation Merchant\u003c/p\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003cp\u003eHouse wife\u003c/p\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.930232558139537%\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.093023255813954%\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"56.97674418604651%\"\u003e\n \u003cp\u003eEducational status No formal education\u003c/p\u003e\n \u003cp\u003e1-8\u003c/p\u003e\n \u003cp\u003e9-12\u003c/p\u003e\n \u003cp\u003eCollege and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.930232558139537%\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.093023255813954%\"\u003e\n \u003cp\u003e21.5\u003c/p\u003e\n \u003cp\u003e35.2\u003c/p\u003e\n \u003cp\u003e32.7\u003c/p\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"56.97674418604651%\"\u003e\n \u003cp\u003eParity Nullipara\u003c/p\u003e\n \u003cp\u003ePrimipara\u003c/p\u003e\n \u003cp\u003eMultipara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.930232558139537%\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003cp\u003e238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.093023255813954%\"\u003e\n \u003cp\u003e21.5\u003c/p\u003e\n \u003cp\u003e16.8\u003c/p\u003e\n \u003cp\u003e61.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"56.97674418604651%\"\u003e\n \u003cp\u003eMarital status Single\u003c/p\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.930232558139537%\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003cp\u003e315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.093023255813954%\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003cp\u003e81.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"56.97674418604651%\"\u003e\n \u003cp\u003eHistory of UTI yes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.930232558139537%\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003cp\u003e278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.093023255813954%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"56.97674418604651%\"\u003e\n \u003cp\u003eHistory of catheterization yes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.930232558139537%\"\u003e\n \u003cp\u003e195\u003c/p\u003e\n \u003cp\u003e191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.093023255813954%\"\u003e\n \u003cp\u003e50.5\u003c/p\u003e\n \u003cp\u003e49.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eETB- Ethiopian birr UTI- Urinary Tract Infection\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe prevalence of UTIs and the types of bacteria isolated\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 386 urine specimens analyzed, 98 had significant bacteriuria, with an overall prevalence of 25.4%. A total of 101 bacterial isolates (bacterial species belonging to seven genera) were identified from the study participants. The prevalence of bacteriuria among patients with gynecological cases who had undergone gynecologic surgery was 73 (31.12%). Of these, 15 (20.5%) underwent emergency surgery and 58 (79.5%) underwent elective surgery. Among patients who had undergone non-surgical procedures the prevalence was 25 (16.4%) and 32 (34.4%) of the isolates were from symptomatic cases. The prevalence of asymptomatic bacteriuria was 66 (22.5%). Of the total 101 isolates, the majority (77, or 76.2%) were gram-negative organisms, while 24(23.8%) were gram-positive bacteria. \u003cem\u003eE. coli\u003c/em\u003e was found to be the most frequent isolate 38 (49.4% of the gram-negatives, 37.6% of all isolates), followed by \u003cem\u003eKlebsiella\u003c/em\u003e spp. 22(21.8%) and CoNS 14(13.9%). The other isolated organisms were S.\u003cem\u003e\u0026nbsp;aureus\u003c/em\u003e 10(9.9%), \u003cem\u003eEnterobacter spp.\u003c/em\u003e 6(5.9%), \u003cem\u003eCitrobacter spp.\u003c/em\u003e 5(4.9%), \u003cem\u003eP. mirabilis\u003c/em\u003e 4 (4%), and \u003cem\u003eP. aeroginosa\u003c/em\u003e 2(2%). Of all, mixed pathogens were isolated from 3(3.1%) patients (Fig. 1).\u003c/p\u003e\n\u003ch2\u003eAssociated risk factors of UTI\u003c/h2\u003e\n\u003cp\u003eTwelve independent variables were considered during the bivariate analysis of risk factors for significant bacteriuria. In multivariate analysis, histories of UTI (AOR = 1.977, 95% CI: 1.06, 3.68, P = 0.032) and catheterization (AOR = 2.38, 95% CI: 1.28, 4.45, P = 0.006) were found to have a statistically significant association with significant bacteriuria (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e Bivariate and Multivariate Logistic Regression analyses of factors associated with significant bacteriuria among gynecological cases (n = 386) admitted at Jimma University Medical Centre, Ethiopia\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"593\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"16.188870151770658%\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"22.09106239460371%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Culture status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"10.118043844856661%\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"45.80152671755725%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSB (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"54.19847328244275%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNSB (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge in years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.188870151770658%\"\u003e\n \u003cp\u003e15-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\n \u003cp\u003e22(19.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.97301854974705%\"\u003e\n \u003cp\u003e92(80.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.55193482688391%\"\u003e\n \u003cp\u003e25-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e41(26.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.460285132382893%\"\u003e\n \u003cp\u003e112(73.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1.53(0.85-2.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e0.91(0.32-2.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e0.857\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.55193482688391%\"\u003e\n \u003cp\u003e35-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e17(25.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.460285132382893%\"\u003e\n \u003cp\u003e50(74.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1.42(0.69-2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e0.61(0.19-1.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e0.411\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.55193482688391%\"\u003e\n \u003cp\u003e\u003cu\u003e\u0026gt;\u003c/u\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e18(34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.460285132382893%\"\u003e\n \u003cp\u003e34(65.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e2.21(1.06-4.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1.32(0.40-4.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e0.645\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.188870151770658%\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\n \u003cp\u003e31(37.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.97301854974705%\"\u003e\n \u003cp\u003e52(62.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e1.44(0.64-3.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e0.45(0.07-2.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\n \u003cp\u003e0.399\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.55193482688391%\"\u003e\n \u003cp\u003e1-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e28(20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.460285132382893%\"\u003e\n \u003cp\u003e108(79.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e0.63(0.28-1.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e0.36(0.06-2.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e0.251\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.55193482688391%\"\u003e\n \u003cp\u003e9-12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e27(21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.460285132382893%\"\u003e\n \u003cp\u003e99(78.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e0.66(0.30-1.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e0.73(0.14-3.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e0.719\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.55193482688391%\"\u003e\n \u003cp\u003eCollege \u0026amp; \u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e12(29.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.460285132382893%\"\u003e\n \u003cp\u003e29(70.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.188870151770658%\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\n \u003cp\u003e9(17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.97301854974705%\"\u003e\n \u003cp\u003e44(83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.55193482688391%\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e7(38.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.460285132382893%\"\u003e\n \u003cp\u003e11(61.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e3.1(0.95-10.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e0.73(0.07-7.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e0.793\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.55193482688391%\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e82(26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.460285132382893%\"\u003e\n \u003cp\u003e233(74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1.7(0.81-3.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e0.49(0.07-3.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e0.462\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e\u003cstrong\u003eParity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.188870151770658%\"\u003e\n \u003cp\u003eNullipara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\n \u003cp\u003e14(16.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.97301854974705%\"\u003e\n \u003cp\u003e69(83.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.55193482688391%\"\u003e\n \u003cp\u003ePrimipara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e15(23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.460285132382893%\"\u003e\n \u003cp\u003e50(76.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1.48(0.66-3.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1.26(0.21-7.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e0.798\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.55193482688391%\"\u003e\n \u003cp\u003eMultipara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e69(29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.460285132382893%\"\u003e\n \u003cp\u003e169(71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e2.01(1.06-3.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e0.95(0.17-5.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e0.953\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of UTI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.188870151770658%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\n \u003cp\u003e42(38.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.97301854974705%\"\u003e\n \u003cp\u003e66(61.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e2.52(1.55-4.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e1.98(1.06-3.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\n \u003cp\u003e0.032*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.55193482688391%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e56(20.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.460285132382893%\"\u003e\n \u003cp\u003e222(79.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of catheterization\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.188870151770658%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\n \u003cp\u003e61(31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.97301854974705%\"\u003e\n \u003cp\u003e134(68.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e1.89(1.19-3.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e2.38(1.28-4.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\n \u003cp\u003e0.006*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.55193482688391%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e37(19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.460285132382893%\"\u003e\n \u003cp\u003e154(80.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMenopausal status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.188870151770658%\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\n \u003cp\u003e82(24.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.97301854974705%\"\u003e\n \u003cp\u003e255(75.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.55193482688391%\"\u003e\n \u003cp\u003epost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e16(32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.460285132382893%\"\u003e\n \u003cp\u003e33(67.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1.51(0.79-2.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1.06(0.23-4.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e0.938\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePregnancy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.188870151770658%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\n \u003cp\u003e28(17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.97301854974705%\"\u003e\n \u003cp\u003e128(82.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e0.50(0.30-0.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e1.07(0.23-4.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\n \u003cp\u003e0.929\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.55193482688391%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e70(30.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.460285132382893%\"\u003e\n \u003cp\u003e160(69.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent symptom\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.188870151770658%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\n \u003cp\u003e32(34.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.97301854974705%\"\u003e\n \u003cp\u003e61(65.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e1.80(1.09-3.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e1.49(0.77-2.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\n \u003cp\u003e0.232\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.55193482688391%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e66(22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.460285132382893%\"\u003e\n \u003cp\u003e227(77.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of catheter \u003cem\u003ein situ\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.188870151770658%\"\u003e\n \u003cp\u003e1-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\n \u003cp\u003e43(28.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.97301854974705%\"\u003e\n \u003cp\u003e107(71.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.55193482688391%\"\u003e\n \u003cp\u003e1-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e9(40.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.460285132382893%\"\u003e\n \u003cp\u003e13(59.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1.72(0.69-4.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1.14(0.36-3.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e0.825\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.55193482688391%\"\u003e\n \u003cp\u003e\u0026gt;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e15(53.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.460285132382893%\"\u003e\n \u003cp\u003e13(46.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e2.87(1.26-6.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1.15(0.34-3.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e0.823\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of hospital stay\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.188870151770658%\"\u003e\n \u003cp\u003e1-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\n \u003cp\u003e41(21.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.97301854974705%\"\u003e\n \u003cp\u003e148(78.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.55193482688391%\"\u003e\n \u003cp\u003e1-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e26(24.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.460285132382893%\"\u003e\n \u003cp\u003e79(75.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1.19(0.68-2.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e0.66(0.28-1.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e0.354\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.55193482688391%\"\u003e\n \u003cp\u003e\u0026gt;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e31(33.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.460285132382893%\"\u003e\n \u003cp\u003e61(66.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e1.83(1.06-3.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.773930753564155%\"\u003e\n \u003cp\u003e0.72(0.29-1.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.219959266802444%\"\u003e\n \u003cp\u003e0.463\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNature of surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.188870151770658%\"\u003e\n \u003cp\u003eEmergency\u003c/p\u003e\n \u003cp\u003eElective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\n \u003cp\u003e15(23.8)\u003c/p\u003e\n \u003cp\u003e58(33.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.97301854974705%\"\u003e\n \u003cp\u003e48(76.2)\u003c/p\u003e\n \u003cp\u003e113(66.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e0.61(0.31-1.18)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.200674536256322%\"\u003e\n \u003cp\u003e0.72(0.24-2.15)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.118043844856661%\"\u003e\n \u003cp\u003e0.560\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote\u003c/strong\u003e: *Statistically significant at P\u0026lt;0.05. \u003cstrong\u003eAbbreviations\u003c/strong\u003e: SB - Significant Bacteriuria; NSB - Non- Significant Bacteriuria; AOR- Adjusted Odds Ratio; COR- Crude Odds Ratio; 1, reference group; 95% CI, 95% confidence interval UTI, Urinary Tract Infection;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAntimicrobial susceptibility pattern of bacterial uropathogens\u003c/strong\u003e\u003c/p\u003e\n\u003ch2\u003eGram negative bacteria\u003c/h2\u003e\n\u003cp\u003eIn this study, gram-negative uropathogens showed high levels of resistance to 68 (88.3%) for ampicillin and 51 (66.2%) for tetracycline. However, all gram-negative bacterial isolates showed a relatively low level of resistance against nitrofurantoin 21(27.3%), norfloxacin 18 (23.4%), ceftazidime 17 (22.1%), and meropenem 3 (3.9%) (Table 3).\u003c/p\u003e\n\u003ch2\u003eGram-positive bacteria\u003c/h2\u003e\n\u003cp\u003eOut of the tested antibiotics, gram-positive bacterial isolates showed a high level of resistance to penicillin (91.6%) and trimethoprim-sulfamethoxazole (66.7%). On the other hand, all gram-positive isolates showed full sensitivity to 100.0% nitrofurantoin. Moreover, gram-positive isolates showed sensitivity towards clindamycin 79.2%, ciprofloxacin 75.0%, norfloxacin 87.5%, and amoxicillin-clavulanic acid 91.6% (Table 4).\u003c/p\u003e\n\u003ch2\u003eMultidrug resistance pattern of the isolates\u003c/h2\u003e\n\u003cp\u003eAmong the total isolates (n = 101), overall, 96 (95.0%) bacterial isolates were resistant to at least one antimicrobial agent, whereas 87 (86.1%) isolates were resistant to \u0026ge;2 antimicrobials. Multidrug resistance (defined as non-susceptible to \u0026ge;1 agent in \u0026ge;3 antimicrobial categories) [19] was seen in 80 (79.2%) of all isolated bacterial uropathogens. 62 (80.5%) of gram-negative and 18(75%) of gram-positive bacteria showed multidrug resistance for the tested antimicrobial drugs. \u003cem\u003eE. coli\u003c/em\u003e and \u003cem\u003eK. pneumoniae\u003c/em\u003e were found to be highly resistant to most of the antibiotics tested (Table 5).\u003c/p\u003e\n\u003ch2\u003eESBL-Producing Uropathogens\u003c/h2\u003e\n\u003cp\u003eThe isolates were \u003cem\u003eE. coli\u003c/em\u003e 38(49.3%), \u003cem\u003eK. pneumoniae\u003c/em\u003e 21 (27.3%), \u003cem\u003eEnterobacter\u003c/em\u003e spp. 6(7.8%), \u003cem\u003eP. mirabilis\u003c/em\u003e 4(5.2%), \u003cem\u003eCitrobacter\u003c/em\u003e spp. 5(6.5%), \u003cem\u003eP. aeruginosa\u003c/em\u003e 2(2.6%), and \u003cem\u003eK. oxytoca\u003c/em\u003e 1(1.3%). In this study, \u003cem\u003eE. coli\u003c/em\u003e and \u003cem\u003eKlebsiella\u0026nbsp;\u003c/em\u003espp. were the most frequently isolated bacteria, and the methods were validated for them. Of the 60 gram-negative isolates of \u003cem\u003eE. coli\u003c/em\u003e and \u003cem\u003eKlebsiella\u0026nbsp;\u003c/em\u003espp., 16(26.7%) were positive for ESBL production, with 10(26.3%) of the \u003cem\u003eE. coli\u003c/em\u003e isolates and 6(27.3%) of \u003cem\u003eKlebsiella\u0026nbsp;\u003c/em\u003espp. All ESBL-producing isolates showed 100% resistance to ceftriaxone, cefotaxime, and ceftazidime, 87.5% of drugs. However, all the ESBL-producing uropathogens were sensitive to meropenem at 100% (Table 5).\u003c/p\u003e\n\u003cp\u003eTable 3: Antimicrobial susceptibility pattern of Gram-Negative bacteria isolated from urine culture of gynecological cases admitted at Jimma University Medical Centre, Ethiopia\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"871\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"6.221198156682028%\"\u003e\n \u003cp\u003e\u003cstrong\u003eIsolates\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"2.7649769585253456%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePattern\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.912442396313364%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSTX\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.912442396313364%\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAMC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCTX\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.451612903225806%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e\u003cstrong\u003eC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAMP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCiP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRO\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCAZ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.797235023041475%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTET\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.912442396313364%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMEM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"6.221198156682028%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eE. coli\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e(38)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"2.7649769585253456%\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.912442396313364%\"\u003e\n \u003cp\u003e15(39.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.912442396313364%\"\u003e\n \u003cp\u003e31(81.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e14(36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e23(60.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e29(76.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e29(76.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.451612903225806%\"\u003e\n \u003cp\u003e19(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e25(65.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e7(18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e17(44.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e27(71.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e30(78.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.797235023041475%\"\u003e\n \u003cp\u003e11(28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.912442396313364%\"\u003e\n \u003cp\u003e38(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"2.9484029484029484%\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\n \u003cp\u003e2(5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e4(10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e2(5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e1(2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.87960687960688%\"\u003e\n \u003cp\u003e1(2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e4(10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e5(13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.2481572481572485%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"2.9484029484029484%\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\n \u003cp\u003e23(60.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\n \u003cp\u003e5(13.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n 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valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e8(21.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.2481572481572485%\"\u003e\n \u003cp\u003e27(71.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"6.221198156682028%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eK. pneum-oniae\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"2.7649769585253456%\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.912442396313364%\"\u003e\n \u003cp\u003e7(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.912442396313364%\"\u003e\n \u003cp\u003e11(52.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e3(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e12(57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e4(19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e14(66.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.451612903225806%\"\u003e\n \u003cp\u003e12(57.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e5(23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e6(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e12(57.1)\u003c/p\u003e\n \u003c/td\u003e\n 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width=\"6.756756756756757%\"\u003e\n \u003cp\u003e2(9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e1(4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.87960687960688%\"\u003e\n \u003cp\u003e2(9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e3(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e7(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e2(9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.2481572481572485%\"\u003e\n \u003cp\u003e2(9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"2.9484029484029484%\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\n \u003cp\u003e13(61.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\n \u003cp\u003e8(38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e16(76.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e8(38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e15(71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e6(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.87960687960688%\"\u003e\n 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width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.87960687960688%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.2481572481572485%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"2.9484029484029484%\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\n \u003cp\u003e1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\n \u003cp\u003e1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.87960687960688%\"\u003e\n \u003cp\u003e1(100)\u003c/p\u003e\n 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valign=\"top\" width=\"6.451612903225806%\"\u003e\n \u003cp\u003e1(25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e2(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e3(75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e3(75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.797235023041475%\"\u003e\n \u003cp\u003e1(25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.912442396313364%\"\u003e\n \u003cp\u003e4(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"2.9484029484029484%\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n 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width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.2481572481572485%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"2.9484029484029484%\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\n \u003cp\u003e4(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\n \u003cp\u003e3(75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e1(25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e2(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n 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width=\"7.371007371007371%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"6.221198156682028%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eCitroba- ct\u003c/em\u003e\u003c/strong\u003e\u003cem\u003eer\u003c/em\u003e spp \u003cstrong\u003e(5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"2.7649769585253456%\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.912442396313364%\"\u003e\n \u003cp\u003e4(80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.912442396313364%\"\u003e\n \u003cp\u003e5(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e2(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e4(80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e3(60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e2(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.451612903225806%\"\u003e\n \u003cp\u003e3(60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e2(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e4(80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e4(80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.797235023041475%\"\u003e\n \u003cp\u003e2(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.912442396313364%\"\u003e\n \u003cp\u003e5(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"2.9484029484029484%\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e2(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e2(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.87960687960688%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e3(60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.2481572481572485%\"\u003e\n \u003cp\u003e1(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"2.9484029484029484%\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\n \u003cp\u003e1(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e1(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e1(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e2(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e1(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.87960687960688%\"\u003e\n \u003cp\u003e2(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e3(60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e5(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e2(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e1(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e1(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.2481572481572485%\"\u003e\n \u003cp\u003e2(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"6.221198156682028%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP.aerogi\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-\u003cem\u003enos\u003c/em\u003ea (2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"2.7649769585253456%\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.912442396313364%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.912442396313364%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e1(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e1(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e2(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.451612903225806%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e1(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e2(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e2 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.797235023041475%\"\u003e\n \u003cp\u003e1(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.912442396313364%\"\u003e\n \u003cp\u003e2(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"2.9484029484029484%\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\n \u003cp\u003e1(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e1(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.87960687960688%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e1(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.2481572481572485%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"2.9484029484029484%\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\n \u003cp\u003e1(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\n \u003cp\u003e2(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e1(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e1(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e1(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.87960687960688%\"\u003e\n \u003cp\u003e2(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e2(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e2(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.2481572481572485%\"\u003e\n \u003cp\u003e1(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"6.221198156682028%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eEnteroba\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ecter\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;spp (6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"2.7649769585253456%\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n 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width=\"6.221198156682028%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e \u003cstrong\u003e(77)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"2.7649769585253456%\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.912442396313364%\"\u003e\n \u003cp\u003e28(36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.912442396313364%\"\u003e\n \u003cp\u003e51(66.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e24(31.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e44(58.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e40(51.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e55(71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.451612903225806%\"\u003e\n \u003cp\u003e38(49.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e40(51.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e9(11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e29(37.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e49(63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.336405529953917%\"\u003e\n \u003cp\u003e58(75.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.797235023041475%\"\u003e\n \u003cp\u003e23(29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.912442396313364%\"\u003e\n \u003cp\u003e74(96.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"2.9484029484029484%\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\n \u003cp\u003e3(3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\n \u003cp\u003e5(6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e10(13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e6(7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e2(2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e4(5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.87960687960688%\"\u003e\n \u003cp\u003e5(6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e8(10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e17(22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e2(2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.2481572481572485%\"\u003e\n \u003cp\u003e3(3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"2.9484029484029484%\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\n \u003cp\u003e46(59.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\n \u003cp\u003e21(27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e43(55.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e27(35.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e35(45.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e18(23.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.87960687960688%\"\u003e\n \u003cp\u003e34(44.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e29(37.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e68(88.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e31(40.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e28(36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.756756756756757%\"\u003e\n \u003cp\u003e17(22.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.2481572481572485%\"\u003e\n \u003cp\u003e51(66.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.371007371007371%\"\u003e\n \u003cp\u003e3(3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eKey: AMP=\u0026nbsp;\u003c/strong\u003eAmpicillin;\u003cstrong\u003e\u0026nbsp;TET=\u0026nbsp;\u003c/strong\u003eTetracycline; \u003cstrong\u003eCiP=\u0026nbsp;\u003c/strong\u003eCiprofloxacin; \u003cstrong\u003eF=\u0026nbsp;\u003c/strong\u003eNitrofurantoin; \u003cstrong\u003eP=\u0026nbsp;\u003c/strong\u003ePenicillin; \u003cstrong\u003eCRO\u003c/strong\u003e= Ceftriaxone; \u003cstrong\u003eSTX\u003c/strong\u003e= Trimethoprim- Sulfamethoxazole; \u003cstrong\u003eAMC\u003c/strong\u003e= Amoxicillin- clavulanic acid;\u003cstrong\u003e\u0026nbsp;CN\u003c/strong\u003e= Gentamycin;\u003cstrong\u003e\u0026nbsp;NOR\u003c/strong\u003e= Norfloxacin; \u003cstrong\u003eC\u003c/strong\u003e= Chloramphenicol; \u003cstrong\u003eMEM\u003c/strong\u003e= Meropenem; \u003cstrong\u003eCTX\u003c/strong\u003e= Cefotaxime; \u003cstrong\u003eCAZ\u003c/strong\u003e= Ceftazidime\u003c/p\u003e\n\u003cp\u003eTable 4: Antimicrobial susceptibility pattern of Gram-positive bacteria isolated from urine culture of gynecological cases admitted at Jimma University Medical Centre, Ethiopia.\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"863\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e\u003cstrong\u003eIsolates\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.952491309385863%\"\u003e\n \u003cp\u003e\u003cstrong\u003epattern\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSTX\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.257242178447277%\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAMC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.952491309385863%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.952491309385863%\"\u003e\n \u003cp\u003e\u003cstrong\u003eC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAMP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCiP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.952491309385863%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRO\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.300115874855156%\"\u003e\n \u003cp\u003e\u003cstrong\u003eE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.373117033603708%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.373117033603708%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCoNS (14)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.952491309385863%\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e3(21.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.257242178447277%\"\u003e\n \u003cp\u003e14(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e12(85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e7(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.952491309385863%\"\u003e\n \u003cp\u003e12(85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.952491309385863%\"\u003e\n \u003cp\u003e8(57.1))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e4(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e12(85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.952491309385863%\"\u003e\n \u003cp\u003e12(85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.300115874855156%\"\u003e\n \u003cp\u003e5(35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.373117033603708%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.373117033603708%\"\u003e\n \u003cp\u003e13(92.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.7754077791718945%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e1(7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e3(21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\n \u003cp\u003e1(7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e1(7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e1(7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.904642409033877%\"\u003e\n \u003cp\u003e4(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.900878293601004%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.900878293601004%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e11(78.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.7754077791718945%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e1(7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e4(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\n \u003cp\u003e1(7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\n \u003cp\u003e6(42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e9(64.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e1(7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\n \u003cp\u003e2(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.904642409033877%\"\u003e\n \u003cp\u003e5(35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.900878293601004%\"\u003e\n \u003cp\u003e14(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.900878293601004%\"\u003e\n \u003cp\u003e1(7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eS. aureus\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e(10)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.952491309385863%\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e5(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.257242178447277%\"\u003e\n \u003cp\u003e10(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e10(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e7(70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.952491309385863%\"\u003e\n \u003cp\u003e9(90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.952491309385863%\"\u003e\n \u003cp\u003e6(60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e3(30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e6(60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.952491309385863%\"\u003e\n \u003cp\u003e7(70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.300115874855156%\"\u003e\n \u003cp\u003e6(60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.373117033603708%\"\u003e\n \u003cp\u003e2(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.373117033603708%\"\u003e\n \u003cp\u003e6(60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.7754077791718945%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e1(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\n \u003cp\u003e1(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e2(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e1(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.904642409033877%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.900878293601004%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.900878293601004%\"\u003e\n \u003cp\u003e2(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e5(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.7754077791718945%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e2(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\n \u003cp\u003e4(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e5(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e3(30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\n \u003cp\u003e3(30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.904642409033877%\"\u003e\n \u003cp\u003e4(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.900878293601004%\"\u003e\n \u003cp\u003e8(80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.900878293601004%\"\u003e\n \u003cp\u003e2(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (24)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.952491309385863%\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e8(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.257242178447277%\"\u003e\n \u003cp\u003e24(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e22(91.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e14(58.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.952491309385863%\"\u003e\n \u003cp\u003e21(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.952491309385863%\"\u003e\n \u003cp\u003e14(58.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e7(29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.6477404403244496%\"\u003e\n \u003cp\u003e18(75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.952491309385863%\"\u003e\n \u003cp\u003e19(79.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.300115874855156%\"\u003e\n \u003cp\u003e15(62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.373117033603708%\"\u003e\n \u003cp\u003e2(8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.373117033603708%\"\u003e\n \u003cp\u003e19(79.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.7754077791718945%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e1(4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e4(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\n \u003cp\u003e2(8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e3(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e2(8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.904642409033877%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.900878293601004%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.900878293601004%\"\u003e\n \u003cp\u003e2(8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e16(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.7754077791718945%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e1(4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e6(25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\n \u003cp\u003e1(4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\n \u003cp\u003e10(41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e14(58.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.281053952321205%\"\u003e\n \u003cp\u003e4(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.52823086574655%\"\u003e\n \u003cp\u003e5(20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.904642409033877%\"\u003e\n \u003cp\u003e9(37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.900878293601004%\"\u003e\n \u003cp\u003e22(91.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.900878293601004%\"\u003e\n \u003cp\u003e3(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eKey: AMP=\u003c/strong\u003eAmpicillin;\u003cstrong\u003e\u0026nbsp;TE=\u003c/strong\u003eTetracycline; \u003cstrong\u003eCiP=\u003c/strong\u003eCiprofloxacin; \u003cstrong\u003eE=\u003c/strong\u003eErythromycin; \u003cstrong\u003eDA=\u003c/strong\u003eClindamycin;\u003cstrong\u003e\u0026nbsp;F=\u003c/strong\u003eNitrofurantoin; \u003cstrong\u003eP=\u003c/strong\u003ePenicillin; \u003cstrong\u003eCRO\u003c/strong\u003e = Ceftriaxone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSTX\u003c/strong\u003e=trimethoprim-sulfamethoxazole; \u003cstrong\u003eAMC\u003c/strong\u003e= Amoxicillin- clavulanic acid;\u003cstrong\u003e\u0026nbsp;CN\u003c/strong\u003e= Gentamycin;\u003cstrong\u003e\u0026nbsp;NOR\u003c/strong\u003e= norfloxacin; \u003cstrong\u003eC\u003c/strong\u003e= chloramphenic\u003c/p\u003e\n\u003cp\u003eTable 5: Level of Antimicrobial Resistance of isolated bacterial uropathogens among gynecological cases admitted at Jimma University Medical Centre, Ethiopia.\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"672\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"16.964285714285715%\"\u003e\n \u003cp\u003eBacterial isolates\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"9.821428571428571%\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"7\" valign=\"top\" width=\"62.5%\"\u003e\n \u003cp\u003eAntimicrobial resistance pattern\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003eESBL\u003c/p\u003e\n \u003cp\u003eProducers\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"12.857142857142858%\"\u003e\n \u003cp\u003eR0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.857142857142858%\"\u003e\n \u003cp\u003eR1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003eR2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003eR3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003eR4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cu\u003e\u0026gt;\u003c/u\u003eR5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.142857142857142%\"\u003e\n \u003cp\u003eMDR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.964285714285715%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGram negatives\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.821428571428571%\"\u003e\n \u003cp\u003e77(69.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e4(5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e5(6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e9(11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e9(11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e4(5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e46(59.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003e62(80.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.964285714285715%\"\u003e\n \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.821428571428571%\"\u003e\n \u003cp\u003e38(37.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e3(7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e3(7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e6(15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e6(15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e1(2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e19(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003e27(71.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.964285714285715%\"\u003e\n \u003cp\u003e\u003cem\u003eK. pneumoniae\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.821428571428571%\"\u003e\n \u003cp\u003e21(20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e2(9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e2(9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e1(4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e16(76.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003e20(95.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.964285714285715%\"\u003e\n \u003cp\u003e\u003cem\u003eK. oxytoca\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.821428571428571%\"\u003e\n \u003cp\u003e1(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003e1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.964285714285715%\"\u003e\n \u003cp\u003e\u003cem\u003eP. mirabilis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.821428571428571%\"\u003e\n \u003cp\u003e4(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e4(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003e4(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.964285714285715%\"\u003e\n \u003cp\u003e\u003cem\u003eEnterobacter\u0026nbsp;\u003c/em\u003espp.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.821428571428571%\"\u003e\n \u003cp\u003e6(5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e1(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e1(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e4(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003e4(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.964285714285715%\"\u003e\n \u003cp\u003e\u003cem\u003eP. aeruginosa\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.821428571428571%\"\u003e\n \u003cp\u003e2(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e1(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e1(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003e2(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.964285714285715%\"\u003e\n \u003cp\u003e\u003cem\u003eCitrobacter\u0026nbsp;\u003c/em\u003espp\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.821428571428571%\"\u003e\n \u003cp\u003e5(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e1(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e1(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e1(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e1(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e1(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003e4(80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.964285714285715%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGram positives\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.821428571428571%\"\u003e\n \u003cp\u003e24(23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e1(4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e4(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e4(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e5(20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e5(20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e5(20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003e18(75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003eNT\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.964285714285715%\"\u003e\n \u003cp\u003e\u003cem\u003eCoNS\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.821428571428571%\"\u003e\n \u003cp\u003e14(13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e2(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e4(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e4(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e1(7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e3(21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003e10(71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003eNT\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.964285714285715%\"\u003e\n \u003cp\u003e\u003cem\u003eS. aureus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.821428571428571%\"\u003e\n \u003cp\u003e10(9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e1(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e2(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e1(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e4(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e2(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003e8(80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003eNT\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.964285714285715%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.821428571428571%\"\u003e\n \u003cp\u003e101(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e5(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.035714285714286%\"\u003e\n \u003cp\u003e9(8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e12(11.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e16(15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e11(10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.928571428571429%\"\u003e\n \u003cp\u003e48(47.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003e80(79. 2)\u003csup\u003eP\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.714285714285714%\"\u003e\n \u003cp\u003e16(26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNotes:\u003c/strong\u003e Non-susceptible to\u0026gt; 1 agent in\u0026gt;3 antimicrobial categories. \u003csup\u003eP\u0026nbsp;\u003c/sup\u003ePercent is computed from total number of isolates, based on which MDR definition is applied. \u003cstrong\u003eAbbreviations:\u003c/strong\u003e R0, no antibiotic resistance; R1, resistance to one; R2, resistance to two; R3, resistance to three; R4, resistance to four; \u0026ge; R5, resistance to five and more drugs; MDR, multidrug resistant.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, the overall prevalence of significant bacteriuria among admitted gynecological cases was found to be 25.4%, which was in agreement with the findings of the previous studies conducted in India 24% [20], Nigeria, 26.2% [21] and USA 22.4% [22]. However, our finding was higher than other studies reported from Norway, 16.3% [23] and USA, 11.3% [24]. But, our finding was lower than the reports from Ethiopia, 58.1% [25] and Nigeria, 76.1% [26]. This inconsistency in prevalence might be due to differences in the sample size, methods employed, standard of personal hygiene, predisposing factors, and study population. Furthermore, the prevalence of uropathogenic bacteria observed in our study is still high compared to those reported in developed countries 6% [27] and this might be due to a difference in the level of health-care development [28].\u003c/p\u003e\n\u003cp\u003eIn this study, gram-negative bacteria isolates were more prevalent with 77(76.2%) than gram-positive bacteria isolates with 24(23.8%). This could be due to the presence of a unique structure in gram-negative bacteria that helps with the attachment to the uroepithelial cells and prevents bacteria from being washed away by urine, allowing for multiplication and tissue invasion [29]. \u003c/p\u003e\n\u003cp\u003eE. coli was the most frequent etiological agent of UTI, accounting for up to 37.6% of isolated cases. This finding is in agreement with the findings from Nigeria, 34.2% [30] and India, 37.3% [31]. The possible explanation for this high isolation rate of \u003cem\u003eE. coli\u003c/em\u003e in the present finding could be due to the significant abundance of \u003cem\u003eE. coli\u003c/em\u003e in the rectal area, which in turn via contamination ascends through genitalia to the urinary tract and causes UTI and it could also be due to \u003cem\u003eE. coli\u003c/em\u003e having various enhanced virulence factors specific for colonization and invasion of the urinary epithelium, such as P-fimbriae and S-fimbriae adherence factors which mediate the attachment of \u003cem\u003eE. coli\u003c/em\u003e to viginal and uroepithelial cells [32]. \u003c/p\u003e\n\u003cp\u003ePatients with gynecological cases who underwent gynecologic surgery had 72 (30.9%) positive cultures, whereas 26 (17%) of the 153 patients who underwent non-surgical procedures had significant bacteriuria, indicating that patients with gynecological cases who underwent gynecologic surgery were more affected than those who did not. This might be due to the close proximity of the rectum to the operating field and the use of urinary catheters, which aid in emptying the bladder during the procedure, which has a strong association with the development of UTI [33].\u003c/p\u003e\n\u003cp\u003eThis study\u0026apos;s findings also show that a history of UTI has a strong association with significant bacteriuria, as shown in Table 2. Similar finding were reported from Ethiopia [25]. This is possibly due to the presence of resistant bacterial strains from those who had a previous history of UTI after poor diagnosis and ineffective treatment. \u003c/p\u003e\n\u003cp\u003eThe prevalence of uropathogenic bacteria in admitted gynecological cases with a history of catheterization was also significantly higher than those without a history of catheterization, which is almost similar to other reports where catheterization is the most important risk factor for the development of catheter associated bacteriuria in Northern America [34] and Ethiopia [25] this is possibly due to catheterization, which could cause urethral mucosa injury when staying for a long time and might induce hematogenous bacterial spread in the urinary tract, the formation of biofilm by gram negative bacteria, and contamination during the insertion of catheters [35, 36].\u003c/p\u003e\n\u003cp\u003eSymptoms were not associated with the significant bacteriuria in this study. From 93 patients with gynecological pathologies who complain of having symptoms that suggest symptomatic urinary tract infection, only 32/63 (34.4%) were found to have culture confirmed urinary tract infection. Similar findings were also reported in Ethiopia [25]. Symptomatic patients whose urine cultures did not show significant growth might be due to several different microorganisms that can cause UTIs, including protozoan parasites, fungi, and viruses, even though bacteria are the major causative organisms [37]. \u003c/p\u003e\n\u003cp\u003eIn this study, 26.7% of the gram-negative (\u003cem\u003eE. coli\u003c/em\u003e and \u003cem\u003eKlebsiella \u003c/em\u003espp.) isolates were found to be ESBL producers. ESBL production of \u003cem\u003eKlebsiella\u003c/em\u003e isolates was 27.3%, which is slightly higher than previous findings in Jimma, Ethiopia of 23.5% [38]. The rise in the prevalence of ESBL-producing uropathogens in the current study might be due to the fact that our study participants were all hospitalized, since hospitalization was identified as the strongest independent risk factor for ESBL [39]\u003cem\u003e.\u003c/em\u003e \u003c/p\u003e\n\u003cp\u003eIn this study, among gram-negative bacteria, the highest resistance was shown to ampicillin 88.3%, followed by tetracycline 66.2%. The reason may be due to the continuous use of these drugs for many years. High level of resistance to beta-lactam ring containing antibiotics could happen because of the presence of extended spectrum \u0026beta;-lactamase in these strains. On the other hand, about 74/77 (96.1%) of isolates were sensitive to meropenem. This might be due to the unavailability of this drug in the area. In addition, lower resistance (higher rate of sensitivity) was observed against 51/77(66.2%) nitrofurantoin, 55 (71.4%) norfloxacin and 58/77 (75.3%) ceftazidime. The possible justification for such low-level resistance might be attributable to the infrequent prescription of these drugs. Hence, they could be considered as alternative options in the treatment of UTI.\u003c/p\u003e\n\u003cp\u003eAmong the gram-negatives, the predominant isolate was \u003cem\u003eE. coli\u003c/em\u003e, which is sensitive to nitrofurantoin 81.6%, ceftriaxone 78.9% and norfloxacin 76.3%. This was consistent with findings in Addis Ababa, Ethiopia [40], while high resistance was shown to ampicillin (31; 81.6%) and tetracycline (27; 71.1%), which is in line with studies from Dire-Dawa, Ethiopia [41] and Gondor, Ethiopia [42]. In this study, \u003cem\u003eKlebsiella \u003c/em\u003espp\u003cem\u003e. showed a\u003c/em\u003e high rate of sensitivity to norfloxacin (14; 66.7%) and ceftriaxone (14; 66.7%), which is in line with a study done at Gondor, Ethiopia [42]. Also, the isolates showed high resistance to ampicillin 22(100%) and amoxicillin-clavulanic acid 17 (77.3%), which is similar to the study done by Belete \u003cem\u003eet al.\u003c/em\u003e, 2020 [43]. The possible explanation of ampicillin and amoxicillin-clavulanic acid resistance might be due to their extensive use in health facilities, as this may augment the selection of uropathogens harboring the \u0026beta;-lactamase enzyme, which can hydrolyze penicillin.\u003c/p\u003e\n\u003cp\u003eGram-positive bacteria were relatively resistant to penicillin (91.6%) and trimethoprim-sulfamethoxazole (66.7%). This might be due to the easy availability and indiscriminate use of these drugs, which could lead to an increase in resistance. On the contrary, all tested gram-positive isolates showed sensitivity to nitrofurantoin 100.0%. The reason for the effectiveness of this drug might be due to its narrow range of clinical indications, which results in less usage.\u003c/p\u003e\n\u003cp\u003eAccording to the international standard for the definition of drug resistance [19], multidrug resistance (non-susceptible to \u003cu\u003e\u0026gt;\u003c/u\u003e1 agent in \u003cu\u003e\u0026gt;\u003c/u\u003e3 antimicrobial categories) was observed in 79.2% of the total isolated bacterial uropathogens, which was comparable with the finding from North East Ethiopia of 80.4% [43]. However, our finding was lower than previously reported MDR prevalence in Ethiopia (95-100%) [41, 42] and Kenya 96.0% [44]. In contrast, the result of this study was higher than studies from other documented results in Ethiopia, 74.0% [45]. The possible reason for this rise in MDR might be the repeated, inappropriate, and incorrect use of antimicrobial agents in empirical treatment, which in turn raises the prevalence of resistant microorganisms in the community [41]. It could also be due to multiple resistant genes that can develop on the mobile genetic elements [46] and plasmids bearing genes-encoding ESBLs, which frequently also carry genes encoding resistance to other antimicrobial agents [14]. \u003c/p\u003e\n\u003cp\u003eAll ESBL-producing isolates showed 100.0% sensitivity to meropenem. Therefore, carbapenems are considered the drugs of choice in the treatment of severe infections caused by ESBL-producing bacteria [47]. All of the ESBL positive isolates showed a high level of resistance; 100.0% to ampicillin, sulphamethoxazole-trimethoprim, ceftriaxone, cefotaxime, and 87.5% to ceftazidime. The treatment of choice for ESBL-producing bacteria is very limited [14]. Such findings indicate that the use of these antibiotics for the treatment of urinary tract infections caused by ESBL-positive strains may not produce the desired effect and may result in a significant amount of treatment failure. Conversely, ESBL-positive strains can respond better to carbapenem drugs such as meropenem, which could be a better treatment option.\u003c/p\u003e\n\u003cp\u003eLimitations of the Study was, it focused on admitted patients until the time of sample collection, before discharge and didn\u0026rsquo;t investigated infections that may have developed after the patients were discharged. Therefore, our study may not provide the actual prevalence of UTI in the ward.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe overall prevalence of UTI among admitted gynecological cases was 25.4%.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cem\u003eE. coli\u003c/em\u003e was the most dominant pathogen, which accounted for 37.6% of the isolates, followed by \u003cem\u003eKlebsiella\u0026nbsp;\u003c/em\u003espp\u003cem\u003e.\u003c/em\u003e The history of UTI and history of catheterization had a statistically significant association with the uropathogenic bacterial isolates. This study also showed that Nitrofurantoin and Norfloxacin were the drugs of choice for both gram-negative and gram-positive bacteria, whereas ampicillin and trimethoprim-sulfamethoxazole were less effective for the management of UTI among our study participants. While meropenem and clindamycin were found effective against gram-negative and positive bacteria isolated, respectively, a significant number of ESBL producers (26.7%) and an alarmingly high multi-drug resistance have been shown in most of the bacterial isolates (79.2%).\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"606\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.859504132231404%\"\u003e\n \u003cp\u003eAOR \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"83.14049586776859%\"\u003e\n \u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.859504132231404%\"\u003e\n \u003cp\u003eATCC \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"83.14049586776859%\"\u003e\n \u003cp\u003eAmerican Type Culture Collection\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.859504132231404%\"\u003e\n \u003cp\u003eBAP \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"83.14049586776859%\"\u003e\n \u003cp\u003eBlood Agar Plate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.859504132231404%\"\u003e\n \u003cp\u003eCFU \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"83.14049586776859%\"\u003e\n \u003cp\u003eColony Forming Unite\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.859504132231404%\"\u003e\n \u003cp\u003eCLSI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"83.14049586776859%\"\u003e\n \u003cp\u003eClinical Laboratory Standard Institute\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.859504132231404%\"\u003e\n \u003cp\u003eCoNS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"83.14049586776859%\"\u003e\n \u003cp\u003eCoagulate Negative Staphylococci\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.859504132231404%\"\u003e\n \u003cp\u003eCOR \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"83.14049586776859%\"\u003e\n \u003cp\u003eCrude Odds Ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.859504132231404%\"\u003e\n \u003cp\u003eDDS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"83.14049586776859%\"\u003e\n \u003cp\u003eDouble-Disk Synergy\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.859504132231404%\"\u003e\n \u003cp\u003eESBL \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"83.14049586776859%\"\u003e\n \u003cp\u003eExtended Spectrum B- Lactamase\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.859504132231404%\"\u003e\n \u003cp\u003eJUMC \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eKIA \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"83.14049586776859%\"\u003e\n \u003cp\u003eJimma University Medical Center\u003c/p\u003e\n \u003cp\u003eKligler\u0026rsquo;s Iron Agar\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.859504132231404%\"\u003e\n \u003cp\u003eMSU \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"83.14049586776859%\"\u003e\n \u003cp\u003eMid-Stream Urine\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.859504132231404%\"\u003e\n \u003cp\u003eQC \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"83.14049586776859%\"\u003e\n \u003cp\u003eQuality Control\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.859504132231404%\"\u003e\n \u003cp\u003eSIM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"83.14049586776859%\"\u003e\n \u003cp\u003eSulphur Indole Motility\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.859504132231404%\"\u003e\n \u003cp\u003eSOP \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"83.14049586776859%\"\u003e\n \u003cp\u003eStandard Operating Procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.859504132231404%\"\u003e\n \u003cp\u003eSPSS\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eUK \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"83.14049586776859%\"\u003e\n \u003cp\u003eStatistical Package for Social Science\u003c/p\u003e\n \u003cp\u003eUnited Kingdom\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.859504132231404%\"\u003e\n \u003cp\u003eUTI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"83.14049586776859%\"\u003e\n \u003cp\u003eUrinary Tract Infection\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"16.859504132231404%\"\u003e\n \u003cp\u003eWHO \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"83.14049586776859%\"\u003e\n \u003cp\u003eWorld Health Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are thankful to our data collectors for their excellent data collection. We are grateful to the entire study participants for their kind cooperation and to Jimma University for logistical and material support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors and Affiliations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDepartment of Medical laboratory Science, College of Health sciences, Mettu University, Ethiopia\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSisay Teferi Guyassa \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSchool of Medical Laboratory Science, College of medical sciences, Institute of Health, Jimma University, Ethiopia\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZewdineh Sahlemariam, Mekdim Mekonnen, Rahel Tamrat.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSchool of Medical Laboratory Science, College of medical sciences, Institute of Health, Wollega University, Ethiopia\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYonas Adisu\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDepartment of Biomedical Science, College of Health sciences, Mettu University, Ethiopia\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTefera Darge\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eST: Conception of the research idea, carried out the experiment work, analyzed the data, and wrote the manuscript. SS, RT, MM, FA: supervision and review of the manuscript. TD and YA: helped data collection and edited the manuscript. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrespondence to \u003c/strong\u003eSisay Teferi\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was not funded. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical permission for this study was approved by Jimma University, Research and Ethics Committee of the School of Medical Laboratory. All participants were voluntary and each supplied informed consent.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFoxman B. Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infectious Disease Clinics. 2014;28(1):1-13.\u003c/li\u003e\n\u003cli\u003eCzaja CA, Hooton TM. Update on acute uncomplicated urinary tract infection in women. Postgraduate medicine. 2006;119(1):39-45.\u003c/li\u003e\n\u003cli\u003eBergamin PA, Kiosoglous AJ. Non-surgical management of recurrent urinary tract infections in women. Translational Andrology and Urology. 2017;6(Suppl 2):S142.\u003c/li\u003e\n\u003cli\u003eEl-Naggar W, Hassan R, Barwa R, Shokralla S, Elgaml A. Molecular diagnosis of gram negative bacteria in urinary tract infections. Egyptian Journal of Medical Microbiology. 2010;19(1):93.\u003c/li\u003e\n\u003cli\u003eKilpatrick CC. Cervical Myomas. MSD Manual. 2019.\u003c/li\u003e\n\u003cli\u003eDewhurst J. 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Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clinical Microbiology and Infection. 2012;18(3):268-81.\u003c/li\u003e\n\u003cli\u003eSabharwal ER. Antibiotic susceptibility patterns of uropathogens in obstetric patients. North American journal of medical sciences. 2012;4(7):316.\u003c/li\u003e\n\u003cli\u003eGhatak D. A study of urinary fistulae in Sokoto, Nigeria. Journal of the Indian Medical Association. 1992;90(11):285-7.\u003c/li\u003e\n\u003cli\u003eHarmanli OH, Cheng GY, Nyirjesy P, Chatwani A, Gaughan JP. Urinary tract infections in women with bacterial vaginosis. Obstetrics \u0026amp; Gynecology. 2000;95(5):710-2.\u003c/li\u003e\n\u003cli\u003eSchi\u0026oslash;tz H. Postoperative bacteriuria and urinary tract infections in gynecological patients. Tidsskrift for den Norske laegeforening: tidsskrift for praktisk medicin, ny raekke. 1996;116(2):246-8.\u003c/li\u003e\n\u003cli\u003eDawson ML, Cramer MS, Thompson DR, Vakili B. Microbiological analysis of urine cultures in women after pelvic reconstructive surgery. Current urology. 2017;11(4):212-7.\u003c/li\u003e\n\u003cli\u003eDereje M, Woldeamanuel Y, Asrat D, Ayenachew F. Urinary tract infection among fistula patients admitted at Hamlin fistula hospital, Addis Ababa, Ethiopia. BMC Infectious Diseases. 2017;17(1):150.\u003c/li\u003e\n\u003cli\u003eAdeoye IS, Oladeinde O, Uneke J, Adeoye J. An assessment of asymptomatic bacteriuria among women with vesico-vaginal fistula in South-Eastern Nigeria. Nepal Journal of Epidemiology. 2011;1(2):64-9.\u003c/li\u003e\n\u003cli\u003eDiMarco C, Croak A, DiMarco D, Klingele C. Urinary tract infections after gynecologic surgery. Infectious Diseases in Obstetrics and Gynecology. 2004;12(3/4):207.\u003c/li\u003e\n\u003cli\u003eR Douglas Scott I, Culler SD, Rask KJ. Understanding the economic impact of health care-associated infections: A cost perspective analysis. Journal of Infusion Nursing. 2019;42(2):61-9.\u003c/li\u003e\n\u003cli\u003eBublitz DC, Wright PC, Bodager JR, Rasambainarivo FT, Bliska JB, Gillespie TR. Epidemiology of pathogenic enterobacteria in humans, livestock, and peridomestic rodents in rural Madagascar. PloS one. 2014;9(7):e101456.\u003c/li\u003e\n\u003cli\u003eEkwedigwe K, Sunday-Adeoye I, Eliboh M, Isikhuemen M, Uro-Chukwu H, Ezeonu P, et al. Prevalence and antimicrobial susceptibility of asymptomatic bacteriuria among women with pelvic organ prolapse in Abakaliki, South-East Nigeria. BMC women\u0026apos;s health. 2018;18(1):1-5.\u003c/li\u003e\n\u003cli\u003eRupakala B, Lasune S, Prakash R, Nagarathanamma R. Postoperative Catheter induced bacteriuria in obstetrics and gynaecological cases. Int J Reprod Contracept Obstet Gynecol. 2017;6:1965-8.\u003c/li\u003e\n\u003cli\u003eSheffield JS, Cunningham FG. Urinary tract infection in women. Obstetrics \u0026amp; Gynecology. 2005;106(5 Part 1):1085-92.\u003c/li\u003e\n\u003cli\u003eSchi\u0026oslash;tz H. Urinary tract infections and bacteriuria after gynecological surgery: experience with 24-hour Foley catheterization. International Urogynecology Journal. 1994;5(6):345-8.\u003c/li\u003e\n\u003cli\u003eEl-Nashar SA, Singh R, Schmitt JJ, Leon DC, Arora C, Gebhart JB, et al. Urinary tract infection after hysterectomy for benign gynecologic conditions or pelvic reconstructive surgery. Obstetrics \u0026amp; Gynecology. 2018;132(6):1347-57.\u003c/li\u003e\n\u003cli\u003eLoeb M, Hunt D, O\u0026rsquo;Halloran K, Carusone SC, Dafoe N, Walter SD. Stop orders to reduce inappropriate urinary catheterization in hospitalized patients: a randomized controlled trial. Journal of general internal medicine. 2008;23(6):816-20.\u003c/li\u003e\n\u003cli\u003ePallett A, Hand K. Complicated urinary tract infections: practical solutions for the treatment of multiresistant Gram-negative bacteria. Journal of antimicrobial chemotherapy. 2010;65(suppl_3):iii25-iii33.\u003c/li\u003e\n\u003cli\u003eImam TH. Overview of Urinary Tract Infections (UTIs) University of Riverside School of Medicine2020 [Available from: https://www.merckmanuals.com/home/kidney-and-urinary-tract-disorders/urinary-tract-infections-utis/overview-of-urinary-tract-infections-utis.\u003c/li\u003e\n\u003cli\u003eAbayneh M, Tesfaw G, Abdissa A. Isolation of extended-spectrum \u0026beta;-lactamase-(ESBL-) producing Escherichia coli and Klebsiella pneumoniae from patients with community-onset urinary tract infections in Jimma University Specialized Hospital, Southwest Ethiopia. Canadian Journal of Infectious Diseases and Medical Microbiology. 2018;2018.\u003c/li\u003e\n\u003cli\u003eBisson G, Fishman NO, Patel JB, Edelstein PH, Lautenbach E. Extended-spectrum \u0026beta;-lactamase\u0026ndash;producing Escherichia coli and Klebsiella species: risk factors for colonization and impact of antimicrobial formulary interventions on colonization prevalence. Infection Control \u0026amp; Hospital Epidemiology. 2002;23(5):254-60.\u003c/li\u003e\n\u003cli\u003eWabe YA, Reda DY, Abreham ET, Gobene DB, Ali MM. Prevalence of Asymptomatic Bacteriuria, Associated Factors and Antimicrobial Susceptibility Profile of Bacteria Among Pregnant Women Attending Saint Paul\u0026rsquo;s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Therapeutics and clinical risk management. 2020;16:923.\u003c/li\u003e\n\u003cli\u003eDerese B, Kedir H, Teklemariam Z, Weldegebreal F, Balakrishnan S. Bacterial profile of urinary tract infection and antimicrobial susceptibility pattern among pregnant women attending at Antenatal Clinic in Dil Chora Referral Hospital, Dire Dawa, Eastern Ethiopia. Therapeutics and clinical risk management. 2016;12:251.\u003c/li\u003e\n\u003cli\u003eAlemu A, Moges F, Shiferaw Y, Tafess K, Kassu A, Anagaw B, et al. Bacterial profile and drug susceptibility pattern of urinary tract infection in pregnant women at University of Gondar Teaching Hospital, Northwest Ethiopia. BMC research notes. 2012;5(1):197.\u003c/li\u003e\n\u003cli\u003eBelete MA. Bacterial Profile and ESBL Screening of Urinary Tract Infection Among Asymptomatic and Symptomatic Pregnant Women Attending Antenatal Care of Northeastern Ethiopia Region. Infection and Drug Resistance. 2020;13:2579.\u003c/li\u003e\n\u003cli\u003eOnyango HA, Ngugi C, Maina J, Kiiru J. Urinary Tract Infection among Pregnant Women at Pumwani Maternity Hospital, Nairobi, Kenya: Bacterial Etiologic Agents, Antimicrobial Susceptibility Profiles and Associated Risk Factors. Advances in Microbiology. 2018;8(03):175.\u003c/li\u003e\n\u003cli\u003eAssefa A, Asrat D, Woldeamanuel Y, Abdella A, Melesse T. Bacterial profile and drug susceptibility pattern of urinary tract infection in pregnant women at Tikur Anbessa Specialized Hospital Addis Ababa, Ethiopia. Ethiopian medical journal. 2008;46(3):227-35.\u003c/li\u003e\n\u003cli\u003eGillespie S, Bamford K. Medical microbiology and infection at a glance: John Wiley \u0026amp; Sons; 2012.\u003c/li\u003e\n\u003cli\u003eRupp\u0026eacute; \u0026Eacute;, Woerther P-L, Barbier F. Mechanisms of antimicrobial resistance in Gram-negative bacilli. Annals of intensive care. 2015;5(1):21.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"gynecological cases, admission, uropathogenic bacteria, antibiotic resistance, multidrug resistance","lastPublishedDoi":"10.21203/rs.3.rs-2291466/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2291466/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Urinary tract infection (UTI) is one of the most common bacterial infections in women; about 50% of women get during their life time. Moreover, it is a common health problem in patients with gynecological pathologies, which increases the chance of acquiring infection. The aim of this study was to determine the bacterial profile that causes UTI and their antibiotic susceptibility pattern among admitted gynecological cases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A cross-sectional study was conducted in south west Ethiopia region. A total of 386 patients admitted with gynecological cases were included and structured questionnaire was used to collect socio-demographic and risk factor-related data. About 10ml freshly voided midstream and catheterized urine specimens were collected using sterile containers. Identification of isolate was done using culture characteristics, gram staining, and a series of biochemical tests. The data obtained were entered into EpiData Version 3.1 and analyzed using SPSS Version 25. A P-value of less than 0.05 was used as a level of significance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eIn this study, the overall prevalence of UTI was 25.4%. E. coli was the most frequently isolated bacteria, which accounted for 38(37.6%), followed by Klebsiella species 22(21.8%), CONS 14(13.9%), S. aureus 10(9.9%), Enterobacter species 6(5.9%), Citrobacter species 5(4.9%), P. mirabilis 4 (4%), and P. aeroginosa 2(2%). Histories of UTI (AOR = 1.977, 95% CI: 1.06, 3.68, P = 0.032) and catheterization (AOR = 2.38, 95% CI: 1.28, 4.45, P = 0.006) were found to be statistically associated with significant bacteriuria. Gram-negative isolates showed a high level of resistance, 88.3% for ampicillin and 66.2% for tetracycline, and a relatively low level of resistance against ceftazidime, 22.1%, and meropenem, 3.9%. Gram-positive uropathogens showed a high level of resistance to penicillin, 91.6%, whereas all isolates were sensitive 100.0% to nitrofurantoin. Furthermore, 80 (79.2%) of the isolates had multidrug resistance, and 16 (26.7%) of both E. coli and Klebsiella spp. produced Extended Spectrum β-lactamase.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eIn this study, a high prevalence of uropathogenic bacteria and multidrug resistance for commonly prescribed drugs were observed with a significant number of Extended Spectrum β-lactamase producers.\u003c/p\u003e","manuscriptTitle":"Uropathogenic bacterial profile and antibiotic susceptibility pattern of isolates among gynecological cases admitted to Jimma Medical center, South West Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-11-29 16:13:52","doi":"10.21203/rs.3.rs-2291466/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-02-15T09:00:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-01-23T15:31:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"92520988-22a7-4e6e-8038-895ba1730cfe","date":"2023-01-16T11:44:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-01-13T09:11:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"ba4a1b62-384f-423a-a027-6bb4b5604043","date":"2023-01-13T06:20:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-11-24T08:15:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-11-24T08:13:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2022-11-23T10:02:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-11-23T09:58:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2022-11-19T13:50:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cd144f5a-8acc-4c7f-8ae2-1ea294269d93","owner":[],"postedDate":"November 29th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":17185168,"name":"Biological sciences/Microbiology"},{"id":17185169,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2023-10-16T20:51:43+00:00","versionOfRecord":{"articleIdentity":"rs-2291466","link":"https://doi.org/10.1038/s41598-023-34048-4","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2023-05-01 20:40:50","publishedOnDateReadable":"May 1st, 2023"},"versionCreatedAt":"2022-11-29 16:13:52","video":"","vorDoi":"10.1038/s41598-023-34048-4","vorDoiUrl":"https://doi.org/10.1038/s41598-023-34048-4","workflowStages":[]},"version":"v1","identity":"rs-2291466","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2291466","identity":"rs-2291466","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}