• Feizollah Mansouri, Hossein Sheibani, Mojgan Javedani Masroor, and Mandana Afsharian.
• Infectious Diseases Department, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
• Int. J. Clin. Pract. 2019 Sep 18: e13422e13422.

BackgroundUrinary tract infections (UTI) and asymptomatic bacteriuria (AB) during pregnancy can result in considerable maternal and foetal adverse outcomes. Production of extended-spectrum beta-lactamase (ESBL) is a major antibiotic resistance mechanism by Enterobacteriaceae.ObjectivesTo determine the global prevalence of ESBL-producing (ESBL-P) Enterobacteriaceae in symptomatic UTI/AB among pregnant/postpartum females.Data SourcesA systematic review of the PubMed, Embase, Scopus, WOS (Web of Science), ProQuest and the grey literature was conducted.Study Selection And Data ExtractionStudies that reported the frequency of ESBL-P Enterobacteriaceae in pregnant/postpartum women with UTI and/or AB were eligible. First, the titles and abstracts of the retrieved articles were reviewed. Then, the full texts of the remained articles were reviewed.SynthesisIn order to estimate the pooled prevalence and the 95% confidence interval (95% CI), meta-analysis was performed using the random-effects model.ResultsTwenty-three studies (six from Africa, two from North America, one from South America, 12 from Asia and two European studies) that reported data on 20 033 Enterobacteriaceae strains were included. The pooled prevalence of ESBL-P Enterobacteriaceae was 25% (95% CI 18%, 32%); I2  = 98.8%. The estimated prevalence (95% CI) rates were 45% (22, 67%) in Africa, 33% (22, 44%) in India, 15% (6, 24%) in other Asian countries, 5% (2, 8%) in Europe, 4% (1, 11%) in South America and 3% (1, 5%) in North America (P < .001). This estimate was 21% (95% CI 11, 31%) in patients with symptomatic UTI and it was 28% (95% CI 15, 41%) in patients with AB (P = .40).ConclusionsThe prevalence of ESBL-P Enterobacteriaceae among pregnant women with UTI/AB was significant and geographic region was a major source for heterogeneity. The findings could be taken into account by healthcare providers and programmers in the management and antibiotic selection of UTI/AB during pregnancy, especially in high prevalence areas.© 2019 John Wiley & Sons Ltd.

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