الفهرس 
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Abstract
The present study showed a high occurrence of Asymptomatic bacteriuria in pregnant women (33.3 %). Most pregnant women with ASB in our study were of low socioeconomic status and low educational level.
ASB is one of the most common bacterial infection requiring medical treatment in pregnancy as it is associated with both fetal and maternal complications. The routine obstetrical checkup in Egypt is still devoid of urine culture and susceptibility testing. Unless this is made mandatory, a positive outcome in pregnancy cannot be satisfactory.
The high prevalence of ASB in this study may justify the use of urine culture as a diagnostic tool, especially in high-risk ANC. Among the screening tests evaluated, Gram’s staining of uncentrifuged urine and using both nitrite test and leucocyte esterase test were the best, the. The dipstick test with both the parameters had the advantage of being simple, rapid, not requiring any expertise. Therefore, dipstick may be used as an office diagnostic test to screen ASB among pregnant women in very low resources primary health care centers and reserve routine culture only for those screened positive. Further studies on cheap and rapid tests will have to be developed and evaluated.
The most commonly reported etiologic agent of bacteriuria was E. coli. Antimicrobial susceptibility revealed that Imipenem and Amikacin were the most active antibacterial agent 100%.
ESBLs are beta-lactamases that are able to hydrolyze the extended-spectrum cephalosporin and monobactam antibiotics. Cephalosporins are one of the drugs of choice for the treatment of asymptomatic bacteriuria and urinary tract infection caused by E. coli during pregnancy. In the current study, 31.7% of Gram negative bacilli were identified as ESBL producers and the frequency of ESBL among E. coli were 37.7%, Genotypic characterization of ESBL producing isolates showed that 84.6% had CTX-M (CTX-M-15=77.3%; CTX-M-9=18.2%), 7.7% OXA and 3.8% both CTX-M and OXA-type ESBLs, while none were of TEM or SHV type.
The high prevalence of resistance `reported in this study, particularly for extended spectrum cephalosporins antibiotics is suggested to be due to the intrinsic capacity of CTX-M–encoding genes to disseminate through the community where hygiene and living conditions are poor and antimicrobial drug consumption is uncontrolled, especially broad-spectrum types. The most common bla gene detected was CTX-M-15-type ESBL. expressing co-resistance to other classes of antibiotics. This emphasizes the necessity for early detection of ESBL-producing isolates using a rapid and a simple method as chromogenic media.
Phylogenetic analysis in this study indicated a predominance of B2 phylotype in the ESBL producing E. coli isolates associated with ASB.
To our knowledge, this is the first study to report O16-ST131 as the predominant type of clonal group in ST131 among CTX-M-producing E. coli in ASB. Our findings indicate that future studies should focus more on O16-ST131 isolates, especially in Egypt.