Abstract
<title>Abstract</title> <p> <bold>Background:</bold> In regions affected by conflict, the rapid escalation of antimicrobial resistance (AMR) presents a significant public health challenge. This study aims to investigate the evolving microbiological landscape and the patterns of antibiotic sensitivity related to urogenital infections among pregnant women residing in Maiduguri, Borno State, an area severely impacted by ongoing instability. <bold>Methods:</bold> A comparative cross-sectional study was conducted, analyzing 300 clinical specimens, including urine and vaginal swabs, obtained from three maternal health centers over the years 2024 and 2025. Pathogen identification was executed using standardized microbiological techniques, while antimicrobial susceptibility was evaluated through phenotypic disc diffusion methods. Statistical significance was determined utilizing 95% confidence intervals (CI) and p-values. <bold>Results:</bold> A notable taxonomic shift was observed, with the prevalence of <italic>Escherichia coli</italic> ( <italic>E. coli</italic> ) <italic/> increasing significantly from 2.3% (95% CI: 0.3–8.1) in 2024 to 51.3% (95% CI: 42.1–60.6) in 2025 (p < 0.001). The third trimester exhibited the highest clinical risk, accounting for 54.3% of all isolates. Additionally, a significant “Urogenital Reservoir” was identified, with 64% of women showing concurrent colonization of urinary <italic>Staphylococcus aureus</italic> and vaginal <italic>Candida albicans</italic> . Antimicrobial sensitivity revealed a drastic decline: the effectiveness of Amoxicillin fell to 0.0%, while that of Ciprofloxacin decreased to 16.7%. Alarmingly, community-acquired Colistin resistance reached 72.2% among coliforms, whereas only Gentamicin demonstrated a 100% sensitivity rate. <bold>Conclusion:</bold> The maternal healthcare environment in Northeast Nigeria has effectively transitioned into a localized post-antibiotic era. The rapid emergence of multidrug-resistant strains of <italic>Escherichia coli</italic> , coupled with the rise of high-level Colistin resistance within the community, necessitates an urgent reassessment of empirical treatment protocols. This study advocates for the adoption of "salvage therapy" approaches and recommends the implementation of mandatory dual urogenital screening for late-term pregnancies to mitigate the increasing risks of maternal and neonatal sepsis. </p>