Antibiotic resistance genes in the gut microbiota of mothers and linked neonates with or without sepsis from low- and middle-income countries

Abstract

Early development of the microbiome has been shown to affect general health and physical development of the infant and, although some studies have been undertaken in high-income countries, there are few studies from low- and middle-income countries. As part of the BARNARDS study, we examined the rectal microbiota of 2,931 neonates (term used up to 60 d) with clinical signs of sepsis and of 15,217 mothers screening for blaCTX-M-15, blaNDM, blaKPC and blaOXA-48-like genes, which were detected in 56.1%, 18.5%, 0% and 4.1% of neonates’ rectal swabs and 47.1%, 4.6%, 0% and 1.6% of mothers’ rectal swabs, respectively. Carbapenemase-positive bacteria were identified by MALDI-TOF MS and showed a high diversity of bacterial species (57 distinct species/genera) which exhibited resistance to most of the antibiotics tested. Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae/E. cloacae complex, the most commonly found isolates, were subjected to whole-genome sequencing analysis and revealed close relationships between isolates from different samples, suggesting transmission of bacteria between neonates, and between neonates and mothers. Associations between the carriage of antimicrobial resistance genes (ARGs) and healthcare/environmental factors were identified, and the presence of ARGs was a predictor of neonatal sepsis and adverse birth outcomes.

Detection of maternal transmission of resistant Gram-negative bacteria in a Cambodian hospital setting

“…Maternal transmission has been implicated in ESBL-E acquisition by neonates by looking at prevalence [10], or by using matched antimicrobial resistance phenotypes [11], pulsed-field gel electrophoresis [12], repetitive element PCR typing [13] to compare strains between mother and infant. Most recently, the BARNARDS study identified identical isolates between mother and infant in E. coli using whole-genome sequencing, suggesting mother-to-child transmission in a large south Asian and African dataset [14].…”

The Tragedy of Neonatal Sepsis in South Asia

“…Nigeria, Pakistan, Ethiopia, and the Democratic Republic of Congo collectively account for almost 50% of neonatal deaths worldwide (WHO, 2022). There is concern that this will increase to 20 million deaths yearly by 2050 (Carvalho et al, 2022).…”

“…Some experts are worried there is a relationship between these infections and overuse of antibiotics around the world. Antibiotic resistance has been identified in mothers and neonates within hours of birth (Carvalho et al, 2022). Is sepsis related to scarce resources in low- and medium-income countries that can be used to adequately diagnose and treat newborn sepsis?…”

“…Mechanisms for maternal or neonate transfer of infection is very complex. Carvalho et al (2022) believe that infection is colonized in newborns during birth or shortly thereafter, either by maternal contact or through the environment in the birthing facility. One hypoth-esis is the transition from birthing sites to home may be inadequate.…”

“…The Oxford University BAR-NARDS team has been working for nearly a decade to make a difference in increasing the evidence on what we currently know about neonatal sepsis in low-to middle-income countries. They have founded 12 clinical sites in Bangladesh, Ethiopia, India, Nigeria, Pakistan, Rwanda, and South America (Carvalho et al, 2022) It is important for maternity and neonatal nurses to be aware of common causes of infant morbidity and mortality in low-to middle-income countries around the world as nurses are increasingly caring for families who have immigrated to the United States and who may have concerns about the health of their baby based on experiences with childbirth in their home country. ✜ Lynn Clark Callister is a Professor Emerita, College of Nursing, Brigham Young University, Provo, UT.…”