Extended-spectrum β-lactamase-producing Enterobacteriaceae among pregnant women in Norway: prevalence and maternal–neonatal transmission

Rettedal, Siren; Löhr, Iren Høyland; Bernhoff, Eva; Natås, Olav B.; Sundsfjord, Arnfinn; Øymar, Knut

doi:10.1038/jp.2015.82

Cited by 60 publications

(54 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two Norwegian studies report on faecal carriage rates of AMR bacteria. Rettedal et al found that 2.9% and 0.3% of healthy pregnant women were colonised by ESBL-producing or AmpC-producing E. coli , respectively [22], whereas Jørgensen et al observed an overall ESBL carriage rate of 15.8% in patients with diarrhoea, ranging from 10.3% in patients with no recent travel history to 56.3% in patients with a history of recent travel to Asia [23]. …”

Section: Introductionmentioning

confidence: 99%

Carriage of ESBL/AmpC-producing or ciprofloxacin non-susceptible Escherichia coli and Klebsiella spp. in healthy people in Norway

Ulstad

Solheim

Berg

et al. 2016

Antimicrob Resist Infect Control

View full text Add to dashboard Cite

BackgroundAsymptomatic carriage has been recognised as an important risk factor for infection caused by antibiotic resistant bacteria. A 14% global prevalence of Extended-Spectrum Beta-lactamase (ESBL) carriage was recently reported, but large intra-and interregional variations were observed. We investigated the faecal carriage rates of ESBL-, AmpC-producing and ciprofloxacin non-susceptible Escherichia coli and Klebsiella spp. in healthy Norwegians.MethodsRectal samples were obtained from 284 volunteers, together with demographic data and information on recent travel history. The rectal samples were screened by selective plating and E. coli and Klebsiella spp. identified using MALDI-TOF. Phenotypic and molecular characterization of resistant isolates was also performed.ResultsESBL- or AmpC-producing E. coli and Klebsiella spp. were isolated from 4.9% and 3.2% of the study population, respectively. Carriage of ciprofloxacin non-susceptible isolates was detected in 9.9% of the volunteers. Molecular typing of ESBL/plasmid-mediated AmpC (pAmpC)-producing isolates suggested an allodemic situation rather than the dissemination of a specific clone in the Norwegian community. In concurrence with previous findings, travel to South-East Asia was associated with increased risk of carrying resistant E. coli or Klebsiella spp., highlighting the contribution of factors such as increased global mobility in erasing the boundaries between healthcare and community settings when it comes to spread of resistant bacteria.ConclusionsOverall, our study recognised Norway as a low-incidence country for faecal carriage of resistant bacteria among healthy individuals. Furthermore, our work denoted the importance of healthy humans as a reservoir for transmission of antibiotic resistant E. coli and Klebsiella spp.Electronic supplementary materialThe online version of this article (doi:10.1186/s13756-016-0156-x) contains supplementary material, which is available to authorized users.

show abstract

Section: Introductionmentioning

confidence: 99%

Carriage of ESBL/AmpC-producing or ciprofloxacin non-susceptible Escherichia coli and Klebsiella spp. in healthy people in Norway

Ulstad

Solheim

Berg

et al. 2016

Antimicrob Resist Infect Control

View full text Add to dashboard Cite

show abstract

“…As a consequence of this outbreak, our current practice (similar to an approach being adopted as prudent in Norway [31]) is that all pregnant women presenting at their first antenatal appointment have ESBL screening performed via a urine sample, albeit resulting perhaps in the screening of inappropriately large numbers of healthy young women with a recognised low positive predictive value.…”

Section: Discussionmentioning

confidence: 99%

The first occurrence of a CTX-M ESBL-producing Escherichia coli outbreak mediated by mother to neonate transmission in an Irish neonatal intensive care unit

et al. 2017

View full text Add to dashboard Cite

Background Escherichia coli (E. coli) comprise part of the normal vaginal microflora. Transfer from mother to neonate can occur during delivery resulting, sometimes, in neonatal bacterial disease. Here, we aim to report the first outbreak of CTX-M ESBL-producing E. coli with evidence of mother-to-neonate transmission in an Irish neonatal intensive care unit (NICU) followed by patient-to-patient transmission.MethodsInvestigation including molecular typing was conducted. Infection was defined by clinical and laboratory criteria and requirement for antimicrobial therapy with or without positive blood cultures. Colonisation was determined by isolation without relevant symptoms or indicators of infection.ResultsIndex case was an 8-day-old baby born at 34 weeks gestation who developed ESBL-producing E. coli infections at multiple body sites. Screening confirmed their mother as colonised with ESBL-producing E. coli. Five other neonates, in the NICU simultaneously with the index case, also tested positive. Of these, four were colonised while one neonate developed sepsis, requiring antimicrobial therapy. The second infected neonate’s mother was also colonised by ESBL-producing E. coli. Isolates from all eight positive patients (6 neonates, 2 mothers) were compared using pulsed-field gel electrophoresis (PFGE). Two distinct ESBL-producing strains were implicated, with evidence of transmission between mothers and neonates for both strains. All isolates were confirmed as CTX-M ESBL-producers. There were no deaths associated with the outbreak.ConclusionsResources were directed towards control interventions focused on hand hygiene and antimicrobial stewardship, which ultimately proved successful. Since this incident, all neonates admitted to the NICU have been screened for ESBL-producers and expectant mothers are screened at their first antenatal appointment. To date, there have been no further outbreaks.

show abstract

“…As a result, frequent and consistent evaluation and study of the prevalence, etiologic agents, and predisposing factors of UTI during pregnancy is necessary in developing countries like Somaliland in order to reduce its devastating effects during pregnancy on both maternal and fetal health [2]. In many parts of Somaliland antimicrobials have been widely used irrationally.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, knowing the type of the isolates and the magnitude of drug resistance is critically important as the changing rate of antibiotic resistance has a large impact on the empirical therapy of UTI in pregnant women [2].…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial Resistance and Extended Spectrum Beta-Lactamase Profile of Uropathogens Among Pregnant Women Attending Antenatal Care at Edna Adan Hospital, Hargeisa, Somaliland

Mohamoud¹,

Tadesse

Derbie

2020

Preprint

View full text Add to dashboard Cite

Background The emergence and spread of antimicrobial resistance (AMR) among uropathogens is increasing, especially in resource limited settings due to a number of reasons. The emergence of drug resistance and particularly the production of Extended Spectrum β-Lactamase (ESBL) by some strains of E. coli and methicillin resistance of Staphylococcus species, limits the choice of antimicrobials in the treatment of urinary tract infection (UTI). However, little is known about the bacteriology of UTI among pregnant women in Hargeisa, SomalilandMethods A cross-sectional study was conducted in the period of 1 Feb to 30 May 2019 among pregnant women at Edna Adan Hospital (EAH), Hargeisa. Following the standard procedure, clean-catch mid-stream urine samples were collected and processed for bacteriological culture. A urine sample was considered positive for significant bacteriuria (SBU) when a single organism was cultured at a concentration of ≥ 105 Colony Forming Units/ml. Antimicrobial sensitivity testing (AST) was done using Kirby-Bauer disc diffusion technique. Ceftazidime (30 µg) and Cefotaxime (30 µg) disks were used for ESBL screening as per CLSI guideline and each ESBL screening positive isolate were phenotypically confirmed by a combination disk test.Results Among 376 study participants, 79 (21.0%) had SBU. Majority at 58(73.4%) of the isolates were Gram-negative. The most predominant isolate was E.coli at 36(45.6%) followed by K. pneumonea 16(20.3%) and S. aureus at 9(11.4%). The proportion of ESBL producing isolates was at 25(32.9%). Gram-negative bacteria showed high level resistance to ampicillin, amoxicillin, cefotaxime, and cephalexin at 87%, 85%, 57%, and 52%, respectively. Previous history of UTI, monthly income, educational status and having dysuria were significantly associated with SBU (p < 0.05).Conclusions Most of the isolates were found resistant to the commonly prescribed antimicrobial drugs. Therefore, actions to minimize AMR should be in place to reduce the impact of urinary tract infections among pregnant women. Future large scale study is warranted to find out bacteriological and other factors associated with ESBL producing uropathogenes.

show abstract

Extended-spectrum β-lactamase-producing Enterobacteriaceae among pregnant women in Norway: prevalence and maternal–neonatal transmission

Abstract: The prevalence of ESBL-E carriage among pregnant women was low in our region, but the high maternal-neonatal transmission rate suggests that colonized mothers represent a substantial risk for infant colonization.

Cited by 60 publications

References 41 publications

Carriage of ESBL/AmpC-producing or ciprofloxacin non-susceptible Escherichia coli and Klebsiella spp. in healthy people in Norway

Carriage of ESBL/AmpC-producing or ciprofloxacin non-susceptible Escherichia coli and Klebsiella spp. in healthy people in Norway

The first occurrence of a CTX-M ESBL-producing Escherichia coli outbreak mediated by mother to neonate transmission in an Irish neonatal intensive care unit

Antimicrobial Resistance and Extended Spectrum Beta-Lactamase Profile of Uropathogens Among Pregnant Women Attending Antenatal Care at Edna Adan Hospital, Hargeisa, Somaliland

Contact Info

Product

Resources

About