Maternal vaginal colonization with selected potential pathogens of neonatal sepsis in the era of antimicrobial resistance, a single center experience from Sri Lanka

Abstract

BackgroundMaternal vaginal colonization with antibiotic resistant organisms is a growing concern in countries with high antibiotic resistance rates.MethodsA low vaginal swab was collected from mothers on admission, on discharge and a peri-rectal swab was collected from the neonates born to these mothers on discharge. Routine microbiological methods were used to identify the colonization rates for Escherichia coli, Klebsiella spp. and Streptococcus agalactiae.ResultsThe pre-delivery colonization rate among the 250 participants for total Enterobacteriaceae was 18.8%. The colonization rates for Klebsiella spp., E. coli and S. agalactiae were, 12.4, 5.6 and 14.8% respectively. Two Klebsiella spp. and two E. coli isolates were confirmed to be exentend spectrum β lactamase (ESBL) producers with the commonest resistant determinant being blaCTX-M. Post-delivery swabs were collected from 130 participants and the colonization rates were 41.5% for Enterobacteriaceae, 25.4% for Klebsiella spp., 10.8% for E. coli, and 10.8% for S. agalacteiae. Three Klebsiella isolates and one E. coli isolate were confirmed to be ESBL producers with the commonest resistant determinant being blaCTX-M. Considering the 130 participants with both samples, there was a significant increase in the colonization with any Enterobacteriaceae and Klebsiella spp. (p < 0.05). Peri-rectal swabs were collected from neonates in 159 instances. The isolation rates for Enterobacteriaceae was 34%. The genus specific isolation rate for Klebsiella was 21.4% while the rates for E. coli and S.agalactiae were 10.1 and 5.7% respectively. Two of the E. coli were confirmed to be ESBL producers while none of the klebsiellae were identified to be so. Considering these 159 instances where both the mother and baby were sampled, random amplification of polymorphic DNA (RAPD) analysis revealed that Enterbacteriaceae with same strain type was present in 6.9% of the instances, indicating possible transfer between the mother and neonate. The transfer rate for ESBL producers were 0.6%.ConclusionsThe lower level of antimicrobial resistance among these potentially community acquired isolates is encouraging. However, in view of the increasing level of resistance reported elsewhere in the region, regular monitoring is warranted.

Colonization with selected antibiotic resistant bacteria among a cohort of Sri Lankan university students

“…Another study done among children attending pre-school childcare facilities in Laos has identified 23.2% of the study population to be colonised with ESBL producers [ 25 ]. The rate of colonization we found in the current study is much higher than the rate of vaginal colonization found among pregnant females presenting for delivery at Teaching Hospital Peradeniya [ 26 ]. The differences in sampling sites and study cohorts may be possible reasons for this difference.…”

The Vaginal Microbiota Composition and Genital Infections during and after Pregnancy among Women in Pemba Island, Tanzania

“…The prevalence of GBS observed in this study (6.8% at <20 weeks GA, 10% at the ≥20 weeks GA timepoint in pregnancy, and 27% post-delivery) are in line with the pooled prevalence of a recent meta-analysis report on the prevalence of GBS in pregnant and post-delivery women in Tanzania (16.14%; 95% CI 2.9, 29.4) [ 87 ]. It should be noted that about 1 in 100 infants born from mothers carrying GBS develop invasive GBS infection disease in studies performed on other populations [ 88 , 89 ]. Thus, as evidence on the involvement of pathobionts in maternal and new-born health, and their possible vertical transmission, it is essential to further investigate the association between abundance of GBS, and other pathobionts, and perinatal health.…”

“…Thus, as evidence on the involvement of pathobionts in maternal and new-born health, and their possible vertical transmission, it is essential to further investigate the association between abundance of GBS, and other pathobionts, and perinatal health. It is even more so, now that some of these pathobionts strains, like Klebsiella and E. coli , are becoming increasingly resistance to a broad range of antibiotics [ 81 , 89 ].…”

Early Acquisition and Carriage of Genetically Diverse Multi-Drug Resistant Gram-Negative Bacilli in Hospitalised Small Vulnerable Newborns in the Gambia

“…Dissemination of ESBL-GNB in African communities is widespread, with outpatient cross-sectional studies indicating 32.6% carrier prevalence for children in Guinea-Bissau [48], 21.1% prevalence for children in Madagascar [52] and 63.3% carriage prevalence in adults and children in Egypt [53]. Maternal acquisition of GNB temporally related to hospital admission has also been described with rectovaginal carriage prevalence increasing from 18.8% pre-delivery to 41.5% at time of postnatal ward discharge in Sri Lanka [54].…”