Neonatal outcomes associated with maternal recto-vaginal colonization with extended-spectrum β-lactamase producing Enterobacteriaceae in Nigeria: a prospective, cross-sectional study

Abstract

Objectives: The objective of this study was to assess the prevalence of maternal recto-vaginal extendedspectrum b-lactamase producing Enterobacteriacea (ESBL-E) colonization, identify risk factors for maternal and neonatal ESBL-E colonization, and subsequent impact on neonatal mortality. Methods: A prospective, cross-sectional study was conducted at the University of Abuja Teaching Hospital from April 2016 to May 2017. Maternaleneonatal pairs were screened for ESBL-E exposure at time of delivery. Neonatal mortality was assessed at 28 days. Results: A total of 1161 singleton deliveries were evaluated. In total, 9.7% (113/1161) of mothers and 4.3% (50/1161) of infants had ESBL-E-positive cultures at delivery. Maternal antibiotic exposure was associated with ESBL-E recto-vaginal colonization (18.6% (21/113) vs. 8.4% (88/1048), p < 0.001)). Maternal ESBL-E colonization (adjusted odds ratio (AOR) 14.85; 95% CI 7.83e28.15) and vaginal delivery (AOR 6.35; 95% CI 2.63e17.1) were identified as a risk factor for positive ESBL-E neonatal surface cultures. Neonatal positive ESBL-E surface cultures were a risk factor for neonatal mortality (stillbirths included, AOR 4.84; 95% CI 1.44e16.31). The finding that maternal ESBL-E recto-vaginal colonization appeared protective in regards to neonatal mortality (AOR 0.22; 95% CI .06e0.75) requires further evaluation. Conclusions: Maternal ESBL-E recto-vaginal colonization is an independent risk factor for neonatal ESBL-E colonization and neonates with positive ESBL-E surface cultures were identified as having increased risk of neonatal mortality.

Risk Factors of Initial Inappropriate Antibiotic Therapy and the Impacts on Outcomes of Neonates with Gram-Negative Bacteremia

“…Because colonization of the newborns with MDR Gram-negative pathogens makes them the potential source of nosocomial outbreaks [8,40], further routine surveillance of colonization is also suggested.…”

“…Early-onset sepsis and late-onset sepsis were defined as clinical sepsis combined with bacterial growth on a blood culture obtained within the first 72 h of life and > 72 h of life, respectively [5,8]. A bacteremia was classified as community-acquired in this study if the neonate had been discharged from NICU or baby room for at least two days, and the first positive blood culture occurred ≤ 48 h after hospital admission.…”

“…Although coagulase-negative staphylococci remains the most common pathogen of neonatal bacteremia, there is an increasing trend of Gram-negative bacteremia (GNB) in the NICU [3,4], especially after long duration of hospitalization, gram-negative bacteria colonization, or underlying gastrointestinal pathology [5][6][7]. The emergence of antibiotic resistance among GNB is a great concern, because the use of broad-spectrum antibiotics for antibiotic resistant GNB may cause a vicious cycle [8][9][10]. The condition may become especially critical when severe GNB, defined as a fulminant and rapidly devastating sepsis, is encountered.…”

Maternal colonization with extended‐spectrum β‐lactamase‐producing Enterobacteriaceae in term versus preterm pregnancies

“…12,13 Neonatal positive ESBL-E surface cultures were recently identified as a risk factor for neonatal mortality. 22 The single neonatal death recorded in our cohort was related to early ESBL-E neonatal sepsis, which was initially treated with inadequate empirical antibiotics. Elsewhere, a neonatal ESBL-E infection rate of 5.6% was demonstrated among colonized neonates after maternal-neonatal transmission; the mortality rate in preterm infants was 50%.…”

Reporting of systematic reviews and meta-analysis of observational studies

“…These include rare cases of treatment that cannot be examined in a RCT (e.g. appropriate vs. inappropriate empirical antibiotic treatment) [ 1 , 2 ], complex interventions that are difficult to examine in RCTs (e.g. infection control or antibiotic stewardship) [ 3 , 4 ], comparative effective research and quality improvement programmes (comparisons between commonly used, approved, antibiotics, monotherapy vs. combinations or treatment durations) for which resources for RCTs are lacking [ [5] , [6] , [7] , [8] , [9] , [10] ], or studies rapidly launched during outbreaks, such as the coronavirus disease 2019 (COVID-19) pandemic [ [11] , [12] , [13] ].…”