Evaluation of sampling locations in pregnant women and newborns for the detection of colonisation with antibiotic-resistant bacteria

Abstract

Up to now, little has been known about the prevalence and clinical relevance of colonisation of asymptomatic pregnant women with methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA) or extended-spectrum β-lactamase (ESBL)-producing Escherichia coli. In this two-centre cross-sectional study, we evaluated the performance and importance of screening at different times and different locations for colonisation in pregnant women and newborns. Between October 2013 and December 2015, four samples were collected from pregnant women, two from newborns at birth and three from 3-day-old newborns. Samples were screened on culturing media and were confirmed with molecular methods. MSSA was used as a surrogate for MRSA, as the two share most microbiologic characteristics and colonisation patterns. Of 763 pregnant women, 14.5% (111) were colonised with MSSA, 0.4% (3) with MRSA and 2.6% (20) with ESBL-producing E. coli. Of 658 newborns, 0.9% (10) were colonised with MSSA at birth and 13.1% (70) at 3 days old, 0.5% (3) were colonised with MRSA and 2.6% (17) with ESBL-producing E. coli. Nasal sampling identified 91.0% of MSSA-colonised pregnant women and 60.0% of newborns. In newborns, nasal and umbilical sampling at 3 days after birth discovered 84.0% of colonised cases. For ESBL-producing E. coli, the perianal region was positive in all colonised pregnant women and in 88.2% of colonised newborns. Combining nasal and perianal swabs is optimal when screening for antibiotic-resistant bacteria in pregnant women. Nasal, perianal and umbilical sample collection from 3-day-old newborns significantly increased the sensitivity compared to screening immediately after birth.

Screening for antimicrobial-resistant Gram-negative bacteria in hospitalised patients, and risk of progression from colonisation to infection: Systematic review

“…Screening was performed at hospital admission in 35 studies 13,14,17,21,24,25,27,30,41,44,48,50,51,54,[60][61][62][63]66,69,70,[74][75][76][78][79][80][81][82][83]90 and at admission and repeatedly in 40 studies 16,[18][19][20]22,23,26,28,[32][33][34][35][36][38][39][40]43,[45][46][47]49,52,…”

“…Screening of all admitted patients was conducted either at the time of arrival to hospital (n=6; 8%) 19,44,63,74,78,82 or at admission to a specific ward (n=45; 60%) 13,14,16,17,20,21,[23][24][25][26]28,[32][33][34]36,[38][39][40]43,[45][46][47][51][52][53]55,[57][58][59][60]62,64,67,[69][70][71][72][75][76][77]80,81,86,90 . High-risk patients-based screening (n=24 studies, 32%) targeted patients with defined clinical conditions (mostly oncologic patients) (9, 37%) 22,…”

Uma revisão descritiva sobre o perfil de resistência de Staphylococcus spp. em gestantes e uso de extratos de plantas medicinais como perspectiva terapêutica

“…Os autores sugerem que haja um acompanhamento dos recémnascidos, pois pode haver uma infecção transplacentária, pela qual o feto se torna infectado é a hematogênica transplacentária (Chen et al, 2006;Andrews et al, 2008). Zamfir et al (2017) realizaram um estudo transversal em dois centros médicos situados na região da Baviera, Alemanha, durante um período de dois anos, entre outubro de 2013 e dezembro de 2015 e coletaram quatro amostras de gestantes maiores de 18 anos, com parto vaginal planejado, duas de recém-nascidos ao nascer e três de recém-nascidos com três dias de idade. De 763 mulheres grávidas, 0,4% foram colonizadas por MRSA e de 658 recém-nascidos, 0,5% foram colonizados por MRSA.…”

Vertical transmission of methicillin-resistant Staphylococcus aureus at delivery and its clinical impact: an observational, prospective cohort study

“…Although MRSA can be detected in various sites, they are commonly detected in the nares 9,10 . In addition, we were interested in how often MRSA can be detected in the vagina.…”

“…Therefore, we screened for maternal MRSA colonization using nasal and vaginal samples in our study. For neonates, we used nasal and umbilical samples for screening, as these sites had the highest detection efficiency according to the previous reports 9,10 .…”