Acquisition of extended spectrum beta-lactamase-producing enterobacteriaceae in neonates: A community based cohort in Madagascar

Abstract

In low and middle income countries (LMICs), where the burden of neonatal sepsis is the highest, the spread of extended spectrum beta-lactamase-producing enterobacteriaceae (ESBL-PE) in the community, potentially contributing to the neonatal mortality, is a public health concern. Data regarding the acquisition of ESBL-PE during the neonatal period are scarce. The routes of transmission are not well defined and particularly the possible key role played by pregnant women. This study aimed to understand the neonatal acquisition of ESBL-PE in the community in Madagascar. The study was conducted in urban and semi-rural areas. Newborns were included at birth and followed-up during their first month of life. Maternal stool samples at delivery and six stool samples in each infant were collected to screen for ESBL-PE. A Cox proportional hazards model was performed to identify factors associated with the first ESBL-PE acquisition. The incidence rate of ESBL-PE acquisition was 10.4 cases/1000 newborn-days [95% CI: 8.0–13.4 cases per 1000 newborn-days]. Of the 83 ESBL-PE isolates identified, Escherichia coli was the most frequent species (n = 28, 34.1%), followed by Klebsiella pneumoniae (n = 20, 24.4%). Cox multivariate analysis showed that independent risk factors for ESBL-PE acquisition were low birth weight (adjusted Hazard-ratio (aHR) = 2.7, 95% CI [1.2; 5.9]), cesarean-section, (aHR = 3.4, 95% CI [1.7; 7.1]) and maternal use of antibiotics at delivery (aHR = 2.2, 95% CI [1.1; 4.5]). Our results confirm that mothers play a significant role in the neonatal acquisition of ESBL-PE. In LMICs, public health interventions during pregnancy should be reinforced to avoid unnecessary caesarean section, unnecessary antibiotic use at delivery and low birth weight newborns.

Carriage and Acquisition of Extended-spectrum β-Lactamase–producing Enterobacterales Among Neonates Admitted to Hospital in Kilifi, Kenya

“…In Cambodia, young hospital-born infants were found to be at a greater risk of early colonization by third-generation cephalosporin-resistant gram-negative rods compared to infants born at home, a health center, or other locations and subsequently admitted to hospital [20]. In Madagascar, Herindrainy et al reported that low birth weight, cesarean delivery, and use of antibiotics by mothers at delivery were independently associated with neonatal acquisition of ESBL-E during the first month of life [21].…”

Transmission Routes of Extended-Spectrum Beta-Lactamase–Producing Enterobacteriaceae in a Neonatology Ward in Madagascar

“…In case of C-section for example, the newborn is not exposed to maternal microbiota that may confer protection against ESBL colonization. 37,38 In addition, delivery in a potentially septic context (maternal fever, prolonged rupture of membranes etc.) has been shown to increase infant ESBL colonization risk, consistent with potential vertical transmission from mother to child.…”

Prevalencia de β-lactamasas de espectro extendido en enterobacterias causantes de sepsis neonatal y factores asociados

“…Herindrainy P. y cols. 24 , reportaron que el uso de antimicrobianos durante el embarazo favorece la infección neonatal por enterobacterias maternas productoras de BLEE (HR 2,2; IC 95% 1,1-4,5).…”

“…Herindrainy P y cols. 24 , detectaron colonización intestinal por EP-BLEE en 19,6% de las madres, mientras que Strenger V y cols. 28 , la identificaron en 18,4%.…”