Colonization of Extended-Spectrum-β-Lactamase- and NDM-1-Producing Enterobacteriaceae among Pregnant Women in the Community in a Low-Income Country: a Potential Reservoir for Transmission of Multiresistant Enterobacteriaceae to Neonates

Abstract

The spread of extended-spectrum-␤-lactamase-producing Enterobacteriaceae (ESBL-PE) in low-income countries, where the burden of neonatal sepsis is high, may have a serious impact on neonatal mortality rates. Given the potential for mother-to-child transmission of multiresistant bacteria, this study investigated the ESBL-PE rectal colonization among pregnant women at delivery in the community in Madagascar and estimated a prevalence of 18.5% (95% confidence interval, 14.5% to 22.6%). One strain of Klebsiella pneumoniae isolated was also a New Delhi metallo-␤-lactamase-1 (NDM-1) producer. Severe bacterial infections are responsible for a large number of neonatal deaths in low-income countries (LICs) (1, 2), with Enterobacteriaceae most frequently isolated in neonatal sepsis (3,4). The production of plasmid-borne extended-spectrum ␤-lactamases (ESBL) is the main mechanism of resistance against expanded-spectrum cephalosporins (ESC) among Enterobacteriaceae, with the CTX-M-15 variant being the most common enzyme (5). In LICs, where neonatal sepsis caused by ESBL-producing Enterobacteriaceae (ESBL-PE) may be associated with higher fatality rates (6), colonized mothers could represent a source of transmission to neonates. The objectives of this study were to estimate the prevalence of ESBL-PE rectal colonization among pregnant women in Madagascar in an urban area, Antananarivo, and a semirural area, Moramanga, and to identify associated risk factors.This study was conducted in the context of an international pediatric cohort, the BIRDY (bacterial infections and antibiotic resistance disease among young children in low-income countries) program, approved by the Ethics Committees of Ministry of Health, Madagascar, and Institut Pasteur, France. All pregnant women living in the study areas were identified by medical or community workers and enrolled after giving written informed consent. A stool sample was taken at delivery for ESBL-PE screening. Among the women enrolled, 356 gave birth between June 2013 and March 2014 and were included in the present study. A risk factor analysis was conducted on a subset of 231 women who delivered during a 6-month period (June to September 2013 and January to March 2014). Sociodemographic characteristics, previous health care exposure, and antibiotic consumption (collected with prescription documents, remaining tablets, or visual aid) were recorded. Fresh stools were plated onto Drigalski agar supplemented with 3 mg/liter of ceftriaxone at the clinical laboratory of Institut Pasteur of Madagascar. Plates were incubated for 24 to 48 h at 37°C. Every oxidase and Gram-negative colony type was Citation Chereau F, Herindrainy P, Garin B, Huynh B-T, Randrianirina F, Padget M, Piola P, Guillemot D, Delarocque-Astagneau E. 2015. Colonization of extendedspectrum-␤-lactamase-and NDM-1-producing Enterobacteriaceae among pregnant women in the community in a low-income country: a potential reservoir for transmission of multiresistant Enterobacteriaceae to neonates.

Prevalence of Carriage of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae Among Pregnant Women in the Primary Health Care Center and Hospital Setting in Indonesia

“…. Other studies in different countries have reported lower rates of ESBL-E carriage in pregnant women compared to this study, for example 2.9% (26 out of 901) in Norway in 2012 (13), 8.6% (18 out of 209) in Germany in 2012-2013 (14), 31.7% (32 out of 101) in Nigeria in 2014 (33), and 18.6% (66 out of 356) in Madagascar in 2014(21). The high prevalence of ESBL-E carriage in pregnant women in this study is probably associated with the high prevalence of ESBL-E carriage in communities in Indonesia(8)(9)(10).…”

Screening for Third-Generation Cephalosporin-Resistant Bacteria Reduces the Incidence on Late-Onset Sepsis and Antibiotic use in Neonates

“…Several studies have identified the 3GCRB-colonized mother as substantial risk factor for colonization of the neonate [4,6,9,10,24,25]. Recent data of the German surveillance system for nosocomial infection in preterm infants on neonatal wards (NEO-KISS) indicate that 8.45 % of neonatal colonizations with multidrug-resistant gram-negative bacteria were brought in by colonized mothers [21].…”

Maternal colonization or infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae in Africa: A systematic review and meta-analysis

“…Bebell et al (2017)) identified single marital status (OR 2.6, 95% CI 1.1-6.1, p = 0.026), low CD4+ count of <200/ml (OR 2.9, 95% CI 1.1-7.7, p = 0.031), and current UTI symptoms (OR 2.5, 95% CI 1.1-6.0, p = 0.03) as independent predictors of ESBL-E infection. The following elements were not found to be significantly associated with ESBL-E colonization/infection in these three studies: being employed or being a housewife (Tito et al 2017), drinking water supply from a spring or a well (Chereau et al, 2015), and hospitalization in the last 3 months (Djuikoue et al 2016a,b).…”