Extended‐spectrum beta‐lactamase (ESBL)‐producingEnterobacteriaceaeand urinary tract infections in pregnant/postpartum women: A systematic review and meta‐analysis

Abstract

Background Urinary tract infections (UTI) and asymptomatic bacteriuria (AB) during pregnancy can result in considerable maternal and foetal adverse outcomes. Production of extended‐spectrum beta‐lactamase (ESBL) is a major antibiotic resistance mechanism by Enterobacteriaceae. Objectives To determine the global prevalence of ESBL‐producing (ESBL‐P) Enterobacteriaceae in symptomatic UTI/AB among pregnant/postpartum females. Data sources A systematic review of the PubMed, Embase, Scopus, WOS (Web of Science), ProQuest and the grey literature was conducted. Study selection and data extraction Studies that reported the frequency of ESBL‐P Enterobacteriaceae in pregnant/postpartum women with UTI and/or AB were eligible. First, the titles and abstracts of the retrieved articles were reviewed. Then, the full texts of the remained articles were reviewed. Synthesis In order to estimate the pooled prevalence and the 95% confidence interval (95% CI), meta‐analysis was performed using the random‐effects model. Results Twenty‐three studies (six from Africa, two from North America, one from South America, 12 from Asia and two European studies) that reported data on 20 033 Enterobacteriaceae strains were included. The pooled prevalence of ESBL‐P Enterobacteriaceae was 25% (95% CI 18%, 32%); I2 = 98.8%. The estimated prevalence (95% CI) rates were 45% (22, 67%) in Africa, 33% (22, 44%) in India, 15% (6, 24%) in other Asian countries, 5% (2, 8%) in Europe, 4% (1, 11%) in South America and 3% (1, 5%) in North America (P < .001). This estimate was 21% (95% CI 11, 31%) in patients with symptomatic UTI and it was 28% (95% CI 15, 41%) in patients with AB (P = .40). Conclusions The prevalence of ESBL‐P Enterobacteriaceae among pregnant women with UTI/AB was significant and geographic region was a major source for heterogeneity. The findings could be taken into account by healthcare providers and programmers in the management and antibiotic selection of UTI/AB during pregnancy, especially in high prevalence areas.

Maternal Vaginal Colonization and Extended-Spectrum Beta-Lactamase-Producing Bacteria in Vietnamese Pregnant Women

“…In the present study, the prevalence of vaginal Enterobacterales and ESBL-Enterobacterales colonization among pregnant women was 30% and 10%, respectively. The ESBL-E incidence observed in this study is higher than other upper-middle-income countries, such as Norway (3%) [15] and Argentina (5%) [17], but lower than in other African countries (17%), respectively [18]. Nonuniform approaches to study design, particularly differences in inclusion criteria, age groups, the inclusion of hospital and/or community populations, etc., may modulate the reported ESBL incidences across geographic regions [19].…”

Global Prevalence of Nosocomial Multidrug-Resistant Klebsiella pneumoniae: A Systematic Review and Meta-Analysis

“…The estimated prevalence of Enterobacteriaceae in these two studies was slightly higher than the estimated prevalence of nosocomial MDR K. pneumoniae in this analysis. Another study by Mansouri et al [ 55 ] showed a pooled prevalence of ESBL-producing Enterobacteriaceae at 25% (95% CI, 18.0–32.0) globally. In addition, the recorded estimated prevalence in Africa, Asia, Europe, South America, and North America was 45% (95% CI, 22.0–67.0), 15% (95% CI, 6.0–24.0), 5% (95% CI, 2.0–8.0), 4% (95% CI, 1.0–11.0), and 3% (95% CI, 1.0–5.0), respectively.…”

Prevalence of multidrug-resistant and extended-spectrum beta-lactamase (ESBL)-producing gram-negative bacilli: A meta-analysis report in Ethiopia

“…As compared to resource-rich countries, the pooled proportion of ESBL-producing isolates was thus considerably higher in resource-limited countries, including our setting. For instance, the pooled global prevalence of ESBL‐producing Enterobacteriaceae among pregnant women diagnosed with urinary tract infections (UTIs) is 25%, with the highest rates in Africa (45%) and India (33%), followed by 15% in other Asian countries, 5% (2.8%) in Europe and the lowest one of 4% in South America and 3% in North America ( 37 ). This study finding is also close to data reported for China, where a nationwide survey that included 30 hospitals reported over 46% resistance due to ESBL ( 38 ).…”