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

Bulabula, Andre N H; Dramowski, Angela; Mehtar, Shaheen

doi:10.1016/j.ijid.2017.08.015

Cited by 41 publications

(41 citation statements)

References 54 publications

(59 reference statements)

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“…There was high variability regarding the prevalence of ESBL‐P Enterobacteriaceae in different geographic regions as the highest rates were seen in Africa (point prevalence of 45%) and India (point prevalence of 33%) and the lowest ones belonged to North America (3%, although only two studies were found from this area) and Europe (5%). In a previous systematic review performed on studies from African countries, the authors reported a pooled prevalence of infection/colonisation by ESBL pathogens in pregnancy/postpartum period as 17%. It should be noted that, here, we did not include colonised mothers and confined the inclusion criteria to those diagnosed with symptomatic UTI/AB by urine culture.…”

Section: Discussionmentioning

confidence: 99%

“…Two previous systematic review and meta‐analysis studies have been conducted regarding the prevalence of ESBL‐P Enterobacteriaceae during pregnancy. In a systematic review confined to primary studies from Africa, the authors reported the pooled prevalence of maternal colonisation/infection with ESBL‐P Enterobacteriaceae as 17%. The other systematic review determined maternal colonisation with these organisms as 8% (95% CI, 5%‐10%) .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…It occurs in the first three days of life and usually transmitted from mother to baby during delivery [1]. e infection may be also transmitted vertically when the amniotic membrane ruptures or prior to the onset of labor causing intra amniotic infection [1,2]. e organisms most frequently associated with EOS are Streptococcus agalactiae and Escherichia coli [1,2].…”

Section: Introductionmentioning

confidence: 99%

“…e infection may be also transmitted vertically when the amniotic membrane ruptures or prior to the onset of labor causing intra amniotic infection [1,2]. e organisms most frequently associated with EOS are Streptococcus agalactiae and Escherichia coli [1,2]. e latter accounts for about 24% of all EOS; 81% of cases occurring in preterm infants [1].…”

Section: Introductionmentioning

confidence: 99%

Phenotypic and Genotypic Characterization of Extended-Spectrum Beta-Lactamases Produced by Escherichia coli Colonizing Pregnant Women

Ghaddar

Anastasiadis

Halimeh

et al. 2020

Infectious Diseases in Obstetrics and Gynecology

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Introduction. Infections caused by extended spectrum beta lactamase (ESBL) producing bacteria continue to be a challenge for choosing the appropriate therapy since they may exhibit coresistance to many other classes of antibiotics. The aim of the study was to screen pregnant women for ESBL producing bacteria in Beirut, Lebanon, to examine their phenotypic and genotypic characterization and to study the association between ESBL colonization with adverse neonatal outcomes. Method. In this cross-sectional study, vaginal samples from 308 pregnant women at 35–37 weeks of gestation were studied during a one-year period. The samples were plated on MacConkey agar and selective MacConkey agar supplemented with ceftazidime. Phenotypic confirmation of ESBL production was performed by double-disc synergy test and all isolates were screened by PCR for the resistance genes blaSHV, blaTEM, and blaCTX-M. Clonal relatedness of Escherichia coli isolates was investigated by pulsed-field gel electrophoresis. Results. In total, 59 women out of 308 (19.1%) were colonized by ESBL producing gram negative bacteria. Two babies born to mothers colonized with ESBL were diagnosed with sepsis. The susceptibility rates of isolates to other antibiotics were 39% to co-trimoxazole, 49.2% to ciprofloxacin, 91.5% to gentamicin, 18.6% to aztreonam and 35.6% to cefepime. Most of isolates were highly sensitive to meropenem and imipenem, with a susceptibility of 93.2%. PCR was performed on all E. coli isolates to detect the most common ESBL producing genes; blaCTX-M was the predominant gene (90.7%), followed by blaTEM (88.4%) and finally blaSHV (44.2%). PFGE analysis of 34 E. coli isolates revealed 22 distinct clusters showing more than 85% similarity. Conclusion. In conclusion, this study showed that Lebanon has a high prevalence of ESBL carriage in pregnant women. Further studies that include a continuous screening of pregnant women and follow up of their newborn clinical status should be conducted to foresee the risk of transmission.

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“…Globally, the proportion of pregnant women colonized by ESBL-E in the urinary tract ranges from 2.0 to 75%, the highest percentage found in developing countries [19,20]. In Africa, a high proportion above 70% is seen in sub-Saharan countries due to extensive antibiotic use in agriculture, veterinary, and human health centers [14,21]. In Tanzania, the proportion of ESBL-E to urinary isolates in pregnant women ranges between 18.8 and 45.2% [22].…”

Section: Introductionmentioning

confidence: 99%

Fecal carriage and factors associated with extended-spectrum β-lactamase-producing Enterobacteriaceae among pregnant women at the tertiary referral hospital, Tanzania

et al. 2020

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Background Infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) are increasing worldwide. Evidence indicates that fecal carriage of ESBL-E in pregnancy predisposes women to potential life-threatening urinary tract infections and subsequently increasing the risk of neonatal infections. There is limited data regarding fecal carriage of ESBL-E and associated factors among pregnant women in Tanzania. We aimed to address the gap by determining the proportion of pregnant women with ESBL-E fecal carriage and identify the related factors. Methodology A hospital-based cross-sectional study was conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania. A total of 182 pregnant women at the gestational age of 37 weeks and above were enrolled. Participants’ socio-demographic, clinical, and hygienic information were collected by using a well-structured questionnaire. Rectal swabs were collected and processed for isolation of ESBL-E. The extended-spectrum β-lactamase production and antibiotic susceptibility test (AST) were performed using a double-disc synergy test and Kirby-Bauer disc diffusion method, respectively. Results A total of 117 (64.3%) pregnant women were found to carry ESBL-E. Factors such as self-prescription of antibiotic medication during pregnancy, low education level, and toilet sharing were independently associated with ESBL-E fecal carriage. Five ESBL-E species that were isolated include Escherichia coli (84.6%), Klebsiella pneumoniae (8.9%), Klebsiella oxytoca (3.3%), Citrobacter spp. (1.6%), and Enterobacter spp. (1.6%). ESBL-E isolates demonstrated high resistance to aztreonam and sulphamethoxazole-trimethoprim. Conclusion This study has revealed a relatively high fecal carriage of ESBL-E among pregnant women, suggesting that there is a need for routine screening among that population. We recommend further studies to explore comprehensively the factors associated with high fecal carriage of ESBL-E in pregnancy and the potential transmission kinetics to their newborn babies.

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

Abstract: The prevalence of colonization and/or infection with ESBL-E in pregnant and post-partum women in Africa exceeds that reported from high- and middle-income settings, representing a risk for subsequent neonatal colonization and/or infection with ESBL-E.

Cited by 41 publications

References 54 publications

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

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

Phenotypic and Genotypic Characterization of Extended-Spectrum Beta-Lactamases Produced by Escherichia coli Colonizing Pregnant Women

Fecal carriage and factors associated with extended-spectrum β-lactamase-producing Enterobacteriaceae among pregnant women at the tertiary referral hospital, Tanzania

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