Perirectal Screening for Carbapenem-Resistant Enterobacteriaceae Obtained From 100 Consecutive Healthy Pregnant Women in Labor at a Brooklyn Hospital: Results and Risk Factors

Rawstron, Sarah A.; Jackman, Janelle M.; Serebro, Elena; Johnson, Gail; Cabbad, Michael; Bromberg, Kenneth; Kondamudi, Vasantha; Sepkowitz, Doug; Landman, David

doi:10.1017/ice.2017.295

Cited by 6 publications

(7 citation statements)

References 6 publications

(13 reference statements)

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“…The prevalence of colonization with carbapenem-resistant bacteria in our study was 2%, similar to that reported among Algerian pregnant women [39] and among women in labour at Brooklyn, New York Hospital [40]. These studies including ours suggest the importance to assess maternal colonization with carbapenem-resistant bacteria during labour as there is potential for vertical transmission of these bacteria to newborns.…”

Section: Discussionsupporting

confidence: 88%

Vaginal colonization with antimicrobial-resistant bacteria among women in labor in central Uganda: prevalence and associated factors

Tumuhamye

Steinsland

Bwanga

et al. 2021

Antimicrob Resist Infect Control

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Background According to WHO ( CISMAC. Centre for Intervention Science in Maternal and Child health), the antimicrobial resistant bacteria considered to be clinically most important for human health and earmarked for surveillance include extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, carbapenem-resistant bacteria, methicillin-resistant (MRSA) and, macrolide-lincosamide-streptogramin B -resistant vancomycin-resistant (VRSA) Staphylococcus aureus and vancomycin-resistant Enterococcus (VRE). If these bacteria are carried in the female genital tract, they may be transmitted to the neonate causing local or systemic neonatal infections that can be difficult to treat with conventionally available antimicrobials. In order to develop effective treatment strategies, there is need for updated information about the prevalence of colonization with important antimicrobial-resistant pathogens. Objective We sought to estimate the prevalence of vaginal colonization with potentially pathogenic and clinically important AMR bacteria among women in labour in Uganda and to identify factors associated with colonization. Methods We conducted a cross-sectional study among HIV-1 and HIV-2 negative women in labour at three primary health care facilities in Uganda. Drug susceptibility testing was done using the disk diffusion method on bacterial isolates cultured from vaginal swabs. We calculated the prevalence of colonization with potentially pathogenic and clinically important AMR bacteria, in addition to multidrug-resistant (MDR) bacteria, defined as bacteria resistant to antibiotics from ≥ 3 antibiotic classes. Results We found that 57 of the 1472 enrolled women (3.9% prevalence; 95% Confidence interval [CI] 3.0%, 5.1%) were colonized with ESBL-producing Enterobacteriaceace, 27 (1.8%; 95% CI 1.2%, 2.6%) were colonized with carbapenem-resistant Enterobacteriaceae, and 85 (5.8%; 95% CI 4.6%, 7.1%) were colonized with MRSA. The prevalence of colonization with MDR bacteria was high (750/1472; 50.9%; 95% CI 48.4%, 53.5%). Women who were ≥ 30 years of age had higher odds of being colonized with MDR bacteria compared to women aged 20–24 years (OR 1.6; 95% CI 1.1, 2.2). Conclusion Most of the women included in our study were vaginally colonized with potentially pathogenic MDR and other clinically important AMR bacteria. The high prevalence of colonization with these bacteria is likely to further increase the incidence of difficult-to-treat neonatal sepsis.

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Section: Discussionsupporting

confidence: 88%

Vaginal colonization with antimicrobial-resistant bacteria among women in labor in central Uganda: prevalence and associated factors

Tumuhamye

Steinsland

Bwanga

et al. 2021

Antimicrob Resist Infect Control

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“…The prevalence of CRKP varies between countries and regions and between medical institutions [9, 10]. Although some studies have identified a series of CRKP infection risk factors in children, newborns, and pregnant women [11, 12], few studies have focused on adult ICU patients in high CRKP infection incidence areas such as Henan province in central China. During our five-year study, we found that the average CRKP isolation rate was 48.1% among ICU Klebsiella pneumoniae infection patients in central China, which is far beyond the average ratio in the Chinese bacterial surveillance system (13.4%) [3].…”

Section: Discussionmentioning

confidence: 99%

Carbapenem-ResistantKlebsiella pneumoniaeInfections among ICU Admission Patients in Central China: Prevalence and Prediction Model

Shen

Zhu

et al. 2019

BioMed Research International

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Objective. To investigate the prevalence of infections due to carbapenem-resistant Klebsiella pneumoniae (CRKP) among ICU admission patients in central China and develop a reliable prediction model. Methods. Five hundred and seven consecutive ICU admission patients with Klebsiella pneumoniae (KP) infection were enrolled in this retrospective multicenter case-control study from January 2014 to June 2018. The prevalence and antimicrobial susceptibility pattern were analyzed. Multivariate analysis was performed by logistic regression modeling to determine the risk factors. A prediction model was developed and verified using data from six hospitals in central China. Results. Of the total 507 isolates of KP, 244 (48.1%) strains were carbapenem resistant. The majority of these isolates were from sputum (30.9%) and blood (20.9%) samples. Tigecycline had good activity against CRKP (95.5%). The most common sequence type (ST) of CRKP was ST11 (84.4%), and 98.6% of them had the blaKPC-2 antimicrobial resistance gene. Thirteen variables were identified as independent risk factors for CRKP infection, including KP colonization or infection in the preceding year (OR=3.32, 95% CI 2.01-4.38), CD4/CD8 ratio <1 (OR=2.98, 95% CI 2.02-4.19), and parenteral nutrition ⩾48 h (OR=1.88, 95% CI 1.22-3.04). The model developed to predict CRKP infection was effective, with an area under the receiver-operating characteristic curve of 0.854 (95% CI 0.821-0.884, p<0.001). Conclusions. ST11 carrying the blaKPC-2 antimicrobial resistance gene was the most common type of CRKP among the ICU admission patients in central China. The model demonstrated excellent predictive performance and exhibited good discrimination.

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“…To best of knowledge, only a few studies have evaluated CRE presence among pregnant women. One study, conducted in Brooklyn, found CPE in 2% of the 100 pregnant women who were screened [25]. In a recent study from Algeria, 4.6% of the participating women carried OXA-48-producing Enterobacterales [26].…”

Section: Discussionmentioning

confidence: 99%

Mother-to-Neonate Transmission of Antibiotic-Resistant Bacteria: A Cross-Sectional Study

et al. 2021

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We evaluated carriage rates of extended spectrum β-lactam-producing Enterobacterales (ESBL-E), Carbapeneme-resistant Enterobacterales (CRE), vancomycin-resistant Enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) among pregnant women and determined the maternal-to-neonate transmission rates of these antibiotic-resistant bacteria (ARB). Pregnant women provided rectal and vaginal samples, proximal to delivery. Stool samples were collected from newborns within 48 h of birth. All samples were cultured on selective media for ARB identification. Clinical and demographic data were collected from the participants’ medical files. We performed molecular and phenotypic characterization of the different resistance mechanisms, and determined the isolates’ antibiotic susceptibility and biofilm-forming ability. The prevalence of ESBL-E, MRSA and VRE among pregnant women were 16%, 6% and 1%, respectively. The prevalence of ESBL-E and MRSA among neonates were 7.6% and 1.6%, respectively. Maternal-to-neonate transmission rates of ESBL-E and MRSA were 48% and 27.8%, respectively. Maternal and neonatal isolates shared similar characteristics. Maternal-to-neonate transmission of ARB plays an important role in bacterial colonization in newborns. Future studies should investigate the outcomes of the high ESBL-E transmission rate. The biofilm-forming ability of ARB was found to affect transmission. Additional factors should be investigated in order to understand the differences between transmitted and non-transmitted bacteria.

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Perirectal Screening for Carbapenem-Resistant Enterobacteriaceae Obtained From 100 Consecutive Healthy Pregnant Women in Labor at a Brooklyn Hospital: Results and Risk Factors

Cited by 6 publications

References 6 publications

Vaginal colonization with antimicrobial-resistant bacteria among women in labor in central Uganda: prevalence and associated factors

Vaginal colonization with antimicrobial-resistant bacteria among women in labor in central Uganda: prevalence and associated factors

Carbapenem-ResistantKlebsiella pneumoniaeInfections among ICU Admission Patients in Central China: Prevalence and Prediction Model

Mother-to-Neonate Transmission of Antibiotic-Resistant Bacteria: A Cross-Sectional Study

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