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Vagino-rectal colonization and maternal–neonatal transmission of Enterobacteriaceae producing extended-spectrum β-lactamases or carbapenemases: a cross-sectional study

https://doi.org/10.1016/j.jhin.2018.09.010Get rights and content

Summary

This study sought to determine the prevalence and risk factors for colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) and carbapenemase-producing Enterobacteriaceae (CPE) in 815 mothers and 800 newborns using a cross-sectional design; 59 women and 13 neonates were colonized by ESBL-E (prevalence (95% confidence interval): 6.7% (5.2–8.7) and 1.6 (0.7–2.5), respectively). No CPE were found. The most frequent ESBL-E were CTX-M-14 and SHV-12. Vertical transmission occurred in 14% of colonized mothers. The risk factors for colonization were, in mothers: complications in previous pregnancies, more than one urinary tract infection, non-Caucasian ethnicity, and frequently having the main meal outside home; in newborns: colonized mother and vaginal delivery.

Introduction

Antimicrobial resistance is recognized as a public health problem globally [1]. Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) are resistant to penicillins and cephalosporins, and frequently also to non-β-lactam drugs. ESBL-E cause a considerable proportion of invasive infections caused by Enterobacteriaceae, and these infections have been associated with worse outcomes than those caused by antibiotic-susceptible strains [2]. In neonates, micro-organisms causing early neonatal sepsis are thought to be mostly vertically transmitted through the birth canal; early neonatal infections caused by ESBL-E may lead to inappropriate empiric therapy. However, data on colonization by ESBL-E in mothers at delivery and on rates of vertical transmission are scarce [3], [4], [5], [6]. Whether screening for ESBL-E colonization in mothers should be performed is a matter of controversy [6].

The objectives of this study were to investigate the prevalence of colonization by ESBL-E in mothers and their neonates, the rate of vertical transmission, and the risk factors associated, in an area with a well-characterized epidemiology of these organisms.

Section snippets

Design, site, study period and participants

A cross-sectional study in which colonization by ESBL-E or carbapenemase-producing Enterobacteriaceae (CPE) in pregnant women at the time of delivery and their newborns was performed at Hospital Universitario Virgen Macarena, a teaching hospital in Seville, Spain, which serves a population of 450,000 and attends 3600 births per year. The study was conducted from August 2014 until June 2015. The hospital has a very active infection control programme, including surveillance of hand hygiene in the

Results

Overall, 815 women and 800 neonates were studied. The main characteristics of the participants are shown in Supplementary Table S2.

Discussion

In this study, prevalence of ESBL-E colonization in mothers and newborns at birth was 6.7% and 1%, respectively, and vertical transmission rate of ESBL-E from colonized mothers was 14%. Also, some risk factors for colonization were identified.

A probable episode of nosocomial transmission of ESBL-producing K. pneumoniae in mothers was identified. Since no environmental source was found, it may be that the spread occurred through cross-transmission, despite >80% global adherence to hand hygiene

Acknowledgements

We thank A. Micelli, Z. Frías, V. de la Chica, M. Fernández, J. Gutiérrez, I. Martínez, I. Barrena, and K. Hoffner for their help in recruiting patients and collecting the samples.

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Authors contributed equally to this study.

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