Carriage of antimicrobial-resistant Enterobacterales among pregnant women and newborns in Amhara, Ethiopia

• DOI: 10.1016/j.ijid.2024.107035
• Publication Date: 2024-03-30T07:08:16Z
• Authors: Getnet Amsalu; Christine Tedijan...; Olga Perovic; Addisalem Gebru; Bezawit M. Hunegnaw; Fisseha Tadesse; Marshagne Smith; Addisalem Fikre; Delayehu Bekele; Lisanu Taddesse; Grace J. Chan
• Keywords: 03 medical and health sciences; 0302 clinical medicine; Antibiotic resistance; Sepsis; Carbapenem-resistant Enterobacterales; Neonates; Vertical transmission; Infectious and parasitic diseases; RC109-216; Article; Extended-spectrum-beta-lactamase-producing organisms

AbstractBackgroundInfections are one of the most common causes of neonatal mortality, and maternal colonization has been associated with neonatal infection. Data on carriage of bacterial pathogens and mother-child transmission patterns in low- and middle-income countries is sparse.MethodsWe sought to quantify carriage prevalence of extended-spectrum-beta-lactamase (ESBL) - producing and carbapenem-resistant Enterobacterales (CRE) among pregnant women and their neonates and to characterize risk factors for carriage in a rural area of Amhara, Ethiopia. We sampled 211 pregnant women in their third trimester and/or labor/delivery and 159 of their neonates in the first week of life.ResultsWe found that carriage of ESBL-producing organisms was fairly common (women: 22.3%, 95% CI: 16.8-28.5; neonates: 24.5%, 95% CI: 18.1-32.0), while carriage of CRE (women: 0.9%, 95% CI: 0.1-3.4; neonates: 2.5%, 95% CI: 0.7-6.3) was rare. Neonates whose mothers tested positive for ESBL-producing organisms were nearly twice as likely to also test positive for ESBL-producing organisms (38.7% vs. 21.1%, p-value: 0.06). Carriage of ESBL-producing organisms was also associated with woreda (district) of sample collection (Fisher exact test maternal p-value: <0.01; neonatal p-value: <0.01) and recent antibiotic use (maternal p-value: 0.55; neonatal p-value: 0.011).ConclusionsUnderstanding carriage patterns of potential pathogens and antibiotic susceptibility among pregnant women and newborns in this region will help to inform local, data-driven recommendations to prevent and treat neonatal infections.Main pointCarriage prevalence of ESBL-producing Enterobacterales was high among pregnant women and neonates in a rural area of Ethiopia, and neonates were more likely to test positive if their mother tested positive. This work informs prevention and treatment of neonatal infections.