Acquisition of extended spectrum beta-lactamase-producing enterobacteriaceae in neonates: A community based cohort in Madagascar
- PMID: 29494706
- PMCID: PMC5832238
- DOI: 10.1371/journal.pone.0193325
Acquisition of extended spectrum beta-lactamase-producing enterobacteriaceae in neonates: A community based cohort in Madagascar
Abstract
In low and middle income countries (LMICs), where the burden of neonatal sepsis is the highest, the spread of extended spectrum beta-lactamase-producing enterobacteriaceae (ESBL-PE) in the community, potentially contributing to the neonatal mortality, is a public health concern. Data regarding the acquisition of ESBL-PE during the neonatal period are scarce. The routes of transmission are not well defined and particularly the possible key role played by pregnant women. This study aimed to understand the neonatal acquisition of ESBL-PE in the community in Madagascar. The study was conducted in urban and semi-rural areas. Newborns were included at birth and followed-up during their first month of life. Maternal stool samples at delivery and six stool samples in each infant were collected to screen for ESBL-PE. A Cox proportional hazards model was performed to identify factors associated with the first ESBL-PE acquisition. The incidence rate of ESBL-PE acquisition was 10.4 cases/1000 newborn-days [95% CI: 8.0-13.4 cases per 1000 newborn-days]. Of the 83 ESBL-PE isolates identified, Escherichia coli was the most frequent species (n = 28, 34.1%), followed by Klebsiella pneumoniae (n = 20, 24.4%). Cox multivariate analysis showed that independent risk factors for ESBL-PE acquisition were low birth weight (adjusted Hazard-ratio (aHR) = 2.7, 95% CI [1.2; 5.9]), cesarean-section, (aHR = 3.4, 95% CI [1.7; 7.1]) and maternal use of antibiotics at delivery (aHR = 2.2, 95% CI [1.1; 4.5]). Our results confirm that mothers play a significant role in the neonatal acquisition of ESBL-PE. In LMICs, public health interventions during pregnancy should be reinforced to avoid unnecessary caesarean section, unnecessary antibiotic use at delivery and low birth weight newborns.
Conflict of interest statement
Figures
Similar articles
-
Neonatal acquisition of extended-spectrum beta-lactamase-producing Enterobacteriaceae in the community of a low-income country (NeoLIC): protocol for a household cohort study in Moramanga, Madagascar.BMJ Open. 2022 Sep 23;12(9):e061463. doi: 10.1136/bmjopen-2022-061463. BMJ Open. 2022. PMID: 36153019 Free PMC article.
-
High Gastrointestinal Colonization Rate with Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Hospitalized Patients: Emergence of Carbapenemase-Producing K. pneumoniae in Ethiopia.PLoS One. 2016 Aug 30;11(8):e0161685. doi: 10.1371/journal.pone.0161685. eCollection 2016. PLoS One. 2016. PMID: 27574974 Free PMC article.
-
High prevalence of extended-spectrum ß-lactamase producing enterobacteriaceae among clinical isolates in Burkina Faso.BMC Infect Dis. 2016 Jul 11;16:326. doi: 10.1186/s12879-016-1655-3. BMC Infect Dis. 2016. PMID: 27400864 Free PMC article.
-
Household carriage and acquisition of extended-spectrum β-lactamase-producing Enterobacteriaceae: A systematic review.Infect Control Hosp Epidemiol. 2020 Mar;41(3):286-294. doi: 10.1017/ice.2019.336. Epub 2019 Dec 11. Infect Control Hosp Epidemiol. 2020. PMID: 31822301
-
Maternal colonization or infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae in Africa: A systematic review and meta-analysis.Int J Infect Dis. 2017 Nov;64:58-66. doi: 10.1016/j.ijid.2017.08.015. Epub 2017 Sep 7. Int J Infect Dis. 2017. PMID: 28890179
Cited by
-
Neonatal sepsis and mortality in low-income and middle-income countries from a facility-based birth cohort: an international multisite prospective observational study.Lancet Glob Health. 2022 May;10(5):e661-e672. doi: 10.1016/S2214-109X(22)00043-2. Lancet Glob Health. 2022. PMID: 35427523 Free PMC article.
-
Maternal-infant antibiotic resistance genes transference: what do we know?Gut Microbes. 2023 Jan-Dec;15(1):2194797. doi: 10.1080/19490976.2023.2194797. Gut Microbes. 2023. PMID: 37020319 Free PMC article. Review.
-
Transmission Routes of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae in a Neonatology Ward in Madagascar.Am J Trop Med Hyg. 2019 Jun;100(6):1355-1362. doi: 10.4269/ajtmh.18-0410. Am J Trop Med Hyg. 2019. PMID: 31017082 Free PMC article.
-
Prevalence and factors associated with faecal carriage of extended-spectrum β-lactamase-producing Enterobacterales among peripartum women in the community in Cambodia.J Antimicrob Chemother. 2022 Sep 30;77(10):2658-2666. doi: 10.1093/jac/dkac224. J Antimicrob Chemother. 2022. PMID: 35794710 Free PMC article.
-
Prevalence, Risk Factors, and Genetic Characterization of Extended-Spectrum Beta-Lactamase Escherichia coli Isolated From Healthy Pregnant Women in Madagascar.Front Microbiol. 2021 Dec 24;12:786146. doi: 10.3389/fmicb.2021.786146. eCollection 2021. Front Microbiol. 2021. PMID: 35003019 Free PMC article.
References
-
- Liu L, Hill K, Oza S, Hogan D, Chu Y, et al. (2016) Levels and Causes of Mortality under Age Five Years. In: Black RE, Laxminarayan R, Temmerman M, Walker N, editors. Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC). - PubMed
-
- UNICEF (New York 2015) Levels & Trends in Child Mortality, Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation, Report 2015.
-
- Liu L, Oza S, Hogan D, Chu Y, Perin J, et al. (2016) Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet 388: 3027–3035. doi: 10.1016/S0140-6736(16)31593-8 - DOI - PMC - PubMed
-
- Oza S, Lawn JE, Hogan DR, Mathers C, Cousens SN (2015) Neonatal cause-of-death estimates for the early and late neonatal periods for 194 countries: 2000–2013. Bull World Health Organ 93: 19–28. doi: 10.2471/BLT.14.139790 - DOI - PMC - PubMed
-
- Seale AC, Blencowe H, Manu AA, Nair H, Bahl R, et al. (2014) Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, south Asia, and Latin America for 2012: a systematic review and meta-analysis. Lancet Infect Dis 14: 731–741. doi: 10.1016/S1473-3099(14)70804-7 - DOI - PMC - PubMed
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources